Almost exactly three years ago, on Friday 17 December 1982, I presented a petition which said:
There is a need for the full range of facilities to be maintained at Beckenham Hospital for the benefit of the local communities. Wherefore your petitioners pray that your Honourable House will urge the Secretary of State for Social Services to instruct the Bromley Health Authority to maintain the present range of facilities at Beckenham Hospital.
As I told the House at the time, the petition had been signed by a wide cross-section of community leaders. It was supported by more than 22,000 signatures, which were gathered in only six weeks. It represented the largest demonstration of support for a local institution that I could remember in the past 25 years.
That unprecedented gesture reflected, in part, the fear that the authorities would soon take far-reaching decisions without being aware of the strength of local sentiment and, in part, gratitude for the splendid skill and dedication of the staff at Beckenham hospital, which has been demonstrated so often for so many years.
The petition was prompted also by the fact that there is an imbalance in the provision of health facilities in the Bromley health authority district. Most of the hospital beds are in the south and most of the people live in the north. Nearly 50 per cent. of my constituents in the northwest third do not have cars and find journeys to hospitals in the southern part of the district exceedingly difficult.
We feared three years ago, and we still fear, that if cuts had to be made in any hospital provision, the convenience of the doctors who live and work in the south of the district would count for more than the convenience of the patients who live in the north. On 24 January 1983, in replying to the petition, the Secretary of State said:
Bromley Health Authority will produce a Strategic Plan in 1983 setting out plans for developing local health services. While the Strategic Plan cannot be anticipated in detail, the Authority does intend to maintain a wide range of facilities at Beckenham Hospital for the benefit of the local community: this does not mean that the existing range of facilities will necessarily remain unchanged in every respect … but Beckenham Hospital will continue to play an important role in the district.
When the strategic plan was produced, it was eminently sensible. In its draft plan, Bromley health authority said that it had
as a long-term objective the provision of 60 per cent. of hospital services in the north of the district in line with the distribution of the population.
That sensible declaration was widely welcomed when it was made, for it fitted the social as well as the demographic realities of life in the area.
Since the publication of the draft plan 25 years ago, there have been substantial changes in the provision of health care in Beckenham. Beckenham maternity hospital, which has given such good service to the community for so many years, will soon close. Its facilities will be transferred to Farnborough hospital, which lies about eight miles to the south of the present maternity hospital.
I have accepted the planned closure reluctantly. The move to Farnborough will create some inconvenience for constituents, especially in the north-west of my constituency. There are substantial medical arguments in favour of the transfer, although I would have wished that the Beckenham maternity hospital could continue on its present site until the planned new accommodation in Bromley hospital is available in the early 1990s. Meanwhile, there has been a reduction in the number of acute beds in Beckenham hospital. They were replaced by a geriatric day hospital and two wards of geriatric patients.
Despite some initial misgivings that the switch in emphasis towards geriatric provision was going too far, the present balance between orthopaedic beds, gynaecological beds and geriatric beds and the geriatric day hospital and outpatient services provides a service to the community that is highly valued. That service is provided efficiently and effectively in a way that commands the respect and affection of the community. There is one operating theatre in Beckenham hospital. From the beginning of January until 19 December this year, 2,245 operations were carried out there, showing that the theatre fills a real need and is managed most efficiently.
Despite the fact that Beckenham hospital has avoided a reputation for conveyor-belt medicine, its throughput of patients is substantially better than in the district as a whole and the regional average. In orthopaedic beds, Beckenham's throughput is 27; the average for the district is 20·2; and the average for the south-east Thames region is 27·2. It does not sound wholly appropriate to talk about throughput in reference to gynaecological beds, but the throughput figure for beds in the Beckenham gynaecological ward is 73, compared with a district average of 57·2 and a regional average of 64·7. In geriatric beds, where clearly throughput must be viewed differently, the Beckenham figures are slightly better than elsewhere in the district. The future of Beckenham should be assured on grounds of convenience and efficiency.
The Bromley health authority's meeting on 17 December was faced with a management paper recommending the closure of the operating theatre and the gynaecological and orthopaedic wards in Beckenham hospital. The management paper envisaged total closure of Beckenham hospital in the near future and the closure of all acute beds in Orpington hospital in the south of the district.
The Bromley health authority is spending, in round terms, £50 million a year on hospitals. Looking ahead to 1986–87, the Bromley health authority estimates that it will be faced with a shortfall in income of £2 million. To meet that shortfall, the health authority has been urged by the management to reduce the number of acute beds from 659 to 566 in 1986–87. In other words, to meet a projected revenue shortfall of 4 per cent., the management proposes a cut in acute beds of more than 16 per cent.
Of course a shortfall of £2 million a year is serious, but to meet this by a cut of 93 hospital beds is barmy. According to the management's own figures, it will produce a saving of £1·2 million a year. In other words, the management will have precipitated a major crisis in the Health Service locally and will still have gone barely halfway towards meeting the projected financial shortfall. That would plainly have the most harmful effect on our waiting lists.
At the moment, the Bromley health authority is in the top quarter of the 200 odd districts in England and Wales when it comes to the shortness of waiting lists, but 28 per cent. of the 350 people on our waiting lists have had to wait for more than a year for an operation. If the proposed plans go through, the waiting lists and the time that those on them will have to wait can be expected to escalate sharply.
The effect of the proposed changes on Beckenham hospital will be out of proportion to the savings that can be achieved. If and when the orthopaedic and gynaecological wards at Beckenham are closed, it is suggested that the beds will be filled with geriatric patients who at present go to Farnborough and Orpington hospitals. That would mean that the sole major identifiable saving would be made on the operating theatre at Beckenham hospital. Its closure will save £60,000 a year.
We are then talking about the destruction of Beckenham hospital as we know it for a paper saving of £60,000 a year. It would, of course, be possible not to move in additional geriatric patients, but just close the orthopaedic and gynaecological wards. When I discussed that matter with the management at Beckenham hospital yesterday, it was plain that that alternative made no economic sense when one considers the division of overheads. If the whole of Beckenham hospital were to be closed, it is said that the savings would be £2 million a year. I suspect that the estimated savings are illusory, while the social and medical loss would be enormous.
The most charitable thing that I can say about the proposals by the chairman of the Bromley health authority and the new management team is that they seem to be ill-considered and are likely to produce the maximum disruption for the minimum of saving.
The new chairman and the new management team should not be asked to take most of the blame for this new crisis. They are being strangled by the guidelines of the resource allocation working party. That working party, which produced its guidelines in the mid-1970s, had the laudable objective of seeking to equalise the provision of medical services across the country as a whole. That was a desirable objective, and it was hoped that progress towards achieving equality between one part of the country and another could be made painlessly by a process of differential growth between the regions.
Relatively under-provided regions would merely have a larger annual increment of growth than the relatively over-provided regions. In theory, no one would suffer. As Dick Crossman, the egalitarian and highly political Labour Secretary of State for Social Services, wrote in the 1970s:
I can only equalise on an expanding budget.
Between 1979 and 1983, that in effect was what happened. There was differential growth on an expanding budget and the operation was comparatively painless.
In the past three years, however, London and the southeast have been faced with a real loss of resources as money has been transferred to other regions and the regions have been encouraged to carry out their own resources reallocation programme. That means that, if the RAWP guidelines continue to be enforced so enthusiastically, we shall be faced locally with a perpetual crisis. As one senior nurse said to me yesterday at Beckenham hospital, "However many economies we make in Bromley, we always seem to be £2 million a year short."
We have done what the Government want. Our administrative costs in Bromley are lower than those in the region as a whole, and we are saving £2 million a year through the introduction of competitive tendering. However, we still face a crisis. What then should be done? In the immediate future, the Bromley health authority management team should go back to the drawing hoard and do its sums again. I am glad to say that that is already happening.
There should be urgent talks between the Bromley health authority and the South-East Thames region about the application of the RAWP guidelines in the financial year 1986–87 and the years immediately following that. That will help during the course of the next month.
The Secretary of State and his admirable team of Ministers must look urgently at the application of the RAWP formula. I am glad to note that on 17 December this year the Secretary of State announced that he had asked the National Health Service management board to review the operation of the formula, particularly the way in which the relative needs in different parts of the country are measured. I hope that the review will act quickly but, inevitably, it will take time. The hospital service in my area, and in London as a whole, cannot wait for a lengthy academic review which may or may not produce some relief for the current crisis. In order to meet our immediate crisis, I hope that in the new year the Secretary of State will meet the chairmen of the four Thames regions and the chairmen of all the health districts in greater London to consider what remedial action may be taken to relieve the immediate problems faced by London.
This is the last but one debate in the House before the new year. I wish you, Mr. Deputy Speaker, and the Under-Secretary a merry Christmas. If the patients and the prospective patients at Beckenham hospital in particular, and Bromley hospitals in general, are to have a happy and healthy new year, they will need more help than they are getting at the moment.
I congratulate my hon. Friend the Member for Beckenham (Sir P. Goodhart) on the way in which he has raised the issue of the effect of RAWP in Bromley and the vigorous style in which he has defended his constituents. I am grateful for the opportunity to contribute briefly to the debate.
I should like to emphasise that Bromley health authority has reduced its expenditure, as my hon. Friend said. It has done that by efficient economies and by contracting out. It has been congratulated in the House by the Secretary of State on the way in which it has done so. However, it still finds that it is continually having to make reductions in its services because it cannot meet its budget.
I am not going to argue the case for Beckenham or any other hospital. I have no hospitals in my constituency because they are situated in the other three constituencies in the area. However, whatever reductions are made, whether in Beckenham or elsewhere, the ultimate effect will be a reduction in patient care for my constituents and those of my hon. Friend. I accept the principle of RAWP and what it seeks to achieve, but I urge the Under-Secretary to consider a substantial slowing down of the effect of RAWP or an abatement of it.
Like my hon. Friend, I wish the Under-Secretary a peaceful Christmas, but I urge him, when he returns in the new year, to look carefully at the effect that RAWP is having in an area such as Bromley, and to reconsider its effects.
I am happy to have the opportunity to respond to my hon. Friends the Members for Beckenham (Sir P. Goodhart) and for Chislehurst (Mr. Sims). I reciprocate the wishes for a peaceful, happy and prosperous Christmas for all of us and a healthy and well cared for new year for constituents in the Bromley area.
The concern of my hon. Friend the Member for Beckenham for the Beckenham hospital is well known and, as he has reminded the House, he has made sure that Ministers in the Department of Health and Social Security are well aware of his concern. That was particularly manifested by the presentation in December 1982 of a petition to the House signed by around 22,000 people.
I endorse the tribute that my hon. Friend paid to the skill and dedication of the staff at Beckenham hospital, and the loyalty of the local people to the hospital. That is the case in many hospitals. We should be proud of that and take advantage of it.
At the same time, we must improve and develop our health care. I leave aside the resource constraints and problems, which are inescapable. Progress in medicine, shifts in population and the need for more technical and clinical services to be grouped together must be taken into account. I hope that we all agree that there must be changes. Inevitably, we run into problems of the conflicts of old and justified local loyalties with the advances of modern technology. The Health Service must be concerned primarily with the delivery of service to our constituents.
The inescapable shadow of the distribution of resources must always hang over us. Neither of my hon. Friends will need reminding that nationally our record is good. Since 1979, we have increased expenditure on the National Health Service by 20 per cent., and, according to the Chancellor's autumn statement, next year there will be a further increase of 2·2 per cent., in real terms. Of course, there are pressures of pay and additional staff, but we always need to remind ourselves that they, too, are services. Some 70 per cent. of the cost of the NHS is staff pay. Staff are a valuable and crucial commodity in the delivery of health care. We have achieved real increases in pay and in the numbers of doctors and nurses. We are happy to have done so. All that is at the national level, and should be recognised.
Both my hon. Friends referred at length to the complicated resource allocation working party formula. I was glad to note that my hon. Friend the Member for Beckenham accepted that the move towards the RAWP objective of equalising services throughout the country was laudable. That proposition was supported by my hon. Friend the Member for Chislehurst. That is the Government's position, as it was of previous Governments.
We are moving towards that objective at a steady and measured pace, not at a helter-skelter pace. Long-term revenue plans assume annual reductions of 0·3 per cent. until 1993–94. That can be regarded in no sense as undue or immoderate haste or pressure. As my hon. Friend the Member for Beckenham was good enough to acknowledge, the pressures on several areas, particularly the four Thames regions, have been recognised in two ways—by the statement following the autumn statement and by the broad RAWP outlines announced by my right hon. Friend the Secretary of State on 17 December.
There was an increase in funding in the Thames regions to take account of the pressures to which both my hon. Friends referred. The management board of the Health Service was invited to review the operation of the RAWP formula. That is being done within the basic principles of RAWP, with which we all agree, but we recognise that an examination of the pressures is required. My hon. Friend rightly suggested that the examination be speedy. That is a fair point, and I take note of it. I hope that he will accept that we recognise those pressures.
I shall now deal with the proposition of Bromley health authority, and the future of Beckenham hospital. I stress that these are still proposals for discussion. As I understand it, a formal consultation process will begin next month. The proposals are revisions of proposals which have been around for some time.
My point is that this is still an issue for the health authority. As my hon. Friend recognises, our system must be based on policies being made essentially at district health authority level. The region and the Department only take part at appropriate points in the process.
Given that the health authority is above RAWP and that financial adjustments are still to be made, I am sure that my hon. Friend will agree that better dispositions of resources can be achieved. Therefore, it must be right for the health authority to examine all the available options, taking due account of the sensitivities of local support for particular services and facilities. I hope that my hon. Friend will not seek to cramp the authority's intellectual style in the search both for the most effective use of resources and, more important, for the delivery of the services which his constituents need. I understand that the health authority is adopting that approach. Obviously, we shall maintain close contact with it.
The proposition is that the acute services will be dealt with in two hospitals rather than four, taking account of the fact that the hospital throughput is rather slow and expensive for acute services. Clearly there is a need for improvement. The delivery of the full range of high-quality clinical acute treatment is difficult to achieve. It is not for the Department or Ministers to take a decision on that. However, we must consider whether these days an 80-bed hospital can truly provide the level of acute treatment that our constituents have a right to expect. Whatever may have happened on 17 December, I understand that the authority has judged that the answer to the provision of a better service is to concentrate acute services in two hospitals, and to use the facility at Beckenham hospital for geriatric and mental illness provision.
We have watched the development of the issue carefully, and I have no doubt that the chairman and members of the district health authority of Bromley will take careful note of the points made with sincerity and conviction by my hon. Friends. The community health council has been involved in the discussions from the earliest stages. It appreciates the need to put the proposals into effect. But the measures will be the subject of the usual consultation, and Ministers will not come to a firm view unless and until the proposals are referred to the Department for consideration.