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.