This debate on the crisis in London's Health Service comes at an important time. For understandable reasons the debate is shorter than it might have been, and that is regrettable.
Earlier this week we had a statement from the Government on health spending in Britain and how they are planning to increase it to cope with the present crisis. Many of us were sceptical when the statement was made and, having had a couple of days to look at the details and the figures and do calculations for our own areas, I can reveal that the amount allocated for the four Thames regions—if all the money was spent in London alone—would meet only half the needs of the crisis. In fact, the four Thames regions cover far more than Greater London.
Because of the background to the debate, it is worth putting on record the fact that the levels of health spending in this country, despite all the best efforts of the Government in their huge propaganda machine, are woefully inadequate when compared to any other industrial country that is seeking to run a proper Health Service. The figure for this country of total health spending per capita is $161, compared to $232 in Australia, $220 in West Germany and $141 in Japan. Therefore, only Japan comes lower than the level in this country. One can make many more comparisons which will always show that health spending in Britain is significantly lower than in any other comparable country.
There are three early-day motions on the Order Paper today concerning London's health emergency. All three are in the names of the London group of Labour Members, all of whom have signed them. The first
deplores the closure of 590 acute beds in inner London and a total of 1,000 hospital acute beds across London since May 1987, and the crisis of funding imposed by cash limits on London's health service which will result in increased suffering and hardship for Londoner".
It calls for more money for London. However, that money has not been forthcoming.
The second motion, which is in many ways just as important, deals with the loss of rate support grant to London local authorities, which has undermined the quality and level of service of community care and social services that local authorities provide. The motion reflects the real nature of the Government's policies for London. It calls on Her Majesty's Government to restore the loss of £4·4 billion in rate support grant and to make a further £35 million available to allow district health authorities to avoid further cuts in health facilities. There is a close correlation between the two.
The third of our emergency motions deals with staffing in London. There is a crisis in Health Service staffing in London because of low pay, privatisation and a loss of morale. That is a measure of the low regard that the Government have for Health Service staff in London. We are calling on the Government to make substantial improvements in the 5·5 per cent. offer for London weighting and to fund the Thames region sufficiently to enable it to pay any new offer to health authority staff.
Those of us who have been involved with the Health Service for a long time—for many years I was a full-time official of the National Union of Public Employees, and I am sponsored by it in the House—know full well that the consequence of the Government's not funding health authority pay awards is that it creates a false division between Health Service staff and the needs of patients, when in reality they are very much the same. We resent the way in which these divisions have been brought about.
The crisis that we face is that, despite the money that the Government announced this week, which is inadequate, we are facing an immediate series of cuts in London over the Christmas period. Camberwell health authority is closing 110 beds at King's College hospital for two weeks; Wandsworth health authority is closing nine wards for two weeks—the number of beds in each ward varies; Islington health authority is closing the Royal Northern hospital, which is located in my constituency, and moving patients to the Whittington hospital from 18 December until 4 January. Additionally, there is an attempt to close the hospital altogether.
Merton and Sutton health authority is closing eight wards for two weeks, one of which will be permanently closed thereafter; Brent health authority is closing six wards for an unspecified period. Again, there is concern that those wards will not reopen. Barnet health authority, in which the Prime Minister's constituency lies, is closing Victoria maternity hospital because of nurse shortages. It is £1 million overspent and the Victoria maternity hospital will be closed indefinitely pending consultation on its permanent closure. That is an activity that we have seen increasingly within the Health Service.
Since the beginning of this year the number of beds lost in London health authorities is staggering. I shall not quote every example, but Brent health authority has lost 50 beds, Harrow 32, Hillingdon 75, Paddington 92, Bromley 58, West Lambeth 137, Hampstead 112, and Haringey 127. Haringey health authority no longer has any acute services within the borough. There has been a process of cut and closure in every hospital in the borough of Haringey. The nearest emergency services are at the North Middlesex hospital, which lies just inside the borough of Enfield.
On 26 November, the day that the House was last debating the crisis in the Health Service, the London Evening Standard reproduced an excellent report from London Health Emergency. It outlined a few of the problems. Bloomsbury health authority has a budget of £137 million and has not overspent. That has been achieved by the authority saving £1·3 million by freezing vacancies and other such matters. Hammersmith and Queen C'harlotte's, which has a budget of £46 million, is overspent by £700,000. The main cause of that is the underfunding of pay awards and the need to upgrade kitchens and dining rooms. Greenwich, which has a budget of £65 million, is overspent by £250,000, and even to achieve that figure it had to introduce savings of £750,000. In effect, the cut is £1 million on a budget of only £65 million. That is an enormous cut in one year.
In the current year we have lost almost 1,000 beds. That must be considered against the background of what has happened in the Health Service in London since 1979. The Minister is always keen to quote the state of the Health Service under the last Labour Government, but we must consider the success of the Conservative Government in providing for the health needs of the people of London. In 1979 there were 64,736 National Health Service beds in National Health Service hospitals in London. The great achievement of the Government has been to reduce that figure to 52,708.
If anyone were to consider the cuts that have taken place in the past eight years in particular health authorities he would be astounded. Let us take one or two at random. The City and Hackney district health authority had 1,990 beds; it now has 1,686. Waltham Forest district health authority had 3,311 beds, and that number has been reduced to 2,407. Barnet district health authority had 2,841 beds and that number has been reduced to 2,324. In my authority—the figures are available only from 1982 because of Health Service restructuring—the number of beds has gone down from 1,177 to 866. It is one of only three authorities in London which have fewer than 1,000 beds available for their populations. Those figures are a measure of the disaster that faces the Health Service in London.
The Minister has spoken of the problems of Health Service spending in London, but there are a number of confusing aspects. London is covered by the four Thames regions—there is no London health authority. I believe that it would be better if there were such an authority, because I am fed up with the idea of inner-London health spending always being compared with spending in outer-suburban areas. I have absolutely no wish to see the home counties suffering health cuts, but I believe that the way in which the RAWP formula has been operated by the Government has resulted in the biggest cuts taking place in some of the Thames regions.
In fact, the sub-regional RAWP movements have resulted in a permanent process of cuts, closure and decline in every inner-London health authority. Although we do not want cuts anywhere else, we ask the Government to recognise that there are enormous health needs within London. We are not indulging in special pleading for London at the expense of other parts of the country: we are seeking a cash increase that will help the people of London. It is important that that is on the record.
In the years between 1982–83 and 1985–86, the North East Thames health authority, which covers my constituency, has lost 0·9 per cent. in real terms in capital revenue allocations. It has also suffered as a result of the sub-regional RAWP figures.
It is also important to consider the regional var: ations in hospital costs for in-patients. The costs in London are considerably higher than those in any other part of the country. That is why London weighting is available for staff and why we ask the Government to take proper account of the increased costs in London. Building costs, land costs and transport costs are all higher in London. The efficiency of any service—the ambulance service, or anything else—is markedly less in London because of the continuous, inevitable congestion.
Let us consider the costs for hospitals with more than 300 beds. In the North West Thames regional health authority, the cost per patient per day is £108·97. The equivalent figure for the Oxford authority is £99·72, arid for the West Midlands, regional health authority it is £95·86. The average in England is £99·63. The costs for acute beds in those regions are as follows. The cost in the North West Thames health authority is £81·80. The cost in the west midlands is slightly higher than average and the average for the whole of England is £79·79. It is important that the Government should take account of those figures.
When the Minister made his statement this week, he said that, as a result of the total increased allocation for extra services in the Thames regions, the North West Thames health authority would receive £4·7 million, North East Thames health authority £6 million, South East Thames health authority £5·3 million and South West Thames health authority £4·3 million. We should compare those figures with the needs identified in our early-day motion, which require £38,257,000. That sum is needed to avoid the immediate acute crisis that faces the London Health Service. That is a measure of how far we have still to go, and of how little we have achieved so far.
There is a serious staff crisis in the London Health Service. There have been large numbers of job losses because of a process of privatisation and of deliberately keeping vacancies in the Health Service. Anyone who visits a London hospital from year to year can see how bad the situation is becoming. One sees the generally scruffy appearance of the entrance areas to so many hospitals. People have to wait a long time. One comes across cases of double bedding—or hot bedding, as it is called—whereby patients are shuffled from bed to bed at enormous speed. In some hospitals people are treated in the corridor.
A case was reported recently in a well written article by a constituent of mine in The Guardian. My constituent's son broke an arm. She would be the first to admit that she is a relatively comfortably off person, in that she has access to a car. When she took her son to the local Whittington hospital she found that he could not be admitted even though the X-rays were done there, so he had to be taken to the Edgware hospital, to which she was able to drive him, and after a four-hour wait he was admitted. Others, who are not so lucky, have to rely on ambulance services, which are so overstretched that they cannot meet these demands.
I wish to give some figures about the Paddington health authority — an inner-city authority. There has been a long-term plan of reduction of facilities at St. Mary's W2 hospital, which has now finally been closed. There have been reductions in service at St. Charles's hospital, and everything has been centralised in St. Mary's on the Praed street site. The effect of that is to make travelling more difficult for everyone and to create a large, impersonal hospital. The privatisation of the staff there has resulted, at St. Mary's in Praed street, in 60 catering jobs and 280 domestic jobs being lost, and the privatisation at St. Charles's hospital has resulted in the loss of 170 domestics. Bringing in the company Mediclean has resulted in a different atmosphere, which is hostile to the needs and aspirations of staff, and in considerable difficulties for union organisation and representations.
Before I allow the Minister time to reply, I want to draw his attention to one or two other matters. I shall deal first with the London ambulance service, which was the subject of a lengthy debate following the passage of the Consolidated Fund Bill, during which we were able to show that the service is finding it increasingly difficult to meet the needs of the people of London—especially for emergencies. On the night of the King's Cross fire, about 40 ambulances were unavailable for service. I would be the first to praise the heroism of the police, station, fire and ambulance staff, but it is not good enough to shed crocodile tears in the House about the needs of the London emergency ambulance service if, at the same time, funding is not provided so that the ambulances can do the job properly. Many people are fed up with Ministers going around hospitals after disasters like ghouls, when they are not prepared to pay the money that is needed to avoid such accidents in future.
The problems of the service are compounded by a general shortage of staff and controllers, which in turn leads to enormous stress among the staff. Ambulance staff are not particularly well paid. Anyone who has watched them at work will realise the terrifying stress of trying to drive an emergency patient through London's traffic, knowing full well that there is another emergency after that—and another after that—with the attendant fears that one might arrive too late because of the traffic and the shortage of ambulances in the first place. That must be understood.
In 1980 the London ambulance service covered a total of 9,101,000 miles. That has been reduced by 1987 to 8,238,000. In every area fewer emergency ambulances are available, even though they are working efficiently and hard. Emergency ambulance miles covered have kept up, but at the expense of non-emergency services and by increasing the use of hired cars, minicabs and volunteer drivers, which is an unacceptable way of doing things.
Islington health authority is in an inner-city area and is facing a long-term cut in health standards. The Friern Barnet psychiatric hospital is to close and its patients will be forced into the community. The social services department is worried that it will be unable to meet the needs of those people, in the same way as Camden and Haringey are also unable to meet them. The Royal Northern hospital is closing temporarily over Christmas and will close permanently soon after that. The Southwood hospital is also to close.
People in my constituency are greatly worried that the Health Service is becoming increasingly unable to cope with the needs of patients. Indeed, in the constituency of my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) the lack of funding for the elderly assessment centre at Bart's hospital is causing great concern, and we look forward to an announcement from the Minister that he will support that venture.
Health is much more than a series of statistics, although that is the only way in which one can present it in the House. Health means the knowledge that the Health Service is available for all those who need it, at the time that they need it. In London, that is increasingly no longer the case. Waiting lists become longer and longer, small hospitals are closed and large hospitals are closing wards and operating theatres. There is great concern among the staff, who either leave or continue to work in such appalling conditions that we wonder why they stay in the employment of the health authority.
The announcement this week of some increase in funding shows how scared the Government are over the increasing protests about the level of health spending. They have been frightened by publicity and by letters from leading doctors. They now realise that every family knows that there is something badly wrong with our hospitals, wherever they may be throughout the land. We need a large increase in Health Service spending in London, and we need it very quickly, to stave off the crisis that we are facing this Christmas.
However, it must go further than that. Barbara Young, the spokesperson for the hospital managers, has said that any money often comes too late to stave off ward closures. The Minister could do us a good turn today by announcing that he is prepared to alleviate the crisis in London by giving the Health Service the money that it needs, now.