I do not wish to rehearse too much the background to the Health Service crisis which has so badly affected my constituency in the last six months, as that has already been done adequately through the diligence and eloquence of my hon. Friend the Member for Mid-Kent (Mr. Rowe), whom I see in his place and who raised the issue in the House a few weeks ago.
We have a brand new hospital in Maidstone. Last year there was an unprecedented rise in activity, so that we were treating about 30 per cent. more patients. That rise in activity was not predicted and could not reasonably have been so. That meant that the health authority was badly overrunning its budget.
The district health authority was already extremely efficient, because it had introduced privatisation measures, because it had cut waste and because it had already increased its throughput per patient bed; therefore, it had very little scope to find economies and savings to meet the additional strains upon the budget. It therefore reacted with ward closures. One major closure was in the brand new hospital. It also closed all physiotherapy facilities and threatened further ward closures.
I am very grateful to my right hon. Friend the Minister for Health for the immediate help which he made available and for giving us money enough to reopen those wards. I am also very grateful to him for the additional money which enabled Maidstone to appoint a third orthopaedic surgeon and a fourth gynaecologist to cut some of our severest waiting lists.
But those measures are addressed to the immediate crisis and are designed to cope with immediate problems. It is more to the future that I want to look tonight, because I have to cope in the constituency both with a very heavy legacy of the past six months, which in itself is bound to affect the future, and with the major question that I know to be in the minds of my constituents, which is not so much whether the present crisis is over as what guarantees we have that we shall not be in this situation again this time next year if we continue to be efficient and to increase our activity.
The legacy I am left with is one of badly increased waiting lists. A cardiac patient came to my surgery last Saturday who needs a test to establish whether he needs major heart surgery. The test, never mind the operation, will not be available until October 1988. He has been offered various appointments at various hospitals within the South East Thames area, but October 1988 seems at the moment to be the best that can be offered.
Cataract patients write to me in desperation and say that they are prepared to go to Inverness. They do not have quite to go to Inverness, but the nearest I found recently was Glasgow, which is not too far from there. My office has been turned into an agency for finding places for operations.
In the immediate term, this is something that can be addressed and can be tackled. It is about the future that I am particularly concerned — not only the future funding but the future adminstration of the South East Thames regional health authority. There has been very Z little in the past to inspire confidence on the part of the people of Maidstone in some of the decisions taken by the authority.
First of all, we were the only hospital in the entire region which, when it opened, was not given additional money for running costs. Secondly, a purely regional decision, not one that has been taken by other regions and not one that has been decreed by central Government, to change from RAWP to ACORN has removed £1·2 million from Maidstone's future expectations. When we are just recovering from a major crisis, to find that £1·2 million has been taken off our future expectations does very little to give us hope and confidence.
Is my hon. Friend also aware that, in an apparently unique regional hospital authority decision, the hospital in Medway where students come gets no money at all towards paying the costs of those students? It appears to be the only regional authority in the country that has taken that decision.
I am grateful to my hon. Friend for his intervention and that addition to this debate.
Furthermore, those concerned work on out-of-date statistics which work very badly to Maidstone's disadvantage, calculating our allocation and our entitlement on birth statistics and population flows that were obtaining six years ago.
When the crisis erupted in Maidstone in the summer, I immediately entered into negotiations with the South East Thames authority to find out what it could do for us. It promised us two things, or rather half-promised us two things. First, it said that it would look at its finances and see if there was any flexibility for loan or other arrangements; secondly, it said that it would try to improve the statistics, which was bound to work to Maidstone's advantage.
Several months after the receipt of that letter, neither of those half-promises had been implemented. It was not until I managed to see the Minister, in conjunction with my hon. Friend the Member for Mid-Kent and my right hon. Friend the Member for Tonbridge and Mailing (Mr. Stanley), that we finally got the extra money and help that we needed. According to a reply given to the hon. Member for Southport (Mr. Fearn), the authority has a budget of £933 million—Maidstone needed less than £1 million to keep its wards open—but, if it cannot manage the cash flow better than that, it does not hold out much confidence for the future of the South-East Thames region.
The South East Thames regional health authority is a little remote. It is in Bexhill-on-Sea. It is quite an intrepid character who goes to Bexhill-on-Sea. Whether one goes by road or rail, one needs a great deal of time on one's hands. The health authority said that it moved to Bexhillon-Sea because it was too expensive to stay in Croydon. It moved from Croydon to Bexhill-on-Sea, but it still has its empty, £600,000 premises in Croydon. For £600,000, we could have kept our wards open.
If it may be gathered from this that I am not wholly at one with the way in which the regional health authority operates, the fact remains that the authority does have the odd cross to bear. This is an urgent matter and I ask my hon. Friend the Minister to respond to certain points which could help the authority to help Maidstone.
I quoted from out-of-date statistics. The authority's consistent defence is that it does not decide which statistics to use. It is simply not supplied centrally with up-to-date figures. I wish to ask my hon. Friend whether it is possible to expedite the updating of those figures.
Secondly, there should be clear guidance to all regional health authorities to reward efficiency, because efficient district authorities do not have the scope to economise when they are faced with financial difficulties. Inefficient authorities do, so there should be a reward which recognises efficiency. If we had that, we would have had far fewer problems in Maidstone.
Thirdly, there is the underfunding of pay awards. I do not believe that it has been wrong for the Government to have some underfunding of pay awards. Blank cheques do not promote efficiency and the elimination of waste. Some authorities have reached an efficiency ceiling, but not all. Before we believe that an efficiency ceiling has been reached in the South East Thames area, I have here statistics which show Maidstone's performance to be well above that of others. Some authorities are not performing to the expected standards, but presumably are still funded for the expected standard. When an efficiency ceiling is reached, there is no longer the flexibility to react by the elimination of waste. I appeal both to my hon. Friend the Under-Secretary of State and to my right hon. Friend the Minister for Health to consider the effects of under-funding of pay awards on those areas which suffer through the regional allocations and which have already reached their efficiency ceiling.
I do not feel particularly penal towards the South East Thames regional health authority, but I think it would benefit the NHS as a whole if the regions were abolished. However, we shall have enough of that in two weeks' time in another debate. I shall not ask my hon. Friend to respond to that tonight because I am sure that she would not wish to do so.
Finally, we need an overhaul of the NHS and a reform of its structure and system as well as of our level of funding. In short, we must not roll from crisis to crisis.
I have a letter from the South East Thames regional health authority chairman which suggests to me that, although he can guarantee sufficient money — indeed, has already given sufficient money — to reopen our wards this year, he is concerned about the economies that have been implemented for the future.
I am concerned about where my constituents will find themselves this time next year. Will they still be queuing up at my surgery for me to find them operations in Glasgow, or will they be able to rely on proper rewards for efficiency, which is what my district health authority deserves and what is too little recognised throughout the South East Thames area?
I congratulate my hon. Friend the Member for Maidstone (Miss Widdecombe) on obtaining the debate and once again reiterating her concern about her local health authority, as she has also done in six recent parliamentary questions, in her contribution to the debate on the Health Service during the debate on the Consolidated Fund Bill on 8 December, at a meeting with other local Members of Parliament with my right hon. Friend the Minister for Health on 30 November and in much correspondence with Ministers, some of which I have still to respond to.
I also commend my hon. Friend the Member for Mid-Kent (Mr. Rowe), who is in his place tonight. I commend both my hon. Friends to their constituents for their energy, interest and concern. I take note of what my hon. Friend the Member for Maidstone says about visitors to her constituency advice bureau and no doubt as a result of what she has said tonight she will have many more. In a few moments, I shall offer my hon. Friend some figures which may be new to her. I hope that, with her considerable experience of finance, she will find them interesting.
Maidstone district health authority's cash allocation for this year is over £32 million — a 8 per cent. change over the previous year, which, in turn, was nearly 6 per cent. more than in 1985–86. Also in recent years, the capital allocation has been between £2·5 million and £3 million each year, even after the opening of the magnificent new district general hospital, which, as my hon. Friend knows, I recently visited.
My hon. Friend asked whether we could obtain more updated figures and I share her interest and concern on that. She probably knows about the Korner reforms, which mean that statistics will be more readily available this year when the new system comes on stream. I hope that if, as a result, there is any comment about the cost of administration, clerical and computer staff, she will still consider it a good idea.
My hon. Friend talked about the underfunding of pay awards. I am sure that she realises that no Government ever give a blank cheque on pay awards. Certainly we do not, and have no intention of so doing.
I and everybody else fully accept that the Government do not write blank cheques, but neither does the region nor the district. Somebody must pick up those pay awards, which I accept are agreed by the independent review body, not the Government. All that I am appealing for is that the shortfall should not be such that it makes inroads into funds that should be spent on patient care—[Interruption.]
The hon. Member for Rhondda (Mr. Rogers) says that we should give my hon. Friend a party card. I am not sure to which party he is referring.
My hon. Friend's point is well made and well taken. I merely put it to her that pay awards are not an alternative to service to patients. Paying our staff properly is part of our service to patients, particularly if it thereby ensures that we can keep the staff whom we want. Current discussions with the review bodies for the doctors, dentists and nurses will no doubt have their outcome in due course. However, I repeat that it would be a foolish Government who gave a blank cheque for pay awards in the middle of a pay negotiation. I am sure that my hon. Friend can find it in her heart to agree with something in that statement.
I hear what my hon. Friend says about the regional system. I am sure that she is aware that I shall not have a chance to respond to her debate on 26 January. However, I hope that she will recognise the recent valuable role of the regional health authority. Earlier this year, the region calculated that the total projected overspend among its districts would be over £9 million.
Those health authorities have a statutory duty to remain within their cash limits, as I have to remain within my budgets. So the region correctly stressed that to the districts, and emphasised that reductions in service had to be made only as a last resort. Most of the districts, like Maidstone, introduced further savings measures not affecting patient care, such as slowing down some service developments and instituting income generation schemes. The region, too, has implemented savings and has clearly taken note of my hon. Friend's previous remarks, because I understand that it will be reducing its expenditure in 1988–89 by £275,000. We expect it to keep to its budget just as much as anyone else in the area.
However, a number of districts had to make temporary service reductions. To help those districts, the regional health authority co-ordinated what it called a cash management exercise, whereby health authorities whose cash position is less critical this year assisted by contributing to a regional pool to help the other authorities, such as Maidstone, that were facing particular problems. At that stage in the autumn, the region was predicting that it would break even in this financial year.
Then we had the storm, and we have since allocated, as my hon. Friend knows, £8 million to the South East Thames health authority for the damage done. That is what it asked for, and what it got. We then found that there were further emergency measures, some of which my hon. Friend has referred to, to avoid overspending. But there was also the announcement on 16 December of about £75 million extra for the hospital and community health services in England for this financial year.
South East Thames asked the district to bid for additional money, which it could use in this financial year to meet immediate problems of the sort that have been described. Maidstone asked for an additional £191,000, which I can tonight confirm that it will receive. That will enable Maidstone to reopen, later this month, the temporarily closed general surgical ward at Maidstone district general hospital, which will then no longer be on amber alert. Eighteen temporarily closed beds at Kent county ophthalmic and aural hospital will also reopen shortly. An additional programme of joint replacement operations at the local private hospital will be undertaken, until another ward at the district general hospital can be commissioned to enable such operations to take place there.
Two wards that have been temporarily closed at Linton and Preston Hall hospitals might also have been reopened with the money, but they are having to be used to accommodate some patients from Maidstone hospital psychiatric wing, which had to be evacuated following extensive storm damage. I hope that my hon. Friend can accept that. In addition to the £191,000, Maidstone will get a further £135,000, which will go towards reducing its credit of balances and put the authority on a sounder financial footing for the coming year.
My hon. Friend is probably aware that we have been repeatedly advised by our financial advisers that if we delay paying our creditors for too long, all they do is put the prices up next year; so it is a sound, counter-inflationary measure to ensure that our health authorities have a reputation for paying on time. As a result, since my hon. Friend last raised the question with me, Maidstone district health authority has received an extra £326,000 for this financial year.
I fully accept that, after being able to reopen temporarily closed services with additional Government money, Maidstone does not want to be in the same position again next year or, indeed, in April of the coming year, when it may have to close some services again. It is for the regional health authority to decide on allocations to districts, and it will be doing that for 1988–89 on 21 January. That is the present system. I know that district and regional officers are discussing bridging finance from the region to help Maidstone get back on a sounder financial footing, but my hon. Friend will appreciate that, for the moment and for the foreseeable future, this is primarily a regional responsibility. However, I shall make sure that the region is aware of her views and those of my hon. Friend the Member for Mid-Kent.
My hon. Friend will observe that many of my hon. Friends who serve and represent constituencies in the South East Thames region are sitting in this evening. We would emphasise that we all share the concern of my hon. Friend the Member for Maidstone (Miss Widdecombe) about what will happen in the next allocation. We hope that, even under the present system, my right hon. and hon. Friends will ensure that the South East Thames region takes account of the several deprived districts in its area.
My hon. Friend has made her point extremely well. I should also draw attention to the presence in the Chamber tonight of my hon. Friends the Members for Dover (Mr. Shaw), for Sevenoaks (Mr. Wolfson), for Gillingham (Mr. Couchman) and for Faversham (Mr. Moate), and to that of one or two Opposition Members who come from a long way away.
No, forgive me, but I shall not give way because I do not have the time.
My hon. Friend the Member for Maidstone has drawn attention to the statistics that are based on performance indicators which, as she rightly says, come from the data for 1985–86 which, of course, are the latest information that I have. She is quite right that the authority has a high throughput. Indeed, it is one of the best in the country. I am talking mainly about Maidstone hospital. Although in fact it is not the best in South East Thames regional health authority—All Saints is the best—Maidstone is highly efficient and cost-effective.
The costs per case of Maidstone district health authority were £601 for 1985–86. I agree that that compares favourably with, for example, Brighton at £1,194 per case, Orpington at £1,074 per case or Lewisham at £1,257 per case. They are all similar hospitals—major district general hospitals with more than 250 beds. Among the 21 similar hospitals in the region, Maidstone ranked not first, but sixth in terms of cost per case. Kent and Canterbury and Eastbourne district general hospitals are cheaper. Although the difference is not great, it is worth putting it on record.
In terms of medical and dental costs per case, Maidstone DGH ranks not first but seventh in the regional health authority. The Royal Sussex county hospital, for example, spends much less on nursing per case and Greenwich district general hospital spends much less on medical staff per case. However, Maidstone has very good hotel and maintenance costs, which is amazing. I am curious to know why it costs nearly four times as much to run the ancillary services at Brighton general hospital as at Maidstone. Perhaps our two splendid lady chairmen, Mrs. Cumberlege and Mrs. Nelson, could get together on that and share lessons.
I know that the regional health authority is reviewing its policy on cash allocations — [Interruption.] I am disappointed in the hon. Member for Rhondda. He is usually interested in health matters. I also know that the regional health authority—
The hon. Gentleman knows that time is restricted in Adjournment debates.
My hon. Friend knows that the regional health authority is reviewing its policy on cash allocations for mental illness. It is essential that in all the discussions about the pressure on acute services, we do not lose track of the need for services for those with mental handicap, mental illness or other groups who, perhaps, are not always in a position to make much fuss. I have no doubt that Maidstone district health authority's feeling that other DHAs, which send large numbers of patients to Maidstone, are getting something good on the cheap, will be taken into account. I gather that the DHA says that it is between £300,000 and £400,000 out of pocket as a result of treating out-of-district mental illness patients. There may be some discussion about the exact amount, but I know that the region has taken that fact on board.
I also know that, following the regional health authority's meeting on 19 November, further work is being done on bed usage at Maidstone and on whether there is scope for increasing the use of day care and short-stay accommodation. The district health authority has recently shown considerable improvements on the day-case side, but in ear, nose and throat treatment, 95 per cent. of patients are in-patients. I have no doubt that in its discussions the DHA will take account of facts such as bed occupancy in ENT, for which there is a waiting list of well over 500 for non-urgent surgery and treatment. The figure is over 400 for opthalmology. The occupancy for those specialties has been below 50 per cent. for many years. On the other hand, the gynaecology department treats more than 20 per cent. of its patients as day cases and has relatively good occupancy rates and a tiny waiting list. I make no judgment from those figures but hope that the regional health authority will consider them. I am sure that with good will and the willingness to change some long-held practices, issues such as these can be resolved in the interests of patients, possibly without using additional funds.
We have to make a point here about planning. Estimates of future patient numbers, on which we base much of our financial planning, are based partly on recent history and demography, and partly on population patterns and changes. Whether or not they are six years out of date, I can assure my hon. Friend the Member for Maidstone that every effort is made to take them fully into account. We also base our financial planning on any planned growth of services such as an additional consultant or expected changes in practice.
In 1982–83, the growth of in-patient cases in Maidstone was 1·5 per cent. In the following years it was 4 per cent. and then 5 per cent. In the year after that, it seemed to have levelled off because there was a very small drop in activity for in-patients at about 1 per cent. What is then clear is that the 13 per cent. jump in in-patient cases in the following year took everybody by surprise. Indeed, nobody could have planned for that and known that it would happen. I do not think that anyone would have believed the people of Maidstone if they had said to us blithely that they expected an increase in numbers of inpatient cases of 13 per cent. in one year.
It is a tremendous tribute to all the staff concerned that they managed to cope with such an increase in demand. I do not believe that the regional health authority should be blamed for its failure to anticipate that sort of growth. I suspect that, even if it had anticipated it, other DHAs would have objected strongly to anything like a 13 per cent. increase being given to Maidstone in a year.
In relation to the cost of the region's accommodation, I understand that if it had not moved in 1983, it would have been faced by a rent review in Croydon, and the rent would have cost about £1 million a year.
What the authority did was to buy the existing premises at Bexhill and expenditure since has been much less than it would have had to pay at Croydon. I assure my hon. Friend the Member for Maidstone that the region has been active in trying to dispose of the remainder of the lease and no doubt will do so shortly. However, we have an extra £800,000 in revenue savings as a result of the move, which has been spent on improving mental illness, mental handicap and renal services. I hope that this information is helpful to all my hon. Friends.
Question put and agreed to.
Adjourned accordingly at thirteen minutes to Eleven o'clock.