If the hon. Lady will permit me, I shall be happy to deal with that in the eight minutes left of this Adjournment debate.
Before I do so, I should like to tell the hon. Lady that I visited Hackney earlier this year to look at the community psychiatric services. I know that the hon. Lady will join me in congratulating the district health authority on its organisation of those excellent services. I visited the community psychiatric research unit which is based at the hospital. The unit was funded originally through the generosity of David Sainsbury and is now funded by the district health authority. I met the directors, Dr. Turner and Mr. Adrian Lovet, and I visited two people who were living in their own flats with support from the district health authority, having left psychiatric care at the hospital. I also visited two group homes, one at Clapton common which is run by the local mental health association and one in E8 run by a local voluntary organisation called Vanguard Housing. I was very impressed by what I saw. I have reached the conclusion that community psychiatric care is working in Hackney and I congratulate all those involved.
The hon. Lady referred to patient throughput. I remind the House that the discharge of patients from hospital is a matter of clinical responsibility. Doctors, not hospital administrators, take decisions about when people are discharged. The national trend in Britain, together with many other western European countries, is that the average stay in hospital is getting shorter. That is to be welcomed. Patients generally prefer to leave hospital as quickly as possible after they have been medically treated. I am advised that in the City and Hackney district health authority, day surgery increased by 22 per cent. between 1982 and 1986. That is excellent.
The Labour party's common belief that the quantity, though not necessarily the quality, of health care in the National Health Service can be measured by the number of beds available is misleading. What counts is not the number of beds but the number of patients treated. Patient throughput in the City and Hackney area has gone up, and that is the best measure of health care.
The hon. Lady might be interested in the 1987–88 Kôrner Health Service indicators for the City and Hackney. I hope that she has studied them, but if she has not had the chance to do so I should be happy to send her the statistics. The document states:
Throughput values ranged from the high values for Ophthalmology and Gynaecology to the low values for Trauma and Orthopaedics and General Surgery/Urology. Lengths of stay for patients over 65 years were high or very high for all specialties except Ophthalmology. For patients age 16–64 years they were mostly mid range except for very high value for General Surgery/Urology. They were also very high for Paediatrics. Day case rates were mainly mid range except for the high values for Ophthalmology and Gynaecology.
Therefore, patient throughput needs to be examined by specialty.
The hon. Lady asked me to comment on the situation at Bart's and I am happy to do so. Three wards have been closed temporarily. The hon. Lady knows that two have been closed for operational reasons of maintenance and fire safety and one has been closed for financial reasons. The hon. Lady mentioned the financial difficulties not only for Bart's, but for the entire health district. North East Thames regional health authority recognises the position of the City and Hackney and is in discussion with the district about what can be done to ameliorate the present situation.
One of the main causes of the potential overspend in City and Hackney health authority is due to the increased numbers of cases being referred to St. Bartholomew's hospital from outside the district requiring complex and intensive nursing care. As a result, the authority has had to use additional agency nurses and ask nurses to work increased overtime.
The hon. Lady will know, if she has studied the White Paper "Working for Patients", that that document carries an excellent message of hope for Bart's, a major teaching hospital, and I trust that she will join me in hoping that legislation, if presented, will receive a swift passage, since it will bring hope to her constituents and represents an excellent message for the medical staff at St. Bartholomew's.
That will be the position because money will follow the patient. The hon. Lady will know that only about 30 per cent. of patients treated at Bart's live in the district. About 70 per cent. come from outwith the district. Thus, our proposal that money should follow the patient will mean that, through the mechanism of contracts, resources will flow from surrounding districts to Bart's in those specialties in which, as the hon. Lady rightly said, Bart's has an outstanding reputation.
We shall end the efficiency trap by which consultants and doctors who work hard eat up the fixed resources in their budgets more quickly and then, halfway or two thirds of the way through the year, find themselves having exhausted their budgets and having to curtail their activities. We do not want that to happen in future. We want greater flexibility in the funding of the NHS, and the Government's White Paper, presented earlier this year, foreshadowing legislation, will be of great assistance, not only to the hon. Lady's constituents but to the NHS in general.