Debates on the financial crisis in Gwynedd health authority seem to have become a regular feature in the Chamber. We had one in June 1988 and another in March last year. The Minister of State has good reason to remember the latter debate because on that occasion, as on this, he had to stand in for his colleague the Under-Secretary of State for Wales, who was then, as now, indisposed. We send him our best wishes for a speedy recovery.
The Minister also deserves our commiserations because once again he has picked up a poisoned chalice. He needs no reminding about the financial crisis and cuts in the Health Service in Gwynedd. For example, the closure of services at Llandudno general hospital has been a matter for public outcry in his constituency. Whatever brief he may have today, the Minister knows in his heart of hearts that the present situation cannot continue. There must be a resolution of the perpetual state of crisis in the Health Service in Gwynedd.
The present position goes back to three years ago when a team of consultants published a damning indictment of the lack of budgetary control in Gwynedd health authority. The authority then had a cash shortfall of £1·3 million. A desperate programme of action was drawn up to bring the authority back into balance, supposedly by March 1990. The consultants said that the plan was feasible but to my mind it was entirely and hopelessly unrealistic.
The programme was based on closing six valuable community hospitals. The consultants thought that that could be achieved within 12 months. How on earth the Welsh Office allowed such a palpably unrealistic time scale to be adopted defies credulity when it was clear that five of the six proposals would be fiercely opposed by the communities affected. The closures also showed a cavalier contempt for the Welsh Office planning paper SPP5 representing a complete departure from its procedures. Even if the five hospitals had been closed 18 months ago as the consultants assumed, the claimed saving would have amounted to about £1 million a year. The shortfall now facing the authority is £4 million a year. So let us have no excuses that the delay in the closures caused the present crisis.
While I am referring to hospital closures, I again protest that Porthmadog, in my constituency, will be left without a single hospital as a result of the changes. It will be dependent on a converted workhouse in a nearby village. I also protest at the way in which Caernarfon has been treated and the closure of the cottage hospital there. It is a much-loved hospital which has served the town well. I know that because it was at that hospital that our two sons died. I remain committed to turn every stone possible to ensure that the health authority and the Welsh Office are not allowed to get away with robbing the town of such vital services.
I ask the Minister to look again at the way in which Caernarfon is being left with no casualty cover whatever following the cottage hospital closure. Will he review the lack of information given to the public about alternative provision? In particular, will he undertake to review the working of the alternative arrangements that the health authority is preparing in the context of long-term plans for the health services in the Caernarfon area, about which the Secretary of State wrote to the authority on 20 April.
Will he also review the provision of GP beds in Caernarfon to see whether it is possible to replace the lost 14 beds at the cottage hospital by using the empty fourth ward in Eryri hospital in Caernarfon for that purpose?
Can the Minister clarify what will be the position when the cottage hospital building is disposed of by the authority? It was built largely by voluntary subscription in the town. If a use for that building can be found that is compatible with the original purposes—perhaps in the context of developing care-in-the-community proposals in the wake of the NHS Bill—could the authority be prevailed on to regard such a proposal sympathetically? Can the Minister guarantee that any funds obtained from the sale of the hospital will be available to improve the Health Service provisions in the Caernarfon area?
The crisis facing Gwynedd health authority is infinitely worse. I understand that Deloittes, the consultants, are again investigating the position. Can the Minister tell the House when we can expect their findings?
The extent and depth of the crisis was brought home graphically to my hon. Friend the Member for Ynys Môn (Mr. Jones) and me last month when we met some 200 employees of the health authority. They poured out their souls to us, describing their despair at the way in which cuts were hitting services. It was not in any way a politically motivated gathering. It was a cross-section of professional health care workers, from ancillary to consultant level, who told us of the extent of the rundown.
We heard of wards being left empty, posts frozen and nurses who worked all day, going home at six o'clock only to return at 10 pm to work a night shift because of the lack of cover caused by frozen jobs. I was told of stroke victims unable to get physiotherapy or speech therapy because of staff shortages. We heard of services, such as the child development unit, in danger of being closed and of cuts in the family planning service. The staff spoke of the breakdown of trust between the top administration and those delivering the services. They felt that they were being asked to shoulder an ever-increasing workload with inadequate staff resources.
An example of how this continuing crisis has affected one department can be seen from the case of radiology. In 1983, in the old hospitals, about 1,200 cases were being treated a month by 28 radiographers. Initially after opening ysbyty Gwynedd, the number of radiographers increased to 32, but it quickly dropped back to 28. In 1990, the same complement of staff is having to deal with 5,000 cases a month. Because of the freeze on heads, there are only 24 radiographers in situ. Over the summer, with the holiday period at hand and any further freezing of jobs, the number could be down to 15. Clearly, that is inadequate. A year ago the waiting list was only three weeks, but now it is up to 20 weeks and it is likely to worsen this summer to about 30 weeks. Those who are caught by such a waiting time include patients possibly suffering from cancer of the colon. One member of staff has even suggested that the policy of freezing radiography posts is deliberately undertaken to reduce the number of cases that have to be treated, thereby avoiding expenditure on patients. The situation is grotesque.
During the past three weeks there was a strike by senior secretaries—mercifully it was settled this week—who since last November have been trying to negotiate a settlement, but they have found nothing but prevarication.
All that has had a traumatic effect on staff morale. There seems to be a breakdown of confidence between senior managers and those who provide the services. One specialist told me that he had not seen a senior administrator for six months or a member of the authority, other than the chair, for six years. No wonder morale is at rock bottom.
If asked, the health authority attributes the cause of the dilemma to three factors. The first is underfunding by the Welsh Office. Provision is too low to cover wage settlements and inflation. The allegation was supported by the Deloittes report of 1987, which stated that that had
contributed significantly to the deterioration of the financial position.
Since 1987 that has cumulatively worsened.
Secondly, the health authority says that the capital allocation, based by the Welsh Office on a formula which is unfair, gives Gwynedd, which has more than 80 per cent. of the population of Wales, a capital allocation of under 4 per cent. I understand that the Welsh Office is undertaking a review of the capital allocation methods. Perhaps the Minister can tell us when that will be completed.
The third bone of contention is the revenue allocation formula which is used by the Welsh Office. The health authority feels that the use of an element called the standardised mortality ratio is unfair because the authority is penalised for keeping people alive. If more people died, it would get more money. Clearly that is ridiculous. I understand that in England the weighting given to the ratio is being halved. Will the Minister undertake to make a similar change for Wales?
The health authority contends that it is the most efficient in Wales and it has used Welsh Office figures to show that the cost per standard unit of work at ysbyty Gwynedd is the lowest in Wales. In 1988 it was £713 per unit compared with the Welsh average of £864. However, because that authority is strapped for cash by the Welsh Office, it is having to shut hospitals, close wards, reduce services and worsen the health care available to the people of Gwynedd. The irony is that, once the authority closes the community hospitals, it will not be able to move patients out of ysbyty Gwynedd to those hospitals and that will have a significant effect on their efficiency. A study by Kernick and Davies showed that, if a community hospital is not available, it is likely that half of the patients will need to be admitted to a general hospital.
The important message that emerges from the reasons given by the health authority for its overspend is that, in each instance, it claims that it is the Welsh Office's fault. Time after time health authority people have gone on record to say that. That allegation is not made by a so-called loony-left authority, nor by a politically motivated cabal putting out anti-Government propaganda. The Gwynedd health authority is controlled by hand-picked people; they have been picked by the Welsh Office to do the job asked of them. They are the people, however, who are now telling the Welsh Office that they cannot maintain standards of service because they have not been given the necessary resources.
As I understand it, the Welsh Office has replied by saying that Gwynedd health authority has been given quite enough cash, that it is one of the best-funded health authorities in Wales, and that it should get on with the job and stop squealing. Both claims cannot be right. If the authority has adequate resources, it is obviously using them wrongly by spending too much on bureaucracy and working inefficiently. If that is the case, how much longer is the Welsh Office prepared to tolerate such an inadequate performance? The final responsibility for the health authority rests fairly and squarely on the shoulders of the Secretary of State. If it is doing a hopeless job, he should be aware of that and do something about it.
Alternatively, perhaps the health authority is not as ineffective and incompetent as Ministers would have us believe. Perhaps health care in Gwynedd is underfunded, which is a direct cause of the crisis. If that is so, the blame again rests entirely on the shoulders of the Welsh Office. After successive years of alleged underfunding, we are now faced with a mega-crisis.
In my opinion, for what it is worth, Gwynedd health authority has not been very clever in its financial control, nor in its ability to justify capital expenditure projects. Gwynedd has been desperately underfunded in terms of capital, possibly because of its inability to present persuasive evidence to the Government. If Gwynedd had received the average capital allocation per head of population for Wales, it would have received an extra £14 million in the past five years. Current expenditure in Gwynedd on health has been 9 per cent. lower than the Welsh average for the past five years. If that expenditure had been in line with the Welsh average, we would have had between an extra £4 million and £5 million per annum and there would have been no crisis.
The leadership of the health authority seems incapable of getting the message across or compiling a coherent strategy to give the Government the confidence to back its judgment with the necessary cash.
Is the Minister satisfied with the performance of the health authority in the past three years? Does he believe that it is putting forward an adequate case for capital investment? Does he believe that the health authority membership understands the strength of feeling in places such as Porthmadog, Caernarfon, Llangefni and Llandudno and taken it sufficiently into account? Are monitoring systems available to the Welsh Office to scrutinise the performance of Welsh authorities adequate? Is he happy that Gwynedd health authority has a coherent, strategic plan to which it is working? In the light of experience in Gwynedd, can he seriously claim that the Health Service is safe in Conservative hands?
The previous Secretary of State for Wales had no interest in the Health Service and during his term of office the situation got out of hand. One way or another, the Welsh Office must bear responsibility if there is a health authority in Wales that it regards as inadequate and in which it has lost confidence. The Welsh Office should sack that authority and start again. On reflection, however, if the Welsh Office finds that it has been underfunding the authority, particularly on the capital side, now is the time to be honest, admit the mistake and give the health authority the money it needs at least to sustain basic services rather than totter from crisis to crisis.
The choice for the Minister is simple: either he backs the authority with more cash, or sacks it for incompetence. The one thing the Welsh Office cannot do is continue to ignore the problem in the hope that it will go away. The need for leadership and positive action is great, and now is the time for it.