QUEEN VICTORIA HOSPITAL, MORECAMBE (Hansard, 3 July 1950)

§ Sir Ian Fraser (Morecambe and Lonsdale)
The town of Morecambe and Heysham is a very independent town, and one that has a long history of local patriotism, of looking after itself and taking care of its own needs. There are some 50,000 persons living in that town; the population is more than doubled in the summer months, and that fact presents some very special problems.
Some 50 years ago the town built its own hospital, out of its own contributions, and ever since it has maintained, and indeed improved, it. Here we have a very good hospital; there were 73 beds, until recently used, as one would expect, for all the purposes of the town in connection with medical and surgical care; surgery, medicine, gynaecology and obstetrics; and the hospital provided what the townsfolk thought to be not merely a good, but a very satisfactory, service.
When the National Health Service came into existence, this hospital was called a "general practitioner hospital" and so it remained until 10th May of this year. Up to then, general practitioners were recognised and allowed to go to that hospital to take care of the cases they were looking after as general practitioners in the town. On 10th May, the general practitioners were told that they must no longer go to the hospital, except as other citizens, who had the right to visit or talk to patients; but, even if their own patients were in the hospital, they were told they could not go there to treat them.
I want to explain, first, what has happened to the hospital; secondly, what the public think, and thirdly, the peril to medicine which has been caused in this town—and, where there are similar cases, in other towns as well. This hospital has been made into a "surgical unit." It no longer serves the general interests of the town but the surgical interests of a wide area around the town; but in so far as surgical cases come in from round about, there are no beds for the medical cases of the town.
206 This town probably has a high proportion of old people; older and middle-aged people go to Morecambe. It is a place to which people retire, and they suffer from medical rather than surgical conditions, and they are being deprived of the beds which they look upon as their own. They are, they feel, the beds they have paid for. Furthermore, they feel they are being deprived of their own medical practitioners in whom they have faith; and hon. Members in all parts of the House will agree that faith in one's hospital and one's doctor is a very important part of treatment.
Therefore, I submit that the treatment that can be given to them is less good than it was before. Not only that, but they are put to the trouble of going four or five miles to another hospital instead of to their own. Their relations are put to the trouble of going eight to 10 miles to visit them, and all because of the desire to produce a scheme which will be symmetrical and theoretical. The practical thing, it seems to me, would be to allow this Morecambe hospital to go on treating Morecambe people and allow the general practitioners to go on treating cases in the hospital.
There is a general question involved here, and it is this. I believe that the Minister is, in the main, advised by senior medical men who have been brought up in the teaching hospitals or in the big towns. They have a big-town complex and they do not realise and understand the situation in the smaller towns. Therefore, they are rather impatient at the strong local feeling which the public and doctors show. It is true that in this case the doctors who ordered this arrangement from Manchester did it arbitrarily and did not come down and discuss it with the general practitioners, much less with the public.
The Minister himself realises this matter to a much greater extent than some of his advisers, and he did issue an order called RHB (49) 132 in which he specifically dealt with the question of small hospitals. I have only time to summarise it in one sentence and to say that this circular urged regional authorities not to overlook local sentiment and not to overlook the importance to medicine generally of having the general practitioners continue to go into the hospital and, to quote the words of the circular, "to be in charge 207 of beds." There is the essence of the matter. If the general practitioner is not in charge of beds and cannot follow his patient in, he loses touch with all the interesting circumstances of that case and with all the educational value which comes to him by discussion with colleagues and by discussion with consultants. This is, therefore, rather a wider issue than merely a Morecambe issue, but I am speaking particularly for the Morecambe hospital.
I want to ask the Minister whether he cannot consider applying the spirit of RBH (49) 132 to this case; whether he can answer why it has not been applied in this case; and whether he will give us back in Morecambe, say, 50 beds or even 30 beds, to be "a general practitioners' wing." These words appear also in RHB (49) 132, to which I have made reference. The Minister evidently wants local sentiment to be considered and evidently wants the general practitioners to continue to do this valuable work and maintain this important contact. I therefore ask him if he will reconsider the decision which is now being put into force in this case.
I would add, finally, that the town council of Morecambe has passed a resolution unanimously asking that their hospital may be given back to them and that a petition is being widely signed, having in the first instance been signed by the ex-mayor, the present mayor, and all the members of the town council, and that there really is widespread feeling here that the hospital which these people built of their own accord without asking the central Government to help them, and that the hospital which they have cherished and nourished and looked to all these years, should continue to look after them in their old age and give them the full service they need and allow them to have in their hospital the treatment of their own general practitioners.

§ Dr. Hill (Luton)
My hon. Friend the Member for Morecambe and Lonsdale (Sir I. Fraser) has spoken clearly and forcibly on the local conditions in Morecambe. May I comment very briefly on the underlying general principle? None would deny that the main role of the hospital is to provide accommodation for the treatment of specialist conditions in one 208 of the many specialist fields; but it is sometimes forgotten—and it is important that this House should not forget—that an important role for hospital accommodation is to provide, in addition to the field of specialist conditions, beds, nursing and other assistance so that the conditions falling within the scope of the general practitioner can be treated by the general practitioner in the circumstances and surroundings of the hospital.
There are all too many people whose conditions could properly be treated at home given satisfactory domiciliary conditions but who nowadays must perforce be treated in hospital, not because of the specialist character of their condition but because of the domestic circumstances; and I would, in support of my hon. Friend's plea, urge upon the Minister the real importance of securing that regional hospital boards observe the terms of the circular which he has sent out and do their utmost to retain such general practitioner beds as exist, and indeed to develop such beds in the future.
It is of real importance to the public, as well as to the status and efficiency of general practice, that there should be such beds in which the general practitioner can treat patients whose condition falls within his proper scope in hospital beds. It is essential to the public interest and to the general practitioner's efficiency that such beds should be retained and. indeed, developed.

§ Mr. Reader Harris (Heston and Isleworth)
I support what has been said by my hon. Friends. There is a very strong feeling among general practitioners that their service is being debased. They feel that in many ways, and one of the ways in which it is felt most is their increasing exclusion from the hospitals, if I may put it that way. The case raised this evening is merely symptomatic. It is merely another example of what is happening. We have had the case of the Kingston Victoria Hospital. The same sort of thing happened in the West Herts Hospital, where a specially-built maternity block has been closed down. We have exactly the same thing in other places in that area—at Tring, Berkhamsted, Hemel Hempstead and King's Langley.
I do not know whether the circular to which I want to refer is the same circular as that to which my hon. Friend referred, 209 but I ask the Minister whether he still stands by these words: The Minister … would ask regional hospital boards to make sure that in carrying out their plans they are not depriving local patients of a valuable feature of the general practitioner (cottage) hospital. Again—mark the Minister's words— It is essential if the level of general practitioner medicine is to be maintained that the interchange of ideas between general practitioners and specialists should be facilitated by such consultation and by informal contacts on the occasion of regular visits from consultants to general practitioner beds. I do not know whether this is the same thing as my hon. Friend quoted.

§ Sir I. Fraser
It is.

§ Mr. Harris
It is the same thing—well, that reinforces what he said. We want a definite statement from the Minister on this point. It is reinforced, too, by the fact that health centres will not be provided, at any rate, not for many years; and if they are not to be commenced, the next best thing is the general practitioner hospital where the general practitioner can get all the experience that he requires.

§ The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)
I am grateful to the hon. Member for Morecambe and Lonsdale (Sir I. Fraser) for raising this subject and for the very courteous information that he gave us of his intention beforehand.
I should like to say right at the start that we fully intend that the attention of regional hospital boards shall be called to the circular that was issued and to which reference has been made this evening. It was a circular and in no sense an order. The Minister was calling the attention of regional hospital boards to the desirability of their paying attention to local sentiment, and to the desirability, as mentioned by the hon. Member for Luton (Dr. Hill), of maintaining, wherever possible, the contact of the general practitioner with hospital work within his own field. It is important that I should emphasise those words "within his own field" because we would claim that in this case this was not a general practitioner hospital in the ordinary sense of the term but that, in fact, the larger proportion of cases coming into the hospital were specialist cases rather than ordinary general practitioner cases.

§ Sir I. Fraser
This was called a general practitioner hospital by the Ministry, and the general practitioners were recognised and paid by the Ministry to go there and do the work.

§ Mr. Blenkinsop
I know that has been the case, but the reorganisation of the service has been under consideration by the regional hospital boards, acting on behalf of the Minister, for some time, and it was natural that they should take under review a hospital of this kind, where there is no doubt at all that the great majority of cases that were treated in that hospital were cases of a specialist kind.

§ Sir I. Fraser
No, no.

§ Mr. Blenkinsop
But, in fact, a very large number of surgical cases were treated there, and it is clear from the information we have of the type of case coming in, and indeed from the specialists who were called in very frequently from outside, that in fact there is a very wide service given in it of a specialist character.

§ Sir I. Fraser
More than half the beds were used by Morecambe medical cases.

§ Mr. Blenkinsop
I am quite aware that the Morecambe general practitioners did use this hospital as a general hospital, but the argument that I am making is that much of the work they did in that hospital was, in fact, of a specialist character. They did frequently call in specialists from outside, when they felt it desirable, but they were not in any way required to do so.
In our view, it is highly desirable that the specialist facilities that are available should be made more generally available in areas like Morecambe and other districts of that kind, within their proper field. Indeed, it has been one of the main purposes of the reorganisation of the hospital service as a whole that we should be able to make more generally available the specialist services in the interests of the patients themselves, while at the same time doing our utmost to maintain that contact with the general practitioners which is suitable within their own field.
I suggest, therefore, that this is not a case of a hospital that comes within the definition of a change in service, a change from a general practitioner cottage hospital to a specialist hospital. In our view, 211 the specialist work has always been done there, and therefore it is not a change of function so much as a change from the general practitioner to the specialist in charge of what has always been largely specialist work.
In fact, this hospital consists of three main wards, one of which has been reserved for female cases, another for male cases, and another for maternity cases. As far as the maternity cases are concerned, I understand the general practitioners' position will not be altered. They will still have full control over 12 maternity beds. There will, in fact, be an additional four maternity beds for specially difficult cases for the specialist to be in charge of. The 12 beds that have always been available to the general practitioner in Morecambe district will still be available in future. Our experience has been, as far as true medical cases are concerned, that very few have been taken in.

§ Sir I. Fraser
That is quite untrue. I am not saying that the hon. Gentleman is not telling the truth, according to his information, but what he states is quite untrue. More than half the beds have been used for cases of medical ailments in Morecambe and district, and the general practitioners have looked after them.

§ Mr. Blenkinsop
I am not disputing the fact that general practitioners have looked after the cases, but much of the work they have done would be regarded as specialist work, and if we are to improve the standard of work it is only right to see that specialists should be in charge in a field essentially their own. We are arranging for four beds in side ward—two male and two female—as emergency medical beds to be available to general practitioners for their emergency cases.
We feel it to be undesirable, as do the regional board, that medical cases should, in fact, be mixed up in the ward with surgical cases as they have been. Therefore, we are arranging in future for the medical cases proper to be transferred to Lancaster which is, as the hon. Gentleman said, some four miles away. It is not a very great distance, and we would expect that, in fact, very few cases will have to do that journey, because the 212 great majority of cases coming into Morecambe Hospital will still go there to receive the specialist treatment available for them.

§ Dr. Hill
There is an important point of difference here. As I understand my hon. Friend, he says that approximately half the cases entering Morecambe Hospital are medical cases, from which I assume medical cases within the field of general practice, and attended by general practitioners. The Parliamentary Secretary challenges that. It is important to get the facts right.

§ Mr. Blenkinsop
I quite agree. It is quite true that more than half the cases have been attended by the general practitioners in charge—in some cases a consultant is called in from outside—but much of that work has fallen within special fields which we, at any rate, would regard as the province of the specialist.

§ Sir I. Fraser
Coronary thrombosis is not a surgical condition, or am I wrong? Such cases can no longer be sent there. The old people who get "hearts," strokes, and urinary troubles, and a lot of other medical trouble that is not always surgical, can no longer go there.

§ Mr. Blenkinsop
I am not denying that with the exception of the four general medical beds, they will now go to Lancaster, but the number of cases of that particular type which went into Morecambe Hospital were very few indeed. There were a great variety of cases of all kinds which did require very often specialist treatment, whether in fact that was called in or not. It is a very well equipped hospital for surgical work, and therefore it is highly desirable that the type of cases which have always gone in should continue to be dealt with by those most proficient to handle them.
It seems to us that the general practitioner is not being excluded altogether. He will have as much maternity work as he ever had; he will have this special arrangement for emergency beds; and he will also be able to use the outpatient clinic. The hon. Gentleman said that he would come in as a visitor, like a relative to a patient, but surely the position is simply that he will be able to call in as he would normally call in at a general hospital. He would be able to consult with the specialist in charge of 213 the case, but he would not in future be in charge of the case. That is really the point at issue.

§ Mr. R. Harris
The specialists will not be resident on the premises, will they?

§ Mr. Blenkinsop
No, of course not.

§ Mr. Harris
They will be eight miles away.

§ Mr. Blenkinsop
But they will be able to consult with the specialists when they are present, of course, and in that way they will be able to maintain contact, which they naturally would desire to do, with the progress made by their patients.
The suggestion has been made that this will in some way reduce the facilities for emergency treatment. In point of fact the reverse is the truth. There will be at 214 least one, if not two, resident medical officers who will be available for emergency treatment, and there will also be on call, as there always has been in the past, general practitioners to take any emergency cases.

§ Mr. Harris
Will they be paid for it?

§ Mr. Blenkinsop
In fact, therefore, over the whole picture it seems to me that, far from any reduction in the service to the people in Morecambe, there will be a great improvement of service, and they will have the benefit of specialist services which in the past have not been wholly available to them.