§ 4.3 p.m.
Miss Elaine Barton (Coventry, South)
There may be other areas with hospital problems just as urgent as those of Coventry, but I would say to the Minister that there are not many in a worse plight. I know the Minister believes, and it may be, that those areas being dealt with before our turn comes are in as bad a situation as we are. Quite honestly, I cannot believe that they are in a worse position. All that we are asking of the Minister today is a small first step to remove the most serious overcrowding in our hospitals.
2433 Perhaps I might ask the Minister whether he is aware that Coventry has played a part in the defence and export programmes of the country which has been excelled by none. This has meant that the expansion of industry since the end of the war has been so great that we believe the Government should make a decisive effort to give us the means of having a decent civilised community. We have some of the finest new schools and some of the best designed new houses, but the hospital problem is quite incredible.
Since 1900 our population has increased by 200,000. During the last 20 years alone, 90,000 additional people have come to live in Coventry. That is the background to the problem. If one has a good case, no purpose is served by exaggeration, and I want quite simply to state the facts of the position in Coventry.
In 1938, the Coventry and Warwickshire Hospital had a bed accommodation of 347. This was made up of 307 on the central site in Stoney Stanton Road and 40 at a recovery unit at Keresley, a small village about three miles from the city centre and about three-quarters of a mile beyond the city boundary. In September, 1939, hospital extensions on the central site were completed. This meant that after we had allowed for a reduction in the bed complement because of overcrowding and sub-standard accommodation, the beds on the central site were increased to 410, which, together with the 40 beds in the recovery home at Keresley, gave a total bed complement under the administration of the Coventry and Warwickshire Hospital of 450 beds.
During the concentrated air attacks on Coventry in November, 1940, and April, 1941, practically the whole of that in-patient accommodation of 410 beds, plus the boiler house laundry and other accommodation, was destroyed. Immediate first-aid repairs were carried out, but the point which I underline first is that the only two wards which remained standing after the blitz are today still in their crude first-aid repaired state.
When the bombing occurred, the voluntary hospital raised an appeal fund and with the money erected air-raid shelter type wards, in associration with the recovery unit at Keresley. These wards, upon which the Ministry of Health, quite 2434 rightly, permitted only limited expenditure, were intended solely to enable patients to be accommodated during the war under relatively safe conditions. The second point which I underline to the Minister is that these air-raid shelter type wards have had to serve the major needs of Coventry for the past 12 years.
I think the Minister knows that the overcrowding is severe. Wards that were designed to accommodate 32 beds now hold 44 and 45 patients. The medical ward caters for both male and female patients; both have to use the same ward conveniences. The male patients have to pass through the female ward. The ophthalmic unit was originally a chicken farm. This hutment was purchased in Norfolk, transported to Coventry, and erected by the hospital staff. The doctors tell me that it is structually dangerous owing to its heavy corrugated asbestos roof, while the possibility of fire and the risk to the ophthalmic patients is a constant source of anxiety to them.
The children's ward is also of air-raid shelter construction; and the tonsil unit was originally erected as a gas decontamination unit. It is into accommodation like this that, in 1952, 10,096 patients were admitted with, what I know the Minister would regard as particularly important, an average stay of 109 days. The average stay has been "bettered" this year, although I think that the Minister may perhaps agree with me that one can hardly call an increase in an already dangerously rapid turnover of patients a betterment; but if one can call it a betterment that in-patient stay has been reduced to 10.5 days.
I would emphasise from the doctors in Coventry that it is only by this excessive in-patient turnover that it has been possible to meet Coventry's demands and keep down the waiting lists. I would not say that, not would the doctors give me the information, unless we had something substantial on which to base it. The Minister will recall that we have already informed him that the average in-patient stay for the whole of the region is 15 days as compared with ours in Coventry of 10.5 days. Obviously, if the average regional figure had obtained in Coventry in the last two years alone we should have treated 6,000 fewer patients and the waiting lists would have increased accordingly.
2435 What have we tried to do to help ourselves before coming here? Early in 1946, which I appreciate was before the present Minister took office, the then board of management of the Coventry and Warwickshire Hospital, after two years of careful study and planning, published proposals for the rebuilding of the hospital. Those proposals, as the Minister will know, included the erection of two new wards—in part-replacement of temporary accommodation at Keresley and in completion of the building scheme, the first section of which was completed in 1939—and the full reinstatement of the two damaged wards. This initial scheme, to cost about £250,000, was prepared and submitted to the Ministry.
Owing to the then shortage of building labour and materials it was indicated to the management committee that it would be necessary to submit more modified proposals. This was done, and in 1947 the then Minister of Health received a hospital deputation and authority was given for the first phase of the work to proceed. That included the reinstatement of a section of the out-patient department to provide a new out-patient casualty and accident unit, a new dispensary and other ancillary accommodation.
I have gone very carefully into this and so have the doctors, and I do not think that the Minister will disagree that the records would seem to show that approval of the work to proceed was given on the understanding that it would be phased. The hospital deputation in 1947 was quite willing to agree to this, fully understanding that the remainder of the scheme—embracing the new ward units and reinstatement of existing wards—would follow on consecutively. Nothing has been done in furtherance of the building of the ward units although more than six years have now elapsed since the reception of the deputation by the Minister.
What we are now asking for in Coventry is the immediate carrying out of phase three. I might make it quite clear that this demand for the carrying out of phase three now is quite independent of where any new hospital may be sited or when any new hospital may be built. We feel that the additional accommodation for which we are asking cannot wait any longer. We want to stress to the 2436 Minister that the provision of new wards is a very great need, because quite obviously until additional accommodation is available existing buildings cannot be vacated to allow for their repair and renovation or to reduce overcrowding.
There is an urgent need for 150 to 200 additional beds to be provided quickly. I am informed, and I think it is true, that there are adequate steam and other services available on the Stoney Stanton Road central site. The hospital management committee, plus the regional board, are in agreement.
Most seriously, the third point I want to underline is that Coventry is in need. We believe that the situation is so serious that prompt and vigorous action by the Ministry is more than justified, even if it involves a departure from the normal routine in the financing of hospital projects.
I want to ask the Minister to consider other cities which have precedence over us. What other city in 1938 had a population of 220,000 and saw this increased by 1952 to 262,000; while at the same time in 1939 it had hospital bed accommodation for 450 and today has seen that reduced to 341? In other words, what other city has increased its population by 42,000 since 1938 and at the same time has had a decrease in hospital bed accommodation of nearly 25 per cent. or one-quarter?
What other city in 1948, at two major hospitals, had an in-patient turnover of 12,590 and in 1952 saw it increased to 17,119, an increase of 36 per cent. as against a decrease of 25 per cent. in the accommodation available? Lastly in this series of questions, what other city in 1948 had a waiting list of 2,277 which increased in 1952 to 2,539? I know the Minister would agree that that waiting list would have been greater if the average in-patient stay had been the same as in the region. So I am asking the Minister, what other city has had all these factors to contend with while suffering a 25 per cent. reduction in hospital bed accommodation?
We have taken every practical step to utilise to the best advantage the available hospital accommodation. Every effort has been made to maintain a hospital service for the city of Coventry. The Coventry and Warwickshire General Hospital is in my constituency. I know 2437 it and have visited it. I know the staff and many of the patients there. I would say the result of the work of all these people to maintain a hospital service in the city of Coventry would have been outstanding in the terms of numbers of patients treated if conditions had been good. Under existing conditions I think that sufficient tribute cannot be paid to the hospital management committee, to the doctors and, above all, to the staffs of the hospitals, particularly the Coventry and Warwickshire Hospital.
I want to be fair. The Minister has been good enough to receive a deputation from Coventry. He listened to all we had to say, and it is our belief that we have his good will. We know that if there should be underspending in any of the regions in 1954, Coventry will have a priority claim on any money that is going. But even allowing for that, it is not enough. That is why I think today that I can quite reasonably on behalf of Coventry ask the Minister to take exceptional measures to give us more hospital wards, not in 1957 or later, but in 1954 at the latest.
§ 4.20 p.m.
§ The Minister of Health (Mr. Iain Macleod)
Had it not been for the good fortune, if that be the right word, of the hon. Lady the Member for Coventry, South (Miss Burton) in winning a place in the Adjournment ballot, I should have been concerned at this time with another hospital. I should have been at the opening of an out-patient department at Balham. But as the major interest in Balham, judging from the local papers and the national Press, appears to be whether a statue that is there should or should not wear a fig leaf, I am perhaps well employed in replying to the hon. Lady on this matter. Also, of course, I am very happy to do so, because the House of Commons comes first.
Whether we are Ministers or not, and on whichever side of the House we sit, we are all constituency Members. The hon. Lady—as hon. Members usually are, and quite properly on Adjournment Motions—is concerned with her own constituency of Coventry. I am a constituency Member, but in health matters I have the wider parish of the whole of England and Wales to consider. I can only consider the problems of Coventry not in isolation, but in relation to the 2438 problems of every other area in the whole of those two countries. I have to look at the problems of South and North Wales, the very crowded Newcastle area, and the areas round Liverpool and Manchester, to mention only a few of those in desperate need of hospital accommodation.
The Birmingham Regional Board has a very difficult problem of priorities. It has to weigh the claims of Coventry with all the other claims of the cities, towns and districts which make up that most important area. It is important to make clear how capital expenditure in the National Health Service is financed in view of what the hon. Lady is asking me to do in the case of Coventry.
The provisional capital allocations for the next financial year, 1954–55, were notified to regional boards in July, 1953, subject to Government approval—and, indeed, subject always to Parliament ultimately voting the necessary money. The Birmingham Regional Hospital Board was allocated a sum of £625,000, which compares with £572,000 for the current financial year. There is a substantial increase, but the first principle, which is of great importance, is that it must be the duty of the regional board to decide how that money is to be spent, knowing the needs far better than the man in Whitehall can possibly know them.
I have always resolutely refused to take upon myself the onus of selecting projects as against other equally, or almost equally, desirable alternatives, so far as ordinary capital expenditure is concerned. I allocate the money that I can obtain from the Chancellor of the Exchequer—or almost all. with the exception I will come to in a moment—to the regional boards and the boards of governors of the teaching hospitals. A small reserve, but less in fact than goes to most individual regions, is kept back for any such emergency as a fire.
Then we come to the allocation which concerns us this afternoon and which the hon. Lady is asking me to use in this case. It will be clear from the figures I have given that some schemes are so vast in themselves that it would be unreasonable to expect a regional board to allocate money for these schemes within the total that is given to it. We are able, on the provisional estimates for next year, 2439 to resume setting aside certain monies for large schemes. This is put in two parts. First, for the new large schemes and for the carry-over of the present large scheme programme, and secondly for the mental services, to which I have always attached the very greatest importance.
The essential question which the hon. Lady asked me was: Can phase three of this building be included next year? Let me say straightaway that, of course, there is much that is common ground between us. I agree that the hospital accommodation in Coventry is thoroughly unsatisfactory. Indeed, I have seen it myself. I have been around these wards to which reference has been made. I agree that the wards are overcrowded, and I know that there has been a large increase in population. I would be prepared to agree, too, that Coventry has a special claim in view of its position in the industrial and export market and also because of its suffering during the war.
I would add also that the fact that the accommodation in Coventry is deplorable does not mean—I should not like a wrong impression to go out from this House—that the standard of work being done is also poor. That is not so, as I know the hon. Lady will agree. I was very impressed indeed to see what splendid work is being done in what I frankly describe as thoroughly unsatisfactory conditions. I agree that large-scale hospital rebuilding in this area is required.
The problem then is where and when. The question where is one that has been a matter of dispute between the Regional Board and the Hospital Management Committee and to some extent my Department, under its successive Ministers, for some time. The alternatives are building on the Stoney Stanton Road site or building a new hospital on the perimeter.
It seems now to be agreed—and I hope it is, because I think it is important that we should have no more delay in these matters—that a new hospital ultimately will be built at I think Walsgrave, and that phase 3 should be completed as soon as may be on the Stoney Stanton Road site. I must be frank and give the answer to the hon. Lady which I think she knows already.
There was a deputation from the Hospital Management Committee and the 2440 Regional Board to my officials about six weeks ago, and the hon. Lady brought personally a deputation of the local doctors to see me only a week or two ago. They asked essentially the same question and if there is any virtue in a thrice told tale, I am afraid that I must give the same answer. It is purely because of this overriding demand for priorities.
Frankly, Coventry stands very high on the list. I have said that it has not been possible to put it in the programme that I hope to carry out in the next financial year, but if the total available for hospital building for 1955–56 is not less than the amount contemplated for 1954–55, and I have no reason to expect that it will be, I hope to be able to finance it not only in that year but in later years from my central reserve, because the building and the completion of what is described as phase 3 of the Stoney Stanton Road site is too big a scheme to expect a region to carry out in the ordinary way.
The hon. Lady mentioned that I had given her a private undertaking that we would look next year at the possibility of capital underspending. I repeat that undertaking so that it will be on record. We must, of course, give the particular warning that we are here in the realm of speculation. We do not know whether there will be capital underspending next year. Certainly it looks very unlikely that there will be any this year, and although it has happened in the past I do not know whether it will happen next year. I shall be more than happy to look at the claim of Coventry as sympathetically as I can if such an underspending does take place in the course of the next financial year.
I should like, as the hon. Lady knows, to say "Yes" to phase 3, and indeed to the different phases in other hospitals, not only in Coventry, but in many other places in the country, but we have to face the fact that, as long as there be a limit on the amount of money we can allocate to hospital building, or indeed to anything else, we must have a careful system of priorities.
The hon. Lady asked me perfectly fairly whether I knew of any city which was in exactly the same position as Coventry, in relation, for example, to the load which has been put upon it, 2441 the growing population of the area, and the needs of Coventry and the surrounding districts. Quite frankly, that is not the only test, though it is a test of great importance. We cannot only plan for a future on the basis of a comparison with the amount available in the past. There are many areas—and we can perhaps go into this by Question and answer if the hon. Lady wishes—in which, I do not doubt, the situation is much the same as in Coventry. What I have to look at is whether the hospital services in that area are or are not as good as they might be in the circumstances at the time, and it is true to say that, at Coventry, in spite of these deplorable conditions, which I hope to see removed very soon, really fine work is being done.
2442 I should like to be able to give the hon. Lady a straight "Yes" to the question she asked me, but I am afraid I cannot do that without taking away money already allocated to other areas. I have told her what we will do, and that we will do with all good will towards Coventry. We will, assuming that there is no reduction in the money available, give this high priority in the financial year 1955–56, and if there should be any under-spending in the next year of capital investment, we will look with great sympathy into her claim. Beyond that I cannot go.
§ Question put, and agreed to.
§ Adjourned accordingly at Twenty-seven Minutes to Five o'Clock.