NELSON HOSPITAL, MERTON (Hansard, 16 November 1953)

§ Mr. Cyril W. Black (Wimbledon)
I desire to raise a difficulty in respect of the Nelson Hospital at Merton. That hospital concerns the constituents both of my hon. and gallant Friend the Member for Merton and Morden (Captain Ryder) and the constituents of my own division of Wimbledon. It so happens that, having been fortunate in securing the Adjournment debate tonight, the opportunity comes to me to raise this matter in which we are both jointly interested and concerned.
The difficulty arises from the fact that in this much esteemed general hospital the women's ward for medical and surgical cases, which comprises 24 beds, is too small to meet the demands upon it, and there is always a waiting list of cases for that ward, whereas the children's ward, which comprises 18 beds, is too large for the requirements of the district, and many of the beds in that ward are normally unused.
A method has been discovered of overcoming this difficulty, as on the first floor of the hospital, at the south end of the building, there is quite a large vacant room, 37 feet by 25 feet in dimension, which was originally intended to be used as a second operating theatre but which has never been so used and is not required for that purpose. The proposal of the hospital committee is that this vacant room should be adapted as a new children's ward to contain 12 beds, and that the existing children's ward should be used as an additional women's medical ward which would contain nine beds.
The effect of this arrangement would be to reduce the total number of children's beds in the hospital, and to increase the total number of beds available for 1530 women's medical cases. These proposals have been considered both by the group management committee and by the regional hospital board, and have, I understand, been approved by both those bodies. To carry out the comparatively minor alterations and adaptations which are necessary to use the vacant room as a new children's ward will involve an expenditure of about £3,000. The use of building materials would be very small, indeed only about 1¾ tons of steel and about .95 standards of timber.
The regional hospital board is unable to provide the £3,000 of capital expenditure out of the funds available for that purpose for the whole of the region. As a result of that, the hospital committee has obtained a very generous offer from King Edward Hospital Fund to provide the sum of about £3,000 which is necessary for the work. When that very generous offer was received the hospital committee considered that their difficulties were overcome and they anticipated being able to carry out the proposed alterations without any further delay. Their disappointment can be imagined when the hospital secretary received from the secretary of the group management committee a letter in which the following paragraph appears: We have now heard from the Ministry of Health that all capital schemes which were to be financed privately, will not receive their sanction, anyhow, for the present, unless they are included in the regional board's capital programme. This means that, to include such schemes, the board would have to defer some of their own, and this of course they cannot be expected to do, as there are a great number of these private schemes from other management committees besides ourselves. If that condition, made by the Minister of Health, is in fact insisted upon in this case, it seems to me to be inevitable that three results will issue from the decision.
The first must be that this much-needed work cannot proceed, at any rate for the time being, and the hospital will therefore be denied the opportunity, at any rate 1531 for the present, of making use of the vacant room for which there is a genuine and urgently necessary purpose. Secondly, it seems to me to be clear that the very generous offer of King Edward Hospital Fund will in all probability be lost; because if the offer cannot be accepted and the money used for the purpose for which it has been offered, presumably the King Edward Hospital Fund will find some other use for it and it will not, or may not, be available at some future time.
Thirdly, if that consequence follows then this further consequence is inevitable, that when this work ultimately comes to be done—and there is no doubt that it will have ultimately to be done—the cost will then fall upon the Minister and will not fall upon the money which King Edward Hospital Fund has offered now to provide.
I understand quite clearly the difficulties of the Minister in this matter, owing to the Treasury arrangement by which, no doubt, he is bound in cases of this kind. If this were a scheme involving a very large amount of capital works, and the use of a substantial quantity of building materials in short supply, I could readily understand the condition which has been made. But, while this is an urgently necessary alteration to the hospital, in terms of money and materials it is a very small scheme indeed.
I want to appeal very strongly to the Parliamentary Secretary, who I feel quite sure is not personally unsympathetic towards the desire of the hospital to carry out this project, to reconsider the matter and to see if some answer can be given which, if it would not enable the committee to proceed immediately with the work, would at any rate hold out the hope of their being able to do so at some not far distant date.

§ Captain Robert Ryder (Merton and Morden)
In supporting my hon. Friend, I wish first to express my appreciation of his action in utilising the Adjournment debate which he had the good fortune to secure in order to raise a matter in my constituency which I feel needs the consideration of the Minister.
What does this amount to? It is a very small project. It is a scheme to re-allocate the resources of the hospital to meet the urgent needs of the present 1532 time. There is an excess of accommodation for children and a shortage of accommodation for women. There is in the hospital a large room which, much to my surprise, has never been used since it was built before the war, although it is complete in almost every respect with heating and lighting. That alone makes the matter worthy of consideration.
What is needed? Virtually little more than a fire escape. The amount of materials required is derisory, comprising one and three-quarter tons of steel as the principal item and a small quantity of timber. I appreciate that the Minister must consider these questions in relation to the country as a whole, and that he will point to the fact that there are numerous small items of work which are brought forward outside the general allocation of the Ministry of Health. It may be said that in total they will add up and that if the Minister gives way on one that will be regarded as a precedent and he will be called upon to give way on many others.
I suggest that here is a case which does not create a precedent. This is a very small item indeed which will greatly increase the efficiency of the hospital. The Nelson Hospital is a good hospital which is worthy of the consideration of the Parliamentary Secretary. It has a high reputation among patients both for its efficient organisation and for the excellent medical treatment which is provided. I hope that the hon. Lady will not turn down this suggestion flat. I appreciate that she may not be able to say "Yes" straight away, but we shall be pleased if she will agree to leave the matter open so that it may be brought forward again for favourable consideration at an early opportunity.

§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful for the reasonable way in which my hon. Friend the Member for Wimbledon (Mr. Black) and my hon. and gallant Friend the Member for Merton and Morden (Captain Ryder) have raised this matter. I realise that this question is one which is very near their hearts, and is a subject in which their respective constituents are very much concerned. But, having looked into the matter, I must say that it is obvious that two very important 1533 questions of principle arise upon one of which there is real misunderstanding.
First, I should like to reiterate the interest which my right hon. Friend and I have in the important question of the association of voluntary effort with the Health Service. We should both very greatly regret it if there were any suggestion arising out of this debate that we did not welcome help from voluntary sources in any way they find it possible to assist and support the National Health Service. We are only too ready to welcome offers of assistance from voluntary bodies in whatever shape or form it may be offered. That has been made clear repeatedly by my right hon. Friend during the time he has been at the Ministry. Indeed, we doubly welcome the help of King Edward Hospital Fund because of that fund's long experience in all matters concerning hospitals. They not only bring money with their aid but also wisdom, skill and the advice of their long experience. There is no question but that we welcome their support. We for our part, are anxious, so far as we are able, to use it.
The second principle—and it is upon this that I am afraid I shall find myself in conflict with my hon. Friend—is that there is real misunderstanding about the manner in which the capital investment programme works. I know that my hon. Friends understand the position, but many of their constituents think that the capital investment programme applies only to the expenditure of Government money on the Health Service, or any other service, and that provided the money is found from some other source it can be spent without regard for the capital investment programme.
That, of course, is a complete fallacy. In respect of capital projects we still have to conform with the overriding national policy. I confess that the need to do this sometimes comes in conflict with our own desires to take advantage of capital moneys offered us. My hon. Friend the Member for Wimbledon read the reply of the Regional Hospital Board, and I should like to emphasise that this is no new policy. While I appreciate the tactics of the board in first agreeing in principle and then blaming the Minister when they have to reply and say "No," I would point out that they have known this doctrine for years. 1534 The knew perfectly well that if they accepted this capital money from outside it would have to tell against their own overall capital allocation.
It is not the time, nor am I the person, to expound the economic doctrines upon which our capital investment programme is based, but this much I can say with confidence. The present system of controlling capital investment is based on economic considerations which extend beyond the control on Government expenditure as such, and even beyond the control on building materials. It requires, for reasons that I am not equipped to go into, and which it would hardly be appropriate to develop in this short debate, that all capital expenditure, however financed, is subject to broad control in order to keep the national economy balanced.
The system is operated by making money allocations to Government Departments covering all capital expenditure within their respective fields. The allocation to my Ministry must cover, among other things, all capital work in the hospital service, however financed. Thus, if the regional hospital board should change its mind and wish to finance the scheme itself, it must take—I believe the full cost will be £4,000—the £4,000 from some other project which it has already put higher in the queue.
Our current allocation is, I frankly confess, well below what we should like to be able to spend on the vast amount of capital work which is required to be done in the Health Service to make up the leeway lost during the war years and to complete the many projects that we should like. However, in view of the restriction on capital, there have to be priorities. I know that my hon. Friends the Members for Wimbledon and Merton and Morden would be the first to insist that the people best able to judge those priorities are those on the spot, the Regional Hospital Board, who have the duty and the authority to assess the priorities in their own area from their own knowledge of the area, which must obviously be better than any assessment that we in the Ministry could make from our more remote position.
In this case, the South-West Metropolitan Board have a very long list of projects, which they are most anxious 1535 to fulfil, and most of them will of course be financed from Exchequer funds, but in some cases, like the one we are discussing, they have had offers of funds from voluntary bodies.
I fully appreciate the desire of my hon. Friends that this project shall be completed, but I am informed—I have gone into this in great detail with the board—that the waiting list problem in the area is by no means one of our most acute ones and that the service provided at other hospitals within range, such as St. Helier, can reasonably augment any particularly acute demand on the smaller hospital. Boards must decide the priorities for themselves in their own local area, and they cannot be influenced by the source from which the money comes. It is all capital investment, so the cost must be met within the Department's allocation for any one year. It must not however be thought that the fact that a project is to be financed from private funds in any way damages its chances. Far from it. But it cannot significantly change its position in the priority queue.
In this case, after considering all the information which the regional board had at its disposal, and balancing that information against the knowledge of all the other schemes which it is anxious to fulfil in other parts of the South-West Metropolitan Regional Board area, the board has regretfully decided that it is not possible this year to include the Nelson Hospital scheme in its current programme. It would obviously be wrong for my right hon. Friend in this instance—I can assure my hon. Friends that there are many other such schemes which various hon. Members put up to us from time to time and press in the interests of their own areas—to override the decision on priorities which has been made by the Regional Hospital Board.
I am sure that the Nelson Hospital scheme has very great merit, for otherwise the King Edward Fund would most certainly not have expressed its willingness to finance it, but I feel we must accept the board's decision that this year 1536 it is not possible to place it among those schemes which it is prepared to finance under its allocation.
In conclusion, however, if I may offer a slight hope to my hon. Friends, I should like to say, after what I confess is a somewhat discouraging answer, that nothing that I have said tonight should be taken to mean that the system of capital investment control which I have outlined is fixed and unalterable. Of course, it is kept under review in the light of changing circumstances, and it may well be that with the increasing availability of building resources—though this is not the only criterion—the Government may be able to introduce some relaxation.
This, of course, is not within the decision of my Department, and frankly I have no idea whether any changes are, in fact, contemplated, or whether such changes would make any great contribution to this problem in my Department. I am anxious to emphasise that I am expounding the position as it is at the moment under the control exercised by the Treasury upon the capital expenditure of all Departments.
The Board's decision on this matter is for the current financial year. It has only a few months to run, and it may be that next year they may find themselves able to accept and implement the offer of the King Edward Hospital Fund and go forward with this scheme. I make no promises. This is a matter for the Regional Hospital Board, and I believe it right that their authority and decision in these matters should be maintained. They have extensive claims upon their capital resources, but I think I can say that the door is not closed, and I most sincerely hope that the King Edward Hospital Fund will be able to keep this offer open meanwhile. Beyond that, I am afraid I cannot go, though I assure my hon. Friends of my sympathy for the very important topic they have raised.