HC Deb 10 May 1954 vol 527 cc974-84

Motion made, and Question proposed, "That this House do now adjourn."— [Mr. Studholme.]

10.13 p.m.

Mr. Bernard Braine (Billericay)

I hope that the House will acquit me of using the Adjournment as a device for prolonging the debate on the National Health Service which we had earlier, but I sought to raise the subject of St. Andrew's Hospital, Billericay, and hospital services in South-East Essex, a considerable time before today's business was fixed.

The last 30 years have seen a huge movement of population into rural Essex. The constituency which I have the honour to represent in this House has been the subject of redistribution three times since 1918, and it is now the subject of a fourth proposal. In the Billericay urban district alone, the population has leapt from 37,500 in 1945 to 49,000 today, an increase of about 30 per cent.

It is hardly surprising that in those circumstances the increasing population has tended to outstrip the available services, in particular the hospital services. The South-East Essex Hospital Management Committee, which provides hospital facilities not only for my constituency but for the neighbouring constituency of Thurrock, is responsible for providing those facilities for a population of about 140,000.

When the National Health Service was inaugurated, the only hospital in this area providing general hospital facilities was a small voluntary seamen's hospital at Tilbury with 74 beds. Apart from the Thurrock hospital, which is suitable only for the treatment of infectious disease, including tuberculosis, and Langdon Hills, which is a small sanatorium connected with the Dagenham Sanatorium, there were the Orsett Hospital, with 230 beds, and St. Andrew's Hospital, Billericay, with 343 beds. These were virtually old poor law institutions. Neither had any out-patient or casualty departments. Their operating theatres and X-ray departments were small and primitive.

Since vesting date a great deal has been done especially at St. Andrew's—I think that I ought to say this to get the whole question into perspective—to improve standards and to meet new demands. A modest out-patient department has been provided by improvisation. The theatre suite has been greatly extended. The number of staffed maternity beds has been trebled. During the last 18 months the regional hospital board has made some additions to the consultant staff of all the hospitals in the group.

The contrast between the situation in September, 1948, and today is striking. Then 266 beds were occupied by chronic sick patients; today only 100 are so occupied. Then only 15 beds were occupied by ordinary patients; today the number is 155. Rather significant is that the number of beds out of use for lack of staff is roughly the same now as it was then.

All this represents—I admit it frankly — a very great improvement, but it is not enough. The situation in Billericay is not static. The increasing population is fast outstripping the improvements which are made. The fact that the waiting time, especially for those requiring specialist medical treatment, is lengthening is, of course, not peculiar to Billericay. It is a national problem and arises out of growing awareness on the part of people that these facilities exist. It is not a bad thing at all because our object is to keep patients out of hospital.

However, that can only be done if outpatient and consultant facilities are available. My complaint is that additional out-patient facilities at St. Andrew's cannot be provided because of lack of accommodation. A similar impasse has been reached in regard to in-patient facilities. The shortage of nursing staff is a nation-wide phenomenon, but the problem at St. Andrew's is aggravated by the lack of accommodation. If this is the situation now, what is it likely to be in a few years' time?

In my constituency a new town is taking shape. From time to time I have inflicted on the House some details of the problems which arise from having a new town in one's constituency. I make no apology for that; it is a new experience. Not many hon. Members, apart from my hon. Friend the Member for Epping (Mr. Finlay), know very much about it. Because the tendency is for young families to embark upon the adventure of starting a new life in new towns, the number of small children that they bring with them is surprisingly high, and the need for good out-patient facilities and, indeed, for more maternity beds, will grow substantially.

As our new town grows, obviously the population curve will move up more steeply. About 4,000 people have come to Basildon since it started. I estimate that 2,700 more will arrive this year, 5,000 more in 1955, 6,000 more in 1956, and thereafter the figure will be about 7,000 more each year. These are substantial figures, and if there is a shortage of hospital facilities now, I suggest that they call for action before the shortage becomes still more acute.

What ought to be done? Clearly, there are three inter-related problems so far as our hospital is concerned. First, there is insufficient accommodation for out-patients; secondly, existing in-patient accommodation cannot be utilised because of lack of nursing staff; and thirdly, lack of staff cannot be remedied until more nurses' accommodation is made available.

We have a vicious circle here, and my object in raising the matter tonight is to appeal to the Minister to break it. I have made inquiries and it seems to me that some easement of the problem might be effected if the Essex County Council could be persuaded to surrender beds at St. Andrew's which are reserved for Part III patients. I understand that negotiations are afoot between the regional hospital board and the county council. I do not know how far they have gone and I do not know what success has attended them.

It may well be that the Essex County Council is not in a position to make a decision on the subject. In that case, I should like to know what difficulties stand in the way. I cannot imagine that the Minister is oblivious to the need to resolve the problem quickly. I say with all the seriousness at my command that, unless something is done fairly soon to remedy the situation at St. Andrew's and in the area covered by the South-East Essex Hospital Management Committee, there is a grave risk of hospital services in the area breaking down.

There Ls an added reason why something ought to be done. I have heard it suggested that St. Andrew's might be recognised as a general training hospital for nurses. I know that locally we would all welcome that very much indeed. The quality of the existing medical and nursing staff is very high, as all who have had anything to do with the hospital will testify, but one cannot expect the General Nursing Council to extend recognition to a hospital for training where not only is the living accommodation for nurses inadequate, but the consultative facilities, which after all are vitally important to training, are limited for lack of accommodation. Once the accommodation is improved, recognition will no doubt quickly follow, and the problem of staffing will solve itself, because people will be attracted to serve in the hospital.

When my hon. Friend replies, I hope she will be able to say what steps are being taken to provide adequate accommodation for nurses, for out-patients and consultative facilities at St. Andrew's, and whether there is any possibility of this hospital gaining recognition as a training hospital.

Then I should like her to address herself to the long-term problem. Here is an area in which the population is increasing rapidly. Is there any evidence that anyone is bothering to think about the future? In a way, it is rather ironical that the success of my right hon. Friend the Minister of Housing and Local Government in building large numbers of new houses in my constituency is creating an additional problem for the Minister of Health. People are moving out of London and out of metropolitan Essex into my constituency. They cannot bring their hospitals with them. If it is sound policy for this movement to be encouraged, then hospital facilities must be provided in the reception areas. Therefore, can my hon. Friend say what are the plans for the new town of Basildon?

It may be that it is more economic to concentrate efforts on St. Andrew's and not to bother about building a new hospital at Basildon at this stage. It is more economical to spread the available medical and nursing staff and the expensive equipment over one large hospital than over two smaller ones, and, therefore, it might be better to extend St. Andrew's now rather than build a new hospital at Basildon at some remote date in the future. In any case, as long as there is some severe limitation on capital expenditure, the building of a new hospital at Basildon might prejudice the improvement of the accommodation at St Andrew's.

Whatever is decided, I beg of my hon. Friend the Parliamentary Secretary to convey to the Minister of Health the necessity of deciding soon. I cannot emphasise enough the need for the Minister to recognise that areas containing new towns present special problems which merit consideration now and not at some date in the future, when the strain of the increasing population has brought the existing hospital facilities nigh to breaking point. If my hon. Friend can say something on these questions, I shall be very much obliged to her.

10.26 p.m.

The Parliamentaiy Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

My hon. Friend the Member for Billericay (Mr. Braine) has gone very deeply into this question of the health service in his area, and we recognise that he has a particular problem, in so far as it is a very rapidly growing area in Essex, where there is the new town of Basildon and where there is also a large L.C.C. estate at Aveley.

The problem raised by my hon. Friend really revolves round two main points—hospital facilities generally in the area, and the part to be played by the hospital in which he is particularly interested—St. Andrew's. I should first like to confirm the statement which my hon. Friend made very fairly at the beginning of his speech that a very considerable advance has been made. I think that is a recognition that the regional hospital board is alive to the needs of this growing area.

As my hon. Friend said, there were only 78 beds in a hospital at Tilbury in 1948 to provide this area with general hospital services, and there are now nearly 400, while there are 142 for the chronic sick, 62 for maternity, 82 for tuberculosis and diseases of the chest, and 54 for infectious diseases. Most of the general beds have been provided at St. Andrew's and the Orsett hospitals, both of which were formerly public assistance institutions.

As well as this large number of beds, there have been, as my hon. Friend has said, out-patient departments, X-ray and pathological services developed at these two main hospitals, and further developments are pending at Orsett; an accident and reception centre is in the programme this year. The physical medicine department is in progress and a consultative out-patient department is to be included in the programme as soon as possible. Therefore, it may be accepted that the board has recognised the problem in this area and certainly has applied itself to it.

But my hon. Friend, with his usual far-sightedness, points to what will be a growing problem over the next 10 years in that 1,700 new houses are being built at Basildon, and the population, I believe, will develop eventually from 18,500, which it was, to 80,000. Furthermore, on the London County Council estate at Aveley the population will jump from 4,000 to 23,000. Quite obviously, this presents the regional hospital board with a particular problem.

As my hon. Friend probably knows, it was the original intention that there should be a new hospital at Chadwell St. Mary, but in view of the rapid growth at Basildon and the vast rearrangement of the population in the area, it is envisaged that there shall ultimately be a new hospital at Basildon and improvements to the existing hospitals in the Tilbury-Thurrock area. I must, however, tell my hon. Friend frankly that the building of an entirely new hospital is an extremely costly affair, and I cannot tell him when the starting date is likely to be. It would cost something in the region of £1 million, and we cannot at present see the prospect of that sum being included in the programme of the regional hospital board or centrally financed.

Mr. Braine

That is a most interesting figure. Does it not give emphasis to my request that attention should be paid to the extension of St. Andrew's now?

Miss Hornsby-Smith

If my hon. Friend will let me finish, he will probably not be too disappointed with the intentions at St. Andrew's.

At St. Andrew's Hospital at Billericay, only 48 beds are retained by the Essex County Council for the aged in need of care and attention. Whilst negotiations are at present being carried on between the regional hospital board and the Essex County Council—I believe an approach has been made for a meeting between the two bodies—to establish whether it will be possible for the Essex County Council to release this accommodation, I cannot anticipate the outcome of these negotiations. My hon. Friend, who has so often raised the problem of the care of the aged, will know that it is as difficult to find alternative accommodation for the elderly people now occupying the 48 beds as to meet the need for those beds also to be made available to the general hospitals.

But there is the further point that at St. Andrew's Hospital, which now provides altogether nearly 400 beds, 86 of those beds are available but unstaffed. The immediate priority, therefore, is not so much getting back the 48 beds from the Essex County Council, but the staffing of the 86 beds which are already available to the hospital but are as yet unstaffed.

Whilst referring to the improvements that have been made at St. Andrew's, I should like to point out that the upgrading of the hospital is shown by the increase in consultant staff for the hospital group, which even in the last 18 months has included the part-time services of an additional surgeon, an orthopaedic surgeon, a dental surgeon and an ophthalmic surgeon. As well as this, the theatre, the out-patient facilities and the X-ray facilities are being improved and chest clinics being provided at both St. Andrew's and at Thurrock.

These improvements at St. Andrew's have held the position very well so far as the waiting list is concerned. In fact, the waiting list at 31st March, 1954, was shorter than at 31st March, 1951, which shows that the board is alive to this matter and has, at any rate, kept pace with the problem and not allowed it to grow more grave.

The board recognises, however, that with the rapid growth of the population it will require all the beds it can get for the St. Andrew's hospital. Certainly, the overriding priority in opening these beds must be one of staff. At the moment, 98 full-time and 45 part-time nurses are employed at St. Andrew's hospital, with a ratio of 2.4 beds per unit of nursing staff. The hospital is already recognised as a training school for pupil assistant nurses. As to whether it will be recognised as a training school for trained nurses in the General Nursing Council Register, I can only say that the premises were inspected on 28th April by the General Nursing Council, whose decision is awaited.

I cannot quite accept my hon. Friend's theory that if the hospital is so recognised, the problem will resolve itself. Alas, recognition as a school for the training of nurses for the General Register would not automatically bring in more recruits. Nevertheless, even if additional assistant nurses could be found and we could obtain more pupil assistant nurses, it would equally help to make it possible to open those additional beds.

With regard to the nurses' accommodation, 56 per cent, of the existing full-time staff are resident. There is a problem of accommodation, which again raises the question of priority in capital expenditure. The board feels it cannot at the moment finance this, but if the hospital is able substantially to increase its nursing staff, more particularly if it is registered by the Nursing Council as a training school for the general nursing register, it will require permanent nursing accommodation.

I can tell my hon. Friend that the hospital management committee and the board are fully alive to this and have scoured the area to find premises which can be adapted. But there are virtually no premises available. It would mean the building of entirely new additional nurses' accommodation. That, again, makes a priority claim on any capital expenditure.

I should like to make plain to my hon. Friend that the Standing Nursing Advisory Committee has recently made it plain in its policy that it does not regard it as essential for trained staff to live in. We find, in particular, that in many cases we are unable to keep our trained staff because they are unable to live in their own homes. Therefore, while it would be necessary and desirable to provide accommodation for students, who, in their first year, should be resident, we believe that if we could find the staff it might not place as large a burden or call for as much additional residential staff as we hope enrolment would require. Nevertheless, there would have to be additional accommodation, particularly for student nurses. Additional accommodation is included in the board's reserve list of capital works, but, again, must compete with the other urgent calls which are made in this area.

The increased and enlarged out-patient department in which the hon. Member is so interested depends very much indeed on the supply of staff. It would call for considerable expenditure. There would have to be increased consulting and nursing staff, and certainly a considerable increase in X-ray equipment and the like.

In conclusion, may I say that the regional hospital board is fully alive to this problem of a very rapidly increasing population. So far it has met and held that problem very admirably with the limited resources at its disposal, particularly in view of the fact that in this area there were hitherto very few general beds. The board has adapted and upgraded; it has provided consultant staff, equipment and so on, and that has provided very substantially for the population there.

The board is very much alive to the problem of South-East Essex. I understand that the board's chairman and vice-chairman, within the last few days have spent a whole day with the hospital management committee assessing the area's problems and seeing for themselves the problems of St. Andrew's and what can be done. They have received a full report on the group's medical staffing requirements, and this is to be considered by the regional hospital board this month.

A great deal has been done. I can assure my hon. Friend that the board is very much alive to the problems of the area and is actively concerned with them in their negotiations at the present time. I cannot name a date for the new hospital at Basildon, but I can tell my hon. Friend that it is one of the projects in mind for this area and is among the ultimate plans of the regional hospital board. Meanwhile the short-term improvements to St. Andrew's and other local hospitals must be considered, and the speed with which the regional hospital board can implement these improvements, as my hon. Friend knows, must be in accordance with priorities in the area and within the financial limitations imposed upon this and all other areas in the hospital service.

Question put, and agreed to.

Adjourned accordingly at Twenty Minutes to Eleven o'clock.