§ Motion made, and Question proposed, "That this House do now adjourn."—[Sir C. Drewe.]
§ 10.44 p.m.
§ Mr. F. H. Hayman (Falmouth and Camborne)
I desire to raise the question of the need, the immediate need, for an area hospital in Cornwall. The hospital would be situated within the region administered by the West Cornwall Hospital Management Committee; but West Cornwall is really a misnomer, because it includes everything west of Bodmin, which is most of Cornwall and by far the greater part of the population.
Before the war, there was one hospital of 200 beds at Truro. There were three general hospitals of under 100 beds each and nine small hospitals. All these were voluntary hospitals. The hospitals run by the county councils were the Tehidy Sanatorium, the county isolation hospital and the hospital sections of 178 various public assistance institutions. The Royal Cornwall Infirmary at Truro was founded in 1799 partly with money from a closed Lazar House at Bodmin. The Redruth Miners' Hospital was founded in 1863 to cue for miners in what has been described as the most mineralised part in the world. I live there. I spent my boyhood in the shadow of the Royal Cornwall Infirmary at Truro, and for the last 25 years I have lived within a stone's throw of the Redruth Hospital. I know them fairly well.
Each voluntary hospital had its own independent management committee and was staffed for the most part by general practitioners. I understand that not all of the few consultants were fully qualified for their speciality. Surveys sponsored by the Nuffield Trust showed that not even the Truro hospital was big enough to maintain the many specialist departments that modern treatment requires or to attract well qualified consultants. Families of committee members more often than not went to London when they needed hospital treatment. The need for a large central hospital where properly equipped and staffed consultant services could be established was fully recognised. As there was no possibility of raising funds to build a central hospital, the Nuffield Trust recommended the next best thing—that of getting the existing hospitals to co-operate in setting up new services, one here, another there, under properly qualified consultants.
These praiseworthy attempts were frustrated by insuperable difficulties, partly by the poverty of the hospital committees and partly by their insular independence. If ever justification was needed for the nationalisation of the hospitals, it could be found in the poverty of the voluntary hospitals and their insularity. The sanatorium run by the county council lacked many amenities, but the council had prepared plans for a new nurses home and a new hospital block. Both were sanctioned by the Labour Government and were finally opened by the present Minister of Health. The county isolation hospital in Truro was good. At Barncoose public assistance institution, the county council had initiated an experiment in geriatrics catering for old people needing hospital treatment. This institution, despite the terrible condition of some parts of the granite 179 fortress which serves as a hospital block, has done excellent work.
Since nationalisation, the question of providing consultant services to be used in a general hospital has been revived. In the early years, much time was devoted to allocating hospitals for specialist services to serve a wider area. These proposals evoked protests from town after town. The hospital management committee and the sub-committees spent an enormous amount of time preparing these plans, drafted their proposals, and eventually held public meetings in the towns concerned. These interim proposals were put forward pending the provision of a central hospital.
This is a timetable of the efforts of the hospital management committee from 1949 to 1954. On 3th May, 1949, the regional hospital board requested the hospital management committee to send a report on long-term planning with urgent consideration of a central hospital site. On 13th September, 1950, there was a letter from Mr. Waterhouse, the assistant secretary to the regional hospital board, conveying this committee's recommendation that the Truro site should be acquired, with the Redruth site as an alternative.
Many of us felt that the Redruth site would have been a better one. I suppose that it is natural for one living within half a mile of this site to think that, but I would point out that Redruth is the largest urban unit in the county with a population of 36,000, that Redruth would have been easier for Penzance in the far west and not any farther for Falmouth, and that Truro would have no farther to come than Redruth would have to come to Truro. However, Truro was decided on.
§ Mr. Hayman
Launceston comes under the Plymouth Regional Hospital Board.
On 31st October, 1950, there was a meeting at Truro with two doctors from the Ministry of Health with regard to this site and hospital. On 30th November, 1950, a letter was sent from the Ministry to the chairman of the South-West Regional Hospital Board, the third paragraph of which read: 180Provided that good progress is now made with the preliminary planning in connection with this new hospital I can assure you that the project is quite high on the priority list for such major works, and that, as far as can be foreseen at present, there are good prospects of the necessary allocation on the general investment programme being made available to enable a start to be made in the reasonably near future.On 2nd January, 1951, there was a letter from the regional hospital board about the setting up of an area hospital committee. The first meeting of that committee took place on 13th February, 1951, when a medical advisory committee was established. On 17th December, 1952, the report and plans for the hospital were completed. On 26th March, 1953, there was a meeting of the area hospital committee at which the medical advisory committee's report and plans were received and approved for submission to the Minister.
On 15th May, 1953, plans were forwarded to the Ministry of Health. On 19th August, 1954, there was a letter from Dr. Kelly, the senior administrative medical officer of the region, stating that plans were under consideration by the medical planning division of the Ministry and their architects.
I submit that the whole of that diary goes to show that an immense amount of work had been put in on the plans for this hospital and that the hospital management committee had reasonable cause to think that the Minister would arrange for the necessary money to be made available for this hospital to be started soon. That is not so.
On the strength of the assurances given in the letter of 30th November, 1950, it was decided to develop the specialist services. Several fresh departments were set up, and the board appointed several new consultants. Before nationalisation, there were very few consultants. Now there are 37. In 1948 there were 1,212 beds in general hospitals. Today, there are only 1,198. There have been many expedients in an effort to provide some sort of accommodation and equipment for specialists, but this only amounts to a policy of robbing Peter to pay Paul. The orthopaedic beds have been taken for other specialist services, and there is nowhere for a dental surgeon to work in the Royal Cornwall Infirmary at Truro. The out-parents' department at Truro is regularly dealing with troubles of a major 181 degree because of lack of accommodation in the in-patients' section of the hospital.
All this is equally true of general medicine, and the difficulties are not properly reflected in the waiting lists of people seeking admission, because many of the patients—or would-be patients—are acutely ill and have to be treated in their own homes. These difficulties are insuperable without a new area hospital and are creating deadly frustration in the health services of the county. It might almost be said that the consultants have been brought to Cornwall under false pretences, because they were given to understand that this new area hospital would come into being very soon, whereas in fact they now find that it will not come for a very long time.
I hope that the Parliamentary Secretary will convey to the Minister the fact that the services have out-run all the available accommodation and that there is no possibility of further accommodation, such as the provision of beds for dental surgery cases. There is no possibility of further very necessary developments. The correspondence shows that at one time the situation was fully realised by the regional hospital board and by the Ministry, but since May of last year, all progress seems to have stopped.
I should like to call attention to Outpatient and casualty figures. These have nearly doubled in six years. In 1948, outpatient attendances totalled 76,500. In 1953, the figure had risen to just over 134,000, and in 1954 to just over 135,000. The casualty attendances were 25,500 in 1948, but 45,500 in 1953 and nearly 50,000 in 1954. In this connection, I would make the point that during the summer months of June, July, August, and September, the population which has to be served by the West Cornwall Hospital Management Committee increases by 50 per cent. The population of the area is about 300,000, and it is estimated that there are 150,000 visitors coming in during those months.
Although the Ministry will not admit it, ordinary people can see what is the strain put on the accommodation of the hospitals and upon the staffs. The staffs normally expect to have their holidays during the holiday months, but the hard fact is that they have to work harder even than at other periods of the year. 182 The visitors, and we welcome them, probably use the hospitals far more than otherwise because, unfortunately, road accidents naturally increase when traffic becomes congested during the summer months.
I submit that the needs of the hospitals are constantly expanding and that an area hospital is the only solution. The area hospital planning committee met on no fewer than 39 occasions, and planned and re-planned on the assumption that the scheme would proceed, thinking that they were performing a valuable public duty. But much of that effort has been wasted because, all the time, equipment is improving, building design and layout is improving, modern technique is improving, which means that much of the work which has been already completed will have to be done again.
The area hospital planning advisory committee has been asked to consider plans for a new district hospital at St. Austell. No one will deny that the new district hospital is necessary, but if the Minister thinks that this hospital will be any substitution for the area hospital, I suggest that he is making a profound mistake. Some of us may be under the impression——
§ Mr. Geoffrey Wilson (Truro)
The hon. Member will be aware that there are special conditions at St. Austell which give rise to a demand for a local hospital there. A legacy left for a hospital there has not been used.
§ Mr. Hayman
I am coming to that. The hon. Member has taken the words out of my mouth. I said categorically that I agreed with the need for a district hospital at St. Austell, but I object to a district hospital there being used as a substitute for an area hospital. The Treasury could save money, because there happens to be a large bequest which could be used for a hospital at St. Austell. By all means let us have a district hospital there, but we must have an area hospital at the same time. I hope that the Minister will impress that on the Chancellor of the Exchequer.
The Minister must take into account the backward state of the hospital provision in Cornwall before nationalisation, and also that we have not inherited any military hospitals as have other parts of the country. I should like to refer to a 183 questionaire sent to the political candidates in Cornwall at the time of the last General Election. We were asked whether, if we were elected, we would give our full support to this scheme with a view to ensuring its completion within the lifetime of this Parliament. I will not quote any of the replies except my own. I said that the very fact that the Minister of Health in the Labour Government, with the backing of the Chancellor of the Exchequer, approved of the proposal for a new hospital for Cornwall at the beginning of 1952–53, was sufficient guarantee of our sincerity.
I wish to stress that the Minister of Health in the Labour Government in 1951 sanctioned the scheme for this new area hospital, and that it would have been begun in 1952–53. We are now in the year 1954–55, and we would like to know if the Minister will try to persuade the Chancellor of the Exchequer to provide the money for a start to be made in 1955–56. The work being done by the consultants and the nursing staffs and the technicians in the hospitals in Cornwall is carried out under extreme difficulty.
Many of us feel that the time has come when the Minister should take note of the immense amount of money going out in salaries and wages. As I have said to the Minister of Education in relation to schools, if we are spending so much money in salaries and wages, a reasonable percentage should be tied up for capital expenditure on buildings, otherwise a great part of what is spent on salaries and wages is lost, owing to people having to work in defective buildings.
§ 11.5 p.m.
§ Mr. G. R. Howard (St. Ives)
I wish to support the plea for an area hospital. As I understand it, two years ago the regional board in Bristol informed the hospital management committee that this would be a first priority for the South-West Region. The hon. Member has said that the detailed plan has at last been required. If so, is it true that some officer in the regional office in Bristol forecast that building would start in 1953. I am informed by friends on the management committee that the situation is desperate; that the need for beds is desperate. Can the Parliamentary Secretary use her considerable powers of persuasion in asking the Chancellor of 184 the Exchequer to increase the allocation from central funds so that progress can be made with the desperately needed scheme, as has been envisaged by the regional board?
§ 11.7 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to the hon. Member for Falmouth and Cam-borne (Mr. Hayman) for raising this question, for there are obviously certain misapprehensions which, I hope, I shall be able to clear up in the time at my disposal. The West Cornwall area is acknowledged to be a difficult one. It has a population of 260,000 and 1,289 beds. As the hon. Member has said, there has been considerable discussion about where the site of the area hospital should be. I will say at once that there is no question of the Minister going back on the priority need for an area hospital, and the suggestion that we are asking them to consider plans for St. Austell as a substitute is unjustified. We hope that the board will not hold up any plans for St. Austell because of any idea that we are deliberately delaying the hospital. We have had no plans definitely about St. Austell from the board yet.
§ Miss Hornsby-Smith
Perhaps the hon. Member will allow me to complete my statement that the St. Austell project will come in the area allocation. I should like to develop my argument in sequence, as the hon. Member did.
With regard to the site, Truro was chosen because 93 per cent. of the population are within 24 miles of it, whereas at Redruth only 86 per cent. would be within 24 miles of the site. For that, and other reasons, the board agreed that the site at Truro should be chosen. The Royal Cornwall Infirmary will remain an integral part of the hospital service in the area, but it did not offer a suitable site for development.
The site which has been chosen is owned by the Treliske Estates, and while the owners are anxious to complete negotiations for a sale to us, and we are equally anxious to settle with them, we are having difficulties with the lessees, the 185 Truro Golf Club. Until agreement is reached with them, we cannot finalise the price and complete the negotiations. The owners are pressing us to complete the contract of sale, but until we have settled the difficulty with the golf club, it is not possible to agree a price with the owners. We hope that the negotiations will be completed shortly. The site having been chosen, the basic problem rests on the ability to find the capital expenditure from central sources.
I must place on record that there is no evidence in the Department's files that a previous Minister specified any date for this scheme. There were general hopes for many priorities—priorities in the new towns where 250,000 people have been moved in and where there are no hospital beds at all; priority for the teaching hospitals which, like Cornwall, are acknowledged and registered in the Ministry as a priority claim upon central funds when the financial needs of the country make it possible for a larger capital allocation to be allowed. But we have no evidence of any date having been given for the commencement of this hospital. That does not mean to say that we do not accept and agree with the need for a hospital in this region. We recognise that one is necessary.
Despite the fact that we have had £1 million more this year than in any previous year of the National Health Service, we do not see an opportunity of being able to include a priority scheme of this magnitude—which may well cost £1 million—within the next two years. This is dependent on the financial allocations given to us. It will then have to be decided which of these very important priorities I have mentioned—new towns, where the position is similar to that of Cornwall, and certain of the teaching hospitals which suffered severely through enemy action—can have capital expenditure for a general hospital.
The House will know only too well that with the additional capital we deliberately gave priority this year—and to a certain 186 extent we anticipate that we will next year—to the mental side. Cornwall has had its fair share of that as I have witnessed today, because I have been down in the locality of the hon. Member to see the mental side of the Health Service. They have had a fair share of the allocation. I hope it will be possible for an allocation to be made for the central financing of the area hospital as soon as it is possible to increase the main general allocation. This scheme is too big for a regional allocation to meet the cost.
No new general hospital has yet been centrally financed since the advent of the Health Service. The first new project will be one of nearly £3 million spent on mental health over the next three years. St. Austell has been fortunate in having two bequests totalling £105,000. Although the regional hospital board envisaged building 50 or 60 beds to make a general hospital to which would be attached 20 maternity and 100 chronic sick beds, they have put no definite proposals or lay-out before the Ministry.
§ Miss Hornsby-Smith
We know they want to do it, but they have not put a lay-out before us. Consideration is being given to extending St. Austell hospital rather than to providing a new building. That is a matter for the hospital management committee to consider as an alternative suggestion. Getting capital expenditure for a hospital is the cheapest part of it. Once provided, the capital does not meet maintenance, staffing and the whole cost of maintaining a new unit which must necessarily come from central funds and the allocation——
§ The Question having been proposed after Ten o'Clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at Fourteen Minutes past Eleven o'Clock.