HC Deb 17 June 1958 vol 589 cc1055-64

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hughes-Young.]

11.17 p.m.

Mr. Michael Stewart (Fulham)

The Minister of Health is at present considering a proposal to rebuild Charing Cross Hospital and Medical School on the site of what is now Fulham Hospital. The citizens of Fulham first learned of this proposal from the columns of the Press last summer, and were greatly concerned about it, because for more than two years previously the people of Fulham, acting through a committee under the chairmanship of the mayor of the borough, and representing all shades of opinion, in many walks of life, had been agitating for the rebuilding of Fulham Hospital itself. That is to say, they wanted to have their own local hospital, as they have now, but rebuilt.

That rebuilding was, indeed, in process, though we could have hoped it would have been carried on a bit faster. Our hopes had been raised, particularly by the interest taken in the matter by the right hon. Gentleman the Member for Runcorn (Mr. Vosper), shortly before—to everyone's regret—illness obliged him to resign the office of Minister of Health. At that stage, the people of Fulham learned that it was being considered that they should not have their own hospital rebuilt, but instead should have a teaching hospital put in its place.

I readily concede that the right hon. and learned Gentleman, the present Minister of Health, has been willing to consider the views of Fulham people, as expressed by the mayor's committee, and has given up a good deal of his time to receive a deputation and listen to our views. I believe he still has the matter before him and under consideration, and I thought it right, in view of the strength of feeling in the borough, to take this opportunity, before he reaches any final decision, of emphasising why the people of Fulham—and others—believe that this proposal is not desirable and should not be proceeded with, and that it is not in their interests, or in the interests of the teaching hospital itself.

We are not taking merely a parish pump view of this matter. Our objection is supported by people of weight and authority, not directly connected with our local problem, and it is an objection based as much on the needs of the teaching hospital as on the concern of Fulham people themselves.

Their objections may be briefly summarised as follows. First, at present there is provision for some 950 beds. If the proposal to rebuild Charing Cross Hospital on the Fulham site is proceeded with there will be, on even the most optimistic estimate, a loss of some 150 beds to the people of Fulham and the neighbourhood. In discussions that have taken place on this matter in the appropriate organs of the British Medical Association the view has been expressed that the loss of beds may well be as high as 300, but on no estimate has it been suggested, nor was it suggested when we met the Minister, that it would be a loss of fewer than about 150 beds.

Secondly, we have to consider the needs of the chronic sick and of emergency cases. It is known that an ordinary local regional hospital is subject to certain requirements to receive emergency cases, and under the working of what is called the emergency bed service some 700 patients were admitted to Fulham Hospital last year.

A teaching hospital will not and, indeed, cannot provide a service of that kind. In order that it shall do its own work properly it is not made subject to the same requirements with regard to receiving emergency cases as an ordinary hospital is. It is reasonable to say that if in place of the present Fulham Hospital a teaching hospital were established, it would be unlikely to receive more than, say, 200 emergency cases in the course of a year, whereas, as I have said, last year Fulham Hospital received 700 cases under the emergency bed service.

The third point is that in Fulham, as indeed in several parts of inner London, the proportion of the population who are elderly is decidedly above the average of the Kingdom as a whole. Endeavours are already being made even with the present building to meet the special need, and in the plans for the rebuilding of Fulham Hospital, which we hoped were going ahead until this proposal came forward, provision was to be made for a proper geriatric unit. We are obliged to ask whether, if a teaching hospital were established on the site, anything like that provision could be made.

We have pressed this question already in the discussions that have gone on, and although it is admitted that the teaching hospital that was established on the Fulham site could make some provision of that kind, it will not be contended that it could make provision equal in scope to what could be made if the original plan for the rebuilding of Fulham Hospital itself were proceeded with.

A fourth point bearing on the needs of the people of Fulham is this. A teaching hospital by its nature must have in it and ought to have in it a higher proportion of unusual cases than an average hospital. I am told that not so much stress is laid on that today as was formerly the case in considering what a teaching hospital ought to be like. But even allowing for that, it cannot be disputed that it is in the nature of a teaching hospital that, in order to perform its teaching function, it should provide a wide variety of different types of cases, and in order to do that it must have a somewhat higher proportion of unusual cases than an average hospital has.

In order to do that it must draw its patients not merely from the surrounding area but from a rather wider area, because the immediately concerned area will not provide it with a sufficient number of the less usual types of case. That means, therefore, that a teaching hospital, if it is doing its teaching job properly, cannot have quite the same proportion of its beds available for people in that neighbourhood as an ordinary hospital has.

If, therefore, this proposal is proceeded with, first of all there is the loss of total number of beds that I referred to earlier. Then we have to notice that of such beds as there are, a bigger proportion must be set aside for people not from the immediate neighbourhood. Therefore, the people of Fulham will suffer a further loss in the number of beds. The only way of saving the people of Fulham from that would be to prevent the teaching hospital from doing its own job properly.

That brings me to the other leg of my argument, that we are arguing this matter not only with regard to the needs of the people of Fulham, though the mayor, the citizens and the mayor's committee have quite properly put that as their first concern. I regard it as my duty as a Member of Parliament to mention also the wider question of the needs of the teaching hospital itself. On that point, the striking fact about this whole proposal is that this suggestion that Charing Cross Hospital and Medical School should be rebuilt on the site of the Fulham Hospital has arisen because an earlier suggestion to rebuild Charing Cross Hospital and Medical School on a site in the Harrow area has, as far as many of us think, for no sufficient reason been abandoned.

I put it to the Parliamentary Secretary that the needs of Charing Cross Hospital and Medical School would be better met by proceeding with the Harrow site proposal, where, indeed, the building of the hospital would be welcomed, than by putting it in Fulham where the building of it must necessarily cause concern to the inhabitants for the reasons I have mentioned.

Why do I say that the Harrow site would be better? In the first place, it was to have been a site of 47 acres instead of the 9 acres at most that will be available on the Fulham site. Secondly, and surely this is an extremely important point, putting it on the Harrow site would have meant that the Harrow neighbourhood would have had a greater number of hospital beds made available to it. If it went to Harrow both the Charing Cross Hospital and Medical School and the inhabitants of Harrow would be better off. It would be putting a hospital where there was a need for more beds, and more beds would have been provided. Instead, it is proposed to put it in Fulham where the result must be a reduction in the number of beds for the local inhabitants.

It is suggested that the Harrow site was not suitable because it was not sufficiently easy of access from Central London. Consultations with the Underground railway reveal the fact that it takes just about as long to travel on the Underground from Central London to Fulham as it does to Harrow. That is really not a sufficient reason against the other reasons that I have urged.

The Minister has pointed out to us that it is his duty under the Act to provide teaching facilities, and I think he took the view that if the Medical School said that the Harrow site would not provide adequate teaching facilities he must accept that view and look elsewhere. The Minister has looked and found Fulham. Surely that is not sufficient. If the Medical School says that the Harrow site is not suitable, it ought to provide very weighty and serious reasons for that refusal.

I think it is true to say that so far no reasons have been provided which countervail the very serious objections of proceeding with the Fulham proposal. I would draw the Minister's attention to a phrase in the letter sent to the town clerk of Fulham from his Ministry on 12th September last year. It states: The needs of the Fulham area for hospital facilities will be given no less weight than the requirement of the Medical School for teaching facilities. But proceeding with this proposal means apparently that the requirements of the Fulham area are to be given less weight than what is apparently a very unsubstantial argument advanced against proceeding with the plan for the Harrow site.

I mentioned that Fulham citizens feel very strongly on this matter, and if Ministers have any doubt about that, consultation in the area will reveal it to them very clearly. Many general practitioners in Fulham were asked their opinion about the project, and 75 per cent. of them were opposed to it. I have reports of discussions in the British Medical Association where also the most marked hostility is expressed to the proposal, partly because of the decline in beds in the inner London area that it will mean and partly because of the reduced facilities for emergency cases. It is also true that the Fulham and Kensington Hospital Management Committee has expressed its strong opposition to the proposal.

Consequently, I ask the Parliamentary Secretary to say on behalf of his right hon. Friend that he has completed his examination of the matter and that the proposal to rebuild on the Fulham site is not to be proceeded with. If he cannot say that, I hope that he will say that before reaching any decision he will agree to the holding of a public inquiry in Fulham. I have a leaflet issued by his Ministry about the closure or change of use of hospitals in which it is stressed that when anything of that kind is done it is important to give opportunity for interested persons to express their views. If the right hon. Gentleman is still thinking of the proposal at all, will he please hold a public inquiry in Fulham before proceeding with it? I trust that he will decide to abandon it and, instead, do what the former Minister of Health was apparently inclined towards doing, and that is proceed as rapidly as possible with rebuilding Fulham Hospital itself to provide a real service for the people of Fulham.

11.32 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)

I am obliged to the hon. Member for Fulham (Mr. M. Stewart) for the manner in which he has raised the question, which is indeed one of public importance, transcending, as he said, the needs of Fulham, although obviously those are very much in his mind.

The proposal—at present it is no more than a proposal—to rebuild Charing Cross Hospital at Fulham raises two very important considerations which I would hope we could reconcile when the final arrangements come to be made. First, there is the best way of organising medical education in the University of London, and, secondly—and from the hon. Member's point of view very important indeed—the provision of an adequate hospital service in Fulham in discharge of the Minister's statutory responsibility.

If I may take the University of London's problem first, ideally all medical schools in London should be in central London as close as possible to the university precincts. It is desirable that medical schools should be located as close as possible to the other places where the basic sciences are taught and that clinical teachers should not be separated from other science teachers. I make that point because I do not want the hon. Member to think that the geographical question was the whole point involved here. The physical distance was a point but it was not the whole of it. Also, it is important that medical students should be able to mix readily with other students at the time when they are taking their training.

Nevertheless, in spite of those considerations the Goodenough Committee in 1944 recognised that ideals are not always attainable and recommended that the Charing Cross Hospital should move to Middlesex as part of the necessary decentralisation of hospital services in London. As the hon. Member said, originally the University and the University Grants Committee accepted the move to Middlesex and acquired land at Northwick Park. Subsequently they reconsidered the position, and they now take the view that a solution must be found not involving so distant a separation from other university life and centres where basic sciences are taught. There is also the point that the University statutes contemplate that all its institutions shall be within the administrative County of London, and, hence, the removal to Middlesex, if not strictly illegal, would be contrary to the spirit of those statutes.

If we look at the Minister's problem, namely, the planning of the hospital services, it is clear that the shift of population of Greater London requires some decentralisation of hospitals to serve it. This involves the development of services in outer London and the reduction of the former concentration in the centre. Hence it was that successive Ministers accepted the Northwick Park scheme, and the Charing Cross rebuilding was selected in 1955 as a major project for early progress. But because of the strong views of the University of London and the University Grants Committee that the Northwick Park scheme should be reconsidered in the best interests of medical education, my right hon. and learned Friend felt bound to seek an alternative solution.

Many possibilities were reviewed, and last summer the site of the present Fulham Hospital seemed to provide a reasonable possibility. The hon. Member mentioned that he felt that people in Fulham had not been consulted at a sufficiently early stage, but the original discussions had to be with the hospital authorities concerned, because if they had turned the scheme down, further and wider discussion would have been quite fruitless.

There is a most urgent local need—which I acknowledge at once—for improved hospital facilities, and the demolition and rebuilding of the existing Fulham Hospital, which was badly damaged during the war, had already been agreed upon. From the medical education angle the site of the Fulham Hospital is closer to the University than Northwick Park, and within easy reach of the science departments of the University. It is also within the administrative boundaries of the County of London, thus conforming to the statutes. On that basis the proposal was put before the hospital authorities for consideration last August, and indeed, as the hon. Member said, a letter was sent to the mayor's committee in September agreeing that further consultations would follow.

The new scheme involves the rebuilding of Charing Cross Hospital and Medical School on the site of the Fulham Hospital, Secondly, the rebuilt Charing Cross Hospital would eventually replace the existing Fulham Hospital and also Fulham Maternity Hospital and the West London Hospital. Thirdly, the early regrouping of hospitals would take place, so that the Board of Governors of the regrouped Charing Cross Hospital could start work in Fulham.

Discussions have taken place with the hospital authorities, all parties agreeing in principle to the proposal. The agreement of the South West Metropolitan Regional Hospital Board is subject to two important considerations; first, that the new hospital should provide district hospital services comparable with those proposed under the Board's earlier plans for redevelopment of the Fulham Hospital—and it made a very strong point that the local provision should not be any worse than it would have been if the original Fulham proposal had gone through—and, secondly, that the position of the existing staff should be safeguarded.

The Board of Governors of Charing Cross Hospital has given the following assurances in reply: in consultation with the South West Metropolitan Regional Hospital Board a service fully adequate to the needs of the Fulham area would be provided—and by "fully" I have no doubt that it had in mind a quite precise definition. Secondly, the Board has given the assurance that it would accept the transfer of all the staff involved.

It may be asked whether a hospital can combine the function of a teaching hospital with the provision of a district service, or whether the teaching requirements might unduly restrict the admission of normal cases from the locality, including the chronic sick and emergency cases. It is a fact, as the hon. Gentleman acknowledged, that teaching hospitals now treat most patients from the local community, thus providing a district medical service. The modern tendency is to provide a greater variety of patients for teaching purposes to familiarise students with normal types of cases as well as the more complicated which were formerly sent to teaching hospitals. There is no reason to think that a teaching hospital cannot provide a district service in addition to fulfilling its teaching function.

Anxiety was expressed over the situation regarding the emergency bed service which I do not think is justified. A teaching hospital accepts patients from the emergency bed service although its strict liability to do so does not go quite so far as in the case of the non-teaching hospital. But in an emergency I am quite certain that we could rely on the hospital to help in every way possible. I wish to emphasise that the Charing Cross Board of Governors has already given the Minister an assurance that, in consultation with the regional board, a hospital fully adequate for Fulham's needs would be provided.

I wish to say a word about the fears regarding the loss of beds, the arithmetic of beds, on which the hon. Gentleman spent a little time. It is proposed that the new Charing Cross Hospital should replace Fulham Hospital with 382 beds, Fulham Maternity Hospital, with 28 beds, and the West London Hospital with 238 beds, giving a total of 648 beds which ultimately would be closed. Would the new beds be sufficient for the purpose and provide enough margin for the teaching work? The first point I would make is that the hospitals being replaced will not all be closed at once. Secondly, no decision has been taken on the ultimate size of Fulham were it to be rebuilt as a non-teaching hospital.

Mr. Stewart

One result of the rebuilding would be to give more beds than 650, probably 200 more.

Mr. Thompson

I have not yet mentioned a figure of replacements. I said that 648 beds were being lost, but it is unlikely that the original proposal would have provided Fulham with more than 400 or 500 beds, even allowing for the closing down of the West London Hospital. The Board of Governors of Charing Cross Hospital has in mind a hospital with 700 to 800 beds, with the usual range of specialities. This would mean ultimately that the present total of 648 beds in the Fulham hospitals would be replaced in stages by about 750.

It is proposed that 10 per cent. of the total beds should be allocated for the chronic sick which would give 70 or 80. That is slightly lower than Fulham's present allocation of 87 beds. The Regional Board recognises the need for more beds for the chronic sick and discussions have taken place about where these might be provided.

The hon. Gentleman suggested that in view of these divergent views we should either not go on with the scheme or agree to a public inquiry. My right hon. and learned Friend does not rule out a public inquiry, but he is not entirely convinced that it is the best way to proceed. For one thing, it would entail considerable delay and expense to many people and might not establish many facts or points of view not already known. Many discussions with the various hospital authorities and medical interests concerned have already taken place, and my right hon. and learned Friend heard the views of the local people through the hon. Member's deputation last month. Nevertheless, I repeat, no hard-and-fast decision has been taken, and my right hon. and learned Friend has not closed his mind to this possibility.

The proposals have been under consideration, and discussions have been going on since last summer, and, while full investigation and discussion are obviously essential, I can say that my right hon. and learned Friend hopes to come to a decision fairly soon.

Question put and agreed to.

Adjourned accordingly at fourteen minutes to Twelve o'clock.