§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sharples.]
§ 10.2 p.m.
§ Mr. Leo Abse (Pontypool)
Over the decade there has been growing in Wales an ever-increasing demand to meet the urgent need for more hospital buildings, a demand which hitherto has received scant consideration. No one, therefore, would or should lightly urge any delaying action when at long last the prospect has emerged that the long promised new Welsh teaching hospital is soon to be built. But the desire in Wales is for a teaching hospital worthy of the nation instead of a hospital that may be a museum piece before even the first brick is laid.
We have asked for a teaching hospital so imaginatively and elastically designed that it will meet not only present needs but be sufficiently flexible to adapt itself to the changes in scientific medicine that are bound to come with amazing rapidity in the next decades. Chemotherapists, virologists and the public health services are changing the internal pattern of our hospitals faster than ever before. Everyone one knows how within the last ten years the need for beds for tuberculosis, acute specific fevers, poliomyelitis and general childrens' diseases has been dramatically reduced. But this ossified hospital design accepted from a septuagenarian architect by assessors led by another septuagenarian architect is a design for a hospital for 1950, not as it should be for a 1980 hospital. Wales wants a forward-looking teaching hospital; it is being proffered a mausoleum.
The contemptuous attitude to research is well illustrated by the location and space allocated to the animal house. Animal work has led, as we all know, to so many spectacular medical advances. It is notorious in Wales that the younger members of the medical teaching staff at Cardiff are in despair that the space allocated to the animal house is minimal. Is a teaching hospital in Wales to rely solely upon the pathologist for research? Is not work to be done upon live organisms?
Again, how can one hope for good work, clinical as well as research, with- 322 out an X-ray department capable of expansion? In defiance of the most elementary principles of hospital planning, the X-ray department is so embedded within the building that expansion is well nigh impossible. Yet, judging by the developments of technique cine-angiography in recent years, and by the possible use in the future of remote control television in the field of radiology, the department is bound to need further development. Meantime, too, a derisory amount of space is allocated for radioisotopes, although surely the use of isotopes should become almost a standard need in every form of medical work.
A similar lack of anticipation of the real hospital needs, present and future, is shown in the department of mental health, to which space for a trivial 32 beds has been allocated. The grave challenge of mental illness in Wales, where almost half our hospital patients are in mental hospitals, is once again being evaded by the medical college at Cardiff. Through squalid medical politics, the college has thwarted for decades the establishment of a chair and department of psychiatry. Despite demands, time and again by the Welsh Regional Hospital Board, despite protests in this House, despite the recently declared wish of the Minister for Welsh Affairs, still there is no sign of a department and chair being created.
The relegation of psychiatry in this hospital to a cinderella rôle is little short of scandalous. I would particularly ask the Parliamentary Secretary to compare the miserable ancillary space and facilities intended to be given to the department of mental health with the standards laid down by the Ministry of Health Memorandum Building Note 5, which, in draft form, I understand is being circulated throughout the regional hospital boards. I believe she would then realise the importance of the Minister of Health adding his voice to that of the Minister of Welsh Affairs in calling for a chair and department of psychiatry.
If the House think this language is extravagant, let me draw attention to the conclusion of the architectural journal whose experts, alarmed by the vigorous condemnation of the hospital made by an independent specialist contributor on hospital design, sought yet another expert 323 independent opinion who, after painstaking investigation, declared the design as medically an antique and architecturally a disaster. Is it any wonder that the distinguished architect editors have now said that Wales is being offered a second-rate hospital and that this hospital is a mistake which must not be built? Again let me draw the attention of the House to the conclusions of the temperate British Medical Journal, which has spoken of the design as old-fashioned, as a hospital embodying many faults, as a design where flexibility has been sacrificed to monumental mass, and has bluntly subtitled its editorial upon the architectural competition with the heading, "Was it worth it?".
The most dismaying feature of the proposed hospital is the ludicrous amount of space allocated for research work in relation to bed space. No one has been more dismayed by the present allocation than the University Grants Committee, which, it is well known, wants the research facilities increased. The present design gives every appearance of there having been a battle for beds between heads of departments who have measured their prestige by the number of beds allocated to them rather than being prompted by a concern that the hospital should be a great teaching centre serviced with extensive research facilities.
Welsh Members of Parliament in peripheral areas know that without every department being adequately supported by research facilities, difficult cases brought in from distant areas will be unnecessarily delayed in this hospital. If a constituent patient of mine coming, say, from Blaenavon at the top of the valley, is sent into the hospital at Cardiff, I want to be assured that the diagnostic facilities are optimum, ensuring that the patient can be speedily sent back to the hospital near his home and near his relatives. But if this design is carried through, Cardiff will have a glorified cottage hospital and Wales will have lost its opportunity to become a great medical research centre.
Lamentably, blunder after blunder emerges as we examine the design of this £8 million hospital. Quiet rooms are in the noisiest part of the building; the sluice room is furthest from the beds most needing its services and is unrelated to the treatment suite; cross infection 324 risks are increased by infected material being brought into the ward suite for disposal and by inadequate air conditioning; lavatories are so sited as to increase difficulties of early ambulation, being concentrated in blocks and not related to bed areas or day spaces; the proposed operating theatre is to have a wood block floor which could never be sluiced clean; current ideas on ward planning, sponsored by the Ministry itself, reducing the maximum to six are not being followed; the positioning of the patients' lock rooms conflicts with early ambulation; the day space provided is quite insufficient to cope with the intended number of patients or with their conflicting interests; the huge expanse of low building in front of the low block will require constant artificial light; deep shadows will be flung across the quadrangle behind the main block; the eight-storey light wells for the ward block are contrary to modern practice and will mean that wards will be badly lit and have a wretched outlook; with the boilerhouse at the southwestern corner of the site, the prevailing wind will blow the smoke from the chimney to the ward block; there appears to be doubt that there could be extension to the hospital without emptying wards in use; and, when medical thought is looking more and more to out-patient work and less to hospitalisation, the expansion of the out-patient department would be according to the Architects' Journal, a most difficult operation. All these wretched blunders, and many more which I could enumerate if I had time, will be housed in a dull cliff-like bulk of buildings unmistakably institutional in appearance.
I do not expect the Parliamentary Secretary to answer all these criticisms tonight. However, I must tell her that a whole series of blunders has taken place. Despite expert advice given to the contrary, a competition—the only competition which has been held in this country so far as teaching hospitals are concerned—was held in terms that are quite unsuitable for a teaching hospital, for it is impossible for an architect to submit plans for such a hospital without considerable consultation between architects and heads of all the medical departments of the hospital. A bad design has now been selected. Worse, it seems that instructions were imprudently, 325 if not impudently, given to the selected architect to proceed without any prior consultation with the Ministry. Now an attempt is being made, by hurrying some of the junior architects down to Cardiff, to commence work and so ride the criticism that has come from the architectural and medical Press, from Members of Parliament, from The Times of 19th August and the Western Mail and South Wales Echo.
Wales may perhaps forgive all the blunders which have been committed, but what Wales will not forgive is this hospital, which costs the fantastic figure of £10,000 a bed, being built in its present form. I urge the Minister to call in without delay the director of his own achitectural department and his own eager research staff and, by a ruthless overhaul of the detailed plans, radically overhaul the design. The Minister has the capacity and the power to save Wales in the present situation from the folly of what has gone on in the past, and I urge the Minister, now that he has belatedly come into the picture, at least to consider my suggestion.
In America the miners' own union—the United Mineworkers—has built ten hospitals within a range of 250 miles which are the pacemakers in hospital design in the Western world. The mining communities of Wales are entitled to no less than the miners of Kentucky or Virginia, and, with £8 million about to be spent, the Minister, and his able architectural department, if they move very quickly, can still, in my view and in the view of many of my colleagues, save Wales from the possibility of its most expensive administrative blunder in the post-war years.
§ 10.14 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
I welcome the opportunity which this debate affords me of discussing the University Hospital of Wales and of replying to some of the criticisms which have been voiced in the Press and which the hon. Member for Pontypool (Mr. Abse) has repeated. The University Hospital will be the new medical teaching centre for Wales, and it is to be built on a 53-acre site on the Heath at Cardiff, a site which has already been purchased.
The fact that it is an undergraduate medical school dictates not only the concept of the work to be performed there 326 but also the size of the hospital, which is to have 650 beds. The scheme must be viewed against the development of acute hospital services in South Wales. These will involve not only another major acute regional hospital working in the Cardiff area, but also major acute hospitals which either exist or are being provided at Bridgend, Pontypridd and Newport, and those which are projected in the Welsh Hospital Board's plans for Merthyr and North Monmouthshire. In part, my emphasis on the whole of the expansion in Wales is perhaps the answer to the hon. Gentleman's point about the peripheral facilities.
The promoters of the scheme are the Board of Governors of the United Cardiff Hospitals and the Welsh National School of Medicine, who have throughout worked in the closest co-operation and harmony. What was desired was a hospital integrated with a medical school. This close integration was considered so important—it will be the first if its kind in the country when achieved—that the foreword to the schedules for the competitors made it abundantly clear that this was both a challenge and an opportunity.
It was considered that the closest possible working arrangements between the professional and the clinical staff, with the various departments, and their research and other laboratories, all adjoining their wards and patients, was essential. This is what the promotors wanted. This is what they have got.
It is perhaps right for me to make special mention, as the hon. Gentleman did, of the out-patients' department. This has been conceived in full accord with modern thought and is to be developed on polyclinic lines with a view to carrying out the maximum amount of investigation and treatment on outpatient or day hospital basis.
§ Mr. Abse
As regards the outpatients' department, has the hon. Lady any comment to make upon the statement of the Architects' Journal that it will be exceedingly difficult, in view of the form it is taking and the fact that it is so sub-divided, for it to be capable of expansion? Does the hon. Lady challenge what the Architects' Journal has said on this subject?
§ Miss Pitt
I hope to show a little later that some of this comment is at least premature. I was trying to say that we believe that this conception of the outpatients' department will, in line with modern thought, avoid unnecessary hospital admissions. Hence, the outpatients' department, with this aim in view, is perhaps slightly larger than we should normally expect in a hospital of this size.
The architectural competition for an important scheme of this size was thought preferable to the alternative, and the normal practice hitherto in the National Health Service, of selecting an architect, because competition would give incentive to a number of architects to think about problems set by the promoters, and it was hoped that new ideas and techniques would be evolved.
§ The Rev. Ll. Williams
Why did the Ministry make a distinction between the new St. Thomas's Hospital and this new teaching hospital at Cardiff? There was no architectural competition for the St. Thomas's Hospital.
§ Miss Pitt
I shall not give way again. I was saying that the promoters thought that it would cause a number of architects to think about the problems set by the promoters and it was hoped that new ideas and techniques would be evolved.
Competition, however, can do no more than select an architect and, in a scheme of this size, a fundamental design. The disadvantage is that the promoters and architect can deal with each other on paper only in broad outline. The details must wait till later. Nevertheless, they arrive in due course—this has still to come in the present scheme—at the same point as if an architect had been selected, namely, detailed sketch plans which represent the views of the customer.
328 Under the competition system it is also possible to proceed in two ways. Either there is a one-stage competition, as was done here, where the final choice is made from all the entries submitted, or there is a competition in two stages where less detailed plans are produced, a short list is then compiled by the assessors, and these architects are invited to develop their schemes in detail when a final choice is made. In Cardiff, both alternatives were considered, but the promoters and their advisers preferred the one-stage competition, and the Royal Institute of British Architects, under whose rules the competition was held, approved the proposals.
The fundamental conception of the promoters was, as I have explained, of a completely integrated hospital and medical school. They did not ask for a medical school tacked on to a hospital or a hospital set alongside a medical school. They wanted the two together. They required a building in which the department of medicine, with its teaching facilities and research laboratories, formed part of the medical wards, the surgical department with the surgical wards, etc. They considered that this integration, with the close day-to-day working it will produce, is a progressive concept which will be followed by many others in this country and elsewhere in the future. They foresee great benefits in the care and treatment of patients, in the furthering of medical education and in the promotion of research.
Since the hon. Gentleman placed particular emphasis on research, I would say that that point is perhaps best answered in these terms. The scheme provides for over seventy laboratories, of which forty are specifically allocated to research. In addition to the integration of the various school departments with the corresponding hospital wards, the promoters, because of the dependence of medical units one on another, also require a reasonably compact, complete unit. These requirements, which the promoters regard as fundamental to their conception, have inevitably tended towards a main building of some bulk, and this is a price which they are prepared to pay for the fullest development of their ideas.
Much of the criticism voiced has been based on conclusions on points of detail that have been reached prematurely, 329 because the scheme has not yet been fully developed. Naturally, in the process of development of sketch plans much rearrangement and replanning is being carried out. A series of working parties has been set up to go into the plans of the various units with the architect and with the engineer. Ward units, out-patients' department, lifts and communications, catering and food distribution, training accommodation, the dental school, etc., are all being looked a: in this way.
As an instance of the work that is going on it might be convenient to quote the internal design and lay-out of the ward unit. This has already been re-planned to provide better access and better supervision, to take account of the latest thoughts on cross-infection; and more single rooms have been provided, and the large ten-bed unit has been broken up into smaller units. This is a perfectly normal process which one would expect to take place with any design, and similar replanning is going on throughout the hospital.
I made an extensive list of the points that have been raised in the Architects' Journal, and repeated by the hon. Gentleman, in the hope that I would have time to deal with them tonight. However, I doubt whether I shall be able to get through them all, but I will answer what I think are the main criticisms. If I do not succeed in getting through them all I will, if the hon. Gentleman wishes, write to him to answer points of detail with which I may not now be able to deal.
I think that the most important point on which the hon. Gentleman would desire an answer is the criticism:The building is of great bulk, institutional in appearance, has none of the virtues of concentration, is unnecessarily congested while leaving parts of the site clear and the integration with the medical school has been achieved 'in the oddest fashion'.A building housing anything from 650 to 800 hospital beds must be of considerable size. The reasons for this concentration of accommodation are overriding. It is necessary that the hospital beds and the out-patients' department should be as close as possible to ancillary services such as X-ray, pathology and the operating theatres, to minimise traffic lines, and it was a fundamental requirement of the promoters that the 330 medical school should be integrated with the ward accommodation. This integration has been achieved in a manner that is wholeheartedly welcomed by the Provost of the Welsh National School of Medicine and his colleagues. The nominated architect is satisfied that his treatment of the main block will avoid an institutional appearance. Concentration of the accommodation has enabled parts of the site to be kept clear. This is an advantage. It leaves room for future building, particularly for development of research.
The second point that I must try to answer tonight is the comment thatThe boiler house is so sited that the prevailing wind will blow smoke from it straight at the ward block.The principal consideration in the siting of the boiler house was that of thermal efficiency. The possibility of smoke nuisance has not, however, been overlooked. Arrangements have been made for a wind tunnel test on a scale model of the hospital at the National Physical Laboratory, and this may point to a need for a higher chimney or other remedy.
The third point was the comment, again made by the Architects' Journal and repeated by the hon. Gentleman, thatThe method of achieving integration with the medical school involves the use of 8-storey light wells. Consequently some wards are badly lit and have poor outlook.These are, in fact, 7-storey light wells, about 140 ft. by 60 ft., which will allow adequate passage of light. The planning of the ward blocks provides that the bed positions are, in the main, on the outside walls and it is the service rooms which face inwards The only bed accommodation facing into the well is in the multi-bedded section of the ward which also has windows looking outwards.
The fourth comment was:The proposals for expanding wards from 650 to 800 beds are unworkable unvolving building construction above wards in use.It is true that the plan envisages building at a later stage above wards in use and that this would be inconvenient; but this inconvenience would be outweighed by the disadvantage of the alternative of having additional ward accommodation in the wrong place. One of the modifications already under consideration is the possibility of completing the ward 331 block at the outset, leaving additional building if required to be carried out elsewhere on the site.
As to the next point, that the conditions for the competition are said to have taken nine years to produce, I believe that the hon. Gentleman did not raise this matter, although I prepared myself for it.
§ Miss Pitt
I will therefore not occupy the time of the House in replying to it.
The other comment was that the building was restricted to ten storeys, apparently without logical reason. The hon. Gentleman did not raise that matter; nevertheless I would like to get an answer on the record. I think the hon. Gentleman did not introduce it tonight because he knows the answer. The answer is that the planning authority, which is Cardiff, does not permit building above ten storeys.
There are several other points. I made notes of some of them, and there are others, perhaps not so important as those which I have been able to talk about tonight. I will certainly write to the hon. Gentleman to answer the points of detail which he mentioned.
I should like to say something in conclusion. It is very easy to criticise the weaker features of the winning design by reference to the best features of the other entries. What the assessors had to do was to select the best overall design of those submitted. This proposed hospital represents a considerable advance 332 on what has gone before. Inevitably hospitals take a long time to design and bring into operation, and, with an expanding hospital programme, they must be overtaken by new conceptions embodied in a later model before they are off the production line. I have already said that the hospital gives the promoters what they want. They have examined the design carefully in the light of the numerous criticisms and are satisfied that the completion of the process of preparation of detailed sketch plans which is now going on will give them a modern and efficient hospital and a medical teaching centre.
It is at this stage that the Minister's approval will be required for the detailed sketch plans, which I hope answers the last point that the hon. Member made with such emphasis. This hospital will be a considerable forward step in the orderly progress of hospital design in a rapidly evolving world of medical practice and building technology. I think it is premature at this stage to be too critical of the detailed planning because, as I have tried to explain, the details have still be filled in, and that process is taking place now.
I am aware of the concern which the hon. Gentleman has expressed. It is my earnest hope that, when this hospital is completed, the Welsh people will have a hospital in accordance with their wishes and a hospital of which they, the Welsh people, may be proud.
§ Question put and agreed to.
§ Adjourned accordingly at half-past Ten o'clock.