HOSPITAL BEDS, EAST ANGLIA (Hansard, 26 July 1962)

§ Mr. J. M. L. Prior (Lowestoft)
I should like to start by paying tribute to the predecessor of my hon. Friend the Parliamentary Secretary to the Ministry of Health and to thank her for her courtesy, help and hard work. I should also like to wish my hon. Friend the present Parliamentary Secretary every success in his new appointment.
The object of this short debate is to draw attention to the need for greater provision for acute bed accommodation immediately in the Eastern Regional Hospital Board area and to the long-term plans for hospitals which were published in A Hospital Plan, Cmnd. 1604. I certainly do not say this in any carping spirit because I am sure that East Anglians will be gratified to know that it is estimated that 18s. 5d. per head of the population will be spent this year on new hospitals or improvements as compared with 6s. 5d. in 1959 and 2s. 7d. in 1949. This is a remarkable improvement, and is the fulfilment so far of the Conservative election pledge given to improve and to start rebuilding our hospitals.
The standards of hospital provision are within limits to be laid down for the first time. At present, the ratio of beds to population varies widely between different areas, and the Report goes on to state, in paragraph 9, that detailed study is necessary to determine the right scale of local provision. It is this scale of local provision that I wish to examine.
Perhaps I should say at this stage that my hon. Friend the Member for Eye (Sir H. Harrison) wished to take part in the debate and has asked to be associated with the remarks that I am making.
I think that, like all good East Anglians, the Eastern Regional Hospital Board has been thrifty and careful in spending its money. For this it should 1872 be encouraged and certainly not penalised. I am led to believe by what I have been told that it has been penalised because it has not been ambitious enough, and this is rather confirmed by the Report appearing in one of the local newspapers, the Eastern Evening News of 19th July, which quotes Mr. C. W. Guillebaud, a member of the Board, as follows: When the Ministry had asked if the Board's ' Further Look' estimates of expenditure for the next 3 years were realistic it had been possible to show that they were unrealistic in the sense that, trying to keep to the 2 per cent. level of increase laid down by the Ministry, the Board had under-estimated its real need. An increase of 3 per cent. to 4 per cent. was required. The past pattern of hospital development has resulted in many inequalities. Some areas have always been better off than others, and it is very important to sec that these inequalities are not perpetuated in the new plan. The Eastern Regional Hospital Board has the lowest number 3.0 per 1,000 of acute beds and by 1975 under the new hospital plan it will be 2.9 beds per 1,000.
I would point out to my hon. Friend that in an adjoining area like Colchester and north Essex, which he will know well, and which is very similar in the type of development in the area generally, will have 3.4 acute beds per 1,000 under the new hospital plan. At present, the Eastern Regional Hospital Board area is 11 per cent. below the average for the country and by 1975 will be 15½ per cent. There are no adequate grounds on age structure, death or illness rates for supposing that the Board should have a bed ratio of 11 per cent. to 15½ per cent. below the rest of the country.
The recent investigation carried out by the Nuffield Provincial Hospitals Trust suggested the need for about two beds per 1,000 of the population. This was carried out at Norwich. I think that these figures are low, and it is surprising how much more a service is used once it is properly available. For example, at the new biochemistry laboratory at Ipswich the laboratory increased its work in the first year by 100 per cent. Medical experience suggests that the Minister's figure of 33 beds per 1,000 is about right.
When the Health Service began, the standard of hospitals for acute medicine 1873 in East Anglia was very inadequate. East Anglians have had a healthy—or perhaps unhealthy—contempt for hospital treatment, but this is changing very rapidly with better communications, higher education, and so on. Although the hospitals are greatly improved, much remains to be done. Over the last ten years, capital expenditure in the area has put the Board about half way up the league table of capital expenditure. That was good news, but I have tried to show how much remains to be done. The financial summary in Appendix C of the Hospital Plan shows that the East Anglian Region will drop to lowest place in the table.
I raised this debate tonight to give my hon Friend an opportunity for saying that this is not the final stage in the ambitious Hospital Plan and that the needs of East Anglians will be properly safeguarded. If he has good news for us, I hope that he will give it and earn the undying gratitude of all East Anglians.

§ Mr. Dingle Foot (Ipswich)
I associate myself with what has been said by the hon. Member for Lowestoft (Mr. Prior). Whatever the reason may be, the fact is that East Anglia is, and apparently under the Hospital Plan will continue to be, less well equipped with acute beds than any other region.
On page 3 of the Hospital Plan we read: The variations between regions are considerable. For instance, there are 3 acute beds per 1,000 population in the East Anglian Hospital Region and 5.6 in the Liverpool Region. Of course, one appreciates that there may be differences of need between one region and another, but that is a great disparity. It is difficult to understand why, except for historical reasons, the number of acute beds per 1,000 of population should be so much smaller in East Anglia than elsewhere.
As the hon. Gentleman has pointed out, under the Hospital Plan as we have it today this situation will continue. Even in 1975, East Anglia will come at the very bottom of the league table—a position to which we are not accustomed in Ipswich and Suffolk.
In my submission, the figures for acute beds given in the Hospital Plan are to some extent suspect. For example, on 1874 page 80 several figures, including the numbers of acute beds, are given. But those include 40 beds at Chantrey Park, Ipswich, and 55 at the Suffolk Convalescent Home, Felixstowe. Those are convalescent beds, and it is at least questionable whether they ought to be included in the category of acute beds.
There is great dissatisfaction in Ipswich and Suffolk about our present situation not only in respect of acute beds, but in respect of geriatric facilities and the general hospital provision. We think that we are poorly used compared with other parts of the country, and we consider that the situation ought not to be allowed to continue.

§ Mr. Kenneth Robinson (St. Pancras, North)
I congratulate the Parliamentary Secretary on assuming his new duties and I wish him well in the Ministry of Health.
What the hon. Member for Lowestoft (Mr. Prior) and my hon. and learned Friend the Member for Ipswich (Mr. D. Foot) have said about the situation in East Anglia confirms what I said about the situation nationally during the recent debate on the Hospital Plan. It seems that the Ministry have not done the research studies into acute bed need that should have been done before bringing a plan of this size forward.
I wonder whether the hon. Gentleman could reply to a point which I made then and to which the Minister did not reply, and that is, what basis of revision is to be undertaken in this plan? We are told that it is to be revised annually, and the hon. Gentleman expressed the hope that it would be as far as East Anglia is concerned. But how are the revisions to take place? We are very anxious to know, and we should like more details than have been vouchsafed to us hitherto.

§ The Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I should like, first, to thank my hon. Friend the Member for Lowestoft (Mr. Prior) for the kind reference that he made to my predecessor, a tribute, I am sure, to which all of us in the House would readily subscribe. 1875 May I thank him, too, and the hon. Member for St. Pancras, North (Mr. K. Robinson) for their kind references to myself?
I am very glad that my hon. Friend has had the opportunity to raise this important question at this particular time. Coming as I do to my new office with some trepidation, I recall the old Latin proverb, "Ad sanitatem gradus est novisse morbum," which, I understand, means, "It is a step towards health to know what the complaint is." I know, of course, that in raising this matter my hon. Friend, and also the hon. and learned Member for Ipswich (Mr. D. Foot), are voicing anxieties which exist in parts of East Anglia in regard to the hospital provision in that region —but, in doing so they furnish me with an opportunity to remove certain misconceptions and to put the matter, I hope, into clear perspective.
I fully appreciate that publication of comparative figures in the ten-year Hospital Plan of provision for the country as a whole may have given rise to anxiety in East Anglia that it will not receive its fair share of the resources available and that, as a consequence, the people of the region may get a service inferior to that available elsewhere. In particular, it may well have given rise to the fear that the number of acute beds will continue to be significantly below the average.
I concede straightaway that the provision of acute beds in East Anglia has traditionally been and still is below the national average. It is true that in present circumstances variations between regions are considerable. That is borne out in the plan itself. As the hon. and learned Gentleman said, there are three acute beds per 1,000 of the population in the East Anglian Hospital Region and 5.6 per 1,000 in the Liverpool region, and the numbers elsewhere vary between those two figures.
It seems that these variations are largely due to historical reasons though they sometimes also reflect differences in morbidity, social conditions and in the scale of local authority services. There are also great variations in the average stay of patients in hospital. Those of us who live in East Anglia 1876 know that it is a particularly healthy part of England and this may be a fact of consequence.
I go further. I do not think Chat the Hospital Plan implies that these variations will always obtain and must continue in the future. The point should be made that bed ratios per 1,000 are not meaningful in isolation. In short, the plan is not rigid and final; it is an indication of what can be achieved within a given period. Its figures are not sacrosanct, and its significance cannot be measured in terms of the number of beds.
For example, the total estimated cost of hospital building schemes expected to start in East Anglia in the period from 1960–61 to 1970–71 is £22 million. Included in this are major projects such as new general hospitals at Ipswich and Great Yarmouth, a new hospital for the mentally sub-normal at Fulbourn, substantially remodelled hospitals at Norwich, King's Lynn and Peterborough and major developments at Wisbech, Stamford and Rutland and Saffron Walden.
During that period, however, there will be a great deal of upgrading of existing accommodation and much better provision of supplementary services, so that the average number of persons treated per bed may be expected to increase. As the hon. Member for St. Pancras, North, who specialises in this subject, knows very well, new hospitals cannot be built at short notice. Indeed, if we are to provide the kind of hospitals of which we can be proud in the future, embodying all the latest techniques, there must be careful long-term planning. That is being undertaken now.
If that is so, then the short-term solution lies in making much better use of existing facilities. In this, the East Anglia Regional Board is acting with all urgency and vigour. One cannot be precise, but a great many of the small schemes that are now taking shape or are envisaged in the near future, while small in themselves, are expected in total to have a major effect on the improvement of the service in the region as a whole.
I have a particular case in mind. The House will understand if I do not identify it at this stage, because so many 1877 schemes are in course of preparation and may be modified. In one corner of the region, it is hoped that minor adaptations, changes in the use of accommodation and extensions, which have been formulated since the plan was published, will add over 40 acute beds which are not included in the plan. In fact, a continuous process of modernisation and remodelling is going on ail the time with a view to making the service more adequate to the needs of the region. I should like to dispose of one point raised by the hon. and learned Member for Ipswich. We are concerned here with the shortage of acute beds in East Anglia. Geriatric provision, to which the hon. and learned Member referred, will be above the anticipated national average level, while maternity provision will be at about the national average.
I well understand why a cursory glance at the comparative figures in the Hospital Plan might lead one to the conclusion that the ratio of acute beds per 1,000 of the population provided for East Anglia is lower than it ought to be in relation to the rest of the country. Paragraph 9, on page 3, of the Hospital Plan is careful to warn against drawing wrong conclusions from the figures. It points out that in estimating the needs in 1975, the ratios are valid only in relation to large areas and detailed study will be necessary to determine the right scale of local provision. As the hon. Member for St. Pancras, North has mentioned, the plan suggests a ratio of 3.3 beds per 1,000 of the population as the normal maximum of requirements. This is not, however, to be taken as a national minimum or as an absolute standard to which all regions and all areas within each region must conform. Comparisons between one area and another can be highly misleading without full knowledge of local conditions.
I should like to pursue that argument a little further. Paragraph 10 of the plan rightly makes the point that In arriving at these ratios it has not been possible to take full account of the potential development of services outside the hospitals or of the scope for increased efficiency in the hospitals themselves. On these grounds alone, therefore, if on no others, it would be right to look for reduction in these ratios as time goes on, unless new and unforeseen needs for hospital treatment should arise. It is clear, therefore, that the comparative figures which have given rise 1878 to the anxiety voiced by my hon. Friend the Member for Lowestoft and by the hon. and learned Member for Ipswich are themselves tentative and approximate. It follows that there will have to be considerable discussion of all major schemes by the regional hospital boards, local authorities and other interested bodies. These discussions may well modify the content of particular schemes. For example, they may lead to the provision of acute beds at the earlier stages where, in the plan, geriatric or maternity beds have been suggested.
Moreover, the 1975 figures are not final in another sense, for in a number of oases only the first stages of new or redeveloped hospitals will be completed by 1975. Thus, the Hospital Plan shows no acute beds at the new Ipswich Hospital and only 120 at Great Yarmouth by that date, and these, of course, are two major projects, very exciting projects to which we are looking forward, but they will not contribute their full potential of acute beds till after 1975.
My hon. Friend the Member for Lowestoft suggested that there is a view in some quarters that the Hospital Board ought to have pressed its case more vigorously, that it should not be penalised now—and I think that was the thought at the back of his mind— in the allocation of resources simply because it had been provident in the past and had made do with what facilities it had. I can assure him that there is absolutely no foundation for this, and would like to emphasise that the Board has not lacked skill in presenting its case, or wisdom in the way in which it has been improving and staffing its services. The Board can be assured that the good husbandry and worthy restraint it has exercised in the past will not result in the region being penalised now or in the future.
My hon. Friend also mentioned a recent statement in the Press attributed, I think, to a distinguished member of the Board, Mr. Guillebaud, as to whether the estimates of the hospital boards are realistic or not. I am advised that Mr. Guillebaud was referring to the revenue estimates of hospital boards for the next year or two. These have been discussed quite recently with 1879 representatives of the Ministry, and we hope to give an indication much earlier than in previous years of what boards may hope to receive next year and the year after. I hope that this news will be welcome to my hon. Friend and to the hospital boards.
I ought to say in passing that we have to be realistic not only in regard to what boards think they can do if they get more money but also in regard to the share of the nation's resources which can be devoted to the hospital service as a whole.
My hon. Friend represents his constituency interests with great vigour and he may wish me to say something about the situation in his own area. Admittedly, the existing services in Lowestoft and Great Yarmouth are scattered and inadequate, and both development and concentration are needed. We believe that the best solution is the creation of a new district hospital, at an estimated cost of £4½ million, on the sites of the Northgate and Estcourt Hospitals in Great Yarmouth and a provisional starting date of 1969 has been agreed with the Board. Ultimately, I understand, it should be possible to dispense with the Great Yarmouth General Hospital altogether.
I am fully aware that this lies very much in the future, but we are not waiting till then to improve the pro- 1880 vision of acute beds in the area. We hope to secure a more rational distribution of services on a functional basis by the completion of a new medical unit at a cost of £114,000 at Northgate Hospital. This unit is already under construction. It will comprise 50 beds for acute medical cases, so sited that it can be fitted eventually into the framework for the new general hospital. Moreover, the provision of this new unit will enable much more flexible use to be made of the Gorleston Hospital.
I hope that I have been able to make it clear that we are not making inadequate provision for East Anglia in relation to the rest of the country. The figures given in the Hospital Plan are tentative. They represent merely a stage in the achievement of a hospital service designed to match the real needs of the future. In other words, the Plan is subject to review, and present priorities might well be changed where experience shows this to be justified.
I am happy to give any hon. Friend and the hon. and learned Gentleman an assurance that there is no intention of permitting the provision of acute beds in East Anglia to fall below the level that experience in the next ten years shows to be necessary.