§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Finlay.]
§ 11.15 p.m.
§ Mr. Robert Mathew (Honiton)I am grateful for the opportunity to raise the question of the future of Exmouth Hospital and to express the strongest possible protest against the proposal contained in the Hospital Plan, the Blue Book, to change the status of this hospital from a general hospital to a hospital specialising in the care of old people, from acute to geriatric.
This decision has been greeted with almost universal dismay in Exmouth. There can be scarcely an intelligent person in the area who does not regard the proposal as utterly wrong. Protests have been registered by the Exmouth Urban District Council, the Lympstone Council, the Withycombe Raleigh Women's Institute, the Red Cross, St. John's Ambulance, the Exmouth Branch of the Business and Professional Women's Association, and, I may add, for the benefit of hon. Gentlemen opposite, the local Labour Party.
In addition, the medical staff committee disapproves wholeheartedly and is convinced that the loss to the local community would be irreparable, and the Exmouth Hospital House Committee takes the same view, as do the Friends of Exmouth Hospital League who, as my hon. Friend knows, have done a great deal of work for this hospital.
The preface to the Blue Book states:
Hospitals are for people and exist to serve the public.May I point out to my hon. Friend that here an attempt is being made to rationalise the hospital service, and among those to be rationalised is a large body of patients who will be put to a great amount of trouble to obtain a service which they have previously enjoyed very much more easily.The plan appears to cut right across the policy of the British Medical Association, as recommended in the Platt Report, that there should be more, and not fewer, general practitioner beds, where the general practitioner has the opportunity of looking after his patients 1118 throughout the whole course of the illness, with diagnostic facilities for doing so. It is apparent that the family doctor welcomes his increased responsibility. There is no doubt that it raises his morale, his stature, and, indeed, his status in the eyes of his patients. Should it become possible to include beds for general practitioners in the new district hospitals, it can only affect and help those in the immediate neighbourhood of this hospital, and it would be impossible to replace for many others amenities now enjoyed by family doctors in the general practitioner hospital.
I should like to remind my hon. Friend that the President of the Royal College of Surgeons recently said that if British medicine is to remain British medicine it must not pay lip-service to the general practitioners, but give genuine admiration and support. It has been stated with great emphasis by many consultants that where the doctors had a local hospital wherein they could look after their own patients themselves there was a far higher standard of general medical practice, and the fact is that there is no substitute for the general practitioner. No hospital plan can ever replace the family doctor as the centre of medical care. Any objection that may be made that small hospitals can be uneconomic or inefficient may in certain cases be economically true, but it is not true at all in terms of human needs.
I need not stress to my hon. Friend the fact, of which she will be aware, that Exmouth is a rapidly growing town, and a very prosperous one. The population is now about 20,000, and is growing. There is a high illness incidence, and I should point out that the population may be nearly double during the five months of the holiday season. If Exmouth Hospital ceases to be an acute hospital, or general hospital, many hundreds of people will have to travel a considerable distance to obtain the attention they now receive, both acute medical and surgical, in their own town, and in the care of their own doctor. In those conditions, the general practitioner is his own house officer, and is glad to be so.
I think that my right hon. Friend will concede that this is a first-rate hospital, of which everyone in the area is justifiably exceedingly proud. It may well be —in fact, I concede at once—that there 1119 is need for more geriatric beds, but I submit that those should be in addition to the present facilities. There are already a number of convalescent homes, eventide homes, homes for the aged, residential homes, homes for the blind and private nursing homes in the area, and there is a case for an increase in the number of geriatric beds. There is also a case for an extension of the maternity services in this hospital. I shall submit that the eventual plan should envisage both geriatric and maternity wings, with a total of about 70 beds in the hospital.
The views of the consultants working in the hospital have been sought and, without exception, they view with grave disquiet the proposal to turn the Exmouth Hospital into a geriatric hospital. Apart from the great deal of major and intermediate surgery—which, together with minor surgery, has amounted to more than 600 cases a year—there is a greater and equally important amount of acute medical work, and a heavy load of geriatric patients.
I would point out that the local position will not be made any easier if the Minister's plan, or possible plan, to do away with the Budleigh Salterton Hospital is also carried out. Budleigh Salterton is only a very few miles away, and this intention has caused further indignation. I will, in due course, submit to my right hon. Friend the strongest possible case for the continuation of that hospital, but the whole situation will be exacerbated if both proposals are carried out. If one takes the whole future situation into account, the large number of cases I have cited, together with those appearing in the casualty, X-ray and physiotherapy departments, I submit that in this particular case the district hospital may well be completely unable to cope with the growing number.
My hon. Friend will no doubt say that the distance to Exeter is only about 11 miles but, in fact, because the Exmouth hospital services cover a very much larger area it could be anything up to 17 miles. During the height of the holiday season, on overcrowded roads, I have little doubt that the ambulance service would be strained to breaking point, valuable time would be lost, and the general practitioner denied the opportunity of looking after his patient during the whole course of the incident.
1120 Apart from the approaches made to me and to the Minister from my constituency—which, incidentally, includes a petition that has already been signed by a very large proportion of the whole population—approaches have been made to me and, I think, also to the Minister, by a number of organisations and people outside my constituency who are alarmed at his proposal. I submit that this is really a calamitous proposal, and I urge the Minister to have second thoughts before it is too late.
I often feel that such decisions are arrived at in Whitehall—or, in this case, in Savile Row—by experts who regard the whole United Kingdom as one vast conurbation, but what is suitable and practical in the London suburbs or in the Birmingham area is totally impracticable in rural Devon. Exmouth is not a very large town but it is a considerable centre. The police headquarters for the division and a number of other things of that sort make it comparably a much larger and more important centre than its population would indicate in the overcrowded areas of the Midlands or in the neighbourhood of London.
I put it to my hon. Friend that the voice of the people of Exmouth has spoken in unmistakable terms. The Minister has received a number of petitions and appeals already, and I ask my hon. Friend to act. I suggest that this action should be that, first, the Exmouth Hospital should be put back on the acute list immediately—and by all means let this decision be reviewed in five years' time. Secondly, the hospital should be enlarged and a very necessary geriatric ward added. I suggest also that there should be a maternity unit. There is great need for it in the area and there is no place more suited for a 12-bed maternity unit than Exmouth. I appeal with some confidence to my hon. Friend to recognise that there has been a wrong decision and that this wrong policy decision should be righted before it too late.
§ 11.26 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)First, I should like to assure my hon. Friend the Member for Honiton (Mr. Mathew) that those of us who work at the Ministry in Savile Row and who represent in Parliament areas in the 1121 Midlands know and love the West Country.
My Lon. Friend has raised as a constituency matter an issue—the future of the small hospitals—which will arise in many parts of the country as we go forward with the development of the hospital service foreshadowed in the Command Paper which was published on 23rd January last. This subject was touched upon by my right hon. Friend the Secretary of State for Scotland and other hon. Members in the debate on 4th June on the Hospital Plan, but I think it useful, and I am grateful to my hon. Friend, to have another opportunity of putting before the House the broad principles which arise, and that we should consider the application of those principles in a particular case.
The proposals set out in the Command Paper are based largely on the concept of the district general hospital. This is not a new idea, but rather represents the result of a process of evolution. There has been an increasing realisation in recent years that we shall have the full benefit of the resources of modern medicine in treatment and diagnosis only if we concentrate them in hospitals which offer the full range of treatment, except perhaps for those specialties, sometimes called super-specialties, such as radiotherapy, neuro-surgery and plastic surgery, which need a relatively large catchment area and which would be provided only at certain hospitals.
The district general hospital will normally be of 600 to 800 beds, serving a population of 100,000 to 150,000. Some might be larger and some smaller, but few would be of less than 300 beds. Clearly, the development of district general hospitals must have its effect on the pattern as a whole and, in particular, on existing small hospitals.
We have suggested in the Command Paper how we think that this is likely to happen. There will be cases where the provision of a district general hospital quickly attracts the acute cases which would previously have gone to small hospitals not very far away. In other cases, it may be agreed that an existing small hospital could more usefully serve for older patients who have no acute condition, but who need prolonged hospital care and can best receive 1122 it in the area with which they are familiar. My hon. Friend spoke of the need for this care and for more geriatric beds in Exmouth, and I think that he will agree that, of all cases, these, which are frequently long-term cases, are in a special category calling for treatment in their own home area and their own surroundings.
§ Mr. MathewI agree that that is so, but the suggestion is that that must be, additional, without destroying the great tradition built up around the general practitioner which is so valuable to the local community but which will be utterly destroyed by the district general hospital.
§ Miss PittI am coming to the general considerations, but I wanted to make clear that the provision of local geriatric beds does make a special call on local facilities.
In other cases, these small hospitals may be retained as maternity units, and some, in the more remote areas or where isolated towns receive an exceptional influx of seasonal visitors, may continue to receive medical emergencies which do not require specialist facilities. For the main part, however, we believe that the provision of comprehensive services in district general hospitals will be readily accepted by the people as the best and most practical means of placing the full range of hospital facilities at the disposal of the community; and we believe that people will also readily accept that this outweighs the disadvantage of longer travel for some patients and their relatives.
It is a matter of balance, I think. If we wish to provide the widest range of medical and surgical facilities, with all the equipment to serve them, to attract the best consultants to the service and to give consultants the opportunity of contact with other members of their profession—and this with one idea only, that is, providing to the people who receive the service the best quality that we can obtain—then, on balance, we must come down in favour of the district general hospital. I believe that that would be the approach of all those concerned when thinking in terms of obtaining service for those of their relatives 1123 who have to go into hospital, even though it might involve longer travelling.
The Devon and Exeter area, with a population of 529,000—expected to rise to 549,000 by 1975 is at present served by a total of 55 hospitals, 36 of which are of less than 50 beds. As is stated on page 196 of the Command Paper, it is the policy to concentrate services so far as possible in district general hospitals at Exeter, Torquay and Barnstaple, retaining small hospitals where circumstances make this necessary. My hon. Friend is particularly concerned about Exmouth, which is only about 11 miles from Exeter, and he mentioned also Budleigh Salterton which, if my knowledge of local geography serves me aright, is about three miles away. Both raise the same point about a small hospital which has given good service to the community.
At present, acute work in Exeter is carried on in the Royal Devon and Exeter Hospital and the City Hospital, with the West of England Eye Infirmary and the Princess Elizabeth Orthopaedic Hospital making their special contribution and, of course, serving a wider area. Plans are, however, under consideration for a new district general hospital at Wonford, on the outskirts of Exeter, which will not only permit but will demand a rethinking of the shape of hospital services in this part of the area.
Exmouth Hospital, like many others in the West Country and elsewhere, owes a great debt to the service given by local general practitioners, and I am very glad to join my hon. Friend in paying tribute to the part they have played. We look forward to continued and strengthened association of the general practitioner with the hospital service and this is made quite clear in the Hospital Plan. It was also repeated at some length by the Minister in the debate on 4th June, to which I have referred, when my right hon. Friend stressed that it was perhaps right that the last words in that debate should be concerned with general practice and with the patient as an individual and a human being. I feel that that emphasises the importance which we attach to the continued contribution of the general practitioner to the hospital 1124 service and, indeed, to the community service.
I wish also to mention that among the plans for the Wonford development is a medical centre, to be financed by a local trust, where doctors from the surrounding area can meet their hospital colleagues and thus keep in touch with their cases referred to hospital. I do not propose at this stage to argue in detail what should happen in the case of any particular hospital likely to be affected, because no final decisions have been made. But I should like to draw the attention of my hon. Friend to three matters.
In the first place, it is stated in the preface to the Command Paper—and this was underlined by Government spokesmen in the debate on 4th June—that the intention is that the proposals of the Command Paper shall be reviewed annually. Secondly, as my right hon. Friend stated in the same debate, the Command Paper makes clear that except where specific decisions have already been announced, it does not finally commit the individual details of closure, change of use, or of new building but, as and when the time comes when each executive decision has to be taken by regional hospital boards, the boards will be anxious to consider the views of informed local opinion and indeed will usually take the initiative in so doing. Thirdly, I would point out that the first ward blocks at the new Wonford Hospital are not likely to be in operation until the second half of the decade and it will thus be 1970 or later before we shall be able to judge the effect of the new hospital on other hospitals in the area.
My hon. Friend asked for an assurance that there would be no change for five years and that the Exmouth beds shall remain designated as acute for this period. I can say that the beds at present are acute and will remain so for at least five years. There is, as I hope I have made clear, provision for annual review of the plan and for local discussion and consideration of local views before any decisions are finalised. At this stage, therefore, the question of review, as has been said by my right hon. Friend, is primarily a matter for regional hospital boards, because they are responsible for planning in the area. No doubt my hon. 1125 Friend will be glad to know that representatives of the South-Western Regional Hospital Board have arranged to receive representations from the urban district council on 10th July, and I have no doubt that the council will be fully informed so as to represent all the local views, which my hon. Friend has listed tonight, about developments in Exmouth.
1126 I hope that that will go some way to satisfy my hon. Friend that local consideration is a very live and important part of the developments in the hospital field.
§ Question put and agreed to.
§ Adjourned accordingly at twenty minutes to Twelve o'clock.