§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peel.]
§ 10.29 p.m.
§ Mr. Brian O'Malley (Rotherham)
I raise the question of hospital accommodation in Rotherham on the Adjournment tonight because of the widespread concern and dissatisfaction in the town about the size of the waiting lists. This was a notable feature of the complaints and statements made to me during my by-election campaign in March this year.
In July this year, the Health Executive Council of Rotherham wrote to me through its clerk expressing its dissatisfaction at the priority which Rotherham had been given in the 10-year plan, Cmnd. 1604, for the building of a new district general hospital. Other organisations in Rotherham have expressed similar views, including a number of trade unions and the Business and Professional Women's Club. I understand that at a recent divisional meeting of the Rotherham branch of the British Medical Association a sub-committee was appointed to investigate die whole question of hospital accommodation in the town.
The noticeable feature of this concern with the waiting lists in Rotherham and how it differs from the concern which obviously exists all over the country is that the argument being put forward by many people and many organisations in the town is based on their feeling that the priority which has been given to the building of a new district general hospital in Rotherham is wrong; in fact, that it has been wrongly placed in the second quinquennium of the ten-year plan. Therefore, this evening my main concern is to raise the question of the priority, since I have been writing to the Ministry of Health since August of this year and have not got any satisfactory replies. What I am primarily concerned to establish is what the reasons for the priorities are.
First of all, however, I should like to raise two other points for the consideration of the Joint Parliamentary Secretary. The first concerns the Listerdale Maternity Home where there is a practice of 356 discharging women 48 hours after their confinement. It is a practice which is basically the result of pressure of bed shortage. Nevertheless, the staff are doing their best to work the system, but are encountering great difficulties at the moment. In 1960 there were between 550 and 600 deliveries at the maternity home. The number has now jumped, I understand, towards 1,000, and without any proportionate increase in staff. Therefore, one fears that the standard of nursing, the time which midwives can give to women in labour, the supervision of breast feeding for long-stay patients, are suffering. Therefore, I would ask the Minister if he would take up with the hospital management committee the question of a further labour ward and the question of the employment of extra mid-wives, nurses and also clerical assistance.
I raise this point because the hospital management committee is apparently dragging its feet, and has been on this issue since May of this year, and I believe that this simply will not do, for we are concerned about the large numbers of women who are going into the home for confinement.
The second point I wish to raise is that of existing buildings, and I raise it because we cannot have a new hospital there in the immediate future and it would appear that if the priorities which are at present in operation continue we shall not have a new hospital there till about 1975. Yesterday I had a letter from the chairman of the Sheffield Regional Hospital Board telling me that various improvements were to be made, but since we shall not have a new hospital, apparently, for some years, I would stress to the Parliamentary Secretary the importance in Rotherham of having a new operating theatre at Doncastergate Hospital. We need two new wards there. I understand that the management committee is pressing Sheffield Regional Hospital Board to provide these. Particularly are we in need of another female surgical ward. When one goes round the hospital one is particularly impressed by the shortage of an adequate urine testing room, a shortage even of wash basins.
There are girls working in the records department at Doncastergate Hospital in craft conditions reminiscent of the 357 worst years of the last century. I have wandered around the health authorities, the factory inspectorate—anywhere I could—to see if something could be done about the disgraceful conditions in which these girls are working, and although I understand that nothing can be done through legislation at the moment, I would appreciate it if in the near future we could have some improvements in the conditions in which these girls work.
The last of the minor points I should like to raise is this. I understand from the minutes of Sheffield Regional Hospital Board of 9th September this year that 537 beds in the region were closed during the last year, and I should like to know if any of those were in Rotherham hospitals.
The major point that I wish to raise is the question of the priority, which I consider to be wrong. I sent a memorandum to the Minister in August in which I demonstrated statistically and in considerable detail that there was an overwhelming case for the building of a new district general hospital in Rotherham at an earlier date than the vague one that we have beengiven—some time in the 'seventies.
First of all, the localities and the organisations therein were not consulted. It is true that the health executive, the county borough and the local medical committee were asked for their opinions about the scheme on the broad plans for a new hospital, but at no time were the statistical criteria presented to demontrate that we were in our proper place in the queue.
I have had letters from the Parliamentary Secretary and recently from the chairman of the regional hospital board. The Parliamentary Secretary completely avoids my question: what were the statistical criteria? I believe that Members of Parliament and the public have a right to know the reasons underlying decisions taken by public authorities and boards. The chairman of the board has largely ignored my question.
On the revised plan, I want to ask one thing. I understand that on the new population projections we shall have only 3.2 acute beds per 1,000 population in Rotherham by 1975 while the national average is to be 3.4 beds per 1,000. Rotherham is an area of considerable in- 358 dustrial pollution of the atmosphere, and there is a high incidence of bronchial diseases.
Lastly, with the priority which we are given, in 1960 the Sheffield region had fewer acute beds per 1,000 population than almost any other region in the country. The board has recently acknowledged to me the urgent need for other hospital accommodation, and when it says that at the moment it cannot do any more I put the blameand onus on the Ministry because it seems to me that the allocation of money per head of the estimated 1975 population is a grossly unsure way of arriving at the correct arrangement.
The detailed figures which I sent to the Parliamentary Secretary were rejected on the ground that the area was too small to consider in isolation, and he said that comparisons should be made with Sheffield. They can be, but the statistics for other areas are similarly affected. It is also true that people from other hospital management committee areas come for treatment at Rotherham hospitals. I have looked up the improvements figures, and would like the hon. Gentleman to examine them in detail. The basic situation in Rotherham is worse than it is in other areas where improvements are being made in the 'sixties. There are fever acute beds in Rotherham than in other areas.
With regard to maternity beds, the situation in the Sheffield region is almost the worst in the country, but the situation in the Rotherham-Mexborough area is worse than any other. We have no mental illness beds, and there is considerable strain on the local mental health section. There are some areas where the general surgery priority is better than in Rotherham, where the waiting lists represent 44 per cent. of the total in the hospital management committee area. Other areas are getting new accommodation, whereas we are in the second part of the plan.
With regard to criteria, on 29th July I asked what the average waiting time was, and was told that the information was not known or was not available. I ask the Parliamentary Secretary to look in detail at the statistical criteria which have resulted in Rotherham being put into the second part of the ten-year plan, and I ask him to give me the criteria so 359 that I can make a judgment and so that my constituent can. If we cannot be given the criteria, we can only come to the conclusion either that there has been massive incompetence in high places in the planning of the priorities or that it is thought that Members of Parliament and the public have no right to know the facts. I reject this view entirely, and I hope that the Parliamentary Secretary does. I hope that in view of the situation and the accuracy of my figures, which the hon. Gentleman has not disputed—although I am quite prepared to be proved wrong—he will agree that we have an overwhelming case to be put in the first part of the ten-year plan. This is what I ask him to reconsider.
§ 10.40 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I should like, first, to thank the hon. Member for Rotherham (Mr. O'Malley) for giving us the opportunity tonight to discuss the question of hospital accommodation in Rotherham. Rotherham needs a new hospital. This, at least, is common ground between us. Hospital services are provided in a number of different premises in the neighbourhood. These premises are inadequate in the sense of not being able to provide a sufficient number of beds in various categories. They are also old, and in many ways they are not suited to meet the requirements of a modern hospital. The hon. Member has itemised a number of points which need improvement and I will, if I may, return to that aspect later.
Let me say at the outset that a satisfactory solution to Rotherham's problem cannot be found by adding to and improving any of the existing hospitals. Only a radical change, by starting afresh and building a completely new district general hospital, will solve the problem. This is what the Hospital Plan envisaged for Rotherham—a district general hospital to be started in the second quinquennium, between 1967 and 1971; and, fortunately, a suitable site is already in our possession at Oakwood Hall. The main contention, however, which the hon. Member has advanced vigorously tonight, is that Rotherham deserves to have its hospital earlier than has been indicated in the Hospital Plan.
360 It might be helpful if I devote a few moments to the general question of priorities. In 1948, the National HealthService inherited 2,800 hospitals. Of these, 45 per cent. were erected before 1891 and 21 per cent. before 1861. Even where these hospitals had been subsequently modified, many of them were quite unsuitable for the practice of modern medicine.
In the first 10 years after the war, the capital available for hospital renewal was small and even the increasing expenditure thereafter was insufficient to achieve a really adequate development programme. That was why, two years ago, the Government put in hand what can truly be described as an imaginative plan for providing the country with the most up-to-date and comprehensive hospital service in the world. Even so, despite the decision that substantially increased funds would need to be committed in future years, my Department and the hospital boards were, and are, faced with acute problems in regard to priorities.
Let me explain this. In all our planning, we have had to try to give priority to areas where the needs are most acute and to maintain a proper balance between modernisation and the provision of additional beds to meet existing deficiencies. It is quite impracticable to replace more than a proportion of the obsolete hospital buildings over the country as a whole within 10 or 15 years, nor can the historical distribution of beds in the various parts of the country be rationalised over a short period. The Hospital Plan does not purport to achieve an ideal hospital service by 1975 or, for that matter, by any date. It does, however, provide for the first time a national framework within which detailed planning can be undertaken with vigour and confidence.
I readily concede that there is a great deal to be done in the Sheffield Regional Hospital Board's area. I hope that the House will appreciate the very real problems which regional boards—not merely the Sheffield board—have to face in trying to determine orders of priority between schemes for different districts in their regions. As the hon. Member mentioned, for hospital services Rotherham has been traditionally linked closely with its near neighbour, 361 Sheffield. Many Rotherham people receive hospital treatment in Sheffield hospitals.
§ Mr. O'Malley
The hon. Gentleman will realise that a number of my constituents go into Sheffield hospitals because they cannot get accommodation in Rotherham hospitals. The link is nothing like as close as the hon. Member suggests.
§ Mr. Braine
That is true. It is also true that Rotherham in turn provides facilities for some patients from elsewhere. But, to be fair to the hon. Gentleman, Rotherham is by and large an exporter of patients.
The regional board has felt that in Sheffield the first priority should be accorded to the completion of the new teaching hospital. I think that is right. Undoubtedly, Rotherham will derive some benefit from this very important development.
But while this influences priority, I should like to emphasise that, in planning the size of the new hospital for Rotherham, the board is reckoning to provide sufficient beds to cater ultimately for all the district's basic needs within Rotherham itself. There are, of course, certain specialties which it is only sensible to provide on a regional basis at a limited number of centres. The idea is to solve, as far as is humanly possible, the Rotherham problem within Rotherham itself.
But, apart from this close association with Sheffield, how does Rotherham compare with other places in the region? The hon. Member is a doughty champion of his constituency, but one has to recognise that judgments of priorities are at least as much subjective as objective.
One cannot concentrate on just making up the number of beds short and ignore the need to improve existing facilities. The hon. Member has said that Rotherham deserves attention on both counts, and he is right. But in fact a number of places in the Sheffield region are worse off. Barnsley, Doncaster, Scunthorpe, Leicester and Chesterfield all have a lower ratio of acute beds to population. Some of these places can be helped by additions and adaptations. Some, like Rotherham, need a new hospital alto- 362 gether. I have Barnsley in mind. To change priorities now can only mean that some others of these schemes would have to be displaced. I cannot think that would be right.
Perhaps I should also make it clear—the layman does not always understand this—that there is a time factor involved in providing a new hospital. Planning and building a modern hospital is a much more complex affair than putting up a factory or a housing estate. For one thing, it involves the provision of buildings which must take account of the continuous and inevitable changes in the range, scope and character of medical care in the decades ahead.
Thus, a great deal of work goes into the detailed planning of such a scheme. To start from scratch with planning a new hospital must take longer than planning additions to an old one. The board feels that it will need every minute of the time in which to plan for the new hospital at Rotherham even to achieve the starting date at present contemplated. I must ask the hon. Member to accept that it does take a considerable period, with the best will in the world, to plan a hospital on the scale that Rotherham is entitled to have.
§ Mr. O'Malley
But the hon. Member surely knows that this new hospital has been on the stocks since 1952 and that a document was published by the board as long ago as 1955 discussing the project. What my constituents would like to know is what has been happening in this period? The hon. Member mentions places worse off. I know that Doncaster—seat of the Minister of Health—must be one of the worst situated in the country. But I dare say there are other places in the region which are better off for accommodation which were in the first part of the programme.
§ Mr. Braine
The hon. Member has ignored the point that to alter the priorities now would entail interfering with the plans for every other area in the region which is worse off in this respect than Rotherham, and, as I have said, I cannot believe that that is right, or that even the hon. Member's own constituents would want it that way. I can assure him that the regional board has told me that it will need every minute of the time that it has in which to get the hospital 363 started at the date at present contemplated.
The hon. Member and I have exchanged correspondence on this subject, and he mentioned that fact tonight. Since then I understand that he had taken up with the board his point about the basis of fact and argument on which its decision about Rotherham's priority rests. I hope that he will now feel that there is no attempt to shroud this in mystery. I know that the board is quite willing to discuss the matter further with him if he wishes.
I want to make one point absolutely plain. Estimated increases in future population are taken fully into account in the detailed planning of schemes within the Hospital Plan. In fact, the Sheffield Regional Hospital Board has recently received a new population projection for Rotherham from the West Riding County Council, and appropriate revisions have been made in the bed numbers planned for the future. Now that the bed numbers have been revised, the planning of the new district general hospital will be put in hand with the intention of starting work in 1970–71.
It is true that there are some fairly long waiting lists for admission to the Rotherham Hospital, but it is a matter of experience that waiting lists do not, by themselves alone, provide a reliable guide in assessing priorities. By selecting figures for particular specialties it is possible to indicate specific shortages of beds in many areas. If we consider the number of persons waiting per bed, the figures for Rotherham and Mexborough show that the area is in a better position than the region as a whole in some specialties, but worse in others. The total figure for the Rotherham waiting list at the end of September, 1963, was 1,949, which shows a reduction of 332 on the corresponding figure for the previous year. I am not satisfied with these figures, and I can assure the hon. Member that the regional board is continuing to examine the measures which might be taken to improve the hospital services for Rotherham during the period before the new district general hospital comes into use.
Waiting lists all over the country, not only in Sheffield, are now being 364 scrutinised. My Department impressed on hospital authorities at the beginning of the year the need to reduce them, and gave advice on various ways in which a short-term drive might help to achieve a permanently improved position.
The hon. Member mentioned the question of staff shortages and the general situation at the Listerdale Maternity Home. I have taken note of what he said. I will certainly take up one of the points he made. I do not think, however, that it is fair to say that anyone is dragging his feet. My understanding is that a proposal is at present before the hospital management committee to increase the contribution which this useful general practitioner unit of 24 beds can make to the local maternity service by a greater use of early discharge of patients in suitable cases. This would require additional staff. These proposals have yet to be considered, and I think the hon. Member would agree that in the circumstances I ought not to comment further at the moment.
Perhaps I may be allowed to say in the context of maternity needs that other schemes in the district may help as they come to fruition. Next year, for example, it is expected that an additional 20 maternity beds will be completed at the Montague Hospital at Mexborough. A new maternity unit is being provided at Doncaster Royal Infirmary and when this is completed it is intended to retain the present maternity beds in the Western Hospital at Doncaster as reserve capacity.
I promised to say a few words about what could be done in the short term to improve conditions in the existing Rotherham hospitals. The hon. Member has written to me about this. We have to set a limit to what we can usefully do to improve premises which, in duecourse, will be superseded. That makes sense. Some shortcomings cannot be tackled at all and here we must build anew. At Moorgate Hospital some improvements can be made. The regional hospital board intends to improve the operating theatre facilities and the practical problems are being tackled now with a view to the work being done next year. The vacation by the local authority of the premises known as "The Mount" and agreement to make some of the buildings available to the hospital 365 should enable improvements to be made to the kitchen. We all know how important it is to the well-being of patients to have good cooking facilities. This will also permit a central sterile supply service to be introduced.
The regional hospital board does not feel able to provide an additional operating theatre at the Doncastergate Hospital, but the old theatre is to be improved as soon as possible. A new physiotherapy department is to be built at this hospital and alterations and improvements made to the out-patient and accident departments. This scheme will also include a new gymnasium.
The hon. Member asked me about the figures for beds in the Rotherham area. I am advised that the figure for Rotherham will be about 3.1 per 1,000 population, but this will not include regional specialties which are provided in Sheffield. One can easily get confused about these figures and ratios. The whole object of the Hospital Plan is to bring to every part of the country the fullest range of facilities for treatment and diagnosis. AsI said at the beginning, many of our hospitals are out of date, and many of them are in the wrong 366 places. One should not be mesmerised by these figures. The whole aim of the Hospital Plan is to produce a comprehensive cover for every part of the country.
The hon. Member said something about the question of early discharge of maternity cases. Opinions differ about the extent to which early discharge would be reasonable or desirable even if there were no shortage of maternity beds. The Cranbrook Committee envisaged a 10-day stay in hospital with 70 per cent. of all confinements taking place in hospital. The fact is that not many hospital maternity cases give rise to medical complications. For this reason, doctors may think that early discharge is suitable.
I have, I think—
§ The Question having been proposed after Ten o clock and the debate having continued for half an hour, Mr. Deputy-Speaker adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned accordingly at one minute to Eleven o'clock.