CONGLETON WAR MEMORIAL HOSPITAL (Hansard, 20 February 1963)

§ Sir Arthur Vere Harvey (Macclesfield)

I am grateful to be able to raise the question of the possible closure of the Congleton War Memorial Hospital in my constituency. The Minister of Health has a long-term plan—admirable in many respects—for dealing with the hospital services. This includes between 1,200 and 1,400 hospitals which will or may be closed, and Congleton War Memorial Hospital comes in the latter category, although it is by no means certain.

If I may, I will give the background of this hospital. It was built in 1924 and was paid for by the local people. It was opened by His Majesty the late King as a memorial to 243 men who gave their lives in the First World War. When His Majesty opened the hospital he said: The hospital will always be a reminder to generations to come of the prudent and generous instincts of the townspeople of Congleton, and it is my earnest hope that it may be regarded by those who will follow in your footsteps as an inspiration. Little did His Majesty think at the time that here in the early 1960s the closing of the hospital would be under consideration.

The Minister's plan, as known, has caused the greatest indignation in my constituency. I shall be quite frank about it. As a result, a mats meeting 600 was held at the town hall on 18th September, 1962. There was an overflow of some 2,000 residents, and the meeting was presided over by the mayor. It was unanimously resolved to oppose by every constitutional means any move to prevent its closure or to curtail its present comprehensive service.

In the month which followed a petition was organised which was signed by 24,000 residents in the locality. I am glad to say that after some negotiations my right hon. Friend the Minister of Health received His Worship the Mayor of Congleton and myself last week, and we discussed the matter then.

Until the inauguration of the Health Service in 1948 this hospital was maintained, first, by an industrial hospital fund, to which every worker in the borough contributed 1d. per week; secondly, by the proceeds of an annual hospital carnival; thirdly, by private subscriptions; fourthly, by bequests and the proceeds of special efforts, and, fifthly, by the income from private wards. The hospital has undoubtedly rendered an excellent service over a period of years.

I am told—and, indeed, I know—that during the 24 years of its existence the hospital has been acclaimed to be one of the finest general practitioner hospitals in the country. In fact, Congleton and Biddulph send in acute medical cases which cannot be treated at home, such as acute pneumonia cases necessitating constant antibiotic treatment by injection and cardiac cases in a state of decompression.

The Minister of Health has always stressed the importance of general practitioner beds in general hospitals, and the fact that the regional board in conjunction with the local management committee has spent something like £60,000 in recent years on erecting a first-class maternity ward seems an extraordinary thing to do if the hospital is not going to last a great number of 601 years. No other such department exists within many miles of Congleton.

The same applies to the excellent X-ray department. The hospital has a useful pathological laboratory with the daily attendance of fully-qualified technicians and the weekly attendance of consultants. It also has an up-to-date physiotherapy department, and it enables nursing cases to be accommodated and treated in the home town. This means a lot to old people and children who would otherwise be sent many miles for treatment, and this would involve them in costly journeys. Many poor people would have to spend 3s. or 4s, in fares to get to the nearest hospital.

In an industrial town like Congleton accidents take place, and early treatment can be given by the hospital in such eases. Congleton is an expanding borough. Three new schools and a grammar school are to be built. A more important factor is that the local hospital assists in the recruitment of nurses. Since 1952 the hospital has been a training school for pupil nurses.

I can well understand the Minister's Hospital Plan, but the Congleton War Memorial Hospital is not an unwieldy Victorian type of hospital. It compares with any other hospital in present-day standards. It is highly efficient and extremely well run; in fact, it compares with most.

Congleton is a borough whose Charter goes back to the twelfth century, and the hospital is its mast valued possession. The Minister, in correspondence with the regional board, has said that nothing may happen for 10 years, but this hospital is on the list of those which may be closed, and I cannot stress too strongly the indignation felt by local people who have paid for and built this hospital themselves.

The population in the area is constantly shifting. Only yesterday we were told by the Minister of Housing and Local Government that Manchester, as part of its long-term plan, is to send more people to live in Macclesfield, Winsford, and elsewhere. It may be that Congleton will have to receive some of the Manchester people. I can see the necessity far a long-term plan, but I think it would be better to have a list of hospitals which are definitely to be 602 closed, and not name hospitals which may remain open depending on events.

I am glad to have had the opportunity to place these facts on record. No doubt the matter will not be decided by my right hon. Friend, or even by his successor. The decision may be three or four Ministers away, but I hope that nothing will be done to lessen the importance of this hospital. In view of the part it has played over the years, I am sure that some useful form of service can be found for it in the years ahead. I ask my hon. Friend to give me as full an assurance as possible regarding the future of this hospital which means so much to my constituents.

§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

I am glad that my hon. Friend the Member for Macclesfield (Sir A. V. Harvey) has chosen to speak tonight about the possibility of closing one of our smaller hospitals. He has done so with eloquence and feeling, and I shall do my best to allay the fears to which he has given expression and to answer the questions he has put.

The prospect of closing any hospital that has given good service is one that naturally disturbs the community it serves and prompts sentiments of regret. This is particularly the ease where, as with the Congleton War Memorial Hospital, there are exceptionally close links between the hospital and the community. Yet, for reasons which I hope to show, it is inevitable that some, indeed many, of our smaller hospitals must ultimately be closed as part of the price of progress in medical care.

What must always come first is the patient, and if he is to be provided with the best that modern medical science can provide, then change in the pattern of the hospital service is bound to come and should, on that account, be welcomed. That is why, in answering my hon. Friend tonight, I should like to speak first about the trends, one might even say exciting trends, which are shaping the course of events.

Over the last 30 years there have been far-reaching changes in medical practice. Among the more important of these have been the revolutionary change-over from empirical to scientific methods of 603 diagnosis and treatment, and the introduction of a wide range of new and powerful drugs. These changes have been accompanied by increasing specialisation in the different branches of medicine and by recognition of their growing interdependence. A patient needing hospital treatment today usually requires the attention not only of one physician or surgeon but also of other specialists such as radiologists, pathologists and anaesthetists and the use of complicated and expensive apparatus. However, efficient they may have been in the past, and still are today, it is simply not feasible for small hospitals to provide the full range of services required for the practice of modern medicine.

Undoubtedly, therefore, the most effective way of providing modern hospital care is in large hospitals where a wide range of services and of skills can be brought to bear at all times and—this is an important consideration—where the limited resources of highly-skilled specialist staff needed to provide these services can be mobilised and used to the best advantage.

Hon. Members will be aware that just over 12 months ago my right hon. Friend published a Hospital Plan for England and Wales in which is described a dramatic programme for the development of our hospital services over the next decade. For the reasons that I have just given, the central feature of the pattern of hospital services on which that plan is based is the development of what we term district general hospitals.

These district general hospitals will provide patients with a single centre where they can receive diagnosis and treatment, without reference from one hospital to another. They will also enable the doctors and medical technicians to exercise their special skills working in close contact with each other. These buildings will provide in one group a wide range of treatment and diagnostic facilities for both in-patients and outpatients. In addition to medical and surgical units, most of them will also include a maternity unit, a short-stay psychiatric unit, a geriatric unit and facilities for infectious diseases. These new hospitals will be designed to ensure that diagnosis and treatment can be provided under the most favourable con- 604 ditions in buildings which will allow all concerned to use their knowledge and skill to the best advantage.

Normally these district general hospitals will have between 600 and 800 beds serving a population of 100,000 to 150,000. I think I am right in saying that the population served by the Macclesfield Hospital Group is now approaching the lower of these limits. Some may for special reasons be larger than this and others may be smaller, but a district general hospital can rarely be of less than 300 beds since a hospital smaller than this will normally be unable to provide the required range of facilities.

I listened carefully to what my hon. Friend said about the Congleton War Memorial Hospital. It is typical of many of the smaller hospitals built under different conditions up and down the country in past years. None can deny that the staff of these hospitals have given and continue to give devoted service, all the more praiseworthy because it is often given in outmoded and unsatisfactory working conditions. But as the impact of the development of district general hospitals is felt, it is inevitable that many of these small hospitals will no longer be required for their present purposes. Some may be retained as maternity units in areas where the distance to the district general hospital justifies this; some will provide long-stay units for the care of the elderly, where elaborate treatment is not necessary; others may be retained to provide services for outpatients or for emergencies. But for many the right course will be closure.

These smaller hospitals have a tradition of service to the communities in which they are situated, and I fully agree with my hon. Friend that the initial reaction to any suggestion of closure will be one of regret and even of protest. In one sense, I think this is a gratifying sign of the appreciation by the local community of the devoted service given in these hospitals, and I am sure that this is very true of Congleton. However, when the new hospitals are ready, the benefits that they will bring to patients and to the staffs will be seen much more clearly than is possible now, and many who are doubtful now will see the wisdom of what has been done. I am sure that my hon. 605 Friend would agree that it would be unwise to ignore these benefits which are so clearly in prospect when we are discussing the future of any small hospital, however valuable its services may have been and may continue to be for some years to come.

Equally, it would be very unwise to be dogmatic about the future in the field of health. Here perhaps I might emphasise once again that my right hon. Friend has made clear more than once that the Hospital Plan does not represent final decisions either on the change of use or on the closure of small hospitals. A final decision on the closure or the future of any hospital will not be taken until the alternative provision for the services it provides is already coming into use, which may be many years from now. The choice between continued use for similar or different purposes or closure will then be taken in the light of the needs of the area as they are then found to be.

Before any hospital is closed, hospital boards are required—and I know that they will be anxious—to consult the bodies concerned with the provision of health services in the area in which the hospital is situated; that is to say, the local health authority, the executive council and the local medical committee, and also to arrange, either by public meetings or by statements in the Press, that all interested bodies have an opportunity to express their views. When this is done the board must report to the Minister, and the final decision will rest with him. As I have indicated, his decision will be taken in the light of the situation as it then exists. It is conceivable that at that time needs will have to be met which cannot at present be foreseen. I think that was underlined by my hon. Friend's reference to the population growth in his constituency. Here is an imponderable which makes any kind of forecast very difficult indeed at this stage.

The final judgment in a matter of this kind will depend not upon the population now, but what it is likely to be in 5, 10 or 15 years from now, when the decision has to be made. On the other hand, while it is clearly premature to take decisions far in advance, it is necessary for us to plan ahead now. Modern hospitals are complex and costly buildings 606 which take years to plan and erect and we must work on the basis of providing the best service in the light of our present assessment of what is needed and this certainly points to the development, in our view, of large district general hospitals.

Having said that, I turn now to a closer consideration of the future of Congleton War Memorial Hospital against the background of the kind of development which I have just outlined. The War Memorial Hospital is in the Macclesfield and District Hospital Group which has just under 500 beds in seven hospital units. Macclesfield is at the centre and Congleton, with a population approaching 17,000, is the only other borough in the group. Three of these seven hospital units, providing 311 beds, are in Macclesfield. One providing 43 beds is in Prestbury, about three miles by road from Macclesfield. One providing 24 beds is at Alderley Edge, about six miles from Macclesfield. The remaining two are at Congleton which is about eight miles from Macclesfield. The two hospitals at Congleton are the War Memorial, which provides 10 general practitioner maternity and 29 general practitioner acute beds, and West Heath Hospital which has 55 beds for the chronic sick.

I endorse much of what my hon. Friend has said about the War Memorial Hospital. With its general practitioner maternity and acute beds, its outpatient, physiotherapy and X-ray departments and its operating theatre—on which considerable work has been done in recent years —it provides a most useful service. Consultant cover is provided from the Macclesfield units. However, I have explained the trend in hospital development which we must follow if we are to provide our people with the most up-to-date medical care—and if we are to provide the people of Congleton and district with the most up-to-date medical care—and accordingly the development envisaged in the Hospital Plan for this area is the construction of a new modern district general hospital in Macclesfield, including a maternity department, to start before 1970–71, where provision would be made for the work now done at all the other hospitals in the group. The future of these existing small hospitals, including the War Memorial, will be for consideration nearer the time that the proposed development takes place.

607 The Manchester Regional Hospital Board is holding meetings in each of its hospital planning areas, at which the principles and details of hospital plans are put to representatives of local bodies. No such meeting has yet been held for the Macclesfield Group and there will therefore be ample opportunity in the future for the plan for the group to be fully discussed by all concerned. However, as my bon. Friend mentioned, a deputation from the Borough of Congleton has been received by the chairman and a committee of the Manchester Regional Hospital Board, and at that meeting the chairman of the board pointed out that in any event it would be seine years, certainly not earlier than 1968 or 1969, before the decision regarding the War Memorial Hospital's future had any practical importance. My hon. Friend mentioned also that before the regional board could come to any final conclusions concerning the hospital services in the Macclesfield and District Group as a whole there would be an area conference at which all interested parties, including the local authorities, would be represented and that this was likely to take place in about two years' time.

I do not think that it would be reasonable to expect the regional hospital board to go further than this at present. Nor is it possible for my right hon. Friend to do so. I can, however, assure my hon. Friend that both the regional board and my right hon. Friend will give full consideration to all the views which have been put forward—the views which he himself has expressed here tonight, and the views which will be expressed at the conference in two years' time—before a final decision is reached.

I do not think anybody who heard the speech of my hon. Friend could have failed to be impressed, perhaps moved, by the eloquent plea he made for his local hospital. I can assure him that no decision as to its future—or, for that matter, the future of any small hospital in the country—will be taken lightly. Consideration will be given to ensure that wherever appropriate some useful role will be found.

Whatever the pattern of hospital provision which finally emerges in the Macclesfield area—or, for that matter, 608 in any other area—my right hon. Friend and I earnestly hope that the interest and support of the local population and the voluntary help to the hospitals which stems from it will in no way be diminished. Opportunities will continue to exist for voluntary service in support of district general hospitals as well as of those smaller and more local hospitals which will continue to function. We very much hope that this service will continue to be given, based on the same sense of pride and affection which underlies the reluctance to accept the possible closure of some of our existing hospitals. I trust that there will always be a place for loyalty and affection between a hospital and the community it serves. I mention this in particular because of the great affection which the people of Congleton have for their hospital and for all who work there.

There is one point to which I would especially draw the attention of my hon. Friend. The medical staffing of Congleton War Memorial Hospital, as of many hospitals of its type, is provided by the general practitioners of the area. I emphasise that the transfer of work from small hospitals staffed by general practitioners to larger hospitals does not mean that the general practitioner will have a smaller part to play in the hospital service in the future. On the contrary, we very much hope that his contribution will be strengthened. Reviews are now taking place in all areas following the report of the Platt Committee on the medical staffing structure of the hospital service and the importance of the contribution that can be made by general practitioners is very much in mind and will, I am sure, find recognition.

We have had a useful debate and I ask my hon. Friend to accept that we are not trying to force through a plan without regard to the interests of those for whom the hospital service is provided. The very reverse is the case. What determines all our forward planning for the hospital service of the future is our resolve to bring to the patients the best that modern methods of diagnosis and treatment can provide and to ensure for those devoted and highly-skilled persons who minister to them the best of working conditions.