§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Finlay.]
§ 4.38 a.m.
§ Mr. Anthony Kershaw (Stroud)
I regret that it should have been necessary to delay until a quarter to five in the morning the consideration of the most important business that we have before the House. I also particularly regret that it should have been necessary to keep my hon. Friend the Parliamentary Secretary here all night when the labours of his office are so great.
I wish to refer to the hospitals in the Stroud area. The hospitals I have in mind are the Stroud General and Maternity Hospital, the hospital at Tetbury, Standish Hospital, and the hospital at Berkeley, which is in the constituency of my hon. Friend the Parliamentary Secretary to the Ministry of 1617 Housing and Local Government but is widely used by those who live in my constituency.
All these hospitals are threatened with closure, drastic alteration, or reduction in status, at some time or other, and I can say without fear of contradiction that there is not to be found in my constituency or the area near it anyone—man, woman or child—who wants these hospitals to go.
The suggestion is made in the papers we have had about this matter that in ten or fifteen years' time when the question comes for decision the new large and modern hospitals which are to be constructed at Gloucester and Bristol will provide an alternative to the hospitals to which I have referred and will be preferred by those who have to use them because of their efficiency and because of the general convenience of using them. I suggest that there is only one way in which this preference by the inhabitants of the area will be brought about. It will be, I am sorry to say, by so running down our local hospitals that even large impersonal hospitals, such as large hospitals must be which are situated far from our homes, will nevertheless appear preferable to what we will be left with.
Unfortunately, there is some evidence that our hospitals are already, by the anticipation of these events, suffering in some sort from a war of nerves which is sapping their self-confidence, reducing their reputation, and reducing their efficiency, or is likely to do so.
I do not find that the relations between the consultants who come to these hospitals and the hospitals themselves are very satisfactory. I know that the consultants are under contract to attend. I do not know the exact terms of these contracts. I know that the consultants are extremely busy men. It is obvious that, as is the case with other very busy men, the journey between their base and the hospitals scattered about the Stroud constituency and area takes some time. There is no lack of work at these hospitals. At Stroud, for instance, the waiting period for an average case for a consultant is one month and for urgent cases two weeks approximately, although this may vary in the case of some individuals. The waiting list at Gloucester, for orthopaedic cases, at any rate, is 1618 about four months. Obviously, it would be futile to transfer the work from the hospitals to which I refer to Gloucester or elsewhere, because the congestion would become even worse.
Some consultants have recently prophesied in relation to Stroud Hospital a clinical disaster, and they made proposals that Stroud should become aG.P. hospital. The consultants say that it is not possible to get good staff at the Stroud Hospital. I do not think that they are correct in this. The last two housemen at Stroud were both extremely good, so good that they left their posts after quite a short time to go to work with the consultants. I think that it is unfortunate that there has not been a meeting, such as the general practitioners in my area wish to have with the consultants to discuss this matter. I understand that the consultants as a body are not willing to meet the general practitioners to talk the matter over.
I accept that a certain number of changes should be made, or ought to be made from time to time, in the hospitals. Stroud General Hospital no doubt lies at the moment partially between two stools. It is neither small enough to provide the sort of cottage hospital treatment nor large enough to provide more elaborate treatment.
In considering what changes should be made, we should consider, among other things, the clinical needs of the area. These are rising, and they are not small now. Stroud General Hospital deals with 50,000 cases a year. Stroud Maternity and Berkeley Hospitals and the Tetbury Hospital are always fully occupied. If any changes are necessary in any of these hospitals in the consultancy service, it is more necessary that the consultants should increase their number of attendances and not seek to reduce them. It might be said that the consultants do not have the time to do this. However, I propose the appointment to the Stroud Hospital, which is big enough for this, of a consultant surgeon and consultant physician. I appreciate that that would cost a considerable amount of money, but it would reinforce the status of the hospital, make it efficient in this regard and, for these reasons, the regional hospital board should consider this proposition.
1619 The suggestion that there should be very large hospitals at Gloucester and Bristol is reinforced by powerful medical arguments. I think it is true to say that the atmosphere in a large hospital is not as pleasant as that in a small one from the patient's point of view. However, the equipment is necessarily better, more elaborate and certainly more expensive. Despite this, the vast majority of patients who enter hospital do not need elaborate equipment. I understand that about 70 per cent. of them are either very young or old. What they need is not elaborate equipment but nursing, visiting by their relations and friends, and that personal attention which the very young and old need.
We should face the fact that many people go to hospital not to be cured, alas, but to die. They do not wish, and we would not wish them, to pass their last days far from home, deprived of the comfort of their families; merely numbers on a chart in a large hospital to which they have never been before.
The smaller hospitals scattered about the area have many part-time nurses who play a significant role in their efficient running. These nurses, perhaps former full-time nurses who are now married, could not and probably would not wish to transfer to the very large hospitals some distance from their homes.
From the point of view of visitors to hospitals, Stroud is a rural area and part of it has poor bus services. The distances to the new hospitals will in some cases be twenty-five to thirty miles. The reduction in rail services which is taking place in the area, particularly over the short distance routes, will be a significant factor in making visiting to hospitals even more difficult than it is now.
Most important of all, it must be remembered that the National Health service relies largely on the G.P. It is no secret that the relationship between the G.P. and the Service is one of the most difficult problems facing the Service today, a complete answer to which has not yet been found. One thing is quite certain, and that is that the general practitioner can keep in touch with his patients and maintain that family doctor relationship with those in his care, far 1620 more easly in a smaller hospital close to his practice than he can in a very large hospital twenty or ten miles away.
I am quite certain that we have to consider not only the relationship between patient and doctor, but also the standard of skill and medical knowledge of the general practitioner who, if he is deprived of constant attendance, in company with consultants, on his patients in hospital, will necessarily suffer in his professional knowledge and interest. This problem of the general practitioner in the National Health Service cannot easily be met if the hospitals are to be removed from the area so that many of these doctors will only seldom be able because of the distance and time involved to attend their patients in these large hospitals.
The National Health Service is not for the convenience of the administrators. It is not for the convenience of the consultants. It is not even for the convenience of the doctors. We are not trying to create a Health Service fit for a doctor to work in. As we all know, and should constantly remind ourselves, the National Health Service is a service for the patient. It is paid for by the individual taxpayer, and the democratic right of the taxpayer ought also, to some extent, to be regarded. None of these, the patient, the taxpayer, whoever he may be, wants our hospitals in the Stroud area, or in any other part, to be run down, and I find it hard to believe that they will ever reconcile themselves to the alteration and reduction in status they fear. They have a right to be heard.
I believe that our hospitals in the Stroud area are at present medically efficient. They are sustained by the affection and activities of very many private citizens. The Stroud, Berkeley and Tetbury Hospitals all have very strong friends-of-the-hospital organisations, and I am sure that this energy could not be transferred to the big hospitals far away and comparatively impersonal to those who live in our area.
If our hospitals are first run down and then closed down in the name of some pretended efficiency, some of the humanity will be lost to the National Health Service, much worthy and expert opinion will be saddened and disappointed, and I do not believe that the result can be to the advantage either of those who live in 1621 this part of Gloucestershire or of the National Health Service as a whole.
Finally, may I ask one question? The new ward now ready at Cashes Green geriatric hospital is not being used, and I should like to know when it is to be brought into operation.
§ 4.53 a.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I am very glad that my hon. Friend the Member for Stroud (Mr. Kershaw) has raised the question of the hospitals in the Stroud area. I entirely agree with him that the welfare of the patient must be our first consideration; in any discussion on hospital care, the patient must come first. We are on common ground, I hope, when I say that if the patient is to be provided with the best service that modern medical science can give, change in the hospital service is bound to come, and should be welcomed.
With a great deal of what my hon. Friend says about hospital care I find myself in complete agreement but, with respect, I do not think that he has taken sufficient account of the fact that in recent years there have been far-reaching changes in medical practice.
Among the more important of these has been the revolutionary change-over to more scientific methods of diagnosis and treatment and the development of a wide range of new and powerful drugs. These changes have been accompanied by increasing specialisation in the different branches of medicine and the recognition of their growing interdependence. Perhaps I can give an example. A patient needing acute hospital treatment usually requires the attention not only of a physicianor surgeon but of other specialists such as radiologists, pathologists and anaesthetists who require the use of complicated and expensive apparatus.
However useful they have been in the past and however useful they are now, the fact must be faced that small hospitals cannot provide a full range of services in this sense. The most effective way of providing modern hospital care is in large hospitals where a wide range of services and skills can be brought to bear at all times, and where the limited resources of highly skilled staff and costly 1622 equipment can be used to the best advantage. I refute the suggestion that because a hospital is large and has all the necessary facilities and highly skilled staff it somehow or other becomes inhuman and a place to which people will be afraid to go. These hospitals are the places where, increasingly, all the equipment and all the treatments known to modern science can be made available to restore the patient to full health.
It is for these reasons that the central feature of the pattern of hospital services—on which the hospital plan, published as a Command Paper in January last year is based—is the development of district general hospitals. These hospitals, in addition to the medical and surgical specialties, will generally also include a maternity unit, a short-stay psychiatric unit, a geriatric unit and facilities for the isolation of infectious disease. A hospital of this complexity must necessarily be of a considerable size and must draw its patients from a substantial catchment area.
Normally, district general hospitals will have between 600 and 800 beds, serving a population of 100,000 to 150,000. Some which will provide special facilities, for example, radiotherapy, to serve a larger population, may be larger than this. Others may be smaller, but a district general hospital can rarely be of less than about 300 beds, since a hospital smaller than this could not normally provide a full range of facilities.
Judging by these criteria, it hardly seems that it would be right to provide Stroud and its immediate surrounding area, whose population is about 50,000, with a district general hospital, and it seems likely that as hospital facilities are developed in larger centres, such as Gloucester and Cheltenham, a very appreciable part of the work now undertaken by hospitals in the Stroud area will pass to these new and better centres. Such a change will not be to the detriment of the patient, who in this way will receive the full benefit of modern medical practice and techniques.
I should refer in some detail, perhaps, to the existing hospitals in the Stroud area, and to their future so far as can at present be foreseen. Stroud General Hospital has 52 beds and was originally a general practitioner hospital, but because of the shortage of consultant beds in the area 1623 it has been used in recent years as a specialist acute hospital staffed by visiting consultants from Gloucester and Cheltenham. As a small hospital with a limited range of work, Stroud General Hospital is difficult to staff, particularly with resident medical officers. It is clear that the burden of acute work there must move sooner or later to Gloucester or Cheltenham where a full range of consultant facilities will be available. This is not expected to happen for at least ten years.
Stroud Maternity Hospital provides 23 general practitioner maternity beds. It was opened as recently as 1953 and it is expected to continue to provide a general practitioner maternity service for the area. Standish Hospital near Stroud, which has 270 beds, was originally a tuberculosis sanatorium. The majority of the beds there are now used for non-tuberculous chest diseases, traumatic and orthopaedic conditions and paediatrics. As Gloucestershire Royal Hospital is developed it is expected that Standish Hospital will gradually run down and eventually close.
Cashes Green Hospital, near Stroud, which has 60 beds was originally an infectious diseases hospital. In 1956 it was adapted for use for the chronic sick and it is expected to continue to provide this service at least until the mid-1970s. Tetbury and District Hospital, which has only 17 beds, is a general practitioner hospital in a converted private house. The acute beds seem likely to be transferred to Gloucester, possibly before 1975, but the future of the hospital will have to be considered together with that of the Cotswold Hospital, also at Tetbury, which has 30 beds. This is a former Public Assistance institution now used for the chronic sick.
Berkeley Hospital, which provides 39 general practitioner and maternity beds, is an extended dwelling house. With the development of a maternity unit, at Thornbury, and major acute developments at Bristol and Gloucester it seems likely that the major functions of this hospital will also be transferred elsewhere, although—like a number of other small hospitals—it may continue to provide for out-patient consultations, and may conceivably provide beds for medical cases which do not require specialist facilities.
1624 On staffing, I may say that the regional hospital board has proposals for increases in orthopaedic surgery for the Stroud area following the recommendations of the Platt Working Party. The proposals for Stroud will be considered with the board's other staffing proposals in the light of the board's revenue allocation.
Often the smaller hospitals which are to be found throughout the country provide conditions for those who work in them, and for those who are patients in them, which are outmoded by modern standards. I do not think that my hon. Friend can lightly dismiss that. As district general hospitals are developed and as people come to appreciate more fully the contribution which the large, fully equipped hospitals can make to the treatment of patients, it is inevitable that many small hospitals will quite naturally be found to be no longer required for their present purposes. The hospital plan, therefore, contemplates that many of them will be closed. Some may be retained as maternity units in areas where the distance justifies this, some may provide long-stay geriatric units where elaborate treatment is not necessary. Others may be retained to provide out-patient consultative clinics or to deal with non-specialist medical emergencies in remote places. But for many, closure will be the right and natural course.
I entirely agree with my hon. Friend that these small hospitals have a fine tradition of service to the community in which they are situated. Often they have attracted the devoted service of the leagues of hospital friends, and it is understandable that the initial reaction to what is regarded as a threat of closure is often one of regret or of protest. I make no complaint that my hon. Friend has raised this matter tonight in the way in which he has done, with his customary skill and eloquence. This is natural, but no hospital will be closed until better facilities are available elsewhere, and we believe that as better facilities are provided in the district general hospitals, people will realise that it is well worth while to travel rather further in order to obtain the full range of specialist treatment.
It has been made clear on more than one occasion that the hospital plan does 1625 not represent final decisions, either on the change of use or on the closure of small hospitals. No final decision will be taken on the future of any small hospital until the alternative provision for the services it now provides has become available. Nor is there any danger of any hospital being closed suddenly.
My hon. Friend said that the small hospitals in the Stroud area have a right to be heard. I agree. Before proposing the closure or change of use of a hospital, hospital boards are required to consult the bodies concerned with the provision of health services in the area and to arrange that any person interested may have an opportunity to express his view. Of course, the final decision rests with the Minister, and he will reach his decision in the light of the situation existing at the time.
1626 As I have indicated, the population of the Stroud area would hardly seem to justify a district general hospital, and it certainly seems to me that the best course is to press on with the major developments at Cheltenham and Gloucester, and then to review the position of the smaller hospitals in the light of the situation that then appears. Everything, therefore, that my hon. Friend has said tonight is very much in the mind of my right hon. Friend, and he can be assured that when the time comes to consider the future of any one of the hospitals that he or I have mentioned tonight, the fullest consultations will take place, and no hospital will be closed unless better facilities are available elsewhere.
§ Question put and agreed to.
§ Adjourned accordingly at five minutes past Five o'clock a.m.