§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Batsford.]
§ 12.35 a.m.
§ Mr. Dingle Foot (Ipswich)
I wish to raise the subject of the condition of the hospital services in Ipswich. For a long time, there, has been not only in Ipswich, but, I think, throughout the area round about, a growing sense of discontent both among the medical and nursing staff and among the general public about the inadequacy of hospital accommodation. This feeling came to a head last February when the local evening paper, the Ipswich Evening Star, published a series of six extremely well informed articles on the Ipswich hospitals.
When the first of those articles appeared, it was accompanied by a commentary, part of which I shall now quote:The research has been carried out with the full backing and co-operation of the Ipswich Group Hospital Management Committee who felt that the time had come for the public to know the almost impossible strain under which officials, doctors and nursing staff are constantly working…The fault does not lie altogether with the Regional Hospital Board although Ipswich is the Cinderella of a region starved of much-needed improvements. The blame lies with the Government in its miserable, mean attitudes towards even the most basic and elementary needs of the hospitals in the town.Lest anyone should think that that was merely a piece of journalistic licence, I shall make one other quotation. This is from a letter written by a surgeon at one of the wings Of the Ipswich and East Suffolk Hospital. This is what he wrote in January of this year:At the end of nearly five years in Ipswich, I have come to the conclusion that the training and experience of my colleagues and myself has been largely wasted, as we are prevented from doing the work which we wish to do and are trained to perform.We work under constant pressure and have little opportunity for even the most elementary scientific work or clinical research, or for 1391 training of junior staff. I am personally aware of a constant feeling of frustration in my professional work.That, I believe, represents the general feeling among the medical and nursing staff in the Ipswich and East Suffolk Hospital.
Tonight, I wish particularly to deal with the question of operating theatres at the Anglesea Road wing. At present, there are two general and orthopaedic theatres at Anglesea Road. They are about 100 yards apart. They are both very old. The ventilation is antiquated; it is difficult to keep out the duct, and cleaning presents a perpetual problem. Conditions in both these theatres increase the danger of sepsis.
In April, 1962, the medical staff committee put forward certain proposals which it regarded as the essential minimum if an adequate service was to be provided. The committee proposed to bring together the casualty and accident services in one hospital at Anglesea Road and to provide a new twin operating theatre. It was not until midsummer last year—in, I think, June or July—that they received the answer from the regional board. The board said that it could not fulfil all these proposals, which would cost up to £250,000. There are a good many people in Ipswich who do not accept that figure. The board said, however, that it would contribute £50,000 and asked the hospital management committee how it would like it spent. This offer was regarded by the management committee and by the medical staff committee as quite inadequate but, of course, they accepted it under protest and decided that this sum should be used for a new casualty and reception department. That, however, leaves the problem of operating theatres unsolved.
In this morning's issue of the East Anglian Daily Times, I observe that the Minister has made a statement, in response, I think, to interviews which he had with hon. Members opposite, in which he referred to this problem. The text in the newspaper states:The Minister says that operating facilities elsewhere in the group have been reviewed, and some relief will be given to Ipswich.What exactly does that mean? Does it merely mean that minor cases are to be moved out to, say, Foxhall, or 1392 Felixstowe? According to my information, most of the minor cases have already been treated peripherally and I am told that it would be difficult to extend the process much further.
No doubt, we shall hear reference tonight to the new hospital which is to be built in Ipswich under the Hospital Plan. It was due to start, I believe, in 1969. The plan, however, is now over two years old and it was based on the expectation of a normal growth of population in Ipswich and the districts around. But since then we have had the South-East England Study and the White Paper issued with it by the Ministry of Housing and Local Government.
That Study contemplates that the population of Ipswich shall be increased by, possibly, 50 per cent. or even 100 per cent. over a period of 15 years. I know that that is not final. I was told only two days ago by the Minister of Housing and Local Government that we must wait until next year to know whether those proposals are to be adopted. If they are adopted, it clearly follows that the Hospital Plan will need to be wholly reconsidered in relation to Ipswich, because the facilities proposed in the plan would be quite inadequate for a town which had added 50 or 100 per cent. to its population.
If that be so, if there has to be reconsideration of that nature, is there any certainty that the new hospital will be begun in 1969 and have we any information as to when it is likely to be completed? If it is not to be begun in 1969 or if the period of completion is to be greatly lengthened, the case for an interim measure, particularly in the matter of operating theatres, is enormously strengthened.
I hope that the Minister will not take refuge behind the regional board. In the Press statement to which I have referred, the Minister is reported as saying thatThe regional board, who are primarily responsible for planning, has been concerned to find reasonable interim solutions.The regional board may, in a sense, have the primary responsibility, but the final responsibility rests with the Minister, and it is the Minister—on this occasion, the Joint Parliamentary Secretary—who has to answer to this House.
§ 12.44 a.m.
§ Colonel Sir Harwood Harrison (Eye)
This is not the first time that we in this House have discussed the subject of the hospitals in Ipswich. I am not intervening entirely on the preserve of the hon. and learned Member for Ipswich (Mr. D. Foot), because these hospitals serve a bigger area in the County of Suffolk and many of my constituents are at times patients in these hospitals. We are grateful to my right hon. Friend that he has paid great attention, since he became Minister, to the representations that have been made to him by the hon. and learned Gentleman the Member for Ipswich (Mr. D. Foot), by my two hon. Friends the Members for Lowestoft (Mr. Prior) and Sudbury and Woodbridge (Mr. Stainton) and by myself. We were grateful to receive information from him a few days ago, following visits and talks we had had with him, to which the hon. and learned Member for Ipswich referred, and which has been published in our local newspaper in Suffolk.
It is true that somewhere along the line all is not working smoothly and that the Minister accepts this and is prepared, from what he said in his statement, to do his best to see that any of these difficulties are ironed out. One thing in particular pleased me in his statement. That was that a new geriatric hospital is to be built in Ipswich, because I have seen in the three hospitals in my constituency, at Stow Lodge Hospital, Stowmarket, Hartismere Hospital, Eye, and Bulchamp Hospital, Blythburgh, reports that we cannot deal with our own waiting lists in the county. The announcement is an excellent step forward.
I would like to add to what the hon. and learned Member said about the operating theatres. I was actually a patient, as I think the Minister knows, in one of these theatres only last year and I raised this matter with him by Question on 24th February this year. He told me that it so happened that on that day talks were going on about the interim position during the next four or five years, or it may even be seven or eight years, before this hospital is completed.
Whether the operating conditions cannot be made better in the Anglesey 1394 Road Hospital, is the most important thing for those doctors, surgeons and nurses who are there and who are willing to do all the work, but who have not got the conditions in which to do it.
The Parliamentary Secretary told me that the number of operations performed in that hospital had gone up 50 per cent. in the last 10 years. It seems to those who are most concerned with the hospital that the greatest need of all is a better periling theatre. There seems to be some confusion. It goes backwards and forwards from the regional board, and now a casualty clearing station is suggested to be the right answer.
In view of the representations we have made, I hope that my right hon. Friend will now take a very personal interest in this to see that at least the operating theatres an put right even if some of the other things have to go. They are the centre of all the work and appear to be the most important thing.
We are grateful for the interest that the Minister is taking at the present time, but we want to see this work going on in the interim period pending the new building of a hospital.
§ 12.48 a.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I realise that a number of hon. Members are keenly interested in the subject which has been raised by the hon. and learned Member for Ipswich (Mr. D. Foot) tonight, because the Ipswich and East Suffolk Hospital represents not only Ipswich but a wide area of East Suffolk and the constituencies of my hon. Friends the Members for Eye (Sir H. Harrison), Lowestoft (Mr. Prior) and Sudbury and Woodbridge (Mr. Stainton). Indeed, my three hon. Friends have long been pressing my right hon. Friend the Minister of Health about this matter and they had a meeting with him just before Easter.
My right hon. Friend told them that he fully agreed that hospital provision at Ipswich was not satisfactory. But it is precisely because of this that a major capital hospital project for the town finds a place in the Hospital Plan. The problem which has faced us, therefore, has been what steps should be taken to provide a more adequate service until the time when a new district general 1395 hospital is brought into commission. It is, of course, the responsibility of the regional hospital board, within the limits of its resources and in accordance with its priorities, to decide what these steps should be.
It might be helpful if I began by saying something about the present position at the Ipswich and East Suffolk Hospital. As the hon. and learned Gentleman said, the hospital consists of two wings. First, there is the Anglesea Road wing, the former voluntary East Suffolk and Ipswich Hospital, which dates from 1836, although the greater part of the buildings were erected after 1900. Secondly, there is the Heath Road wing, the former Ipswich Borough Hospital and ex-Public Assistance institution which was taken over as a municipal hospital in 1938.
At Anglesea Road, there are 345 acute and six geriatric beds, while at Heath Road there are 226 acute and six geriatric and 50 maternity beds. Both wings receive largely similar types of cases, general medical, general surgical, orthopaedic and fracture and a small number of geriatric. Other specialties are divided so that Anglesea Road has dermatology, ear, nose and throat, ophthalmology and radiotherapy, while Heath Road has gynaecology, obstetrics and medical pediatrics. Together, the two wings provide general hospital facilities for a population which is now about 310,000.
It is clear that a hospital on two sites and with much of its functions. its specialties and its staffs duplicated creates very great administrative problems and medical and nursing difficulties. As the hon. and learned Gentleman said, this has long caused concern both locally and to the regional board.
The regional board first proposed several years ago to create a new comprehensive district hospital for Ipswich on the Heath Road site and adjacent land. It was later proposed, however, to erect a new district general hospital on land in the board's possession at St. Clement's Psychiatric Hospital, to abandon the Anglesea Road wing and to retain part of the Heath Road wing as a chronic sick hospital.
1396 In the meantime, however, certain improvements are being effected. First, steps have been taken to improve the geriatric provision. As the hon. and learned Gentleman knows, most of the beds for old people at present serving Ipswich are too far away from the town, and this has caused difficulty and even hardship to patients and their relatives. A new 50-bed geriatric unit has been planned for the Heath Road wing and work is to start there very shortly. At the same time, provision will be made for six additional medical beds, a pathological laboratory, a boiler plant and a car park at a total cost estimated to be about £380,000.
A great deal of important upgrading and improvement work has been going on at both wings. At Heath Road, group stores have replaced huts at a cost of £15,000; a ward has been converted and equipped as a maternity block at a cost of £16,000; alterations and additions have been made to Block "D" at a cost of £34,000; theatre sterilising facilities have been reorganised at a cost of £10,000; and the nurses' dining room has been converted to a cafeteria at a cost of £6,000.
At Anglesea Road, the dental and out-patient departments have been extended and modified at a cost of £19,000; a new boiler plant has been installed at a cost of £140,000; a passenger lift has been replaced at cost of £5,000; an automatic processing equipment for the X-ray department costing £7,000 has been installed and improvement will soon be completed to the sanitary arrangements costing £10,300.
I mention this list so that it should be seen that very considerable works have been and are being undertaken. A particularly interesting feature is also being provided—a new cobalt radiotherapeutic unit costing £45,000.
The hon. and learned Gentleman mentioned the difficulties on the surgical side. We have been trying to find a solution that is both practicable and worth while. Of course, this is not easy. The board tells me it is ready to consider any reasonable suggestion. I have mentioned some improvements that are in hand; and alterations are being undertaken this year at Foxhall Hospital, which is, I believe, only about four miles outside Ipswich—though I yield to local 1397 Knowledge here—to provide additional beds for minor surgical cases.
The difficulty here is that within a decade we shall have a new and up to date hospital. It is only common sense, therefore, to recognise that there is a limit to what can be done on interim improvements that will be used only for a few years. One scheme has been put forward, estimated to cost about £190,000, by the local medical staff, supported by the hospital management committee. This proposes that casualty, accident and emergency work should be concentrated at the Anglesea Road wing. This would involve not only extension and improvement of the present casualty department, but the provision of a further 20 beds and an additional twin theatre.
The medical staff also recommended an additional twin theatre at Heath Road to cope with the greater lists of orthopaedic and surgical cases and the gynaecological and obstetric cases. The idea was to make it possible to have the use of the beds at Heath Road for cold general and orthopaedic surgery. Although the twin theatre was regarded as essential, by the medical staff, the board considered it less urgent than the work at Anglesea Road.
The board felt that the cost of the scheme was far beyond the £40,000 which was the maximum it could absorb in its own programme. As my Department had provisionally allocated to Boards all the capital money it was likely to have, and as it had no hidden reserves, it was clearly for the board to determine the priority of this proposal in relation to all the other schemes in its programme and to decide whether it could be fitted in.
I should make it plain that, even if the board could have found the money, we were doubtful—and I think the board was, too—about the soundness of these proposals, that is to say whether they were really appropriate, bearing in mind that they were intended only for an interim period. For example, a twin operating theatre at Anglesea Road, which would take some time to plan and build, might have little more than five years' life. The suggestion for 20 additional beds raised questions about whether they and the theatre could be staffed. When the 1398 suggestion was made there were, in fact, acute stall shortages at the hospital. The boars therefore informed the management committee and medical staff that they if thought that palliative measures costing, say, up to £50,000, which should suffice to provide a twin theatre, would yield worthwhile results, considering their probable life, the board would be willing to consider them.
The board then had a meeting with the management committee and medical staff, pressing very strongly for an answer to the question as to whether it was possible to give relief, by building additional theatres at either wing and re-allocating the work done in the various specialties, to make use of the operating facilities so provided. The medical staff maintained—correctly or incorrectly, it is not for me to say—that no such re-allocation was feasible and that theatres and beds at both wings were in balance at present and more theatres without more beds would achieve noshing.
It was finally agreed that a scheme should be investigated for a new casualty department at Anglesea Road on the lines proposed by the management committee. I am glad to say that a scheme has now been agreed and that the detailed plans are being prepared.
To sum up the situation, the board has been exploring with the medical staff and the hospital management committee how most advantageously to apply a reasonable but limited amount of capital to improve the existing surgical facilities for Ipswich. Certain steps have been taken already. Admittedly, the present theatres are unsatisfactory. Major structural alterations could improve them, but, for the reasons which I have given, these are not feasible
As my right hon. Friend has told my hon. and gallant Friend the Member for Eye and my hon. Friends the Members for Sudbury and Woodbridge and Lowestoft, he is asking the board to see whether adjustments of any other kind are possible. I assure the hon. and learned Gentleman that the matter will be treated as one of urgency, but this will require a readiness on the part of all concerned, the board, the hospital management committee, and the consultants, to make adjustments.
1399 The hon. and learned Gentleman then raised a somewhat wider issue. He asked how the Hospital Plan will be affected by the South East Study of the problems which may be expected to arise out of the growth of population over the next 20 years. The hon. and learned Gentleman will not expect me tonight to embark on a major and detailed dissertation of the way in which the hospital service in the East Anglian region will be affected, but I assure him that my right hon. Friend has constantly in mind the possibility of changes in the plan, and this was a factor to which a great deal of thought was given when the plan itself was being drawn up.
I welcome this opportunity to stress once again that it was never intended that the Hospital Plan should be regarded as a document laying down a definite programme that was complete and final in all respects. As the Command Paper itself indicated at the time, the programme then announced provided the point of departure and the necessary basis for further studies in many directions.
But, while it did not represent a final decision on the individual items included in the plan, it was necessary to take a number of decisions at that time so that the broad intentions for the development of the service as a whole might be known, thus providing a context within which individual decisions could be taken at the proper time in the light of developments, changes in medical practice, changes in population, and any other relevant changes that took place in the meantime. For example, the first revision of the Hospital Plan, which took place last year, made adjustments to the programme, particularly in regard to maternity services, to meet the somewhat unexpected increase in the birthrate.
In view of the increased need which was then seen to have arisen, some 1400 maternity units were increased in size, and earlier starting dates were arranged for others. There was some conversion and extension of existing hospital accommodation, and it was envisaged that some hospital maternity accommodation might be retained in use for somewhat longer than had been intended. It is an essential feature of the Hospital Plan that it should be subject to constant review and that it should be sufficiently flexible to ensure that changing circumstances can always be met and the necessary services provided as the need for them becomes apparent.
As the hon. and learned Gentleman said, the South East Study envisages the possibility of Ipswich becoming a focal point of growth and its population increasing by about half. If that turns out to be the case, the hospital services in Ipswich will clearly need to be larger. Perhaps a second hospital might have to be added to the programme, but it is not possible for me to say anything more about that tonight. As the hon. and learned Gentleman knows, a decision cannot be taken about the possible expansion of Ipswich until the planning authority concerned has had an opportunity of giving my right hon. Friend the Minister of Housing and Local Government its thoughts on the subject. My right hon. Friend has asked for its views by 30th June, and I think he said that discussions would follow and a final decision would not be taken for some time.
The timing of all this does not affect the issues raised tonight. The planning of the new hospital for Ipswich is at a stage which will permit full consideration to be given to all the implications of any decision about the expansion of Ipswich which may be taken within the next year.
§ Question put and agreed to.
§ Adjourned accordingly at five minutes past One o'clock.