§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pym.]
§ Mr. Frederic Harris (Croydon, North-West)
I am grateful for this opportunity to raise what is unquestionably a constituency problem, but one which has worried me considerably for quite a long period. It is a problem which affects a large number of people in my area; namely, the shortage of hospital beds in the Croydon area.
Since 1948, we are told, about 40,000 new hospital beds have been provided throughout the country in line with the increasing population. To have kept pace with this general improvement Croydon should have had an additional 200, but while in 1951 Croydon had 1,651 beds, by 1963 the number had fallen by 143 to 1,508. While allowing for many of the various medical reasons why one can claim that hospital beds are, fortunately, not so much needed now as they were, say, 10 years ago, there is still little doubt that Croydon has not had its fair share of the necessary improvement that has gone on.
I have had much correspondence about this matter with both my right hon. Friend the Minister of Health and my hon. Friend the Joint Parliamentary Secretary, who will be replying to this debate. Although my right hon. Friend obviously does not completely agree with all my figures, the Joint Parliamentary Secretary will recall that he admitted in a letter which he sent me on 17th April last that on Croydon's present population there is definitely a deficiency of about 50 acute geriatric and maternity beds. This was, in my view, a real admission of shortage.
I was disturbed to find that my hon. Friend also had to convey to me the fact that the South West Metropolitan Regional Hospital Board, which is responsible for this area, has no short-term plans for an immediate increase in the number of hospital beds in the Croydon area. In that letter my hon. Friend went on to say that planned developments at Mayday Hospital, which is in my constituency, and which are planned to 1398 start some years ahead, will eventually result in an increase of about 100 beds.
In considering the long-term plans for Mayday Hospital I respectfully suggest that those plans may not even now be providing for sufficient maternity beds. In any case, I stress that my hon. Friend's letter talks about "some years ahead" and this seems to be the only crumb that has been held out. This is a completely unsatisfactory position.
Because of the limited time available tonight I will not go into the reasons for the reduction in the number of beds, but many reasons could be advanced, including closures, minor structural alterations and other general adaptations and improvements to the existing local hospitals. I also fully realise the difficulties of recruitment of nursing and ancillary staff, which goes hand in hand with this difficult problem. It is a vicious circle and unless there is a determined effort to provide additional beds to meet the needs of this important area there will never be the necessary pressure for recruiting essential staff. The Minister has advised me that even in this regional area there are other estimated deficiencies of beds as great as those in Croydon, but I respectfully suggest that two blacks do not make a white, and I want the position in Croydon to be put right as soon as possible.
Because of lack of time I shall not quote the various long-term developments which I know are planned but, as has already been admitted—and this is the vital point—there are no short-term plans. My hon. Friend will no doubt tell us something more definite about these long-term plans. I realise, too, that it will be claimed that there is urgent need for other improvements in our existing hospitals, such as out-patient and accident services, which might, perhaps, be said to have priority, but I cannot see why the problem cannot be tackled as one. Is the Minister seriously restricting the regional board's present capital expenditure plans?
I have gone to some lengths to discuss the problem with doctors in the Croydon area, and there is no doubt at all that there is deep concern about the length of time that patients have to wait, not only for admission to hospital but for out-patient appointments, which are the 1399 usual prerequisite to hospital administration. Croydon doctors are compelled to use hospitals outside the area and this, in turn, causes difficulties to the patients and considerable problems for the doctors.
Some doctors, I know, have even had difficulty in getting emergency obstetric cases admitted to local hospitals, and have frequently had to use the emergency bed service. They do not like using that service, as they cannot exercise any choice of the hospitals to which the patients are to be admitted. There is also the uncertainty of the patients' destinations, which causes considerable distress and concern both to patients and to their relatives. It is obviously wrong that in many cases hospital admission can be secured only when the patient's condition has reached an urgent and emergency stage. Even then, admission often cannot be obtained to a local hospital.
I understand, too, that there is a definite policy these days to move some patients out of hospital as soon as possible, presumably to ease the pressure on beds. Apart from the person who particularly wants to go home, I should have thought that the patient is best in hospital, where all the facilities are available for a final cure. Rightly or wrongly, this seems to me to be rather a policy of desperation, and it adds to my concern over the whole problem.
As I say, I fully realise that, tied up with all this, is the complex question of the recruitment of nursing and ancillary staff. Although we have a wonderful number of young girls always prepared to go into nursing as a vocation, it is surely not fair just to rely on those people. I understand that we also have to depend a great deal on nurses from overseas, who likewise do a first-class job. I do not doubt that the status of nursing and the ancillary services should be raised, and the remuneration and conditions of service improved in order to induce more people to enter. The Minister might also consider the need to establish a nurses' training centre in Croydon, which would be a really important development.
Whilst making all these observations, I want to make it abundantly clear that I think that all those involved in the provision of the health services in the area do an excellent job. I have always found 1400 them extremely helpful whenever I have had to approach them, but if they do not have all the tools necessary they cannot possibly provide the 100 per cent. service that we all want to see achieved for the people of Croydon. In fairness to them all, I make this strong plea of my hon. Friend by asking him whether he can tell us what he is going to do about it, for the inspiration and indeed the approvals must of course come from the Minister himself.
§ 10.45 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
Before I speak about some of the particular matters which my hon. Friend has raised I should like to make it clear, in case there is any doubt on the point, that there has always been a first-class hospital service in Croydon, and by any yardstick Croydon has a good hospital service today. I do not wish to be unkind to my hon. Friend, who I know has raised this matter tonight in the interests of his constituents, but he should be on guard against exaggerating difficulties by making assumptions based on purely mathematical calculations.
I can illustrate the dangers by looking at my hon. Friend's own constituency of Croydon, North-West. Here are located the Mayday Hospital, which provides acute and maternity services, St. Mary's Maternity Hospital, and Queen's Hospital which provides geriatric services. Together these three hospitals have 1,023 beds for a constituency population of about 58,000. On the normal ratios of beds to population my hon. Friend's constituency, taken on its own, might be said to have three times as many beds as would normally be provided. We know of course that this is not the case, since the service provided by these three hospitals extends to people beyond the constituency boundaries. I thought, however, that the point was worth making as an illustration of the danger of relying on a simple application of statistics without taking account of other factors.
My hon. Friend has suggested that because some 40,000 additional beds have been provided in the country as a whole since the National Health Service was introduced, Croydon, which includes three constituencies, ought on 1401 the basis of its population figures to have an additional 200 beds. This I suggest is just the kind of mistaken conclusion that results from a simple application of statistics. I will say something in a few moments about additional beds that have been provided in the country, but let us look first at the position in the Croydon area.
The three hospitals which I have mentioned are not the only hospitals that serve the population of Croydon. The Croydon General Hospital, the Purley and District War Memorial Hospital, and the Waddon Hospital lie in the constituency of my hon. Friend the Member for Croydon, South (Sir R. Thompson) who has himself held my present office and has always shown great interest in health and hospital matters. Norwood and District Hospital is in the constituency of my hon. and gallant Friend the Member for Croydon, North-East (Vice-Admiral Hughes Hallett).
Taken together, these hospitals provide a total of 1,505 beds for a total population of 293,000. Taking the whole of the Croydon area, therefore, there is an overall shortage of about 50 beds, as my hon. Friend has said, on the basis of the usual ratios. But these ratios are not strictly applicable in a large urban conurbation such as Croydon, where people naturally tend to go to the most convenient hospital whether it is strictly in their own area or not, and where teaching hospitals beyond the borough boundaries are within easy reach. We know that minor shortages and minor surpluses occur constantly from one area to another.
There is a need for maternity beds in Croydon, as in some other areas, and additional beds are now being provided. My hon. Friend referred to a letter which I wrote to him but he did not mention a subsequent letter which my right hon. Friend wrote to him telling him that this additional provision was being made.
Where there are waiting lists for a particular operation it is common practice for a consultant who has two appointments, possibly in Croydon and Lewisham, to arrange for a patient to go to the hospital which has the shorter waiting list. This is surely a sensible arrangement which ensures that patients 1402 do not have to wait for a bed while one is available for them elsewhere. It does not necessarily mean that there are not enough beds for a particular specialty.
My hon. Friend has mentioned the additional hospital beds provided since 1948. At the start of the National Health Service, the scale of hospital service provision in various parts of the country was patchy, with some areas being very poorly served. We have endeavoured to remedy this situation and, by September last year, the hospital service had provided a further 41,000 beds by major building schemes, while other schemes in progress at that date will provide an additional 9,600 beds. Naturally, these schemes to provide additional beds are being carried out in the areas where there is the greatest need, that is, where there were either no beds at all or where there was a very considerable shortage. As Croydon was not one of these areas—indeed, as I said at the outset, it has been quite well served for years—there has been no need to embark on such a scheme there. There is, however, in many areas such as Croydon a need for more operating theatres and supporting services and outpatient departments.
It is for this reason that the Regional Hospital Board has given priority to the building of the new out-patient, casualty, pharmacy and pathological department, at Mayday Hospital. Although some delay was at first caused because of difficulties experienced by a private architect employed by the Board, this scheme has since proceeded with all speed and building started in July last year.
The cost of the scheme at the Mayday Hospital is half a million pounds, a figure which was arrived at two years ago and within which we still hope to keep. In the hospital service the main task in the first 10 to 15 years of the National Health Service was to fill in the gaps and to make good so far as possible many of the dilapidated facilities which existed when the Service came into being. We are now, however, moving into a period of major hospital development and the pace is accelerating.
In 1962 we started 14 new or substantially remodelled hospitals; in 1963 we started another 21, and this year we shall start on a further 28, and already we are enjoying the first benefits of a 1403 plan to provide the people of this country with the finest hospital service in the world. But, clearly, this cannot be achieved all at once. In each area the Board has to consider which is the most urgent priority. In Croydon, as I have said, it is out-patient facilities and the necessary supporting services. The new out-patients' department at Mayday will contain theatres which will help to meet the need for them in the hospital generally.
I think my hon. Friend knows that major developments are under way in the region, including a new hospital at Crawley, the final stage of which will begin next year. It will cost £3 million and it will relieve the load on Croydon which at the moment takes paients from the north of Redhill who will be catered for at Crawley. As in some other areas, there is a shortage of nursing staff in Croydon. Some beds are closed at Croydon because of the shortage, but the hospital authorities are doing all they can to remedy this.
My hon. Friend has said that we should consider the establishment of a nurses' training school in Croydon. I am surprised that he should make this suggestion because I am advised that Croydon hospitals have no fewer than seven nurse-training schools. Mayday Hospital and Croydon General Hospital have full training schools for State registered nurses while Queen's Hospital, Purley and District Hospital and Waddon Hospital have training schemes for enrolled nurses and Mayday Hospital and St. Mary's Hospital have full midwifery training to the standards of the Central Midwives' Board. These seven training schools ensure that Croydon is able to train every suitable girl who wishes to take up nursing. I hope that what I have said will serve to reassure my hon. Friend on that score.
My hon. Friend has referred to nurses in glowing terms, and he is right to do so. I gladly join him in paying tribute to the magnificent job being done by the staff of all hospitals in Croydon.
The two hospital management committees of Croydon and Warlingham Park were amalgamated in April to form one larger group. This is a development which should broaden the basis of 1404 administration as well as provide more flexible arrangements to be introduced for elderly and mentally ill patients. My hon. Friend will know of the close co-operation which has always existed beween the Croydon County Borough Council, the Croydon Hospital Management Committee and Warlingham Park Hospital. This co-operation bodes well for the hospitals in the area and for the service that they will afford their patients in the future.
I come now to the long-term plan for the future of the hospitals in the Croydon area. The Regional Hospital Board's planning centres round the upgrading and expansion of the Mayday Hospital in my hon. Friend's constituency to provide 800 beds for all types of patient. The hospital authority is now working on further plans for the hospital, and these will probably comprise a new surgical block of 350 beds, eight operating theatres and other departments. This scheme has, of course, to be fitted into the board's plans for the whole of its region and cannot be started immediately. I should be less than frank if I did not say that it will take some years to plan all the details of the scheme and to carry out the work necessary on the sketch plans and working drawings. The board is likely, however, to be able to fit the scheme into its programme in the second quinquennium as proposed in the Hospital Plan.
My hon. Friend is probably aware that my Department makes an allocation to each hospital board to carry out its capital development schemes. He was concerned about this. We increase the amount which we allocate to boards for capital development each year. Within this allocation, it is for each board to determine the priorities of schemes within its own region. This is, after all, a matter with which they are best placed to deal. It is the kind of task which they exist to perform.
Further stages of the development of the Mayday Hospital are envisaged so that, on completion, the whole hospital will, in fact, have been rebuilt. When all this has been done, and it will, of course, take many years, the Hospital Plan envisages that a further new hospital will be built between Croydon and Redhill.
1405 I do not, therefore, think that there is much justification, taking the hospital picture for the country as a whole, for some of the charges which my hon. Friend has made tonight. I am glad that he has raised this subject because he has given me the opportunity to put the matter into perspective and, I hope, to give him home helpful information. Having said all that, however, I would not wish my hon. Friend, who, like my hon. Friend the Member for Croydon, South, has taken a very keen interest in the development of the hospital service in Croydon, to think that we 1406 are in any way complacent about the service in this area. Here, as in every other part of the country, there is room for improvement. We are extending our provision year by year in accordance with priorities which are very carefully worked out, and my hon. Friend can be assured that Croydon will get a reasonable share of available resources.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Eleven o'clock.