HC Deb 08 December 1965 vol 722 cc565-74

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Harper.]

10.15 p.m.

Mr. Hugh D. Brown (Glasgow, Provan) rose—

Mr. Speaker

Order. Will hon. Members leave the Chamber quietly? An hon. Member has the Adjournment debate.

Mr. Brown

At least this is a change from the Adjournment debate last night, and my hon. Friend can be assured that I shall not take three or four hours. Moreover, on the last occasion when I was successful in having an Adjournment debate, it took place at 5.30 in the morning. I think that we can, therefore, begin in a reasonably happy frame of mind this evening.

This is not the case of an aggrieved constituent, and neither am I raising the subject in anger or in retaliation for a Departmental door slammed in my face. I am glad to say that I have never been an in-patient of the Royal Infirmary, although I have attended the out-patient department. I hope that this can, in the circumstances, be a friendly Adjournment debate. My previous effort in the matter was my letter of 4th August last which attracted a reasonably hopeful reply, so I thought, and it is to confirm that hope that I am pursuing that now.

I fully appreciate that this question can be examined only in relation to the hospital building programme as a whole, and I am not unmindful of the many other heavy responsibilities which my hon. Friend carries, in the raising of the school-leaving age, the teacher shortage, school building, the reform and extension of welfare services, to name but a few. I am not mentioning these things to depress my hon. Friend, because I have every confidence in her ability to solve the problem, given favourable national circumstances.

The hospital building programme for Scotland that was, at present under review, seems to have been conceived by a union of expediency and blatant political propaganda and brought to light with a bit of uncertainty and in difficult circumstances by the earnest efforts of the Royal Infirmary board and the Western Regional Hospital Board. I say that because, in trying to ascertain the position, I have had difficulty in really getting to the bottom of what have been decisions in fact, and what have been, so to speak, only hopes on the part of the regional hospital board and the Working Party.

As I understand it, approval has certainly been given and work is proceeding on phase 1, from 1966 to 1971, the building of a new out-patient department and a casualty department. This decision to go ahead does not in any way invalidate the case which I am putting for reconsideration of the other phases because, undoubtedly, some kind of out-patient department and a new casualty department—I understand that this is really the determining factor—would be needed in this area in any case and can be separated from the rest of the argument.

I have found it difficult, however, to confirm why the decision was made to relocate the Royal Infirmary on its present site, when it was made, and who made it. I do not think that I am unreasonable in making these comments, having taken the trouble to look at Cmnd. 1602, published in January 1962, and revised in 1964, and the replies published in the OFFICIAL REPORT of 31st July, 1963, and on 20th January, 1964, which, I suspect, were prompted Written Answers to Questions by the hon. Member for Edinburgh, West (Mr. Stodart). I have been to some trouble to find out what the present position is. It is important, because that it where we start.

If we look at the first White Paper, we find from page 5 that this was a White Paper which set out to describe the Government's plans for hospital building in Scotland over the next ten years. But when we look at pages 12 and 13 we find that it is guarded by ambiguities or, rather, cloaked with semi-professional language which certainly did not involve a firm commitment. It reads: This ten-year concept of hospital planning in two phases—an initial five years with specific projects to be worked out up to the building stage, and another five years with more tentative projects—is a major step forward. Its provisional nature in the later years is a matter of deliberate intention and not simply the result of the planning being incomplete. With changing needs and changing methods and some uncertainty as to the building and planning times required, a hard and fast programme for the later years would be unreal. There must be an element of flexibility both as to content and to actual building dates, quite apart from the fact that the rate of investment that will be practicable in these years cannot be accurately predicted now. It appears that in 1962 there was no firm commitment given on a project of this kind.

We come to another part of the proposals where we are talking about priorities. The first main objective is the teaching hospitals. In dealing with the Western as distinct from the Royal, the Western is classified as a hospital which is to be "completely or largely rebuilt". The others, including the Royal, are to be "substantially extended or modernised". I am afraid that I cannot distinguish the difference between what is meant by "largely rebuilt" or "substantially extended or modernised". But there was some kind of priority worked out.

When we look at the timetable—and this is the same White Paper—we read that the dates at which they will start building are more or less settled. The second half of the programme includes many projects for which some work is already being done. Although they must remain rather more flexible in concept, Regional Boards have, however, a provisional timetable of starts allied to particular years. In a reference in the Summary dealing specifically with the Royal Infirmary—and this seems to be one of the first mentions in an official circular—we read: Major building developments, the nature of which is still to be finally determined, are projected at this hospital. I am trying to draw attention to the lack of firm commitments at that stage.

I turn to the Revision of Hospital Plan for Scotland, a document no doubt produced for election purposes but which is even more obscure. Again the only reference to the Royal Infirmary in the context 1964–65 to 1968–69 is: A first phase of the redevelopment of this major teaching hospital, the precise content of which has not been finally determined, is to be undertaken. It appears that again in 1964 there was uncertainty and a lack of decision or precision on what were the intentions for the future for the Royal Infirmary. There therefore seems to have been some doubt right up to the time of the present Government deciding to have a review of the whole of the hospital building programme, and we are awaiting the results of that review.

When we look at the Working Party's Report on the Western Regional Hospital Board, it seems to confirm the lack of decision. The basic conception, I may say, is that priority should be given to the teaching hospitals. This is one of the main objects of the Hospital Plan: The modernisation and rebuilding of key teaching hospitals. I do not think that anyone would disagree with that. But it also says Any prescription for a period of 15 years ahead"— that is the period we are talking about in terms of building or rebuilding a hospital this size— should clearly not be rigid however … and they accept that circumstances have changed over the whole field of clinical medicine and that the present plan must therefore be regarded as flexible. That was written early this year. It confirms the lack of firm decision made to or by the regional boards on this project. The only other reference to the Royal Infirmary is a discussion of the size that may be required.

I hope I have established the general background and the uncertainty associated with the project. It is a difficult problem and I am not attacking my hon. Friend the Under-Secretary of State because of the size of it. But what are the objections to rebuilding the Royal Infirmary on its present site plus an extension? First, I suggest that the site is too small for a main teaching hospital. The other day, it was said by a member of the regional hospital board concerned, in reference to Edinburgh Royal Infirmary—presumably a similar type of hospital—that a hospital of this size is two-thirds hospital and one-third a teaching institution. In other words, these may be the proportions of accommodation required on the present site in Glasgow, but I understand that many important departments cannot be accommodated under the proposed new plan.

This is to say nothing of the fact that it will involve pulling down 500 houses, of which we are extremely short in Glasgow. I am not suggesting that this is a major consideration but it must be taken into account. The hospital will be almost adjacent to what is possibly the busiest road in Scotland. Of course it can be argued that this is precisely why it should be located there. However, I do not accept that. Certainly, there will be physical inconvenience to all concerned—patients, staff and builders—by having to build on this site.

I know that the project will not be going on on exactly the same site, but with the decanting of people and the rest of the operations involved the upheaval is likely to last for the next 15 years. I can find no really good reason for the decision—if there has been a firm decision—for the relocation of the hospital on this site. One suggestion in support is that it has always been there. But that does not appeal to me as an argument, although I must admit that the longer one is in this place tradition becomes more important than perhaps arriving at the right decision.

It has been suggested that there has been undue influence of university thinking on this project. Sometimes we are guilty of confusing academic intellectuals or professional ability with administrative ability. That is not always true. Academicians are as likely to be as selfish or narrow-minded as other groups and as hidebound by tradition. I think that the siting of the Western Infirmary was wrong and it was largely due to university influence.

I know that my hon. Friend has enough on her plate just now with universities and their charters, so I will not stray into that subject, but I appeal to her to have a fresh look at this. She has ample room at least not to close the door. The hospital building programme is in her hands at the moment. One of the terms of reference of the Royal Commission on Medical Education is to look at teaching hospitals with particular reference to their siting, location and functions. In considering a project of this size we must remember that Strathclyde University may have a medical chair not in one year or even five but perhaps sooner.

Recently, admittedly by pure chance, there was a possibility of a fresh look at the whole of the east end of the city because of National Coal Board workings. In other words, there might have to be re-zoning in the east end of the city. This might give my hon. Friend the chance to reconsider the possibility of using sites at Stobhill, Robroyston, Gartloch or Queenslie, and to consult local authorities to see whether there is sufficient ground for the re-location of the Infirmary based on the campus idea.

If my hon. Friend would like to go on a tour of some of the new infirmaries in the world—there are not many in this country, as we know only too well—I would be willing to accompany her to Scandinavia, or America, or even to Africa, which might be a backward continent in some respects, but which at least has some new hospitals.

With a project of this size, we have to try to look into the crystal ball and to anticipate the Buchanan Report and the days when every family has at least one car and when the need to locate an institution in a city centre is not as valid as it was almost 100 years ago. If my hon. Friend would consult the Royal and Western Regional Hospital Boards and give some encouragement with an open mind, I believe that she would be agreeably surprised by the support she would receive for reconsidering the concept for which I have been arguing.

All I am trying to do is to ensure that when we create a future Royal Infirmary it will be capable of achieving the distinction and honour of the present Royal Infirmary.

10.33 p.m.

Mr. Anthony Stodart (Edinburgh, West)

The hon. Member for Glasgow, Provan (Mr. Hugh D. Brown) has chosen tonight to raise the subject of the Royal Infirmary in Glasgow and, although I speak with some trepidation as an hon. Member from a city slightly further eastwards than Glasgow, with which city we try to keep our end up and, we think, not unsuccessfully, I venture to say a few words about the Royal Infirmary in Glasgow, because, of course, it was a matter in which I was particularly interested during 1964.

Could the hon. Lady clarify one or two things about the future of the Infirmary, which, frankly, are beginning to puzzle me? As the hon. Gentleman said, in the 1962 Hospital Plan the future of the Royal was classified as a major development the nature of which was still to be determined and it was to feature as part of the major works programme of 1962–66. Then, in 1964, when the revised Hospital Plan was produced, in which a greater amount of money was granted to last over a greater number of years, it was described as a feature of and the first phase of a redevelopment, the precise content of which had not been finally determined, to take place not in 1962–66 but in 1965–69.

I did not altogether understand the hon. Gentleman's reference to the Revised Plan being for electoral purposes when the putting back of the Plan by four years was not exactly to the electoral advantage of the Government of the day, particularly when combined with that there was a postponement of the general hospitals at Ayr, Motherwell and Paisley. What I have been concerned about is a report in the Glasgow Herald of 23rd April, 1965, which said: Schemes listed to be started during 1964–69 are … Then there is a list of others outside Glasgow. Then we come to Glasgow Royal Infirmary, first phase to include new out-patient department, at a cost of £2.3 million. The report goes on: At the Royal Infirmary the present complement of 876 beds for acute cases is planned to increase to 1,050. Of this figure 885 will be acute, with a new maternity unit of 120 beds. This plan, which was published in April, seems to be pretty detailed. It goes not only into the cost to the nearest £100,000, but states specifically the number of beds involved. How does this fit into the plan which has been under revision, as the hon. Lady knows, because I asked her from this Box a fortnight ago, for a year and which is due to be published, as she said, on 17th November, towards the end of the year?

How comes it that we have this detailed plan published in April, which is unavailable to Members of this House on 17th November? This is a matter about which we ought to be anxious. I agree that there are difficulties about building a new Royal Infirmary on the present site. My recollection—and I am sure the hon. Lady will confirm this—is that one moves the Royal Infirmary by a distance of some three or four hun- dred yards, to the north-east, I think. Therefore, the physical difficulties should not be over great.

10.37 p.m.

The Under-Secretary of State for Scotland (Mrs. Judith Hart)

May I first of all say how grateful I am to my hon. Friend the Member for Glasgow, Provan (Mr. Hugh D. Brown), who is a civilised man, for the civilised hour at which he has managed to have this debate. In our recent experience this is not altogether usual. I am very happy to have the opportunity to say just how we see things standing in relation to the Royal Infirmary. I think the hon. Gentleman the Member for Edinburgh, West (Mr. Stodart) will understand that I am at this stage unable to comment on matters likely to be contained in the review of the Hospital Plan. I think he will also understand that in the interim, while the hospital review is awaiting publication, it is perfectly proper for regional hospital boards to outline details of their plans.

May I say to my hon. Friend that my right hon. Friend and I never have closed minds on anything, I hope. What I say tonight is on the Plan as we see it at this stage. He asked me to what extent the Government are committed to the proposals for the rebuilding of the new Royal Infirmary on its present site and whether there is any prospect of a new look being taken at the site. The Government have undertaken to buy a large extension to the existing site, which is going to involve an expenditure of the order of half a million pounds. This includes the cost of various necessary works, such as diversion of services, demolition of buildings and so on. I should like to acknowledge the very great help that the hospital authorities and my Department have had from Glasgow Corporation, which has been prepared to look at the siting and timing of its major roadworks in this area, especially the Townhead interchange, to help the existing site to be extended.

The Corporation has indicated its willingness to rehouse people whose homes are demolished to make way for the Royal Infirmary redevelopment. The rebuilding plan at present involves a first phase of about four years, starting in early 1967. This phase is to include temporary works to allow evacuation and demolition of some existing buildings, the building of a new out-patient department and the demolition of the existing one and the provision of residential accommodation. Later, possibly beginning in about 1973–74, it has been the intention to begin the main element of the reconstruction, which is a very large scheme indeed, which might be completed by about 1980.

My hon. Friend drew attention to the Royal Commission on Medical Education. Approval to this part of the scheme has been withheld until the Report of that Royal Commission is completed, because its recommendations may have an important bearing on the form of teaching hospitals and on the requirements of the teaching hospital building programme. At the same time, as has been pointed out, we have been engaged on a major review of the hospital building programme, looking at the extent to which existing proposals are likely to meet out needs as we now see them and as they are expected to develop. These considerations must inevitably lead us to look closely at the form, the content and the phasing of this large teaching hospital scheme, and this we are doing.

It would, however, be wrong of me to suggest that a change of site is in any way likely. We accept that there are disadvantages in the building of large teaching hospitals on central sites arising from the limited areas that are available, and this is a point to which my hon. Friend drew attention. On the other hand, however, there are great advantages, too. The present Infirmary site is very well situated for a major teaching hospital. It will include a regional accident centre and it will carry a large community commitment. This is important.

As my hon. Friend has said, the site is well placed for access from the university, but this is not the only factor. It is important that major teaching hospitals should be rooted in the community, and certainly the present site would allow for this.

My hon. Friend mentioned the nearness of the site to a busy road. It is only fair to say that we think of busy roads as we see them nowadays around us, but this would be part of a very modern road system. There would not be the sort of traffic danger which one imagines when thinking of present-day city roads. It offers a very great advant- age in being close to a main road junction of the Inner Ring road for Glasgow, which will give it, therefore, easy access by road both from the city and from the region. There is no other site available in its area which could so conveniently serve the population which it serves.

Certainly, we may expect to see great changes in the pattern of transport over the next 20 or 30 years, but I do not think we are likely to see changes that will make sites on the edge of the city, such as Robroyston, which my hon. Friend has suggested, unless they are by chance close to new road developments, nearly as accessible as sites in the centre, especially a site beside the Inner Ring road. We regard this, rather than as an argument against, as a strong argument for the site for the development that is to take place at the Royal.

My hon. Friend reasonably laid emphasis on the advantages which a large site would bring—for example, the campus concept. We have not accepted in general the proposition that the campus concept is necessarily the right way to provide hospital and other health services. There are a lot of differing academic and other views about this.

Our intention is quite clear. It is to provide comprehensive general hospital services in large general hospitals which are situated at appropriate points in the community which they are to serve. Again, I come to the point of the hospital being rooted in the community. This is difficult to achieve with a large campus site.

In addition to the conventional departments of a general hospital, we hope that there will be maternity, geriatric and psychiatric units. We hope, too, that there will be suitable arrangements for close links with general practice, including the provision of health centre services on the hospital site.

A further material point is that while we recognise the advantages of concentration—

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 at a quarter to Eleven o'clock.