HC Deb 28 January 1966 vol 723 cc644-54

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

4.0 p.m.

Mr. J. Bruce-Gardyne (South Angus)

I should like to apologise to the hon. Lady the Under-Secretary of State for Scotland for detaining her in London this afternoon. It is particularly regrettable over this particular weekend. But the matter I wish to raise is of considerable importance to my constituents and to people in the County of Angus generally, and I want to express on behalf of my hon. Friend the Member for North Angus and Mearns (Mr. Buchanan-Smith) his regrets that he is unable to be here owing to a long-standing constituency engagement.

In December, 1963, the Eastern Regional Hospital Board for Scotland published its regional plan for the development of hospital and specialist services in eastern Scotland, which was based on the previous Government's Hospital Plan for Scotland. One of the principal purposes of the board's proposals was to provide a district hospital giving "main consultant services" to each of the areas served by the board.

But, for the County of Angus, the board faced a special difficulty because the money for building a new district hospital for the county was not to be available for at least 20 years. So, in effect, the board faced a choice. Either it could provide the specialist facilities for the county at one of the new hospitals which are to be built in Dundee or it could adapt one of the existing county hospitals to serve until a new permanent hospital for the county could be built.

I accept, though this has been a matter of some local controversy, that with the money that the board had available, there was only one hospital in the county which could be modernised and renovated to serve the purpose of an interim district hospital. This was the hospital. This was the hospital at Stracathro. The choice, in effect, was between Dundee and Stracathro.

The Board opted for Stracathro. That choice has been endorsed by the hon. Lady and her Department and I recognise that we cannot go back on it at this stage. My purpose in raising the matter today is that want to register some of the arguments which have been advanced against the decision in the area so that, if it should turn out by experience that these arguments are justified, we may have second thoughts at a later stage without undue delay.

The choice which faced the board when it was trying to decide where to place a district hospital for the County of Angus was certainly difficult. I believe that the choice of Dundee would have been broadly acceptable to my constituents, and also to medical opinion in the area. But I do not deny that it would have been unpopular in the northern part of the county.

There was the added complication, if the board had opted for the Dundee as opposed to the Stracathro solution, that Stracathro would have had to be closed as its present use would be ended in 1970 and this could have had an important impact on the employment position in the area. Moreover, the board felt that unless an interim district hospital were established in the county, it would not subsequently be possible to build a new district hospital when the money became available in the 1980s. I am not and never have been entirely convinced by the arguments on this point, but they may have some validity.

At any rate, the choice of Stracathro was made and all local objections were over-ridden. The local authorities naturally objected to the down-grading of the local hospitals and also complained about the remoteness of Stracathro and the difficulties about visiting friends and relations—problems of transport. I sympathise with those objections, but I am bound to say that I have never found them overriding. Personally, I am prepared to accept a measure of increasing centralisation of specialist medical services as probably inevitable and desirable. Moreover, it should not be an insurmount- able problem to provide adequate public transport for visitors to Stracathro and in that matter I would hope that we could count on any assistance which the Department could give us.

I have always been worried by the objections to the board's proposals which have been advanced by medical opinion in the area. I am not in any way criticising the hon. Lady. I know that she has given a great deal of attention to this matter and we are grateful to her for the way in which she has handled it. I appreciate that she is bound to attach great weight to the recommendations of the hospital board.

I also accept that the board was entirely motivated by the desire to provide the best medical services for the people in the area, which should be the first consideration of all of us. But it is precisely on this point that the criticisms by local medical opinion have been based and I do not feel that we can entirely exonerate the board from the criticism of showing an excessive determination to ride roughshod over objections once its mind had been made up. I will later show what I have in mind in making that criticism.

The criticisms by the medical profession in the area were essentially these. It was said that the "catchment area"—if one may use such a phrase in this connection—for the district hospital would be too small and that the range of specialities which the interim district hospital at Stracathro could offer would be too narrow to satisfy the medical requirements of the 1970s and 1980s. It was also felt that the proposal to withdraw all specialist services from local hospitals, for even the simplest types of operation, was motivated not so much by medical considerations as by the need to justify expenditure on Stracathro as an interim district hospital.

I think that the board would admit that the population base for Stracathro, which is calculated at about 88,000, is somewhat marginal. But it would argue that its size was definitely viable in medical terms for the 1970s and 1980s. But a great many of the doctors in the area argue that even when the specialist services for the county are concentrated at Stracathro many patients in the area will still insist on being treated in Dundee. These will be patients from Arbroath and Carnoustie Forfar and Mirriemuir and the landward areas and possibly some patients from Montrose. If this argument has any validity we would be facing an intolerable situation because we should be spending about £400,000 on a hospital at Stracathro, which would be something akin to a white elephant. Meanwhile we should be facing the problem of overcrowding and long delays in the hospitals in Dundee.

What worries me most is that the hospital board originally proposed that Stracathro Hospital should have 300 beds, costing between £450,000 and £500,000. Then, when it was suggested by medical opinion in the area that this hospital might be too small to provide an adequate range of specialties, the board upped its sights and we are now told, two years later, that the hospital is going to have 370 beds. Meanwhile the ceiling on expenditure has been fixed at £400,000. I must tell the hon. Lady that I cannot see how these sums can add up.

I cannot help feeling that the board has gone to somewhat questionable lengths to outflank the critics of its proposals. Over these two years we have had a substantial rise in prices. I do not want to go over the subject matter of yesterday's debate, but nobody would suggest that that rise has slowed down in the last 12 months. As a result we are told that we can produce 70 more beds than was originally proposed. I do not believe that we are going to have 370 beds or even 300. I have a nasty idea that we shall have less than 300 beds and less than what the Department itself regards as an acceptable minimum.

On top of all this, the board has decided, no doubt for good and proper reasons, that the modernisation and expansion of the hospitals at Strathmartine and Murray Royal should take place before work is begun on the proposed new district hospital for the County of Angus. As I understand it, this means that the start on the building of the permanent district hospital might be postponed into the 1990s.

As I said, I accept that it is too late to go back at this stage on the decision which has been taken. But I ask for an assurance from the hon. Lady that if the Stracathro hospital does prove acceptable as an interim district hospital, the Government will do everything in their power to ensure that the building of the new district hospital for the county is advanced, and certainly not delayed beyond the middle of the 1980s. Secondly, if the medical objections which have been put forward to the board's proposals turn out to be justified by the early 1970s, can she give us an assurance that there will be a willingness to have second thoughts and that provision will be made for the requirements of the County of Angus, in the second hospital to be built at Nine-wells, in Dundee, even at the cost of some delay in the building of that second hospital at Ninewells?

We do not want to be told in the early 1970s, by the time the force of the objections made to the board's proposals can be judged, that it is too late to revise the Department's plans and to make provision for the county at the second Ninewells Hospital in Dundee. These are the assurances which, if the hon. Lady can give me would lead to some relief of the sincere anxiety which these proposals have raised in the county. I hope that she will be able to give me these assurances.

4.15 p.m.

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

I am grateful to the hon. Member for South Angus (Mr. Bruce-Gardyne) for giving me the opportunity to clarify some of the points which he has raised about which his constituents are concerned. He need not apologise for keeping me in London today. I shall be in Scotland tomorrow for my constituency's Burns Supper.

It is fair to say that there are three main questions involved. First, there is the question with which the hon. Gentleman dealt, namely, whether the hospital services for Angus should be centralised. I know that he agrees that it is inevitable that they should. I will explain why it is important that they should be centralised so that his constituents can understand what lies behind some element of this decision. The other two questions are: if they are to be so centralised, when and where should they be brought together? I hope to give some indication of my answers to the two questions which the hon. Gentleman put to me at the end of his speech.

It is clear to the hon. Gentleman, as it is to me, that modern medicine requires a concentration of facilities, particularly for acute medicine, in order to give a better medical service to the patient simply by providing in one centre the full range of trained staff for the basic specialties. This would include two consultant teams in the main specialties; consultant anaesthetists; nursing staff for operating theatres and intensive care areas throughout the 24 hours; a full range of equipment appropriate to the services provided; and all the supporting labaratory, radiological and other services which an area of this size requires. These are the medical considerations which are at the roots of our policy for the provision of district general hospitals, as should be the case.

Let us consider this matter in relation to the area of the hon. Gentleman's constituents and, indeed, the whole of Angus. The eastern region falls naturally into three main divisions for the purpose of the centralisation of medical services. There is Dundee, which provides the acute medical services for the Dundee area and for certain specialties for the whole region; there is Perth; and there is Angus. If we look at Stracathro and the possible alternatives, we look at possible alternatives apposite for centralising the services for Angus and when they should be provided. No one pretends that Stracathro is the ideal solution for a district general hospital for Angus. I assure the hon. Gentleman that when the regional hospital board and eventually the Secretary of State come to consider a site for the new district hospital they will certainly give very careful thought to the choice of a location which would be most convenient for the majority of those served by the hospital.

However, in the interim, I am satisfied, as the hon. Gentleman knows, from the consideration which I have given to this question and from the discussions which I have had that Stracathro is the only hospital which can be developed to serve the area during the interim period because we are considering not only the hon. Gentleman's constituents but the constituents of his hon. Friend the Member for North Angus and Mearns (Mr. Buchanan-Smith), who, in- cidentally, mentioned to me that he was sorry that he could not be present today.

One of the suggestions made was that Arbroath Infirmary should be developed as an alternative. That would mean new building to provide an additional 250 beds. The money available to finance an interim development is necessarily limited and, while enough for the adaptation for Stracathro, would not be enough to finance a development of this scale in Arbroath.

Another suggestion is that some specialist surgery at least should continue to be provided at Arbroath. This is, in effect to suggest that the centralisation of the Angus hospital and specialist services should be delayed for a further 20 years until such time as the new district general hospital is built. I go into this alternative because any medical criticism of the decision to centralise at Stracathro must have in mind possible alternatives. I do not think that we can afford to leave the people of Angus for so long with a service which has all the defects inherent in being split into geographically separate units. Modern surgery demands a very high standard of medical and nursing care, not least during the post-operative period when the team may be required to deal with unexpected complications which even the best techniques cannot entirely prevent.

All this involves continuous supervision by resident medical and nursing staff. Hospitals must be a certain minimum size to justify the employment of a full surgical team, including anæsthetists and other specialists and supporting staff. To maintain a surgical unit in Stracathro while continuing specialist surgery at Arbroath would be to deprive patients at Arbroath of the full supporting facilities we think should be there. It might also mean that the skilled nursing and medical staff required at Stracathro could not be used to the best advantage.

A further possibility—in effect, the division of the district general hospital into two, with the surgical facilities at Arbroath and the medical facilities at Stracathro—obviously cannot commend itself to anyone who believes that advances in modern medicine require close co-operation between specialties, apart entirely from the fact that it would seem to involve a good deal of inconvenience to patients.

To digress for a moment, I should like to mention that the withdrawal of specialist in-patient services from Arbroath will not leave the area without any casualty services. It is the intention of the regional hospital board to maintain full-time medical services at the infirmary to deal with minor injuries and cases not requiring admission to hospital, and to provide full consultative outpatient services at Arbroath, as well as at Forfar, Montrose and Brechin. Finally, the removal of specialist inpatient services from Arbroath will release beds for general practitioner medical cases, and it is expected that 40 or 50 beds will be available for these purposes, as well as 15 for general practitioner maternity cases and about 45 long-stay geriatric cases. That will still be at Arbroath and will obviously meet the needs of the area.

The hon. Member quite rightly raised the subject of transport. I recognise that at present transport between Arbroath and Stracathro is not good enough and that improvements must be made if we are to minimise, as we certainly want to do, the inconvenience to the hon. Member's constituents. The regional hospital board have this very much in mind. It obtained from bus operators in the area some time ago an assurance that they would be prepared to apply for licences to run direct Arbroath-Stracathro services in the future if the demand proved high enough. The regional hospital board estimates for its part that the demand will be substantial, at least on the principal visiting days—say, Wednesday, Saturday and Sunday. It may be that demand will not be substantial enough to justify a through service on other days, but it may be possible to adjust existing services to make these more convenient for hospital visitors.

The future pattern can probably only be settled once Stracathro is in operation as the interim district general hospital, when the demand for public transport can be tested. But I would say that in order that we may be well prepared for the event the Scottish traffic commissioners have offered their services to arrange further discussions between the regional hospital board and the private bus operators.

I hope that these further discussions under the auspices of the traffic commissioners will take place in a few months' time, as soon as the board has sufficiently phased its building programme for the Stracathro improvements to be able to say at which point in time the demand for transport from Arbroath to Stracathro is likely to arise—

Mr. Bruce-Gardyne

It is not only Arbroath. We also have to bear in mind other burghs.

Mrs. Hart

I mention Arbroath because this is the sort of central problem, but in these discussions under the auspices of the traffic commissioners it will be the whole are and its needs in relation to transport to Stracathro that will be looked at. We have really made a good deal of effort on the problem of transport to try to meet the difficulties of the hon. Gentleman's constituents, and I think that it is right that we should do so, because it is a most important question and no centralisation of hospital services must leave out of account the social needs of people and communities in terms of transport with the new services being provided.

Perhaps I might look for a moment at what is to be the proposed bed complement at Stracathro. It is now to reach a total of 377 beds. The hon. Gentleman says, again rightly, that the population basis for this complement has been taken as 80,000. The complement will include beds for medicine, for surgery—including orthopedic surgery, gynæcology, E.N.T., ophthalmology, pediatrics, obstetrics, geriatrics and psychiatry. It is quite clear that, with 377 beds, Stracathro should be a viable district general hospital for the interim period. We had previously suggested that at least 300 to 350 beds are necessary to form a viable unit, and the number will be above that. These are the criteria which we use for district general hospitals, so that that satisfies those criteria.

The hon. Member asked me what will be the position in the future? Was Stracathro fully acceptable? He asked would the new district hospital be brought forward—

Mr. Bruce-Gardyne

I apologise for interrupting again, but would the hon. Lady deal with the actual expenditure? The original sum suggested for 300 beds was £45,500. How will it come down for 377 beds?

Mrs. Hart

The proposals of the regional board quite clearly, in our view, cover the needs which are to be met at Stracathro. I think that the hon. Member will see from the list of beds I have read out that some of the provision which is being made at Stracathro is very costly; some of it is less costly; for example, geriatric provision needs expenditure on a different scale from the kind of expenditure which one has for acute surgery and E.N.T. and orthopædic surgery. I can assure the hon. Member that there is no reason to believe that to be in any way a lack of cover, or a failure to provide 377 beds or to provide proper standard of care.

The hon. Gentleman asked me, if Stracathro were unacceptable to the area after a few years' experience, what would happen in terms of a new district hospital, and he also asked if medical objections proved to have been justified by the early 'seventies, would we be willing to have second thoughts and to provide facilities at Ninewells, at Dundee, even if this meant delay with the new district hospital.

On the first point, I must say only this to him, that as he knows a review of the hospital programme in Scotland is very soon to be published, as the Secretary of State said on Wednesday. The planning of hospital provision is a continuing and flexible matter. Apart from the years immediately ahead of us, it will be necessary continually to look again at the programme as it stretches on into the future, because populations move, situations change, and I can assure the hon. Member that there will be no rigidity about any proposals, for the new district general hospital will take full account of the experience in the next few years and any changes in population.

That, clearly, is the answer to the second point equally.

I should like, if there were time, to deal with the difficulties which we see with centralisation in Dundee to serve Angus. The difficulties are concerned with staffing and with the problem of staffing up services to suit the whole of the area, but we have to be clear, again, in seeing that we take account of whatever experience shows is the reaction to the experience at Stracathro.

I would not underestimate for one moment the immense difficulties which would be likely to be involved in centralisation in Dundee. When Ninewells is opened, probably in 1970, because of the demands of a major teaching hospital, the regional hospital board will have to recruit 500 or so nurses, an increase of 80 per cent. in the total nursing staff in the city, and, at the same time, the increase in the number of beds in the city will not be enough to provide hospital services for Angus as well as the Dundee area. That is in 1970.

We could only centralise the Angus hospital services in the city in 1970 by keeping in operation both the Maryfield Hospital and Dundee Royal Infirmary as well as Ninewells, and it would require not an 80 per cent. in staff, itself very difficulty to achieve, but an increase of more than 100 per cent. The regional board takes the view, with which I must agree, that we must rule out centralisation in Dundee in 1970 on this ground alone. Staffing difficulties are not likely to be resolved in the next few years because staffing is related to population of the area. That is the difficulty, and one cannot say at this date that there will be any material change in the future involving staff and suitable staff even if there is greater expansion in Ninewells.

The major consideration affecting a later stage of Dundee is that it has not yet been possible to forecast a starting date for the second teaching hospital. There again, therefore, this solution could mean that Angus would be likely to be without district hospital facilities for the next 15 years, and again, therefore—

The Question having been proposed after Four o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-nine minutes to Five o'clock.