§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bishop.]
§ 11.15 p.m.
§ Mr. Patrick Wolrige-Gordon (Aberdeenshire, East)
I rise to plead a solemn cause. The closure of Ellon Hospital to the many millions who have never heard of Ellon, let alone its hospital, may be a matter of small moment. But to the Ellon people it is their hospital; it is the place in which they were born; it is the place to which they look in sickness and sometimes even in health. It is the place to which in future they may have to look in vain. That is the solemn matter before the House tonight.
As befits a Conservative, I stand for progress. I think that change, and fundamental, basic change at that, is essential if mankind is to survive, but I never forget that progress depends upon what has gone before, that a tree will fall if one cuts its roots, however reasonable such action might appear, and that all the projected glories of the medical marvels to come in Aberdeen will never make up for the present reality that is Ellon Hospital.
The regional hospital board is in the position of a large monopoly able and willing to liquefy its assets in the interests of rationalisation and centralisation. People can make a very reasonable impression with such a policy. But it is an approach which I believe has already served to diminish the facilities and the morale of the National Health Service as a whole in this country, and, in general, I oppose it, first, because rationalisation excludes faith, and, second, because centralisation cuts out the people on the periphery, and they are every bit as important as the people at the centre. Taken together, the two ideas can lead to the wrong decision.
There is all the difference in the world between the approach which makes people want to cut down and then find all the attractive reasons for such action, which in the case of Ellon Hospital is not far to seek. There is, finance, staff, distance, pressure on resources, the climbing birthrate in Ellon, and so on. It is not always hard to find attractive reasons 617 for cutting down, but there is also an approach which is determined to use every every asset it has inherited to the full and which concentrates action, as can easily be done, on how to turn the reasons for a negative course into the opportunities for a positive policy.
Take as one example, expense. The regional board says that Ellon Hospital should be closed because it is too expensive to run, but that is never a convincing argument to ordinary citizens like a Member of Parliament, because there is always too much evidence of waste in other matters. What about in Ellon itself the idea, which I understand has been under consideration for some time, of spending £13,000 to provide a clinic for the district nurse without reference to the excellent surgery accommodation already provided through the initiative of local doctors? Thirteen thousand pounds would keep Ellon Hospital running for more than a year?
We are not impressed by the expense argument because by "expense" I think is really meant inconvenience. "Ellon does not fit in, it is not an easy part of a plan, so we shall close it and now let us think of all the good reasons, and of course expense is a good excuse." That is the rationalised, centralised approach which is threatening the existence of this excellent hospital. Not a thought about how to keep it open by running it more cheaply, no, because it is not the difficulties, it is the lack of thought and determination, not how to overcome those difficulties which has condemned Ellon Hospital so far tonight.
The decision to close this hospital seems so misguided that it opens a number of questions which I think should be answered. If the £12,000 which has been given as the cost of maintaining Ellon Hospital can be spent elsewhere so much better, where is that to happen? It is our Health Service and I think we ought to know. The renovation which the board says is so necessary and which, it says, would cost as much as £20,000 to £40,000—a very vague figure—I submit is rubbish. Even in the letter to me in which the Under-Secretary announced the closure, he could only specify narrow doorways, small bathrooms and w.c. compartments not suitable for patients who need assistance of a wheeled chair. It does not cost £20,000 to widen a 618 doorway. If the Under-Secretary would visit the hospital, he would know far better how excellent it is—an opinion which has been formed by many of the medical fraternity who have taken the opportunity to visit it.
Another reason in the Under-Secretary's letter was the awkwardness of Ellon Hospital for staff. That is what the administrators find hard. It does not fit the mechanical materialist world. I reject that argument even more flatly than the other, and I have most fortunately a most formidable ally on this in the regional board itself. Its own hospital plan gives very sound reasons for the retention of hospitals the size of Ellon Hospital. It already administers three hospitals in the same class, and one of them, at Insch, is almost identical with Ellon Hospital. The fact is that Ellon has always obtained staff all right. Experience is the proof.
Finally, the argument comes down to the fact that the trouble is the shortage of maternity and geriatric beds in Aberdeen itself. I sympathise with Aberdeen, and I hope that those shortages can be met. I can testify to the pressure on the hospital accommodation in Aberdeen. In Ellon Hospital only last week I met a couple of young ladies with a pair of spanking babies. Those mothers had had to go to Aberdeen for the birth and had had to leave hospital there the following day.
Those ladies were lucky. They were able to come back to Ellon Hospital. They will not be able to come back to it in the future. The board says to the Ellon mothers, "You will not have to go to Aberdeen. You will have to go to Fraserburgh, 26 miles away, or Peterhead, 17 miles away, or Inverurie, 11 miles away across narrow country roads". I will say to the board on the mothers' behalf that they do not want to go to Fraserburgh, or Peterhead, or Inverurie. If they cannot go to Ellon, Aberdeen is only 13 miles away, 25 minutes in a bus on a good main road. Their people can visit them there.
But the pressure on Aberdeen remains, and I cannot for the life of me see why Ellon's patients should have to travel to Aberdeen for hospital accommodation that is so little available while Aberdeen patients should not have to travel to Ellon for accommodation that is 619 available. Is it just that the predilections of Aberdeen patients seem so much more cogent than those of Ellon patients?
I wish to end with some solid alternatives for the Government's consideration. They could keep this hospital and forget the foolish idea of using it entirely for maternity. The number of patients does not warrant that, but it warrants a maternity unit in Ellon. Human beings are not an automatic production line. Sometimes there are a lot of babies, and then for a week or two there may be none. A bed occupancy percentage of, for example, 70 per cent. in Peterhead can bear no relation to times when expectant mothers must sleep in the corridors because there is no room in the wards. It can and does happen at Aberdeen, and it can happen anywhere. That may be the time when mothers from Ellon or the surrounding area, with its population of over 13,000, may want to have their babies as well.
Therefore the hospital must have a maternity unit, but it could be cut down with not 14 beds but five, and the other wing could be used for 10 geriatric or general purpose beds. If that is done, the only extra building that would be needed at Ellon Hospital would be a labour ward at the other end of the hospital from where it is now. It would simply be necessary to move the present equipment down into it.
I believe that it is very possible that Ellon builders and the town council and community would consider providing that addition by their own efforts. Peterhead won its maternity unit through its own determination to raise a large financial contribution. Ellon may have to seek to get its maternity services in the same way. I do not yet know if it will. The town council is to discuss this proposition tomorrow night, and it is not for me to say whether it will decide to do it.
If it does, that will remove the burden of capital expenditure on new building at Ellon of which the regional board seems so much afraid, and I very much hope that the Under-Secretary will bear that in mind if Ellon makes its decision to support this idea. I regard that solution as the most sensible of all. If that is cast out, then I ask at least that we keep the hospital for general purposes, which are so much less expensive to run. If 620 the Government's heart is still flint—which I can hardly believe—and nothing I have said is adequate to move them, then I beg them at least to keep the building. Ellon faces great expansion in the future. There are plans for at least 600 new houses, and my expectation is that they will be mainly for young couples, some, perhaps, going to work in Aberdeen, but all likely to have their families in the burgh.
I end by referring to a slightly different though related problem. We must now have an ambulance in the burgh, and the need will be all the greater if the hospital services are to go. All we can get at the moment, sometimes after long delays, naturally, is an ambulance from Peterhead. This can mean hours of waiting for Ellon sick and injured. Ellon will look after its own ambulance. I know that one is urgently needed in the burgh now. I hope that the hon. Gentleman will bear this need in mind as well as the real need in Ellon and the large area round about for the retention of the hospital.
§ 11.31 p.m.
§ The Under-Secretary of State for Scotland (Mr. Brace Millan)
To take the last matter first, the question of an ambulance, I shall look at the point which the hon. Member for Aberdeenshire, East (Mr. Wolrige-Gordon) makes and write to him on the subject of ambulance services in the area.
Turning to the main subject of the debate, the closure of Ellon Hospital, I understand very well that the closure of any hospital, particularly one in a small community which has served that community well, is a matter of considerable disappointment to the people living in the area. But it would be quite wrong to leave the impression, as, I think, the hon. Gentleman did, that the regional hospital board had not considered this matter very carefully. He knows, because he has been in correspondence with me and with my predecessor, that the matter has been considered very carefully over quite a long time. There is certainly no question of a hasty decision having been reached by the regional hospital board, and neither is there any question, as he seemed to suggest, that the regional board has taken a decision out of some kind of dogmatic belief that centralisation is absolutely necessary, that 621 small hospitals are awkward, and that they ought to be got rid of as quickly as possibly.
The hon. Gentleman spoke of three small hospitals—I think that he was referring to Aboyne, Torphins and Insch—but he did not seem to appreciate that the point he made destroys part of his argument, because the regional hospital board is maintaining those hospitals. This demonstrates that it has no rooted objection to small hospitals, but it, naturaly, looks at any particular hospital on its merits and according to the local circumstances.
The hon. Gentleman did not try to argue that Ellon Hospital is an economic proposition for maternity provision. He did not give any of the figures about the hospital and, to put matters in perspective, I ought to do so. The closure of Ellon Hospital is part of a general reorganisation of maternity services in Aberdeenshire.
At present, there are 82 general practitioner beds, which are sufficient to provide for over 2,000 patients a year. There are only about 1,500 births a year at these hospitals, and, taking into account the confinements which take place in the specialist hospital in Aberdeen, these births represented in 1965 97 per cent. of all births in the area. This is a very good figure indeed, and, compared with other parts of Scotland, an exceptionally fine one. So there is no question of the closure of this hospital reducing the level of provision in Aberdeenshire to unacceptable levels. That is not so at all. As I have said, this is part of the reorganisation of services. There have already been two small units at Rhynie and Fyvie closed, totalling nine beds, and, of course, there has been the provision of new units at two large centres which previously had none. These units are now in operation, at Peterhead, where there are 11 beds, and Inverurie, where there are 10 beds, and there are, as I think the hon. Gentleman knows, 12 beds at Fraserburgh.
So far as Ellon Hospital itself is concerned, the harsh fact is that the occupancy rate there has been very poor indeed, particularly since the provision of beds at Peterhead and Inverurie, and it has declined from about 70 per cent. a few years ago to an average of only 622 30 per cent. at the present time; in other words, on average only four beds out of 14 are occupied. I know that the hon. Gentleman is not terribly impressed by the economics of this, but I must quote the figures. The result of this fall in use of the hospital has meant that the cost per case has increased from £31 9s. 9d. in 1961–62 to £70 1s. 6d. in 1964–65. These figures are really quite alarming when one considers the general pressure on the hospital service.
§ Mr. Wolrige-Gordon
I interrupt just to say that those figures bear out the strength of the argument, that it would be advisable to reduce the hospital to a maternity unit of, say, five beds—the hon. Gentleman said four were fully occupied during the year—and use the others for general purposes.
§ Mr. Millan
I want to come to that in a moment. I want first of all to deal with the present position. Similarly, still dealing with this particular maternity point of view, I want to make the point again that there will be alternative facilities available in Peterhead and Inverurie. Although obviously it is less desirable to patients that they should have to travel, and obviously we would all like to have hospitals as nearly located to their homes as we can manage it, the distances are not, I think, great, and I certainly could not accept that there is going to be any considerable hardship involved, simply because there is no hospital full of maternity cases at Ellon itself.
The hon. Gentleman said, and has just repeated the point in that intervention just now, that of course, if all those units were not to be used exclusively for maternity cases there would be the possibility of using them partly for maternity and partly for something else, and I want to turn to that. The hon. Gentleman has said that the hospital is an excellent one, but I want to put it to him that the building—in two blocks—does not in fact conform to the modern standards of hospital design and layout, or of engineering services. The labour room, for example, is cramped. There are no day rooms, and none of the wards has provision for babies to be in the same room as the mothers. Ancillary buildings are adjacent at various levels on the site. There are problems with the heating system, and so on. 623 The reason why I make these points is that if the hospital were to be converted to any other purpose there would have to be quite considerable sums of capital expenditure involved. The hon. Gentleman is obviously a little sceptical of that. I can only wish that it were true that we could make alterations in even a small hospital at very small cost, but, unfortunately, our experience is that if these alterations have to be made they tend to be rather expensive jobs, and as for the conversion to geriatric use, I would estimate—I give the estimate, obviously, as a rough one—that it might cost something between £20,000 and £40,000.
The hon. Gentleman has mentioned that Ellon Town Council is likely to consider some propositions by which it might be possible for it to raise certain money itself, as happened some time ago in Peterhead.
Obviously, if the town council makes a decision in that sense we will listen to what it has to say but it is not just a question of capital expenditure. There is also the question of the expenditure in running the hospital. That is at the present time about £13,500 a year and, of course, if the hospital were fully occupied, with the geriatric, general medical patients and maternity beds continuing, the cost would go considerably beyond that and would have to be sustained year after year.
It is part of the function of a regional board to look at its resources and see whether it is using the money available to it, to the best advantage. The money is limited and the board would be failing in its duty if it did not try to use it to the best advantage. Money spent at Ellon would not be available for spending elsewhere.
It is the judgment of the board—a judgment with which my right hon. Friend and I concurred—that this money could be spent elsewhere to very much greater advantage than in continuing the hospital at Ellon. One of the propositions is that the hospital might be converted partly for maternity and partly for geriatric provision. I have already mentioned what would be involved in capital expenditure from this point of view, but it would not be sensible in 624 terms of the demand for geriatric accommodation in the board's area at the moment to spend this money at Ellon.
For example, the most acute need for additional geriatric accommodation is in Aberdeen City itself and next to that the Board considers that the priority would be in Morayshire. In neither of these circumstances does Ellon have such priorities. I repeat—if the money is spent in Ellon it is not available for spending at these other places where, in the judgment of the board, it could be very much better spent.
The same sort of considerations apply to any other suggested use of the Ellon Hospital. The board does not feel that the money spent there would be justified in view of the other demands on its resources.
It is naturally distressing that any hospital should be closed and, of course, such a decision is considered very seriously both at the level of the regional board and by the Secretary of State himself. This case was considered very seriously indeed. I am sorry that I do not feel, despite what the hon. Gentleman has said, that there is any prospect of reversal of this decision. We shall certainly listen to anything that the town council may say following its meeting tomorrow.
As the hon. Gentleman knows, the town council as well as other local authorities, the executive councils, G.Ps. and the rest, have already had the opportunity to make representations to the Board on this proposition and these representations and points of view were taken fully into consideration before the final decision was reached. I see that the hon. Member smiles at this. I know that he does not like the final decision but I take it that he is not suggesting that the Board was in any way neglectful of the process of consultation. I think that he will agree that the process was lengthy and exhaustive and that every interested body was fully consulted before the decision was taken.
In those circumstances, it is very unlikely that there can be any new factors introduced at this late stage which could possibly affect the decision which the regional hospital board has taken. I repeat that it is regrettable that this should have to be done, but if we are to 625 get the most effective use of the resources which we have for the National Health Service, as well as expansion in certain places inevitably in certain circumstances existing facilities will have to be discontinued. It is not something which is lightly done, but it is something which 626 is sometimes inevitable and in all the circumstances it must be inevitable in the case of Ellon.
§ Question put and agreed to.
§ Adjourned accordingly at a quarter to Twelve o'clock.