HC Deb 05 July 1967 vol 749 cc1951-60

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

10.15 p.m.

Mr. John Wells (Maidstone)

In seeking to raise the matter of the hospital facilities in and around Maidstone, I am pursuing the letter from my town council addressed to me on 23rd March, of which a copy was sent to the Minister of Health. My town council is now concerned, and at that date was concerned, at the slowness in coming forward of the new Maidstone General Hospital, and in particular it was concerned at the absence of any accident centre at our existing general hospital. The cause for my applying for the Adjournment debate is the comparatively unsatisfactory nature of the reply which I received when I sent that letter on to the Minister.

I must begin by praising in the highest possible terms both the medical and nursing staff at the scattered hospitals in my constituency. I believe that within the limited facilities which are available to them, they do a magnificent job. In so far as productivity can be measured in a hospital, the productivity and the throughput and cure of patients which has been achieved by the staff in recent years is marvellous. But these are old hospitals. They are virtually worn out. No amount of upgrading will bring them in line with what will be the requirements of the Maidstone district by the date of the proposed advent of the new general hospital.

Our population has soared. In 1959 the population of the immediate catchment area was about 140,000. By 1978 it is likely to be well over 200,000. If the population increases in the Mailing Rural District at the present rate, it could be as much as 238,000. That is a very sharp increase in population. Secondly, there is the undoubted advent of greater motor traffic to this neighbourhood. Since I have had the honour to represent Maidstone in the House, we have had the advent of the M2 and the M20. The M20 is to be further extended. Although these motorways are marvel- lous, they bring more cars, and inevitably from time to time more cars cause major accidents.

Our existing hospitals are situated most inconveniently in small, narrow, old-fashioned back streets. They are in the main one-way, to enable people to get by more swiftly. The fact remains that if there were a major motor pile-up—two or three coaches involved in what is called a shunt—it would place a great burden on the local hospitals. When they are taxed with what they would do, they wave their hands and say, "We have a little plan. Patients would be dispersed". But a man who has been injured in a major accident does not want to be dispersed nor is it wise to send him 15 or 20 miles to the next available hospital. It is the total inadequacy of the existing beds and the alarm felt by my town council if there should be a major accident in the vicinity that urges me in the strongest possible terms to ask the Minister to bring forward the proposed starting date for this new hospital.

In mid-Kent we have seven hospitals of one sort and another. There is the West Kent General Hospital; Linton—in the main a geriatric hospital; the Kent County Ophthalmic Hospital; Fant Lane, which is maternity and very small, and is a G.P. unit; Preston Hall; and Lenham Chest Hospital. In addition there is the well-known and highly satisfactory mental hospital at Oakwood. I am not concerned with Oakwood this evening except to say that both the people of the neighbourhood and the chairman of that hospital are very proud of what it does. I would point out in no uncertain terms that this mental hospital is open to the inspection of anybody at any hour of the day by appointment and that the chairman will be happy for people to see what a fine hospital it is. It is necessary to say this when there is such criticism of some mental hospitals.

To turn to our range of general hospitals, the ophthalmic hospital and Lenham General Hospital have a catchment area which is very much wider than the main catchment area I am speaking of. Perhaps by 1978 the local population will be 200,000 or more, but for these two specialist hospitals the catchment area will be bigger still. Therefore special notice must be taken of their position. Linton Hospital, the leading geriatric hospital in the neighbourhood, is in an old workhouse which has been beautifully developed. It is in part a day hospital which is a marvellous example of what can be done with old premises. There are modern buildings tucked in behind the old hospital buildings, but there are still 110 beds operating in the old main block. The sooner this can be wiped out and Linton Hospital completely brought up to date, the better.

In all the statistics which the Ministry keeps producing there is reference to a further 100 geriatric beds at a place called West View, Tenterden. If the Minister were an elderly gentleman I would ask him to try to make the journey from central Maidstone to Tenterden. The communications are not easy for families visiting this place, which is not only outside my constituency but very nearly outside the next constituency. It is a very nice hospital—I have visited it and found it an excellent place—but it is a deuce of a long way from Maidstone and is therefore fundamentally unsatisfactory for the local residents in my area, in which the population is going up.

Assuming that the existing hospitals have to continue doing the wonderful job they do with the very limited facilities they have until the new general hospital is built, I put one or two specific questions to the Minister. Is the staffing establishment of these hospitals to go up or down? Whenever one tries to get figures and facts one tends to be fobbed off with generalities. When this matter was discussed some time ago, I agree that it was unreasonable to ask about the establishment of the West Kent Hospital because it was being largely rebuilt and major work was going on. Staff was not up to establishment then and did not need to be, but now that the hospital is operating to full capacity, what is the establishment? Has it been cut back? Will it be reasonable, and will it be kept up?

What is the establishment for the ophthalmic hospital? Is it up or down or neither? I draw attention to the fact that in an area such as Maidstone more and more married women are prepared to return to part-time nursing if facilities are available to them. The facilities they need are nursery facilities so that they can take their small children there and do a day's or half a day's nursing work, but two part-time nurses who are married women do not add up in the running of a hospital to one full-time nurse who can be present for any duties which the matron allocates to her. I hope that we shall not have any hard-and-fast ruling to the effect that two halves equal one whole.

I turn back for a moment to the lack of an accident centre, and I draw attention to the fact that, at the time of the opening of the Maidstone bypass, the M20, when it was imagined that motor traffic would be creamed off, about 25,000 vehicles passed Maidstone Bridge in a day. Today, some years after the opening of the bypass, again we have 25,000 vehicles a day passing Maidstone Bridge and about 30,000 a day going along the bypass. That is a measure of the increase in the traffic flow, and, with the probable advent of a Channel Tunnel, it will increase still further. What would happen in my area if there was something like a Lewisham train accident right on our doorsteps is something which worries my town council.

There is a series of other minor points. For example, if we have to wait for the new general hospital, I understand that at Medway, outside my catchment area, there is a modern central sterilising unit. In the two hospitals in the heart of the Borough of Maidstone, there is not the modern ancillary equipment which is needed to make use of the facilities offered by the central sterilising unit, and I am told that it is because of the shortage of cash. That seems faintly absurd, if it would make for more modern technology.

I have referred already to the ophthalmic hospital. There again, new methods of dealing with people with hearing difficulties have caused a great increase in the throughput of patients. In a hospital like this, the out patient is of great importance, but every out patient has nearly as much record filing and paper work attached to him as an in patient. With a large throughput of in patients, the hospital is desperately short of filing accommodation, and that is an important matter if these hospitals have to continue for some years to come.

Above all else, we want a quick building of our new hospital. We want the best possible facilities for our nurses and medical staff until it comes. If it is many years off, we must have new, modern equipment. I have mentioned only a couple of types in passing, but the Minister is aware of the great advance in technology. It is unreasonable that we should be held up for them because we are promised a new hospital somewhere in never-never-land. I am aware that our maternity unit is to be moved to the new site soon, which will make more beds available. However, about 100 patients every year come to London from my area, which eases our burden somewhat. If it were not eased, but if we had the new superb aids available in our hospitals, the disquiet which my council feels would be much allayed.

I must say to the Minister, while on that point, that if more information was available, if there was a better liaison between the administrative staff and the council, if the Minister could explain to the council at every step what was being done, particularly in the difficult years ahead, and if he could mount an exercise in public relations by taking the opinion formers in my area into his confidence, there would be no need to repeat tonight's performance. Indeed, there would never have been any need for this debate had the Minister and his administrators taken the town council and its officials fully into their confidence.

I do not ask for window dressing, but for genuine confidence and for as much modern equipment as possible. Finally, do not let us have any red herring about West View being wonderful for old people. It is out on a limb. It does not suit them and, when one is old, frequently one is very cantankerous.

10.30 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

I think that the House is indebted to the hon. Member for Maidstone (Mr. John Wells) for speaking in so moderate a way about what is a very complex matter. If I do not cover all the points he raised, I shall examine his speech and write to him, but I may be able to cover most of them now.

One of the essential points which has to be made clear—and I do not accuse the hon. Gentleman of not understanding the position, but perhaps it should be better understood locally—is that the concept of a hospital management committee is that it does not necessarily serve the same people as the people living in a local authority area. Thus, parts of a local authority area may be served by hospitals of two management committees, or again the hospitals in a hospital management committee area may serve several local authority areas. This has the advantage of increased flexibility.

For the purpose of providing a comprehensive hospital service for the population of the central area of Kent—may I say in parenthesis that I am a man of Kent, and know the area very well—the regional hospital board has regarded an area containing a population of about 300,000 living in Sevenoaks, Mailing, Maidstone, Tonbridge and Royal Tunbridge Wells, as being served by the hospitals of the Central Kent Hospital Management Committee, the Tunbridge Wells H.M.C., and by the Sevenoaks Hospital of the Orpington and Sevenoaks H.M.C. On this broad basis as adopted by the board I am assured that there is no overall shortage of hospital beds, though it is a fact that many of the beds are in small units which could be more economically managed if they were brought together in a district general hospital.

May I say that sometimes one comes across historical tensions between hospitals which it will be the ambition of those organising district general hospitals to eradicate so that the most economic use can be made of the available beds. This has a certain relevance in the area, as the hon. Gentleman knows.

In the Hospital Plan published in 1962 a new district general hospital was scheduled to be built at Maidstone some time after 1970–71. This is still the intention of the board, although the flexibility of planning on which we have insisted in Cmnd. 3000, the Hospital Building Programme which we produced after a careful survey of the whole of England and Wales in May, 1966, must mean that a date cannot as yet be put on the start of this new hospital. It remains our policy, however, that district general hospitals should be provided where necessary, and at this moment such hospitals are being built at Chatham and Canterbury, and planning is in hand for another at Ashford. It would disturb the priorities of the regional hospital board's capital programme if a start were to be made now on a fourth new hospital at Maidstone, and would overweight the programme in favour of Maidstone.

Although a start on a new district general hospital at Maidstone cannot be considered yet, the hospital services in this area have not been neglected, and about £350,000 has been spent over the past five years on building schemes in hospitals of the Central Kent Hospital Management Committee. These building schemes cover a wide range of services, and include the new ward block at the West Kent General Hospital, twin operating theatres at the West Kent General Hospital, a geriatric day centre at Linton Hospital, and improvements to X-ray departments.

The hon. Gentleman mentioned the Channel Tunnel, and the whole question of accidents, and I would like to deal with this for a moment. The actual route of the Channel Tunnel roadway has not yet been finalised, but the board has extensive plans for accident emergency centres in this part of Kent. We have, on the advice of the sub-committee of the Standing Medical Advisory Committee, recommended a reduction all over the country, not just in this area, in the present number of accident and emergency units so that a 24-hour service with full medical cover may be provided. Full-scale accident and emergency departments are therefore being built and planned at only a certain number of hospitals. In this part of the country major accident centres are being developed now at Brook Hospital, Woolwich, the Medway Hospital, Chatham, and the Kent and Canterbury Hospital, Canterbury. These accident centres are each part of schemes costing more than £500,000 each. The Canterbury accident centre should open next January, the Brook Hospital centre in the autumn of 1968 and the Medway centre in the autumn of 1970.

In addition, a further major accident centre, which will take into account any traffic increases which will arise from the Channel Tunnel, will be incorporated in the new Ashford District General Hospital now being planned, which should start in the not too distant future. Between them, these four major accident centres will provide a first class 24-hours a day accident service with comprehensive facilities for round-the-clock medical cover.

While the development of these major accident centres is proceeding, the regional board will maintain the accident service at present provided in a number of smaller units such as that at West Kent General Hospital. In the long run, however, the major units must take over this work, which can properly only be undertaken at full-scale accident and emergency centres staffed and equipped to deal with all emergencies.

The hon. Member also mentioned the question of communicating information to the local authority and improving the public relations aspect. I take his point; it is very important. But I am advised that the hospital management committee has always been on the best terms with the Borough of Maidstone and has endeavoured to provide answers to the questions put, although very often these are more pertinent to the work of the hospital management committee than that of the local authority. He will recall that the chairman of the hospital management committee, the Reverend Harcourt Samuel, who is also a member of the regional hospital board, has discussed local hospital matters with him. The hon. Member is invariably invited to openings and functions. I make the point because I know that in a Member's busy life it is not always easy to accept invitations, but I think it would be very helpful if he could get around the hospitals a little—I know that he was at one yesterday—and absorb some of the problems which are of a continuing nature and are being solved in the way that I have been describing. The press locally is always provided with copies of the minutes of the hospital management committee meetings, and its inquiries are always answered in detail. But I take the hon. Gentleman's point; public relations in these matters are very important.

The hon. Gentleman mentioned the central sterile supplies department at the Medway Hospital. It is designed to serve the hospitals of several hospital management committees, including those of the Central Kent Hospital Management Committee. The complicated arrangements necessary for the efficient working of the system mean, however, that it can only be introduced gradually. It is hoped to extend the services to the Central Kent Group fairly soon, but a number of technical difficulties have yet to be overcome.

The hon. Gentleman also talked about the establishment of nursing staff. The number of nursing staff in the group's hospitals has increased from 520 in May, 1965, to 560 in May, 1967. The present nursing establishment of the group is 561—one more than the existing staff—and so there clearly is no great problem in recruiting nurses for the hospitals of this group. The regional board keeps the nursing establishment of its groups under constant review, and no doubt the establishment will be increased at a later date. If it is part of the hon. Gentleman's case that the establishment is too low—I have not had that information—we will look into it. There has been some suggestion at various times that Linton Hospital has not had its share of the increased number of nurses. I have gone into the figures, and it is clear that when the number of beds at Linton Hospital was increased the establishment of nurses was increased to take account of the increased load of work.

I also take the hon. Gentleman's point about the distance of travel to old people's homes and the like. This is very important. In another connection we have been studying the need fully to acquaint the transport authorities with the transport needs for this sort of establishment, but it is not always very easy to secure bus transport in the way one would like.

As to part-time nurses, I agree with the hon. Gentleman that two part-time nurses cannot be regarded as equivalent to one whole-time nurse. The statistics used by hospital authorities and my Department are based on the number of hours worked by a nurse compared with a fortnight of 84 hours worked by a full-time nurse.

The hon. Member said that a number of cases were referred to teaching hospitals. This is not a matter for criticism.

Mr. John Wells

I did not say specifically teaching hospitals. I said hospitals outside the area.

Mr. Snow

I am sorry. I understood the hon. Member to refer to teaching hospitals. He mentioned 100 cases going outside the area.

This brings me back to my original comment that we must get away from the idea, whether at hospital or at group level, that they serve a rigid area. That is wrong for a number of reasons. First, it does not give the necessary flexibility of usage of all the beds available. Secondly, medical facilities may be better in one area for certain specific illnesses or diseases than in others and we must have the capacity to juggle in the market of beds available.

I think that I have covered most of the points which the hon. Member raised. I hope that he will not accuse me of being patronising if I say that he is right to raise this issue. There is a limitation on the capital resources available for the plan. It must be remembered that the capital needed, certainly for equipment, for acute hospitals nowadays is so large that it is necessary to reduce the number of small peripheral units in order to make the equipment available to the whole population. This expensive equipment can be located only in district general hospitals. That is the essential point which is sometimes not appreciated. I know that the hon. Member understands it, and the public must understand it. We hear about the wonders and of the marvellous development of equipment. It cannot possibly be located and financed for use in small hospitals.

I therefore hope that he understands that whereas there must be, and always will be, grounds for criticism, by and large the area about which he is so properly concerned is receiving its full share of available resources. I hope that what I have said about plans for the future will demonstrate to him that we have very much in mind the developing economic interests of the area.

Question put and agreed to.

Adjourned accordingly at eighteen minutes to Eleven o'clock.