HC Deb 05 July 1967 vol 749 cc1777-89

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

12.27 p.m.

Mr. Robert Woof (Blaydon)

I feel ever so grateful for this opportunity to raise a matter of substantial importance to my constituency. The proposal of the Newcastle Regional Hospital Board to close out-patients' clinics in Dunston Hill Hospital and Whickham Cottage Hospital has aroused deep concern, not only for those who are involved in the work of the hospital but also, in particular, the general public who, to all intents and purposes, are to be offered facilities in a new comprehensive out-patients department in the Queen Elizabeth Hospital, Gateshead-on-Tyne.

My attention has been drawn to this regrettable idea from many sources of protest, notably Whickham Urban District Council and also the public notice section of the Newcastle Evening Chronicle, through which it called for any comments on the proposals to be sent to the secretary of the regional hospital board by 30th June.

Before I attempt an explicit account of the nature of the protests by adding my own support to what I positively think are valid reasons why such a turning-point of policy is unfavourable to the area, I gladly pay tribute to the regional hospital board in its honourable pursuits.

There is no more pleasing exercise of the mind than gratitude, and I want to take this opportunity to say that it is to the board's everlasting credit that it conceived the idea which brought about the major improvements in the Queen Elizabeth Hospital. No one doubts the board's conscientiousness, the painstaking services which it renders and its efforts to establish the provision of facilities which are specially geared to meet the health needs of each patient.

I also appreciate that my right hon. Friend the Minister of Health and my hon. Friend the Parliamentary Secretary are only too anxious to vouchsafe the best they can give to the hospital service. This is borne out by the fact that more money is being spent on hospitals than ever before. The House will recognise that they realise that the National Health Service is not only a service for the sick, but is also a service to keep people in communities well. Hospitals should not be divorced from the people they serve and to close well-used clinics, especially preventive clinics, is a retrograde step. As a consequence, by presenting certain facts I want to try to convince my hon. Friend that it is imperative that they be retained.

I have in mind the very important rôle which these clinics play. They are adequately equipped with costly modern apparatus, and the way in which they are run and organised is highly commendable to the medical staff and its professional skills. This is all very encouraging and one is deeply moved by the kind of work done there. The patients are accepted predominantly from the catchment areas of Whickham U.D.C., Blaydon U.D.C. and Ryton U.D.C.

In any serious and sustained attempt to explain the new state of affairs, without exaggerating the position, I must frankly say that, after all the time which has been spent on planning activities and general ideas and the intense efforts attached to particular ends and the public money which has been spent on these modern clinics, I am left breathless by the suggestion that these clinics are to close. What makes it so significant is that if the clinics had not been serving a useful purpose and if changes were to render them obsolete, one could well understand the regional hospital board's policy, without being puzzled or dismayed, but, feeling my way to methods of reasoning, if the whole spectacle is to be made understandable. I politely suggest that that is far from being the case.

Going on to the actual panorama of present things, it may well be argued that it might be advantageous to dispense with isolated clinics and to incorporate them into the regional board's larger clinics. I could well understand any argument to establish stringent economy of staff and equipment with greater facilities for research and investigation, but I need only stress that the clinics in question are situated at the very hub of a district with a greatly increasing population and conspicuous for the new housing estates which have been and will continue to be built and with still further increases throughout the constituency on account of the same process.

The House, however, will agree that health is the soul that animates all enjoyment of life, and while the reduction in the incidence of notifiable infectious diseases over the last decade has changed the need for hospital beds—the difference is so greatly marked with improved methods of treatment through the discovery of antibiotics which now permit many patients to be treated in their own homes—nevertheless, there still remain health problems about which it would be dangerous to be complacent.

It is from that point of view, being concerned about environmental health, that one of the main functions of the Whickham Chest Clinic is the prevention of tuberculosis. I am forcefully driven to the conclusion that such preventive medical services differ from curative services and work efficiently only if the patient can use them easily. Every station of life has duties which are proper to it and beneficial to others. Such services recommend themselves and this thought should be kept awake in us at all times, especially when the main source of tuberculosis infection today is elderly people with coughs. They visit their doctor and at his suggestion are willing to be X-rayed. It is important that they should be X-rayed, not only for their own sakes, but because they infect others.

Young people are particularly vulnerable to infection and are at risk especially of tuberculosis meningitis, which is one of the most deadly diseases of childhood. The mothers of young children are also at risk because of contacts and they take their children to Whickham Chest Clinic for B.C.G. vaccination which protects them against tuberculosis. In this respect, I am given to understand from authoritative sources that the figures for preventive vaccination in Whickham and district is higher than the average for the country as a whole, because of the easy access to vaccination.

Another benefit of the service which I must mention is to check up on those who work in dusty conditions. When they feel that they are suffering from a chest disease, they are X-rayed, and we need to note that the clinic is doing an excellent job of work in examination by diagnosing pneumoconiosis and its associated diseases. In fact, at present there are 105 people in the area suffering from pneumoconiosis and kept under regular supervision.

To do full justice to the proper value of the service I should say that 201 clinical sessions were recorded at the clinic last year, with 47 X-ray only sessions, covering 4,650 as the total number in attendance. With this in mind and without making too big an analysis, I would only say that it is of great consolation to reflect that it is part of the task of those who deserve every credit for trying to make life happier and healthier for those in need.

Such a summary of fundamentals evokes the thought that we always wish for knowledge, and many passionately concentrate their noblest energies on the task of getting it. It may be said that if action were equal to reaction, there would be no such thing as evolution and that the world would probably remain a pendulum lacking impulsion to set it in motion. But disease is coeval with life itself. It is one of the attributes of life, an unstable entity in a world of flux and change. It is an ever-changing balance of forces. But I am glad to think that the out-patient clinic of Dunston Hill Hospital is rendering a similar and cherished service.

This clinic was opened at the end of 1963 and at a cost of £6,000. It is equipped with expensive apparatus, and, like the Whickham Clinic, it is in the hands of specially trained experts. The number of out-patients who attended last year was 7,730. Patients have to go through a number of stages, most of them comparatively simple. Arrangements are made so as to obviate difficulty, which shows the high standard of organisation and management and the close-knit efficiency of medical care. Quite often, the consultants hold meetings with the clinic staff to discuss interesting cases.

As a layman, I think that that in itself is an attraction, for the protection and promotion of people's health, and, in appealing for the clinic's retention, I emphasise that, if for no other reason, it illustrates that the new out-patient facilities at the Queen Elizabeth Hospital will not be inadequately used. I am given clearly to understand that the special outpatient facilities available there are not likely to be used on the first occasion when a patient is seen for a consultation. It will, of course, be possible for patients who are seen initially at Dunston Hill Hospital subsequently to receive special out-patient investigation or treatment at the Queen Elizabeth Hospital, and then be subsequently reviewed at Dunston Hill Hospital. All that is of cardinal importance, and therein lies the fundamental significance of the service.

It may well be that difficulties give birth to miracles, and not every calamity is a curse, but we have to remember that the regional hospital board's future pattern of policy to close these clinics will involve constituents in the trouble and fatigue of travelling to Gateshead. It is not a question of criticising the board, to which, manifestly, we are indebted, but we have to make a commonsense approach, in relation to such diversity of activity, and I can think of no more agonising journey. Humanitarian considerations and inconvenience must be taken into account. The stress of travelling cannot be ignored. For many people of limited physical ability, especially old people and mothers with children, it is painfully obvious that there will be a tortuous journey as a result of having to change buses to get to the Queen Elizabeth Hospital.

We can always control a situation which we understand, but I believe that, if the clinics are retained, they would enable relationships between out-patients and those who care for them to continue to be happily cultivated. We try to live in the light of a hard, crude alertness to events, and I was interested to read a chapter dealing with diseases of the chest in a review of the medical services in Great Britain. In that review, the report of a committee sponsored by several distinguished members of the medical profession, it was said: There are dangers that, as the chest services become submerged within the general hospitals, the preventive side will receive less attention. The essential link between the public health and clinical aspects of tuberculosis control needs strengthening. That is part of the case which I have tried to establish. Probably, it is not alone sufficient, but, for all the reasons which I have put, including the contributory sketch which I have made in the time available, I beg my hon. Friend the Parliamentary Secretary to approach the regional hospital board with a view to reconsidering its proposal. I am sure that, if he can do anything in that respect, it will be greatly appreciated by all concerned.

12.45 p.m.

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

I have listened with great interest to my hon. Friend the Member for Blaydon (Mr. Woof), and I can well appreciate the local concern in this matter. I am grateful to him for giving me this opportunity to explain the position regarding closures in general and the present proposals in particular. Before I go further, I wish to make absolutely clear to my hon. Friend that no decision has been taken. I stress also—I think he knows this—that I made a short tour of the area recently, and I was left in no doubt by the advice which was offered to me that those responsible for the design and lay-out of the Health Service in his area must always remember the long history of harsh social conditions there during the past four or five decades.

The recent trend towards greater interdependence among the various branches of medicine and also an increasing realisation of the need to bring together a wide range of the facilities required for diagnosis and treatment led to the concept of the district general hospital. This was further endorsed when the Hospital Plan was reviewed last year. The long-term plan for the Newcastle region, as for all other regions, is to provide a number of these district general hospitals to replace the numerous existing hospitals or clinics which can offer only limited services. I emphasise that nothing I say now must in any way be interpreted as a criticism of the operation of the clinics up to now.

Available resources of capital, manpower and land do not permit building all the new district general hospitals on virgin sites. Many of these must, therefore, be provided by redeveloping in phases existing hospitals. The first phase usually plans to provide the services most required in a particular area. Completion of a phase of a new hospital inevitably involves the transfer of services to the new hospital and consequent closures of clinics and departments in existing hospitals.

The chest clinic, either entirely independent, or in a small cottage hospital, is a legacy of the time when, as my hon. Friend said, tuberculosis was a disease much more prevalent and more feared than it is today. The decrease has been dramatic. The number of deaths in England and Wales averaged almost 8,000 in 1953–55, but in 1965 it was only a little over 2,000. In 1960, hospital authorities were given advice on the future of the chest services. Hospital authorities were advised, among other things, that the chest clinic should be integrated into the general out-patient department of the hospital and that provision should be made for a chest unit in planning new out-patient departments of general hospitals. All consultants, therefore, should have known for many years that this was accepted policy. As regards local consultant opinion, I am not well informed on what my hon. Friend has said, but my information is that there is no unanimity of opinion on this matter among local consultants.

It was recognised that some chest clinics would continue to function outside the general hospital until new hospitals were built. But the aim should be the close integration of the chest clinic with the out-patient department sharing the various services and amenities of the department, as do other specialties. This would provide the chest physician with the full range of hospital out-patient services and give to patients the amenities of general out-patient departments, subject only to measures to prevent spread of infection. Nurses working in the chest unit would no longer be separated from their colleagues.

Since 1960, some progress has been made in reaching these objectives. A more recent review of the organisation of the chest services has just been completed by a sub-committee of my Standing Medical Advisory Committee. I hope to receive its report very soon and give further advice to hospital authorities. I am told that it will emphasise and clarify the earlier advice given that chest clinics should be integrated in the district general hospitals.

The closure of a hospital department or clinic follows a carefully devised pattern. After informing the Minister of its intentions, the regional hospital board—as was done in this case—invites comment from a number of local bodies and the closure is advertised so as to give individuals or bodies whose opinions have not been specifically canvassed the opportunity to express their views. Any objections received are carefully studied, and in some cases they are met, for example, by some adjustment to the closure timetable. Final approval of any closure is given personally by my right hon. Friend the Minister. I am sure that my hon. Friend realises that modernisation of hospital services could not proceed if all small units were retained. What is far more important, the concentration of the best available services and most effective disposition of staff, would inevitably lead to closures.

Diagnostic services for diseases of the chest are now provided at Whickham Chest Clinic and clinics in general medicine, general surgery and orthopaedic surgery in the out-patients' department at Dunston Hill Hospital. These services at present serve mainly the areas of Blaydon, Ryton and Whickham, which are included in the catchment area of the Gateshead Hospital Management Committee. Queen Elizabeth Hospital, Gateshead, is one of those being redeveloped by phases into a district general hopsital. The first phase is nearing completion and will provide modern facilities for diagnosis and out-patient treatment in all specialties except maternity. It will include a new X-ray department, an out-patient operating theatre, and also a day ward to enable more extensive investigations and treatment to be carried out on an out-patient basis. Pathology and other supporting diagnostic and ancillary services are already provided at the Queen Elizabeth Hospital.

As the facilities to be provided will be vastly superior to any of those currently existing in the group, it is considered desirable that the whole community to be served by this hospital should benefit from them, following the opening of the new out-patient department in late 1967, and it is proposed that, except in the case of maternity clinics, all out-patient clinics now held at other hospitals in the group should be concentrated at the new Queen Elizabeth Hospital.

A memorandum summarising the proposals was circulated to the Press, and a letter seeking their views was sent to the Gateshead County Borough Council, Gateshead Executive Council, Gateshead Local Medical Committee, Durham County Council, Durham County Executive Council. Durham County Local Medical Committee, Gateshead and District Hospital Management Committee, Felling Urban District Council, Whickham Urban District Council, Blaydon Urban District Council and Ryton Urban District Council. I understand from the regional hospital board that as a result of these approaches some authorities have agreed to, or have no objections to, the new proposals.

However, the distance of Queen Elizabeth Hospital from Whickham, Blaydon and Dunston, and the inconvenience of the bus journey, will cause expense and hardship to a number of patients, par- ticularly the elderly. I do not deny that the journey may be difficult, but I think there is room for the provision of a voluntary car service. I assure my hon. Friend that, if and when the decision is taken in principle by the regional hospital board, it or one of its agencies will immediately consult the transport authorities to see what amelioration can be achieved in local transport services.

It is also said that the local population is likely to increase. It is estimated that by 1981 it will have increased by about 14,000, but this has been taken into account in the general planning of the hospital services in the area.

Some concern has been expressed that in view of the increased distance which out-patients would have to travel to the Queen Elizabeth Hospital, there would be a reduction in the number coming forward for chest X-ray, B.C.G. vaccinations and Heaf testing, which will he detrimental from the community point of view, but responsibility remains with the general practitioner or local authority. It may cause some inconvenience to patients to travel some miles to Queen Elizabeth Hospital in Gateshead, but a better service will be provided.

The wider range of facilities at the out-patient department there will enable the consultant to diagnose more completely what is wrong with the patient. He will not see his patient merely as a chest case. I am advised for example, that a heart condition may be associated with a chest condition, which will be more easily diagnosed in a hospital than in a clinic. But I emphasise that I am not casting any reflection on the efficiency of the existing clinics.

My hon. Friend has said that the incidence of chest disease remains high in the area served by the Whickham Clinic. The board's medical advisers are well aware of this problem, and it will be taken into consideration when the matter is finally discussed by the board with a view to a decision.

There need he no concern that staff will be made redundant by the proposed closures because there are unlikely to be any redundancies. But if there were, the staff concerned would be offered alternative employment.

I remind my hon. Friend that no decision has yet been reached about the closures. All the objections will be carefully considered, and the proposals to close Whickham Chest Clinic and the out-patients' department at Dunston Hill Hospital will be reviewed in the light of the objections. The Newcastle Regional Hospital Board is not meeting until later this month to consider the objections. I am sure that the House would not expect me to prejudge its conclusions.

I assure my hon. Friend that the Board and my Department are most obliged to him for his persistence in drawing to our attention the social anxieties inherent in the general situation.

And the debate having been concluded, Mr. DEPUTY SPEAKER suspended the sitting till half-past Two o'clock, pursuant to Order.

Sitting resumed at 2.30 p.m.