§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. loan L. Evans.]
§ 4.0 p.m.
§ Mr. Hugh Rossi (Hornsey)
The occasion of this debate on the future of the Hornsey Central Hospital which you, Mr. Speaker, have been kind enough to allow me, is the presentation of a petition by my constituents, which I shall hand to the Minister at the conclusion of these proceedings. The petition reads as follows:We, the undersigned, having heard of the proposal by the North West Regional Hospital Board to alter the status of the Hornsey Central Hospital, Park Road, N.8 from a G.P. Consultant run hospital, serving the health of the surrounding community, into a chronic sick unit with its beds given over permanently to the elderly chronic sick, do strongly urge:That you reject this proposal, since we are convinced this action on the part of the Regional Board will result in a serious lowering of the present excellent standards of service provided by G.P.s and hospitals of the National Health Service in this area.This petition bears close on 18,000 signatures, approximately 30 per cent. of the entire electorate of Hornsey. In addition to this, I have had many letters and many verbal representations in similar terms. Hence, it is not just my voice that the Minister hears. It is the voice of Hornsey. The desires I express are not just my desires. They are the desires of Hornsey. The fears I state are not just my fears. They are the fears of Hornsey.
In saying this I am aware that the right hon. Member for St. Pancras, North (Mr. K. Robinson), the then Minister, stated in March of this year the Government policy, which was to close or change the use of smaller hospitals such as the Hornsey Central Hospital. In a letter to the regional 2058 hospital boards at about that time he wrote as follows:Changes of closures often provoke intense local resistance which is emotional rather than informed. I want to assure you that I am prepared to support rational decisions unpopular though they may be.It is, therefore, abundantly clear that in trying to persuade the Minister I am faced with a most formidable task. The petition itself, despite the overwhelming number of signatories, is clearly not enough. I must also show that it is not simply emotional resistance but that it is based on and supported by informed opinion. Secondly, and perhaps most difficult of all, I must persuade the Minister that, although the proposals of the regional hospital board correctly follow his own general policy, nevertheless in the particular circumstances of the Hornsey Central Hospital his policy has little application, because this hospital still has a most effective part to play in a modernised service.
My first task is easily accomplished. Views similar to those in the petition have been expressed by the following bodies—the Middlesex Executive Committee, the Middlesex Local Medical Committee, the Medical Staff Committee of Hornsey Central Hospital, a group of general medical practitioners in the locality, the Haringey Borough Council, advised by its officers, and last, but by no means least, in view of the proposals of the regional board to turn the hospital into a geriatric hospital, the chairman and staff of the Hornsey Old People's Welfare Committee. All these bodies have come out strongly against the proposed scheme. Not only is this a unanimous and informed opinion. It is an informed opinion by people with a unique knowledge of local circumstances and needs which on no criterion whatever can be lightly dismissed as emotional.
I turn, therefore, to the second and, perhaps, larger task before me. As the Minister knows, the Hornsey Central Hospital is a general practitioner hospital. There are 60 beds, well equipped, with open access to all general practitioners. It has it own X-ray department, operating theatre, and physical medicine department. About 1,100 in-patients are treated each year, a large number of whom are elderly. In 1967, 3,135 patients attended as out-patients. Over 7,000 X-rays were 2059 taken at general practitioner request, and the physiotherapy department gave over 19,680 treatments.
The hospital is situated geographically in the midst of a residential hinterland not easily served by public transport, and the nearest general hospital, the Whittington, is out of the district and can be reached from many parts of Hornsey only by difficult journeys involving changing buses.
The services offered by the Hornsey General Hospital are highly valued by my constituents, as the petition shows. Also, because of the regard in which it is held, there is a strong League of Friends which so far has spent over £20,000 on the hospital and holds a large sum of money in readiness to spend on a worthwhile project. The regional hospital boards proposal will change all this.
The board recommends that only 18 of the 60 beds are to be retained for general practitioner purposes, the remainder to be used for geriatric patients taken from a wide London area. All specialist in-patient work is to be transferred to the Whittington, and if and when a general practitioner unit of about 20 beds to accommodate 150 practitioners is opened at the Whittington, the remaining 18 general practitioner beds at Hornsey will go altogether. This would indeed be a retrograde step and greatly diminish the value of the National Health Service in my constituency.
The arguments given by the Board for its proposals are two-fold. First, it points out that the average daily bed occupancy at the hospital in 1966 was 69 per cent. and in 1967 it was 67 per cent., as against a national average for acute hospitals of 76 per cent. There is some substance in this. But difficulties have occurred, primarily in the ear, nose and throat wards, as happens in all hospitals. Children cancel appointments or admissions at the last moment because of colds. But two or three beds lost in this way in a small hospital with 60 beds have a far greater effect on statistics than in a much larger hospital where two or three beds left empty have a small statistical impact. I urge the Minister, therefore, to approach statistics of this kind with the greatest caution.
2060 In any event, the medical staff committee has made a number of suggestions to the board which would correct the situation regarding bed occupancy. Among the suggestions made were the transfer of the E.N.T. unit, an alteration in consultant staffing, which the consultants themselves find acceptable, and an alteration in the administration of admission arrangements. The board has done nothing to implement these recommendations coming from the medical staff over a long period of time, which the medical staff are confident would greatly improve the bed occupancy arrangements. Furthermore, the board has given no reason why it has not implemented these recommendations.
The second reason given by the board for its urgent need for additional beds for geriatric patients in the North London group is that of demand. It wishes to use the hospital for the old in 11 different postal districts. This is an argument of some weight. but Hornsey already takes a far higher percentage of acutely ill elderly than the national average. The Minister may not have been aware that Hornsey is already well provided with old people's facilities. Far-seeing citizens, through their voluntary effort, have created a large number of old people's homes, some of which are used even for the acutely ill. I ask him to look at the provisions that exist in Hornsey, particularly through the Hill Homes.
The real suspicion aroused by the proposals is that the general hospitals in North London wish to be rid of their elderly patients, who are taking up beds for long periods, and to use Hornsey as their dumping ground. If the need is so dire, one cannot but inquire why the board did not buy up Kenwin Lodge or Grove Lodge, both nursing homes used by the Red Cross until very recently for old people. Why could not the board have taken over those buildings and converted and used them? Grove Lodge in particular, which is within a stone's throw of the Hornsey Central Hospital, has a large area of land attached to it which could be readily used for development for those purposes.
§ The Under-Secretary of State, Department of Health and Social Security (Mr. Julian Snow)
Is the hon. Gentleman 2061 confusing homes with geriatric medical beds?
§ Mr. Rossi
They are homes which could be bought by the board and, with not a great deal of expenditure, used for the purposes of geriatric units, instead of taking over a general hospital for that purpose.
Strathdene is another example which quite recently came on the market. It is a fully equipped nursing home that could have been converted for the purpose. The board did not even inquire into those properties. Why is Hillside being run down in Upper Holloway deliberately if the need is so great? Perhaps it is much easier and cheaper to grab something without payment which has been built up by the people of Hornsey over the years.
The board is not heeding the warning given by the Minister in his Circular, RHB/49/132, which stipulates that the boards must "guard against the feeling that local cottage hospitals are merely buildings to be used as additional accommodation for relieving pressure on beds of the district general hospitals of the group". That is precisely what the board is proposing to do.
However, I do not want merely to create the impression that the informed opinion to which I have referred has only a negative contribution to make. The medical staff committee has made proposals to end E.N.T. treatment and utilise 20 of the beds for geriatric purposes, leaving 40 for general practitioner purposes and for consultants. It is their considered opinion that 40 beds is the minimum viable unit for a general practitioner hospital. Anything less will be of little interest to consultants, and 40 beds will also justify the retention of surgical and gynaecological sessions, which would otherwise go, and the operating theatre would be kept fully occupied.
I shall also give the Minister a second petition, in the terms I have just expressed, signed by the local general medical practitioners. The local practitioner is very worried by the board's proposals. In Hornsey today he can order a barium meal and get a report within a week. If a patient is sent to Whittington he goes to medical out-patients, and there is a three- or four-week delay before he sees 2062 a physician, who will then order the barium meal. Then there is another two weeks' delay before the patient gets the meal. Then there is a delay again while the report is awaited. A total of six weeks can go by before the general practitioner gets his report.
A general practitioner hospital working on a much smaller, intimate basis, with open access, where the general practitioner can care for his patients, gives him a far greater interest in his work and in medicine at a time when, the Minister well knows, the morale in the medical profession is at an all-time low. The Minister's investigations into the drain abroad have suggested that lack of general practitioner facilities is one of the reasons why some of the younger men will not come back from the United States to this country.
Hornsey has several practices with ageing practitioners looking to retirement in the next few years. A viable general practitioner hospital would be an encouragement to younger men to come in and take their place. From all the inquiries that I have made and from all the discussions that I have had I am convinced that the proposals of the board will undermine to a most serious extent the health services in Hornsey.
If I were the Minister, I should not wish to look back in 10 or 15 years' time and see the condition to which a wrong decision now will have reduced these services in Hornsey. Therefore, I plead with him to have full regard to the clear call made to him by my constituents, supported by all informed opinion, and to vary the proposals to those suggested by the hospital medical committee or at least order an inquiry so that he may look very deeply into all the local circumstances before finally coming to a decision.
§ 4.17 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
I am grateful for the opportunity to say two or three words. As a member of the regional hospital board, I have listened with great care to the argument put by the hon. Member for Hornsey (Mr. Rossi). He has marshalled it very ably and supported it with all the points that are available.
But I would make it clear that the board has taken into consideration all the 2063 points that he has made. The difficulty is that it is dealing with 162 hospitals, and in order to attempt a rationalisation with the amount of funds available, one has to take the whole of the medical services into consideration and not just the local pressures in one constituency.
The hon. Member put forward a number of alternatives for geriatrics. But the situation remains that the Government are being constantly pressed by the Opposition to decrease the amount of public expenditure. We are trying to contain it in spite of an increase of £119 million over the whole of the National Health Service last year and spread it more rationally.
All that the board is trying to do is to use its resources to the best advantage for not only the people of Hornsey but the people of North London. I can assure the hon. Gentleman that the points that he has made were thoroughly considered before the decisions were reached.
§ 4.18 p.m.
§ The Under-Secretary of State, Department of Health and Social Security (Mr. Julian Snow)
I am grateful to my hon. Friend the Member for Hornsey (Mr. Rossi) for raising this matter in the modest and moderate way that he has.
I should like to deal with one point very quickly at the beginning. I was appalled when he said that it could take up to six weeks to get the result of a barium meal test. I will look into the matter. Apart from anything else, some of the people who take barium meal tests are very anxious about the results. I will write to the hon. Member in due course.
I hope this afternoon, without prejudging the issue in any way. to place the future of Hornsey General Hospital in the wider context of the National Health Service. For this reason, what my right hon. Friend the Secretary of State must do when he considers the proposals received from hospital boards concerning the closure or change of use of hospitals is to ensure that no kind of change take place until he has given the closest examination to each individual proposal.
Our task of modernising and developing the hospital service is a formidable one because so many of the hospitals that we inherited are unsatisfactory, in- 2064 adequate and unacceptable by modern standards. We are making progress—the most serious deficiencies are being remedied and many valuable improvements made—but we still have a long way to go. We can move forward only as quickly as the resources available permit. Therefore, it is imperative for the resources that we have to be used as fruitfully as possible.
Greater efficiency in the use of money and skilled manpower means that more can be done quickly in improving the standards of care for hospital patients, by improving the standards of accommodation available. With this in mind, it is inevitable that there will be adjustments to the arrangements for the provision of hospital services. Reorganisation and rationalisation of existing services will, by the elimination of hospital units and buildings which are no longer viable economically, enable finance and skilled staff to be diverted to more beneficial use.
I was a little surprised when the hon. Gentleman said that the Hornsey Old People's Committee disapproved thoroughly of the proposal. It is possible that they may not have taken into account the real need to provide attention for old people when they reach the geriatric stage.
§ Mr. Snow
One has to distinguish between care and nursing during the ambulant stage. A great deal of technical care is needed in geriatric cases.
All proposed changes of this nature are looked at very carefully. Each proposal for a closure or change of use is examined in depth by the regional hospital board concerned. In that connection, I welcome the remarks of my hon. Friend the Member for Willesden, West (Mr. Pavia), who said that the board had carefully examined the whole proposal. What bothered me in what the hon. Member for Hornsey said was his suggestion that there had been no communication or sympathetic audience to the representations of the medical staff.
§ Mr. Snow
There is a distinction to be drawn between the hon. Gentleman's earlier and rather more forceful words and what he has just said. To say that representations are made and not accepted is very different from saying that they have been made and ignored.
I assure the hon. Gentleman that it remains the general policy of my Department to encourage arrangements whereby general practitioners can continue to have responsibility. There again, I was worried when he said that the number of beds to be provided at Whittington had to be shared among 150 doctors. I would like to look into that.
It is an inescapable fact that the proportion of old people in our society is increasing and will continue to increase. I am told that there are about six million people aged 65 and over in England and Wales today. It is predicted that by 1981 the figure will have increased to seven million. A huge problem confronts us.
Surveys have shown that where the full range of services for the elderly inside and outside hospitals is well developed, about 10 hospital beds per 1,000 persons aged 65 and over are needed. The age structure in a given area may vary and may lead to a demand for a higher proportion of geriatric beds. Where it is known that there is a shortage of beds for the aged, to overcome the shortage and keep pace with increasing numbers, it is obvious that there must be a steady increase in the accommodation that our hospitals can offer them.
New building is the ideal way of meeting the need, but new buildings take time and are very expensive. We are spending over £100 million a year on improving our hospitals, and repeatedly we have urged hospital planning authorities to ensure that a reasonable share of the money is devoted to improving their services for the aged.
Having sketched out the general position in respect of the need to rationalise the hospital service, the careful consideration given to the future of hospitals, the importance of adequate provision for the 2066 elderly, and the important part that the general practitioner plays in the hospital service, I turn to the more local situation of Hornsey Central Hospital.
I must ask the hon. Gentleman to remember that the historical origin of so many hospitals was based not so much on need as on the sheer fortune of altruism in years gone by. Therefore, we must rationalise the situation in the light of population moves and medical demands.
The board started some consultations a while ago and, as the hon. Gentleman knows, there have been local discussions. But, as yet, the board has made no recommendations about the future of the hospital to my right hon. Friend. I understand that, while there is no shortage of acute beds in the area of the North London group of hospitals—which is not the wider area of London, the expression which I think the Gentleman used Hornsey is part of the North London group of hospitals—in the opinion of the Board there is urgent need for additional beds for geriatric patients. On 31st December, 1967, in the hospitals managed by the North London group 250 beds were allocated for geriatric patients whereas it is estimated that the requirement is 446 beds. The board's present proposal is that this deficiency should be remedied in part by the conversion of Hornsey Central Hospital for geriatric purposes.
The hospital is small, having 60 beds, and is at present used for general medicine, general surgery, E.N.T. and some gynæcology. Its occupancy is low, the average daily figure being about 67 per cent. compared with more than 80 per cent. in other general hospitals. If the hon. Gentleman is now claiming that the figure has been distorted by the non-adoption of positive proposals which do not involve substantial capital investment, I should like to have a look at that.
Further, a catchment area survey carried out by the board a few years ago showed that although 82 per cent. of the hospital's patients came from the former Metropolitian Borough of Hornsey, excluding geriatrics and obstetrics, only 11½ per cent. of the patients from the borough went to Hornsey Central Hospital at that time, the remaining 88½ per cent. going elsewhere.
2067 The board proposes that Southwood Ward of the hospital, containing 18 beds, should be designated a general practitioner ward for male and female medical patients and that the remainder of the hospital should be used for geriatric patients. As a consequence, all specialist in-patient work at Hornsey Central Hospital, other than in respect of the geriatric patients, would be transferred to Whittington Hospital which is a large developing district general hospital, as the hon. Gentleman said.
I understand that steps have been taken to improve the E.N.T. arrangements at Whittington and in the Board's view when these are completed there should be no difficulty in the hospital absorbing the work at present taken at Hornsey. I am aware that there are certain transport difficulties, but I am told that there is only about 1¾ miles difference between the two places. The hon. Gentleman said that this meant bus changes, but I am advised that it is only in respect of one geographical area and that the other does not involve a bus change.
§ Mr. Rossi rose——2068
§ Mr. Snow
We have expert advisers on transport matters, but we will have a look at that, although my information is contrary to the hon. Gentleman's.
At present, while the beds at Hornsey are under consultant supervision—and a large part of the consultant service is provided by Whittington—a large majority of the medical staff are general practitioners, and we think that general practitioners will not be dissatisfied with the change in the long run.
It is part of the pattern which we are experiencing all over the country that there is a local affection for a hospital which has to be measured against the high level of treatment and economic treatment of patients which comes from a district general hospital. We are not depersonalising the issue. We understand the human needs in this matter and the local loyalties, but we have in mind that, with our resources, technical advances can be provided only by the district general hospital with the sort of provision which I have mentioned.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Four o'clock.