§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. McBride.]
§ 11.30 p.m.
§ Mr. Alec Jones (Rhondda, West)
I rise this evening to speak on the decision which has apparently been taken to close the casualty unit at the Llwynypia Hospital. First of all, I should like to say that though I represent but one half of Rhondda in this House, my colleague the hon. Member for Rhondda, East (Mr. G. Elfed Davies) shares my views and wishes to be associated with all my remarks. If he were here he would add his voice to mine, but as Members know he is unavoidably absent due to Parliamentary duties abroad.
579 I think at a time like this that no Member can claim with greater certainty than I can that he is speaking for all the people of his area. The letters, telegrams and phone calls which I have received in the past few weeks all reflect the bitter resentment, the deep disappointment and the justifiable opposition from the people of Rhondda at my right hon. Friend's decision. From all quarters messages supporting me have poured in. My right hon. Friend has done something which no Minister has ever done before. He has indeed achieved the impossible. He has in Rhondda united the Labour Party, the Communist Party, the Welsh Nationalists and even the ratepayers all in bitter opposition to his plans. He has succeeded in uniting trade unions and industrialists, clergy and publicans, teachers and governing bodies of schools, and a host of other organisations and individuals all convinced of the need to retain the casualty service in Rhondda.
I ask my right hon. Friend to believe me when I say that if this were a mere political issue I should not be pressing it. But it is a matter which for people in Rhondda transcends politics. If my right hon. Friend could convince me that his decision was the correct one, then I should not be making this protest, but would be quite willing to defend his decision and to argue his case with my own people. But from my meetings during the past few weeks not only with lay people, but with nurses, with senior sisters, ambulance drivers, general practitioners, doctors in the hospital service, members of hospital management committees—all these people with years of practical experience of administrating and working in the health service of Rhondda agree that the Plewes Committee, which made the recommendation, in the short time available for its inquiries and with its lack of knowledge of the special problems of Rhondda, could not have been expected to make a reasoned judgment on this vital matter.
Because a pattern of hospital service concentrating its casualty services in one base hospital suits the needs of some areas, or possibly many areas, of the country, it does not follow that that is the ideal pattern for all parts of the 580 country, because it pays insufficient attention to the special needs and difficulties of areas such as Rhondda. The problem of the casualty service in Rhondda arises from an accident of history which made East Glamorgan the base hospital for the Pontypridd and Rhondda Group, and there is no justification for that accident of history being perpetuated.
East Glamorgan, as my right hon. Friend knows, is at the edge of the area which it serves. It is some 20 miles from the top of the Rhondda, along winding roads and difficult hills made impassable at some time every winter by snow and ice. East Glamorgan was never sited nor intended to meet the needs of the 97,000 people who now reside in Rhondda. These are physical facts of geography which my right hon. Friend must have known and accepted when in 1965—just three years ago—he gave a directive to maintain the casualty unit at Llwynypia. Even accepting the fact that no directive can be permanent and last for all time, it is impossible to justify a reversal of this policy in a mere three years when there has been no change in the need for a casualty unit in Rhondda.
We are entitled to ask what account the Plewes Committee took of the special geographical difficulties of Rhondda. Did it make the journey from the top of the valleys from Fernhill or Maerdy to East Glamorgan? Did it drive by car apart from such a journey by bus? Did it consider evidence regarding the state of the roads, especially in winter? No outside body on a short visit to Rhondda could hope to be cognisant of these important considerations, not considerations merely of the convenience of patients but considerations of delay in the giving of urgent and life-saving treatment.
I would urge my right hon. Friend to consider and to reconsider his decision, not merely because of the weight of public opinion but remembering that in a democracy these views are of great importance. I would urge my right hon. Friend to look at the matter again, because the Plewes Report, which was, in the words of the hospital management committee, "hastily conceived" could not have taken sufficiently into account the expressed and expert opinion of medical, nursing, ambulance and hospital management committee staffs.
581 Let me quote some of their views, which are apparently to be ignored. In October, 1965, the view was expressed by the consultant orthopaedic traumatic surgeons thatLlwynypia Hospital should be kept open between 9 a.m. and 5 p.m. to cope with the large number of cases which are seen.This view was confirmed in July last year by the medical staffs committee of the Pontypridd and Rhondda Group. In July, 1967, this was the written view expressed by the senior administrative medical officer of the board:Firmly of the opinion that (a) with the medical assistant and full junior personnel in post a full casualty service should be maintained; (b) if the medical assistant is away then a screening service could be provided by the junior personnel.On 10th April of this year, just a month ago, the management committee together with its medical advisers, knowing the particular problems of the area—this is the important point: the management committee together with its medical advisers, knowing the particular problems of the area: I deliberately repeat the words—said that maintenance of a casualty department at Llwynypia Hospital during the dayis absolutely essential for the people of the Rhondda".They added these words for good measure:Indeed, it is good management to divert from the main base those minor injuries which could be treated elsewhere and which would otherwise clutter up the major accident department".This month the Glamorgan National Health Executive Council expressed its 100 per cent. opposition to the closure. Even the doctors at present working in the hospital service were among the 40,000 signatories to the petition opposing the closure.
These are not frivolous opinions, but the opinions of experts with real knowledge of Rhondda's problems, and these opinions are supported by the general practitioners of the area, doctors who are daily confronted with these problems of casualty and accident cases. I know my right hon. Friend has seen letters of protest representing the views of 80 per cent. of the general practitioners of the Rhondda. The 20 per cent. missing were missing because of the lack of time. Not one dissentient voice has come from the 582 general practitioners to support the Minister's view. I should like to quote a little from a letter from one general practitioner particularly well known to meAs a general practitioner who has practised in Rhondda for 27 years I strongly resent the proposal to close the casualty department at Llwynypia… The permanent closure will lead to increased strain on the already overtaxed general practitioner service. Increased distances involved will mean increased risk and danger.I will read an extract from a letter from a younger general practitioner who only recently arrived in the Rhondda.The decision to close the casualty unit at Llwynypia is most likely to force younger doctors to leave the valley for a more secure area with better facilities.I know that this is not the Minister's wish and it is not mine. This doctor goes on to make a suggestion and I would ask my right hon. Friend to pay particular attention to it. He says that it would be possible to enlist general practitioners employed on a long-term sessional basis to man the accident unit.
I ask the Minister to consider this point again and to ask the hospital management committee and the regional board to consider it since it was the staffing difficulty at East Glamorgan which led to the present trouble. One of the reasons advanced in support of the Minister's decision is the difficulty of staffing.
Although we know that there are 36 general practitioners in the Rhondda the Plewes Committee was able to consult only one and he was opposed to the recommendation. Surely in health matters like this the views of general practitioners, who are usually the first people to meet casualties and accident victims, ought to have been given greater consideration and greater weight.
It has been argued that many of the cases now going to Llwynypia Hospital ought to be, and could have been, dealt with in the surgeries of general practitioners. This might be reasonable in some parts of the country, but as the Minister knows the incidence of illness in the Rhondda is 2½ times the average for Britain. The work loads of general practitioners are already far too heavy. It would be impossible for general practitioners at present to treat every minor 583 injury now going to the Llwynypia Hospital.
I know that health centres have been put forward as a solution to the problem. This might be realistic in the future and that is why I said earlier that no decision ought to be permanent. At the moment there are no health centres in Rhondda. I welcome the one to be built at Tonypandy, but one is completely inadequate for present needs.
There is the problem of the extra demand for ambulances. I know that when a deputation went to see the Minister it was said that there would be no extra demand which could not be coped with. This has never been proved. What can be proved is the mileage of ambulances based at Treherbert at the top of the Rhondda has been increased with Llwynypia closed in the evening. Ambulance drivers in their letters to me, and the letters I have received from victims, give examples of the long delays. Ambulance drivers are convinced that the ambulance service is already overworked. I receive numerous complaints on this and the ambulance service will be unable to cope with the extra demand.
School teachers and the governing bodies of schools have expressed deep concern over this in relation to the treatment of minor accidents during school hours. As a school teacher I have taken children by bus to Llwynypia, but I would never attempt such a journey to East Glamorgan.
Of the 750 new cases treated per month at Llwynypia a large proportion will seek an ambulance, and who can blame them? From most parts of the Rhondda one bus will take them to Llwynypia but to go to East Glamorgan they will need never less than two buses, usually three and sometimes four. What importance did the Plewes Committee attach to the bus service in the Rhondda?
The safety of the patient is, I know the basis of the concern of the Minister, and it is mine. From ambulance drivers, nurses and doctors I have heard of patients having to be resuscitated and having to have urgent supportive treatment at Llwynypia before being conveyed to other hospitals.
I quote a letter I received last Monday from ambulance drivers. They said: 584We wonder which would have happened recently to the miner injured at Maerdy colliery with crush injuries, or the woman knocked down in Treorchy whose fractured foot was obstructing her blood circulation, or the little boy who last Friday took an overdose of drugs.These three cases were taken to Llwynypia Hospital and are examples where supportive treatment there saved the possible loss of the miner's life, the woman's foot or the young child's life. We hear from both staff and patients at East Glamorgan that the hospital is already bursting at the seams. That applies to the casualty department as well. I know that improvements are envisaged but is it reasonable to expect that East Glamorgan will be able to cope with the extra demand from patients now being treated at Llwynypia Hospital, especially since the nearby area of Llantrisant is planning a new town development? What investigation did the Committee make into the effects of the new development on the casualty services of the area?
The complete withdrawal of casualty services from Llwynypia Hospital has not been and cannot be justified. Despite the eminence of the members of the Committee, the inquiry was carried out in haste—and this has been referred to by the hospital management committee and was intimated by a member of the Welsh Hospital Board on the deputation. The Committee had lack of knowledge of local conditions, which was no fault of its members, and failed adequately to consult those best able to give evidence, which was probably a question of time. The fact is that the overwhelming evidence both lay and medical, is opposed to its findings.
The Committee's recommendation ought to be reversed or at least reconsidered. The case for the retention of the casualty unit at Llwynypia Hospital is overwhelming, particularly during the day time. Any arguments against this are in direct conflict with those best able by qualification and experience and local knowledge to judge.
I want publicly to thank all those, far too many to mention, who have sent letters and telegrams to me and have helped me to do the job I was sent here to do. I know that our cause is just. I have done my best to present it fairly and efficiently. I appeal to my right hon. 585 Friend to reverse his decision and retain the casualty unit at Llwynypia Hospital, if only from nine a.m. to five p.m. Delay it until the new health centres are built and until we can see whether general practitioners can help the casualty staff at Llwynypia. If all these things are too much, I ask him to accept the plea of Rhondda Borough Council and establish an open inquiry so that justice can not only be done but can be seen to be done on behalf of the people of Rhondda.
§ 11.47 p.m.
§ The Minister of Health (Mr. Kenneth Robinson)
May I, at the outset, say that I have much sympathy for the people of the Rhondda who are naturally greatly disturbed at the proposed closure of the casualty unit at Llwynypia Hospital.
The Welsh Hospital Board informed me that it accepted the Plewes Committee's Report and sought my authority to proceed with the implementation of its recommendations. It is the second of the two main recommendations, the closure of Llwynypia, which has given rise to this debate tonight and it is to this that I gave the most careful thought in arriving at my decision. I would ask my hon. Friend and the people of the Rhondda, for whom he speaks, to believe that, in considering the difficult issues presented to me in this situation, I have been activated solely by the desire to ensure the best possible accident service for the Pontypridd and Rhondda area.
Before I deal with the local question in more detail, I would like to say something of the developments which are taking place throughout the hospital service for dealing with accidents and emergencies. Some years ago a sub-committee of the Standing Medical Advisory Committee made a comprehensive study of these services. It recommended that the existing number of accident and emergency units should be substantially reduced and the services concentrated in a pattern of units staffed and equipped to deal immediately with injuries and other emergencies at any hour of the day or night. Injured patients requiring hospital treatment should, the Report recommended, be taken direct to these units rather than to the nearest hospital, unless of course it included such a unit.
Boards throughout the country have been reorganising and rationalising the 586 facilities for accident and emergency services in accordance with these recommendations. At selected hospitals they have designated accident and emergency units with an experienced consultant in day to day control, and with surgeons, anaesthetists and other medical staff and trained nurses with the necessary supporting services to enable them to deal with injuries and emergencies at all times, including weekends and holidays.
There is only one way of providing an effective 24-hour service of this kind and that is to concentrate hospital resources in terms of manpower and facilities. Unless we do so, essential elements in the treatment of seriously injured patients will be missing when they are needed. In short we are concentrating accident services in order to save lives. It is not possible for every hospital to be staffed and equipped up to the necessary high standard, and in the course of this concentration of services the casualty department at some hospitals will inevitably be closed as the accident and emergency services at the selected hospitals are developed and expanded.
The need for rationalisation is often insufficiently understood. When a patient needs emergency treatment because of injury or for some other reason, it is hard to appreciate that it may not be in his best interest to take him to the nearest hospital. But the fact remains that only if he is taken to a hospital with a comprehensive accident unit will he receive the expert diagnosis, skilled treatment he may need. The trend in modern medicine is towards team work drawing on the skills of a range of medical disciplines. It will be obvious that units of the kind I have described make heavy demand on resources both of manpower and materials, and it was on this account that the committee on accident and emergency services recommended a concentration into a pattern of units each serving a population of at least 150,000.
The population served by the Management Committee referred to is of this order, in fact it is 163,000 and cannot justify more than one such unit.
Experience has demonstrated the wisdom of the general policy in relation to accident services. This policy has the double advantage that not only does the patient get more effective treatment but 587 the resources of manpower and equipment, which cannot be unlimited, are put to the most economical use. In pursuance of this policy a number of casualty departments have already been closed in England and Wales, and a better all-round service has resulted.
Despite all the Welsh Hospital Board and the Pontypridd and Rhondda Hospital Management Committee could do, it has not always been possible to find medical staff to man the unit at Llwynypia, so as to provide even the restricted service of which a small unit of this kind is capable, with the consequence that various limitations have had to be accepted. It has not been possible in spite of every effort to provide anything like 24-hour cover and the service has had to be very much curtailed. For some time past the unit has operated on a 9 a.m.—5 p.m. basis on Mondays to Fridays, 9 a.m.—1 p.m. on Saturdays with no service at all on Sundays.
Staffing difficulties have also been experienced in the accident unit at East Glamorgan Hospital. The situation there became critical towards the end of 1967 and it was this that led to the appointment of the Plewes Committee to which reference has been made in this debate.
The Welsh Hospital Board was thus faced with a difficult choice. To try to maintain two casualty units, neither providing a full accident and emergency service would be against the best interests of the patient, whose safety calls for the highest standards of service and skill that are available in the specially staffed and best equipped accident centre.
Neither would it enable the limited resources of manpower to be used in the most economic and efficient manner possible. Hospital authorities frequently have to balance these considerations against the argument that to concentrate casualty services inevitably means that many smaller departments have to be closed, and that this must entail some inconvenience for patients living at a distance from the accident centre.
I came to the conclusion that the hospital board was right to apply to the Pontypridd and Rhondda group the general principle of concentrating resources, and that the first priority must 588 be the build-up of the accident unit at East Glamorgan hospital with the consequence that the need to maintain a casualty service at Llwynypia will diminish and ultimately come to an end. This does not mean that the hospital at Llwynypia will cease to play a useful part in the treatment of accident and emergency cases. On the contrary, as I have tried to emphasise, accident follow-up services at Llwynypia will not only be maintained but extended. Full use will be made of the beds at Llwynypia, and out-patient clinics will provide for the care of Rhondda patients after their initial treatment at East Glamorgan hospital. In this way each hospital will be making the best contribution that it is equipped to make towards a comprehensive service for the whole area, including the Rhondda. The one will be complementary to the other, rather than both trying to provide casualty facilities with resources that do not permit the maintenance of a satisfactory level of service at either.
I accept that the closure of the casualty unit at Llwynypia Hospital will place an additional burden on the ambulance service in the Pontypridd and Rhondda area, but I am happy to confirm to my hon. Friend that Glamorgan County Council has assured me that it will be able to expand its ambulance service to meet the additional demands that will be made on it.
Those, then, were the factors which determined my decision to accept the recommendation of the Welsh Hospital Board. I knew that it would come as a disappointment to many in the Rhondda who have an understandable affection for their local hospital, but it is not Llwynypia which is to close. It is no more than one limited service that it provides, that of dealing with comparatively minor casualties during normal working hours. The Welsh Hospital Board has no intention of closing Llwynypia Hospital itself. I mention that to relieve some anxieties that I have heard expressed.
From the reports that I have had of the nature of the work done at the casualty unit, much could be handled with the facilities usually available under the general medical services. I know well the difficulties of general practice in the Rhondda, but the proposal to 589 build a health centre at Tonypandy should make it easier for the local doctors to provide this sort of service. To this end I shall do all I can to encourage the development of further health centres or group practice premises in the area.
Though I am unshaken in my conviction that this decision is right and in the best interests of the Rhondda patients, I am not pressing the Welsh Hospital Board to implement it immediately. Indeed it will be a matter of months, not weeks, before this happens. The Welsh Hospital Board will shortly be appointing a consultant based on Church Village to organise and be responsible for the accident and emergency services for the whole area. If he, as the consultant responsible, felt that he favoured some different organisation of the services, and could deploy the resources of manpower at his disposal in some better way, the Welsh Hospital Board and I would be bound to give attention to his views.
590 I do not want what I have said to lead my hon. Friend or his constituents to think that I have weakened in my resolve, but I want them to know that I am very willing, before the proposed arrangements are finally implemented, to take into account the views of the consultant who will have medical responsibility for the service provided for the entire area.
I repeat to my hon. Friend that my only concern is to provide the best possible accident and emergency service for the area. I hope that I have succeeded if not in convincing him, at least in shaking his present conviction that the decision is not for the best. If I have done so, I can only hope that he will commend it to his constituents.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Twelve o'clock.