HC Deb 15 November 1968 vol 773 cc838-56

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ernest G. Perry.]

2.52 p.m.

Mr. William Price (Rugby)

I am grateful for the opportunity to raise a matter of vital concern to all my constituents—one which has caused more controversy and distress in the area than anything for many years. The issue is not basically about any particular specialist facilities, important though they are. It is about the whole future of St. Cross as an important district and training hospital.

The Birmingham Regional Hospital Board will suggest that I have broadened the argument in an effort to embarrass it. That may or may not be true. But what the board has coming to it this afternoon it has been asking for over a very long time. It has treated Rugby in a disgraceful manner, operating secretly, using back-door methods and paying little or no attention to the opinions of my constituents.

I have no criticism at all to make of either the Under-Secretary of State or the former Minister of Health. They have treated us with kindness and generosity and have listened with a good deal of understanding to our arguments over a long period. My criticism is not of them, but of the regional board. May I give notice of a Petition addressed to the former Minister of Health, in these terms: We, the undersigned residents in Rugby, are sending you this protest against the decision of Birmingham Regional Hospital Board, Group 20 Hospital Management Committee, to remove the ophthalmic, ear, nose and throat surgery from the hospital at St. Cross to hospitals near Coventry. We see this step as the beginning of the gradual reduction of hospital facilities for Rugby thus leaving our expanding community with only limited cottage hospital status. That is signed by 10,000 people, and if the Minister wants 40,000 or 50,000 signatures they can be provided. There is formidable backing for the public from the borough council, the rural district council and all the parish councils, and from the Council for Social Services, from the trades council, from trade unions and from a great mass of other organisations, including women's institutes and guilds. Most important of all, I have the support of every consultant, every doctor, every nurse and, as far as I am aware, every administrator. I can claim with some justification that I am not the only one who has fallen out with the regional board.

On the face of it, the issue is straightforward. The board want to transfer the optical and E.N. and T. services from St. Cross to the Paybody Hospital, Allesley, and the Walsgrave Hospital, Coventry, respectively. I am in some difficulty. I believe that those decisions have already been taken, but I do not know. All I can do is to base my case on what I hope are intelligent guesses. I shall be happy if I am wrong, but I suspect that my suspicions are fully justified. It is not easy to know what is happening when one is confronted with an organisation which is behaving like a branch of the Kremlin.

We had a public meeting in Rugby last night on hospital services, and it was packed to the doors. The hospital board refused to send a representative to listen to our arguments. We pleaded with it to do so. Its attitude is a disgrace to democracy, if it will not even send someone to listen to the views of 300 people at a public meeting, many of them doctors and consultants of the highest calibre. The board has shown a shocking disregard for public opinion. What is even worse is the fact that the board declined to give any indication which might have been useful for this debate or for that meeting last night. The reason it gives, contained in a letter to me and others dated 8th November, is: The Board must, therefore—in accordance with the rules of Parliamentary privilege—wait at least until after the adjournment debate before making the conclusions of yesterday's meeting known or commenting upon the matter". I ask the Minister: is that the position? What is this Parliamentary privilege? I have not been in the House for long, but it is new to me, and I do not know what the board is talking about. Or is it, as I suspect, a brush-off such as we have come to expect from this board?

Dealing, first, with E.N.T., the board wants to centralise specialist services on Coventry, and there is logic in the argument that children are entitled to the best possible treatment that can be provided. What is wrong with the treatment in Rugby? The whole essence of treating children is that parents should be readily available. Consider the problem of a parent in one of the many villages wishing to visit a child in the Walsgrave Hospital in Coventry. It will mean three bus journeys each way—into Rugby and out again twice, six journeys in all at a cost of 10s. and four hours travelling time. These amalgamations look good on paper. The trouble is that in Whitehall the human problem tends to become overlooked. If this proposal goes through there will be very real family difficulties in many cases for my constituents.

I come next to maternity services. I concede straight away that the hospital at Harborough Magna will have to close. There are many reasons for this, all of which are well known and I need not dwell on them. For years we have been promised that maternity cases would be transferred to St. Cross, where they belong, as soon as phase 2 of the development was carried out. I believe that the board is trying to throw that promise overboard. I quote the comment made by Mr. W. H. Lewis, who has great experience in hospital matters, and is a member of the H.M.C. At a meeting of Rugby Trades Council, he said that the Birmingham Regional Board left him with the conclusion that after providing more beds than were actually required the board had remained silent on its reasons for transferring services to the Walsgrave Hospital in Coventry. In that way", he said "they were hoping to close St. Mary's maternity hospital, Rugby, to reduce the extent of their planning blunder. I shall forecast the intended sequence of events. As specialist services disappear, our position as a leading training hospital will be in jeopardy. The staff, faced with uncertainty, will drift to greener pastures and patients will go to Coventry or Nuneaton. The regional board will then come with a mass of evidence with facts and figures, to prove that we neither need nor deserve phase 2 to transfer to St. Cross.

I believe the assessment by Mr. Lewis was fair. Even the board had second thoughts because it appointed Professor Stall-worthy, of Oxford, to investigate and report on maternity services in the Rugby area and, I understand, it picked the wrong man because he found in our favour. The board has declined to allow Rugby Hospital Management Committee to see copies of his report. I have not seen one; I am working on fifth-hand information.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

I do not quite follow what my hon. Friend is saying. Is it that the report of the Professor had already been distributed to the H.M.C.?

Mr. Price

The board has made clear to the hospital management committee that in due course it will have to take the decision that Professor Stall-worthy arrived at. The hospital management committee is in the position of having to consider this matter without the evidence it may need.

I come to the third specialist service, that of children's beds. Here there is total and absolute confusion. The former Minister of Health has written to me on many occasions saying that there was no intention of withdrawing paediatric beds from St. Cross, yet this matter is still under consideration by the board. If it is given the slightest opportunity it will transfer those beds as well. If so, it will run into more trouble than it has ever dreamed about.

We are faced with the prospect of losing many of our specialist services. Under these circumstances what is the long-term future of St. Cross? If the board said to us straight away that St. Cross has no long-term future we would know exactly who and what we are fighting, but it is too clever for that. The board is hoping for a quiet rundown with the least amount of publicity and the minimum of trouble. It has not worked that way. I am quite happy to accept blame for that. Throughout this dispute I have made the facts available to my constituents and I am happy to tell the board that documents, confidential and otherwise, have a way of finding their way into my possession. We know people who are sympathetic to Rugby. The board's reaction to continued Press leakage is always interesting. The board says that it is difficult to understand what the controversy is about because no decision has been taken. Is it any use waiting? This is how it operates but it is too late. I have not been long in this House, but one thing I know is that one should get in as quickly as one can.

What is my justification for claiming that the real attack is not on specialist services of St. Cross itself? I shall briefly outline the position. We were provided—and were very grateful for that—with two operating theatres seven years ago as phase 1 of the development of St. Cross. We were promised that under phase 2, the ward block and materity unit, would follow at the earliest opportunity. I was surprised to receive a reply by the Under Secretary that phase 2 would be the first of the capital projects after 1969–70.

That was bad enough. We in Rugby are patient people, and we understood the difficulties with money. We accepted the position without any fuss. Then came the blow. No announcement was made about any change of plans, but I obtained a document in which the board said categorically—it has not denied it—that phase 2 would not now start until after 1976 at the very earliest. Even that forecast was qualified by the statement that it would be subject to a continuing review in the light of the opening of the new Walsgrave Hospital at Coventry. What is happening, in effect, is that we are gradually being phased out of existence. I do not expect answers to these points now, but I should be grateful if my hon. Friend would do me the courtesy which he has done me so often in the past of writing to me. I should like to know why the assurance he gave in the House was cast aside by the regional board. I suspect that the board will argue that Walsgrave Hospital has created a new situation and that planning must be flexible.

I rely for my reply on Mr. Norman Edyvean-Walker, a man of immense experience, as my hon. Friend the Member for Kingston upon Hull, West (Mr. James Johnson), will agree. I am delighted to see my hon. Friend, a former Member for my constituency, present today. There are those who think that my hon. Friend was almost as good a Member as I am.

Mr. Edyvean-Walker, a man of immense experience in hospital matters and a former Chairman of the Hospital Group; in a letter to the Minister dated 31st October said this: The statement that the Regional Board is reviewing the position because of the completion of the 662-bed Walsgrave acute hospital is almost too frightful to be taken seriously. The Walsgrave Hospital, maternity and acute, has been the subject of intense planning for at least 10 years and this planning has been carried out at the same time and in conjunction with the planning for Rugby and Nuneaton; that is, the whole of Group 20. To say now at this late stage that the Regional Board are reviewing the situation to ensure that the best use is made of resources is about the greatest example of bad planning I have heard for many years. The only possible excuse for an alteration in the planning could be a drastic alteration in the needs for hospital beds, and so far as I am aware no such alteration has occurred. Mr. Walker is absolutely right. I will tell the House what has happened. Many millions of £s have been spent on Walsgrave Hospital. Running costs are in excess of £2 million a year and the board is now thrashing around looking for economies. I do not wish to deny the people of Coventry the best possible facilities, but I am bound to tell the Minister that subsequent economies will not come out of my constituents; and the sooner the board gets that into its bureaucratic head the better for all of us.

Within the last few hours some interesting figures have come into my possession. Admittedly they are unofficial figures, but they are prepared by people who have been interested in this matter for years. They find that in Group 20 as a whole the Coventry area has 65.5 per cent. of the people, Nuneaton and rural areas have 19.93 per cent., and Rugby and rural area has 14.57 per cent. Taking figures of capital expenditure on hospital development during the past twenty years and projected over the next few years, Coventry has had £12, 145, 716 or 9006 per cent., Nuneaton has had £1, 122, 815 or 8.32 per cent., and Rugby has had £218, 777 or 1.62 per cent. So with 14.57 per cent. of the population we have had 1.62 per cent of the expenditure.

The Board will argue that we have been consulted on all these matters. Yet in a letter as recently as 29th August to the Secretary of the board the Town Clerk of Rugby complained— there appears to have been little, if any, public consultation on the matter. I should like the Minister to define "consultation". Mr. P. F. Liebert, Chairman of the Rugby and District Council for Social Services, has a very different view of consultation from that taken by the board. He has written to the board saying: My impression is that, whereas we gave full expression to our concern and fears about future proposals and rumours of impending changes, virtually nothing came back from your end of the table. This was with reference to a meeting which a delegation from Rugby had with the regional hospital board. What then are the reasons for your proposals which were supposed to have been divulged at the meeting? If, as you suggest, these have already been given to us, why not send a representative of the board to our forum and restate them for the benefit of the whole community? The board declined to come.

My constituents fear that the Government's desire to centralise specialist facilities is being used as an excuse to begin the rundown of St. Cross Hospital. I have challenged the board on many occasions to confirm or deny my allegations, but it always refuses. It prefers to operate by stealth.

Briefly, what do we want? It has been suggested in the past that we might have a massive new 300-bed unit, a proposal which never seemed to me to be realistic; and if the board is quietly dropping it, I am not surprised. But what we do want, and what we have been promised for years, is a new ward block with a maternity unit to take those beds from St. Mary's. The area has a catchment of 80,000 people. Warwickshire is one of the fastest growing counties in Britain. Our strategic position for an accident hospital is vital. If the board's argument—I think that my hon. Friend will have something to say about this—is that Rugby, with all our villages, is not big enough for its own hospital, what about the Nuneatons? What about Nuneaton Spa? What about Warwick, with a population of 17,000, and Stratford-on-Avon with very few more? Will they all lose their hospitals as well? Are those hospitals to be run down and patients transferred to Coventry? I suspect not. The only hospital being attacked is mine.

My constituents have been patient for many years. They are sensible people, and generally speaking, militant. We have understood the difficulties in finding the money. We know the present problems. We have waited a long time, and we are prepared to wait even longer. But we are not prepared to stand by and see our services filched by a bunch of bureaucratic bone-heads in Birmingham.

3.12 p.m.

Mr. James Johnson (Kingston upon Hull, West)

I have a compulsive urge to catch your eye, Mr. Speaker, and speak for a few fleeting moments because I was formerly the Member for Rugby. We have listened to a doughty champion. My hon. Friend the Member for Rugby (Mr. William Price) said that he is a better Member than I was. That is quite possible. He is certainly more vehement than I ever was, but I think that he has a more vehement case to put. As I heard the names which he gave—Mr. Edyvean-Walker and Mr. Liebert—and the places which he mentioned, and as I heard his case developed, I felt that I should not only sympathise but should support him.

I cannot speak either for or against the detailed statistics and facts which my hon. Friend gave, but, knowing him, I believe that they are correct. I wish only to add a word to put this matter into the context of the environment, so to speak. Rugby, a town of 50,000, is dwarfed by the ever-larger Goliath of Coventry. For some years, there has been a tendency to subordinate Rugby and its neighbourhood to the big fellow next door. There is a saying that sheer size begets size in matters of population and the size of cities. It seems also that sheer size begets further size in the matter of power in the Health Service. I support what this David sitting on my left here is doing in tackling the Goliath, and I am happy to show my loyalty to this champion—

Mr. Snow

My hon. Friend is personalising now.

Mr. Johnson

I assure my very tall hon. Friend that the remark was unwitting and unfelt, and I know that it was uncalled for.

Mr. William Price

I am not sure about that.

Mr. Johnson

As I was saying, the David on my left here can tackle any Goliath, whether in the House of Commons or outside it is battling manfully on behalf [...] 50,000 or 60,000 people of Rugby against the giant next door. I cannot comment on the Nuneatons, Leamingtons, Stratford-on-Avons, Kenilworths and the like, but it seems to me that, if these things can happen in the town for which I was formerly the Member, they may, unhappily, be happening elsewhere. It is a battle of priorities. I think that my hon. Friend has a good case, and I wish him well. I also wish all my former constituents well in this battle, in which their Member is playing such a vehement, articulate and powerful part as their champion.

3.15 p.m.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

I recognise the accuracy with which both my hon. Friends have referred to size, personalised or otherwise, in the difficult matters of allocating funds. Far from resenting the attack of my hon. Friend the Member for Rugby (Mr. William Price), I think that it is a most excellent exercise, and I congratulate him on the moderation with which, with one possible exception, he mounted his attack. It served a very useful public purpose. My only question is whether he has been quite fair in applying certain terms to the Birmingham Regional Hospital Board, bearing in mind that it is composed of voluntary workers who are subjected on the one side to the administrative and financial disciplines imposed by my Department and, on the other, to quite understandable public anxieties. But they are people who are doing a voluntary job to the best of their ability.

I shall deal a little later with the idea that, Rugby has been singled out for special and undesirable treatment. I recognise my hon. Friend's concern for the interests of his constituency and the enthusiasm with which he has presented his case.

Before dealing with the particular circumstances of St. Cross Hospital, I should like to explain some of the general principles of hospital provision. My hon. Friends may feel that they do not want to be lectured about the general set-up of the administration of hospitals under the National Health Act, but some of my remarks migh[...] fully be examined by a wider public than is present today, and perhaps they will balance the rather charged atmosphere in which the matter has sometimes been discussed in Rugby.

I do not under-estimate public attitudes and loyalties and local traditions, all of which are most important. It may not be any comfort to my hon. Friend, but I have had precisely this sort of difficulty to deal with in my constituency. Much of it stems from the provision of district general hospitals. I have had to explain to my constituents more than once—and I think that most hon. Members will have to do the same in their constituencies—that one must find a balance between local loyalties and providing easily accessible points of treatment on the one hand, and on the other the provision of the most up-to-date, highly expensive and very specialised services, which can be provided only in a district general hospital.

Modern medicine requires hospital beds and clinics to be supported by highly-trained, specialist staff and expensive equipment. A simple case is that of renal dialysis. In the local Press from time to time one sees that a good-natured person has started collecting money for the provision of kidney machines. But I have had to explain many times that it is one thing to collect a certain amount of money to provide a renal dialysis machine, but that by far the biggest consideration, which the public do not always understand—and why should they?—is the training of specialist staff and provision of their pay to support such a machine. The district general hospital offers the most practicable method of placing the full range of hospital facilities at the disposal of patients, and this benefit far outweighs the disadvantages of longer travel for some patients and visitors.

Again I say, ask a man, "Would you prefer to have your wife in a hospital within 10 minutes walk of your house and where she will receive good but not the most up-to-date treatment, or would you prefer her to be eight, nine or 10 miles away, but where she will get the best that medicine can provide?", A very difficult, emotionally charged question, but it ought to be put.

Mr. William Price

It has been.

Mr. Snow

[...], it has, but it has still to be rammed home. The question has to be faced by many people.

We are now awaiting a report from a committee which is studying the functions of the district general hospital. I hope that all concerned will keep open minds as they consider possible changes in the pattern of the hospital services which may include the closure of uneconomic hospitals and rationalisation of specialist services. Quite clearly, to retain the new and old services, that is to say, a very expensive, new, up-to-date general district hospital, or an efficient but not so sophisticated local hospital, in parallel would be absolutely economically impossible.

My hon. Friend will, no doubt, be aware of the advice given in February of this year. It urged hospital authorities to look into ways of deploying hospital resources to the best effect. I should like to quote from a letter which the then Minister of Health sent to all hospital chairmen: New forms of treatment and improvements in other aspects of the hospital services are continuously being developed and should be welcomed and encouraged, but all this has to be contained within the total available resources of money and skilled manpower. This we can only achieve if hospital authorities constantly study the use of all their resources, and not just the use to be made of the additional funds made available each year. Total revenue expenditure in 1967–8 on running the hospital service will amount to over £700 million, and a saving of even 1 per cent. by greater efficiency would release over £7 million for new developments". I interrupt the letter here to reassure my hon. Friend just in case he thinks that I am deploying a generalised argument affecting the country as a whole and not St. Cross, Rugby. He must be patient, because I am coming to that.

I continue with the letter: A serious review of present methods is needed, with the intention of redeploying effort to make the best possible use of medical and allied resources. We should not cling to old methods if new ones offer a greater return. Examples of action which might produce considerably improved use of resources include a critical reappraisal of bed use, of arrangements for the assessment and discharge of patients, and of the distribution of beds between consultants; rationalisation of accident and emergency services; concentration of services which might allow closure of small uneconomic hospital units. Except where a radical change in the use of a hospital is planned my right hon. Friend the Secretary of State does not normally intervene in a redeployment of resources such as a transfer of beds in a particular specialty from one hospital to another. This is essentially a matter for the regional hospital board, whose function it is to make the best use of the hospital resources of the region in the light of its local knowledge of all the circumstances.

The Secretary of State must personally authorise the closure of a whole hospital and I assure my hon. Friend that he will not do so unless satisfied that there has been adequate local consultation and that satisfactory alternative facilities are available. Alleged lack of consultation has been queried and criticised by hon. Members, but we welcome local representations which can be made when a regional hospital board has made up its mind and has made a recommendation to the Secretary of State.

When talking about future hospital provision, it is important to remember the point made in Command Paper 3000—The Hospital Building Programme—that the hospital building programme is flexible and must remain so if it is to be responsive to any changes in local and national priorities, variations in the money allocations available from year to year and cost variations on particular schemes. Although boards may, for their own guidance, assign starting dates for new schemes for forward-planning purposes, it would be quite wrong and totally misleading to regard such dates as in any way fixed. Perhaps my hon. Friend will refresh his memory by studying paragraph 20 of Command Paper 3000 on this point.

For this reason, it is not customary to announce starting dates for schemes other than those due to start in a current financial year. While broad indications of priority can be given about later schemes, assumptions made about starting dates which have not been publicly announced must always be liable to cause misunderstanding. Regional hospital boards necessarily keep their building programmes continually under review, but they have been asked to show their revised programmes beyond 1969–70 to the Department next year.

I want now to deal with the particular issues raised by my hon. Friend and his fears about the future of St. Cross. I thank him for his patience in listening to my general preamble.

The new Walsgrave District General Hospital was planned to give a comprehensive range of specialist services over a wide area. In 1967, the population figures for Coventry, Nuneaton and Rugby were, respectively, 360,000, 110,000 and 80,000. Projected to 1981, these figures are calculated to be 427,500, 134,000 and 103,500 respectively. The hospital management committee population area for 1967 therefore covered a total population of 550,000 and the projected population for 1981 is 665,000.

Walsgrave was planned to serve Coventry and the surrounding district with modern specialist services. As the population grows and distribution changes, there will have to be a review of the catchment areas for Walsgrave and neighbouring hospitals. This will be part of the continual review I have referred to.

I come to the transport problem which stems from the location of Walsgrave, which lies just to the east of the centre of Coventry. Buses—and, in the case of Rugby, trains—between the towns run about every hour but at present do not go direct to the hospital. It is for this reason that the regional hospital board is approaching Coventry Corporation for buses to go direct from the town centre to Walsgrave Hospital and has indicated that it will seek to improve arrangements also for the country area involved, which of course, is also very important.

The new Walsgrave District General Hospital was planned to give a comprehensive range of specialist services over a wide area. Building has taken some time, but the acute block will be opened next spring, and this is to be followed by a much needed 284-bed psychiatric department. Recent developments in management techniques and in medicine have made it possible for a hospital of this size to give treatment to a greater number of patients than ever before, and this may in time lead to variation in the catchment area.

As my hon. Friend knows, the annual running cost of the new hospital will be over £2 million; and it will have a staff of about 1,350. A hospital of this sort, offering a comprehensive range of services, should be used as widely as possible, and it is likely that a fresh balance will have to be struck between the conflicting interests of the highest standard of treatment and local service.

With the completion of the 614 bed Walsgrave acute block, the regional board has quite properly conducted a full review of all the hospital services under the control of the Coventry Hospital Management Committee, which includes both Rugby and Nuneaton, to see that the most effective use will be made of the new hospital resources. The board's initial inquiries suggested that there was scope for rationalisation and as far as Rugby was concerned this involved the transfer of some specialist services elsewhere. The proposals did not envisage any reduction in the bed complement at St. Cross Hospital and the rationalisation of services was expected to lead to an improvement in the hospital's services.

Discussions were, therefore, held between the board and the hospitals concerned about the possible transfer of ear, nose and throat, ophthalmic, and paediatric in-patient treatment from St. Cross Hospital. Rugby to Walsgrave, Paybody and Gulson Hospitals respectively. The board's proposals also provided for the transfer of ear, nose and throat and ophthalmology in-patient treatment from Nuneaton to Walsgrave Hospital, Coventry, though out-patient facilities in these specialties were to remain in Rugby and Nuneaton.

News of the board's own discussions spread and the board began to receive representations from local interests about the proposed transfer of these specialties. No doubt my hon. Friend's speech was a reflection of the representations which he has received. Letters on this subject were also sent to us and we have kept the board fully aware of the views expressed. On 14th October, the board held a meeting with local bodies which had expressed interest to explain its proposals and to discuss the implications so that the planning committee would be fully aware of all factors when it met on 7th November.

In the light of the public interest which this proposal has aroused, my right hon. Friend has asked that the decisions of the planning committee should not be published nor acted upon until the board itself has had an opportunity of considering the whole matter at its meeting on 27th November. There is a slight misunderstanding about Parliamentary privilege. The board acts as agent for my right hon. Friend and perhaps the remarks should be read in the light of that relationship. There the matter now rests.

I also understand that since the opening of the new maternity unit at the Walsgrave Hospital, Coventry and the George Elliot Hospital, Nuneaton, the board has been considering whether it would be feasible to reorganise maternity services in the area. Should this consideration lead to a proposal to close any hospital, the board would undertake local consultations before submitting its proposal to my right hon. Friend, and when doing this would also send him full information of any representations made to it. I assure my hon. Friend that if any such proposal is put before my right hon. Friend he will very carefully consider all representations made by local interests before giving his decision. My right hon. Friend will also take careful note of the points which have been made in this House this afternoon.

I am aware of the public meeting which took place last night. Although I have only received what might be described as a Parliamentary carrier pigeon news service about it, because we have not had a full report, I have taken note of certain remarks which were made. I am awaiting confirmation—in the Press or in any other way—of these remarks. I ask my hon. Friend to be patient and I will in due course write to him with a more considered reply to some of the points which were raised.

I would just comment on one small point. I understand, subject to the accuracy of the report that I received, that one speaker said that we were using less of the gross national product than we were 20 years ago in the National Health Service. I am advised that this is inaccurate. But I will send my hon. Friend the precise figure as soon as I can.

Mr. William Price

I can assure the Minister that on his behalf I disabused that gentleman of that belief.

Mr. Snow

I am obliged to my hon. Friend.

I now come to the point for which my hon. Friend has no doubt been waiting, namely, the future of St. Cross Hospital, Rugby. As he knows, the Regional Hospital Board built operating theatres at St. Cross Hospital in 1966 as the first phase of its intended expansion. Later phases were to be a 60-bed maternity unit and a 120-bed acute ward block, and in reply to a Question of 21st June, 1967, I said that these were in the first list of schemes expected to start after 1969–70. This position has not changed.

I accept straightaway that, in the mind of the casual reader, to say that it will start after 1969–70 may indicate it will be within a few months of that date. But I am afraid that my Reply was devised specifically to mean that it would be after 1969–70. I hope that I will not be accused of equivocation in that matter.

I informed my hon. Friend that the two schemes were in the first list of schemes after 1969–70. The Hospital Building Programme (Cmnd. 3000) grouped proposed schemes in three classes. The schemes proposed for St. Cross Hospital were in the higher group to start after 1969–70. The board has given them no lower priority more recently. But it would be quite wrong for me to indicate a firm starting date for these schemes. I must leave it to the board to adapt its programme to changes of need and to consider Rugby's claims in this light.

Let me put this matter in perspective. We have a rising hospital building programme. Since 1964–65 we have seen the annual sums spent on hospital building in England and Wales rise from £59 million to £97 million estimated for the current financial year, and we expect to top the £100 million mark next year. We are making inroads into the major task of creating a modern network of hospitals that match modern needs of people and of medicine. But, large though those sums may be, we have to accept that our aim cannot be achieved overnight.

Mr. Speaker, if you, as I do, went round this country looking at some of our hospitals you would wonder what has been happening in the last 15 years. We are now having to patch up, alter and try to modernise on a huge programme. The current programme, over a 10-year period, is for about £1,000 million. This is a substantial figure.

Within the available resources—and this is a word that means more than just money; it means trained staff, material, building labour, the lot—we have to-choose priorities, and in choosing those priorities we must avoid unnecessary rigidity. I have seen no reason to disput the choice that the Birmingham Regional Hospital Board has made in this matter up to now. I now await the board's present review of its planning programme confident that it will make a sensible choice of priorities to meet current circumstances and knowing that it will be prepared to rearrange priorities if circumstances change. I therefore ask my hon. Friend to share my trust in the board's knowledge of the problems of its region.

I was a little worried when my hon. Friend talked about the lack of communication and information and the difficulty of obtaining the facts from the regional hospital board. I well remember, when I spent a little time as Parliamentary Private Secretary to the late Aneurin Bevan, hearing him say to me that the catchment area of consultation goes wider and wider and that it is difficult to know where it will stop. I do not think that there is any malice aforethought; there is no secrecy. There must be detailed consideration in depth. If that means a delay, bearing in mind the flexibility of the general position, in conveying information to a wider public, it is because it seems the best way of providing the public with accurate information. If there are inherent uncertainties, they are the result of the economic situation and the great medical changes which are being made and which make the job of the regional hospital board so very difficult.

I know how frustrating it is to the constituency Member to put over these considerations to the public. I speak from personal experience. Like me, my hon. Friend has the opportunity of viewing the problem nationally. It is not easy for people living locally to see matters other than from a relatively parochial point of view. They are the people who have to send their children and relatives to hospital, and they want the best for them. It is very difficult for them to understand why tradition should be changed and arrangements altered.

We welcome consultation between hospitals and other interested bodies, but it is not always easy to judge when such consultation should begin. "Begin" is the operative word. It must begin at some point. Proposals may be advanced at board or management committee meetings as a stimulus to discussion. It would be wrong to initiate public discussion until the proposals had been more fully considered and more clearly formulated. If the internal discussion process is taken too far, there is a danger that a position may be reached from which it is not easy to move. But I trust that hospital authorities are aware of this danger and are always ready to keep an open mind about their preliminary proposals and that this attitude will be reciprocated by bodies and people outside.

I have talked at some length about the general position in Rugby as we know it. We do not know, and the regional hospital board does not know, with precision what the position is likely to be at St. Cross Hospital. I have attempted to show the general feeling. I have no reason to believe that Rugby will be isolated. I do not think that the functions of St. Cross Hospital will be radically changed so as to result in its eventual elimination. I should not have thought that that was "on".

I think that its general functions and specialties will be changed, and that the consultants, whose opinion is most valued, will understand that it is intolerable, when there is a large, changing population, for any valid criticisms to be made that there has been an over-provision of maternity beds when existing provision may not be the sort of provision which we would like. The new provision is very necessary, and I have no doubt that if there is spare provision that is very much a temporary matter.

I hope that I have conveyed to my hon. Friend not only that there are great uncertainties, but that it is for the general good that we should not provide hospital services on a purely localised basis. Populations move, techniques change and requirements alter quite rapidly.

I have, however, obtained the authority of my right hon. Friend to say that not only will my hon. Friend's speech be carefully analysed and examined, but that information which we receive from the various public meetings in Rugby will be subjected to careful scrutiny. In due course, and from time to time, I would hope to give my hon. Friend more and more specific information.

Question put and agreed to.

Adjourned accordingly at a quarter to Four o'clock.