§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boston.]
§ 3.50 p.m.
§ Mr. Fred Evans (Caerphilly)I wish to raise the question of the change of function of the Caerphilly Miners' Hospital. The town of Caerphilly lies in the Rhymney Valley, which covers the constituency of Caerphilly, and large areas of the Bedwellty and Ebbw Vale constituencies. It is a thriving and populous town which has succeeded in attracting to itself a considerable and diversified industrial complex which has been accompanied by an expanding population. To the north 1941 of the town is an area which still has coal mining as its main industry. It is separated from the City of Cardiff by a high mountainous area with inadequate road systems. The roads of the Rhymney Valley are narrow and winding, and frequently become difficult or impassable in winter conditions, and this is particularly true of the hill road to Cardiff.
South Wales produced many ancestors to the present National Health Service, both in Aneurin Bevan's home town of Tredegar and in the Rhymney Valley, one of these being at Caerphilly. There, in 1923, the miners, tired of seeing their comrades injured in their dangerous industry having to be taken by train to Cardiff, often with delays which produced serious consequences, set up their own hospital, which has done outstanding work, and was always completely self-supporting prior to being absorbed into the National Health Service.
Since 1945, £½ million has been spent on it. It has developed a fine maternity wing, and a nurses' training school which has the distinction of having secured 100 per cent. passes in final examinations since 1948. The hospital has become an important and much-loved institution in the Rhymney Valley, a position which it thoroughly deserves in view of its history of success.
With the building of a new teaching hospital at Cardiff, the Welsh Hospital Board proposes to remove the surgical wing from Caerphilly and to limit the hospital to maternity and geriatric cases. This will remove the only surgical facilities from a hospital which has 80,000 people, likely to become 100,000 in the next 15 years, in its catchment area, where coal mining is still the most important industry.
Time and again attempts were made to secure information, by myself in this House, by the Caerphilly Urban District Council from the Welsh Hospital Board of Health, and subsequently from the Welsh Office when it assumed responsibility for the health services in Wales. All inquiries were fobbed off with evasive Civil Service answers. Eventually the Chairman of the Welsh Hospital Board agreed to discuss the future of the hospital with the committee fighting to preserve and expand its facilities.
1942 He assured the committee that the forthcoming proposals, since published at the beginning of last November, would be proposals only, and that full discussions would take place and alternative plans considered before final decisions were arrived at. I subsequently received the same assurance from my right hon. Friend the Secretary of State for Wales. To this date no offer of consultation has been made, and one can only conclude that the so-called proposals are, in reality, firm plans.
It is obvious that certain areas of the social services such as health and education are very sensitive areas because they impinge on people so directly. It was obviously for this reason that my right hon. Friend the Secretary of State for the Social Services laid down new procedures for examining the opinions of local communities leading to community involvements, and for examining the opinion of local doctors at a very early stage when plans are made which may close hospitals or change their functions.
Notice of the new procedures was issued by the Welsh Office at the beginning of this December, but by 2nd December the Chairman of the Welsh Hospital Board had been reported in the Press as saying that the new procedure would apply to other parts of Wales but not to the Cardiff area proposals, in which Caerphilly is involved, because, he says, consultations for that area have already begun under the older administrative machinery. The people of Caerphilly have never been consulted, and they will regard this statement with bitterness and cynicism.
Caerphilly is in a populous area with a dangerous industry and an expanding complex of light industry. Industrialists who asked what hospital facilities there were in the areas before they decided to come are now being robbed of a surgical and accident unit, and people will have to travel in very difficult circumstances to a new teaching hospital at Cardiff.
The people of Caerphilly believe that they have not only a sound social case for the retention and expansion of this hospital, but also that there is an overwhelming medical case for its preservation. We have, for example, thoroughly examined the transport problems in this valley of narrow winding roads, particularly at peak traffic times when some 1943 700 vehicles an hour pass through to Cardiff, without the added complication of having ambulances trying to negotiate these roads. The winter conditions, which I have mentioned, are such that they can isolate this valley very easily and this, indeed, could lead to serious consequences for patients.
We have consulted industrialists and we are aware of their needs for a local casualty unit. They are backing the claim by the people of Caerphilly for the retention of this hospital. We claim that we need a casualty unit, backed up by specialist services, and with facilities for detaining casualties overnight when necessary. We suggest that the present casualty unit be enlarged to cope with a possible future increase in the number of industrial and road accidents arising in the surrounding area, and we draw attention to a statement made five years ago that the accident unit at this hospital would indeed be preserved.
We are also concerned about bed availability in the new hospital at Cardiff. The Welsh Hospital Board has decided to close a further four hospitals in this same valley. These total 120 beds, in addition to those which will have to be found for general cases. If we add to this figure about 150 to cover the cases normally dealt with in the Caerphilly Miners' Hospital, we reach a total of 300 beds. Therefore, we find it impossible to visualise how the new teaching hospital at Cardiff will be able to cope adequately with this load when it will have only 630 beds available for general patients.
We are also concerned about waiting lists for simple surgical operations— appendicitis, hernia, tonsillectomy and so on—which constitute the bulk of surgical operations. In the Caerphilly area the waiting list at the moment runs to about two years, and the waiting time is continually getting longer. We cannot see that the transfer of such cases to a hospital at Cardiff will reduce the waiting lists. We envisage rather that they will lengthen. The more complicated cases can, admittedly, be best dealt with in larger hospitals, but at least 70 per cent. of the work load of most surgical units concerns operations which can be carried out, and have been carried out, 1944 efficiently and effectively, in the local hospital in this town.
We would say that if only in the interests of national economy, which suffers as a result of absenteeism, there is a case for a miners' hospital of this calibre extending its present facilities and dealing efficiently with these common cases which can so often result in patients having to remain away from work until an operation can be performed. We have in this area a rising population. We expect that, in the fairly near future, the figure of 100,000 will be reached. Apparently, the Department of Health and Social Security regards a population of 100,000 as the point at which a district hospital should be provided.
§ It being Four o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boston.]
Mr. EvansWe claim, therefore, that the entitlement of this area for a district hospital has been soundly made. We do not wish in addition to go through a period of limbo where services are likely to be run down. Indeed, we are deeply suspicious that the taking away of consultants from the hospital and their replacement by a locum consultant means that, already, a decision has been made, although we have been told that these are only proposals.
Attached to the hospital is a very fine maternity wing, and we claim that this should be backed by specialist services, including at least one consultant gynaecologist, as at present. We cannot expect general practitioners to deal with difficult cases and one cannot always foresee difficulties arising. Forming an unsupported general practitioner unit would, in our view, be a retrograde step and would throw additional burdens on general practitioners.
We are interested, too, in the running costs. Apparently a hospital bed in the new hospital at Cardiff would cost £70 to £75 a week. In Caerphilly Hospital, the cost is in the region of £45 per week.
We have consulted the local medical people, both general practitioners and 1945 consultants, and they are firmly behind the claim for the retention and expansion of the hospital. We are very concerned that my right hon. Friend the Secretary of State for Social Services should be speaking in one set of terms in this House about community involvement whilst, in Wales, a separate voice in the Welsh Hospital Board is claiming that the new procedures for consultation shall not apply to this hospital.
We have written to my right hon. Friend the Secretary of State for Wales requesting an interview. We have not been granted one and we still do not know whether any consultation at all will take place. Yet, many months ago, two part-time consultant surgeons in this hospital were replaced by one full-time surgeon employed on a locum basis. It is now even more surprising to see, from the Western Mail of 2nd December, that the plans for the Cardiff area are too advanced to be affected by the recent statement made by my right hon. Friend the Secretary of State for Social Services.
It is never too late to start afresh from a false position and we say that this is what must be done. There is still time for planning to start from scratch and everyone concerned with Caerphilly Miners' Hospital is more than ready and willing to co-operate.
In addition, my right hon. Friend referred to community hospitals being used for common or routine operations, such as hernia, varicose veins, etc., in the Sunday Express of 30th November, thus highlighting the need to keep hospitals like Caerphilly fully open and indeed expanding. We therefore claim that the Welsh Hospital Board and my right hon. Friend the Secretary of State for Wales should enter into consultations with the people of Caerphilly, including the general practitioners and specialists, in order to examine this problem fully. We are satisfied that it has not been examined as yet in its full implications.
I have received documents from my friends in the medical world who make all these points. They have produced a document which is a resume of all the sound medical arguments for the retention of this important hospital. These will be submitted, as other documents have been submitted, both to the Welsh Hospital Board and my right hon. Friend the Secretary of State for Wales.
1946 Many more strong arguments could be put forward by my constituents who feel extremely passionately on this issue. There is not time in this Adjournment debate, if the Minister is to be allowed adequate time to reply, to go more deeply into the medical arguments, but I appeal to my right hon. Friend the Secretary of State for Wales to have second thoughts about what we consider to be an extremely powerful argument and to meet the committee which is fighting to preserve this hospital, and to enter discussions with it.
I ask him to reject these proposals out of hand and to begin from scratch to examine a serious problem which may influence generations to come. If we feel that a mistake has been made, let us have the honesty and integrity to say so and to discard plans which are wrong and to start afresh and produce something which is intelligent and worthy of a community like the Caerphilly constituency.
§ 4.7 p.m.
§ The Minister of State, Welsh Office (Mrs. Eirene White)I am sure that everyone will have the greatest sympathy with my hon. Friend the Member for Caerphilly (Mr. Fred Evans) in his concern about the local miners' hospital in his constituency and the other associated hospitals. I am glad that he has taken the opportunity of his good fortune with the Adjournment to raise the subject in the House.
In the Welsh Office we are well aware that there are strong local feelings about this matter, but I hope that my hon. Friend will take every opportunity in his constituency after this debate to try to clarify what must be some misapprehension about the procedure for discussion of the reorganisation of hospitals, particularly those in the catchment area of the new group of hospitals at The Heath.
We fully understand that the prospect of drastically altering the function of any hospital which has given good service naturally disturbs the community it serves, particularly those whose life work it has been to give service to the hospital. I should like to take the opportunity of paying the warmest possible tribute to the medical staff, the 1947 nursing staff, and all other concerned with the Caerphilly Miners' Hospital. We know its history and those of us who, like myself, have connections with that part of the country fully understand the feeling of the local community, because it was its effort and its initiative in the first place which brought the hospital into being. We are in no way lacking in sympathy or understanding with local feelings and local sentiment.
Nevertheless, it is the duty of the Secretary of State in these matters always to put the well-being of patients first. It is for him ultimately to decide how best he feels the welfare of patients in this area can be most adequately and fully served, and how to ensure that they receive the most modem medical treatment which science can provide. I was distressed by some of the observations of my hon. Friend, because even he seems to be under a serious misapprehension about the proper procedure.
Before I embark on that, I would like to emphasise that where one has the pressure of increasing demand for increasingly expensive and sophisticated medical services, one has to take into account the total pattern in the area of a new modern hospital. We find that the expenditure on the hospital programme under the present Government, which has greatly increased in momentum, has increased the capital costs of new hospitals, which are high. We also find by experience that these new hospitals are much more expensive to run than the older ones. This is self-evident when one is undertaking very much more sophisticated treatment.
It is therefore essential, in establishing a large new hospital, to ensure that there is no unnecessary duplication or waste of services within its catchment area by continuing to use older hospitals which are less suitable for a particular type of treatment. The new buildings which are being provided must clearly to some extent be regarded not as net additions but as replacements at a higher standard of facilities which may have been provided elsewhere. Unless this basic fact is grasped, and unless we can organise matters in such a way that certain economies can be achieved, we will find that we may have a fine new hospital but 1948 that we shall have neither the revenue nor the skilled doctors and nurses available to run it.
We have to look at the peripheral hospitals in such a situation. It is for this reason that public discussions have now been started about the future pattern of hospital services in the Cardiff Management area which includes Caerphilly. It is the Welsh Hospital Board and the Board of Governors of the United Cardiff Hospitals who have the responsibility for looking at any possible new pattern and it is they who prepare plans for reorganising the services in the Cardiff area. The Boards appreciate that any pattern of reorganisation which is proposed may not meet the wishes of all members of the community and they have therefore indicated not only their own preference but alternative ways in which the service might be provided although they do not recommend these alternative forms of development.
They have put forward choices, fairly, as the basis of discussion and I am sure my hon. Friend recognises this. The Boards have prepared three alternative suggestions for consideration. Two of these suggest a different allocation of beds at the Miners' Hospital although throughout it is proposed that the annexe, what is called the Van annexe, should not be kept open, and I do not think that my hon. Friend has brought that into consideration. It is not for me to go into the merits or demerits of any of these proposals now.
I must make the position of the Secretary of State clear in this matter. At present, no proposals have been approved by the Secretary of State. He is not in any way committed and he does not have before him any firm proposals about the Caerphilly Hospital or any other hospital in the area under discussion. He must wait until the hospital boards have received all the representations which may be made about these proposals. When the Boards have considered them, and in the light of them it is for them to make firm recommendation to the Secretary of State. It is only at that point that he takes cognisance of the proposals of the hospital boards, and in due course, having considered the evidence himself, reaches a conclusion. Therefore, although my hon. Friend brought forward a number of interesting, 1949 important and valid points today, he will appreciate that I cannot comment on them, and it is not possible at this stage for the Secretary of State to do so. They will naturally be taken into account by the Board, together with the other evidence.
I take issue with my hon. Friend on some of his references to the procedure for consultation. He knows that the booklet issued by the United Cardiff Hospital Board and the Welsh Hospital Board in November this year is the basis for these consultations with the local interests in the area. It was unfortunate that he should have said that the local people were fobbed off with evasive answers. He must appreciate that until the Board had been able fully and in detail to study the possible alternatives —and I assure him that there are very many alternatives in this jigsaw of the Cardiff hospital area—it could not responsibly embark on discussions with the local interests because it had first to satisfy itself of the possible alternatives which might reasonably be considered.
My hon. Friend said that no offer of consultation had been made and that it must be assumed that the proposals are firm plans. Neither of those points is valid. I should have thought that a plain invitation was issued by the hospital board in the foreword to the booklet issued in November. It asked that any comments, criticisms or alternative suggestions should be submitted by 31st January next. It said that if further information or clarification of any point was required they should be contacted. Speakers would be provided for any organisation interested in a further discussion and requests for officers and officials of the Board and Board of Governors to meet deputations from public authorities and professional interests would be considered sympathetically. I should have thought that all concerned would have taken up this invitation if they wished to do so. I know that the chairman of the hospital board and others are entirely at people's disposal for the fullest possible discussions and for weighing up the pros and cons of various possibilities.
There has been, understandably, some concern about the new procedure which my right hon. Friends have communicated to hon. Members within the last ten 1950 days or so. My hon. Friend the Member for Caerphilly seemed concerned that the chairman of the hospital board is reported to have said that this new procedure will not apply to the Cardiff and district proposals now before us. He seemed to regard that as unjust. But there is some misunderstanding. We cannot start entirely from scratch in this instance because the hospital at The Heath has been built physically. Because of the difficulties which have arisen in building these new very large hospitals, my right hon. Friends have indicated that when such large hospitals are contemplated in future and it is clear that there will be consequential effects on other hospitals in their neighbourhood there should be much earlier discussion, for example, about the precise location of the new large district hospital. One might then have arguments at that point in time, before any brick or stone is laid, as to the precise place which would be of optimum advantage to the whole service for that hospital.
We had certain discussions in various parts of Wales as to whether certain large new hospitals might with advantage have been sited elsewhere. That situation, however, as I am sure my hon. Friend appreciates, does not arise in Cardiff because the hospital is being built.
§ Mr. EvansSurely, it is because the new hospital at Cardiff was planned without consultations that we are now in the position that we are told we cannot have consultations because we were not consulted before.
§ Mrs. WhiteThere cannot be consultations as to where The Heath Hospital will be; that is plainly ruled out. This, after all, is the kernel of the proposed new procedure that in future, where a hospital which is bound to have such widespread effects on other hospitals is to be planned, there should be much fuller consultation about its location and its relationships with other hospitals before it is begun.
I assure my hon. Friend that he should not see more in what has been said than was actually there. The simple fact is that one cannot start absolutely ab initio when the hospital is already being built. That does not mean that the discussions and consultations on what is, 1951 given that one central fact, the best disposition or reorganisation of the other hospitals are not real and open, because they are. There are various possible patterns for the use of the peripheral hospitals of all kinds, of which the Caerphilly Hospital is certainly one of the most important. All I am saying is that the new procedure means that one starts ab initio, from scratch. One cannot do that because one main factor in this set of circumstances is already given.
I therefore hope very much that my hon. Friend will appreciate that the proposals for consultation are absolutely genuine. There are various permutations and combinations which are possible within the Cardiff hospital catchment area. It is important that these should be fully discussed and I hope that they will be discussed calmly and with good sense.
I know that these matters arouse acute emotions, but we are all anxious to try to find the best solution in the circumstances. I can repeat only that my right hon. Friend the Secretary of State has reached no conclusions whatever on any of these proposals, that he will await the results of the consultations which have been invited with the two hospital boards and that he hopes that everyone in the locality will try to look at the whole problem as a problem which we are all concerned to solve in the best interests of the community and if possible, not simply as an emotional campaign.
There are all kinds of considerations which we must try to reconcile so that we get the best possible care for different types of patient. One of the most important things to keep in mind is that certain hospitals in the peripheral system could well be used for different sorts of patients. One must take social as well as 1952 medical considerations into account. The Welsh Office is very much alive to this and would wish to take into account considerations not only of the purely medical aspects of the hospital service, but also of the patients' families, visitors, and so on, and their own convenience.
Before I conclude, I should refer to the suggestion made in a circular letter which, I think, we have all received and to which my hon. Friend referred. It suggests—I am sorry that these rather emotive suggestions should be made— that there has been some policy of deliberately running down hospitals prior to any firm decisions being taken. I received this letter only today, but I made it my business to make immediate inquiries. There is certainly no question of any deliberate policy of the sort, and I am told that there is no evidence of any drifting away of staff at the hospital. There have been one or two difficulties about consultants at the moment, but this has nothing particularly to do necessarily with the situation at Caerphilly. I am also advised that, so far as orthopaedic surgery and gynaecology are concerned, arrangements have very recently been made for even more sessions to be provided at Caerphilly than in the past. It is true, of course, that in the present position no new capital works are likely to be undertaken at any hospital in the area, but I think this is understandable; till their future functions have been decided, I think that that is very reasonable.
I hope that, with these explanations, my hon. Friend and his constituents in Caerphilly will feel that their views on the matter will have a very fair hearing, and that, to use a famous phrase, the options are still open.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-six minutes past Four o'clock.