§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Harper.]
§ 12 midnight.
§ Mr. W. F. Deedes (Ashford)
On the face of it, this is a small local matter, but in reality it is rather more. It has led a Government Department—not the Department of the hon. Gentleman who is to reply to this debate—into going back on an undertaking to consider loan sanction. It exemplifies the extreme difficulties confronting an urban district council seeking expansion under the Town Development Act and trying to clothe its work with decent facilities. It also illustrates the complexity in securing medical facilities, a complexity which the Government have gone some way to recognise in their recent Green Paper.
It follows that the Department of Health and Social Security carries only part of the blame here. I shall resist the temptation of visiting the sins of other Departments on the Under-Secretary of that Department. The Ashford Urban District Council has spent about £3,000 in two years wrestling with the Department of Health and Social Security and Kent County Council to secure a surgery and clinic for the largest of the London housing estates, which have now been denied to it. The urban district council has been dished by Whitehall.
I will give a short summary of the rather tedious history of this story. In July, 1967 it was agreed at a meeting with Kent County Council to provide the surgery and clinic for this estate of about 5,000 people. On 2nd October, 1967, the Minister of Housing and Local Government wrote:As promised at the meeting on 12th September, I am writing to say that the Department is prepared in principle to consider an application for loan sanction for the clinic and surgeries as described in the plans submitted.The county council at the same time signified its approval. By August, 1968, the clerk was able to signal agreement on design of the clinic with the county council architect and agreement with the National Health Executive Council 1882 and the doctors concerned on the design of the adjoining surgery. The cost was to be in the region of £23,000.
From that point there arose continuous difficulties. For the first time the hon. Gentleman's Department appeared on the scene with objections to the design of the surgery. It wanted a second surgery accommodated. It also informed the executive.There is no guarantee that the Minister of Housing and Local Government will be able to agree to the expenditure requiredwhich was a flat contradiction of the approval already received. At the same time it brought the clinic under fire so that the county medical officer was compelled to write to Ashford:The county members have now considered the proposal, having regard to a letter received from the Ministry of Health in August, in which it was pointed out that the estimated cost is far in excess of the cost limit that would be allowed under the Local Authority Building Notes No. 1, Appendix F, which would be applied if the County Council were to erect the clinic in the usual way. In these circumstances, the sub-committee were unable to recommend acceptance of the estimate of £23,250 for the work.However, this seems to have been a false alarm. On 12th December the county council decided that the estimate fell within the cost limits, but by the end of December it was raising fresh doubts arising fromcurrent financial restrictions which cause every item of expenditure to be looked at very closely with a view to ensuring that no unnecessary items of expenditure are incurred.In January of this year the clerk of the executive council made a personal pilgrimage to Ashford to discuss these difficulties. He expressed deep regret that the urban district council, having gone so far out of its way to provide medical facilities for which it was not directly responsible, should find so many obstacles in the way of progress. Underlying the difficulties, he stressed—I have no doubt correctly—were recent modifications in Government policy in respect of such services. He undertook to meet the Ministry and discuss the matter.
There followed an exchange of correspondence which I have here, which the hon. Gentleman has seen, and which I think might be politely described as word spinning, and I do not propose to spin it out here tonight. Delay meant that the estate had developed and tenants 1883 were naturally finding their own medical advisers by this time. This, in turn, affected the financial arrangements proposed for the surgery.
At about this time the Department indicated to the county a further change in these rather ominous words:In order to comply with the recommended space standards and produce an efficient viable unit it is considered the plans would need to be completely re-drawn. On these grounds alone this project is not one for which we would recommend the expenditure of public moneys nor, in our view, would the over-extensive accommodation merit full reimbursement under the scheme for direct payments for rent and rates.One might be forgiven for regarding the terms of that letter as discouraging. If the Ashford Urban District Council had some grossly distasteful project in mind, it could hardly have expected more cold water to descend on it from a greater height. The clerk of the Council observed on 6th March, 1969, I think with some justice:For the Department of Health to insist on viewing these proposals as a medical centre can only be with the deliberate intention on their part of frustrating the proposals, despite the assurance of the Ministry of Housing and Local Government that loan sanction will be forthcoming.In April, the Ministry of Housing weighed in and observed that, in view of the lapse of time and change of plan, its letter of October, 1967, was no longer effective.
That was the end of the road. I have not much to add to it by way of narrative. An exchange of not particularly helpful correspondence between myself and the noble Lady, the Minister of State ensued, but it is not wholly relevant. I did not find her arguments entirely convincing. I have tried to deal with the case on the basis of historical fact and not of polemics, although I confess to feeling a sense of disappointment, even disgust, at the effect of the action of the Ministries on this modest and well-intentioned plan.
The hon. Gentleman will, quite properly and fairly, answer all this detail for detail and he will acquit Housing or Health of sharp dealing. What he cannot dispute is that the withdrawal of an undertaking on loan sanction is very rare, fortunately, because in terms of mutual confidence between Whitehall and town hall it is very damaging.
1884 What I am concerned about is the broad picture which emerges from this 18 months of totally abortive effort by a small town which is trying to provide facilities to implement Government policy—because overspill, for which the town is responsible, is Government policy. That is what is so depressing about it.
I happen to think that the Town Development Act, for which the Conservative Government were responsible, is a daft way to go about the decentralisation of London, but I will not enter into that. What I think such a town has a right to expect is a degree of co-operation and encouragement from the bigger Government Departments. This was a good idea for a big estate of some 1,300 houses and 5,000 people, even in detail. When every allowance is made for what I suspect happened, namely, a change of rules as we went along—no doubt for sound economic reasons—even in detail it was not far wide of the mark. Moreover, there was a degree of urgency behind it, because we have some local difficulties about hospital accommodation. We are not talking about trimmings—community, social or youth centres—funds for which are in short supply, but health facilities, which are vital, to use that overworked word correctly.
What I want to ram home, although the hon. Gentleman represents only one of the Departments involved, is that this overspill is agreed Government policy. The Government are keen enough to get the population moving out of London, but often prove less willing to provide what is needed if these large new centres of population are to become communities and not just brick and asphalt camps.
Behind this tragic muddle lies a failure of Government Departments, which is repeated over and over again, to comprehend the difficulties of small authorities trying to enlarge their towns by a third or a half to make this social contribution to the London problem. We cannot change the terms of the agreement with the Greater London Council, not without a lot of fuss, so it is unfair to change, as the Departments did, their terms for a small matter of this kind.
What these authorities desparately want is encouragement and help, not discouragement and hindrance. If I can get that across and get it on the record 1885 tonight, the exercise may not be totally wasted.
§ 12.12 a.m.
§ The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)
I do not complain about the way in which the right hon. Gentleman has deployed his case. If I give a slightly different gloss in my account at times, it will be just as well to put it on the record.
I am well aware of the zeal with which the Ashford Urban District Council wishes to serve the residents of the Stanhope estate as best it can. I have received representations from other sources about this matter. They view things very much from the right hon. Gentleman's point of view in this context, but are not necessarily the right hon. Gentleman's political friends. The Stanhope estate caters for about 6,000 people. I agree with the right hon. Gentleman that it might have been prudent to try to achieve contemporaneous provision of these health facilities.
It might be of assistance if I explain at the outset that the urban district council is not a local health authority under the National Health Service Act, 1946, and that, therefore, my Department has no power to recommend the issue of loan sanction in respect of any expenditure which it might propose to incur on medical premises. The local health authority for Ashford is the Kent County Council. One of its duties under the 1946 Act is to provide a service for the care of expectant and nursing mothers and young children. In the discharge of this duty it sometimes erects its own purpose-built premises or clinics but more frequently leases accommodation from other public or private bodies. In recent years the amount of loan sanction which my Department has been able to make available for the provision of purpose-built clinics has been very limited.
In July, 1966, the urban district council asked the Ministry of Housing and Local Government whether, in principle, loan sanction would be available under housing powers for the provision of practice premises on the Stanhope estate for local doctors as part of their overall plans for the development of the area. The Ministry replied in August, 1966, that it had no objections to the proposals in principle.
1886 In September, 1967, the urban district council made a further approach to the Ministry asking whether the scheme could be extended to cover the provision of a clinic as well. The urban district council had understood from the Kent County Council that there was no early prospect of my Department being able to entertain an application for loan sanction for a purpose-built clinic at Ashford. The Ministry of Housing and Local Government replied it was prepared in principle to consider an application for loan sanction at that time for the provision of a clinic and practice premises, and that it awaited formal application in the usual way. It was suggested to the urban district council that a firmer estimate of cost should be submitted for approval before tenders were invited.
In July, 1968, the urban district council forwarded plans to the Ministry of Housing and Local Government, saying that it was now ready to go out to tender. The Ministry, following normal practice, sent the plans to my Department for advice.
Here I will go back for a moment to September, 1967. At that time the South East London and Kent Executive Council, which has the responsibility for organising the provision of general medical services in the area, wrote to local authorities, asking them to consider the need for medical services in any programme of expansion. The urban district council responded with commendable speed by writing to all general practitioners who might be interested in the Stanhope estate project. One doctor in each of two practices expressed interest but, later, it appears that one of these withdrew. At any rate, the plans submitted by the urban district council in July, 1968, catered for only one doctor.
My Department's examination of the plans for the doctors revealed that the provision for the practice premises was greatly in excess of the reasonable requirements for modern medical practice and that the layout from a medical point of view could be improved. In short, redesign would have provided in the same area two adequate medical suites. The hon. Gentleman said that we had said there must be two doctors. In the long run this may be necessary, but the real fact that came out of this was that the space that was proposed to be provided would or could have allowed for two suites.
1887 This is an important point because executive councils can, subject to certain conditions, reimburse doctors for rent and rates of practice premises. Excessively large premises could lead to unnecessary expenditure of public money and, for the doctor himself, higher running costs. My Department was therefore unable to support the proposals for the practice premises in that form.
More recently, the doctor who had earlier withdrawn his interest in the project renewed his interest in practising from publicly-owned premises on the Stanhope estate. However, the estate was rapidly filling up and residents were registering with doctors close by. I take the point that because of these delays, for one reason or another, whatever the blame may be, the public were resorting to what medical practitioners they could find and where they could find them.
The executive council, after consulting the local medical committee—a body representing general practitioners in the area—concluded that the provision of practice premises on the Stanhope estate was no longer a viable proposition. It so informed the urban district council in February this year.
As far as the clinic is concerned, my Department on being advised of what was planned wrote to the county council asking for further information about the project, pointing out that the estimated cost was much above the figure which it would have been prepared to approve had the project been submitted by the county council and had the Department been able to accept it for inclusion in the capital building programme.
The Kent County Council replied that it had come to an arrangement with the urban district council under which the latter would design and build a clinic as part of the development of the Stanhope estate for use by the county council as the local health authority. The design and the cost of the building, as negotiated by the district council with its contractors, were to be subject to the county council's approval. If agreement on these points could be reached the county council had indicated its readiness to lease the premises at a rent to be negotiated between the two parties. It explained that by August, 1968, agreement on the design had been reached between the two 1888 councils and that it had been informed that the estimated cost of the building was £23,250, including external works such as car parking but excluding the cost of land and professional fees. It added that in its view the project was little different from any other proposed leasing of accommodation for the provision of local health services.
There is, of course, a certain amount of truth in this. But my Department had to have regard to two other factors. First, the population to be served is relatively small and it seemed likely that the building as a clinic would not be fully used. Normally my Department does not consider the provision of purpose-built premises for clinic purposes is justified where the population to be served is less than 7,000. It is therefore doubtful whether the scheme could have been approved in principle had it been submitted by the Kent County Council and it is very unlikely that it could have been given any degree of priority.
Second, and perhaps more important, the project appeared to be unnecessarily expensive. To serve a population of up to 10,000 my Department would not expect a clinic built by a local health authority to cost much more than £18,500, excluding expenditure on any abnormal site works and the cost of the land and professional fees. This is some 25 per cent. less than the estimate of £23,250 put forward by the urban district council and suggests that there is scope for some economy in the council's scheme.
For these reasons, therefore, my Department felt unable to advise the Ministry of Housing and Local Government that the clinic scheme could, without modification, be accepted for loan sanction.
Broadly speaking, the position is this. It is generally agreed that it is in principle sensible that, as part of large schemes of new development there should be provision for community health services. It is in many cases desirable that this should take the form of a health centre; but I accept that in some circumstances this may not be possible. There is thus no dispute that the urban district council's proposals were in principle to be commended; and this was clearly implied in the reply which the Ministry of Housing and Local Government made to the council's original inquiries in 1966–7. The detailed proposals which 1889 finally emerged in 1968 were, however, unacceptable, as I have related, and I am quite clear that, having regard to the scale of services to be provided, the size of the practice premises and the cost of the clinic were excessive. Thus the advice given by my Department to the Ministry of Housing and Local Government that the detailed proposals were unacceptable as they stood was in my view right.
The mind of the ordinary member of the public must boggle at my account of the history of this matter, but its cause is that of protecting the taxpayer. I would, therefore, certainly not accept that this is an example of bureaucratic interference or of unreasonable decisions by the central Department. I fully understand the urban district council's feeling of frustration in not being able to provide what it honestly feels is needed on 1890 the Stanhope estate. The right hon. Member will recall from the reply to his Question on 6th May that the Ministry of Housing and Local Government is ready to join in any consideration of alternative arrangements for this project.
In view of this tortuous progress of events, I have arranged that officials of both the Ministry of Housing and Local Government and my Ministry will meet the Kent County Council as the local health authority and the Ashford Urban District Council to work out a satisfactory answer to this problem. The meeting will take place early next month. I do not pretend that there are not difficulties in the way but we for our part are ready to try to overcome them.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-three minutes past Twelve o'clock.