§ Motion made, and Question proposed, That this House do now adjourn.—[Dr. Miller.]
§ 11.39 p.m.
§ Mr. Anthony Kershaw (Stroud)
Mr. Deputy Speaker, I am grateful to have been able to catch your eye on this occasion so that I may raise one or two points about the hospital position in my constituency and in the area nearby. I have given the Minister notice of most of the points that I wish to raise to make it easier for him to reply, because I do not consider this a matter on which the House should take sides, and I do not wish to lambaste the hon. Gentleman in any way.
The first item that I wish to raise is that of the Gloucester Royal Hospital, and I am indebted to Mrs. Sally Oppen-heim for providing me with many of the facts that I have. The hospital is in ancient buildings more than 200 years old. The buildings are obviously not wholly suitable for their purposes today, and it would be found difficult to make them so. We also know that a new hospital is to be built. When is that likely to be started, and when is it likely to be completed or to come partially or wholly into operation? No doubt when it comes it will be a complete and perfect hospital, but in the meantime no one denies that the shortcomings of the Gloucester Royal Hospital are considerable.
In particular, I wish to refer to the difficulties in the operating theatre. The layout is such that the theatre does not provide the usual rooms which are considered necessary in modern medical techniques for those who are to work in the theatre to dress themselves under proper conditions. The nurses, and indeed the surgeons, can be seen garbing up for work in the theatre in a sort of cupboard under the stairs just outside. 1334 There are no lavatory or washing facilities available in the immediate neighbourhood for the nurses.
The dressings are packed in an open lobby, and then stored on shelves hanging behind a curtain in the passage. The sterile and unsterile trolleys from the theatre pass each other in the same rather narrow confines of the small ante-room. If an emergency patient arrives, a patient who may have had pre-operational therapy has to be sent home. I have been told that when a heart crisis arose in the theatre the necessary machine to revive the patient was obstructed in its passage along the corridor by the food trolleys of the hospital.
It is a great credit to the staff and to all who work in the Infirmary that they have been able to combat these difficult conditions and to instil confidence in the public—which I do not wish by my words to undermine in any way—that the medical facilities are as good as they should be. There is no doubt, however, that they have been operating under great difficulties.
I understand that in order partially to cure that situation the Minister proposes to instal an Octatent which is presently at Plymouth. There is no doubt that in doing that he will be able to improve the theatre itself, but the approaches to the theatre are bad—and the construction cannot easily be altered—and they will become even more difficult when the second theatre in this Octatent is installed, and the congestion from all the non-sterile conditions will in no way be altered by the installation of this Octatent.
I suggest that the Minister should instal something admittedly at more expense, namely, a prefabricated theatre for which there is just sufficient space in the hospital precincts. It will, of course, be more expensive than the Octatent, but all that expense will not be lost, because when the new hospital comes into operation either this prefabricated theatre will 1335 be able to be transferred to the new hospital, or, I dare say more likely, it will be available to be erected in another place. I therefore believe that it would be not so expensive as at first sight appears if it were found possible for this prefabricated theatre to be installed.
Another question might be raised. If a charitable organisation or the exertions of individuals raised this extra money would the hon. Gentleman be willing to accept that donation to pay for this obviously better facility? An answer to that might vitally affect meetings which are due to take place in the near future. I am sure that he is not against prefabricated buildings in principle. The prefabricated buildings in which the administration of the regional hospital board and others is housed in Porton Road would willingly be exchanged by many of the patients for the ancient premises in which they still are.
The hon. Gentleman may ask why this should be raised now, after all these years, and what is so burning about it which was not the case before. My answer is, enough is enough. This has gone on a long time and the opportunity has come to make changes. Now that the Minister has proposed a certain change, I suggest that a different change would be better. At all events, I know that the hon. Gentleman will not use the words which an official of the Board unfortunately used the other day, when he was reported in the Press as having said, "It is, after all, no worse than it was 20 years ago."
I wish next to refer to Standish Hospital.
It is proposed that Standish Hospital, near Stonehouse, should be brought under the Gloucester, Stroud and Forest Management Committee. This is a large hospital, with 269 beds—the largest in the area except for the mental hospitals, and well known for the excellence of its treatment and buildings. What is the reason for this proposal? No economic, medical or organisational argument has been given. Some may exist, but it has not been put forward. The only possible exception is that it was alleged that the laundry might be cheaper, but even that is not strongly pressed.
1336 All the local authorities in the area oppose this change, as does everyone who has been consulted, so far as I know. I cannot escape the conclusion that this change is a kind of empire building by the regional hospital board which I would have thought had enough to occupy it elsewhere, particularly in Gloucester, instead of this extra responsibility and the extra staff which will be necessary.
I turn now to the Berkeley Hospital which is in the constituency of my hon. Friend the Member for Gloucestershire, South (Mr. Corfield) but which largely serves the people living in my constituency. The Board proposes that the 15 maternity beds there shall be reduced to four emergency beds. The hospital serves a population of about 25,000 and the proposal is universally condemned. Every local authority in the area, every trade union with large representation there, every voluntary organisation has condemned it. The local doctors working in Dursley have said that it will be impossible for them to deal with their patients if they have to go further away than Berkeley Hospital. Therefore, the control of patients by the doctors, which is so important, especially in maternity cases, will be fractured. To that extent the medical practitioners will lose in medical experience and the patients will not be pleased to be transferred at the last moment to doctors not of their choice.
The regional hospital board has said that this decision is in part due to the danger of fire at the hospital concerned. Admittedly, the building is old and the electric wiring is not up to standard. However, when the board promised to consult the county council—the only body it has promised to consult—it did not point out that the friends of the hospital had offered to restore the wiring to any degree necessary or demanded at their own expense. That the Board did not mention this offer to the county council must be a reflection on the good faith of the board in this matter.
The percentage occupancy of this hospital is extremely high, and certainly much higher than that at Thornbury, which it is proposed should be used. I admit that the beds at Thornbury are not used, but that is because the board 1337 over-provided and now wishes to correct its mistake at the expense of my constituents. In time Thornbury will expand, and then the hospital will be fully used. What, at that stage, will happen to my constituents and where will they go?
Nobody in the county believes that the board is correct in this matter. I therefore ask the Minister to examine this decision carefully before passing it. Perhaps a decision in this matter is not strictly for the Minister in that it is not proposed to close the hospital. But as it is proposed to reduce it to four beds, that is virtually the same as closing it.
As for the hospital at Stroud, about two years ago there seemed a danger of it being closed or having its activities curtailed. At one point the staff was reduced. That danger now seems to have passed and the hospital is fully used. Its activities are increasing and it is providing valuable hospital accommodation for the district. Will the Minister reassure us that he has no intention of changing the status of the Stroud Hospital? If he would, his words would be music in the ears of my constituents.
The proposals for Berkeley, Standish and Stroud hospitals have been resolutely opposed by every authority, voluntary and otherwise, in the area. However, so far the board has shown no signs of changing its mind. About 30 of us, representing all shades of opinion, formed a delegation to complain about the Berkeley proposal, but apparently our pleadings fell on deaf ears.
These boards are subject to no electoral discipline in that their members are not elected in the normal way. Talking to them is like talking to a brick wall. One might as well talk to oneself.
It is the unanimous wish of those with the slightest influence in the matter in the county that the local board should change its mind. The trouble is that it is difficult to understand how these boards, as at present constituted, can react flexibly to popular opinion. The area of the Regional Hospital Board stretches from Gloucestershire to the far west, to Cornwall. What should a representative appointed because he lives in Gloucester say if it is proposed to close a hospital in Cornwall? How would he know anything 1338 about it? He would keep absolutely silent, and it would be the same with someone appointed from Cornwall considering a proposal affecting Gloucester. The chap who actually runs the "joint" is the secretary of the regional hospital board. That is bureaucracy and is undemocratic.
In future these boards should be brought under the local authorities. That may be part of the reorganisation we shall see in the next year or so. Unless it is possible for local people to feel that they have some voice affecting these decisions which affect them so vitally, they will feel out of sympathy with the way the hospital service is run. In the meantime the Minister is responsible. I ask him to stand up for what local people want in my part of the world.
§ 11.56 p.m.
§ The Under-Secretary of State for the Department of Health and Social Security (Mr. Norman Pentland)
I have listened to what the hon. Member for Stroud (Mr. Kershaw) has said about various matters regarding hospital provision in the city and county of Gloucester. I am grateful to him for sending me notice of some of the points he wished to raise. I am also glad to see present my right hon. Friend the Member for Gloucester (Mr. Diamond), who is involved and interested in the hospital in his constituency, giving me support, although, of course, he cannot take part in this debate.
I should like to set the record straight. Let me first deal with the Berkeley Hospital maternity beds. It could be claimed that the Regional Hospital Board has it in mind to close down a service highly respected locally; that it is trying to do this in a "hole and corner" fashion. What are the facts? The maternity unit consists of 15 beds on the first floor. Last summer the fire prevention officer made clear that it was an unacceptable fire risk. This called for action by the board.
It immediately put in hand a thorough review of the maternity service not only at Berkeley, but for the whole area. This is at a preliminary stage, but it would be useful, I think, to explain that the Department approved the opening of local consultations—but no further steps—on the following lines: the potentially unsafe first floor at Berkeley should cease 1339 to be used for maternity; that four maternity beds should be put on the ground floor at Berkeley; that while this is being done, maternity cases from Berkeley should go to Thornbury hospital and finally that on completion of the Berkeley adaptations, any cases which could not be taken there should go to Thorn-bury. The local consultations have not yet been completed, and consequently the regional hospital board has yet to reach firm conclusions.
Should it decide to proceed as outlined it will require the approval of my right hon. Friend the Secretary of State. This is because any decision to withdraw hospital services can only be made by a Minister. But as my right hon. Friend has not received any firm proposal, I cannot do other than say he will give all due weight to local feeling if and when the matter comes before him.
I now turn to the regional hospital board's handling of this matter so far. Before approaching the Department in August, 1968, the regional hospital board had already received a local deputation the previous month. This included the hon. Member, and the hon. Member for Gloucestershire, South (Mr. Corfield). The deputation, I understand, also included representatives from the county council, parish and rural committees, trade unions, voluntary workers and doctors. The Chairman of the Board assured the deputation that fullest consultation would take place before any firm plans were made. And I have complete confidence this assurance will be fulfilled.
The hon. Member has raised the question of the operating facilities at the Gloucester Royal Hospital. I am informed that the Chairman of the Regional Hospital Board has recently announced that a solution had been found and will be carried out.
No one denies that the present operating facilities are not up to the desired standards and are under pressure. The complete solution is the redevelopment of the whole hospital. This is proceeding in accordance with the plans for the area, which are on public record. "A Hospital Plan for England and Wales" (Command 1604, 1962) stated that Phases III and IV of the development of the Gloucester Royal Hospital would start 1340 in the period after 1970–71. The Hospital Plan revision of 1966 (Cmnd. 3000) again made plain that the Gloucester Royal Hospital would be reconstructed with Phase III of the scheme starting in the period 1969–70. The latest information is that the work should start this year and be completed by 1973.
The third phase of development will include a suite of seven operating theatres at a cost of £270,000 and a central sterile supply department costing £60,000. The whole phase will cost £3½ million, which suggests the scale of the planning effort.
That the Gloucester Royal Hospital has been accorded a fairly high priority is evidenced by the fact that the first two phases are already complete and the third phase about to begin.
The longer-term solution is, therefore, being pursued. The question then is: what is being done to remedy the situation in the interim?
If it could be shown that those responsible had been forced to act only on account of adverse publicity, there would indeed be grounds for criticism. But this is not in accord with the facts. The first interest by the publicity media was shown on 28th January, 1969, when a B.B.C. representative interviewed members of the staff. Various newspapers carried articles in the weeks that followed. All this took place after action had got under way. The shortcomings of the present operating theatre were being examined by the Regional Hospital Board and the Hospital Management Committee in November, 1968. By 18th December, 1968, a Working Party had gone over all the possibilities and had recommended an answer. This was to evacuate one of the existing wards and provide inside it an Octatent as a second theatre at a cost of £10,000–£20,000. I am informed that the Octatent will be in Ward 3 which is being evacuated and, therefore, will not share the approach to the present theatre, a question on which the hon. Gentleman expressed concern. Implementation of this solution involved tackling problems arising from the evacuation of a ward without loss of its services. The medical and nursing staff were consulted and they agreed to the plan to re-organise services elsewhere in the hospital not only to maintain the services displaced by the Octatent but, in fact, improved them.
1341 In case there is any doubt in this, I shall explain what the Octatent is. It is a portable operating theatre of 320 square feet, with its own mechanical ventilating plant supplying filtered air under pressure. Surgeons who have used it have expressed complete satisfaction. Once obtained, the theatre itself can be quickly and easily installed, but engineering works must be carried out as a prerequisite to installing necessary supporting services, including the autoclave. The Octatent is a highly specialised product with limited availability and fairly lengthy delivery time. Nevertheless it is intended to install it in about three months from now. I should like here to express appreciation and gratitude to the members of the medical and nursing staff, who have applied themselves to this problem and solved it, for it is certainly upon their shoulders that the burden of making it work will fall. I should like to do more. Underlying the publicity is an unstated implication that the medical and nursing staff were failing their patients by accepting intolerable conditions. I do not suggest the hon. Member was party to this, but I think it is right to bring it out into the open and scotch it once and for all. The Consultant medical staff, through their chairman, have stated emphatically that they have been fully aware of the situation and would not have allowed it to continue if there were any possible danger to the patients.
The hon. Gentleman has referred to a prefabricated building as a suggested alternative. Such a suggestion might be feasible but because of the engineering and other services it would inevitably take longer to provide and would cost between £50,000 and £100,000. Expenditure 1342 of this magnitude on a building which would be abandoned on completion of the main hospital redevelopment would be hard to justify when the Octatent can be used at a far lower cost.
A solution like this was in fact considered and rejected in December. It would be interesting to know on what grounds it is now being pressed, since the medical and nursing staff have supported the Octatent solution.
I have complete confidence in the hospital authorities, who lost no time, when the urgency of this situation became known, in devising a workable solution and pursuing it with vigour.
Let me now turn to the possible integration of the Standish Hospital with the Gloucester, Stroud and Forest Group. The facts are that the Regional Hospital Board wished to consider this actively and the Department approved local consultations as a first step. This is the normal procedure. Any possible amalgamations must be canvassed locally to establish local views as information in advance of any decision. Should there be a dispute, and this is the case here, then my right hon. Friend reserves the decision to himself. I had better explain that he will carefully consider all relevant factors, including local feeling, how staff will be placed, and efficiency. But since matters have not yet reached this stage, the hon. Member will I am sure understand when I go no further here, than to say that the points he has made will be borne in mind by my right hon. Friend.
§ Question put and agreed to.
§ Adjourned accordingly at eight minutes past Twelve o'clock.