§ 5.59 a.m.
§ Mr. Hector Monro (Dumfries)Even at 6 a.m., I am very pleased to have this opportunity of raising the problems of the hospital services in South-West Scotland. I am very glad to have with me my hon. Friend the Member for Galloway (Mr. Brewis), who will speak particularly about the hospital service in his area, if he is fortunate enough to be called.
For some years I have been pressing the Minister and his predecessors to implement the hospital building programme in relation to Dumfries. It is an old hospital. I do not know whether or not it is the same building in which Sir James Simpson did the first operation under chloroform, but I can well believe that it is. In it, the consultants, specialists, doctors and the nursing staff give first-class attention to their patients, but the hospital serves a huge area and it is hopelessly inadequate to its task.
I give an instance of the increasing demand by stating that in 1967 the number of out-patients treated at the hospital was 80,468. In 1968, this increased to 86,266—a really dramatic increase in 12 months. There has also been a 30 per cent. increase in the use of the out-of-hours X-ray department. This is caused by the unfortunate increase in road accidents, and the accident unit has been very busy and very valuable in helping with this problem. The use of the radiological department, too, has been rising by about 10 per cent. per annum.
There is no room in the hospital for an intensive care unit for specialised post-operative treatment. There is no cardiac ward or specialised coronary care unit, and this work has to be carried out in a general ward. In general, there is a shortage of specialised accommodation.
It is important that everyone in Dumfries should realise that first-class attention is available at once if he or she requires urgent medical care. But why should doctors and nursing staff struggle with antiquated buildings to provide it? Space is seriously limited, and simple general surgical cases often experience delays of six months. In some cases, 12 months will have elapsed before a 1561 patient has an operation, and for cases of low priority there are often delays of 24 months. This sort of situation is quite unacceptable. No one looks forward to an operation with any enthusiasm, and to have it hanging over one for such a long period is not to be tolerated.
The board of management is doing a first-class job in difficult circumstances. Certainly the delays are caused to some extent by the shortage of staff, especially of anaesthetists. But, with all the staff in the world, the situation could not be improved without adequate operating theatres and wards. For this reason, some operations are done at Lochmaben Hospital, which is another elderly hospital which was used originally for T.B. cases and is now used for geriatric cases—
§ Mr. John Brewis (Galloway)And at Castle Douglas, too.
§ Mr. MonroAs my hon. Friend says, at Castle Douglas, too. How right he is.
It is no use doing short-term improvements. The hospital's services are stretched to the limit. No more steam can be provided, electrical circuits are fully loaded, and I understand that the plumbing arrangements will be difficult to improve satisfactorily. I am sure that the Minister realises that these problems are mounting fast, due to the lack of space.
In Dumfriesshire, there are pluses on the credit side. In recent years, a new accident unit has been provided at the Royal Infirmary, and I was very honoured to be asked to open it. There are a new laboratory, X-ray facilities, a women's clinic, and a bio-chemistry department. Above all, there is a first-class training school for registered and enrolled nurses, and the congratulations of the whole area should go to the matron and her staff on making it such a success.
It is a happy hospital, and many volunteers willingly give their help. But it is a hopelessly out of date hospital. There are 220 beds. The new hospital is designed for 400, plus the 150 geriatric beds which are to be placed in the present Royal Infirmary. As there is a serious shortage of geriatric beds throughout the South-West of Scotland, these will be a very valuable addition.
1562 I know that we are to lose other elderly hospitals and convalescent homes in the neighbourhood, but I think that the position will be accepted when people see this great new medical complex on its magnificent site near Crichton, not far from Cresswell, and probably with the health centre close by.
Where exactly do we stand? First, I want to look at costs. As the Minister knows, the project was designed and planned a long time ago. Two years ago it was estimated to cost £4.6 million. Those of us who looked at the Civil Estimates, published yesterday, will be very concerned to see the tremendous escalation in the cost of hospitals at present under construction. I need only instance the new hospital in Dundee: original cost £10 million; present cost £15¾ million; or the General District Hospital in Glasgow, which is perhaps of more comparable size: original cost £5 million; present cost £6¾ million.
If the Dumfries hospital was to cost £4.6 million two years ago, it will obviously be well over £5 million by the time construction starts. Yet I hear that the board has been asked to prune off £250,000. Setting this against the escalation in costs, I am concerned that we are bound to lose facilities and services that have previously been agreed. I hope that the Minister will say that this is not so.
I turn to the timetable. This hospital was in the 1962 Hospital Plan (Command 1602/1962) starting in the period 1966 to 1971.
In 1964, when the first revision came out, this was accelerated to start in the period 1964–65 to 1968–69. In a way this was confirmed in the 1966 Hospital Plan when it was in the period 1966 to 1971. I presumed, in the light of the revised plan of 1964, that it was early in the programme. To confirm this I put down a Question for 9th March, 1966, when the right hon. Member for Lanark (Mrs. Hart), who was then the Minister responsible, confirmed:
This project is expected to start in 1968 and to take about four years to complete."—[OFFICIAL REPORT, 9th March, 1966; Vol. 725, c. 519.]As the Minister knows—and I am grateful to him for being present at this early hour of the morning—I raised this matter in the Estimates Debates for 1966, 1563 1967 and 1968. Yet he gave no indication in those debates that the priority had changed. But 1968 has gone and nothing has yet happened on the ground.The staff had a feeling, through hospital board sources, that it might be commenced in September, 1969. But when I put down a Question on 12th March, 1969, the Minister said that the start would be in May, 1970. This is getting a long way from the original intention. The medical staff are particularly disappointed at this recent Reply. I know that it must be for financial reasons. It cannot be because the building resources are not available. Dumfries has a high unemployment rate of six per cent. I am certain that the building trade would welcome the project now.
I hope that the Minister will explain these delays and tell me whether he really understands the consternation that has been caused at Dumfries Royal Infirmary. The staff want and expect better conditions. They are concerned that further postponements will follow and that other projects might jump the queue. For instance, there are thoughts that the new town at Irvine might have to have a new hospital and that it might come ahead of Dumfries. This would be quite unacceptable.
I welcome the fact that we have a very fine maternity hospital at Cresswell, and that there are, too, small but useful cottage hospitals in the county. They are all doing excellent work, and we wish to retain them. I have no time to go over all these services because I want to say something about the Crichton Royal.
As everybody knows, or should know, it is the finest hospital of its type in the country, and of which we are justly proud. Like the Royal Infirmary, it has a first-class staff, and a first-class nurses training centre, but during Estimates debates over the last three years, by Questions, and by letters, I have been urging the Minister to provide a unit for mentally retarded adolescents. There is an excellent unit for children up to the age of 14 at Ladyfield as part of the Crichton. After this age the problem becomes acute, particularly in secondary education.
The board has been pressing for a long time for a new unit of about 30 beds. 1564 The Western Regional Hospital Board indicates that perhaps the year 1972–73 might be the period when this new unit could be constructed, but I think that this is too long to wait. I think that now is the moment to act. When we have the new social work departments going we shall be able to use many of the workers in these departments to help in visiting homes and preparing homes for children coming back from the Crichton. I think that we should be able to integrate this service even more than is the case at present. I should like the Minister to say that it will be possible very soon to provide accommodation for adolescents.
I have also raised with the Minister the slightly different problem of mentally defective children who have to go to the Royal National Hospital at Larbert. The Minister knows that it is a relatively inaccessible place for visits by parents at weekends, and that it is a long journey from Dumfriesshire. It is extremely important that these children should see their parents as often as possible, and I am sure that just as soon as finance is available the Minister will make a really big effort to provide facilities in the South-West of Scotland.
I conclude where I began, at the Dumfries Royal Infirmary. It has a first-class medical staff—as indeed have all the hospitals in South-West Scotland—who are devoted to the service of their patients. In emergency and serious cases, immediate attention can and will be provided. Everyone can have confidence in that, but I hope the Minister will realise from what I have said that the building is hopelessly inadequate and is causing despondency amongst the staff. I want a firm promise that the latest postponement is the last, and that if possible the starting date will be brought forward to this year. I am sure that that can be done if the will is there.
§ 6.14 a.m.
§ Mr. John Brewis (Galloway)I am glad to follow my hon. Friend the Member for Dumfries (Mr. Monro) in his remarks about the hospital service in the Dumfries area, which is of great interest to people in my constituency. Last year I had the pleasure of opening the new medical ward at the Garrick Hospital in Stranraer, and it is now a modern hospital serving a wide area.
1565 I should like to draw the Minister's attention to the bad accommodation at the Clenoch Maternity Hospital and also at the Waverley Home for Elderly Patients at Stranraer, both of which leave much to be desired. The Clenoch is housed in temporary buildings which were originally, I believe, a Royal Naval fever hospital. The Waverley Home is over 100 years old—a great gaunt building both costly to maintain and imposing unnecessary burdens on the staff. For some time now, a composite building to replace both has been planned on a site which is already available near the health centre in Stranraer. When will approval be given to starting this work? There is a constant stream of official visitors to the Garrick Hospital and the health centre, but the two other institutions never seem to be included in any of the programmes. I hope that the Under-Secretary will be able to give us good news about both these buildings.
The Royal Infirmary at Dumfries serves the population in the east of my constituency, and the building of a proper district general hospital has been postponed for far too long. I, too, remember when it was first mooted, in the Hospital Plan back in 1962. It is no exaggeration to say that this postponement is causing the greatest possible inconvenience. The waiting list for operations is very long. One patient, for example, has been waiting for his operation since 21st September, 1966, and an Army wife from Town-head Range has waited almost as long. As military tours of duty are usually only three years, her husband may be posted before she gets her operation. Neither case is serious, but having to wait for so long is clearly unsatisfactory.
Nor is the accommodation in the Royal Infirmary of the best, although I know that the staff work very hard to make the best of a very difficult job. There is no accommodation in Dumfries, for example, for geriatrics. The occupational therapist lives in a separate town, Lochmaben, several miles away. Sometimes, surgical and medical cases have to be catered for in the same ward, so great is the lack of accommodation. Clearly, a new hospital to be the focus of treatment for a wide area is urgently needed.
I also support my hon. Friend's remarks about mentally retarded 1566 adolescents. This is a problem that one continually comes across in constituency visits, and I hope that we shall get a new unit—if possible, before 1972–73.
I should like to turn now to the ambulance service. When such large distances are involved, the efficiency of the ambulance service is very important—and I am convinced that it is efficient. I should like to know whether any research has been done to see whether ambulances can be made more comfortable for patients, as they should be if a patient has to be rushed, for instance, 60 miles to Dumfries or Ballochmyle in Ayrshire over country roads.
In urban areas, it is usual to have two men on an ambulance, but often the ambulances in country areas have only one. That means that he must get assistance with a stretcher case, which can be very awkward if it is an old patient living in an area with mainly elderly neighbours. Sometimes a helicopter service is suggested, but I doubt whether it would save much time, except in wintry weather. There is also the danger of shock to a very ill patient who has never flown before.
I understand that there are inflatable splints, but I gather that they are not generally available in Scotland. Cannot more use be made of mini-buses for patients who are capable of walking, as well as a greater use of private cars?
It would be helpful for patients from my constituency if a separate day could be set aside for those who must travel long distances. In some instances they must wait about for some hours after their appointments, and often this results in their missing their buses home. It would be an idea, too, if more use were made of the radio telephone to enable country G.P.s to be connected to the ambulance service wavelength. This is not an idea borrowed from the Australian outback; it is already in use in, for example, Yorkshire.
My hon. Friend the Member for Dumfries will wish to join with me in paying tribute to Dr. Bruce Dewar, who did so much for the Regional Hospital Board. I also pay tribute to the devoted staff, doctors and ambulance drivers for the excellent work that they do in the hospital service for the South-West of Scotland.
§ 6.22 a.m.
§ The Under-Secretary of State for Scotland (Mr. Bruce Millan)I am glad of this opportunity to answer some of the points that hon. Members have raised. I appreciate that there are difficulties in the hospital service in South-West Scotland, but I hope that it will become apparent from my remarks that I am in no way complacent about the situation either there or in other parts of Scotland.
Before dealing with the situation in Dumfries and in other parts of South-West Scotland, I must remind hon. Gentlemen opposite that all this depends on increased hospital capital expenditure. I am entitled to remind them of this because their hon. Friends take the view that public expenditure is too high and should not be continually rising. If, however, one examines particular spheres of public expenditure, one sees how easy it is to make out a case for yet more to be spent. Hospital building is one such case. We are all aware of both local and national problems which need more public expenditure for their solution.
However, increases in hospital capital expenditure have been considerable in recent years. While in 1964–65 we spent about £8 million on hospital building in Scotland, we shall this year be spending more than £14 million, a considerable increase which, we hope, will continue.
We in Scotland are now paying the penalty for a long period—it started with the first Labour Government after the last war and went on until only a few years ago—when very little was spent on hospital capital building in Scotland. The result is that we now have a considerable backlog; and it is against this background that we must consider the hospital building programme.
I need not say much about the present position at the Dumfries Infirmary because it is accepted—I certainly acknowledge this—that the situation is unsatisfactory. I have visited the Infirmary and I confirm that it is a tribute to the staff that so much is being done in what are admittedly inadequate conditions by modern standards. Perhaps I could also pay my tribute to Dr. Bruce Dewar, whom I had the pleasure of meeting when I visited Dumfries, and whose work for 1568 the whole area played a considerable part in developing the hospital services in the Western Region, and particularly in Dumfries.
The situation at Dumfries is that we can get adequate services there only with the building of the new Dumfries District General Hospital. Therefore, it is true that it is not possible to make temporary improvements in Dumfries which would make a substantial improvement to the present situation now that we are dealing with the question of the start of the new district general hospital. The position, as I stated in a Written Answer to a Question from the hon. Member for Dumfries (Mr. Monro) on 12th March, is that
The regional hospital board hopes that the tender for this scheme will be let towards the end of this year, with a start on site about the beginning of the financial year 1970–71."—[OFFICIAL REPORT, 12th March. 1969; Vol 779. c. 283.]It is true that the original starting date was to be 1968, but this scheme, among others, suffered deferment by an announcement made in 1968 dealing with the hospital building programme as a whole. This was for reasons which had nothing to do with any cut-back in the total hospital building programme but was for a number of special reasons affecting the Sick Children's Hospital in Glasgow, and one important reason, namely, that we are now making quicker progress in the planning and construction, once the construction starts, of hospitals. We are spending money more quickly on hospital building than we expected two or three years ago, because of the greater facility in planning and the greater experience that the new hospital building programme has brought to the regional hospital boards. The deferment was nothing to do with the cutting back of expenditure; in fact, the expenditure envisaged in the review of the hospital plan for Scotland in February, 1966, is being fully maintained and, if anything will be rather enhanced compared with what we expected it to be when published in the review.But there was a year's delay because of that, and there has been some further delay since. But the position is, as I said on 12th March, that that position will not be affected by any other development in other parts of the Western 1569 Region in terms of priority. It is now firmly fixed that this priority will not be affected by any subsequent development. The position now is that the planning is at the sketching and drawing stage. Plans have been completed, and final cost limits are being negotiated now.
The hon. Member is right in what he says about the ultimate cost of the project. It is not possible for me to say what the final figure will be, but I hope that these current difficulties will be overcome and that we shall be able to get to the tendering stage later this year, so that we can start in April, 1970. That is what the hospital board is working for at the moment, and the board of management is keen that there should be no delay in this development.
The hospital may take about four years to complete, although with the increasing expertise that we have got in building hospitals it is possible that the programme will take rather less. The board would like to see this. But to be realistic about this one should look upon it as a four-year construction period. When that is completed it will be possible to close down a number of units in Dumfries and the surrounding area, and the infirmary can then be made available for a geriatric hospital, meeting a considerable need for additional geriatric accommodation. Everything depends on the progress of the district general hospital.
I hope that what I have said today, though it does not add anything to the existing position, has at least reassured the hon. Gentleman that there is no question of this hospital being displaced from the programme. It is now firmly fixed in the programme and sufficiently far ahead for there to be no question of its being displaced by any other project coming forward within the near future.
The Crichton Royal Hospital is a hospital which I have visited and by which I was considerably impressed. Some of the work which is done at this hospital enjoys a reputation which extends well beyond Dumfries, and, indeed, well beyond Scotland. The hon. Gentleman mentioned two separate questions. One was the question of the mentally defective children who at present have to go to Larbert. I agree at once that this 1570 is not a satisfactory position. It is necessary in dealing with mentally defective patients to get a sufficiently large unit to be able to deploy all the necessary skills in dealing with the patients. Therefore, it is not desirable to have small units spread over different parts of the country. I accept that the situation with regard to children in the South-West area is unsatisfactory.
The last occasion on which I wrote to the hon. Gentleman about this was in September, 1967, when I pointed out that the long-term position was that there was a proposal that there might be a 350-bed mental deficiency unit set up at the Crichton Royal but that from the short-term point of view the possible first development of that would be a further 30 mental deficiency beds at the Crichton Royal. I have very little to add to that at present. This, again, is a question of fitting the project into the hospital building programme. At present there is no unit for mentally deficient children at the Crichton Royal firmly fixed in the forward programme, but this is a matter which the Department will be discussing, among many other matters, with the Regional Hospital Board. I know that the local board of management is very anxious about this unit. I am not able at present to say when such a unit might be provided. All I can say is that I am by no means unmindful of the necessity to have accommodation in this area of Scotland nearer than the accommodation which is at present provided in Larbert, which is obviously, from the children's point of view, not satisfactory.
The other question concerned what the hon. Gentleman described as mentally retarded adolescents. I think he meant to say maladjusted adolescents. There again, there has been a good deal of discussion about the possibility of providing a unit for maladjusted adolescents at the Crichton Royal. I recollect that this question was raised with me when I visited the hospital about 18 months ago. As I understand it, there has been discussion between the Western Regional Hospital Board and the board of management, but the situation at the moment is that a firm proposal by the board of management is now awaited by the regional hospital board. Therefore, I am not able to say anything definite at present.
1571 In some respects the position in Southwest Scotland is not as unsatisfactory as in other parts of Scotland because of the existence of the unit at Ladyfield. I have found considerable difficulty in getting provision for disturbed children in my constituency, and in many cases the only provision possible has been at Lady-field. So in some cases the movement is the other way, from Glasgow down to Dumfries. There is great difficulty in providing accommodation which is reasonably geographically spread because of the small numbers being dealt with.
The position on the question of the maladjusted adolescents is that discussions are still taking place between the board of management for the Crichton Royal and the Western Regional Hospital Board. I can say no more about that now, except that priorities in this, as in so much else of the hospital building programme, are in the first instance not for the Department and not for the Government but for the hospital board, which has planning responsibility for the hospital building programme.
I now turn to the situation in Stranraer raised by the hon. Member for Galloway (Mr. Brewis). He said that when official visitors came there they visited the hospital but did not visit the Clenoch or the Waverley Home. When I visited Stranraer, largely at the hon. Gentleman's insistence, I visited both, and therefore I know the situation there. There is no question of pretending that the situation is satisfactory. It is not. That is why there is the project in mind for the replacement of both. I felt that the Waverley Home in particular was completely inadequate. Some of the accommodation there is among the poorest I have seen anywhere in Scotland, and so I accept the hon. Gentleman's criticisms on this.
There is now agreement with the county council about the joint scheme for the replacement of the residential accommodation along with the hospital accommodation. I cannot be more definite about the timing than to say that it will, I hope, start sometime in the early 1970s. That is the latest position I have been able to give the hon. Gentleman, and I cannot add anything substantial at present. But it will be a joint project 1572 for the replacement of Clenoch and the Waverley Home.
If there are any particular difficulties in South-West Scotland with regard to the ambulance service, I shall be glad to look into them, but the questions the hon. Gentleman raised were largely general criticisms which are made elsewhere. There has been a good deal of research into the design of ambulances and improving patients' comfort, and so on. The new ambulances that have been introduced in Scotland are a considerable improvement on the older conversions from many points of view, including the comfort of the patients. But very difficult technical problems are involved, and it would be misleading to say that I think we have solved ail of them and produced a completely satisfactory ambulance.
But we have done a great deal in the way of looking at questions of ambulance provision. I am speaking off the cuff now because I did not realise this point would be raised. There were two working parties, one on the training of ambulance crews and the other on ambulance equipment, which reported about 18 months ago. Their recommendations are now being considered through new central committee arrangements that we have established to deal with matters of this sort on a United Kingdom basis, in which the Scottish ambulance service will be represented. I hope very much that we shall be able to announce proposals about the training school arrangements for Scotland and elsewhere reasonably soon. I hope that both in training and equipment we shall be able to make very considerable progress in the next few years. We are introducing double manning again as quickly as funds allow. Many parts of Scotland have double manning already, although single manning exists to a considerable extent.
The question of the use of mini-buses raises wide questions about the organisation of the ambulance service, but there are areas where mini-buses—or private cars, for that matter—are operated on a kind of voluntary basis. For example, the W.R.V.S. operates car services in some areas whereby patients are taken to hospital without the use of an ambulance.
All this raises the question of the organisation of the ambulance service. 1573 It is a difficult service to organise to suit both aspects fully—the hospitals, which are the main users, and the ordinary patients in providing them with a service which will take them to hospital and bring them back home without excess waiting. A study is being carried out of the ambulance service by a research fellow of Strathclyde University with two post-graduate students, and matters of this sort are among the things being looked at.
On the main question of the hospital services, I do not think that I am able to add much to what I have already said. I hope that both hon. Members will accept that the position in Southwest Scotland is appreciated by the Department and by me, that in the case of Dumfries there is a certainty about the project which I have been able to indicate, and that in the case of Clenoch and the Waverley Home we fully appreciate the unsatisfactory position and that it is simply a question of having to fit the project there, which I would accord a high priority, into the programme against, unfortunately, the many competing projects, many of which are also of considerable urgency.