§ 2.0 p.m.
§ Mr. T. L. Iremonger (Ilford, North)I should like first of all to thank the Minister for being here personally to answer this debate, and I think the whole House would like me to take this opportunity to say to him how very glad we all are to see him in fine and full health after his recent illness, of which we were all very sorry to hear.
The Minister is responsible at this moment for decisions which will affect the development of hospitals in every region in the country. Every regional hospital board has just completed its review of its own region and has submitted to the Minister its plans which will require his approval, if the taxpayers' money is to be provided for implementing them. Therefore, the nature of the siting of every new major hospital in every area will depend utimately on the decisions which the Minister is now in process of making. My object this afternoon, and that of the hon. Gentleman the Member for Ilford, South (Mr. Arnold Shaw), who may hope to catch your eye, Mr. Deputy-Speaker, is to put into the mind of the Minister and to put clearly on the record the arguments in favour of a particular decision which we firmly believe to be the only right one in the interests of our Ilford constituents in the London Borough of Redbridge.
The proposition with which we have to start is that the hospital service of the future is going to be based upon a number of large, 1,000-bed, district general hospitals for acute cases in each 882 district which will also be served by a number of ancillary smaller hospitals for longer-stay patients. The reason for developing such mammoth general hospitals is understandable. The resources of equipment and manpower, the vast capital outlay, and the highly trained medical and ancillary specialists—and, even more, teams of specialists—which are required to exploit the latest advances in medical knowledge and techniques must be concentrated in one place to serve an optimum large population. In every region, therefore, we will accept that the Minister has got to decide, on the recommendations of the regional hospital board, which hospitals from among the existing ones shall be expanded to become the district general hospitals, or what other sites should be developed to accommodate them.
The particular decision which I want to urge upon the Minister now, when he considers the Ilford district in the region of the North-East Metropolitan Regional Hospital Board, is that the proposed new district general hospital should be built on the site available in the huge grounds of more than 40 acres in which stands the present Goodmayes Hospital. This site is more or less in the centre of the Ilford district, and a district general hospital there would serve a cohesive and established community of getting on for 200,000 people.
The medical focus and heart of the Ilford district has for over a generation been the King George Hospital, which is a stone's throw away from the Goodmayes site, just across the road over Eastern Avenue. Ideally, of course, one would wish to expand the King George Hospital building itself into the new district general hospital, but, even if all the adjacent space were to be used the maximum available land there would just not be enough—not half enough, actually, Reluctantly, therefore, one has to envisage the King George building being relegated eventually to the needs of longer-stay and non-acute cases, though, surely, the consultants and specialist staff should have to move no farther than across Eastern Avenue to the new district general hospital close by.
The first reason for my conviction that this decision to develop the Goodmayes site is the only right one is geographical, and a glance at the map of north-east 883 London makes it simply and dramatically plain. If we mark every other existing hospital and possible or impossible alternative to the Goodmayes site we see that they all lie along the perimeter of a circle some eight miles in diameter; and bang in the middle of that circle is the Goodmayes site, and close by it, as I have explained, is the hospital, the King George Hospital, Ilford, which at present serves the very purposes which the new district general hospital would ultimately have to serve instead. If we were to develop any one of the alternatives on the perimeter, the people of Ilford would be deprived and disadvantages in a way which no comparable group of the population would be disadvantaged by the development of the new district general hospitals at Goodmayes. While we are looking at the map I would remind the Minister that when we talk of eight miles, in the most densely populated area in the world, we are talking in terms of—in certain traffic conditions even in 1969, without contemplating the year 2000 and after—maybe as much as three-quarters of an hour by ambulance, which can be a fatal factor, especially in cases of certain accident injuries; and the accident hospital which now serves the area is the King George Hospital.
The second reason is administrative, but with implications far more profound and far-reaching than that word might at first sight imply. The whole future tendency in the development of community services will be for all the services, medical and social, to come much more together, and for the needs of the whole person and the whole family more and more to be treated by specialists working as one team, rather than for those needs to be compartmentalised into specific departments such as pre-natal, maternity, child guidance, children in need of care, psychiatric, chiropodic, geriatric, and so on. These are needs which, in the individual and in the family, inevitably overlap, and ought to be treated more and more together. Now, the chosen and, I am sure, the proper agency for ministering publicly to many of these needs is the local authority. Other such needs are ministered to by medical services which must inevitably revolve more and more in the future round the hospital and health centre—in 884 fact, round the new district general hospital contemplated for each district. Obviously it will be a snug and sensible arrangement for the area of the local authority to coincide with the area served by the district general hospital. Any other arrangement would be an administrative dog's breakfast. And the areas of the local authorities in Greater London are fixed now, by the London Government Act, 1963, for the next hundred years. The Goodmayes site is pretty well central to the Greater London Borough of Redbridge.
The third reason is that unless the medical focus and heart is retained and developed in the centre of the Ilford area the whole of that community will suffer increasingly over the years from the effects of one of the inevitable consequences, namely, the flight of the family doctor. General practitioners just are not so keen to take on practices in places where the major hospital is comparatively remote from them. If the district general hospital of the future is not in central Ilford more general practitioners are going to be more remote from it, and unnecessarily so, than if it is in the centre of Ilford, and the whole quality of life for every Ilford family will be depreciated accordingly.
It is hard enough as it is to keep our most gifted young doctors in this country, let alone attract them to general practice, and, therefore, anything which positively tells against any locality in the mind of a prospective general practitioner will militate against the interests of every local family, one of the prime requirements of which must inevitably be its good family doctor. The prospective general practitioner's first concern in deciding where he will practise his art is to know what sort of facilities he will have for diagnosis and treatment and care from the best and nearest hospital for his patients. Executive committee advertisements of general practices are always seen to feature the availability of open department facilities and, I add, postgraduate facilities.
Besides, if a district is not to be starved of young general practitioners, it must be able to offer opportunities of combining junior hospital appointments with general practice. In this context, the Minister must know that the King George 885 Hospital within one year of the publication of the Report of the Royal Commission on Medical Education has already had its loan sanctioned and is starting fund raising for its academic centre which will bring together undergraduate and post-graduate education and general practice.
Those, therefore, are the three main grounds for deciding to develop the district general hospital on the Goodmayes Hospital site in Ilford—geographical, administrative and in the interests of maintaining the standards of the local general practitioner service.
There remain three incidental factors which tell in favour of this decision and I would not care to omit them. The site itself, as well as being large, is level and, being on Eastern Avenue, ideally accessible. It is so large that car parking and even helicopter landing would present no problems in future. It also happens to be hard by the local ambulance station in Ley Street, Ilford. It also happens that as well as the King George Hospital, which deals with general medicine and surgery and more than 40,000 accident and emergency cases every year, in the close neighbourhood of the Goodmayes site there are the following hospitals: the famous Goodmayes Hospital itself, one of the great psychiatric hospitals of the world and possessing its own power station and supply; the Ilford maternity hospital and the Chadwell Heath hospital, which deals with geriatrics and infectious diseases and medicine. This close agglomeration of existing hospitals could not fail to get the development of the new district general hospital here off to a flying start and sustain it well in its future development.
The third incidental factor is the provision at the present King George Hospital of training for nurses for full registration, the only such training available for both Ilford and Barking.
In conclusion there are two things I should like to say.
I know that it is extremely delicate for a regional hospital board to consider its plans and make recommendations to the Minister and at the same time combine proper discretion and flexibility and frankness with all concerned. Inevitably, such times of flux must cause much local anxiety, and certainly most general practitioners 886 and consultants and others concerned with medicine in the Ilford area are feeling very puzzled and isolated and out of touch with the powers that be. But I think the Minister would like me to pay, as I wish to pay, a personal tribute to the North-East Metropolitan Regional Hospital Board and particularly to the unique personality of its chairman, Sir Graham Rowlandson. For anything to be acceptable just now, it has to be said by Marx or Marcuse, or by Lenin or Lennon, but it was actually Kipling who said:
Ships is all right; it's the men in 'em.That probably accounts for the confidence which all who have contact with the North-East Metropolitan Regional Hospital Board have in that board, because no organisation could possibly have more imaginative and sympathetic leadership. And, finally, all concerned were most favourably impressed by the receptiveness of the right hon. Gentleman the Secretary of State for Social Services when he answered a Question which I put to him on Monday, and particularly by his answer to my supplementary question. He kindly agreed that the hon. Member for Ilford, South, and I might go to see him and talk about this. It is a good thing that this debate should be on the record, but I hope that we may not fail to avail ourselves of that invitation.
§ 2.15 p.m.
§ Mr. Arnold Shaw (Ilford, South)May I, too, express my pleasure at seeing my hon. Friend fully restored to health? May I also express my gratitude to the hon. Member for Ilford, North (Mr. Iremonger) for having brought to the notice of the House a matter of mutual interest to our two constituencies?
The subject of the future of the hospital services in Ilford is not new to the House. It was raised in an Adjournment debate by my predecessor in January, 1958, when he dealt with this very problem. At that time, there appeared to be a difference of opinion between the local practitioners, who favoured a new hospital in the district, a new hospital of 800 to 1,000 beds, and the North-East Metropolitan Regional Hospital Board, which thought that the situation might be met by an extension of the King George Hospital in Ilford.
887 Some improvement has been made since then, but there is now a scheme for district general hospitals in the board's area and the matter is being actively discussed. There is some disquiet about whether the needs of Ilford will be neglected in the resultant plan. The origin of this disquiet was the board's decision not to take over the War Memorial land from the Redbridge Borough Council. Consultations and negotiations have been going on for some time, and it looked as though something would be done on these lines, but a sudden decision was taken and people were a little anxious and felt that it might result in the King George Hospital being run down and possibly eliminated.
I understand that assurances have been received that the King George Hospital will continue to function but that the site is not large enough for a district general hospital of the required size, though even at this stage I am not altogether satisfied that that is the case. It may be, but there is much redevelopment to the north of the King George Hospital site and a feasibility study might produce a scheme to extend the present King George Hospital to the necessary requirements. I hope that my right hon. Friend will take account of that before a final decision is made.
This solution may not be feasible, however, and so we come to the purpose of the debate, namely, the way in which Ilford may best be served by a hospital on the Goodmayes hospital site. This conception has been eloquently adduced by the hon. Gentleman opposite who put forward a most persuasive case. I hope that my words will reinforce his plea. There is no shortage of land in relation to Goodmayes Hospital. There is a powerful case for the possibility of siting a hospital in that area on land which is already in the possession of the regional board.
The claim for a district general hospital in Ilford is not merely a question of local patriotism or of keeping up with the Joneses. It is a matter of life and death to the residents in the area. In the Adjournment debate in 1958 it was said that there were 35,000 attendances at the casualty department of the King George Hospital. Last year the number was in the region of 40,000.
888 The high accident rate on the trunk roads passing through the town provides strong argument for a general district hospital in the area with all the facilities necessary for treatment in one place. If the facilities are situated too remote from the needs of the people of the borough, it will provide real hardship to patients and to hospital visitors. A decision needs to be made on this matter at the earliest possible time.
There are fears that suitable candidates for the hospital service, and indeed for general practice locally, are being deterred from coming to the area because of the uncertain future. A modern district hospital, with proper provision for facilities for post-graduate status, inevitably will attract the young consultant and the general practitioner.
I should like to express my pleasure at the reply given by my right hon. Friend on Monday to our request to see him on this matter. Both the hon. Member opposite and I look forward to meeting him in order to press the urgent needs of our constituents. I would ask for consideration to be given, not merely to the Goodmayes site, but to the chances of development of the King George Hospital, which in my opinion would be the number one choice.
§ 2.23 p.m.
§ The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)I wish at the outset to thank both the hon. Member for Ilford, North (Mr. Iremonger) and my hon. Friend the Member for Ilford, South (Mr. Arnold Shaw) for their kind remarks, which I greatly appreciate. I wish to thank both hon. Members for their thoughtful speeches in explaining the need for a district general hospital at a particular site in Ilford. They have drawn attention to this particular problem on several occasions recently. Both speeches were couched in moderate terms and exemplified the difficulty with which we are confronted in hospital planning.
As the hospital programme gains momentum, the hospital service has frequently to decide whether a hospital should be rebuilt on its existing site or whether a new hospital should be built on a new site. There are other difficult decisions to make. Perhaps the most difficult of all, because any 889 decision will inevitably not satisfy everybody concerned, is to decide whether in a particular area a hospital should be built to meet, most effectively, economically and efficiently, the future requirements of the population likely to live in that area. Essentially this is the problem of the Ilford area, to which both hon. Members have drawn attention.
My right hon. Friend the Secretary of State is well aware of this matter. He visited Barking Hospital on 2nd May and met some members of the Ilford and District Hospital Management Committee.
For many years the development of the hospital service has been planned on the basis of the district general hospital with provision for all the usual acute specialties. This takes its origin from the earliest days of the National Health Service even before the original hospital plan of 1962, Cmnd. 1604, which endorsed the earlier concept. Each district general hospital would provide a wide range of facilities required for modern diagnosis and the treatment of patients. Such hospitals, treating both in-patients and out-patients, would include maternity, geriatric and psychiatric units as well as the usual medical and surgical cover: selected hospitals would provide, additionally, for other specialties such as radiotherapy and neurosurgery, to meet the needs of a wider catchment area than the normal area served by the hospital.
So far as possible, each hospital would be located in, or near, the centre of one of the centres of population it was to serve. Early hospitals were planned to serve 100 to 150,000 persons but hospital planning has generally advanced this figure and the advantages of larger hospitals have been recognised where local conditions permit this: the benefits are not only in general efficiency but also, and most important, in the service to patients. In urban areas particularly it has become not unusual for district general hospitals to be planned and built to serve some 200,000 to 250,000 persons. This, then, is the background to the current studies of hospital provision for Ilford.
When the National Health Service was set up in July, 1946, there were 16 hospitals containing some 1,806 beds, serving the South-West Essex area generally comprising Ilford, Barking, 890 Romford and Brentwood. The area covers the band of urban development extending from Ilford and Barking to Brentwood. Following the local government reorganisation in the London area these areas are now the London Boroughs of Barking, Havering, and part of Redbridge; Brentwood Urban District and parts of Chigwell are also involved. The 1961 population was 655,000 and by 1981 the population is expected to have increased to 695,000. In this period there is expected to be a shift in population. The westward parts are declining in population, but this is likely to be more than offset by a considerable increase in the Romford and Brentwood areas, a trend which is expected to continue.
In 1962 the first hospital plan envisaged that the growing deficiency in the number of beds in part of the area and in hospital services generally would be met by large developments in district general hospitals. It was expected then that Oldchurch Hospital, Romford, Barking Hospital, King George Hospital, Ilford, and Rush Green Hospital would be developed into full district general hospitals.
When the hospital building programme was reviewed and put on a more realistic basis in 1966, the North-East Metropolitan Regional Hospital Board still expected that district hospitals for the area would be provided at Barking, King George (Ilford), Oldchurch, and Rush Green hospitals, all of which would be developed and expanded. However, both hon. Members have suggested that somewhere else in the Ilford area should be used for a district general hospital, The hon. Member for Ilford, North will recall that some time ago he was urging the case of the King George Hospital to meet the needs of Ilford. But I think that it is generally agreed now, in spite of the attractions of this view, that the King George Hospital could not cope with what is required for a district general hospital in terms of area and the facilities which could be provided.
This hospital, with 208 beds, and the nearby Ilford Maternity Hospital, with 54 beds, have long provided hospital services for the town. The Regional Board considered purchasing the War Memorial Gardens, just over 12 acres, which would have provided a larger site. Last year, the regional board decided not to buy the gardens because, even 891 then, the site would not be big enough to build a district general hospital economically and because of certain other factors of which both hon. Members are aware.
The population of the Ilford area may be some 167,000 in 1981. But Ilford is now part of the London Borough of Redbridge, and that borough, in turn, forms part of a larger densely populated area on the eastern edge of outer London. This larger area is expected to have a population of some 695,000 by 1981. Bearing in mind that the population is tending gradually towards the east and that the lines of communication mainly are east and west, the board had to decide the most reasonable provision for hospital services. It also has to consider the existing hospital facilities, the state of the hospitals, and which could be enlarged if required.
I have mentioned already the attention which was given to King George Hospital, and this has had to be abandoned in the light of the factors that I have outlined. The hospital was only abandoned as a future district general hospital for the area after a great deal of careful planning and consideration had been given to the services which could be provided on such a restricted site. While it is most unlikely that the decision will be reversed, today's speeches will be read carefully by the Board, and any new factor which may have been introduced into the matter will be considered carefully. Incidentally, I understand that the health centre for general practitioners will be built at the King George Hospital site.
Both hon. Members explained in some detail the possible advantages of providing a district general hospital at Goodmayes. Currently, this is a psychiatric hospital with 1,300 beds on 120 acres of land. Understandably, they have paid less attention to other hospital sites on this eastern edge of London. However, other hospitals in this densely populated area could be developed equally well, and perhaps even more easily, to provide a comprehensive district general hospital service. As I said earlier, the problem is to decide the pattern of the hospital provision so that the whole area is covered as effectively and 892 as comprehensively as possible within the resources available.
I was a little worried when the hon. Member for Ilford, North referred to an identification of local authority and hospital areas. That is not a logical equation because of population tendencies and future plans, apart from such other factors as the use of land which may be required for other purposes, including what used to be called "the green line" problem.
The regional board has to consider also, for example, the service given by the hospital at Barking on which £2 million has been spent in recent years to provide more maternity beds, outpatient facilities, improved dispensaries, x-ray, pathology, physiotherapy and similar support facilities, as well as more operating theatres and staff residential accommodation. Money has also been spent on improving services at Oldchurch Hospital in Romford and at Rush Green Hospital.
Goodmayes has several attractive features, of course, not the least of which is the availability of a considerable area of land on which a hospital could be built. On the other hand, the site is in a less densely populated area with less satisfactory public transport services and access by road. There are no district general hospital facilities already on the site. The whole pattern of services for the area is being considered very carefully by the regional board to take into account changes of population, transport arrangements and local government reorganisation. Various possibilities for the future provision of district general hospitals are being considered and are to be discussed with officials of my Department.
I thought that the hon. Gentleman perhaps inadvertently was indicating that the discussions had been concluded and that a final decision had been reached, but that is not so. Once the outline principles of the hospital provision to be made are clear, the regional board will undertake at any early stage of planning to inform the authorities concerned with the provision of hospital services for the areas, including the hospital management committees, the local health authorities and representatives of the general practitioners, probably through the local medical committee.
893 I fully accept that we must support and help general practitioners in present circumstances as much as possible. My right hon. Friend has indicated on more than one occasion the value that he attaches to the relationship between general practitioners and the hospitals.
My right hon. Friend gave an assurance on the subject of consultations as recently as 19th May, when he said that development on the Goodmayes site was one of several possibilities under consideration, that there were major decisions to be taken, and that he would like local community interests to be fully appreciated and consulted when ultimately they are taken.
The adoption of more modern planning concepts was facilitated for the North-East Metropolitan Regional Hospital Board at the same time as the basis of distributing capital funds to regional hospital boards was modified. Particular account was taken of forecasts in population and, in the case of the metropolitan boards, of the investment in teaching hospitals in London. I hope that both hon. Members will bear in mind that, if there is any tendency which is slightly worrying my Department at the moment, it is that in future the big teaching hospitals in London, which are probably the finest in the world, ultimately may be under-used because of developments elsewhere. In reviewing its programme to take account of the latest allocation, the Board took the opportunity to suggest significant alterations in its programme so that district general hospitals could be built more quickly or could be built in larger stages.
As I have said, the regional board is aware of the possibilties of developing a district general hospital at Goodmayes. But it is only one of several alternatives being considered very carefuly. The arguments deployed today by both hon. Members will be considered by the Board and my Department. I think that I have said enough to explain why it is not possible with any precision to say what we feel about the Goodmayes site. The position is still fluid, and both speeches today will be taken into full account at various levels of consultation.