HC Deb 14 October 1969 vol 788 cc365-74

Motion made, and Question proposed, That this House do now adjourn.—[Mr. James Hamilton.]

11.3 p.m.

Mr. Anthony Stodart (Edinburgh, West)

I am grateful for the opportunity to draw attention to proposals which were drafted by the South-Eastern Regional Hospital Board, Scotland, on 11th July. It is a pity that they were not available in time for our debate in the Scottish Grand Committee on the Health Estimates on 8th July, three days previously. It would have been of advantage to have had these proposals, which are radical in their scope and would have allowed us a little more time. However, they were not issued to Members of Parliament for the district or to the Press or even to the hospitals closely involved until 29th July, which was after the House had risen for the Summer Recess. Therefore, this is the first opportunity that I have of discussing them.

I shall concentrate on three projects which are mentioned in the proposals. First is the Royal Sick Children's Hospital; second the Royal Infirmary; and third the Western General Hospital. I shall be most grateful if the hon. Gentleman can refresh my memory on certain events which took place at the end of 1964 with regard to the Sick Children's Hospital in Edinburgh.

I have been looking up the OFFICIAL REPORTS and, somewhat to my surprise, I can find no reference to the matter there apart from one Question which was asked by myself and answered by the right hon. Lady the Member for Lanark (Mrs. Hart). But my recollection is that when I held the office which the hon. Gentleman at the moment holds there was a very strong campaign to the effect that the Sick Children's Hospital was in such a condition that work virtually could not continue there in safety, that the most urgent steps had to be taken with regard to it, and I can very clearly remember that a decision had to be taken on the siting of a new hospital. There were strenuous and understandable moves to have it sited within the complex of the Royal Infirmary.

I can remember that I was advised that it was quite impossible to get planning permission within the time by which this new hospital must be built. As ground was available within the complex of the Western General Hospital, I advised the Secretary of State that if the hospital were put near the Royal Infirmary it could not be started within 10 years and our advice was that we could not possible wait that amount of time.

The present Government clearly accepted this urgency because in the 1966 Review of the Hospital Plan it was stated that it was hoped to start the Royal Sick Children's Hospital in the period of that Review, 1966–71; and, indeed, that review also stated that a new hospital in West Lothian, to be sited at Livingston, and the plastic surgery unit at Edinburgh, which had been in the 1964 review, were to be postponed to make room for the Sick Children's Hospital and one or two other comparatively minor projects.

This project is not even in the programme for the period after 1971–72, a period which, incidentally, is not defined at all, compared with the quinquennial terms which previous hospital plans had, and it features only as No. 2 on the list of what are described as "Further priorities". I should like to know how it comes that the extreme urgency which demanded the rebuilding of this hospital in 1964 has been so completely dissipated that it has disappeared from the programme other than a mention in "Further priorities".

I want now to turn to the two other projects that I mentioned, at the Royal Infirmary and the Western Hospital. I take them together because I believe it is natural and proper that I should do so. They are great teaching hospitals, upon whose complementary association a great deal of emphasis is laid in the report of the working party which was included in the circulation of the recommendations of the hospital board. I hope I can speak dispassionately about these hospitals. The Western General is within my constituency and, therefore, obviously I have an attachment to it. But my life I probably owe to the skill of the nursing that I once received in the Royal Infirmary.

Friendly rivalry has its place within a complementary association, but I am certain that there should not be, and must not be, animosity between these hospitals. An interesting part of the working party's report is that which deals with the "complementary association" which, it says, it was hoped would develop between the two. It does not seem to have worked out that way. In paragraph 4 on page 2, we are told that the Royal is developing special units in parallel with those at the Western, and I think it a not unfair interpretation of the working party's observations to go so far as to say that the complementary concept is pretty well a "dead duck".

I should not say that the results of this complementary association are altogether insignificant. I understand that Professor Gillingham, the professor of neurosurgery, has his real centre of operations—I use that word not only in the medical sense—at the Royal but he has a unit at the Western as well.

I do not propose to pass any judgment on the conclusion of the working party that the plans for the Western should be put right back while work on the rebuilding of the Royal should go on, since the working party has had access to a great deal of information which I do not have. I merely point out that a sum approaching £3 million has been spent on some extremely important basic foundation services at the Western, and if a superstructure to those foundations is not to follow, the investment of that £3 million cannot be properly and fully utilised and cannot yield the dividends which it ought to yield.

With medical science moving at the pace it is, one could not possibly make plans and keep them rigid in a straitjacket, but the changing of plans, with hospitals being in in 1964, out in 1966 and in again in 1969—that is what has happened, for instance, to the hospital at Livingston—must lead to great administrative expense in the planning departments and tremendous frustration, too, not only in those departments but, perhaps even more, among the medical profession.

I question the importance which is attached to modernising the maternity unit at Simpson at a cost of £1 million. If one of the two maternity units at the Royal or the Western is to be brought right up to date, it seems to me that everything points to its being the Western. I do not say that because the Western unit is 100 years old whereas the Simpson was absolutely slap up to date only 30 years ago. I say it because the Sick Children's Hospital, I understand, is still to be built within the complex of the Western, and where that new Sick Children's Hospital is to be, I am told on extremely good medical advice, there must be a tip-top maternity unit close by.

Finally, a point about the composition of the working party. Mention is made in the board's proposals of a new spinal unit at the Princess Margaret Rose Hospital. The Minister may remember correspondence I had with him on the subject. Perhaps he does not, because it is nearly three years ago. Practically every authority of note has declared that that unit should be sited not at the Margaret Rose but at the Astley Ainslie. Among those authorities were men like Norman Dott, Professor Gillingham, Sir John Bruce, the professor of surgery at the university, and the head of the Stoke Mandeville spinal unit.

The Minister admitted all this in his correspondence with me, but said that the board considered that the opinions of those who were to work in the unit, the active clinicians, were more valuable than the opinions of these eminent gentlemen. If that is to be the thinking—and I think it questionable—it is worth pointing out that not a single member from either of the hospitals I have discussed was on the working party. No clinician took part who was to do the work within whichever was to be the new hospital. No one from one of them, and possible no one from either, was asked for his advice on this matter. Certainly the Western General was not consulted at any stage. I can well remember the heated criticism when the Western Regional Hospital Board in 1964 was supposed to have decided against proceeding with three general hospitals in the western part of Scotland without consulting the boards. It is certainly true in this case that the Western General knew nothing of the proposals affecting it until it read the newspapers on 29th July.

I am on record, and would certainly stick to this, as admitting the extremely difficult issues that arise when the demands for additional services and new or replacement hospital buildings run ahead into the limits of the investment programme, so that is one aspect of the problem facing the hospital board which I do not criticise tonight. But I hope that the hon. Gentleman will tell us whether these proposals are any more than proposals—whether his right hon. Friend has yet considered them, whether he has yet to consider them, and whether he will decide on them. Perhaps he will also comment on some of the points I have raised.

11.18 p.m.

The Under-Secretary of State for Scotland (Mr. Bruce Millan)

The hon. Member for Edinburgh, West (Mr. Stodart) has concentrated on one or two hospitals within the South-Eastern Regional Hospital Board's proposals for the period after 1972. But I think that as well as answering his points I should set these proposals in a rather wider context, because otherwise it is not possible to see exactly what is happening here and why the proposals have been brought forward in the way that they have.

The programme that the South-Eastern Regional Hospital Board provided for the Secretary of State is one of five, because other regional boards have similarly produced programmes for the period after 1972. They have been produced at the request of my right hon. Friend so that we can look at the whole hospital building programme for that period and determine priorities not just within a particular board's area but within the Scottish context.

On the question of timing, the proposals of the South-Eastern Regional Hospital Board were the last of the five proposals to come in, and it is only now that we have the five sets of proposals that we can look at the Scottish position as a whole.

In asking the hospital boards to submit lists of the schemes they would like to start in the period after 1972, we gave each board an approximate total figure within which to frame its proposals. We also asked them to indicate what other schemes they would include if larger allocations could be made available. The basis on which the boards were asked to prepare programmes was, therefore, in itself provisional, and it may alter in total according to Government decisions about the resources which can be made available for hospital building in the period in question and may alter in distribution among regions if, in looking at the priorities of the project, we feel such adjustment to be necessary. Of course, this is all in the context that we are considering all the boards' proposals at present and may wish to take up with individual boards the priorities that they have determined within their own regions.

The sum to which the South-Eastern Regional Hospital Board was asked to plan was a total cost to completion of £20 million. It is worth pointing out here, as I have done a number of times, that the amount of money spent on hospital capital expenditure in the last few years has considerably increased. In the year 1961–62, for example, the figure was just over £4 million. That went up in 1964–65 to over £8 million, and in 1968–69 it is about £15 million. Thus, when considering the difficulties which the boards and the Government have in determining priorities within the budgets that we have available, one has to remember all the time that these budgets themselves have been considerably increased over the last few years.

The South-Eastern Regional Hospital Board, in producing its proposals for the post-1972 period, took the view that it was necessary to recognise the changes and problems which had arisen since its long-term plans were last reviewed in 1965. This is in line with what the hon. Gentleman himself said—that it is not possible to produce rigid programmes or rigid priorities and stick to them regardless of changes in circumstances.

It is a criticism which applies to the hon. Gentleman's Government as well as to our Government that in the past hospital building programmes were far too definite about long-term planning, with the result that we have had on occasion to have these changes made in priorities and dates of starting and so on, which, I agree, are frustrating and irritating to the staffs of the hospitals concerned.

In any case, the South-Eastern board, in looking at its programme for post-1972, decided in particular that due regard had to be given to the provision of facilities for the ageing population, the mentally ill and the mentally handicapped, even if this meant altering its strategy of planning which had rested hitherto on the early and current replacement of the major teaching hospitals in Edinburgh.

Without going into the merits of this decision, we all know that there has been a considerable amount of concern recently about the priorities which in the past have been devoted to mental and mental deficiency hospitals. I have taken the view that some of that concern is perhaps more appropriate in conditions in England and Wales than in Scotland. That is my reading of the situation. Nevertheless, we have taken account of the fact that the provision for the elderly, the mentally ill and the mentally handicapped does in Scotland still require very considerable improvement. So in deciding on its allocation of the £20 million the board took that fully into account.

The £20 million therefore breaks down as follows: teaching hospitals development—that is, the Western General and the Royal Infirmary—£8 million; psychiatric, mental deficiency and geriatric services, £6 million; obstetric services—that is, the Simpson, mentioned by the hon. Gentleman—£1 million; special units such as plastic surgery, burns and spinal injuries, and rehabilitation, £1.75 million; the West Lothian District General Hospital, £3 million; supporting services, such as laundries, etc., £500,000. That was the breakdown in the board's proposals to my right hon. Friend. The proportion of the total allocated to the teaching hospitals is about 40 per cent., which is a not insignificant proportion.

Nevertheless, the board's decision in this respect was not an easy one to make and was made only after it had received the views of a working party set up specially to examine this question. The hon. Member mentioned the working party report and has obviously therefore read it. I think he will agree with me that it is a careful analysis of the problems of teaching hospitals in Edinburgh. The various considerations which he mentioned have been very much taken into account. The university itself, which has a large interest, and the Scottish Home and Health Department as well as the regional board were represented on the working party, but the final decisions, of course, are those of the regional board itself.

The working party came to the conclusion that, if the best interests of the community were to be served within the financial constraints placed on the board, it would be possible to proceed only with phase II of Edinburgh Royal Infirmary reconstruction in the teaching hospitals' share of the programme and, therefore, the development of the Western General Hospital and the building of the new Sick Children's Hospital would have to be deferred. Perhaps I may interpolate that the working party specifically mentioned that the various improvements made in the Sick Children's Hospital over the last few years made its replacement, in the working party's view, less of a priority than further work on the Royal Infirmary and the Western General Hospital, and that is the explanation for the different scale of priority which has now been granted to the Sick Children's Hospital. In any case, on the basis of the working party's report, the proposals of the board have been placed before the Secretary of State.

I know that there is concern in the Western General Hospital and I very much sympathise with the medical and other staff there in the disappointment they must feel at what they would regard as the lack of priority which has been given to the development of the Western General Hospital in the board's proposals. However, I must stress that in doing this the board has emphasised that these deferments do not entail any change in its policy to develop the Western General Hospital as a major teaching and community hospital and to replace the Royal Hospital for Sick Children.

As these schemes are not included within the £8 million which I have mentioned as being allocated to teaching hospitals, the regional board proposes that £1 million should be spent on improving and maintaining services for the Sick Children's Hospital and the Western General in the meantime so that the services can be improved in this interim period. This sum of money should make it possible to effect material improvements at both hospitals. At the Western General the improvements will supplement important major developments which have already been provided, or which are being built, such as the radiotherapy institute, the department of sur- gical neurology, the transplantation surgery unit, new laboratories and, more recently, the new out-patient and diagnostic department, laundry and boiler plants.

The bulk of the balance of the £8 million for the teaching hospital programme, about 17 million, will be allocated to phase II of Edinburgh Royal Infirmary so that it can immediately follow the completion of phase I. The second phase will provide a substantial area of academic accommodation to meet university needs, accident and emergency facilities, intensive therapy facilities, outpatient and investigative and diagnostic facilities. The board considers that it is necessary to proceed with the complete scheme in order to maintain the service that the hospital gives to the community and to maintain the position of the medical school.

I understand the disappointment on the score of the new maternity unit at the Western General Hospital, but the most pressing problem with maternity services in the region, as the working party brought out, is the need to upgrade the Simpson Memorial Maternity Pavilion, which at present is operating well below its potential because of the inadequate and out-dated accommodation. The board has, therefore, allocated £1 million in its programme to this purpose. The occupancy of this hospital in 1968–69 was only 69 per cent., and this compares very unfavourably with other hospitals in the region. With upgraded facilities, the number of women admitted should be able to be increased considerably.

Mr. Stodart

It can hardly be as outdated as the Western General.

Mr. Millan

Hospitals built 30 years ago do not meet modern requirements. The Western General has had improvements in the last 100 years, as the hon. Gentleman knows. The position at the Simpson is serious, and we are not getting the major benefits we should be able to get from that hospital because of the inadequate facilities. The occupancy rate is a very poor one in comparison with other developments elsewhere

As to the spinal injuries unit, the location of that was not considered by the recent working party. This is an old argument which I rememeber quite vividly. It was drawn to my attention when I visited Edenhall a couple of months ago by the Astley Ainslie Board of Management chairman and one or two of the board of management members, among others. The decision was taken a long time ago, whether or not the hon. Gentleman agrees with it. The argument is not really open any longer.

These are the particular points that the hon. Member raised. I have tried as well as saying something about these points, to place them in the context of the hospital building programme as a whole to some extent, but certainly in the context of the need for the regional board in producing its proposals for us, to look at the priorities over the region as a whole, geographically and in terms of the particular kind of facilities which it feels most accurately and adequately meets the development needs of 1972 and beyond.

These programmes are still to be considered by the Secretary of State. We will consider the relevant priorities of the schemes included in the programme, and we shall also be considering the question of what priority might be given to any additional schemes we find are possible to insert in the programme, either now or later, either in the South-Eastern Regional Hospital Board area or one of the other board's areas in Scotland.

There is certainly an element of flexibility in the position. When we have finished the consideration of the board's proposals we want to give a certain definite order at least on priorities for projects in the South-Eastern Region and the other regions of Scotland. We shall certainly have full regard to the priorities which the regional board has given to us. We would not lightly discard the priorities of any board. We have to integrate the five regional programmes into a Scottish programme and try to get the right order of priorities for Scotland as a whole. When we have done that each board will be advised of the scheme for which planning should proceed on the basis that it will start——

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-seven minutes to Twelve o'clock.