HC Deb 01 December 1970 vol 807 cc1242-54

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

11.21 p.m.

Mr. John Brewis (Galloway)

At this late hour, I am grateful for the opportunity to raise the question of Laurieston Hospital, Castle Douglas. I am also grateful to my hon. Friend the Under-Secretary of State for being here to reply to the debate, and to my hon. Friend the Member for Wanstead and Woodford (Mr. Patrick Jenkin) for being present on the Treasury Bench.

Laurieston Hospital is a small country house situated in beautiful surroundings some six miles from Castle Douglas, the largest town in the district, yet centrally placed for the wide Glenkens area which includes the town of New Galloway, Dalry, Carsphairn and many other villages.

Possibly the term "hospital" is a bit of a misnomer. Laurieston House is used for the care of old people who are not bedridden, but who need rather more attention than can conveniently be given in an eventide home. Because of its surroundings and the work of the matron and staff, it is an outstandingly happy place.

It will be readily agreed that such an atmosphere is an important item in the treatment of geriatric patients. It is also important that they should be accommodated as near as possible to their home area and thus able to receive visits from relatives, friends and younger members of their families. Here I join issue with the decision of the Western Regional Hospital Board made many years ago that geriatric patients from Galloway should be concentrated in Dumfries when the new General Hospital is completed in 1974. Concentration may be all very well in cities and large towns, but in rural areas it is bound to cause hardship and visiting difficulties when the catchment area may be up to 80 miles wide.

As I say, Laurieston was scheduled to close in 1974. I will be prepared to fight that issue nearer the time, but the immediate subject of tonight's debate is the decision of the Regional Hospital Board to close Laurieston on 18th January, 1971, long before the new Dumfries Hospital is built. I might say in passing that I am glad to see my hon. Friend the Member for Dumfries (Mr. Monro) in his place.

Let me say in passing that a date in January in the depth of winter is an unfortunate if not inhuman time to move old people from the surroundings to which they are accustomed. Some are to go to Lochmaben, a town about 40 miles away but in a very different part of Scotland, another to Stranraer over 50 miles away. Such flittings, if they take place at all, should take place in summer.

I now come to the Department's case for closing Laurieston. The reasons were set out in a letter that the Under-Secretary of State wrote to me on 13th October. One of the points made by my hon. Friend is that, when a census was taken last August, many of the occupants were found not to be local people. From this he deduces that Laurieston is not convenient for local geriatric patients. This is very definitely not the view of the local doctors and the Galloway Executive Council. They point out that there are many local patients, some living in substandard cottages, who could well be accommodated in Laurieston if beds were available. At the time of the census, there were in fact several geriatric patients in Newton Stewart Hospital who came from the Glenkens. As I have said earlier, one cannot play general post with old people and Laurieston has to take the case which is available when there is a vacancy. The provision of geriatric beds must be looked at taking the region as a whole.

The Glenkens is an area to which people retire and it therefore has an ageing population. One local doctor tells me that his practice has 33 per cent. more patients over 65 than the national average.

The Under-Secretary has been told that Laurieston is not well served by public transport. Few places in the country now are, but, to be realistic, many people now have their own cars and are prepared to take someone who wants to visit an old relative six or seven miles in the evening after work. It is quite a different matter if the evening run is to be 40 miles each way to Lochmaben. Then the use of public transport becomes inevitable. With the changes of buses involved, the journey to Lochmaben could not be made by public transport to coincide with after-7 p.m. visiting hours, and I am doubtful if it could be done at any time on Sundays. If the Under-Secretary thinks Laurieston is inconveniently situated, he must see that Lochmaben is infinitely worse for most patients from Galloway.

I want to address myself now to the Under-Secretary's other points; namely, that Laurieston is outdated, needs substantial capital expenditure and is a fire risk. I feel that the fire risk weighs heaviest in his mind. There was a tragic fire recently at an English hospital and there have been one or two bad cases in Glasgow in recent years in warehouses and factories.

Laurieston is a 19th century solid, stone-built house, no more liable to catch fire, in my submission, than any other house of its character. Most of the patients are ambulant and all of them sleep on the ground floor. I believe that the Under-Secretary has been told that Laurieston is the worst fire risk in the hospital board's region. I simply do not believe it when there are hospitals of which I know that are of much the same date and construction on two or more floors, but with no fire- or smoke-proof doors and crammed to the gunwales with bedridden patients.

The staff at Laurieston have fire-fighting equipment and are most fire conscious. They have had the local fire brigade inspector round more than once and he has had no special observations to make. All the patient areas have emergency exits, some in the form of French windows to the garden. Indeed to provide all the bedrooms with exits to the outside would involve only two more French windows—hardly a crippling capital expense. I hope that the Under-Secretary will explain why he considers Laurieston an exceptional fire risk and how, to quote the Fire Precautions Bill, the means of escape are not reasonable in the circumstances of the case. There seems no substance whatever in the Board's allegation.

Of course, Laurieston is out-dated when compared with a purpose-built new hospital, but the accommodation is quite adequate for the limited purpose it serves and certainly adequate with a few running repairs till 1974. It is unlikely to fall down, as happened two or three years ago to a hospital in Glasgow. It is a mystery how the technical officers of the hospital board arrived at a figure of £20,000 needing to be spent on it. This figure should be scrutinised. I am told that one could double the accommodation for half this sum. Of course, if one allows for re-roofing the house, putting in new boilers, making generous allowances for dry rot, the presence of which has never been observed, one can arrive at virtually any figure one likes.

I turn now to the position of the staff. In his letter to me the Under-Secretary said: All those who wish it will be offered alternative employment. No doubt this is true, but I wonder if he realises what the phrase conceals. It is easy enough to offer alternative employment in a city, but many members of the staff are local women who act as nursing orderlies. No doubt "if they wish it", they can be moved to Lochmaben 40 miles away, but what about married women whose husbands and families work in the Laurieston district? The Under-Secretary cannot offer them alternative work. In the Laurieston district many men work for the Forestry Commission and there is no alternative work for their wives, even if they have nursing qualifications. The offer of alternative employment for the staff at Laurieston is a hollow one.

Before concluding I want to touch on the more general question of hospital beds in Galloway. We know there are no more geriatric beds to be provided if Laurieston closes. The pressure must therefore come on general practitioner beds in hospitals like Newton Stewart and Castle Douglas. Surely the hospital board does not contemplate moving old people from as far away as Wigtownshire to Lochmaben? This would be thoroughly reprehensible. Already the board's own figures are of an occupancy rate at Newton Stewart of 97 per cent. I know for example of a patient who has had to wait 3½ years for a bed there to have a simple operation for varicose veins.

The board's figures for beds needed were calculated in 1963–64 on the assumption that Laurieston would stay open. Since then there has been another radical change of circumstance. I refer to the explosion of holiday visitors. One doctor's normal list of 2,000 patients swells to 7,000 or 8,000 for a short period in the summer. The majority of visitors live in tents, caravans or houses offering bed and breakfast, which are quite unsuitable for the treatment of illness. There are unfortunately more traffic accidents as well. I have got the figures of visitors taken ill over the last 10 years. It is a sharp progression. In 1960 the figure was 2,866. In 1965 it was 4,111, and in 1970 it is an estimated 5,947.

By 1974, when Dumfries Hospital is at last available to take the strain this projection may well throw up double the number of tourists needing hospital beds compared with 1963–64, when the board's plans were made. Against these figures, the closure of Laurieston seems even more incomprehensible.

The Under-Secretary will know that the closure is opposed by both town councils in the area, by the local newspaper The Galloway News, the Galloway Executive Council and also by the local people. When a petition was organised before the closure was announced, it attracted 500 signatures, a very large number for the Glenkens, in three days. It was particularly unfortunate that the hospital board was not able to have a meeting to hear the views of the medical executive council until six weeks after the closure had been announced. This is a great pity, because it is in the interests of the community at large that the three branches of the Health Service achieve the maximum co-operation. I think the vehemence of the executive council's opposition must have been a surprise to the hospital board.

In his reply to a Parliamentary Question on 11th November the Under-Secretary said the decision would not be reconsidered unless new circumstances arose of which he was not aware at the time of the decision. I submit that I have brought to his notice a plethora of new circumstances. The case against Laurieston has been vastly exaggerated. It is not out-dated, it is not a special fire risk, it is not inconveniently situated, and it does not need a substantial capital expenditure. Its closure would result in hardship to old people and a serious strain on the available hospital beds in Galloway. The original decision of the Hospital Board to keep Laurieston till 1974 ought to be adhered to.

11.34 p.m.

The Under-Secretary of State for Health and Education, Scottish Office (Mr. Edward Taylor)

I welcome the opportunity presented by the initiative of my hon. Friend the Member for Galloway (Mr. Brewis) to explain the background to the Laurieston Hospital case. My hon. Friend has concentrated on questions about the location and conditions at the hospital, the consultations undertaken by the hospital authorities about the closure, and the arrangements made for the staff. I shall deal with these points as fully as I can.

Much of the alarm locally seems to stem from a belief that Laurieston Hospital is occupied primarily by local people and they are going to be transferred en masse from their homes and friends to Lochmaben Hospital 40 miles away. There is also a belief that this is being done, not for any valid, objective reason, but merely to satisfy some remote administrative convenience. If any of these fears had been justified I can assure my hon. Friend that the Secretary of State and I would never have agreed to the proposal.

In looking at the question of convenience, there are two aspects to be considered. The first is how convenient the hospital is at present to the local community and to the patients in it, and the second is whether the alternative accommodation to be provided in the event of closure will be as convenient to the communities and individuals affected. As my hon. Friend has said, it is the hospital authority's view that over the years it has found difficulty in filling the places at Laurieston with local people—and indeed, at counts in March and April of this year only five or six people could be regarded as being local. The majority of patients came from further afield—from Dumfries and beyond, even as far away as Troon.

This—and the advice of my medical advisers who have visited the hospital and discussed its operation with the consultant in geriatric medicine for the area—goes a long way towards confirming the hospital authority's claim that because of the relative absence of any local demand for hospital accommodation in Laurieston it has had to fill up beds with people from much further afield.

Mr. Brewis

Is my hon. Friend aware that nobody in the district has been able to find the patient from Troon?

Mr. Taylor

I shall check on what my hon. Friend says, but the advice that I have is that we have a patient from Troon.

Complementary to this question whether the hospital is fulfilling a primarily local need is the question whether, when the hospital is closed, the existing patients will be better or worse off, in terms of convenience. It is on this issue that we seem to have failed to convince local people that what is involved is not a wholesale transfer of patients without regard to age, home or their clinical condition, to Lochmaben, 40 miles away. I repeat that if this had been the case my right hon. Friend and I would not have agreed to the closure—and I am sure that my Department would not have recommended us to do so. Indeed, the hospital authorities have assured us and the local people that they will do what they can to accommodate local people locally, and I think that they have fulfilled this promise.

Only yesterday I obtained an up-to-date list from the Dumfries and Galloway Board of Management of where it is suggesting the patients might go on the closure. This list has been prepared after full discussions between the patients at the hospital and the consultant in geriatric medicine, and it reflects in almost all cases the expressed preference of the patients, having regard to the convenience of the hospitals to relatives and friends. Perhaps the most significant feature of this list is that all the five Lower Glenkens area residents are being offered places at Castle Douglas Hospital.

I am glad to be able to take the opportunity of announcing that the hospital authorities have agreed to make available five more beds for geriatric patients at Castle Douglas without—I emphasise this—encroaching in any way on the general practitioner beds. Instead, beds are being reallocated from general surgery—where the statistics suggest that there has been over-provision; for example, during one six-months' period last year the occupancy rate was less than 20 per cent. This reallocation is not permanent, but will be reviewed in the light of experience in both general surgery and geriatric medicine. I am sure, however, that my hon. Friend will note with satisfaction the fact that these new geriatric beds are now to be provided.

No one, I am sure, will dispute that patients will be much more conveniently placed at Castle Douglas for visits than they were at Laurieston, and the same is true of virtually all the other patients who are being accommodated in the hospitals of their choice. I do not think that there is any justification for the remark that the closure would result in hardship to old people.

My hon. Friend suggested that the hospital was not a particularly high fire risk, and that there was no real need for the expenditure of the £20,000 or so estimated by the technical officers of the board of management and the regional board as being necessary.

I think that this is a question essentially for technically qualified people, but the firm advice of the board of management to the regional hospital board was that capital expenditure of this order would be necessary. If a hospital had a long-term future of course £20,000 is a relatively small sum, but in the light of the fact that the estimated maximum life of the building as a hospital was only four or five years the hospital authorities obviously had to look critically at the need to incur such expenditure.

It was felt by the technical officers of both boards, who made independent assessments, that, even for the short-term life ahead of it, the hospital would need new boiler plant, re-routing of mains, and rewiring of electrical services. It would also need expenditure on the hot water system and on improving the sanitary annexes. I have no reason to disbelieve the advice of the two different groups of technical officers. I should add that the regional board's officers' view was that the estimate was a conservative one. One of my medical officers who visited the building was in no doubt that it should be vacated as soon as possible.

My hon. Friend also asked why the hospital was regarded as a fire risk when all the patients are on the ground floor. I must straight away say that I am not aware that I have ever been told that Laurieston is the worst fire risk in the Regional Board's area. I have said that it is a fire risk and that money would have to be spent to reduce the risk. I am sure that my hon. Friend will agree that, although the potential fire risks in two hospitals may be very similar, much depends, too, on the location of the building and the type of patient. The consequences of a fire in a remote rural hospital with geriatric patients and part-time staff could be far more disastrous than in a similar hospital with a larger staff in the centre of the community.

The Western Regional Hospital Board in recent years has devoted much attention to the problems of fire in hospitals. In fairness to the board I should say that it did not say to me that Laurieston was the worst fire risk in the region, but nonetheless it is its view that there is a fire risk in the hospital and expenditure would be necessary to reduce this.

I should say that neither the condition of the building itself nor the inherent fire dangers would themselves have been sufficient justification for the closure if it had not been that the long-term intention was to close the building on the completion of the Dumfries District General Hospital, and in the light of this it was thought that the expenditure of £20,000 would not be justified for continuing the life of the building for another four or five years.

I want now to touch on the question of consultations about which my hon. Friend and I had a brief exchange at Question Time on 11th November. The regional hospital board consulted the local health authorities in the area—the three county councils and Dumfries Town Council—and none of them objected, although there were patients from each authority's area in the hospital. We rely on the local authorities to give us a "consumer's" point of view on proposals such as that of the closure, in their capacity not only as local health authority but also as the elected representatives for the area. The regional hospital board also consulted the executive councils for Dumfries and Galloway and here, too, we thought that there were no objections in principle. The Galloway Executive Council recorded the view of the local medical committee that— With the closure of Laurieston Hospital it is desirable that additional beds should be provided at the peripheral hospitals over and above the present complement to accommodate geriatric patients as near as possible to their own homes without encroaching on the existing general practitioner beds. I know that there is a local feeling that the views of the executive council were disregarded or, even worse, misrepresented to us when my right hon. Friend and I considered the closure proposal. It may be that there has been some misunderstanding about what the executive council intended to say in reply to the request from the regional board, but there is no doubt that the impression given to the hospital authorities, my Department and myself from the letter of October 1969—I have a copy here—was that the Council did not oppose the Laurieston closure in principle but was concerned about the general question of the availability of general practitioner beds throughout the area.

We knew that the regional board were discussing this with the executive council and, as we had not regarded its observations as having been in any way an objection in principle, we did not feel that we should necessarily delay any decision about the closure until the completion of the discussions. A meeting was arranged in June but was called off by the executive council. However, I understand that at the meeting held last week the regional board assured the executive council representatives that there was no question of closing any other small hospitals in the area other than those indicated in its 1966 Review of Hospital Services in the South West, and these closures, if approved by the Secretary of State, would not take place until the Dumfries District General Hospital opens. The regional hospital board were able to say to the executive council members that five more beds were being made available at Castle Douglas Hospital for geriatric patients without any encroachment on the existing general practitioner beds.

It may be that the executive council intended, in effect, to oppose the closure of Laurieston unless more beds were made available elsewhere, but this was not evident from the tone of their letter. I am sorry if there was any misunderstanding, and I hope that it has now been resolved.

I should like to deal also with the representations received from the local people. A petition against the closure of the hospital was organised in the Glenkens area by my hon. Friend's constituent, Mr. Sillar. It was signed by 500 people. The petitioners argued that the expenditure required for the maintenance of the building would be well repaid by the resulting satisfaction of the local people. I understand, too, that in the spring of this year my hon. Friend discussed the petition with my predecessor in office, who assured him that all closure proposals were considered personally by the Secretary of State. I can give him the same assurance, that no closure is authorised without the proposal being personally considered by the Secretary of State and myself.

My hon. Friend asked, in effect, what was meant by the phrase "alternative employment". He suggested that it meant very little in the situation of Laurieston because of the difficulties of travel elsewhere. I gather from the board of management that of the 22 staff now in post 17, after discussion about their preferences, are about to be offered alternative employment in Kirkcudbright, Castle Douglas and Dumfries hospitals; all are being offered either their first or second preference.

Of the remaining five, one, the matron, is retiring next month; two, the porter and his wife, are remaining at the hospital for the time being for caretaking duties; and two ladies may well opt for redundancy payment.

I can appreciate that any change of job can be upsetting for the staff, particularly if they are local people who are now faced with longer journeys to work; and I am glad to say that the hospital authorities have agreed to make a hospital vehicle available to help them in travelling to their new jobs until the future of Laurieston Hospital premises is resolved. The caretaker of the hospital will act as the driver.

It has been suggested also that the closure is being rushed and there might be a case for deferring it. With respect, I dispute the suggestion that we are rushing the closure. There have been discussions about it for the last eighteen months, and there has been ample time for everyone to put his view. Our decision to approve the closure was announced in October, and the board of management has now suggested that it take effect in January. I think that by then there will have been three months' notice of the fact that the hospital is definitely to close, and almost two months' notice of the precise date. I should have thought that this was reasonable.

My hon. Friend asked whether the announced closure date could be deferred to some time after 18th January, the date which the board of management has announced. I do not see any great advantage in this. I do not think that there is any likelihood of new facts coming forward between now and then which might affect the decision taken by my right hon. Friend and myself. We are satisfied that the case made out by the hospital authorities for the closure on the ground that substantial capital expenditure would be needed to refit it for continued occupation is valid, and we are satisfied that the patients in general will be better off as a result of the proposed transfer to other hospitals in the area. Further delays will merely prolong the uncertainty with no clear benefits and we should aim to have the patients safely accommodated elsewhere before the worst part of the winter is on us.

I can assure my hon. Friend that if there is any difficulty about evacuating the patients on 18th January because of severe weather the hospital authorities will be ready to delay the closure for a few days until weather conditions improve—so there should be no danger of any ambulances being stuck in snow drifts or otherwise impeded.

It would be wrong if, as a result of what has been said about the closure of Laurieston Hospital, any impression was created that the hospital was in any way unsatisfactory from the point of view of patient care as opposed to accommoda- tion and I would like to pay tribute to the work of the staff in the hospital and at the board of management. From the local reaction it is obvious that Laurieston creates a happy and pleasant atmosphere for the old people who are accommodated in it and, in the circumstances, this can only have been achieved by the enthusiasm and co-operation of all concerned in the running of the hospital.

It may seem unfortunate to local people that a pleasantly situated building of this kind should be withdrawn from service as a hospital but I am satisfied that in this case the expenditure required to maintain it satisfactorily would not be justified, taking account of its location and likely future.

It is not however my, or the Western Regional Hospital Board's policy to centralise hospital services solely for the sake of reducing the number of small hospitals. The cottage hospitals—and Laurieston would not be classified as one of these—will remain an important feature of the hospital service particularly in the South-West and the aim will be to provide bed facilities for patients of most kinds within reasonable distance of their homes.

I must conclude, too, by saying how much I appreciate my hon. Friend's interest in health matters and I know how interested he has been over the years in the development of the hospital and other health services in the South-West.

He certainly has fought hard in this case and I must say in all sincerity that if anyone could have influenced the Laurieston decision he was the man, by the painstaking way in which he has pursued these matters. I am only sorry that to us the case for closure seems to be so very strong.

Question put and agreed to.

Adjourned accordingly at nine minutes to Twelve o'clock.