HC Deb 04 February 1970 vol 795 cc585-92

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

11.46 p.m.

Mr. Peter Walker (Worcester)

I am grateful to the Joint Under-Secretary of State for the Department of Health and Social Security for attending this debate. I apologise that stray sheep have kept us until this late hour.

The subject I wish to raise is the future of the brine baths at Droitwich. These baths have been in existence since the latter part of the 19th century, and in recent years have contributed very considerably to the treatment of patients suffering from arthritis and from difficulties with limb movements following major operations. The brine baths are used by the neighbouring Highfield Hospital, and a very considerable number of National Health Service patients have over recent years used the facilities offered.

A few years ago, much to the shock of those involved in this project, it was announced that in future the hospital service would not be using the brine baths at Droitwich. I want at once to express my gratitude to the Under-Secretary's predecessor, the hon. Gentleman the Member for Lichfield and Tamworth (Mr. Snow), for the interest he has taken in this matter and the manner in which he tried to assist in seeing that if closure was not prevented it was at least delayed.

I want, in particular, to refer to the letter I received from the then Parliamentary Secretary, when I complained to him about the announcements that the brine baths were to be closed. After referring to examination of the case and of the facts that he had discovered about the position, he stated: It may be helpful if I first set down some points on which there is no dispute about the facts. I accept that, whereas the number of physiotherapy treatments given yearly at St. Andrew's Baths has fallen in recent years, the number of patients actually treated each year has remained fairly constant. It seems that treatment of rheumatic diseases generally is more effective and that hydrotherapy in particular is being used less for each patient but more effectively, so that there are fewer re-attendances. I also accept that the buoyancy of the brine enables a physiotherapist to supervise more patients than would be possible without other support in fresh water. The letter concludes: I am glad to know that the Droitwich Medical Trust"— and it is the Droitwich Medical Trust which manages the brine baths— are ready to co-operate in every possible way in the interests of the patients, including placing their expert knowledge, and rights in the brine, at the disposal of the Hospital Board. I would suggest that the next step is discussion between the Trust and the Board which, I hope, will be fruitful. The letter from the hon. Gentleman clearly indicated that after detailed inquiries by the Ministry it recognised that the brine baths were serving a very useful purpose and there was a real case. The facts which he conceded were facts put up against all the contentions and arguments propounded by the regional hospital board. The board has produced figures to show that the number of treatments was declining and it consistently argued that the use of the brine itself was of no great importance. What concerns me about this case is that basically now the decision of the hospital board is to install at the nearby Highfield Hospital facilities for treatment but with ordinary water and not with brine.

The board argues that on medical advice the brine itself has no direct medical advantage and that there are additional costs in using brine. Therefore, the board intends to create a new section at Highfield Hospital which will not use brine but fresh-water for this type of treatment.

This strikes me as an incredibly narrow and distorted view of the situation because, although there may be no direct medical advantage in using the brine itself, anyone who visits these baths will see the incredible advantage of brine in providing the treatment involved. If brine is not used, the patient is always conscious of the possibility of not remaining afloat while the treatment takes place and has to be supported while it takes place. Therefore, there is a tremendous increase in the number of staff involved.

Recently, in a television programme on this subject, I was able to demonstrate to the public at large groups of patients going through the treatment taken by skilled physiotherapists with half a dozen patients being treated at one time, whereas if brine is not used each patient has to be treated individually and considerably more staff are necessary. In a brine bath the patient cannot sink and this means that exercises which have to be carried out are carried out with far greater confidence and far more success. The whole of the medical staff involved at Highfield Hospital is completely unanimous in saying that brine is of considerable advantage in the treatment of patients.

The right course for the regional hospital board was to continue treatment at the brine baths, but, nevertheless, it has decided to create a new wing at the hospital at considerable expense. Then came an offer from the medical trust and local people that if Highfield Hospital was to use a wing of its own rather than the brine baths that hospital wing should have brine rather than ordinary water. This was rejected by the board in a remarkable way. First, it suggested that there would be an additional capital cost of £14,000. It was discovered on examination that the capital cost included the cost of providing pumps and pumping which could have been provided by the medical trust itself and, therefore, the capital cost suggested was not a reasonable figure. The board suggested that because the brine had adverse effects in terms of corrosion and there would be an additional cost of piping maintenance.

Droitwich is a small town which is noted for its charitable support and particularly for its support of hospitals. The Friends of Droitwich Hospital offered themselves to meet the entire cost of additional maintenance which would be required by providing the brine. This offer was rejected in a most remarkable way by the regional board. Having first refused the offer of an additional figure for maintenance, the board put forward a figure of £100, then £500 and then £770 and at these levels the Friends of Droitwich Hospital was still willing to meet the entire cost and to ensure that no cost fell on the public.

This was refused. One of the main reasons given was that plans were going ahead on the basis of using ordinary water and the whole thing should not be further delayed. This proved a completely bogus excuse, because not one brick of the new wing has been provided and not even the land has been acquired. So there is no slowing down of the project if the hospital board would only decide to use brine instead of ordinary water.

The Medical Trust is a charitable trust. It knows full well that immense advantage of brine to the patient. The people of Droitwich know this advantage. They are willing to make considerable contributions to ensure that National Health patients and ordinary patients can continue to obtain the benefit of this type of treatment. It has been a story of incredible frustration to the medical staff, to local people in Droitwich, and to the very dedicated people that work at the brine baths, to receive absolutely no encouragement or word of support from the regional hospital board. There has been a blank wall—"In our view, there is no medical advantage in brine". In propounding that view the board goes against all the feelings of the medical staff and the patients involved.

I sent in a petition, signed by a very large number of patients and former patients, pleading with the Minister to intervene to ensure the brine treatment can continue. These are the only brine baths in the United Kingdom. This is now the only place where treatment in brine can continue. I believe that it will be a very real tragedy if the regional hospital board does not take a much more enlightened view of this matter and make decisions which will ensure at least that this hospital treatment by brine can continue, to the benefit of patients and in accordance with the beliefs of the medical staff.

I hope that the Under-Secretary will be able to cause the regional hospital board to re-examine this position yet again and enable the brine treatment to continue.

11.56 p.m.

The Joint Under-Secretary of State for the Department of Health and Social Security (Dr. John Dunwoody)

I welcome the opportunity which the hon. Member for Worcester (Mr. Peter Walker) has provided for the discussion of a complex and important subject. It is a matter of considerable concern, not only locally, but elsewhere since the Droitwich brine baths have provided a service that has been appreciated and valued far afield.

Indeed, I want to pay a tribute to the work done by the Droitwich Medical Trust and its staff at the St. Andrew's baths. I know from the large number of letters my Department has received that people in Droitwich and in many other parts of the country greatly value the treatment they have received there over the years, and there is no question of the arrangements at St. Andrew's baths being brought to an end before satisfactory alternative provision is made elsewhere.

I think that, to explain the developments which call for ending the contractual arrangements with St. Andrew's Hospital, it would help if I set this particular case in a wider perspective and to do this I need to go back a few years. The original connection between the National Health Service and the Droitwich Medical Trust consisted in an arrangement between the Birmingham Regional Hospital Board and the Trust to provide physiotherapy and hydrotherapy for Health Service patients referred to hospitals in Droitwich for treatment.

These arrangements carried on, the board paying an annual lump sum to the Trust for the treatment given, until the summer of 1966, when the Trust approached the board and explained that the arrangements could not go on in the present fashion since with the decrease in the number of treatments under the Health Service the Trust's financial position was becoming difficult.

The number of units of treatment at the baths had gone down from 42,816 in the financial year 1963–64 to 24,068 in 1968–69, a decrease of 43 per cent. I do not have exact figures for the number of patients treated, but my understanding is that it has not decreased as much, for, amongst other reasons, the reason that the hon. Member mentioned. The board and the Trust held consultations about the solution to the problem and the upshot was that, as the Trust could not continue to treat Health Service patients under the present arrangements, the hoard decided that it would have to end the contractual arrangement with the Trust and make alternative arrangements for the treatment of its patients.

In addition to the very heavy costs of keeping the brine baths running, there are some very heavy recurring expenditures involved in the frequent restoring of plant, because of the corrosive effects of brine and the problems of piping it to and from the baths. The board decided that it could not assume the heavy financial liabilities of the Trust. I must make it abundantly clear that the initiative for ending the arrangement for the treatment of Health Service patients at St. Andrew's Hospital came from the Trust and not from the regional hospital board.

Faced with the decision of making the best provision for its patients the hospital board decided to build an out-patient department at Highfield Hospital at Droitwich and to include, at the same time, the construction of a hydrotherapy pool. It was under considerable pressure from local interests to have brine from St. Andrew's baths in this pool. The greater buoyancy which brine provides is an advantage, but there is, of course, the disadvantage that the brine is irritating to the eyes, and great care has to be taken to avoid splashing.

Consultants involved in the rehabilitation procedures recognise that the small hydrotherapy pool is useful for selected patients and regularly refer them for this form of treatment. Nevertheless, the real need for hydrotherapy in a large hospital is relatively small and there are various techniques which can achieve the buoyancy required by the individual patient in a normal hydrotherapy pool.

The buoyancy and warmth of ordinary water at body temperature provide a useful medium for the re-education of function in many muscular and locomoto disorders and particularly in the conservative and post-operative treatment of arthritis of the spine, hips and shoulders in older patients. Modern hydrotherapy pools are used to re-educate patients in walking because the amount of weight-hearing can be graded according to the depth of water in which the patient is walking.

They are also used to mobilise individual joints while the trunk and limbs are supported by floats made of terylene slings with plastic foam material at either end. These buoyancy aids are quickly and easily slipped into position and do not hinder movement to any significant extent. The resistance due to moving the floats through the water provides an exercise for the muscles acting on the joints.

Although brine baths are quoted as having psychological effects, other than the physical properties of the increased buoyancy there is no clinical evidence that in itself brine has any therapeutic value whatever. I am sure that the larger number of patients treated in the brine bath at Droitwich is due to the fact that doctors tend to prescribe, and patients expect, treatment in the unique brine bath, whereas in other hospitals more comprehensive procedures would be prescribed even though a hydrotherapy pool is available.

The board considered in great detail the feasibility of using brine but decided that the advantage of brine—its greater buoyancy—did not outweigh the very great disadvantages of piping the brine to the pool and then disposing of it. During the course of discussions with the Medical Trust the board's officers had been left in no doubt that the corrosive effect of concentrated brine on almost all materials with which it comes into contact poses virtually insuperable problems.

The disposal of the brine would have involved arrangements for the use of the existing brine drain and settling tanks at St. Andrew's baths from which a controlled release is made into the nearby river. The arrangement is subject to rigorous controls. If St. Andrew's baths ceased to function when the Health Service contract ended, the regional hospital board would be faced with the cost of maintaining the whole disposal system.

The new buildings at Highfield Hospital will provide generally better and more comfortable conditions for both patients and staff that are at present available. The hydrotherapy pool which the board is planning to include will, I am sure, provide facilities which will be superior to those at present used in St. Andrew's in every way except possibly for the size of the pool. Arrangements for the treatment of patients at the hospital will be made in the same way as at any other Health Service hospital.

Health Service patients will be referred by their general practitioners or by consultants at other hospitals to the hospital and private patients will also be admitted through the medical staff. I know that in the past patients have come from far and wide to Droitwich, but many Health Service hospitals now have hydrotherapy pools comparable to those at the Spas and patients can be treated much nearer to their homes.

The hon. Member mentioned the problems that might arise in stopping treatment in the brine baths at St. Andrew's Hospital. The action of the board in proposing to terminate its contractual arrangements is not in fact an embargo on the continued opening of the brine baths. I recognise with some regret, that the major part of the income of the St. Andrew's Hospital comes from the payments made to it by the regional hospital board for the treatment of Health Service patients, but the Trust cannot expect the hospital board to take over the whole of its existing establishment since part of it has no relevance to hospital interests. I also understand that a considerable amount of money would need to be spent on improvements at St. Andrew's Hospital.

The board is anxious to start work on the construction of the new out-patients' department at Highfield Hospital and the construction of the hydrotherapy pool, but it is at present being delayed by procedural difficulties in acquiring a small portion of land which is needed so as to widen the access gate to the grounds of the new buildings. Once these procedural difficulties have been settled the board hopes to make swift progress with the provision of the new facilities. It has undertaken to give nine months' warning to the Medical Trust before terminating the contractual arrangements. It has also made it abundantly clear to the Trust that the board will be prepared to take over the staff at present employed at St. Andrew's baths if they wish to come to Highfield Hospital.

I think that you, Mr. Deputy Speaker, will agree that there has been nothing sinister in the actions of the regional hospital board in this matter. Patients who require hydrotherapy will continue to be able to receive it either at Highfield Hospital or at a district hospital nearer to their homes.

Question put and agreed to.

Adjourned accordingly at seven minutes past Twelve o'clock.