HC Deb 27 October 1970 vol 805 cc169-82

9.59 p.m.

Mr. Michael Roberts (Cardiff, North)

I beg to move That an humble Address be presented to Her Majesty, praying that the National Health Service (University Hospital of Wales (Cardiff) Designation) Order 1970 (S.I., 1970, No. 686), dated 5th May 1970, a copy of which was laid before this House on 13th May, in the last Session of the last Parliament, be annulled. I am grateful for the opportunity to speak to this Prayer and, as this is the first occasion on which I have had the privilege to speak in this House, I wish to begin by saying of my predecessor, Mr. Edward Rowlands, that he is regarded with respect and affection by the people of Cardiff generally and in particular by the people of Cardiff, North.

My constituency is situated in the centre of the capital City of Wales. Edward Rowlands showed, and still shows, great concern in its interests and problems—in particular, the central development, the proposed urban motorways and the university expansion. He was recognised as a person concerned with the welfare and well-being of the people.

Most of the great buildings for which the capital City of Wales is justly famous are situated in my constituency. One of the most magnificent recent additions is the University Hospital of Wales at Heath Park, Cardiff, which is included in the Schedule of Statutory Instrument 686. The Statutory Instrument consists of two Schedules, one which lists 29 hospitals in the Cardiff area, and the other setting out the constitution of the University Hospital of Wales Hospital Management Committee.

The purpose of the Instrument is to unite the hospitals of the Cardiff area under a unified administration. This is eminently necessary as the division of responsibility between the United Cardiff Hospital and the Welsh Hospital Board, through its management committee, has not produced a unified and efficient service for this area. The purpose of the Instrument in unifying the service is rational and satisfactory as a unified service opens up greater opportunities for treating the sick and for teaching purposes.

However, the method by which this unification has been achieved is questioned by many closely associated with the hospital service. The medical board of the United Cardiff Hospital, comprising 140 medical staff, made representations to the Welsh Office requesting that Statutory Instrument 686 should be deferred. It is questioned because there is a fear that the teaching functions of that service will be damaged. Unification of the hospitals in the Cardiff area should be achieved without damaging the teaching side of that service. This could have been achieved by the preservation of the board of governors for the teaching hospital and by placing the hospitals listed in the Schedule of the Statutory Instrument directly under the control of the board of governors.

That this process could have been carried out is exemplified by the fact that within the last 12 months the Welsh Hospital Board transferred one hospital—the Royal Hamadryad General and Seamen's Hospital—from the Welsh Hospital Board to the board of governors. This process could be carried out to a larger extent to include all those hospitals listed in the Schedule. This method of achieving unification of hospital services has already been implemented in the London area.

The University Hospital Group proposed in Statutory Instrument 686 carries in the eyes of those connected with the medical service a lower status than that of an established teaching hospital, such as the United Cardiff Hospitals, prior to 1st October. Although I concede that the University Hospital Group now proposed will have more responsibility than that carried by a hospital management committee, it certainly will not have the same independence as that enjoyed by a teaching hospital.

Professional status and prestige may seem of little significance to the layman, but it is of great importance to the medical profession. A teaching hospital is in competition with the other teaching hospitals of the United Kingdom. Indeed, the competition is international. The loss of status for the teaching hospital of Wales could have a serious effect on its ability to attract highly qualified staff and to retain the staff already serving.

We are about to commission in Cardiff, in 1971, the new University Hospital of Wales—the most modern teaching hospital in the world. Given the right impetus, the Welsh teaching hospital should be able to establish supremacy throughout the United Kingdom. However, those seeking appointments in teaching hospitals—often the most highly qualified men in their profession—will fact the choice of London teaching hospitals, with greater independence and making their own appointments, and the new University Hospital of Wales, with less independence and with appointments in the hands of the Welsh Hospital Board. In the fiercely competitive world of teaching hospitals, if the teaching hospitals outside Wales are more attractive because of their administrative independence, the Welsh teaching hospital will not develop as well as it should. In those circumstances, the unification of the hospital services will have been achieved at a too high and unnecessary price.

For these reasons, I sincerely hope that my hon. Friend the Minister of State will recognise the fears which have been expressed, not only by me, but by many experienced consultants and specialists in the Cardiff area, and that he will withdraw the Order.

10.7 p.m.

Mr. George Thomas (Cardiff, West)

It is not often that it falls to an hon. Member of the House to offer his congratulations to another hon. Member representing the constituency in which he lives. The hon. Member for Cardiff, North (Mr. Michael Roberts), much against my will, took the place of Ted Rowlands and I deeply appreciate, and so do my hon. and right hon. Friends, the generous tribute which he has paid tonight to Ted Rowlands. Both my right hon. Friend the Member for Cardiff, South-East (Mr. Callaghan) and I gave our full support, as the hon. Gentleman would expect, to keeping him at his worthy occupation as a schoolmaster in the City of Cardiff.

The hon. Gentleman is a schoolmaster in my constituency—a distinguished headmaster of the Church of Wales Secondary School. For many years the hon. Gentleman and I, though on opposite sides in political matters, and deeply so, have been colleagues in the teaching profession. We are both members of the National Union of Teachers and I therefore have especial pleasure in congratulating him on the fluency and the power in which he argued his case on this, his first address to the House. It is traditional to congratulate people on their first speech but I offer him a warm and sincere congratulatory tribute for the way in which he succeeded in commanding the attention of both sides of the House tonight. I am sure that we all look forward to hearing him in future debates.

The hon. Member will not be surprised if I disagree with the content of his argument. We are in the unusual situation tonight of the Government having generously provided time to discuss my Order, which was laid before the House, which carries my signature and which I trust the Minister of State will support later. This Order was essential for the proper planning of the hospital resources in the City of Cardiff. The new hospital to which the hon. Member referred will provide 800 beds—an enormous hospital which has a direct effect on most of the other hospitals named in the First Schedule. Staffing this new hospital presents the Minister with a great difficulty.

Recruitment of nurses, doctors and hospital staff generally is bound to have a major disclocating effect on the other hospitals in the City of Cardiff. Overall comprehensive planning of our hospital resources would have been impossible without this Order. The hon. Gentleman said that the work in Cardiff has been impeded by the fact that we had two hospital management committees. One was concerned with teaching group hospitals and the other—this is a rough division—with all the rest. That meant that we had one important hospital committee dominated by its responsibility to staff the new university hospital by the spring of 1971. I understand it being the committee's first concern but the other hospital management committee, under the Welsh Hospital Board, equally has been dominated by the struggle to maintain proper staffing in the hospitals within its care.

Common sense dictated that this Measure be submitted to the House. Once I had resolved that this was a course of action essential for the proper development of our hospital services in Cardiff I called a conference of all interested parties. We had detailed consultation. I know that the Minister and his right hon. Friends do not go for consultation very much but on this matter there was considerable consultation over a period of months. The university, with its direct interest in the quality of medical teaching in Cardiff, was represented at these discussions. I met representatives of the other workers in the hospital services and for six months there was intensive consultation and discussion before the Order was submitted to the House. The Permanent Secretary to the Welsh Office, at my request, presided over a working party seeking to formulate an agreed plan for the merging of these two committees.

On that working party the medical consultants to whom the hon. Gentleman has referred were represented. They had as the guardian of their interests one of the doyens of medical consultants in Cardiff, Mr. Dilwyn Evans, and the Welsh Office and I understood that he carried the confidence of his colleagues. He was accompanied for the earlier part of the discussion by another great friend of us all, Mr. Howell, the physician consultant, who, unfortunately, had a fatal illness earlier in the year.

I attended a meeting in Cardiff of all the medical consultants who were available to come. Well over 100 medical consultants attended a meeting in, I believe, the Cardiff Royal Infirmary. I spoke there on the recommendations of the working party. I remind the Minister that the working party's recommendations to me when I held the office of Secretary of State were unanimous. The medical consultants agreed to the formula. They agreed to the details which have been submitted in this House.

I must express my surprise, at the lowest, and my indignation that the consultants should seek to renege on an agreement which they reached with other members of that committee. If the miners, the teachers or the railwaymen went back on their word when an agreement had been reached around the table in that fashion, the first people to de- nounce them would be those who are going back on their word through the hon. Member for Cardiff, North, whom they have approached to bring this matter before the House tonight.

The medical consultants already have generous representation on the new hospital management committee. Indeed, my anxiety is lest it is too generous. The new scheme has already started; it began on the first of this month. Obviously, there are teething troubles. We must give it a chance to work.

The Welsh Hospital Board, which was one of the negotiating partners in this matter, has behaved in a highly responsibile way and I want to pay my tribute to Mr. Gwilym Prys Davies, Chairman of the Welsh Hospital Board, for his readiness to meet the board of governors on the concessions which they required. I believe that the Chairman of the United Cardiff Hospitals has been equally responsible. Thus, major concessions were agreed by the Welsh Hospital Board in order that the merger should go ahead.

They agreed, for instance, that Mr. Jeffcot, chairman of the board of governors of the teaching group, should be the chairman of the new United Hospital Committee. They agreed to generous representation, as reflected in the Order which is before the House tonight, of the teaching group on the new committee. They agreed to a special committee in which the university is well represented in making the new appointments.

The hon. Member for Cardiff, North raised certain fears before us tonight. He talked of the new University Hospital of Wales being in competition for recruitment with other hospitals elsewhere in the country. This £20 million hospital will be one of the best, if not the best, in the whole of Europe, and the equipment which is to be at the disposal of the medical profession there will be equal to anything found anywhere in the Western world. Because of this, I believe that the hon. Gentleman, and those for whom he has been speaking tonight, are grossly exaggerating the difficulty of getting people to work in that hospital because they do not like the constitution of the committee. I happen to know that in one major hospital in Cardiff 100 per cent. of the medical consultants have already opted to go to work in the University Hospital of Wales. I happen to know that medical consultants who put the hon. Gentleman up to this tonight are themselves falling over one another to get the right place in the University Hospital of Wales. They have used the hon. Gentleman for a little bit of empire-building in this regard.

The hon. Gentleman is afraid that the teaching function of the hospital might be damaged. I hope that the Minister will agree with me that that is offensive to the University, which welcomes the proposals which are before the House, for in the archives of the Welsh Office there is a letter which the Secretary of State of the day received from the University in Cardiff thanking us for the way in which the arrangements had been conducted. There are a minority who seek to go back on the agreement reached in their name by Mr. Dilwyn Evans, for whom I have the utmost regard.

I hope that the Minister, who is speaking on this Order, and who is in a strange position tonight—

Sir Harmar Nicholls (Peterborough)

Not half as strange as is the right hon. Gentleman.

Mr. Thomas

I am so pleased to see the hon. Gentleman again. I was going to the Missing Persons Bureau to look for him—and for his right hon. Friend.

The Minister of State has either to defend my Order tonight or withdraw it. He cannot withdraw it. I am the only person, I submit, who is able to withdraw this Order, because the Government have paid me the high tribute of providing time for an Order which they have put at our disposal today and which reminds me of a former existence when I served in the Welsh Office. I confidently expect the Minister of State to tell his hon. Friend that this Order must stand.

10.23 p.m.

Sir Harmar Nicholls (Peterborough)

I do not want to comment on the merits of the Order because I do not know anything about it. I have not read it and I do not know the details. However, I want to comment on the tone adopted by the right hon. Member for Cardiff, West (Mr. George Thomas). He is normally one of the most attractive of our colleagues in this House. We know that, and we enjoy his company. But why does he despise the parliamentary procedure so much?

The whole basis of this procedure on statutory instruments is so that Parliament can discuss orders, even at the last minute, so that we can be certain that all points of view have been examined. What does the right hon. Gentleman do? He says he is indignant because my hon. Friend the Member for Cardiff, North (Mr. Michael Roberts) has thought fit to place on record the views of people who ought to know something about it. Why is he indignant? If it is certain that the Order is above question and cannot be criticised, let the right hon. Gentleman say why he feels that to be the case. But it is not right that he should be indignant because people wish to use Parliament for what it is designed to do and that he should make accusations against my hon. Friend because he wants to know what certain people in that part of the world think about this matter.

The right hon. Gentleman is nothing like as charming in Opposition as he was when he was a Minister having to defend such an Order as this. Those of us who do not know the new hospital at Cardiff and who have not had an opportunity to look at the details of the Order must accept the verdict put forward in the debate by people who know something about it, but we are all entitled to resent the great indignation which the right hon. Gentleman has displayed in such intolerant terms tonight.

10.27 p.m.

Mr. Geoffrey Finsberg (Hampstead)

I join in the compliments which have been paid to my hon. Friend the Member for Cardiff, North (Mr. Michael Roberts). I wondered whether an Englishman was considered to have a right to intervene in Welsh affairs. Some people may say that that right is doubtful. However, by virtue of my father's birth in the Principality I can claim to be half Welsh and I still have many friends there. I listened carefully to the mellifluous tones of everything the former Secretary of State said. He is in a unique position this evening. He mentioned that he made the Order and that this Government have the dubious distinction of having it.

Mr. George Thomas

If the Minister of State says he wants to withdraw this Order, if he wants to revert to the former position, I will co-operate with him.

Mr. Finsberg

I am grateful for that clarification. What worries me is the complete support of the Order by the former Secretary of State. It makes me highly suspicious. I have heard him in other spheres and his Welsh eloquence can often charm the birds off a tree. It does not mean, however, that there are any facts in his argument. I think his speech is unfortunate because this Order has come into effect already and comments in the newspapers in the Principality have added to the rightful indignation of many people. The possibility that this scheme might be abandoned has drawn comments from officials who should know better.

Perhaps calls for the protection of the rights of Parliament do not normally come from new Members of Parliament, but we new Members wish to guard those rights as jealously as do senior Members. I believe it is wrong that this state of affairs should confront this Parliament before we had had an opportunity to compel the Order to be withdrawn. I hope that the Minister will be able to convince those of us on this side of the House—and no one will ever convince the right hon. Gentleman opposite of anything in this sort of matter—that Parliament's rights are being safeguarded and that the issues raised can be dealt with satisfactorily.

10.30 p.m.

The Minister of State, Welsh Office (Mr. David Gibson-Watt)

We have listened to a short but important debate initiated by my hon. Friend the Member for Cardiff, North (Mr. Michael Roberts), whose speech was rightly described by the right hon. Member for Cardiff, West (Mr. George Thomas) as fluent. It was also brief, and, in my experience, that commends it to the House. I take this opportunity of wishing my hon. Friend a long and successful life in this House. If he continues as he has started tonight, there it little doubt about that.

The right hon. Gentleman's speech came from one who has knowledge of the subject-matter, but I hope that he will understand when I say that I think that he spoiled his case by over-stating it. He said that he felt indignant, and he went on to accuse this section of doctors of going back on their word. I want to rebut that accusation, and I hope that the right hon. Gentleman will accept my rebuttal.

Mr. George Thomas

Does the Minister of State confirm or deny that the medical consultants, acting on behalf of all their colleagues, agreed with the unanimous recommendation of the working party?

Mr. Gibson-Watt

That is not quite the point. My point was that the right hon. Gentleman over-stated his case when he accused the doctors of going back on their word. That is very different from what the right hon. Gentleman seeks to argue, and I ask him to accept that.

The Order sets up the University Hospital of Wales (Cardiff) Hospital Management Committee, and it was laid in May by the previous Administration. My hon. Friend the Member for Cardiff, North, in a very well-informed speech, set out the very difficult and sensitive problem on which it has fallen to my right hon. and learned Friend the Secretary of State to decide.

One of the first deputations which I received at the Welsh Office as Minister of State was from the medical staff of the teaching hospital in Cardiff about this Order. I met their representatives on 10th July and, having listened to their case, I promised that I would consult the Secretary of State and see them again. I did so and, on 15th September, I told them that after due consideration of all the facts, the Government had decided to stand by the Order.

My hon. Friend and the right hon. Gentleman have given the House a good deal of the history of the matter, but I wish to deal with it in greater detail and to explain why the Government adhere to their decision. The proposal to set up a University Hospital Group in the Cardiff area originated some time ago. The right hon. Gentleman, who rightly said that his name was on the Order, was the Minister at the Welsh Office responsible for this move. The object of his decision was to unite all the hospitals in the Cardiff area, especially in the knowledge that the new University Hospital of Wales at Heath would be commissioned in the near future.

The merger was started at a meeting when the right hon. Gentleman announced his intention of finding a solution, and, as he rightly said, he set up a working party to consider the matter. That was in October, 1969. The working party had on it representatives of the University of Wales, the Welsh Office, the Welsh Hospital Board, the Board of Governors, the Welsh National School of Medicine and the Cardiff and District Hospital Management Committee.

The working party reported in February this year, and the report, which was unanimous, recommended: first, that the establishment of a university hospital group was feasible and desirable; secondly, that suitable arrangements could be made to delegate certain responsibilities to the new group; thirdly, that acceptable transitional arrangements for both capital and revenue finance could be made and had in fact been informally agreed by the Welsh Office, the board of governors and the Hospital Board representatives; and, fourthly, that it would be possible to introduce a new group by the 1st October 1970, if Ministers agreed, which they did.

Having met the representatives of the teaching hospital, I fully understand their feelings. A teaching hospital—and up to now this is the only teaching hospital that we have in Wales—is a very special organisation. These men are specialists in the true sense of the word. Before this merger they enjoyed a particular position, with direct access to the Secretary of State, without being responsible to the Welsh Hospital Board.

The men who put this case to me at these two meetings showed genuine concern that the teaching hospital would lose its independence and that there would be unnecessary delays in reaching day-to-day decisions. They told me that what had led them to accept the merger proposed by the working party was the expectation that reorganisation of the National Health Service would take place in the near future and that a new order of events would be introduced anyway. Their fears are understandable, but I believe that they will be found to be groundless.

I should like to conclude by giving several specific reasons why I think that this is so. Both the board of governors of the United Cardiff Hospitals and the University of Wales have accepted the report of the working party. I wish to stress that there will be a very strong university and medical representation on the new management committee and that it has considerable delegated powers. The chairman of the new management committee, who was the chairman of the board of governors, as has already been said, will have direct access to the Secretary of State if and when it is required. This is an important concession and is evidence both of the good will of the Hospital Board and of the Secretary of State's determination that Cardiff Teaching Hospital remains a centre of excellence.

I do not pretend that this has been an easy decision for me or for my right hon. and learned Friend to reach, for the men who represented the Medical Board produced their arguments with a sincerity and an ability which could not fail to impress anyone with any knowledge of the medical profession. The Hospital Board is in no doubt that in holding to the original decision the Secretary of State has placed upon it a particular and special responsibility.

The standards of the Cardiff Medical School are recognised throughout the country. They are certainly recognised by the Hospital Board and by my right hon. and learned Friend and myself. If we had thought that this Order would put those standards at risk, we should not have placed it before the House tonight, nor should I have spoken as I have. That is why I ask the House to accept the Order.

10.39 p.m.

Mr. James Callaghan (Cardiff, South-East)

I congratulate the hon. Member for Cardiff, North (Mr. Michael Roberts) on his speech. My right hon. Friend the Member for Cardiff, West (Mr. George Thomas) said that he was one of the hon. Gentleman's constituents. The hon. Gentleman once fought me at an election. I have fought six or seven opponents put up by the Conservative Party in the elections that I have contested. The hon. Gentleman was the opponent who gave me the closest run, and I always felt that one day he would get into Parliament. He is here now, and I hope that he will enjoy himself.

I hope that the hon. Member for Hampstead (Mr. Geoffrey Finsberg) is convinced of the merits of the case. Despite the eloquence of the hon. Member for Cardiff, North, I thought that the Minister made a case which is probably right. Let the hon. Gentleman not shelter, if he is tempted to do so, behind the belief that because my right hon. Friend introduced the Order the Government's hands are fettered. I hope it is clear to the hon. Gentleman that this is the Government's responsibility, and not the responsibility of my right hon. Friend. They are entitled to withdraw the Order. They are entitled to change the situation if they wish to do so.

Mr. George Thomas

They could have withdrawn it at any time.

Mr. Callaghan

Yes, and they could do so even now. The Minister of State has not withdrawn it because he knows that this is the right solution. He advocated it with sincerity and a certain amount of passion.

I pay tribute to the medical school at Cardiff. I think that there are some fine people there. The consultants and all those with whom I have come in contact there have impressed me very much indeed. We have heard a lot about all the people with interests there, except the patients, and in that sense this has been a strange debate, because although the interests of the medical school are important, as are the interests of the University of Wales and all the other medical staff there, what all this is about is the patients, the people who go there to be cured.

Having seen the operation of these boards ever since the Health Service was set up, I have long been convinced that it would be a good thing to amalgamate them in the way proposed, and the Minister has put his seal on it. But there is such a large whale in the middle of comparative minnows that we should get the whole situation unbalanced in terms of provision for the patients unless there was integrated management for the group. The hon. Member for Cardiff, North mentioned the Royal Hamadryad, a small hospital in my constituency with 50 beds. We should be running the risk of drawing resources from that type of hospital—and there is more than one of that type—if this tremendous complex of which we are all proud, the new Cardiff teaching hospital, were to act on its own, inevitably drawing the best staff, inevitably attracting the nurses, inevitably attracting all the facilities from the smaller units around, and it is a good thing that they should be brought together.

We are proud of this great new hospital which was completed during the days of the Labour Government, and we thank our lucky stars that it was completed before that lot on the benches opposite got their plundering hands on the Health Service.

Question put and negatived.