HC Deb 03 February 1971 vol 810 cc1839-50

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

11.53 p.m.

Mr. William Price (Rugby)

I am grateful for the opportunity to raise a matter of vital importance to my constituents. I represent a politically militant area, but if there is one issue which certainly arouses emotions on a non-party basis it is the future of our hospital. There has been a long, involved argument, extending over more than 10 years. It has not been without its share of bitterness, and I am quite happy to admit my part in it. I have kept up a continual flow of Questions, and a long series of letters to various Ministers, and I have attracted my share of abuse from Birmingham Regional Hospital Board and Coventry Hospital Management Committee. I certainly make no apology for that.

I should like to ask the Under-Secretary some fairly detailed questions. I do not really expect too detailed an answer tonight, and I shall be quite happy if he in due course will let me know the answers to what I ask this evening.

The one question which I want to ask above all others, and on which I hope he can give me information is this. What is happening to the Birmingham Regional Hospital Board's £3.8 million proposed development at the hospital of St. Cross? This proposal followed recommendations of the working party established by the right hon. Member for Coventry, East (Mr. Crossman) when he was Secretary of State to consider the future needs of Rugby and Nuneaton.

A decision was promised in June, and some of my constituents feel that we have waited far too long. I do not criticise the Department on that score. With new Ministers and a change of Government the Secretary of State is entitled to take a long look at major capital spending programmes, and I do not think that this decision has been delayed unduly. We are in Rugby reasonable people, and the Under-Secretary of State will be relieved to know that I am not expecting him tonight to give me £3.8 million. We appreciate that there are many demands on his limited resources and many other priorities. We know that our scheme is a major one which we could not expect to be implemented for perhaps five to seven years. We understand all that and accept it. What we want and what we are entitled to is a statement of intent from the new Government about the future of St. Cross and its ancillary hospitals, St. Mary's Harborough Magna and St. Luke's.

We are getting the worst of both worlds. The uncertainty of recent years is having a sad effect upon the morale of the staff. We have lost certain specialist facilities. There has been talk of taking accident cases to Coventry and maternity cases to Nuneaton. In addition, in recent weeks three other matters have arisen which cause us concern.

First, on one recent week-end, as a result of staff shortages, the accident and casualty department was closed. People coming to the hospital late at night for treatment—and I spent two hours there in the middle of the night—were told to go to Coventry, 11 miles away. This decision was taken at the last moment and no publicity was given to it. When that happens to a major hospital we are entitled to know what is going on.

Secondly, I discovered last week that a newly-adapted ward produced out of an old operating theatre which would have provided desperately needed beds has failed to open because Coventry and Birmingham between them have refused to supply the two nurses which are needed to staff it. That ward, with six beds, has been ready for six months, the operating theatre is available, the surgeon is available, the capacity is there, but it remains closed because we cannot have two nurses.

Thirdly, the General Nursing Council proposes to take away State Registered Nurse training because the number of beds has fallen below the 300 minimum. At the moment when the Secretary of State is considering a major development for this hospital the General Nursing Council proposes to take away the most important part of nurse training. We will not accept that decision. We shall fight it every inch of the way. I have never been clear what authority the Secretary of State has over the General Nursing Council, but I suggest that that decision should be postponed at least until we what the long-term future of St. Cross is likely to be.

Among the Questions currently down for Answer was one asking for comparable State Registered Nurse examination results for Rugby, Coventry and Nuneaton over the past 10 years. I now have the Answer and I hope the hon. Gentleman will look at it closely. He will see that the hospital with by far the best record of the three is the one which is likely to be run down.

Behind this decision and many more decisions involving Rugby hospital looms the £9 million hospital at Walgrave, some 11 miles away. I believed from the beginning that Rugby would have to make a significant contribution to the cost of that hospital and, knowing all that has happened in the past three or four years, I have no cause to change my mind. I understand there are severe staff difficulties at Walgrave and it is bound to look for staff from Rugby.

I am convinced that there are people on the Coventry Hospital Management Committee who are determined to run Rugby down, if it can possibly be done. I personally do not get on very well with the Birmingham Regional Hospital Board. I do not find many people who do. It is a strange masonic-type organisation. Getting information out of it is a work of art. With one or two exceptions, the board is made up of amiable people who cause the least trouble, plus officials who stand no nonsense. It is not a happy set-up.

Occasionally a Minister makes a mistake and appoints to the board a member who tries to lift the veils of secrecy. There has been one famous case involving a Mrs. Theresa Stewart of Birmingham. Her period of service has just been ended by the Minister. That is what she got for her trouble. I know where the recommendation came from, and I know Members in the West Midlands, including myself, will seek to ensure that the Minister and his right hon. Friends hear a great deal more about Mrs. Stewart. Her sacking was, in my view, a piece of political malice and vindictiveness. I do not expect the hon. Gentleman to comment on this, but if he is looking for a replacement for Mrs. Stewart, I am delighted to offer my services. I hope the hon. Gentleman will pass on that information to whom it may concern. We already have my hon. Friend the Member for Nuneaton (Mr. Leslie Huckfield) on the regional board and I dearly should like to follow him.

I do not believe the board has been open and honest with Rugby, even allowing for its difficulties—and I know it has many. I am prepared to admit that some of the criticism levelled against it from Rugby has been severe. In the past some of us have tried to argue that, if we were not careful, Rugby would slowly be reduced to cottage hospital status. The board denies it and in one respect it is correct; there will never be any announcement of that nature.

What worries us, however, is that there is more than one way of taking a pig to market. We say that anybody setting out to run down St. Cross, to amalgamate, call it what one will, could hardly go about it in a more effective way. The pattern has been predictable and inevitable. We lose our specialist services, nurse training, possibly our matron, possibly also our accident services. Our staff drift away and others cannot be recruited. Where do we go from there?

The Under-Secretary of State said in the House yesterday: At a meeting with representatives of the Birmingham Regional Board on 28th January it was agreed that further consideration should be given by the Board to the provision of acute beds."—[OFFICIAL REPORT, 2nd February, 1971; Vol. 810, c. 1452.] I was interested in the Answer and grateful for it. It indicated, perhaps for the first time, that something was beginning to happen.

Several question arise. First—and this is the crux of the matter—when are we likely to see some development and what is it likely to be? Secondly, what has happened to the proposed 112 geriatric and 40 maternity beds, all part of the £3.8 million proposal? Thirdly, is the promise by Mr. Julian Snow, as he then was, in a similar debate to this one in 1968, that work would start as soon as possible after 1969–70, to be fulfilled?

The Rugby Advertiser, which has a long and honourable record on hospital matters, recently described the hospital issue as "an incredible saga", and it added: The bewilderment must not be allowed to continue. The Minister for Health must himself sort out just what is going on in Birmingham, and he must be prepared to tell the people of Rugby the whole truth and nothing but the truth. The Chairman of the Rugby Social Services Hospital Committee, Mr. Norman Edyuean Walker, is a man with many years of service to hospitals. He was recently quoted as saying: Some patients requiring cold surgery are waiting up to two years and yet St. Cross has modern theatres which are not worked to capacity simply because there are not enough beds. It is quite scandalous. Parliamentary answers have indicated that our waiting list for surgery is about 50 per cent. above the national average. I ask that the Ministry should take the view that the time has come to put the matter right.

Finally, I understand that the Under-Secretary will be accepting an invitation to visit our hospitals. Perhaps I could thank him in advance and assure him of a most cordial and possibly warm welcome.

12.6 a.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

I am grateful to the hon. Member for Rugby (Mr. William Price) for providing an opportunity for us to discuss the future of the hospital services at Rugby, and for making his speech commendably brief.

As he mentioned, I intend to visit the hospital of St. Cross at Rugby later this year, so I have naturally been interested to hear his views and comments in advance. Over the years, the hon. Gentleman has taken a great interest in not only that hospital but all the hospital services in his constituency. He has frequently drawn the attention of the House to the existing provision. I know that he has the hospitals' interest very much at heart and I will try to give him at least some of the assurances which he has sought.

Perhaps I can place the debate in its proper local context. There are at present three hospitals at Rugby: St. Cross, St. Luke's and St. Mary's, Harborough Magna. The hospital of St. Cross is a former voluntary hosiptal standing in about 16 acres of land. The original hospital was built in 1882 but there have been a number of additions since then, the most recent being the provision of a twin theatre suite in 1966. St. Cross has 154 acute beds and provides most of the general hospital services for the town. I understand that the buildings are quite substantial and in reasonable condition. I shall have a chance to assess them when I visit Rugby.

There are several capital schemes proposed for the hospital to provide day and out-patient facilities for mental illness patients and to upgrade the existing X-ray facilities and engineering services. The southern portion of the hospital site, about seven or eight acres, is vacant and available for building purposes. It is on this site, as I shall explain later, that the Birmingham Regional Hospital Board proposes to redevelop the existing hospital services, and I stress that.

St. Luke's Hospital is a former poor law institution and occupies a four-acre site which is built up on all sides. It currently consists of 30 acute and 96 geriatric hospital beds and is, I am told, far from adequate.

The other hospital in the area is St. Mary's Harborough Magna, about five miles from Rugby. This is a former isolation hospital standing in nine acres of land. The present buildings date from the mid-1930s and it provides some 47 maternity beds.

The board intends to concentrate the hospital services at Rugby on the Hospital of St. Cross site. As I told the hon. Gentleman on 11th November, the board proposes to redevelop this hospital to provide 376 beds, made up of 224 acute, 112 geriatric, and 40 maternity beds, together with supporting services at an estimated cost of £3,800,000. The first stage of the main development is planned to provide 40 maternity beds and 128 acute beds, with other services including new boilers, ante-natal clinic and pharmacy. That is the first stage development which the hon. Gentleman asked about. When this stage is completed, it is envisaged by the board that St. Luke's and St. Mary's will no longer be required for their present use.

I hope that the hon. Gentleman will accept this as a firm and categorical declaration of intent, to use his words. He is aware of all this, I think. At least he will be more confidently aware of it now.

As the hon. Gentleman said, his main concern is not only if, but when. I hope that I have settled "if" to his satisfaction. He is also concerned as to when the new provision will take place. My Department, together with the Board, is at present examining the functional content of the proposals, as I told him in answer to his Question yesterday, and we are especially concerned about the acute bed ratio for the size of the population and the revenue consequences of this capital development. All these are under consideration, and they are typical of the sort of detailed scrutiny which only serves to underline the reality of what is in prospect.

I should perhaps explain now that part of our planning requirement is not only to cater for current need but to attempt to assess demand in a decade's time taking account of such factors as population estimates, local authority social services and possible changes in medical techniques. Regional hospital boards and my Department have acquired a certain amount of expertise in this field. The hospital building programme is based on a high degree of co-operation between the boards and the Department. But it is the regional hospital boards which are primarily responsible under the National Health Service Act for their own building programmes giving priority to the areas of greatest need.

The estimates for the Birmingham Region show that it has to plan for a population which is expected to increase by at least 10 per cent. to some 5½ million by as early as 1981, largely by a high rate of natural increase and also by movement into the region from outside. The major problems are to provide for this increase, including the new towns developing at Telford and Redditch, to provide better accommodation where there are large populations and to improve the hospital services elsewhere. Inevitably, the board is faced with tremendous problems in assessing priorities where the backlog of old and inadequate buildings is very considerable.

It is against this background that the hon. Member's demand for replacement of the present hospital services in Rugby has to be slotted in and examined. The original Hospital Plan published in 1962 envisaged a start on the construction of a district general hospital within the decade. Since 1962, as circumstances have changed, various alternative dates have been adopted for planning purposes. As I have already mentioned and I am sure the hon. Member will appreciate, there are numerous difficulties confronting regional hospital boards in formulating and keeping up to date their capital building programmes where these are projected several years ahead. Needs and priorities within the region must be assessed, costs must be estimated and a programme of building drawn up which is realistically matched to the resources which are likely to be available in future years.

These and other factors such as the rate of capital expenditure on building works in progress are by no means constant. In fact it is inevitable that over the necessarily long period involved these capital programmes are often highly variable. Such programmes must therefore be capable of adjustment, and starting dates other than within the current financial year provisionally adopted for planning purposes must necessarily be tentative. It is unrealistic at any stage of planning to attach too much weight to a starting date several years ahead which is arrived at solely for planning purposes. The hon. Gentleman might be better served if we did not attempt to give him more than this firm assurance that we are committed to what I have already said, without giving a factual and firm date at this stage.

However, I must point out to the hon. Member that this Government, as one of their early actions, have taken steps to ease these difficulties faced by hospital boards. In our public expenditure review we have been able to more than maintain an expanding hospital building programme. Solid additional funds will be provided over and above those planned by the previous Administration for the National Health Service over the next four years, and some of these will undoubtedly be available to the building programme. As my hon. Friend the Secretary of State told the House on 11th November, this will enable the normal development of the service, including building programmes, to continue and progress to be speeded in vulnerable sectors, such as the care of the mentally ill, mentally handicapped, and the elderly.

In addition to the general problems inherent in a capital programme, the board has to grapple with the particular problems related to a large catchment area—in this case the provision of hospital services for the Coventry, Nuneaton and Rugby area. The board's first priority for the area was to provide a new district general hospital at Walsgrave, Coventry, to replace the totally inadequate hospital services resulting from the severe bombing of Coventry during the Second World War. The Walsgrave Hospital is now open and provides a hospital service not only for the people of Coventry but various specialist facilities for the Rugby area, such as neurology, cardio-thoracic and E.N.T. surgery. The board's plan in fact for the whole area is based on the district general hospitals at Coventry with supporting hospitals being provided at Rugby and Nuneaton.

It is, of course, the prospects for this subsequent provision that has led the hon. Member to raising the matter this evening. As I have explained, the board is at present examining in depth the scope of the hospital provision, particularly acute beds, to be provided in future for Rugby. The current plan is to provide a medium-size hospital concentrated on the St. Cross Hospital site within the town. I hope, at the invitation of the Hospital Management Committee, to be able to visit the existing hospital and new site later this year and to examine for myself the extent of the existing provision and the need for its replacement.

I suspect, without prejudicing my visit at all, that I will find a standard of hospital provision at St. Cross and at Rugby generally not dissimilar to that which exists at present in many other towns in England. Certainly not the ideal medical provision for the 1970s, but of a standard that we all too frequently have to accept as adequate. There still exist too many "black spots" outside Rugby in our hospital service and it is the replacement of these, as I am sure everyone will agree, that must take first priority.

It is very much to the credit of the hon. Member that he has pressed his claim for new hospital provision in his constituency with such diligence. I note that he seeks to pursue it even more actively by proposing himself as a member for the board. We shall have to look at that separately.

The board will, I am sure, meet the hon. Member's claims as resources and priorities permit. Of course, similar claims could be pressed on the board by all the hon. Members representing constituencies in that region. All in all, I think the board is sensibly following a carefully prepared programme with reasonable provision being made for the most urgently needed areas.

Perhaps I might touch briefly on three points made by the hon. Gentleman. I would rather not comment on the first matter about accident and emergency services without looking at the facts, but I will write to the hon. Gentleman about it.

The approval of nurse training schools is conducted by the General Nursing Council, the statutory body responsible for nurse training. The Council has no responsibility for staffing the hospitals, except to ensure that there is adequate supervision for student and pupil nurses; but it is very much concerned to ensure that nurses in training receive the best education and experience available

It is both the Council's and my Department's policy to introduce group training schools based on the hospital group area when a group, such as the Coventry Group, adopts the Salmon structure of nurse administration. This ensures that the experience available in the group is used to the benefit of all students. As the existing school at Rugby barely meets the Council's minimum requirements the introduction of a group training school will clearly be to the benefit of students there. Previously, because of the necessary secondments to complete their experience students at St. Cross spent only about 18 months of their three-year training on the wards of St. Cross. In the group school students recruited at St. Cross will spend 12 months on the wards, there but the decrease in service provided should be offset by increased recruitment and retention of nurses as a result of the better training facilities available.

Therefore, I do not think that there is much fear for the St. Cross nursing prospects, with the group school that we hope to develop which will possibly raise the standard both of the nursing profession and the recruitment possibilities in the future.

Question put and agreed to.

Adjourned accordingly at nineteen minutes past Twelve o'clock.