§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Goodhew.]
§ 1.40 a.m.
§ Mr. Michael O'Halloran (Islington, North)I am grateful to be able to bring to the attention of the House the very serious position of the Royal Northern Hospital in Islington, the fact that no definite plans exist for its rebuilding, and the fact that there is a grave shortage of beds. This sense of grievance is not confined to one part of the community but is deeply felt by the medical staff and, most important, by prospective patients.
Since 1947, suggestions which have been made for a major increase in the number of beds on the hospital site have been rejected on the grounds that the Inner London Authority is well provided with hospital beds and that this applies in the Holloway and Islington areas because of the proximity of the Whittington Hospital. In 1948, that hospital had 2,000 beds. Now, it has 990. In the newly planned Whittington Hospital, there will be 920 beds, of which 150 will be for psychiatric patients. If an accident service is planned on that site, 200 beds will have to be allocated for this special problem, thus leaving an overall number of 570 beds, which will make a further reduction from the present 990 to 420.
Examination of a map of the area surrounding the Royal Northern Hospital shows that it is very well placed in relation to traffic routes and that transport 530 facilities are excellent. It will also be seen that, apart from teaching hospitals, there are no hospitals between the Royal Northern and the City in the south or between the Royal Northern and the West End in the south-east and east. There are no hospitals except the Metropolitan and the Prince of Wales, Tottenham, both of which are comparatively small, and I understand that their viability is at present under consideration.
The Royal Northern stands in an island site and all the properties and land there belong to the Department of Health and Social Security, so no compulsory purchase orders would be needed to acquire land for expansion. The hospital now provides services equal to, and in some cases greater than, those associated with hospitals of 500 beds or more. It is evident that, if the number of beds on the Holloway site were appreciably increased, the cost per patient would go down. The trouble is, there are now 265 general beds available at the hospital.
On 2nd February, 1968, Mr. Kenneth Robinson, then Minister of Health, wrote to my predecessor, the late G. W. Reynolds, saying that there was an urgent need for more beds to enable the hospital to fulfil its responsibilities to the National Health Service. He then suggested increasing the number of general beds available by closing the maternity department and decreasing the number of private beds, so that the resulting increase was only 17 beds.
It should be noted that, in the years 1964–67, the income from the private beds was £362,000 and the overall spending on allocations for the whole group was £293,624, so that the private wing of the Royal Northern financed the overall spending on the general beds not only in this hospital but in the whole group.
531 Future plans for the Islington area were discussed in detail at the Department of Health and Social Security in January this year "as part of a discussion about a geriatric research centre". The Department officials eventually acknowledged verbally that by 1981, after the Royal Free Hospital, University College Hospital and Whittington developments were under way, there would be 60,000 or 80,000 requiring hospital services for whom no provision has been made by those three hospitals under the direction of the North-East Metropolitan Regional Hospital Board. In other words, about 400 additional general beds would be required, so that if the new Royal Free, University College and Whittington Hospitals were not increased in size, the Royal Northern would still be needed, and there seems no possibility of altering the plans for these three new hospitals.
The Royal Northern is almost unique in having a very large number of outpatients but a very small number of inpatient beds. The out-patient and casualty service of this hospital is out of all proportion to its present size, and this shows another planning problem for the future in that without the Royal Northern, as things are even now, Whittington Hospital will have to take about 280,000 casualty out-patient attendances yearly, and this has not yet been planned for in the new hospital.
In 1958 the Royal Northern had 72,991 out-patient attendances. In 1965 it had 95,000. For the quarter ending 31st December, 1970, it had 37,979 outpatient attendances. In the casualty department in 1958 it had 44,418, and in 1965, 50,312. The total number of admissions to the Royal Northern of all types increased from 5,075 in 1951 to 7,572 in 1966. The average duration of stay in the five hospitals within the Board's area from 1965 to 1968 was: New End, 17.9 days; Whittington, 15.9 days; Central Middlesex, 14.3 days; Paddington General, 14.2 days; and the Royal Northern, 11.2 days.
The major problem facing us in the next 20 years is the solution to the problem of the care of the aged, the chronically sick who need permanent hospital care, and the geriatrics who need hospital help but who can, with imagination and skill, be incorporated back into society. The problem regarding the 532 Royal Northern is now under review by the Department of Health, but the Hospital Group Management Committee has for the last nine years repeatedly, without the slightest success, asked the regional boards to tackle this problem.
In the last 10 years improvements to the Royal Northern Hospital have been a new out-patients department with X-ray and full casualty and accident services, four new operating theatres, a new nurses' home and an intensive care unit, and this will be completed this year.
The City of London Maternity Hospital is at present sited in Hanley Road, about half a mile from the Royal Northern. It is the second largest maternity hospital in London, having over 100 beds. Both the Hospital Medical Committee and the Management Committee have agreed that the City of London Maternity Hospital should be redeveloped on the Royal Northern site.
I feel it advisable that a maternity hospital should have at its disposal all the disciplines and ancillary services of a general hospital. There is at present an acute shortage of maternity beds in this area of North-West London and I am informed that, owing to the shortage of beds and facilities at the Royal Northern, patients for pregnancy termination have to be put on the waiting list.
The Royal Northern Hospital has served the people of Islington and the neighbouring area from 1856 and I suggest that there is a viable case for the future development of this hospital on these grounds: the ratio of beds to the population; the present move of the Royal Free from Grays Inn Road to Hampstead; the need for a local accident service; the need for a regional geriatric service for this part of London; the necessity of establishing the City of London Maternity Hospital on the island site of the Royal Northern; the ability to recruit staff and to continue to give post-graduate training; and the continuation of a hospital which has shown itself to be one of the best in London.
Rumours have been circulating among the medical staff of the hospital and statements have appeared in local newspapers to the effect that the Royal Northern is to be phased out. I hope that the Minister will say tonight that the Royal Northern Hospital will continue to serve the people of Islington.
§ 1.50 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)I am glad that the House has the opportunity from time to time to discuss problems which are not directly concerned with the great national or international questions of the moment but with the more local issues—often the saner issues —which touch intimately the affairs of most of us at some time or other during our lives—and, in this case, touch a large block of people, both the users of the hospital and those who work in it, very intimately and particularly.
Tonight, the hon. Member for Islington, North (Mr. O'Halloran) has given us the opportunity to take time to consider the place of the Royal Northern Hospital, both in the present and in the future, in the life of the staff and the people it serves. I know that this busy acute hospital of 270 beds is held in the highest regard in the locality which it has served since its foundation as long ago as 1856, and I realise that its extremely hard working, efficient and competent staff who serve it both devotedly and loyally, having the best interests of the hospital at heart, are, naturally, concerned to know its future place in the scheme of things in that part of London.
As the hon. Gentleman knows, the body with overall responsibility for the planning of hospital services in this area, which includes Islington and Camden, is the North West Metropolitan Regional Hospital Board. In the Hospital Plan, Cmnd. 1604 of 1962 and in the Hospital Building Programme, Cmnd. 3000, published by the last Government in May 1966, that Board provided for the future development of the Royal Northern Hospital, and it told me recently that its present intention remains in accordance with those proposals, which were that it should be redeveloped on its existing site. The first stage of the redevelopment comprising out-patient, accident and diagnostic X-ray departments was completed in 1963, and this was followed in 1969 by a new nurses' home.
The hon. Gentleman will appreciate, however, that the future of an individual hospital cannot be planned in a vacuum and that the planning authority must pay regard to such factors as population trends, the rôle of other hospitals in the 534 locality, and the pattern of teaching hospital services. While, therefore, in the Board's view, there is no reasonable doubt about the continuing acute rôle of the Royal Northern Hospital, it has not come to any final zconclusion about its future size, which would need to be related, obviously, to the future population of the area.
For this and other reasons, the Board has not found it possible to include the full further redevelopment of the hospital in the current capital building programme which extends up to 1978. In the short term, however, the transfer of the radiotherapy department to the Royal Free Hospital has enabled the Board, as the hon. Gentleman probably knows, to arrange a necessary addition of about 20 acute beds to the hospital.
In assessing what the future size of the Royal Northern Hospital might be, the Board will need to have regard to the factor of population, as I said, and to the future rôle of the teaching hospitals. The population of the area around the Royal Northern Hospital is declining in contrast to other areas in the region where the build-up of population has created heavy pressure on hospital services leading to the need to augment them as rapidly as possible.
Into the area pattern must be slotted developments in the teaching hospital field and the likely service effects on these must be taken into account. The main developments are the building of the new Royal Free Hospital at Hampstead and the assumption of the district function by University College Hospital.
In recent years it has become apparent that if the country is to train the doctors needed not only to maintain but to improve medical services, medical schools in association with hospitals must expand to be able to accept more students and the hospitals concerned must have access to a population big enough to provide experience in the treatment of illness for students under the guidance of experienced consultants. In order to achieve this aim, and to make the best use of available resources, it has been found desirable in many cases for teaching hospitals to add to their teaching function that of hospitals serving a local community. In this way they assume responsibility for serving a district, meeting 535 all hospital needs and not merely specialist interests, and in turn come to be regarded as the district general hospital.
In North London, it is hoped that the Royal Free Hospital and the University College Hospital might assume the responsibilities of district hospitals and thus together serve a population of some 270,000. There would remain in the London Boroughs of Islington, Camden and Haringey a population of 230,000–250,000 which would continue to be served by the North London Group of hospitals including the Royal Northern Hospital.
Another factor which makes it difficult for the Board to finalise its planning in this area is the effect of forthcoming proposals on reorganisation of the health services. As the hon. Member knows the Government have announced their intention to unify the three parts of the National Health Service outside local government. The reshaped National Health Service will come into operation on 1st April, 1974, the date set for the coming into operation of the new local authorities promised in the White Paper of my right hon. Friend the Secretary of State for the Environment called "Local Government in England".
The hon. Gentleman in particular will also know that we are by no means satisfied that the proposals for the administrative structure of the National Health Service set out in the previous Administration's two Green Papers, particularly the second, would create an efficient structure for a unified service. We are therefore studying carefully the comments made on that Green Paper and hope to issue shortly our own proposals for the reorganisation of the service. It is our intention to provide an efficient and effective management structure in order to provide the comprehensive care and treatment to which the public rightly looks.
However, these planning uncertainties have, as I have said, led to the Board's being unable to include the full redevelopment of the Royal Northern Hospital in its current building programme but the programme is a flexible one. For example the medical staff's proposal for a geriatric research centre is under active consideration. More should not therefore be read into this exclusion for the current programme than that develop- 536 ments elsewhere merit in the Board's view a higher priority, at least for the present.
I think that the hon. Member will appreciate from what I have already said that there is absolutely no prospect of any change in the general rôle of the Royal Northern Hospital in the immediate future. My hope and expectation is that it will continue its excellent and devoted service to the people of the area for years to come.
§ Mr. O'HalloranI have here a paper from the Royal Northern dated 31st December, 1970, when it had 1,057 people on the waiting list for beds. Some of them had been waiting for three years to have operations. What will happen to them?
§ Mr. AlisonI take the hon. Gentleman's point. This merely serves to underline my point that the general rôle of the Royal Northern Hospital for the immediate future is certainly secure. The picture he has presented of an extensive waiting list demonstrates the essential rôle it is fulfilling now. It is my hope and expectation that it will continue this service and live to discharge its long waiting list for years to come. However, with the best will in the world, the hon. Member would not expect me to forecast the future with any certainty for more than 10 to 15 years ahead, particularly in the context of London, with its fluctuating population and the introduction of "district" responsibilities to teaching hospitals. But for the future, numbered certainly in years, I am confident that its rôle is secure, and I believe that that is the Board's view.
Even if at some time in the unknown future a change of circumstances, however unlikely it may appear at the moment, led to a review of the rôle of the Royal Northern, the hon. Member can be assured that the closure or change of use of any hospital is a matter for decision by my right hon. Friend, and that, before he makes a decision on a proposal of this kind, he satisfies himself scrupulously not only that the proposal is sound but also that the regional board making it has undertaken proper local consultation before recommending it to him.
The task of securing local understanding and acceptance of a proposal to alter 537 the rôle of a hospital is a difficult, indeed delicate one, and guidance has been issued to regional boards on the handling of proposals they make to my right hon. Friend. Over the years, as the hospital building programme has developed and new or developed hospitals have replaced those which have become redundant, considerable experience of the task has been gained, and the latest guidance, which was issued by my right hon. Friend's predecessor, reflects that experience. I think that it might be helpful if I were to outline here the essence of that guidance.
I make this point to the hon. Gentleman not to suggest that we regard any proposal to change the status of the hospital to be imminent—we have no knowledge of any such proposal—but to underline that there is an enormous amount of carefully staged discussion before any proposal even comes to be considered by my right hon. Friend, so many safeguards are built in.
The procedure commended to boards has a number of essential features. Boards are advised to follow a plan designed so that the local community can understand the reasons for any proposal and also the new arrangements that would be brought into operation if the proposal were to be accepted by my right hon. Friend—in short, to ensure that informed public discussion is possible. They are urged to undertake local consultations with representatives of the bodies most concerned, particularly the local authorities, the general practitioners and the staff. And before finally making up its mind on a proposal, the board must, of course, give proper consideration to reasonable opinion expressed during 538 the course of the consultations. Of course, the staff of the hospital would have ample opportunity to make their views known to the board if any proposal were envisaged long before it came to the Secretary of State. The board then makes its recommendations to my right hon. Friend, together with a full report on the proposal and on the consultations and, as I have already said, the final decision then rests with him, and with him alone.
So the hon. Member will see that, even if in due course, the North West Metropolitan Regional Hospital Board were to propose that, in future, the Royal Northern should fulfil a different rôle, there would be no hasty or unpublicised action on the proposal. The opportunity would be provided for local interests to examine and comment on it and the final decision whether to accept it be taken in the light of all the comments made. I make this point merely to show that there are many stages to be gone through long before any proposal reaches my right hon. Friend. I have no reason to believe that any proposal is imminent in this case, however.
I hope that I have said enough to reassure local residents, the staff of the hospital and the hon. Gentleman that, in the light of present day circumstances, and subject to planning considerations not apparent now but which may become so in the future, the Royal Northern Hospital has a promising future and so features and continues to feature in the Board's proposals for the future.
§ Question put and agreed to.
§ Adjourned accordingly at four Minutes past Two o'clock.