HC Deb 28 January 1971 vol 810 cc1101-12

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

4.57 a.m.

Mr. Jerry Wiggin (Weston-super-Mare)

I was grateful to Mr. Speaker for using his selection for this subject. Little was I to know that it would be nearly five o'clock in the morning of Friday before we should start to discuss hospital facilities— of which we shall all be in need shortly.

When I was first selected for the candidacy in the constituency of Weston-super-Mare I was immediately apprised of the substantial concern that was felt by all my constituents over the lack of hospital facilities in our area. During the period of almost two years that I have been a Member I have tried all possible legitimate and private means of pressing the case of this hospital. It is with some reluctance that I find it necessary to have an Adjournment debate. My predecessor, David Webster, was responsible for a great deal of the work done on this matter. I have a massive file that was handed to me of work done by him. Both the Weston-super-Mare Borough Council and the Axbridge Rural District Council, to say nothing of all the doctors and many individuals, particularly Councillor C. Curtis, have pressed this matter to the best of their ability over a period of 12 years or more.

The last straw came on Monday, 18th June, when the accident unit at our general hospital was closed at six o'clock in the morning owing to lack of staff. It is perhaps fortunate that the G.P.s in our area were able to organise a voluntary rota to keep a skeleton schedule of three hours each morning so that there was some service available for those who required urgent medical attention.

The statistics of the last four years of what the accident unit has dealt with will show the vast amount of work that is done there and the extreme crisis caused by the lack of facilities. In 1967, 27,834 attendances were recorded; in 1968, 31,257; in 1969, 34,258; in 1970, 36,275. Between 1960 and 1970 there Las been an increase in the work load of 50 per cent. The minimum total attendance in 1970 on any one day was 31 and the maximum 183. The average daily attendances for 1970 were 99, and the average daily attendances in July, August and September were 128. I am sure I do not have to remind the hon. Gentleman of the work that would be entailed in seeing personally 128 constituents on any one day. Every patient who goes through the accident department has to be seen by a doctor.

The reason for the closure was, quite simply, lack of staff. There are normally four doctors, one in charge of the department and three who work a rota system to keep the unit manned throughout the 24 hours. The department has been short of one doctor for some time, but with the illness of one other doctor it has ceased to be possible to keep the unit open. It is not surprising that many of my constituents are extremely disturbed by the lack of this facility. The morale of our nursing staff, which has suffered for some time through the semi-closure of our nursing school, takes yet another battering.

I will point out the special disadvantages of taking emergency cases 18 miles or more into Bristol. There is the pain and distress inevitably caused to patients. There is the pressure on the Bristol hospitals, which are already working to high capacity. There are the weather and road conditions to take into account, and it is of not insignificant import that during the week before last traffic delays in the centre of Bristol were up to two hours during the whole day. Most important of all, the ambulance men have been told that if they believe a case to be imminently fatal, they should take that patient to Weston for emergency attention. That is an extremely heavy responsibility to place upon an ambulance man who, after all, has only limited qualifications in this respect.

There is an urgent need to provide extra staff. This is the only accident unit in the South-West Regional Hospital Board area that has been completely closed, although I understand that Bridgwater is in similar trouble. Advertisements have been placed to fill this staff vacancy. Although the problem is not unknown elsewhere, it should not be beyond the wit of the South-West Regional Hospital Board and the Department of Health and Social Security to find a stand-in while illness keeps the unit shut.

There are, admittedly, plans to improve the facilities of this overcrowded and ancient part of the General hospital. About £70,000 is due to be spent, starting in April of this year. I ask my hon. Friend to see whether work can be started while the unit is closed. A few months ago I visited all the hospitals in my constituency, and the staff at the General Hospital are seriously concerned about their working conditions, while building work goes on around them. Could not advantage be taken of the unit being shut?

I turn from this specific subject to the more general one of the total deficiency in hospital facilities and the necessity for a new district general hospital in Weston-super-Mare. I regret to tell the House that the history of this matter reads rather like a comic opera. It would be funny if it were not so vitally important and tragic. As far as I can find out, the need for this new hospital first came to light in 1954. There is a record in 1958 of the borough council having passed a resolution expressing concern over the inadequacy of the facilities in the town. By 1963 they were beginning to talk about the first selection of a site.

The House will be aware that in January, 1962 the then Minister of Health issued a blue book. This set out that, … to give the hospital service of England and Wales both the physical equipment and also the pattern and setting which will everywhere place the most modern treatment at the service of patients and enable the staffs who care for them to exercise their skills and devotion under the best conditions. In the original plan the Minister did not expect work to be started on the new district general hospital at Weston-super-Mare until after 1970–71. But in the promised revision of the plan in 1963 the new hospital was mentioned as coming into the ten-year programme, and, as a result, a project team was set up by the regional hospital board to plan details of the new hospital. In the 1965 revision it was not even mentioned. The project team ceased work. No revision was issued in 1965.

In 1966 a further revision was published in which it was stated: A new district general hospital will be built at Weston-super-Mare, and this will enable the Royal Hospital to be used for geriatric purposes. This revision also stated that among schemes which it is hoped to start in the period up to 1969–1970 would be— Weston-super-Mare— new district general hospital— phase 1 (maternity unit). The project team started work again.

The then Parliamentary Secretary to the Ministry of Health wrote in 1965, addressing the letter to my predecessor: The Board have been in touch with Weston Borough Council about the site for the new hospital and it is hoped to make a firm choice between the two selected as suitable within the next few months. When this is done the land for the new hospital will be reserved and the possibility of early purchase will be carefully considered. After more dithering, events proceeded with breath-taking slowness. In February, 1967 the then Parliamentary Secretary wrote: I told you that approval has already been given and work should start in 1969–70)… The Regional Hospital Board has a site in mind for the new hospital and are at present negotiating its purchase with the owner. Another year passed, and in November, 1968 the Axbridge Rural District Council passed a resolution: That the Department of Health and Social Security be informed that this Council which has for several years been concerned to see that a new hospital should be provided to serve the needs of the expanding population of the Rural District as well at the Borough of Weston-super-Mare is alarmed by the prospect of further delay and that the Minister be requested to review the needs of the area as a matter of great urgency. That was in 1968. In September, 1969 a Press statement was issued: Meetings have taken place between Mr. W. J. English, Chairman of the South Western Regional Hospital Board and Mr. Richard Crossman, Secretary of State for Social Services, as a result of which a site has now been selected at Uphill… The Secretary of State is now proceeding with the necessary arrangements to enable the site to be acquired. That was in 1969. In November, 1970 the hospital board was writing to the town clerk explaining why the site was not yet purchased. I am sorry to say that there is still no firm news that the purchase of the Uphill site has been made. I hope the Minister will be able to give me an assurance about the completion of that contract.

The pressure built up during this period from both the borough council and Axbridge Rural District Council and from the Member of Parliament. Delegations visited Ministers in December, 1964 and November, 1969. Petitions with 13,000 and 14,000 signatures were presented in March, 1965 and November, 1969.

After the issue of a Press release which was not sent to me until I asked for it in early December of last year or late November, the board announced that the starting date for the hospital had been postponed to 1974–75. It claimed on the credit sited that a single phase development would enable the hospital to be completed earlier than under the original plan. Since, however, the original plan had neither a firm starting date nor a completion date, I can only say that must have been a wild assumption.

I should like to know whether the project planning team is once again at work. I suggest that perhaps, with the rapid advance of medical science, a shell-type of building, providing necessary services, with moveable internal partitions, might be an adequate way of starting construction in the time.

The reasons for the urgency are simple. At present we have eight separate units in an area of ten miles around the central hospital. Our present population is 90,000 and several people will say that it is much bigger. On any one summer day 40,000 extra tourists and holiday makers can come into our area. With the exception of Bath, Weston-super-Mare is the largest borough in Somerset. By the end of next year we shall have the M5 motorway running within a few miles, and inevitably this may well lead to urgent accident cases having to be treated at our hospital.

While it might be said that we can get more quickly to Bristol, it is safe to say that access from the motorway will scarcely be adequate.

The waiting list in 1970 for our hospital amounted to 1,284 cases; 479 general surgical cases, 265 gynaecological, 388 tonsils and adenoids.

I wonder whether the Minister could explain to the House in his reply how his Department assesses the requirement of tourists and holiday makers. In the matter of transport the South-West is badly served. I believe that similar criticisms may be levelled on medical grounds. Though a tourist may not be living permanently in Weston-super-Mare, as soon as he moves into the area, even for a short time, he ceases to become the medical responsibility of his home area. There is no doubt in my mind that the South-West in general gets far too small a share of the national cake in terms of medical finance.

In conclusion, I must praise the way in which our medical staff, doctors and nurses, work in extremely difficult conditions. I should be much happier, as would many of my constituents, if the Minister could give me one or two assurances. Could he say whether the site at Uphill has been purchased and, if not, when completion will take place? Could he give a definite starting date for the new hospital? I should like a firm promise since, through all this unhappy saga, we have never yet been told anything firm. Will he press the South-West Regional Hospital Board over the staffing of the general hospital accident unit? Will he press that hospital board to get on quickly with any improvements at the General Hospital, or at least to direct the funds in such a way that the new hospital can start a little earlier?

5.15 a.m.

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

I congratulate my hon. Friend the Member for Weston-super-Mare (Mr. Wiggin) on his resolution and endurance in sitting through the night until 5.15 a.m. on behalf of his constituents to raise a matter which, I agree, is of the utmost importance. I am sure that the conscientious attention which my hon. Friend has paid to this need in this debate at an extraordinary hour will not go unnoticed in the West country.

The hospital services in the Weston-super-Mare area are dispersed amongst a number of hospitals. Some of these were opened a century ago. Of course, over the years improvements and additions to the facilities have been made, but these measures have hardly kept pace with the rate of obsolescence and the problem of fragmentation has remained. Moreover, the population has been increasing and is expected to continue to increase. The growing numbers are, of course, considerably enlarged each year by holiday makers and other visitors. Hon. Members will appreciate that in these circumstances the services have been under considerable strain. The strain, however, has been felt in the main by the medical, nursing and other staff, and because of their devotion and skill— I am obliged to my hon. Friend for drawing attention to this— I am sure that few patients would complain about the treatment that they have received.

Nevertheless, it is clear that the present hospital facilities in Weston fall short of the standard which is desirable, certainly in a modern health service, and this has been recognised by the South-Western Regional Hospital Board in its plans to improve facilities throughout the region. The long-term solution proposed by the board, as my hon. Friend knows, is the provision of a new district general hospital for the Weston area. Before I speak about this, however— and I shall try to cover the points my hon. Friend raised— I should like to say something about the crucial factor of the accident and emergency services.

I am aware that because of medical staffing difficulties it has recently been found necessary to suspend temporarily the 24-hour, seven-day a week service normally provided by the accident and emergency department at Weston General Hospital. This major department, which had a total of 16,528 new patients and 34,258 attendances in 1969, has an establishment of one medical assistant and one senior house officer— two in all. The medical assistant is now ill and the senior house officer post is vacant.

The service was suspended on 18th January after consultation between the regional hospital board and the hospital management committee. The position was discussed with other interested bodies and alternative arrangements were immediately made and put into effect whereby patients requiring urgent hospital treatment as a result of an accident or other medical emergency would be taken direct to one or other of the three main hospitals in Bristol— Southmead, Frenchay and the Bristol Royal Hospital. In order to spread the workload it was agreed that each of these three hospitals should provide cover on alternate days. A patient who would normally have attended Weston General Hospital but was referred to one of these three hospitals for urgent initial treatment and who required to be admitted to hospital or was in need of follow-up out-patient treatment subsequently, would be transferred to the Weston General Hospital which would provide the necessary subsequent treatment. Such arrangements necessarily make increased demands on the ambulance service for the transport of patients the 20 or so miles to Bristol, but plans have been made to supplement this service by making use of taxis for patients not in need of full ambulance facilities.

I am glad to say that a locum replacement for the medical assistant has been obtained and is due to report for duty on 7th February following which the accident and emergency services will be reinstated. In the meantime, the work is being partially covered by a general practitioner. Advertisements have been placed for a senior house officer, but no applications have been received. The problem which has arisen regarding the staffing of the department has been discussed with the local general practitioners who have offered some help at night.

Difficulties in recruiting medical staff for accident and emergency departments are being experienced by a number of hospital authorities in different parts of the country at the present time. Due to a reduction in the inflow of doctors from overseas, there has been a reduction in the rate of increase in the total number of hospital doctors— provisionally 2 per cent. in the year to 30th September, 1970 compared with over 3 per cent. in previous years, which is quite a significant drop. Accident and emergency services, which are not the most attractive to junior medical staff, have been particularly affected by this decline in the rate of increase in the numbers of doctors.

There are long-standing problems in the staffing of these departments, which are manned to a great extent by junior staff with comparatively little participation by consultants. My Department advised hospital authorities in a circular issued in 1968 that provision should be made for personal day-to-day supervision of the work of these departments by their consultants. My Department's recent survey of progress has shown that there is still far too little day-to-day participation in these departments by consultants. In consequence the training value of junior posts is not as good as it should be, nor are young doctors able to see prospects for a career in this type of work.

There are real problems in this which cannot be solved overnight, but I know that representative bodies in the medical profession itself have recently given a great deal of thought to the future of these departments, and I hope that we shall be able to work out with the profession measures which will deal with the underlying long-term problems. This can be worked out only by good will on both sides in this sort of discussion with the profession.

Because the benefits of the major redevelopment project will not be available for some years, there may be an impression that hospitals in the Weston Group are not being improved and kept up to date in the mean while. This is not so. In the next financial year, 1971–72, there is a considerable programme of proposed building works and its total estimated expenditure would amount to the considerable sum of, in round figures, £250,000 in Weston. The details may interest my hon. Friend. First, there is a scheme, of which he may be aware, to improve and extend the existing casualty department in the Weston General Hospital. My hon. Friend asked, incidentally, whether money should not rather have been spent now on that scheme to improve the existing accident and emergency department— brought forward, as it were— but on the whole we feel that it would have been wrong not to have concentrated all possible attention and energy on reinstating the existing accident and emergency service, the closure of which was due to freak conditions of staffing.

Second, we hope to provide an extra radiodiagnostic room and improve the X-ray Department; and to set up a Central Sterile Supply Department to serve hospitals in Weston. This alone is estimated to cosi £85,000, of which £73,000 would be for building and engineering work, and £12,000 for equipment. This is expected to start on site in June or earlier. Third, there is a scheme to adapt existing accommodation in the General Hos- pital to provide eight emergency admission beds and six high-dependency beds. This would cost altogether about £99,000 of which £85,000 would be building, and £14,000 equipment. Fourth, refrigeration would be provided for the operating theatre suite at a cost of £8,000. Fifth, records accommodation would be set up at a cost of about £5,000.

Turning from the Weston General Hospital to the Royal Hospital, the fifth proposed project would give 16 additional geriatric beds, plus associated accommodation at a cost of £65,000-odd, of which £50,000 would be building, and £15,000 equipment. Finally, in Eastern Hose, an estimated expenditure of about £14,000 would provide 21 beds for convalescent patients on the second floor which would free 17 beds on the first floor for post-operative and preconvalescent patients. The board plans to spend in aggregate £276,000 on these schemes starting, we hope, in this financial year, 1971–72. This is substantial capital renewal, albeit that it is renovation and adaptation rather than new building.

I will turn now to the proposal for a new district general hospital. The proposal was published in the Hospital Plan of 1962, which did not expect the scheme to start until after 1970. Since 1962, as circumstances have changed, various alternative dates for a start on the building work have been adopted for planning purposes. Hon. Members will understand the difficulties confronting regional hospital boards in formulating and keeping up to date their capital building programmes, especially when they are forecast a long way ahead, and especially as regards starting dates. 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 addition to the general problems inherent in a capital programme, the board has to grapple with particular problems related to the project— in this case, notably, the problem of the selection of a suitable site. This is not the occasion to deal in detail with the history of the Weston project to date, but a word or two on the problem of choosing the site would, I think, be helpful. I do not need to remind my hon. Friend that much of the Weston area is low lying and of poor load-bearing capacity. These conditions are far from ideal for hospital building. They tend to increase the costs of development.

It was therefore necessary to undertake a careful examination of a number of sites and the likely costs of their development before it could be decided which site was the most suitable. I believe that the delay over the site caused a great deal of anxiety locally, and that in November, 1969 my hon. Friend led a deputation to the then Minister of State in the Department of Health and presented a petition containing some 14,000 signatures, so he has been pressing this for a long time, as we appreciate. The deputation was, of course, concerned that work on the new hospital should be started as soon as possible. It was not then possible to announce a starting date, but I believe that my hon. Friend was assured that the project was the board's top priority for hospital building, in Somerset and I am glad to confirm that it remains the top priority.

If I may go to the immediate question that my hon. Friend asked, discussions on initial plans have already taken place at officer level between the board and my Department. The endeavour now will be to see that detailed planning proceeds as swiftly as is possible, consistent with good planning. The latest information entitles me to report some progress this morning. Agreement between the board and the vendor about the purchase of the site has recently been reached——

The Question having been proposed after Twelve o'clock on Thursday evening and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Twenty-seven minutes past Five o'clock a.m.