HC Deb 29 January 1971 vol 810 cc1208-18

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

4.5 p.m.

Mr. Michael Barnes (Brentford and Chiswick)

I am very glad to have the opportunity to raise today the question of the future of Brentford Hospital. It has been known for some time that the North-West Metropolitan Regional Hospital Board wants to close the hospital when the new King Edward Memorial Hospital at Southall is opened, which it is expected should be in 1975. But it was only at the end of last year that the board took a formal decision to recommend to the Secretary of State for Social Services that when the new King Edward Memorial Hospital is opened the needs of the area will be adequately met by that hospital and that, therefore, Brentford Hospital could be closed. That view is hotly disputed in Brentford, and I intend this afternoon to set out the main reasons why I think that Brentford Hospital should continue, if only in a secondary rôle.

First, I should like to dispose of a red herring which has confused the argument about the hospital unnecessarily. That is the proposal to realign the A315 road, which at present is Brentford High Street, along a route which could involve the destruction of part of the hospital. It is not my purpose today to set out the argument against the new road, but it is my view and that of many of my constituents that the new road is completely unnecessary. I am forced to refer to it because there seem to have been times when it looked as though the Regional Hospital Board on the one hand and the planners on the other were in danger of falling into a sort of circular argument, with the board thinking that closing the hospital did not matter because the planners were going to put a road through it, and the planners saying that putting a road through the hospital did not matter because the board was going to close it.

In fact, the road need not affect the hospital. If the road goes ahead, it will be in two stages, the first of which is from Kew Bridge to Boston Manor Road. The Council hopes that the route for that part will be clear by 1974. But if, as seems likely, there is a ground level interchange between Boston Manor Road and the new road, the hospital would not be affected at all by the first stage of the road. The second stage of the road is phased for the latter part of the period 1976–81. It involves the destruction of part of the hospital, but the hospital could be resited, mainly on its existing grounds.

If that is the position, surely it would be perfectly possible, once a firm decision had been taken to keep the hospital, to modify the road plan to spare the hospital altogether?

In any case, a road plan should never be regarded as a fait accompli. These things always take far longer to complete than people think at the beginning. In many cases, they cost far more money, and sometimes they are even abandoned. There is mounting opposition in Brentford to realigning the road, and various things might happen. The authorities might take the view that they should go ahead only with stage 1 of the road. It might even be possible, though it is unlikely, to persuade them not to go ahead with realigning the road at all.

The only reason I mention the road is that it has bedevilled the argument about the future of the hospital far too much, and I have sought to show that the road need not affect the future of the hospital at all. The road tended to influence my right hon. Friend the Member for Coventry, East (Mr. Crossman) when he was Secretary of State. When I had a discussion with him about the future of the hospital in July, 1969, he went so far as to say that if there was no road plan he believed the right thing was to retain Brentford Hospital in a secondary rôle. There are strong arguments for Brentford Hospital to be retained in a secondary rôle and it is to this that I should like to turn.

In the last few years Brentford has had a health centre and the local doctors who run it find that they can do their job very much more effectively with the facilities at the health centre than they were able to do previously when working from their own surgeries. This health centre has become a valued part of the community in Brentford. If Brentford Hospital is allowed to continue, it could be an effective community-based link between the health centre and the local doctors on the one hand and the big hospitals, including the new King Edward Memorial Hospital, on the other.

In order to support that claim I can do no better than to quote the views of two doctors. One is a local general practitioner, Doctor A. G. Philp, who last year wrote to the Medical Officer of Health at the Hounslow Borough Council a letter from which I should like to quote. He said: I have discussed the proposed closure of the hospital with my colleagues in Brentford, with several others in Chiswick and Hounslow, with patients, and with members of the League of Friends. The unanimous opinion is that closure of the hospital would be a catastrophe. … Over the years I have found that the existence of the Brentford Hospital has proved an invaluable asset to the people of Brentford and the surrounding district, and to myself and my colleagues in general practice. Not every patient admitted to hospital requires intensive investigation and treatment. … On many occasions I have arranged for patients to have an operation in a large hospital, and within a matter of days be transferred to Brentford Hospital for the remainder of their post-operative care. This means that the larger hospital can deal with more patients requiring more intensive care; it means that the general practitioner has some continuity in the case of his patient; for the patient it means that he sees familiar faces in an atmosphere that is less impersonal than the larger unit; for relatives it means shorter journeys and less inconvenience and the expense (and very often an explanation of what is happening and what it is all about in terms they can understand). … Among many instances of the benefits to patient and doctor that accrue from the privilege of having a Cottage Hospital such as Brentford, consider the 'healthy invalid' admitted during the summer to allow a devoted family to have a much deserved holiday, returning refreshed to care for an elderly dependent relative for yet another year. Or the younger terminal patient who can receive all necessary kindness and care near his own home. I would also like to quote a passage from a letter written by the surgeon to whom I referred, Mr. E. J. Radley-Smith, who is surgeon to the Royal Free and to Brentford Hospital. He wrote a letter to the Chairman of the League of Friends and said: In these days of divorce between the hospital services and the general practitioner medical services, the type of hospital which Brentford Hospital represents is invaluable because it bridges this gap. The local practitioner may feel that his patient needs inpatient treatment; he therefore admits the case to one of the beds in Brent Hospital and continues, while the patient is an in-patient, to look after that patient in co-operation and consultant with the consultant staff and when ready for discharge from the ward he is in full possession of the facts concerning the investigations, etc., and then is the better able to continue supervision once the patient has returned home and comes under the care of him and as a general practitioner. This renders ideal service to the patients and is also of great benefit to the local doctors. It would be a thousand pities to destroy any such hospital, particularly as many structural improvements have taken place recently. In addition to those views, practically every local organisation in Brentford and Chiswick, from the Brentford Chamber of Commerce to the Brentford and Chiswick Public Relations Council, is unanimous in the view that the hospital has a continuing rôle to play in the life of the community.

I feel bound to say that the attitude of the Regional Hospitial Board leaves something to be desired. On 30th June last year the board issued a rather bald statement setting out its proposals. There was no reference in that statement to the fact that the final decision in this matter is made by the Secretary of State. So it corrected this in a revised statement which it sent out on 3rd July. The board then sent out a further correction to its original statement on 22nd July in which it said: It is regretted that the statements issued by the Board on 30th June and 3rd July, 1970, regarding the future of this hospital stated in error that it is less than one mile from the new King Edward Memorial Hospital at Southall; this should have read 'three miles'. It may seem a small point, whether it is one mile or three miles, but it makes a lot of difference in an area where public transport is not all that good. It is an important point, and one wonders how it can have been overlooked.

The regional hospital board asked for comments on its proposals, and a number of people and organisations, including myself, commented at considerable length last year. All that I have received so far is this very short letter, dated 31st December, which makes no attempt to deal with the arguments which had been set out. It just simply states: Your comments, together with observations from various other interested bodies, were considered by the Board at a recent meeting and they decided to recommend to the Secretary of State for Social Services that the needs of the area would be adequately met by the new hospitial and that Brentford Hospital can be closed when the new King Edward Memorial Hospital is opened. This attitude of the board is most unsatisfactory. The board's proposal affects not only Brentford; it has implications for the whole of the Health Service.

Is it right to have big hospitals, on the one hand, and a great gap between them and local G.P.s on the other hand? Or is it right to try to make the Health Service, wherever possible, more community-based with the G.P.s playing a more important part in it?

There is no doubt what people in Brentford and Chiswick want. They want to see Brentford Hospital continuing to play the kind of rôle which has been described in the letters which I have quoted. It may have to be secondary rôle after the new King Edward Memorial Hospital is opened, but it will, none the less, be a vital rôle for all that. Indeed, the kind of rôle which Brentford Hospital could play is exactly the one advocated in a very interesting Report published by the Office of Health Economics last year entitled, "Building for Health". I ask the Under-Secretary of State to consider that Report very carefully. I hope that the hon. Gentleman will also consider very carefully all the representations which have been made and the arguments which I have set out.

I do not know whether the hon. Gentleman would care to visit Brentford Hospital. I am sure that that could be easily arranged. If the Under-Secretary visited the hospital, I believe that he would find it to be, and see that it was, a hospital of great character and charm which successfully meets a vital community need and which the people of Brentford want to see continuing to do its valuable work for many years to come.

4.19 p.m.

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

I am grateful to the hon. Member for Brentford and Chiswick (Mr. Barnes) for the warm way in which he has recognised the role of this important hospital. It is one of which we in the Department are very proud, just as is the hon. Gentleman. I am also grateful to the hon. Gentleman for the way in which he has presented the case for a continuing rôle; for the local cottage hospital type of establishment, because the remarks that he has made are obviously of assistance to us in trying to decide on the difficult question which he has spelled out to some extent of the future rôle for what the Bonham Carter Report described as the peripheral hospital, the hospital on the edge of some great district hospital or large hospital such as the King Edward Memorial Hospital when it is rebuilt.

It may seem strange that this question of closure should have arisen at all, and it might help if I run through a little of the background to it. The Hospital Plan of 1962, and its revision of 1966, contemplated that the King Edward Memorial Hospital, Ealing, would be redeveloped and extended on a site at Southall, and that this scheme would enable better provision to be made for the work now done at Brentford Hospital, which is a general practitioner hospital with relatively few beds—in fact, 33. The services in the area have been under heavy pressure, and I think the hon. Gentleman will acknowledge that improved facilities are much needed.

The North-West Metropolitan Regional Hospital. Board, which is the planning authority for the area, is now proceeding to make good this deficiency in its plans and in its capital allocations by providing the new King Edward Memorial Hospital on land adjacent to St. Bernard's Hospital in Southall. The first phase of building started last year, and the board estimates that its full cost will be about £5 million and that the building will be ready for occupation in the latter part of 1975.

It will provide about 400 beds and supporting services, and its opening will make possible a reorganisation and rationalisation of the hospital services in the area. The board's initial plans, I concede, have envisaged that alternative hospital use could then be made of the facilities at the existing King Edward Memorial Hospital, and that those at Brentford Hospital could be closed as a result.

I doubt whether there is any need for me to take time to explain the need to reorganise and rationalise the hospital services as they develop. I am glad to say that the Government have been able to provide additional funds for the National Health Service over the next four years, and this will enable the normal development of the service to continue and progress to be speeded up in vulnerable sectors such as the care of the mentally ill, mentally handicapped and the elderly. The increased momentum of the hospital building programme, and the pressure of increasingly expensive services which have to be built into the new building, when related to our limited resources, clearly make it necessary to achieve, as a corollary to the sort of major development that we propose, the timely closure or change of use of hospital buildings which will not, in relevant terms, be very much needed.

Whether Brentford Hospital will be required after 1975 is a question yet to be answered. It is certainly a question which properly arises in the circumstances; namely, that a new hospital is being built to serve the same area, and there do not appear to be any major problems at all of accessibility to the new hospital for patients, staff or visitors, or of employment for the existing staff.

The answer to the question could be that the hospital should be closed. Alternatively, it could be that the hospital should be retained, perhaps for a different purpose, the sort of purpose which the hon. Gentleman discussed with his right hon. Friend, as he said, and which he spelled out a little this afternoon. I do not want to give a final and categorical answer on this issue now.

The hon. Gentleman will know from statements made in the House in reply to Questions that my right hon. Friend the Secretary of State for Social Services is very well aware of the support for the retention of the small general practitioner hospitals. He has undertaken to look at the possible future rôle of these hospitals in his review of policy on district general hospitals and the hospital building programe arising out of the proposals in the Bonham Carter Report and, indeed, following some of the criticisms and comments made on that by the Office of Health Economics publication to which the hon. Gentleman referred. My right hon. Friend expects and hopes to make a statement on general policy in this direction in the quite near future.

The hon. Gentleman will also know that my right hon. Friend is testing the Oxford Regional Hospital Board's concept of the so-called community hospital, which is a quite narrow, and in many ways fascinating, concept which is being subjected to a pilot scheme in the Oxford region under the supervision of an eminent academic at the university in consultation with the board.

It embodies precisely the interplay of factors such as early discharge after operation, care in a domiciliary unit, and so on. I mention these matters to reassure the hon. Member that consideration of the future of smaller hospitals generally is very much in our minds, and to help explain why I cannot deal in detail this afternoon with all his points about a rôle for the small hospital with which he is concerned. The whole concept of Brentford is very much in the melting pot in respect of our thoughts about these important units. We have a predisposition to find a positive role for them where they are viable. I have, however, carefully noted for further study a number of points made by the hon. Gentleman—and not only in relation to the general sense of his remarks.

I turn to the narrower question whether Brentford Hospital should close. That is what he is most concerned about, and that is what Lord Brentford and his League of Friends and others at Brentford are concerned about. It may help to reassure the hon. Member if I say something more about the method of handling hospital closures and our change-of-use proposals. The method has been adopted in the light of experience and is generally designed to lead to the right answer. In the last few years many hospital closures have taken place. Over the past three years approval has been given to proposals to close or change the use of 130 hospitals in England—37 of them in the last year. Handling all these proposals has provided the regional hospital boards and the Department with valuable experience of the difficult problem of working out reasonable proposals and securing understanding and acceptance of them locally.

The hon. Member's right hon. Friend put in hand an important new procedure of consultation, and very often the adaptation to new forms of procedure for consultation initiated by his right hon. Friend has led to some of the current muddles, shortcomings and contradictions that have emerged in the transition period in the ways the boards have handled the matters. We are trying to develop this procedure in order to get the maximum amount of feeling of participation and general consultation.

The procedure now followed by regional hospital boards on proposals of this kind is designed to ensure that the public are informed at the earliest practicable stage of the plan to build a new hospital and of the closures and change of use of existing hospitals that go with it. But rationalisation of the hospital service also affects local authorities and general practitioners, and it is essential that they should be consulted early in the planning stage, so that their views on new developments and the consequences of the developments can be taken into account.

This kind of consultation—both informal and then formal—leading to proposals to the Secretary of State, which he has to decide, is repeated in the latter stages of planning when more specific proposals are available. The procedure envisages that, as consultation continues, agreement should often be reached at an early stage on matters which may prove to be controversial. The final decision whether a hospital will close is, however, referred explicity to my right hon. Friend the Secretary of State and it remains for him and him alone to make it.

In accordance with this procedure the North-West Metropolitan Regional Hospital Board has carried out extensive consultations on its proposals that Brentford Hospital should close when the new King Edward Memorial Hospital is opened about three miles away. The hon. Member has been given, and has taken, the opportunity of commenting to the board on its proposals. Many bodies in the area have done likewise.

The board has carefully considered the question in the light of all the representations that have been made to it and has informed the Department, as a consequence of those consultations, that it is satisfied that the needs of the area would be adequately met by the new hospital and that Brentford Hospital can be closed when the new hospital is opened. That is the board's view, in response to the consultations that have taken place, but I assure the hon. Member that I take considerable care in the Department to lock at the record of consultations that have taken place and to examine the representations that have been made. It is by no means a justifiable fear that the hon. Member expresses this afternoon that consultations are a mere formality and the board has pre-determined the issue even before the representations have been considered. We insist on seeing what is being done. The process does not finish with the board's consideration of and responsibility to the representations made to it.

It is, of course, difficult for the board to make an assessment of the future in circumstances such as those which obtain here, and it would not claim to be able either to foresee with absolute certainty the precise needs to be met five years hence or to state with complete confidence the way in which those needs, whatever they might be, should be met. Obviously, no one can be completely confident at this stage that the proposal is the right one.

The present position is that the board has made a full report of the representations which it has received and this is now being studied with great care in the Department. It is clear that the view is strongly held locally that there is a place for Brentford Hospital in the future pattern of hospital services for the area. This emerges from the representations recorded in the board's report to us, and in the direct representations by the hon. Gentleman both in my Department and on occasions like this.

The position is to some extent complicated by plans to realign the local road system, and these will have to be studied further by the Department in conjunction with the Department of the Environment. But let there be no mistake about it. This is, as the hon. Gentleman suggested, to some extent a red herring. The gift in this matter is entirely in the hands of the Department as the hospital authority with responsibility for providing the necessary hospital facilities. Viewed purely as a Health Service problem, this is not a matter on which my right hon. Friend is required to make any immediate and final decision on, for example, road or town planning grounds.

On this basis, the proposed closure would not take effect before 1975, if it did take effect at all, and if it were decided to pursue the proposal, the board would wish to undertake a further round of consultations in three or four years' time. By then the issues would no doubt be very much clearer and the area of controversy greatly diminished. Meanwhile, I can assure the hon. Gentleman that there is no question of deciding that the hospital should be closed immediately, this year or even next year. There is no case for that. It is plain that Brentford Hospital is still required in its present role and I hope that the hon. Member and all those connected with it, both volunteer and professional staff, patients, friends and so on, will be reassured by what I have said. We know that the hospital serves the area splendidly and we want it to continue in its magnificent present rôle with the maximum possible morale. There is no question of any closure arising in the immediate period to come.

I hope that this reply will satisfy the hon. Gentleman that we want to advance the area but, if he remains in any doubt, I hope that he will take up my offer to him to come and talk to me in the Department about it at any time he may wish.

Question put and agreed to.

Adjourned accordingly at twenty-six minutes to Five o'clock.