HC Deb 11 March 1971 vol 813 cc755-66

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

11.36 p.m.

Mr. Edward du Cann (Taunton)

I am grateful for this chance to state the need for a new district hospital at Taunton, a subject about which I feel keenly. I am equally grateful to the Minister for being here to hear and answer the debate. I am also pleased to make common cause with my hon. Friend the Member for Bridgwater (Mr. Tom King), who I know hopes to speak later.

We speak not only for our constituents but for the whole of West Somerset. Indeed, we speak for a wider area, with a total population of perhaps a quarter of a million, and all of them would like the facilities of a new district hospital. We speak also, in the name of common sense, for the medical staff, nurses, local managements and local authorities in these areas.

I wish, at the outset, to make two important points. First, the present hospital facilities are inadequate—indeed, are sadly and dreadfully inadequate. Secondly, it is essential that the proposed new district hospital, which is supposed to be built at Lyngford, should be begun in 1975, as currently planned. There should be no further delay or postponement. Indeed, it is highly desirable that the starting date should, if possible, be brought forward.

The present hospital buildings are old and inadequate, and I will give two principal examples. The first is East Reach, Taunton, which was built in 1809. Its basement is not infrequently flooded. Being near the A38, it is subject to traffic difficulties which hon. Members will readily imagine. No development is possible on this limited site unless the whole place is pulled down.

The second example is Musgrove Park, also in Taunton. It is a more modern building, having been built during the second war, though as a temporary structure. The work that is done in this hospital, as in East Reach, is magnificent, but the physical arrangements are deplorable. Great distances must be travelled between key areas of the hospital, there are special maintenance problems, about £95,000 must now be spent on the roofs, and, again, there is no room for expansion or improvement.

More telling than any words of mine to describe the physical inadequacies of the buildings and equipment is the catalogue of work which the regional hospital board requires as essential, even though a new hospital is planned.

There is programmed to start in 197172 at Musgrove work on a new theatre, work to refurbish the old theatres and the provision of a sterile supply unit, these three items being planned to cost just over £175,000. One must add to that the cost of a new X-ray room, at £74,600, meaning that in 1971–72 we shall be spending in Musgrove about £250,000.

At East Reach the modernisation of the ophthalmic and orthopaedic theatres are planned to cost about £80,000, and, with the renewal of the engineering services, the bill at this hospital will be nearly £250,000 as well. It will be seen, therefore, that the total expenditure in 1971–72 on essential facilitiesx2014;not on frills or furbelowsx2014;will be approaching £500,000. There is additional projected expenditure not so far programmed for a paediatric unit, mortuary, additional E.N.T. beds and radio-isotope investigation service, and these will cost about £85,000.

There is a whole list of other desirable items of modernisation or improvement in addition to those I have outlined. In other words, a vast sum is required to maintain even the present facilities at as nearly as possible an acceptable level, though a level below what it could and should be.

What will the expenditure be by the time the new hospital is ready in, say, 1978 or 1979? Will it be £1 million, £1½ million, or what? No one can say. If that money is not spent, the people of West Somerset will continue to suffer second-grade facilities until such time as the new hospital is built.

Compare those sums, though, with the cost of the new hospital. A figure of £5 million has been presupposed. The situation is a commentary on the way in which delay in the provision of new hospitals has resulted in increased expenditure and, I believe, an unnecessary expenditure of public money on a large scale.

Nor do I understand why it will take so long to provide this new hospital. I speak as chairman of a property company responsible for development on a very large scale in the United States, in Australia, and in the United Kingdom. I truly believe that, particularly with the standardisation for which my hon. Friend the Minister is correctly responsible, matters could be accomplished much more quickly if a greater sense of urgency were shown by those responsible.

Meantime the position continues to deteriorate. The demand for facilities in local hospitals continues to increase. Again, the best illustration is examples. In the decade 1960–70 discharges and deaths rose from just under 9,000 in 1960 to over 13,000 in 1970; accidents and emergencies dealt with were up by 60 per cent.; pathology requests were up by nearly 150 per cent.; X-rays were up from 39,000 to 88,000: the waiting list rose from 1,260 to 2,950.

As my hon. Friend the Member for Bridgwater knows, Bridgwater and Taunton groups are now amalgamated and all acute important work takes place in Taunton, but all available ward accommodation has been taken up at Musgrove and there is no room for expansion at East Reach. Hence, if in our area a person requires an operation which is non-emergency in character and he cannot afford to pay for it himself or he is not insured under some scheme like B.U.P.A. he may wait any period between six weeks and six years to get it. I am told that there are examples longer than six years.

We have certain special needs. More beds to deal with geriatric cases are urgently required. Yet the regional hospital board has postponed the construction of 75 additional beds at Trinity Hospital pending the transfer to Musgrove when Lyngford begins—another example, perhaps, of the need for this new hospital to be begun. There are long waiting lists in orthopaedics.

Then there are the problems that arise from the division of acute services between Musgrove Park and East Reach. It means in effect that facilities which exist at one may be denied to patients at another. I do not speak lightly. I speak of what I know, because both I and my hon. Friend the Member for Bridgwater have homes in our constituencies. These difficulties apply especially to the accident department, the intensive therapy unit, and the children's unit.

Hearing this catalogue, do you not think, Mr. Deputy Speaker, that we are right to press for the new district hospital to he provided without delay? It is astonishing that the leagues of friends of our hospitals are now providing not merely amenities but necessities and, indeed, are shouldering voluntarily a part of the responsibility that should be the taxpayers' as a whole.

Another reason, and perhaps the most significant, for continuing the campaign, with which I have been associated since I became a Member of the House 15 years ago, is this. I will recite a little of the history. In 1962 the case was first pressed with the planning authority. No definite answer was obtained or seemed to be obtainable. In 1966, accordingly, I found myself leading a deputation to the then Ministry of Health; and that deputation included representatives of the local authorities, which have always taken a great interest in the matter. We expected—indeed, we had every reason to believe—that the planning of a new hospital would begin in 1968.When that did not materialise there was, naturally, acute disappointment. Naturally, too, further strong representations were made by us all.

As a result, perhaps, on 23rd October last year it was announced by the regional hospital board that the construction of the new hospital would start in 1975–76.

Reluctantly, perhaps, but quite certainly, I find myself wondering: should we have had that undertaking if we had not pressed, and pressed hard, our deserving case? Cynicism is not really in my nature, but I reflect also on what happened about the provision of a new accident centre at East Reach a year or two back. Again, had I not agitated for that, I wonder whether we should have had it today.

I have been concerned with this matter now for well over 10 years. On present plans, it will be 20 years from start to finish of the campaign. Because the need is great, because all of us locally are deeply concerned to see that the starting date is adhered to, if not, as I suggested, brought forward, my hon. Friend the Member for Bridgwater and I asked the Under-Secretary of State if he would be good enough to meet us. He received us with his usual courtesy, and we were most grateful for that and for the interest he showed in the points which we made. Tonight, we make them more publicly. We ask him for his endorsement and his support, and we ask in the confidence that we shall have an affirmative answer.

11.45 p.m.

Mr. Tom King (Bridgwater)

I greatly appreciate the opportunity to take part in this short debate and to support the most effective and eloquent plea made by my right hon. Friend the Member for Taunton (Mr. du Cann). This is a matter of great concern not just to those living in Taunton and the immediate surroundings but to a very much wider area, including the great majority of my constituents.

While we are extremely critical of the inadequate and obsolete facilities which exist, I wish to make clear at the outset—I know that my right hon. Friend will support me in this—that this in no sense reflects on the enthusiasm, energy and conscientiousness of the staff concerned at these hospitals, whose tremendous efforts in the face of extreme difficulties are recognised and greatly appreciated.

But, while they are striving as they are at present, there must be a limit, and one can only view the future with great concern. The Minister will recognise that the present prospect is of virtually no real improvement in this decade. In the coming years we face real anxiety about the staffing problem in the hospitals, and concern about the ability of the hospitals to attract the calibre of staff that the area deserves. A choice between mid-Georgian and World War 2 temporary, which is all we have to offer, is hardly an appealing prospect for the medical profession in the 1970s.

I pay tribute also—my right hon. Friend referred to this too—to the voluntary bodies which support the hospitals in this area. I make no apology for referring to the Friends of Bridgwater Hospital as to the one I know best. I know that there is a similar most energetic body in Taunton, and I am pleased to say that one is shortly to start for Minehead Hospital as well. The activities of these bodies, which were originally conceived to provide extra amenity and comfort for patients and staff, have now been directed towards essential provision. In Bridgwater now, the Friends of Bridgwater Hospital are supplying funds to provide a bathroom and lavatory for the men's ward. We have reached a pretty pass when a lavatory has become an optional amenity to be provided out of voluntary sources.

It is against that background that the problem we are raising tonight must be considered. I have three main points to add to the very full case presented by my right hon. Friend. The first concerns the background to the policy which has been implemented of centralising the main hospital facilities on Taunton. This has been recognised over recent years to have been at the expense of the facilities available at the two hospitals in my constituency, at Bridgwater and Minehead. This policy has presented very real problems to my constituents in both areas. In many parts of West Somerset where urgent attention is needed an ambulance journey of over one hour may be involved, and in holiday traffic considerably more. It obviously also presents problems for relatives and friends wishing to visit patients in hospital when long journeys are involved.

This might not be so bad if there were something they could look forward to at the end of the journey. The implicit promise which I am sure was understood by my constituents when the policy was introduced was that they could expect better facilities at Taunton as a result. On present evidence, this implicit promise has not been honoured to date.

My two further points concern factors that could be overlooked in assessing the hospital needs of the area in relation to the numbers involved. First, in the western part of my constituency in particular there is a surprisingly high proportion of retired people. It is a most popular retirement area. Minehead has, I think, the distinction, which it shares with Worthing, of having the highest percentage of people over retirement age in the country. This age group represents a high demand on hospital facilities.

Second, besides being a holiday area in which a considerable number of people spend their holidays it is the route to the most popular holiday area in the country. This has the result of giving it an enormously inflated population for almost half the year with the extended holiday season. Apart from the normal visitors who come to stay in Minehead, which has a population of 7,000, the Butlins camp alone has a weekly intake of up to 14,000. This puts a tremendous load on the hospital facilities.

A brief study of the accident record of the A38 also shows the considerable extra load on the hospitals.

It is for these reasons, and those advanced by my right hon. Friend that I hope my hon. Friend the Minister will recognise the special urgency of the matter and give us some real encouragement tonight.

11.53 p.m.

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

I should like at the outset to say that I do not think that there is any dispute between my right hon. Friend the Member for Taunton (Mr. du Cann), my hon. Friend the Member for Bridgwater (Mr. Tom King) and my Department on the main point, which both have so eloquently made. We all agree that there is a need for a new hospital to serve the Taunton area.

In saying this, however, I do not wish to suggest in any way that this debate is not valuable. On the contrary, I am sure that it is. I welcome it, and I am grateful to my right hon. Friend for initiating it and to my hon. Friend for supporting it. My right hon. Friend has given me the opportunity to emphasise that I recognise the need for a new hospital and its importance for the health and well-being of the people of the area. He has also given me the chance to explain something of the problem of meeting the need and how the problem is being tackled. In doing so he has helped us considerably by clearly referring to the local feeling on the issue which he and my hon. Friend obviously both know intimately from their local connections, and has made a number of important points that must be taken into account in planning the development of the local hospital services. I reassure my right hon. Friend and my hon. Friend that I shall see that a copy of the OFFICIAL REPORT of the debate is brought to the notice of the chairman of the regional hospital board.

Both my right hon. Friend and my hon. Friend will understand that the problem at Taunton, as in so many other spheres of administration, is to determine the priority to be given to a desirable project which is one among many. This can be done only against the background of the wider area in which the problem is set.

Taunton lies in the South-Western Hospital Region, and the regional hospital board is responsible for planning its hospital services. The region extends from North Gloucestershire right down to South-West Cornwall over a distance of some 220 miles and has a population of over 3 million which rises sharply and considerably during the summer months. It has been well served over the years by a large number of small and medium sized hospitals. But, as elsewhere, many of the hospitals are out of date. I concede the point which my hon. Friends have made.

The Hospital Plan published in 1962 and its revision published in 1966 envisaged that the future service would be based on district general hospitals in the principal towns, supported where necessary by smaller hospitals. The implementation of these proposals is no simple task. It calls for considerable resources. Doctors, nurses, architects, engineers and others expert in hospital planning are needed. A substantial part of the capacity of the local building industry must be applied.

Clearly, the proposals can be carried out only over a period of years, and the board must assess and compare the needs of different parts of the region in order to determine how and in what order they should be met. This process of assessment and comparison is a continuing task, and it is complicated by the factor of changing circumstances; for example, developments in patterns of medical care and, obviously, in population trends. The process of fitting building schemes into a coherent capital programme matching the resources likely to become available is also a task at once continuous yet unpredictable, alas. The programme must be adaptable to accommodate variations in the cost and timing of current schemes and other factors.

It is perhaps impracticable to measure the real progress so far made by the regional hospital board in the South-West. Hospitals are for people, and their contribution to the quality of life can scarcely be measured in £ s. d. But there is no doubt that progress has been made and that it is real. Over the years 1962–63 to 1969–70, the capital expenditure of the regional board has amounted to nearly £32 million, or some £4 million a year. During this time, a large number of building schemes have been completed, and, in particular, district general hospitals in new or substantially redeveloped buildings have been or are being built at Exeter, Gloucester, Torbay, Truro and Yeovil.

The planning of further substantial development is well in hand, and the new hospital for the Taunton area will be fitted into this future programme, which includes the provision of district general hospitals at Barnstaple, Plymouth and Weston-super-Mare and the redevelopment of existing district general hospitals at Bath and Bristol. As my right hon. Friend the Secretary of State for Social Services said in the House last November, the additional funds being provided for the National Health Service over the next four years will enable not only the normal development of the service, including hospital building, to continue, but also progress to be speeded up in vulnerable sectors such as the care of the mentally ill, mentally handicapped and the elderly.

The area which looks to Taunton—and to its neighbour Bridgwater—for major hospital services extends roughly from Minehead in the north-west to Chard in the south of Somerset, and it is estimated that by 1981 it will have a population approaching 250,000. The main hospital is the Taunton and Somerset Hospi- tal, which has two branches—East Reach and Musgrove Park—but there are a number of other hospitals in the smaller centres of population.

While I recognise the need for a new hospital for the area, I should not like it to be thought that this reflects in any way on the devoted service being given by the staff of the existing hospitals. The doctors, nurses and other staff have difficulties to contend with at present but I doubt whether any patient of theirs would wish on that account to criticise the treatment he receives. Perhaps I could express my appreciation to my hon. and right hon. Friends for the tributes which they have paid to the staff in these hospitals.

This is not by any means the first time that my right hon. Friend the Member for Taunton has presented a case for the early provision of a new hospital for the area. He has been active in the matter for a great many years, and, as he knows, the broad plan is to establish a district general hospital as soon as practicable on a site which is already available at Lyngford, Taunton. The regional board intends to redevelop the hospital services of the area in a way which will integrate them more closely with the other parts of the National Health Service, and it is important to note that it does not propose that hospital services should be concentrated entirely at Lyngford. The intention is that supporting hospitals will be available to serve a number of places in the area, including Bridgwater, Chard, Mine-head and Williton. The board's detailed proposals have not yet been put to my Department, but I know that already the board has held preliminary consultations with the local authorities and has set up a project team, including a representative of the county medical officer of health and a local general practitioner, which is charged with the task of preparing the initial plans for the new hospital.

In these circumstances my hon. and right hon. Friends may ask why I cannot announce the date when building of the new hospital will start, and I should like briefly to try to answer this question. The essence of the answer is that a hospital takes several years to plan and several further years to build, and it is impracticable at an early stage to fix an early starting date. Of course the regional board must plan on certain assumptions, and, as my right hon. Friend knows, at different times in the past different dates have been provisionally adopted for planning purposes, but these dates have had to be reviewed and revised as circumstances have changed. As I said earlier, hospital building programmes have to be adaptable. Priorities, national and local, can change. The capital available is dependent on the view taken of the proportion of the available resources which can be devoted to the health services and to hospital building in particular. For various reasons, projects which have already started may progress more quickly or more slowly than forecast or may cost more or less. These are among the unpredictable forward planning factors which make it unrealistic to announce the starting date of a major hospital building project several years in advance.

Nevertheless the project team which has been set up by the regional board is urgently working out plans for the new hospital, and I hope that this news will give welcome assurance to the people in the area which the new hospital will serve including voluntary helpers. I am obliged to my hon. and right hon. Friends for touching on the vital contributions that voluntary bodies can make. I can also assure my hon. and right hon. Friends that the regional board is maintaining existing services and providing certain improvements, for example to the operating theatre facilities, which are necessary until the new hospital can be completed. My hon. and right hon. Friends will be glad to know that in providing improvements the board is conscious of the need not to prejudice the provision of the new hospital by over-investment of capital in advance. The measures are therefore, individually, comparatively minor in cost, but their completion significantly improves the conditions under which the staff have been working and the service the staff is able to give to its patients.

In particular the improvements to the operating theatre facilities which are planned for this year should materially contribute to the solution of the grave problem of waiting lists to which my right hon. Friend has referred.

Finally, I would like to assure my hon. and right hon. Friend that I have listened with the greatest interest to all the points they have made, which have powerfully reinforced the case they recently put to me privately. The planning of the new hospital is at a formative stage and it is most timely and helpful to have their comments now. These will, I am sure, be carefully noted by the regional hospital board and will encourage all those planning the new hospital to continue their important task for the benefit of the local community with their present sense of urgency.

Question put and agreed to.

Adjourned accordingly at four minutes past Twelve o'clock.