§ Motion made, and Question proposed,That this House do now adjourn:—[Mr. Fortescue.]
§ 4.2 p.m.
§ Mr. Ivor Richard (Barons Court)
I am grateful to have the opportunity to raise on the Adjournment the question of the future of Queen Charlotte's Hospital, in West London, which is in my constituency. The aim of this short debate is to try to obtain from the Government a specific and, I hope, a clear and unqualified assurance that despite the reorganisation of hospital facilities in West London, this hospital shall continue to exist.
As hon. Members may know, an attempt was made in another place on Monday of this week to raise this issue and to seek the same specific assurance. Unfortunately, no such assurance came from the noble Lord, Lord Aberdare, the Minister who was then replying to the debate. I hope that his hon. Friend will be able to do slightly better than the noble Lord did on Monday last.
A great deal of public concern is now being felt both inside and outside the medical profession about the future of Queen Charlotte's Hospital and it is right to say that concern is certainly not confined to one side of this House or to any one political party. Hon. Members on both sides have expressed their concern to me within the last few days. Only yesterday I received a letter from the National Council for Women expressing deep concern about the possibility that the hospital might be forced to close.
This afternoon I want to look at some of the arguments advanced in favour of retention, and also to look at some arguments which appear to have been hinted at, if not openly expressed, in favour of abolition.
I say at once to the Government that many, I fancy, will approach the subject as I do; namely, we will require very strong evidence before we are prepared to accept the destruction of a fine hospital and a fine institution like Queen Charlotte's Hospital. If there is such evidence, it is important that the Govern- 1960 ment should present it. In the absence of a case being put, the Government must not be surprised if we draw our own conclusions.
What are the arguments in favour of retaining Queen Charlotte's? The argument is basically simple and it can be put in a few sentences. First, Queen Charlotte's exists, it is fully used, it is fully occupied, and it fulfils a need. Moreover, it is a hospital with a standard of excellence and of skill in its own specialist field which is unique in Britain.
In a leading article recently The Times described the hospital as a centre of excellence and went on to say this:It is renowned for the treatment of its patients. That is why it attracts so many from so far afield. It is also known for the quality of its research and pioneering in new developments. Moreover, it is a centre of postgraduate training.To this must be added the hospital's training of midwives, which again is of very high quality.
Therefore prima facie, to use a lawyer's phrase, the arguments for retaining Queen Charlotte's are very strong. The onus which is on the Government, to use yet another lawyer's phrase, to justify Queen Charlotte's destruction is one which they will have to discharge to the full.
What are the arguments in favour of closing the hospital? Again as I understand it, there are two main arguments. First, there is the argument over the bed provision and the number of beds available in West London. Second, there is what I may call the Todd approach to closer integration of post-graduate and specialist facilities into a general and larger district hospital.
I will, out of order, deal with the second point first, because I shall be spending a little time on the first point. I am conscious that the Todd argument is the fashionable one at the moment in medical circles. I am also conscious that fashions change in medical circles, just as they change in any other circle. Indeed, I have no doubt that the Minister and the House will have seen the letter in The Times this morning, from which it would appear that the total integration argument is no longer fully accepted.
Even if the argument is a good one, and even if it is a principle which we 1961 would accept, as most of us probably would, nevertheless it can at best be only a persuasive argument. Were it an ideal situation one would say that a specialist hospital, particularly a postgraduate specialist hospital, ought to be integrated into a larger district hospital. Even accepting that principle, however, at best it can be only a principle to which one would subscribe, but it would in no way justify destroying an institution of the quality of Queen Charlotte's.
I therefore think that the argument must be met and analysed on the figures, particularly on the catchment area argument. It is important to try to analyse this, because the main argument, as I understand it, against Queen Charlotte's continuation is that there might be over-provision of maternity beds eventually in the three boroughs of Hammersmith, Kensington and Chelsea, and Westminster.
The first thing that strikes me about that argument is that the occupancy at Queen Charlotte's is higher than it is at most hospitals. It is certainly higher than it is at other maternity hospitals in this area. This must mean that doctors want to send their patients to Queen Charlotte's.
The second fact which must be borne in mind when the figures are being considered is that Queen Charlotte's turns down many who want to go there from outside the three boroughs which the Ministry has chosen as the hospital's catchment area.
Therefore, even if the Ministry's methodology and figures were right—I do not accept either, and I hope to show the House why the Ministry is wrong in both its figures and its methodology—the fact that the occupancy is higher and the fact that Queen Charlotte's has to turn down applications for beds coming from outside the area of the three boroughs must mean that the demand is very great. Even if beds were statistically being over-provided, nevertheless that demand would be met by Queen Charlotte's. It is inconceivable that beds in a hospital like Queen Charlotte's would be empty even if the Ministry's figures and projections were right.
What are the figures? In 1969 4,703 patients went into Queen Charlotte's. Of those 4,703, 4,492 came from the London boroughs as a whole. That means that 1962 95 per cent. of the patients at Queen Charlotte's came from the G.L.C. area. Taking the three boroughs of Hammersmith, Kensington-Chelsea and Westminster, if one looks at the number of patients that they sent to Queen Charlotte's in 1969 some interesting facts emerge. Hammersmith sent 1,401–29.8 per cent. From Kensington and Chelsea there came 379–8 per cent. From Westminster there came l01–2.15 per cent. It is perhaps not insignificant to note that if one looks at the figures for all the London boroughs, the 101, which is the number who came from Westminster, is the same as the number who came from Brent.
If one adds the percentages of those three boroughs—because this is the catchment area on which the Ministry have chosen to base their argument and analysis—one finds that only 40 per cent. of the patients at Queen Charlotte's in 1969 came from the three boroughs of Hammersmith, Kensington-Chelsea and Westminster. It is over-provision in those three boroughs which is supposed to be the basis for the Ministry's argument for closing Queen Charlotte's.
Again it is useful to look at some other statistics. Looking at three other boroughs—Ealing, Hounslow and Richmond—which are the next three on the list apart from the three which formed the Ministry's catchment area, we find that from Ealing there were 1,020 patients —21.69 per cent.; from Hounslow 735–15.63 per cent.; and from Richmond 279 —6.36 per cent. If one adds the number who came from those three boroughs outside the catchment area, it amounts to 42 per cent. More came from three other London boroughs to Queen Charlotte's than came from the three boroughs that form the catchment area which is the basis of the Ministry's argument.
§ Mr. Nigel Spearing (Acton)
As a Member from the London Borough of Ealing, I should like to confirm what my hon. Friend says on the subject of grave public disquiet. May I ask him whether he is aware that when a hospital was due to be closed in one of those three boroughs the Member got official notification so that one was able to comment, as indeed was the case in the constituency of Brentford and Chiswick, but in this case I have had no notice except from the Press.
§ Mr. Michael Barnes (Brentford and Chiswick)
May I also say that my constituency of Brentford and Chiswick is the other side of the road from Queen Charlotte's Hospital. Many of my constituents in the London borough of Hounslow have been to the hospital, but many others have not been able to get in when they wanted to do so, and there is strong feeling that it does not make sense to confine too rigidly the catchment area when there is a hospital like Queen Charlotte's which has an international reputation.
§ Dr. Gerard Vaughan (Reading)
May I add that professionally there is a great deal of anxiety about this. Would the hon. Gentleman agree that this internationally famous teaching centre has been the unfortunate victim of a circular situation? On the catchment area argument, the numbers have been decreased. It is argued that the teaching institute should be moved. Now, because the institute has been moved, it has been argued that its numbers should be decreased.
§ Mr. Richard
If I might interrupt my own speech. I accept the points which have been made by my hon. Friends the Members for Acton (Mr. Spearing) and for Brentford and Chiswick (Mr. Barnes) and the hon. Member for Reading (Dr. Vaughan). It would seem to me that it is extremely difficult, on the catchment area argument, to justify the possible closure of Queen Charlotte's Hospital. There emerge from all this two or three salient and, I think, unanswerable points. The first, which I think the Minister must accept, is that no fewer than 60 per cent. of the patients of Queen Charlotte's come from outside the catchment area which is the basis of the Ministry's argument; 60 per cent. of the patients come from outside Hammersmith, Kensington-Chelsea and Westminster. Indeed, more come from another three boroughs, as I say—Ealing, Hounslow and Richmond—than come from the three boroughs making up the catchment area which is the basis of the Ministry's argument.
In terms of usage, which, surely, is the factor which ought to weigh most of all in the Ministry's mind—that is, who uses Queen Charlotte's Hospital, not so much what is the usage in a particular catchment area—if one were to re-draw the 1964 catchment area so as to make it Hammersmith, Kensington-Chelsea and Hounslow, one would have a usage of no less than 67 per cent., and that would, perhaps, appear to be the most logical area.
As regards the way in which the figures have been used by the Government, if this is, in fact, the Government's decision —I hope that we shall be told if it is not —if it is the argument that the catchment area which provides 40 per cent. of the patients will be over-provided with maternity beds in a few years, I can only say that that argument is both fallacious and misleading. Pushed to its conclusion and applied, say, to public transport, one could say that if, for instance, only 5 per cent. of the people using Acton Town station came from Westminster, this would justify closing it, because there was no Westminster demand for it, provided, of course, one ignored the numbers using it who lived in Acton and concentrated only on those who lived in Westminster.
With respect, if that is the argument, it is the statistics of the madhouse, and it involves four propositions, all of which may be false.
First, it involves the proposition that one's catchment area is properly drawn. Why is this catchment area drawn in this rather peculiar way? I suspect that it is a hangover from the days when we had a London County Council and a Middlesex County Council, for Queen Charlotte's is directly on the boundary line of Gold-hawk Road between Hammersmith, which used to be in the old L.C.C. area, and Brentford and Chiswick, which used to be in Middlesex. If that is the only justification for retaining a catchment area comprising the three boroughs of Hammersmith, Kensington-Chelsea and Westminster, it is a point which one would have hoped had gone under the London Government Act.
The second proposition which may be wrong is that one has estimated accurately the birth rate in the area one is considering. In the past, as the Minister knows, predictions of birth rates have not been the most reliable of statistics on which to base any policy.
Third, the argument involves the proposition that one can safely ignore the re-provision of facilities for the 60 per cent. majority who come to Queen Charlotte's from outside the area.
1965 Fourth, it involves the proposition that one can reprovide the facilities for the 40 per cent. in the catchment area of the three boroughs somewhere else.
On that argument, however, it is proposed, so we understand, to scrap a hospital of proven worth and international reputation. Were it not so serious, it would be laughable, on that information. The Government really must think again about this proposal. It is a proposal which would be condemned, I am sure, by the medical profession. It would certainly be condemned by the people who live in the area.
The Government seem to have approached the matter on far too narrow a basis. It involves the destruction of an institution which has proved itself over 200 years to be of almost inestimable value to the health of the country and to the well being of the medical profession. I very much hope that the Minister can give us an assurance that this grave mistake will not be made.
§ 4.18 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I am much obliged to the hon. Member for Barons Court (Mr. Richard) for giving Parliament a further opportunity—he has already referred to the earlier opportunity which occurred in another place a day or two ago—to consider this important question. I am grateful to him for the matters which he raised, as I am to the hon. Members for Brent-ford and Chiswick (Mr. Barnes) and for Acton (Mr. Spearing) for intervening briefly, and to my hon. Friend the Member for Reading (Dr. Vaughan), whose comments will have been noted.
The hon. Member for Barons Court referred to the need in effect, to "Save Queen Charlotte's". I assure him and the House that this is precisely the Government's aim. There are many factors affecting the decisions facing us about the future of Queen Charlotte's Maternity Hospital and how best to secure for it a worthwhile future within the framework of change and development in our social services generally and of the National Health Service in particular. I am glad to have this opportunity to outline some of the special considerations affecting this case.
1966 Wonderful work has been done and is being done at Queen Charlotte's. I wholeheartedly support the view of the hon. Gentleman, his hon. Friends and my hon. Friend that it would be a tragedy if all that is best in the tradition and reputation of this famous hospital were to be denied to the medical and nursing professions, who have served so long there and benefited from it, and even more to the general public.
Because pregnancy is not an illness but a normal condition, it is possible, given the appropriate basic information about local populations and their age distribution, to define the upper limit of need for maternity services with a fair degree of accuracy. There was a time when women chose to have their babies at home wherever possible, and practitioners referred to maternity hospitals only those women who were suffering from a condition which needed specialist help which he was unable to provide.
Since the inception of the National Health Service immense strides have been taken—and we are still moving forward, of course—in maternity as in other medical and surgical specialties, to improve the quality of local hospital provision. As a result, most women have their babies in hospital as a matter of course, and those local hospitals are increasingly able to manage not only the routine and straightforward cases but those involving serious medical complications which at one time would have necessitated reference to a highly specialised hospital such as Queen Charlotte's.
Assessment of the need for hospital maternity services is made by the relevant hospital authorities on the basis of advice issued from time to time by my Department; it takes account of such factors as the estimated size of population and birth rate, the length of pre-natal and post-natal stay in hospital, and the needs and wishes of the local community.
A sub-committee of the Standing Maternity and Midwifery Advisory Committee recently reported on domiciliary midwives and maternity bed needs and recommended that sufficient facilities be provided for 100 per cent. hospital delivery. That report is still being considered, and I cannot yet say whether this recommendation will be fully accepted. However, in view of the trend towards shorter stay in hospital, in many 1967 areas a great increase in beds may not be necessary to achieve 100 per cent. hospital confinement. And, of course, we must respect the wishes of those women who wish to have their babies at home.
For the reasons which I have mentioned, I believe that members of the public welcome the development of better hospital facilities in their own local areas; one result of these developments is to be seen in a growing disinclination to travel unnecessarily far for hospital and specialist treatment. The London teaching hospitals, all of them situated in Inner London, have experienced this trend and are developing close links with other health services and with their own local committees accordingly.
When we look at the position in Inner London in particular, we have perforce to take into account the clear forecasts, particularly those of the Greater London Council, that its population is falling and to realise that in looking forward to what is likely to be the case at the end of the current decade—this is the time scale I ask the House to consider in this context —it is probable that this downward trend will continue. In Inner West London, that is, the London Boroughs of Hammersmith, Kensington and Chelsea, and Westminster, the proportion of births which take place in institutional care is already substantially above the national average, and to an extent that it would appear that the level of demand from the existing population is already being met.
Indications from statistics of hospital bed occupancy and throughput, however, are that the number of maternity beds available exceeds the number necessary to provide even this high level of service, and on service grounds alone we see a need to reduce the hospital maternity beds by half, from 600 to 300 by 1981. This number would still provide enough beds for 100 per cent. hospital confinement on the formula recommended in the report to which I referred earlier.
Looking more widely at the area from which Queen Charlotte's currently draws most of its patients, we see that the changing need follows a similar though less dramatic pattern.
§ Mr. Richard
The hon. Gentleman is being less than charitable. Not only 1968 is he reading a brief; he is reproducing in the same words the speech which his noble Friend the Minister of State read in the House of Lords the other day. I put a number of specific points to the hon. Gentleman about the nature of the catchment area. Will the hon. Gentleman now deal with that rather than giving the House a demographic view of London?
§ Mr. Alison
I am coming to the hon. Gentleman's points. He raised one about the catchment area. It is not confined to the three boroughs. The three boroughs contain several teaching hospitals. There is an over-provision of maternity beds in London as a whole, and the tendency not to wish to travel long distances rather reinforces my point.
In planning hospital services in West London, there is the additional consideration that most of the hospitals serving the local communities who live in the Inner West London boroughs are teaching hospitals. The conclusion we have reached is that even allowing for the continuing attraction to patients and their family doctors of the special skills of the teaching hospitals, the projected need cannot be seen as greater than a total of 350 maternity beds. But we have put on an extra 50 as a bonus, because of the special concentration of teaching hospitals in the area.
This conclusion has been reached in close consultation with and the complete agreement of the two regional hospital boards concerned, although we all recognise that given the uncertainties about the long-term effects on the birthrate of changes which have taken place in the law relating to abortion or the developments of family planning services and contraceptive techniques, this may well prove to be an over-estimate.
The appreciation by the University of London of the requirements for clinical teaching in obstetrics has taken due account of the service constraints—
§ Mr. Richard
On a point of order. This is exactly the same wording that the hon. Gentleman's noble Friend read to the House of Lords on Monday. With respect, this is not in order.
§ Mr. Alison
If I may use that as a point of argument and not a point of order, the hon. Gentleman will appreciate that we are a single government dealing with a single and extremely pertinent issue.
§ Mr. Alison
One of the special constraints that I have described is the requirements for clinical teaching in obstetrics, and here I quote the description of the London University of the constraints which are relevant. One is:that in future the Institute of Obstetrics and Gynaecology should be sited in association with a general hospital which will provide the necessary collateral clinical investigative and research facilities, including the relevant basic medical sciences".The other isthat in allocating the scarce clinical facilities for teaching of obstetrics within the 3 Boroughs, priority should be given to the needs of the General Medical Schools".In other words, the undergraduate teaching hospitals should have maternity beds, if necessary at the expense of postgraduate teaching hospitals.
As a result of this appreciation, it is now proposed by the University authorities that the Institute of Obstetrics and Gynaecology should be built at the Hammersmith Hospital, where it is proposed also to provide, with the help of a generous endowment, a peri-natal institute. In this connection, I should perhaps mention that the incidence of infant mortality has fallen from 34 per 1,000 in 1948 to 18 per 1,000 in 1969, and that deaths in children are now concentrated in the last stages of pregnancy, during birth and in the first week of life. For this reason we see a need for increasing liaison between obstetrics and paediatrics and for enabling those providing maternity services to enjoy the full supporting facilities which are available in a general hospital.
Indeed, I understand that evidence is becoming available which will show that provision of this type of intensive special care and support for babies which the proposed new unit will be able to provide in the context of a general hospital will not only help to reduce infant mortality still further but will prevent or reduce handicap, such as cerebral palsy, in those who survive.
1970 The more closely one looks at the combination of the factors affecting maternity services in West London, the more one is drawn to the realisation that since Queen Charlotte's will in any case cease to be a postgraduate teaching hospital when the postgraduate Institute with which it is associated is transferred elsewhere, its own future development as a centre of excellence both in clinical practice and research, might well lie in closer association with the undergraduate teaching. Charing Cross Hospital is being completely rebuilt on the site of what used to be the Fulham Hospital, and the disposition of maternity beds between this and the other hospitals in West London is the subject of discussions which are still going on between my Department and the various hospital authorities; and I would stress that a decision about the best means of securing the future of the teaching function at Queen Charlotte's Hospital has not yet been taken.
I hope that the hon. Gentleman will accept that no decision has yet been taken to close Queen Charlotte's Hospital. We want a future for it. Before any such decision could be made, there would have to be the formalities of consultations and proposals by the regional hospital board. The decision about the best means of securing the future of this teaching function has not been taken. The future is open and has not been determined, as the hon. Gentleman and other hon. Members seem already to have decided.
I should like at this point to reject firmly the accusation that the views of the Board of Governors of Queen Charlotte's Hospital are being excluded from our deliberations. Hon. Members might be forgiven for thinking that members of the Board constituted a body completely independent of my right hon. Friend the Secretary of State for Social Services, whereas in fact the chairman and every member is appointed by my right hon. Friend. In these circumstances it would have been inconceivable for him not to have taken the views of the board of governors who are his agents. It is true that the earliest discussions ranged over a wider area than that of any single hospital authority, but consultation with Queen Charlotte's was begun as soon as the issues could be brought into focus as I have tried to outline them today. And it is perhaps worth recording that 1971 the idea of reviewing hospital maternity services in West London has at no time been informed by considerations of administrative convenience. Our aim is to provide the public with the best possible services, as conveniently and economically as possible, consistent with meeting the legitimate teaching requirements of the University of London.
The hon. Member for Barons Court made some comments about the fact that what I have told the House has been similar to what was said by the Minister of State in my Department in another place. I must assure him that in the short time between the debate there and the debate which he has had the good fortune to secure this afternoon, it is extremely unlikely that any long-term plans could have been formulated to make it proper for the Government to make a different statement about new factors having emerged which had not been long considered.
1972 It is entirely proper that, paying careful attention to representations which have been made to them and which continue to be made, the Government should speak with one voice even though that voice emanates from two different bodies speaking in two different places. I hope that the hon. Gentleman will accept that the gloomy prognostications for this hospital at which he hinted are by no means justified by the circumstances I have described. There are, nevertheless, factors which we have to weigh carefully as we consider the time scale which I have mentioned, and 1981 is a sort of—
§ The Question having been proposed after Four o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-eight minutes to Five o'clock.