HC Deb 13 March 1972 vol 833 cc259-68

2.15 a.m.

Mr. David Waddington (Nelson and Colne)

I make no apology for raising what at first sight may appear to be a narrow parochial issue, because on closer examination it will be seen that far-reaching considerations of Government policy are involved.

The Reedyford Memorial Hospital at Nelson was built between the wars and is not called a memorial hospital for nothing. It is, in fact, a war memorial hospital, the cost of building which was met by public subscription—by ordinary people giving a few coppers a week out of their wages because they felt that there could be no more fitting memorial to the dead and wounded than a hospital.

As the years have gone by the Reedyford has never failed to attract massive support from voluntary organisations in the town. The annual hospital gala, in particular, has always been one of the most important events in the calendar.

It is against this background that the Minister will understand with what dismay there was greeted the publication in the local paper of a statement by the Burnley and District Hospital Management Committee to the effect that it had always been intended to close Reedyford eventually and replace it with new wards at the Burnley General Hospital, and that, as it now looked as if Reedyford would have to be demolished to make room for an intersection on the Calder Valley Road, the closure that had always been planned would be brought forward.

I have long campaigned for the Calder Valley Road and for a fast route between the M6 and North-East Lancashire. I have always believed that it is vital for the future of Nelson and Colne that road communications in the area should be improved, and that without such an improvement there is little chance of our attracting into the area the new industry that we so badly need.

When, therefore, it became apparent that the building of the new road would involve the demolition of the hospital it might have been tempting to argue that it would be folly to make too much of a fuss about the hospital in case it delayed construction of the road. I have never looked on the matter in that way. The issue is very simple: is there a case for a hospital in Nelson? If there is, yet the old Reedyford has to be demolished to make room for the road, there is a case for ensuring that a new Reedyford rises out of the ashes of the old.

Some people have already said that this is a lot of fuss about nothing—that the advantages of a large general hospital are manifest, and that in any event people in Nelson are not entitled to talk about it as "their" hospital, because only a minority of the patients treated there actually live in the town. The fact that, because of what some may consider the eccentric way in which things have been arranged by the hospital management committee, Nelson people travel to Burnley for treatment and vice versadoes not remove the right of people in Nelson to look upon it as their hospital, standing as it does in the town, and paid for by the people of Nelson. They feel very strongly that there should always be a place for a local hospital, and they have no enthusiasm whatever for a plan which will mean more people having to make long and expensive journeys to obtain treatment or to visit friends or relatives who have been taken ill, or who have had to undergo operations. They know—because it has also been announced—that if the hospital management committee gets its way on this question it will not be long before Hartley hospital, in Colne, is also closed. We will finish up with people living in Earby, Barnoldswick and Trawden having to travel as far as Burnley for treatment.

A year or so ago we had the closure of Reedyford as an accident unit. Now the argument is levelled against us that Reedyford is no longer providing the sort of facilities that justify its continuance as a local hospital. If Reedyford goes it will be that much easier for the hospital management committee to argue for the closure of Hartley Hospital—and so we go on.

Far from going in for more and more centralisation, the planners ought seriously to reconsider some of the steps that they have taken, like the closure of Reedyford as an accident hospital. If we cannot get an in-patient hospital at Nelson we are at least entitled to ask the powers-that-be to consider setting up some sort of unit in the town to deal with accidents and out-patients.

I freely admit that this is in the nature of an exploratory exercise. At this stage I want to learn something more of the Department's thinking on these problems, and to prod the Secretary of State into developing a little further certain ideas which he threw out during a speech at Goodmayes Hospital on 8th February. I was encouraged that in that speech he said that he had been taking a far-reaching look at the place of the local hospital, and said that he was: a healthy sceptic on over-concentration". He made it plain on that occasion that he did not subscribe to the view that the day of the local hospital was gone for ever, and he pointed out that there was a need for community hospitals for patients who did not need all the expensive facilities of a district general hospital. He said that in the local hospitals patients could be looked after nearer their homes and their friends, benefiting from the good will and service —whether voluntary or paid—that can be focused on a small hospital serving its community.

It seems to me that the existing or a rebuilt Reedyford has a place as just such a hospital, and I hope that the Secretary of State will study the proposals by the hospital management committee with the utmost care and will think hard before giving his blessing to a plan to which there has already been widespread local opposition. I say that the opposition is widespread because in due course I shall have to present in this House a petition against these proposals which contains thousands and thousands of signatures.

2.25 a.m.

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

I see that the leader writer in a recent issue of the Colne Times quotes my hon and learned Friend the Member for Nelson and Colne (Mr. Waddington) as viewing the subject of today's debate as a matter of immense local importance and as agreeing with those who think it is a matter which needs investigating very carefully before any final policies are passed". I certainly agree with his view, and I am glad my hon. and learned Friend has had a chance of raising the matter today, albeit at this exceptional hour.

Perhaps I should begin with a little background history. When my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), who was then Minister of Health, published in 1962 "A Hospital Plan for England and Wales", it was envisaged that developments at Burnley General Hospital would enable more modern and improved provision to be made there to take over the work now done at Reedyford War Memorial Hospital, Nelson, and the Hartley Hospital in Colne. As forecast in the plan, a new maternity unit has since been provided at Burnley General Hospital, and the second phase of redevelopment—comprising a new outpatients department, accident departments, physiotherapy and X-ray departments—is due to start later this year. Further schemes to complete the redevelopment of Burnley General—providing new ward accommodation, operating theatres and supporting services—are planned for the future. It was as a result of these future developments that it was foreseen in the hospital plan of 1962 that some thought would need to be given in due course to the future of the two hospitals that we are talking about today.

As my hon. and learned Friend has said, matters have been rather abruptly brought to a head by plans for the proposed new Calder Valley Road, joining this part of Lancashire to the M6. I think it fair to say that public opinion in the area has always recognised and shares my hon. and learned Friend's view of the importance of the new road development proposed by the county council, with its object of furthering local economic growth.

The feature that concerns us this morning is that part of the development which provides an intersection between the new road and the existing A682 Scotland Road. Nelson would, by means of this intersection, have direct access to the M6 motorway. The rub comes in the consequences for Reedyford Hospital. The line proposed by the county council as the most economical route provides for the intersection at a point which would render the hospital no longer viable. Alternative routes would, it is suggested, be more costly, less satisfactory from a traffic-flow point of view—since it would involve carrying the new road over the Scotland Road—and in any case likely to lead to intolerable noise levels, as a result of having hospital and a dual three-lane fast road so close together.

I should, however, emphasise the conditional, as things now are. We are here considering not decisions but only proposals. Stage III of the Calder Valley Road is now being considered, along with schemes from all over the country, for inclusion in the principal road preparation list. My right hon. Friend the Secretary of State for the Environment hopes to be able to announce an extension of this list within the next month or so. If this road scheme is included, Lancashire County Council will be able to carry out more detailed preparation of a scheme. So neither the precise line nor the date of construction is settled.

There will, I can assure my hon. and learned Friend, be plenty of opportunity for public comment on the detailed scheme. There would almost certainly need to be a public inquiry, because no line is shown on the town map. At a later stage, compulsory purchase orders would have to be published and if there were substantial objections to these a further public inquiry would be necessary.

I understand that my hon. Friend the Minister for Local Government and Development is due to visit the area next week to discuss the road proposals, and I imagine that he will be meeting my hon. and learned Friend among others. If the road has to involve the demolition of Reedyford War Memorial Hospital—and we cannot be certain about that until the more detailed preparation work to which I have already referred has been done—the hospital board will receive compensation to enable it to provide replacement facilities at Burnley at an earlier date than had been envisaged. The hospital board will also be required to hold public consultations if it is proposed to close or change the use of the hospital. That takes into account the outcome of these consultations in making its final recommendations to my Department, and both my right hon. Friend the Secretary of State for Social Services and I weigh them in the balance with all the other factors involved before a final decision is taken.

This is equally true of the Hartley Hospital in Colne. I have seen a number of newspaper reports, and my hon. and learned Friend has spoken about the possible future of the hospital. The present position is simple: I have had no proposals from the regional hospital board and would not expect any in the near future, since that hospital's position would not come up for consideration until planning begins on the final stages of the redevelopment of the Burnley General—and that is some years ahead. In any case, as I have said, any proposals for the closure or change of use of Hartley Hospital will be subjected to the full rigours of public discussion before any decisions are taken.

The Government are very conscious of the invaluable rôle of voluntary effort in the life of such hospitals as the Reedy ford War Memorial Hospital and the Hartley Hospital, and of the loyalty and devotion that people feel for their local hospital. We are determined that as far as possible these assets will not be lost. They must not be, because the service could not afford to be without them; nor could the health of the community as a whole. But, much as we would like to, we cannot avoid the economic realities. That is not to say that they are the only consideration, but they have, unavoidably, to loom large in our thinking.

My hon. and learned Friend referred to the speech that my right hon. Friend made last month to the Stratford and Redbridge division of the British Medical Association. My right hon. Friend has been taking a long hard look at the place of the local hospital in a modernised service. As he said, the foundation stone on the hospital side will continue to be the district general hospital, providing comprehensive services for populations of up to about 250,000 people. The reasons are well known. With the clinical advantages of having all the major specialities under one roof, the scarcity of money and of skilled men and women, and the increasing complexity of techincal services, some concentration to reap the economies of scale and to give the patient the best service possible within available resources is inevitable.

We simply do not have the resources of money or skilled manpower both to provide new hospitals—which we all know are badly needed—and to keep all the old ones going. It is often suggested that the life of the old hospital is finished, but sometimes the hospital at risk is a well-loved local hospital—as with Reedyford and Hartley Hospitals—and those who use it, whether doctors or the general public, find it difficult to see why it should not continue to serve the local community. That is why my right hon. Friend, in talking to the B.M.A., described himself as a healthy sceptic of over-concentration, and stated that there will continue to be a rôle for some local hospitals—the ones that we are now calling community hospitals—for patients who need hospital care but do not need all the expensive facilities of a district general hospital.

Mr. Waddington

Is my hon. Friend prepared to go so far as to say that that is possibly just the rôle that the existing Reedyford or a new Reedyford, built in Nelson, could perform? I am not asking him to say that it is necessary that for all time in the future in Nelson there should be a hospital treating patients in the way in which they are treated at the present Reedyford, but may there not be a case for a community hospital in Nelson of the sort that the Secretary of State was referring to in that speech?

Mr. Alison

It is tempting to give an answer that will supply my hon. and learned Friend with precisely the reassurance that he seeks, but I cannot go as far as that at present. The concept of the community hospital is being evolved at present and is evolving on the lines that my right hon. Friend has set, but the aim is to show that there is a rôle, and will continue to be a rôle, for the small local hospital. The future of the Hartley Hospital is not in question at present, but that of the Reedyford is if the road proposed goes through on the present suggested line.

Against that background, with the hopeful view of my right hon. Friend of the whole concept of the community hospital, I hope that my hon. Friend will extract from an uncertain future what crumbs of comfort he is able to find, but I cannot be pressed to be more specific about the future pattern, which still remains completely unclear.

Mr. Waddington

I understand my hon. Friend's difficulty, because it is one with which I have been faced. Does he appreciate that all along this whole debate has been bedevilled by the plan for the new road? Am I entitled to assume that even if the new road involves the demolition of the present Reedyford Hospital the Secretary of State will not have a completely closed mind on the issue, and that it will still be open to try to persuade him that in Nelson there should be either a community hospital or, at the very least, a unit providing out-patient treatment and accident facilities?

Mr. Alison

My difficulty, as I have said, is that not only do we not know for certain whether the road will be agreed and finally set down on the hypothetical line which has been discussed; until that has been decided and determined, the Department cannot even have before it firm proposals from the regional hospital board, in whose gift it is to make those proposals and to suggest how local facilities may be developed. It would be quite improper for me at this stage to make suggestions, not having had the proposals from the board, which should properly take the initiative in suggesting how a replacement for Reedyford's facilities might be developed.

I have already suggested that compensation will be payable to the board if Reedyford is demolished. One obvious advantage is that it would be able to bring forward the acute final stage facilities at Burnley earlier than would otherwise be the case. Whether at the same time it would want to propose the development of a community hospital in this part of the world would be up to the board. The concept of the community hospital has struck a sympathetic note with my right hon. Friend, who has stressed his desire to preserve local loyalties, and so on.

The real problem is to translate centralisation—producing major benefits for the mass of patients, and the maintenance of local facilities—into practical policy; what the size of the community hospitals should be, the types of patients they should care for, what staff and supporting services they should have, their relations with the district general hospital, and so on.

As my hon. and learned Friend has already heard, the community hospital concept is being elaborated in the Oxford region. The Department is already giving financial help to an evaluation of the idea of the community hospital. The evaluating process will last one or two years yet, but my right hon. Friend nevertheless hopes soon—before the evaluation at Oxford is complete—to be able to announce the Government's policy for small local hospitals. When he is able to do so it will become clearer which local hospitals may be retained and even developed to play a part in the future of the service. We shall not be able to keep all of them, but for some there will be a new vigorous life, perhaps in a new shape, with improved links between the hospitals and the community.

I am not yet able to add to what the Secretary of State said last month, but I can say that we are working hard on this matter, and I hope that it will not be very much longer before my right hon. Friend will be able to issue a firm policy statement on the development of small local hospitals of this kind, based upon the Oxford community hospital model that we are evaluating.

The subject of the debate is in many ways a microcosm of one of society's most difficult problems, namely, the necessity for change, but for change which all too often may at the same time hurt. The benefit of progress has often, alas, to be paid for in the loss of something cherished. The area represented by my hon. and learned Friend needs both new roads and new hospital facilities, both of which are real benefits. But one of the costs is the shadow of uncertainty, unavoidable in this context, which is cast over two well-loved local hospitals. Before any decisions are taken it is essential that the Ministers responsible for taking them are fully aware of the views of all the interested parties—the local authorities, local industry, the hospital authorities and the local townspeople. In due course we shall certainly be receiving proposals and representations from the regional hospital board.

The debate has been a very worthwhile means for making some of these views known and for spotlighting some of the conflicting factors involved. That is one reason why I am extremely glad, even in advance of the regional board's representations to us, that my hon. and learned Friend has succeeded in focussing our attention so early in the processes which arise in the development of roads and the associated hospital closures, so that we have the benefit of his views, which reflect most intimately and fully the views of his constituents in this situation. We shall study carefully what he has said and do our best to meet local wishes as fully and sympathetically as possible.

Question put and agreed to.

Adjourned accordingly at eighteen minutes to Three o'clock.