§ 10.46 p.m.
§ Mr. William Rodgers (Stockton-on-Tees)
I first raised the question of the North Tees General Hospital in the House over nine years and some five separate Ministers ago. I am glad to have the opportunity, but regret the necessity, of raising the matter again.
My concern then, nine years ago, and now is the same: that, as soon as possible, the hospital, which is situated in my constituency, should be contributing fully to the health and community needs of the area. My anxiety then and now is that it may fall short of its potential and disappoint expectations.
190 Nine years ago I was hoping that the date for the commencement of construction could be advanced. Later I was concerned with the design of the hospital and the intention not to provide a double corridor ward plan. At one stage the main contractors went bankrupt. The fact fortunately remains that the hospital is there and building continues to make progress. We are proud of it in Stockton, and we have high hopes.
In passing, perhaps the Under-secretary will confirm the timetable for the completion of stage 2 and developments thereafter. Perhaps he will also remind us of the total costs. The investment in bricks and mortar, in equipment and amenities, is massive. What bothers me—and this is the crux of my argument tonight—is that in the provision of medical services the hospital may nevertheless fall short.
First, I should say, in parentheses, that during the last year I have taken the opportunity of discussing some of these matters with both the Chairman of the local management committee and with the regional hospital board. In particular, I have seen and had recent correspondence with Colonel Lee, the chairman of the board. At all times he has been most helpful.
I am raising this matter tonight not in criticism of anyone, but to draw certain matters to the attention of the Minister, to lodge them in his mind, and to hear such comments as may be appropriate. Even now I am more concerned that he should listen, mark and inwardly digest than that he should give a precipitate reply. I want to engage his interest, not to bully or even to persuade.
Two minor matters are unrelated to my main theme, and the Minister may say that they are outside his competence. I mention them for the record, and so that my concern may be passed on.
The first is the question of access to the hospital by road. I do not think that sufficient attention could have been paid to this when the hospital was being planned. It is very well placed in a large, new housing estate, but the approach to it is not easy and the width of the roads is quite inappropriate to a large volume of traffic. Ambulances could be impeded or accidents caused. It is not a happy situation. It needs remedying.
191 The second arises from the recent case where children died in tragic circumstances at a hospital elsewhere in the country through what was thought to be the action of an intruder. I can understand that security should be carefully examined, but it would be a great pity if this hospital were to be surrounded by, for example, a massive fence of iron railing.
In Liverpool, where I was brought up, 40 years ago all the hospitals, the majority being Poor-Law institutions, were surrounded by high walls and railings. They were sinister fortresses set apart from the local communities. As the psychological barriers to medicine go down it would be a pity to erect physical barriers round our new hospitals. The present open landscaping of the hospital humanises it and helps to make it a part of the community, and I hope this quality will not now be lost.
I now come to my main point and I can express it briefly. I am deeply concerned that the hospital will be denied specialties that are essential both to its future reputation, and its power to attract first-class staff, and to its service to the area. In particular, I am much bothered by the suggestion that it would be denied ear nose and throat provision in spite of original plans for the inclusion of a theatre and obvious local needs.
I believe my anxieties are felt and shared by the North Tees Management Committee, the medical advisory committee and the local medical committee, which I think the Under-Secretary will agree is a, powerful consensus. Even a large new general hospital of this kind cannot have all the specialties, but is it really necessary or desirable to be denied all of them? And is it to be denied what is after all a run-of-the-mill speciality which local G.P.s expect and waiting lists justify?
We have a modern building and excellent doctors, nurses, administrators and ancillaries. Are we, nevertheless, to have a second-class hospital serving 180,000—a technocratic white elephant? I hope the Under-Secretary will say that I am wrong. He need not, as I have implied, be dogmatic tonight. I am asking principally for his interest but my 192 fear is shared by others and I hope it will be allayed, if not this evening then later.
I understand that some historical factors may be involved. Ten years ago there was certainly a shortage of E.N.T. consultants in the area. Similarly, it is said there is a shortage of anaesthetists today although this may be mainly a question of their deployment, given the distance between many small hospitals. Perhaps I should be raising with the Under-Secretary the whole question of local manpower and asking how many registrars are in training for E.N.T., for eyes, and to become pediatricians or radiologists. It may be that the regional hospital board is trying to cope with the shortage. It is certainly the impression that has been put about.
I am not dismissing a real problem of this kind. I cannot judge how acute the shortage may be. But surely a short-term problem should not prejudice the long-term future of the hospital. In any case, I cannot see why all the specialists need be concentrated in the South Tees Group, even if there is a case against dividing any one of them. I gather that in most regions the solution is to scatter the specialties between the hospitals. It gives each hospital something else to offer by way of training junior doctors and nursing staff. I should like to believe that the Under-Secretary smiles upon such arrangements and will do so if they are made in our case.
I want to return in a moment to E.N.T. and the local position, because it sums up my anxiety. I have been referring, of course, to in-patient provision. But I gather also that certain out-patient facilities originally envisaged for the hospital, like neurology, radiotherapy, and nephrology may now be withdrawn. Again I hope I am wrong. The Under-secretary will understand why confidence is being eroded, and if he cannot restore it tonight I hope he will do so in due time.
As for E.N.T., on 14th March, the Minister answered two Questions of mine about relative provision in the country. Only two of the general hospitals completed in the last decade are without E.N.T. beds. The Minister will agree that those at Ashington and Airedale are small compared with North Tees. In the case of new hospitals, at Greenwich, Frimley and Bury St. Edmunds, in which the Department is directly and specially 193 involved, I gather that all will have E.N.T. beds, despite their being considerably smaller than the North Tees General.
When we compare beds with population, there seems some difficulty in reconciling the Minister's figure of 0.18 per thousand population at the North Riding Infirmary, at present covering the whole of Teesside, north and south, with the board's own figure of 0.95.
Be that as it may, there is no reason to be complacent about the position when, at the last date of which I am aware, 30th November, 1970, there was the huge figure of 1,306 E.N.T. patients awaking admission for surgery, with waiting periods for some of over a year. If the Minister says that the position is improving, I shall rejoice. If he can guarantee its continued improvement, I shall be delighted. But, if not, surely there ought to be an all-out effort to provide beds in the North Tees General. With the best will in the world, there is clearly a limit to what the North Riding Infirmary—a hospital of an older generation—can reasonably do.
So I come back to the beginning. I am asking for reassurance. Is the North Tees General Hospital to fulfil its expectations and the requirements of the area, or is it to be bypassed? If there are genuine problems of medical manpower, why should it not be regarded as the primary hospital in the area with a status and reputation equal to its size and design? Are we to be a poor relation within the region, a wasted and eventually wasting asset?
I and others are disturbed. The whole concept of the district general hospital is at stake—the whole quesion of whether the investment of these very large sums of money is in some ways to fall short. I hope that the matter will have the Minister's personal attention. I hope that his Department will examine all the issues at first hand. I do not ask tonight for his dogmatic views but simply for the assurance that he and his Department are alert and well-disposed.
§ 10.58 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I welcome the opportunity provided by the hon. Member for Stockton-on-Tees (Mr. William Rodgers) to discuss and consider the hospital services 194 in North Teesside and the progress and future development of the North Tees General Hospital. I should also like to thank the hon. Gentleman for giving me a little prior intimation of the range of subjects that he would raise. I certainly assure him that I shall continue to take a personal interest in the affairs not only of that region but of the particular district in it. I also congratulate him on having got in another short speech on the last day of the Budget debate.
At the start of the National Health Service, the Newcastle Regional Hospital Board inherited hospital buildings and facilities which provided a hospital service lower in standard than that which existed in many other parts of the country. The Teesside area was no exception, nor for that matter North Teesside with which the hon. Member is particularly concerned.
On Teesside, services were fragmented among many hospitals, and the continuation of this dispersion would prevent the development of the kind of hospital service and level of provision which the citizens of the area have every right to expect and which it is the aim of both the regional board and my Department to provide. It is for this reason that the Newcastle Regional Hospital Board has planned to provide two new district general hospitals, one, the North Tees General Hospital at Stockton, the development of which I will come to shortly as the main part of my speech, and the other at Middles rough for South Teesside.
I will comment on the subject of waiting lists as these remarks will fill in some of the background. While the hospital services in Teesside are being steadily improved, and in particular the North Tees General Hospital is being developed, we can, from the waiting list position, make some assessment of the pressure on the hospital services. Waiting lists provide some guide, if not an infallible one, to the position.
Comparison of the North Teesside figures with the national picture shows that patients there fare no worse, and in some respects fare better, than those in the rest of the country. Nevertheless, as I am sure the hon. Gentleman has heard me emphasise before, we in the Department are certainly not complacent about waiting lists, and a special study 195 is in progress to determine how best to secure an improvement.
But waiting lists can be misleading as a full and uniform measure of pressure because the different criteria used in each area means that they cannot be compared meaningfully across the country. They do not of themselves indicate a short fall of resources, and in any case they probably include cases also on other waiting lists, and people who have moved away, died, or no longer need treatment. Names of people in these categories still appear on some waiting lists. But we aim to ensure that the time-waiting for admission is within an acceptable maximum in relation to the patients condition and other circumstances.
Waiting lists tend to increase, though I am glad to report that 1970 showed a downturn in the recent trend, because the population is increasing and demand is rising, due partly to generally higher levels of expectation. The availability of new forms of treatment—operations for arthritis of the hip or cardiac surgery—and the unwillingness of patients to put up with conditions suffered by early generations, for instance gynaecological conditions, all go towards causing waiting lists to increase at a time when resources in hospital services increase, a paradox which is as inevitable as it appears to be unavoidable.
As for waiting times for consultations, patients in all specialties who require urgent consultations are seen without delay. But for those who have to wait, the most protracted waiting times are in the specialties of general surgery and orthopaedics.
As a number of hospitals are involved, the picture is not uniform. In Stockton and Thornaby Hospital the waiting time could be up to 12 weeks, while in Sedgefield General Hospital it is no more than three weeks. In E.N.T., which is carried out in the North Riding Infirmary, waiting times compare favourably with the national picture. The position in other specialties in the North Tees Group is better and in nearly every case has shown improvement over the past year.
One of the problems in the North Teesside Group is that out-patient services 196 are fragmented among a number of hospitals, three of which have facilities which are inadequate by the standards of contemporary hospital design. This problem will be resolved with the opening of the new hospital in 1974, when all out-patient facilities will be centralised in purpose-built accommodation.
I come to the development and progress in the building of the new hospital, about which the hon. Gentleman sought up-to-date information. Planning of the hospital commenced as long ago as 1958—since when the hon. Gentleman has been making speeches on the subject—when the Newcastle Regional Hospital Board, which is primarily responsible for the planning of hospital capital developments in its area, set up a special committee to consider the development of hospital services in Teesside.
The Hospital Plan for England and Wales, published in 1962, envisaged that a district general hospital would be developed at North Teesside, and it was expected that the first phase of the new North Teesside General Hospital would start in the five years following the publishing of the Plan.
In fact, the first phase, consisting mainly of the maternity department, 50 mental-illness beds and day hospital and supporting services, started in August, 1965, and was completed in June, 1968, at a cost of about £2 million. Thus, a substantial contribution to the ultimate development was started within the time expected.
The so-called Hospital Building Programme, published in 1966, in reviewing the hospital plan, re-affirmed the intention to provide a new hospital at Stockton and said that the general hospital services in the North Teesside area would be concentrated at the new hospital. It was hoped to start the second phase of the new hospital within the period up to 1969–70. Here, again, there was good progress in the planning, and a start was made on the second phase in September, 1969, with completion now expected in early 1974, at a cost of about £5 million. This phase is a large one including 440 acute beds, a further 132 mental-illness beds, an accident and emergency department and supporting services. Unfortunately construction was delayed for a 197 while because the original contractor went into liquidation in October, 1970, but I am glad to say that the regional hospital board was able to find another contractor and work was started again in January, 1971.
A further part of the second phase, consisting of staff residential accommodation and an education centre, was started in January, 1972, and is due for completion by the end of 1973 at a cost of about £½ million.
I do not wish to weary you, Mr. Deputy Speaker, with details of the phases of this new hospital but the hon. Member has raised the question of the progress being made. So far, the progress I have outlined is according to plan. But we have been able to improve on this. Recently, my Department has agreed to the planning of a 202-bedded geriatric unit to be financed under the regional infrastructure programme announced in the House on 14th July last year by my right hon. Friend the Secretary of State for the Environment, to a design produced in the course of my Department's research and development programme. Building is expected to start later this year, and be completed next year at a cost of about £¾ million.
The infrastructure programme has enabled the provision of geriatric beds to be brought forward many years at the North Teesside General Hospital. This will make an important contribution to the care of the elderly in the hon. Gentleman's constituency. This means that the new hospital of over 900 beds will have been virtually completed by 1974. Without being complacent, I think that I am entitled to say that this will represent a considerable achievement by all concerned. But I very much appreciate the hon. Gentleman's remarks about his relations with and appreciation of the Newcastle Hospital Board, and Colonel Lee, in particular.
I appreciate the hon. Gentleman's concern that the new hospital should provide a comprehensive service for the Stockton catchment area, and I have just described the progress towards completion. The concept of the district general hospital aims to provide a complete service for the needs of the people in the district but, as I am sure the hon. Gentleman appreciates, certain specialties need to be provided on a sub-regional or area basis 198 if the full advantage of the latest developments in medical practice and facilities are to be made available to as many patients as possible. In this way the best use is made of scarce resources of medical and nursing skill and expensive advanced equipment.
In addressing themselves to the task of planning for the provision of sub-regional area specialties the Newcastle board decided that the needs of the region would best be served by four sub-regional centres—Newcastle, Sunderland, Middlesbrough and Carlisle—with an additional centre for area specialties. In deciding that Middlesbrough should be a sub-regional centre, the board took into account population and geographical factors, including the distance from the regional centre at Newcastle. The board also took the view that there was obvious merit in siting the area specialties in the sub-regional centre, particularly in the case of the two largely surgical specialties of ophthalmology and E.N.T.
The area specialties which will eventually be concentrated in the South Teesside Hospital Group are planned to serve the needs of Hartlepool, Northallerton and Darlington as well as the whole of Teesside.
§ Mr. William Rodgers
I do not quite understand why the decision has been made to put them in South Tees. As the Minister knows, the dates for the starting and for the completion of the South Tees General Hospital are in doubt, so why should patients not go into the best, the largest and most modern hospital in the area, at least for the time being?
§ Mr. Alison
I shall deal a little later with the details of the patient facilities. Teesside will have, as the hon. Gentleman knows, the existing North Riding Hospital in Middlesbrough, which makes a contribution to E.N.T., so there is provision in Middlesbrough alongside the services at the present time.
§ Mr. William Rodgers
Would the Under-Secretary agree that that hospital is out of date and unsuitable for the needs of the area?
§ Mr. Alison
That is true, but there is no necessity for the service to be removed from the area if there is to be a replacement hospital, as there is to be, in South Teesside.
199 I feel certain that the hon. Gentleman will agree that the distances to be travelled from North Teesside to what will be the eventual site of the planned new hospital in Middlesbrough are not excessive and are served by public transport facilities. I must also emphasise that out-patient clinics will be provided in the new North Tees Hospital in all the area as well as many of the sub-regional specialties. Thus the future North Tees Hospital will be developed on the lines of many other district general hospitals in other parts of the region and indeed in other parts of the country. There will be out-patient facilities with a very closely adjoining major unit in the new South Teesside unit for E.N.T.
E.N.T. is one of the area specialties to which I have referred and I propose to go into this question in some detail as it is a matter about which the hon. Gentleman and his constituents have been particularly concerned.
The facts are that the E.N.T. consultants based upon the in-patient unit at the North Riding Infirmary will provide the full range of E.N.T. services required for the Stockton area until such time as the new hospital is built in Middlesbrough. Additional out-patient facilities will become available when the new North Tees Hospital opens. This pattern of service was decided upon by the board upon the best medical advice available to them and with the support of the E.N.T. surgeons concerned. But I can give the assurance, particularly against the background of the reports that the hon. Gentleman has given me of the immediate reactions of consultants and others in his district, that the senior administrative medical officer of the Newcastle Board is presently to visit the hon. Gentleman's constituency and the medical staff there, particularly to encourage any discussions with them on this very subject, which will certainly enable them to make further representations directly to the officers of the board about their misgivings.
§ Mr. William Rodgers
I ask the Under-Secretary's forgiveness for interupting again, but from what I have heard I understand that he is saying that the matter is open and consultations are taking place.
§ Mr. Alison
I believe I am right in saying that the board has made up its mind on this and has taken a good deal of advice about it; but this is fundamentally a matter for the board. The fact that the senior administrative medical officer is at least to visit the area in the near future means that, although I shall not say that the board is prepared to change its mind, at least it wants to argue the forcefulness and validity of the case which it believes it has to the staff, and this may serve to allay their misgivings.
It would be extremely difficult for the board to have taken a view different from that of the professional staff who have to operate the service. Moreover, the concept of concentrating the E.N.T. service to provide the most effective cover for the area is not simply a local view of the best solution. It accords with the view of the British Association of Otolaryngologists at national level. Since the hon. Gentleman has shown some interest in establishing whether the Teesside pattern is any way out of line with what prevails elsewhere, I shall, if I may, return to the issue of the national pattern after rounding off my remarks on the local situation.
The board's concern in Teesside has been to make the best use of real resources of medical and nursing staff, and accommodation and equipment. This is not an end in itself, but serves the further aim of giving a better service to the patient than would be possible with a number of smaller units. At present there is a 64-bed E.N.T. unit in the North Riding Infirmary. This, as the hon. Member knows, gives a cover of 0.13 beds per 1,000 population for the whole of Teesside. This figure is slightly above the regional average, although corresponding to the national average. The unit is staffed by three E.N.T. consultants, two of whom will provide out-patient sessions in Stockton when the new hospital is completed. The E.N.T. operating facilities in the North Riding were extensively upgraded in 1970 and further improved in 1971. This has enabled the unit to treat more patients per bed. Despite this increase in workload the waiting list has been reduced considerably. In 1972–73 an additional 16 E.N.T. and eight eye beds have been 201 planned to provide services for the Hartlepool area.
As indicated, this kind of deployment of services is one which the E.N.T. specialty advises at a national level. Again, the basic reason is one of resources of skilled staff. E.N.T. is a specialty which has some difficulty in attracting a due proportion of high-calibre doctors, and the Association of British Otolaryngologists sees as the chief remedy concentration of services into units staffed by teams of two or three consultants. This ends professional isolation, a very real problem of the specialty at present, and permits a greater specialisation of work within the E.N.T. spectrum. It would also provide the consultants and their supporting staff with a large enough caseload to develop further expertise.
Further, such concentrated units would justify the installation of the sophisticated hardware required in dealing with problems of deafness, and the special quiet rooms in which hearing tests should be carried out. The hon. Gentleman will gather therefore, that Stockton is unlikely to be the only hospital without E.N.T. beds. This does not mean that it will have no E.N.T. service. I do not regard this as a weakness. Rather, it is a strength of the N.H.S. that boundaries need never cramp planning and that the objective of the best medical service to 202 the patient can be pursued without too much regard to lines on the map.
I believe that the close proximity of Middlesbrough to the hon. Gentleman's constituency and the free flow and counterflow from the inpatient and outpatient facilities provided by the Teesside area generally will provide a first-class service in future for those who live in the future.
My information on the point of road access is that, as far as the board knows, the road access problem, at least at present, is not serious. We will bring what the hon. Gentleman has said to the board's attention. Perhaps when the S.A.M.O. visits the area in the near future he will examine the question. I understand that the site is off the A277. There is road access to all points in the area.
The board has no proposals to amend the existing landscaping. The idea of a prison-like, isolated area, is far from what is proposed. I hope that in setting out these proposals I have at least put on record the position—
§ The Question having been proposed after Ten o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at sixteen minutes past Eleven o'clock