HC Deb 26 February 1973 vol 851 cc1242-54

12.8 a.m.

Mr. Elystan Morgan (Cardigan)

I welcome the opportunity of raising once again in the House a matter which is of acute concern to many scores of thousands of people who live in the area of Mid-Wales. The grievance concerns the absence of a resident consultant in the area in a range of medical specialties. The principle involved is that people who live in a rural locality are as morally and legally entitled to the same high standard of locally-based services as their urban brethren.

The area which is the subject of the debate is that part of Mid-Wales which is served by the 280-bed Bronglais Hospital, Aberystwyth. It receives its patients from a wide area which stretches from Caersws in the north to the River Teifi in the south, and from North Radnorshire to the Mawddach Estuary.

The indigenous population of the area is about 75,000, but many of the coastal communities have a summer population which is three, five or even seven times the number of their permanent inhabitants. These figures are not without relevance, since the number of people actually served by the main base hospital for the area—namely that at Glangwili, Carmarthen—is about 90,000. Thus, taking into account the localities served by the Glantawe group of hospitals, even as regards the indigenous population the number of people served by Aberystwyth is only slightly less than that actually served by Glangwili. It is obvious, therefore, that where facilities cannot be provided at Aberystwyth, the distances which people from Mid-Wales have to travel to the peripheral general hospitals are immense.

The problem is further complicated by the fact that fewer than half of the rural communities are served by any form of public transport. Patients taken to a district hospital from Llanidloes, for example, would travel 70 miles to Glangwili, 46 miles to Shrewsbury and 56 miles to Wrexham. Patients from Machynlleth would travel 80 miles to Glangwili, 61 miles to Shrewsbury and 65 miles to Wrexham. Patients from Towyn in Merionethshire would travel 85 miles to Glangwili, 75 miles to Shrewsbury and 65 miles to Wrexham.

As the Minister of State will know, in terms of medical risk as well as of human misery and anxiety it would be difficult to exaggerate the element of very real hardship which flows from such a situation. This hardship centres around three basic specialties. In what I believe to be ascending order of priority, they are the establishment of a psychiatric unit, an ENT specialty and a full paediatric service.

In relation to psychiatric disorders, I am sure the House will agree that it is a disquieting thought that psychiatric patients have to be taken to the huge St. David's Hospital at Carmarthen when they could so well be accommodated in a ward designated for that purpose at Aberystwyth. Likewise, patients who undergo fairly straightforward ENT operations also have to suffer transportation to Carmarthen.

The specialty, however, in respect of which the lack of local provision has given rise to the deepest feelings of injustice and to a protracted campaign in the House and elsewhere is the service which deals with the care of sick children and infants, the paediatric service. This issue has been given even greater prominence following representations made in the House three weeks ago by the hon. and learned Member for Montgomery (Mr. Hooson) following the death of a nine-year-old boy in his constituency. That child was admitted to Aberystwyth Hospital suffering from an acute peri- tonitis condition. He was operated upon immediately. The operation seems in every way to have been properly conducted. The child did not recover and some weeks later he was transferred to Wrexham where, after three or four weeks, tragically he died.

It may well transpire from the inquiry now taking place that the matter did not involve a paediatric situation as such. Nevertheless, that sad happening has given a new impetus to an old campaign to establish a paediatric service at Aberystwyth. I have received numerous representations from local government bodies and from social and educational bodies and establishments, in addition to many scores of representations from people representative of all walks of society in my constituency, in support of the establishment of this most important service.

The general case appears to be wholly irrefutable. Within the last 18 months two authoritative reports have given strong support for this proposition. First there was that of Professor Gray, the regional adviser in paediatrics, in October 1971. After an examination of all the possibilities, Professor Gray came down firmly in favour of establishing a paediatric consultant at Aberystwyth. According to Professor Gray, such a person would be able to provide both in-patient and outpatient cover for all sick children and infants and develop comprehensive child care services. This appointment would reduce travelling time and expense for parents and sick children; daily visiting would be more practical and there would be cover for the newborn and special care babies. Much needed domiciliary help would be available for the local practitioners. That view was further buttressed by the Stacey Report on Children in Hospitals in Wales which appeared in July of last year and which made a specific recommendation that there should be a joint appointment between the hospital board and the local government areas concerned of a person who would operate both as a paediatric consultant and as a community child health physician.

The numbers of paediatric or child patients discharged from Aberystwyth each year is about 300. The structural amenities for such a service already exist and so could easily be added to, if necessary. In addition there is already in existence a full range of supporting services.

Sometimes it has been contended—-unfairly in my view—that the actual number of patients in Mid-Wales in relation to each of the specialties I have mentioned does not justify a consultant. This is a spurious argument and it has been clearly demonstrated to be so on a number of occasions when specialties have been located at Aberystwyth. That has been true in relation to gynaecology, ophthalmology, pathology, orthopaedics and geriatric medicine. In each case the level of demand at the time the new consultant was established was comparatively low, but there was a spectacular increase within months of his appointment and that increase has remained steady ever since. If there are any doubts on this matter I should be prepared to give the fullest particulars to the Minister of State.

The demands are there, the needs are there, but their full extent will never be appreciated until a consultant in each of the specialties I have mentioned is established in the area. There must be no placing of the community of Mid-Wales in the invidious position of having to choose between one specialty and another, and there is no question of their having to elect to extend the range of specialties and suffer a general fall in standards.

I appeal to the Minister, who lives in Mid-Wales, to use every authority he has, every power of persuasion which he possesses, to have these three vital specialties established at Aberystwyth, because without them the hospital service in Mid-Wales will be incomplete and substandard.

I very much hope that the Minister will not seek to shelter behind general norms which great moguls of medical administration have laid down but which have no relevance to the wholly exceptional situation of Mid-Wales. Much could be said tonight about what the Bonham Carter Report says in its advice that consultants should operate in teams and that general district hospitals should be established for populations of 200,000 and upwards.

Nevertheless the Minister must know that the Bonham Carter Report of 1969 itself spelt out certain situations which had to be regarded as exceptional. I quote from paragraph 27: Nevertheless, we accept that in the more sparsely populated areas of the country there will have to be some compromise between specialist staffing and accessibility: we have examined the pattern of district general hospitals at present planned for several such areas and we accept that in some places it will remain necessary to provide a district general hospital to serve less than 150,000 people, and in a very few places even less than 100,000. If there is any area in England and Wales that is to be regarded as an exception, surely there can be no area, with its small towns, its scattered villages and its thinly populated hinterland, that has greater merit in this respect than Mid-Wales. I ask the Minister to speak tonight as a Mid-Welshman and to say that it would be monstrous to apply an artificial general formula of this nature to this area.

The situation at Aberystwyth has been described by many as being deprived and incomplete, and both these terms are clearly true. That should not in any way be regarded as suggesting that there is a lowering of standards in Aberystwyth among the present range of specialities for which the hospital caters. Splendid and noble work is done at Aberystwyth, often by consultants who operate singly. Indeed, Professor Peter Gray himself has paid tribute to the single-handed consultants operating in Mid-Wales.

Of late anxieties, to my mind needless anxieties, have been created about Aberystwyth. The impression given in a programme that appeared on Harlech Television about a fortnight ago was that there had been a blizzard of complaints descending on Bronglais Hospital. That is not so. I have checked with the group secretary and I find that the facts are that in 1970 there were 13 complaints; in 1971, there were eight; and in 1972, so far as can be established, there were 10. In other words, it has been a level of complaints far below the average for a hospital of that size.

Some wonderful research, which is accepted by the highest medical authorities, is done at Aberystwyth. Time does not permit me to consider the future following local government reorganisation, but I hope that I shall have the opportunity to raise that matter.

One theme that is common to everything I have sought to compress into this short debate is that administrative systems have no purpose or justification except to serve the individual and the community. In an area such as Mid-Wales, which lacks many general amenities, the danger which looms large for the hospital service is that people will be made subservient to bureaucratic systems. It is the duty and privilege of Parliament to reverse that.

12.23 a.m.

Mr. Emlyn Hooson (Montgomery)

In a short debate of this kind it is difficult to convey the tremendous anxiety felt by the people of Mid-Wales about the services available to them in the district general hospital at Aberystwyth. The hon. Member for Cardigan (Mr. Elystan Morgan) was right to pay tribute to the specialists there and to those who continue to give that service, but it is grossly unfair to those specialists that they should have to work in a vacuum knowing, for example, that when an acutely ill child is admitted, no specialist paediatrician is there to give advice. That is grossly unfair to the population of Mid-Wales.

The Minister of State and I have been corresponding about this matter for a long time and in his letters to me he has repeated the advice that he has received no doubt from the regional hospital board and his medical advisers. The sadness of the situation is that no kind of inquiry was instituted into two tragedies that occurred; I know that on 5th February the Minister undertook to institute an inquiry into two cases that I called to his attention.

I live in Mid-Wales and I should not allow a child of mine to be taken to Aberystwyth if she were acutely ill. I have a high regard for the specialists there, but no parent with a choice would send his child there when there is no specialist paediatrician service available. It is disgraceful that the hospital board and the Welsh Office have hidden behind the general advice of the Bonham Carter Report when clearly an exception can and should be made in the case of Mid-Wales.

The Minister and the hon. Member for Cardigan have kindly allowed me some of their time and I do not wish to take too long, but it is important for the Minister to realise that the people of Mid-Wales are seething with anxiety about this matter. For the most part, if they had a choice they would not allow their children to go to Aberystwyth. How can that be fair to the population of Mid-Wales? How can it be fair to the general practitioners in the area? How can it be fair to the staff at the hospital at Aberystwyth?

There is a great problem of morale relating to the whole of the Mid-Wales area, from the staff at the hospital to the people of the area which it serves. It is up to the Minister to twist the arm of the Welsh Hospital Board and see that something is done immediately.

12.26 a.m.

The Minister of State, Welsh Office (Mr. David Gibson-Watt)

I welcome the opportunity to talk about this subject tonight in response to the hon. Member for Cardigan (Mr. Elystan Morgan) and the hon. and learned Member for Montgomery (Mr. Hooson). I wish to take up at once one point made by the hon. and learned Gentleman, who was inclined to say that the first suggestion of an inquiry came only when those cases occurred the other day. I assure him that in April 1971 I gave the Welsh Hospital Board general guidance on hospital facilities for children and asked it to undertake a review of the organisation in Wales. The board has completed its task, and copies of its report have been widely distributed for comment. I expect to receive the board's recommendations later this year.

The provision of hospital services in Wales is primarily the responsibility of the Welsh Hospital Board. There is no time tonight to dwell on the state of affairs which the board inherited 25 years ago, when it took over a mixture of old buildings and wartime temporary constructions. But I think it wholly proper to put on record the Government's appreciation of the board's dedicated hard work over the past two decades and to acknowledge the steady improvement in the hospital services in Wales that has resulted.

In planning hospital services for Mid-Wales, one must take into account the whole area, and its needs must be viewed in the context of resources available for Wales as a whole. The total population of the area which will form the new Powys health authority is 99.000. The population in the adjoining Dyfed area health authority, outside the Llanelli district, is about 220,000. So we start-1 think this was recognised by both hon. Members—with the basic problem of a large area with a small scattered population.

In such areas it is a hard fact of life that we in Mid-Wales have always had to go further for many facilities and amenities—not only hospital treatment—than others living in urban environments. It is my responsibility to ensure that the people of Mid-Wales get the best possible medical treatment, and reconciling this responsibility with the convenience of the individual is far from easy. But if the patient is to get the best possible treatment for many acute conditions, I am advised that he is best cared for in a large unit having full facilities and 24-hour consultant cover in the specialties which it carries. Once this is accepted, the problems of Mid-Wales come into sharp focus.

It is national policy that the keystone of the hospital service is the district general hospital providing comprehensive services for populations of about 250,000 people. There are demonstrable clinical advantages in having all the major specialties under one roof and, given the limitations of resources, both human and financial, and the increasing complexity of technical services, some concentration of facilities is inevitable. It was on that basis that the hospital at Glangwili, Carmarthen, was planned and developed.

The needs of Cardiganshire and Pembrokeshire justified further hospital provision at Aberystwyth and Haverfordwest, at which most of the major specialties could be provided. At Aberystwyth the main work was completed in 1966, and I hope that work will start before long on the new 324-bed hospital at Haverfordwest.

The problems of Central Wales are very similar. Brecon, Radnor and Montgomery have a total population of only 99,000.

The second stage of the Nevill Hall Hospital at Abergavenny is nearing completion and when it is commissioned next year it is envisaged that that hospital, too, will cater for the major specialties and thus make suitable provision for those living in a part of Central Wales. The major hospitals will be the backbone of the service. The Welsh Hospital Board is nevertheless very conscious of the part played by the smaller local hospitals, and these have not been neglected.

For example, a 30-bed unit for geriatric patients was recently completed at Llandrindod Wells. Work should soon begin at Glangwili on a 32-bed unit for the mentally handicapped similar to one under construction at Pembroke Dock, and these will be followed by a similar unit in the Aberystwyth area and another in South Montgomeryshire. At Carmarthen there will be a unit for the younger chronic sick. Facilities for geriatric patients are planned at Tregaron, Knighton and Welshpool. Many of these schemes will be financed from the special additional funds made available by the Government for improvement of provision for the mentally ill, the mentally handicapped and the aged.

Mr. Morgan

Before the Minister leaves that point will he tell us whether he accepts the wholly exceptional character of Mid-Wales as defined in paragraph 27 of the Bonham Carter Report?

Mr. Gibson-Watt

I was not referring in my speech to paragraph 27 of the Bonham Carter Report. But I agree, and I have been saying in my speech, that Mid-Wales is a very exceptional place. The hon. Member asked me earlier today a question to which I had to give him an off-the-cuff answer. He wanted an assurance that the percentage of total capital expenditure on the hospital services received by the Mid-Wales Hospital Management Committee is no less now than it was three years ago. The latest figures I have are for 1971–72. In that year the percentage of capital expenditure received by the Mid-Wales Hospital Management Committee was 2.5 per cent. of the total. The figures for the three preceding years were 1.2 per cent. in 1968–69, 0.8 per cent. in 1969–70 and 2.0 per cent. in 1970–71. So the story is a good one.

A key problem is medical manpower. I ask the House to understand that, because it is the key to the whole question. The hon. Member laughs. What he has to laugh about I cannot imagine. If he would kindly explain why he is laughing at the shortage of medical manpower I shall gladly give way.

Mr. Morgan

How can the Minister say that there is a lack of medical manpower when an administrative decision has been taken over the years not to give any opportunity for these appointments to be made? Only then would the matter be put to the test.

Mr. Gibson-Watt

I am distressed that the hon. Member should take that attitude. The shortage of doctors in the hospital service is fully recognised and we are doing something about it. We have announced plans to increase the number of students for suitable places in medical schools: the target figure and annual intake of 4,100 by the late 1970s compares with the present intake of about 3,000. It must be admitted that this is a long-term measure since it takes many years to train a doctor particularly for hospital specialist work. But we are beginning to benefit from the expansion of medical training programmes.

In particular the growing success of the vocational training schemes for hospital consultants needs a special word. We can see in the immediate future an expansion of some 4 to 5 per cent. per annum in the number of consultants.

I regard the expansion of the consultant grade as a matter of very high priority although I realise that there are many other priority demands on our financial resources. A Welsh Manpower Committee has recently been set up under the aegis of a Central Manpower Committee covering England and Wales whose duties are to advise the health departments on planning targets for staffing. This Welsh Committee is already functioning and giving valuable advice to the Welsh Hospital Board about medical staffing in the hospital services in Wales.

I know that the hon. Member and the hon. and learned Member are particularly concerned about paediatric and ENT services. The Welsh Hospital Board's policy is to concentrate the in-patient services for Dyfed at Carmarthen and at the same time improve the out-patient services at Bronglais and Haverfordwest.

In 1970 the Chief Medical Officer of the Welsh Office carried out a review of health services in Pembrokeshire—and to some extent the adjacent counties—and recommended the appointment of a second paediatric consultant additional to the one in post at that time. He further recommended that this paediatrician should be based at Carmarthen.

This recommendation was later supported by Professor Gray, the hospital board's own consultant adviser in paediatrics. The appointment of this second paediatric consultant was made recently. I know there was disappointment that the appointment was made to Carmarthen rather than to Aberystwyth or Haverfordwest. This disappointment was shared not only by the hon. Gentleman and the hon. and learned Gentleman but by some of my Conservative supporters in the area. But professional opinion opposes single-handed appointments in this specialty. It was therefore considered that basing the second consultant at Carmarthen would make the best use of available resources while providing the most satisfactory service for Dyfed as a whole.

Professor Gray also recommended that there should eventually be four paediatric consultants in the Carmarthen-Aberystwyth-Haverfordwest area, with the third consultant based at Aberystwyth. But at present there is only one consultant paediatrician per 130,000 population in Wales. It is important to see this figure in the context of the catchment population of Bronglais Hospital, which is very much less.

In the first instance it is vital to establish one really first-class paediatric department at Carmarthen with adequate consultant cover and nursing expertise in the care of children.

The same applies to the ENT services. The hospital board's strategy in concentrating the in-patient facilities at Carmarthen has full professional backing. Through its doing it in that way the children will get the best available service.

In addition Carmarthen would become a centre for the assessment of handicapped children, having readily available not only paediatric advice but also that of an ENT department in the assessment of deafness, which is so important in dealing with handicapped children.

The hon. and learned Gentleman referred to two recent cases calling into question the treatment and services at Bronglais Hospital. I have called for a full report from the Welsh Hospital Board, which I shall study very carefully. Tonight I can only express my deepest sympathy to the parents of the young boy who died.

I have spoken in the House and elsewhere on this subject a number of times recently. I am aware of the concern. I know that no hon. Member would accuse me of not being aware of it or of not having studied the question carefully.

I repeat my assurance that we will continue to do the best we can with the resources available. There has been over the years a steady progress in the improvement of the hospital services provided for those who live in the rural areas of Mid-Wales. This progress will continue.

Question put and agreed to.

Adjourned accordingly at twenty-three minutes to One o'clock.