HC Deb 09 November 1973 vol 863 cc1424-38

3.35 p.m.

Mr. Paul B. Rose (Manchester, Blackley)

The Manchester Victoria Memorial Jewish Hospital owes its inspiration to the need to provide medical care for what at the turn of the century was a predominantly poor immigrant Jewish community. It has since become a symbol of humanism and it has a fine record of service to people of all creeds and faiths in Manchester. It has become well-loved and well-established.

The foundation stone of the hospital was laid 70 years ago, on 23rd July 1903, Present on that occasion were the Lord Mayor of Manchester and the Mayor of Salford. The new wing, which was for the use of out-patients, was opened by Sir Winston Churchill, who was then President of the Board of Trade. A key was presented to him as a token of the esteem of the citizens of Manchester.

The hospital, among other things, was a pioneer of women's lib. The first medical officer, Paula Copeland, was appointed by the hospital and she achieved a very high standard of medical care. Indeed, the hospital was rated so highly that service at the hospital has been a badge of honour for those who work there.

I have a personal feeling for the hospital, since I have been treated there following a couple of sporting injuries. The first sign of any shortage of staff came some years ago, when my small daughter had an accident in the middle of Manchester. She was immediately taken to the hospital unit and had to wait two hours—not through any fault of the staff, but because there were more important cases to be dealt with and there was obviously then a growing shortage.

Just as the hospital takes cases from central Manchester, it also serves the whole of the Manchester conurbation and also areas of Salford and constituencies such as Cheetham—in which it is situated—Exchange, my own constituency of Blackley, and Middleton and Prestwich. About 13,000 signatures have been collected in an effort to save the emergency and accident unit, and those signatures have been appended by persons who are resident in widespread areas of Manchester.

My fear is that because of over-centralsation and an increasing work load, the dedicated staff of the Crumpsall Hospital, in my constituency, will have to suffer what has happened in other areas, such as the Middlesex area, where the staff at the Central Middlesex Hospital talk about nights of hell. This is what happens when there is a great concentration of cases at one hospital in an urban area and where casualty departments have been closed at the drop of a hat. A continuous stream of people come to casualty departments and the staff have to suffer abuse and even physical attacks. Since the staff have to cope with road accidents on top of all this, they have very little time even to snatch a meal. One wonders whether this is what will happen at Crumpsall and Ancoats.

I have a personal interest in this matter because my wife was a nurse at Crumpsall Hospital—a hospital with a very good record of service. It is not good enough for the Secretary of the North Manchester Hospital Management Committee to say that Crumpsall Hospital is a suitable alternative because it is situated about a mile from Elizabeth Street and maintains a 24-hour service casualty department. First, I take issue with his geography. Anyone who knows the area will know that this is a difficult and arduous route to Crumpsall Hospital.

The issue has stimulated and generated much correspondence in the local Press. The letters illustrate the problem as it affects people in the area. One gentleman writes: There are many like myself who live alone and have no phone and it is not an easy matter to summon an ambulance late at night. I therefore spent a sleepless night in great pain before I managed to go to Crumpsall Hospital the following morning. Even though it was late I could have managed to get to the Jewish, but I could not manage the long drive up to Crumpsall especially at night. Needless to say I had immediate and excellent attention at Crumpsall. He points out that the Jewish Hospital lies in the centre of an industrial area where unfortunately many accidents happen which need immediate attention and, being within walking distance, there is no need for many cases to have an ambulance which one would require in order to go to Crumpsall.

Other correspondents have pointed out in the local Press that it has to be appreciated that most of the people resident in that area do not have their own cars, that Crumpsall Hospital does not treat children and that traditionally people expect to go to the Victoria Memorial Jewish Hospital. The only other hospital within easy reach is the Northern Hospital. There the casualty department closed a long time ago. We are left in the north of Manchester solely with Crumpsall and I understand that that in turn is scheduled for closure.

One of my fears is that as a result of the Government's phase 3 policy we are seeing a cut-back in the amount of money spent on hospitals generally which in turn affects accident units. In our area we know that £2 million has been lopped off proposed expenditure which means that that has cost us a new hospital in Lancashire. It is part of a regional imbalance which is causing an outcry in Manchester.

During the Recess I spent several weeks on doorsteps at street corners and in shopping centres in my constituency. Everyone was talking about the way in which money could be found for a Channel Tunnel, the white elephant of Maplin and the albatross of the Concorde, but that when it came to a Piccadilly-Victoria Line in Manchester it could not be found and that when it came to a hospital accident unit in Manchester again Manchester was a victim.

My last Adjournment debate, like a number of others, dealt with the way in which facilities in Manchester have been sacrificed, not least in the north of the city. Just as there is an imbalance between the north and the south of the country as a whole, there is in Manchester an imbalance between the north and south in terms of the facilities available, and when I refer to the south of the city I mean the more prosperous part extending into the Cheshire belt. That is reflected in many ways and is not confined to medical care and attention.

Odd though it may seem, those who have been brought up and have lived all their lives in the north of Manchester of whom I am one, do not know the geography of the area. Frequently they do not know where the alternative hospital is. I was amused to see a local newspaper carrying a large headline above a story discussing the number of people concerned about the closing of the emergency and accident unit. The headline read: How do you get to Ancoats anyway? Having lived in Manchester for 34 of my 37 years, I do not know how to get to Ancoats. When I next play football I hope that I do not suffer any serious injury.

For many people who do not have the facilities and do not know the geography of the area, the need to traverse the centre of Manchester will impose great hardship and in many cases a great deal of suffering. The area with which we are dealing has within a one-mile radius of the Victoria Memorial Jewish Hospital nearly 1,000 factories and 19,000 residential units, which assumes a population of perhaps 50,000. Within a two-mile radius the figures are staggering—3,000 factories and about 70,000 residential units, so there could be nearly a quarter of a million people. Yet, in that concentrated conurbation there is not to be the kind of facility that is required.

I should like to refer to a copy of a letter, which I think the Minister has received, from a general practitioner with a great deal of experience of the area, not least of the hospital itself. He has been in general practice for 45 years, and he writes: there are many medical colleagues who are considerably troubled by certain aspects of the hospital centralisation programme—particularly in regard to casualty departments in congested city areas. We all reach the same inevitable conclusion that no such densely populated areas should be deprived of accident departments—even in some cases clearance stations for intermediate injuries—in the name of false economy. There is absolutely no doubt that lives are already being endangered because there are so many times when the time factor in preliminary treatment of injury is vital. Many people do still come to the Jewish Hospital accident department hopefully, but ambulances do not always come quickly, there are not enough of them, and never could be to deal with multiple injuries in, for example, serious motorway pile-ups or other traffic accidents, if the casualty services here are to be so drastically reduced. He goes on to say that he and many of his colleagues are also perturbed at the callous way in which cases of coronary thrombosis attacks have been transferred to Crumpsall Hospital—quite simply, a dangerous procedure. These cases have always been regarded as acute emergencies, not to be moved in the initial stages. He then deplores what he describes as the stark lack of imagination and of professional responsibility on the part of those regional hospital board officials who are the architects of the hospital reorganisation programme. I do not know whether they are. I wonder whether they are merely the people who carry out the programme and that the real architect is the Minister. Whether the responsibility lies with the Minister or those in the regions, they are bad architects, because it would seem that they are about to deprive this area of a much-needed facility.

The results of over centralisation are considerations that I hope the Minister will take into account before making a final decision. He must understand the geographical problems in a conurbation such as Manchester and consider them in human terms, taking into account the realities for people who live in areas to which they are accustomed.

I know that there is a national shortage of casualty officers. This shortage is certainly recognised in this country. This is not a local but a national problem, and it is the Government's responsibilty. The Government ought to be doing a great deal more about the career structure and rules governing the work done by less qualified medical staff in hospital accident units. Many accidents are of a minor nature—cuts, bruises, and so on—and could be dealt with by a general practitioner. In such cases the services of a highly-qualified consultant would not be necessary.

Dr. Caro of the Casualty Surgeons' Association, has suggested that the hospital service should appoint about 350 casualty consultants to act as "troubleshooters" and improve the running of accident and emergency departments. He says that casualty departments of many hospitals are not being run properly because of staff shortages, lack of a career structure, wrong use of services by some patients, and poor facilities. He makes an unassailable case for the idea that emergency medicine ought to be recognised for the first time as a speciality in its own right and for an integrated accident service to be planned around the new post of casualty consultant.

In answer to a Question of mine on 24th July the Minister said that he had approved the establishment of 79 consultant posts, seven of which were in the Manchester area. I should like a breakdown of those figures. What is significant is that the staff shortage in Manchester occurred not at the Jewish Hospital but at Ancoats. It was to plug the gap there that the accident and emergency unit at the Jewish hospital was closed, but that fact was concealed from the public until the Minister answered my Question. A great deal of inconvenience, suffering, hardship, and worse, is being caused by the closure of the department. A good deal of heartlessness on the part of the authority—although made up for by the wonderful services of the nursing and medical staff in other hospitals—is being displayed.

There is a spin-off to all this, in the sense that if the Government do away with an emergency and accident unit, because emergencies are not taken into a hospital the staff there get little experience of dealing with emergency cases. The result, as one consultant who trailed me home one night said, is that the hospital becomes little more than a nursing home. The inevitable result of the closure of the unit will be a general decline in the standards and attractiveness of service in that hospital.

If the Minister is not able to give an undertaking today—and I do not ask for a decision now, because I want him to consult as many people and organisations as possible and to sound out feeling in the area, which is running high—will he at least consider one possibility? If the staff problem is such that the hospital accident unit cannot be kept open at all times, let it be kept open at least during the day. Many people suffer injury and have to return to hospital a number of times, and there is no reason why they should have to make the journey across Manchester to Ancoats, or undertake the tortuous journey on a No. 26 bus to Crumpsall, when they could attend a hospital close to where they live or work. If that were done, something would be salvaged.

I ask the Minister to give a sympathetic ear to the plea that comes not only from the 13,000 people who signed the petition but from many firms in the area which are now cutting off their welfare contribution to the hospital because of the closure of the unit, and also from a host of people on the north side of Manchester and, indeed, from Salford, who are extremely perturbed at the prospect of a densely populated urban area such as Manchester being deprived of facilities to which they have been accustomed for so many years.

3.54 p.m.

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

I congratulate the hon. Member for Manchester, Blackley (Mr. Rose) on securing the Adjournment debate and on raising a subject which has aroused considerable feeling in Manchester generally and his area in particular.

The problems involved in the proposed closure—a final decision has not yet been taken—of the accident and emergency department at the Victoria Memorial Jewish Hospital in Manchester are not peculiar to that hospital. They are national problems, as the hon. Gentleman himself said, and should be seen in a national context. They stem from two main considerations—too few staff spread over too many accident and emergency departments.

Part of the cause of the problems should be laid at the door of a tradition which began before the introduction of the NHS —that the friendly local casualty department of the nearest hospital was the natural calling place for all comers, whether or not they were suffering from a serious injury or merely seeking advice about minor cuts, stings or bruises which could equally well have been treated by their family doctors.

This was no problem when there were sufficient staff, but the increasing shortage of medical and nursing staff—or rather the extent to which growth in demand for health services is outstripping the practical rate of growth—has presented difficulties. Over recent years, the hospital service has found it more and more difficult to maintain full-scale emergency services at all hospitals.

In 1962, a working party under the chairmanship of Lord Platt was set up to study this problem and discovered, among other things, that of all new cases attending casualty departments, 60 per cent. were cases of injury, of which 12 per cent. were serious injuries, but that the remaining 40 per cent.—over a third, nearly half—did not relate to any injury at all. It became apparent that too many hospitals were trying to provide a general casualty advice service, to the probable detriment of those patients suffering from clear injuries requiring immediate clinical treatment.

It was therefore essential that any reorganisation of the accident services should be based on the recommendation that such services should deal primarily with serious cases and that the flow of minor injury cases should be reduced by persuading those patients to use their family doctors, the proper agents in that sort of situation. Just as there is a tradition of going to the local casualty department for such injuries, in many parts of the country there is, fortunately, a tradition of going to the family doctor with such cases. They are the proper people to handle minor injuries.

The rationalisation of accident services which Platt recommended is not simply a negative response to staff difficulties. It is positively to ensure that there is available in one place to those patients needing treatment for serious injuries all the concentrated medical and nursing skill, the necessary supporting paramedical services and the extensive and modern complicated equipment needed for expert diagnosis and immediate lifesaving treatment.

It is not possible for every hospital to be staffed and equipped to the necessary high standard to deal with serious injuries or emergency cases. Indeed, the more effective we become in complicated surgical and clinical operations and in work involving modern equipment, new commitments and new techniques, the more necessary it is to concentrate these units. They just cannot be multiplied all over the region.

Therefore, concentration of services is in the best interests of patients with serious injuries, as is their being taken direct to a major casualty department where facilities are concentrated, even though this may involve a longer ambulance journey. It is better for them to be taken to such a hospital than to a nearer hospital which might involve less travelling time but in which there is not the modern range of facilities and equipment. It would simply mean that very often they would have to be moved in turn from the nearer hospital to the place where we have to concentrate the massive deployment of modern manpower and technology which an up-to-date department can lay on.

It being Four o'clock, the Motion for the Adjournment of the House lapsed without Question put.

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

Mr. Alison

In recent years, the development of group practices has made it easier for the family doctor to arrange rotas and deputies so that calls for minor casualties can be answered promptly. My Department has prepared publicity material to help educate the public in the best way of using the National Health Service services and to discourage the unnecessary use of hospital facilities by casual attenders. The "Help your Doctor" leaflet which has been widely distributed explains the primary function of accident and emergency departments and asks people with minor injuries or ailments to go to their own doctor if practicable.

The Platt Report also found that the staffing of these accident departments needed considerable improvement. It became apparent, following a survey on the development of A and E departments which we undertook in 1966, that although some improvements had been achieved, particularly in the provision of consultant cover, conditions were still far from ideal. For most departments clinical consultant cover was being provided, and overall responsibility for medical administration of the departments was being undertaken by consultants whose main clinical commitments lay elsewhere, and who devoted a relatively small part of their time to accident and emergency work.

The hon. Gentleman will appreciate the dilemma here. In the nature of an accident and emergency department, one can never be certain which speciality is most relevant to the kind of accident case that is brought in. It may be neurosurgery, orthopaedics, pediatrics or general surgery. One simply cannot predict what it will be. To have consultants from every speciality on tap to deal with needs of this kind is impracticable. Yet to have one consultant representing only one specialty, under the old set up, is almost a guarantee that he will devote only a small part of his main interest to the accident and emergency service, where so many of the casualties may be irrelevant to his particular speciality insight.

Meanwhile, against the background of the perhaps rather loose consultant cover in these departments, the main staffing was provided by junior doctors in training grades, including a high proportion of overseas doctors, who were not attracted to the work and did not spend long in it. Some of the reasons for this were that training in these departments did not help a doctor towards a consultant post, again for self-evident reasons, because it pointed in too many directions, except by way of providing a relatively small part in the training needed for a surgical career. The work also afforded relatively little opportunity for learning from consultants through day-to-day contact with them.

A further point, specially underlining the difficulty in staffing these departments, is that the junior training grade staff are exposed to real risks in these departments in making decisions for treatment against a background of relatively little experience. A case which is brought in may look superficially like a minor injury but may prove, in fact and in practice, to be far more profound than their experience allowed them to diagnose. If they make a mistake and consultant cover is not available, they can literally ruin their careers at the outset if litigation follows. It is no wonder that many of them are hesitant to come forward willingly to serve in accident and emergency departments where consultant cover is not regularly and fully available and deployed for them.

The Department has discussed the staffing problems thoroughly with representatives of the professions in the context of wider discussions about the development of consultant services, the improvement of medical career patterns and recruitment of new staff, but these difficulties cannot, unfortunately, be solved overnight.

I shall now focus on how Manchester fits into the problems with which I have been dealing. The Manchester region has been experiencing much the same difficulties as other regions. On staffing, as I have already informed the hon. Gentleman in reply to a parliamentary Question in June this year, three new consultant posts have already been established in the region, and four more approved for establishment this year. These new posts should help directly in staffing accident and emergency departments by making them more attractive to junior staff. They will have not only consultant oversight for their work but a consultant whose speciality lies in accidents and emergencies.

It is, however, the strategic question of the deployment of resources within the region which can cause the heartaches. The board has acted in accordance with departmental advice based on the recommendations of the Platt Report, and is endeavouring to concentrate accident and emergency services into major departments at major centres. I am afraid this often means a reduction in accident and emergency services at other hospitals.

In north-east Manchester there are three hospitals. Crumpsall has 1,018 beds, Ancoats has 148 beds and the Victoria Memorial Jewish has 103 beds. They were all striving to provide a 24-hour accident and emergency service, mainly to their catchment populations, and were experiencing considerable difficulty in doing so.

In early 1971 the accident and emergency department at Crumpsall was closed from 5th to 30th April because of medical staffing difficulties. It was reopened only by the transfer of a medical assistant from the Victoria Memorial Jewish Hospital, which was, as a result, closed temporarily for a month. In January of this year, more acute staff problems caused the board to have to close the accident and emergency department at the Victoria Jewish Memorial Hospital temporarily. I believe it has not been possible to reopen it and it remains closed today.

The board believes that the best overall solution is to concentrate facilities at Ancoats, where the new accident and emergency department which is now open, with consequent improvements to the out-patient and x-ray departments, will be adequate to cope with most of the demands of north-east Manchester. I understand that the board also proposes to retain the accident and emergency department at Crumpsall, although the hon. Gentleman suggested that that might be closed.

The board are of the opinion that the accident and emergency department at the Jewish Hospital should be closed. I should here, perhaps, remind the House that hospital boards are not empowered to close departments of hospitals, except those involving minor non-controversial changes, without wide public consultations and reference to my Department, and the final decision on a closure rests with my right hon. Friend the Secretary of State.

The public consultation stage has now been reached in respect of the board's proposal to close the Jewish Victoria Memorial Hospital accident and emergency department. When the time for consultation comes to an end the proposal will be reviewed by the board in the light of all the observations received from the people they have consulted with—namely, the public—and a recommendation will be made to my right hon. Friend, accompanied by details of any representations made against closure.

I am well aware—not least through the efforts of the hon. Gentleman—that local feeling about the proposed closure is very strong. This is both understandable and commendable. It shows a deep personal interest in the local hospital and the work it does. The Victoria Jewish Memorial Hospital has a great local reputation for its high standard of service combined with its intimate and friendly atmosphere. No wonder a lot of controversy has been generated locally.

I do not now want to go into the detailed pros and cons of closure. My right hon. Friend must await the board's submissions and to comment on the proposal before hearing fully the arguments for and against would be premature. It would be wrong to make comments on the final argument before we have heard all the pros and cons.

I undertake first to send a copy of the hon. Gentleman's speech to the board so that it may set out its counter-arguments in its submissions. That will mean that it will be bound to take his representations on behalf of his constituents into consideration as part of the process of consultation, which it is obliged to undertake. Second, my right hon. Friend and myself will fully consider what the hon. Gentleman has said before taking any decision. In other words, it is a proposal so far. It is a proposal out for consultation and discussion locally. It is a proposal which must finally be submitted formally to my right hon. Friend with a review of the arguments against the proposal which have been raised locally, including arguments put forward by the hon. Gentleman today. Only then will my right hon. Friend be able to consider the whole situation in the round. The decision is not final and fixed. We shall weigh carefully what the hon. Gentleman said.

I do not want to raise hopes unduly. I hope that the hon. Gentleman appreciates the modern realities—that concentration in accident and emergency work of teams, of supporting services, of expensive equipment, is in the best interests of people with serious injuries, even if they have to travel further by ambulance or by whatever means. This kind of concentrated and up-to-date service cannot be sited in every town and city. If we are to concentrate a modern service, we must be prepared to take people to it, perhaps from a greater distance.

Meanwhile, much can be done by family doctors, indeed, by family doctors sometimes deploying their services in hospitals. These are options we often consider in considering proposals for closure.

I repeat that the issue is not fixed and final. We shall examine it as sympathetic- ally as we can in the light of what the hon. Gentleman said this afternoon.

Question put and agreed to.

Adjourned accordingly at eleven minutes past Four o'clock.