HC Deb 18 October 1973 vol 861 cc547-56

10.13 p.m.

Mr. Edward du Cann (Taunton)

I am most grateful for the devoted support of right hon. and hon. Members. I appreciate that what I have to say is of more local interest. I am concerned to complain as strongly as I can about the delay in the provision of a new general hospital for Somerset at Lyngford on the Bridgwater side of Taunton. It is a delay which I regard as unnecessary, disappointing in the extreme and cruel in its effects. I shall put specific requests to Ministers arising out of the matter.

I am grateful for the support and interest of my hon. Friend the Member for Bridgwater (Mr. Tom King) and my hon. Friend the Member for Weston-super-Mare (Mr. Wiggin). They and our constituents share my deep concern about the matter. I appreciate too the presence of my right hon. Friend the Secretary of State for Social Services. It is not unprecedented for a Secretary of State to answer an Adjournment debate. However, my right hon. Friend's interest in the matter is especially appreciated. Perhaps his presence underlines the seriousness of the matter. He surely knows the concern which we all feel.

Of all the specific tasks which I set myself to realise when I was elected the Member for Taunton in 1956, this has proved to be by far and away the most intractable. It is worth reciting part of the history. I was pressing the matter with the planners before 1962. In that year, as my right hon. Friend will know, we had the Government's hospital plan. In 1966, I led a deputation to the Ministry and in that year the plan was revised. In October 1970, we had an announcement that construction would start in 1975–76. I wonder whether we would have got that far if we had not put on so much pressure over the years. I omit all reference to the letters, personal representations and the like, of which my right hon. Friend is aware.

Then, on 11th March 1971, we had a debate in this House in which my hon. Friend the Member for Bridgwater joined. My hon. Friend the Under-Secretary of State, who is good enough to be here also, kindly said then: This is not by any means the first time that my right hon. Friend has presented a case for the early provision of a new hospital for the area. He has been active in the matter for a great many years. Necessary as that pressure has been and is, I regret the need for it at all.

What is our hospital in Taunton? The Taunton hospital service is provided in four different buildings in the town, with departments divided—Trinity for geriatrics, chest medicine at Cheddon Road, and the two main branches at Musgrove Park, a temporary wartime building, inconvenient and dispersed, and at East Reach, built in 1809, which is 164 years ago, old and inadequate. How right was my hon. Friend when he said in that debate in 1971: We all agree that there is a need for a new hospital to serve the Taunton area." —[OFFICIAL REPORT, 11th March 1971; Vol. 813, c. 764 and 761.] It is sufficient criticism of these places to say that, in addition to the ordinary maintenance expenditure, which is necessarily higher in the case of old buildings than it otherwise might be in the case of more modern places, additional capital expenditure on essential facilities, such as engineering renewals, the modernisation of the ophthalmic and orthopaedic theatres and so on, was authorised at the beginning of 1971–72 amounting to at least £500,000.

A few days ago my right hon. Friend was in Taunton—and how much his presence was appreciated. He said: I am the biggest slum landlord in the country. This is his inheritance, not his fault. Our social services probably owe more to him for their development and maintenance than to almost any one of his predecessors. But, alas, what he said was true, and Taunton is a bad example. Yet my right hon. Friend knows that we have in Taunton as high and as devoted a standard of care and service in our hospitals as anywhere in England or in Somerset itself—and I speak of what I know, since my family have benefited from these services and are grateful.

The Secretary of State for Social Services (Sir Keith Joseph)

indicated assent.

Mr. du Cann

It is good to see my right hon. Friend, with his special knowledge, acknowledging that point.

I have no hesitation in saying that instead of patching up buildings not fit to serve as hospitals, taxpayers' money could be better applied. Working in poor conditions is a profound discouragement to those who are obliged to do so. The Bridgwater and Taunton constituencies perhaps take in together a catchment area of some 250,000 souls who inevitably receive a lower quality of service than is their reasonable and legitimate expectation. We have said this before. It is still true today.

Now what is the position about the new district general hospital? There are two main areas of change of plan, newly announced. First, when planning started in 1971 the target starting date for construction was April 1975. It is now estimated to be October 1976—in other words, a further 17 months delay. This is unacceptable to us and I ask my right hon. Friend to see that the original starting date is maintained.

Second, the original programme was in three phases. Phase I would provide the bulk of the acute services and 676 beds; phase 2 would provide the balance of 226 acute beds; phase 3 would provide 283 community and mental handicap beds, the total bed complement thus being 1,185.

In summary and in simple language, the board's original proposal was to build in one place a 676-bed hospital with full accident and emergency, out-patient, day hospital, diagnostic and treatment facilities, in one building which would centralise all the services on one side. It would enable a number of existing hospitals to be closed.

Now it is proposed to divide phase 1 into two sub-phases of 344 and 322 beds respectively. Phase 3 is perhaps to be abandoned and 250 beds to be provided at Musgrove Park. The revised total bed complement of the new hospital will be 937. This change in plan is also unacceptable to us and I ask my right hon. Friend to reject these proposals out of hand. I will say plainly why. The original phase 1 comprised a viable unit for all acute medicine and surgery and would allow for major life-saving and supporting services to be provided in a single building with all the convenience and economy that implies, in stark contrast to the situation today with our hospitals so divided.

Now with the new proposals to divide phase 1, with half the beds in one centre and half in another, there will be extra expense in terms of money and manpower and difficulty of administration. It may even prove impossible to provide life-saving and supporting services in both centres.

The present revised proposals are not only unsatisfactory in the way I have described. Under them as presently stated we have no guarantee that the second half of phase 1 will follow promptly upon the first. If it does it will still be 10 to 15 years from now before a fully viable entity will be available. If no undertaking to that effect is given, if there is a 10-year gap, I do not want to exaggerate, but it is possible that it will he 20 to 25 years before the unit is complete.

Thus, as plans stand, Somerset will be deprived of a full district hospital for a further 10 to 25 years, and perhaps between 30 to 40 years since I first interested myself in this matter. My right hon. Friend will therefore understand my concern. I live locally, as do both my hon. Friends. Some of my constituents have even longer memories. The need for a new major hospital was recognised before the war. The Lyngford site was purchased by the then hospital board of governors in 1943 for a new Taunton and Somerset hospital which it was proposed to build immediately after the war. What an irony it is—and I speak as a supporter of the National Health Service—that the nationalisation of medicine has in fact deprived us of a new hospital.

The present situation is a discouragement to consultants, medical staff, doctors and nurses and all working in the hospital. It is bound to affect recruitment and this we can ill afford. Nor can we afford the waste of public money involved. Phasing will inevitably add to the overall costs in terms of capital and running expenses. I want to emphasise the practical difficulties. Medical staff will be hard pressed if there are two acute hospitals. Nursing supervision, because of the potential split in services between Musgrove Park and Lyngford, will be more difficult. Neither the complexities of modern medicine nor the thinness of our resources should be forgotten.

Above all it is people we are talking about—our constituents. It is the patients who will suffer. The life-saving problem, as I hope I have indicated, has existed for many years. I had hoped that we were in sight of ending it. It is a bit of a disappointment to find that we are not.

It is people that count. The quarterly returns of the waiting list as at 30th September 1973 showed that 2,000 people were awaiting surgery and orthopaedics. Of that number 800 were waiting up to a year, 400 more than a year and over 200 were waiting two years. A further 200 were waiting more than three years. I leave it to the House to imagine the personal anxieties involved in each individual case for Hope deferred maketh the heart sick. It is true that the regional hospital board, soon to become the area board, has responsibility for the allocation of funds and the decision on priorities as to expenditure in this or that location. But it can allocate only what the Government allow.

There is a desperate need—I hope that what I have said has shown that. Indeed, I believe it to have been acknowledged by what my hon. Friend the Under-Secretary of State and my right hon. Friend have said. I beg my right hon. Friend to see that our need is satisfied without further delay.

10.25 p.m.

Mr. Tom King (Bridgwater)

I am grateful to my right hon. Friend the Member for Taunton (Mr. du Cann) for the opportunity to add my voice to his plea about the Lyngford hospital. My interest is slightly different from that of my right hon. Friend. Although the hospital will be sited within his constituency, it will serve also my constituents.

There is a particular reason why my constituents feel aggrieved. The whole basis of the organisation in Somerset and in my constituency has been to centralise health services and to justify some diminution of the services in my constituency on the grounds that the services could be better rendered centrally in the main Taunton area. If the hospitals in my constituency are to have their services reduced, the least they expect is that the corollary of this argument for centralisation will be honoured and that there will be by that same token much better services centralised in a new district hospital.

More than two years ago in a debate on this subject I said that when by reason of a particular complaint or need patients were transferred to Taunton they had an unenviable choice between mid-Georgian and "World War 2 temporary" in hospital provision. My constituents feel most strongly about this.

I am grateful to the Secretary of State for being here. My right hon. Friend the Member for Taunton has paid a tribute to him which I totally endorse. The Secretary of State's presence is a recognition of the concern which we share.

I am glad that my hon. Friend the Under-Secretary of State is also here. We had an Adjournment debate on this subject on 11th March 1971, and I am surprised that it is necessary to return to this subject. We voiced our concern about the hospital and we received perfectly satisfactory assurances from the Minister on that occasion. My hon. Friend said that hospitals take several years to plan and several further years to build, but he was able to assure us that the planning of the hospital was in a formative stage. He went on to say that the project team was urgently working out plans for the new hospital and hoped that this news would give a welcome assurance to the people in the area which the new hospital would serve. In the light of the latest news of a possible delay, where is that assurance now, and how welcome can it be?

I remember the words of the last line of Shaw's St. Joan: How long, O Lord, how long? If there is any truth in the rumour of a further delay that will be far too long. It is a delay which cannot be accepted. No one who is aware of the facilities available in the Taunton area can contemplate the sort of delay that my right hon. Friend the Member for Taunton envisages.

I enter the strongest plea with my right hon. Friend. This is a matter of paramount importance. If the regional hospital board cannot raise the necessary resources for this matter of the highest priority I ask my right hon. Friend for special assistance from him and his Department.

10.30 p.m.

The Secretary of State for Social Services (Sir Keith Joseph)

I should like to start by paying tribute to the unremitting assiduity and vigour of my right hon. Friend the Member for Taunton (Mr. du Cann) in the interests of his constituents.

While I have complete confidence in the Under-Secretary of State, my hon. Friend the Member for Barkston Ash (Mr. Alison), who has probably answered 50 or 60 Adjournment debates in this Parliament, I thought I should break my duck regarding Adjournment debates and answer my very first one in 3¼ years in office. I do so for two reasons: first, out of respect for my right hon. Friend and, secondly, because it is right that I should take the blame firmly for the delays which are occurring not only in Taunton, but in other parts of the country.

I assure my right hon. Friend that no one in my Department disputes the need for a new district general hospital at Taunton. He does not have to argue the need. In this respect I should like to echo his tribute to the staff who have served, are serving, and, I am sure, will continue to serve, the public devotedly in buildings which, to put it mildly, are less than convenient.

The House will be aware that there was no hospital building for 15 years after the war. Rightly or wrongly, successive Governments put their priority on building roads, factories, houses and schools.

When we started the hospital building programme again in 1962 not only had we to rebuild museum hospitals all over the country, but we had to catch up with the growth in population and try to make good the neglect of generations regarding the needs of the growing numbers of elderly, mentally ill, mentally handicapped and physically disabled. That is the background against which we now have to view the hospital building programme.

I could say to my right hon. Friend, in truth, that under this Government the hospital building programme has increased substantially in real terms. That would be the truth. However, it may be no comfort to him, because it has not yet produced a new hospital for Taunton.

I could say to my right hon. Friend, in truth, that the share of the growing hospital building programme going to the South-West region has also increased. That would be true, but that again would be no comfort to him because that has not yet produced a new hospital for Taunton.

The size of the total hospital building programme is my responsibility within the Government. The regional hospital board—from April, the regional health authority—has to use the money allocated to the best of its ability. It is its invidious job to choose the sequence of building operations.

In the region there are a number of district general hospitals in course of building. It is hoped that the Barnstaple district general hospital will soon start. Consideration is being given to a new district general hospital in Plymouth. I note the presence of my hon. Friend the Member for Weston-super-Mare (Mr. Wiggin). Consideration is being given to a new district general hospital at Weston-super-Mare.

It is the opinion of the regional hospital board that those areas, for a combination of reasons associated with the vintage of the buildings that respectively serve the different population centres, have the edge on Taunton when it comes to priority. It is infuriating for my right hon. Friend and his constituents that that should be so. They should blame me for the total size of the cake. But they should, I think, respect the difficulty of the task of the regional hospital board. Let them criticise it and argue with it, but let them recognise that the blame lies with me.

My right hon. Friend is perfectly entitled to criticise the length of the waiting lists. Alas, waiting lists are long in many parts of the country. This situation is unrelated to private accommodation or to the vintage of the buildings. The Government, I hope with the help of the medical profession, are about to give advice on how waiting lists can be cut.

My right hon. Friend allowed himself to suggest that perhaps it was shortsighted to spend scarce resources on what he was pleased to call patching, but the patching to which he referred is the substantial provision of modern departments—admittedly in old shells—the provision of new services—though I admit not enough—and the provision of new facilities. Since we cannot at present expect to have the resources to rebuild everywhere simultaneously, we have to make tolerable life and working conditions in the hospitals which still have a number of years before them. I take some comfort from the fact that over the last years money to the tune of seven figures has been spent in improving working conditions at Taunton.

My right hon. Friend also criticised the proposal of the regional hospital board to alter the phasing so as to have a series of slightly smaller contracts—more numerous, but smaller—than the original proposal. This is because the recent rise in building costs and the current inflation have made building contractors hesistant to take on large, long phases of contracts. The board considers that it will get more reasonable tenders if it breaks up the complete new hospital into a greater number of rather smaller contracts. This is done in order to tackle the building more quickly than might otherwise be the case.

The need in the hospital building programme, as in so much else, is to increase the growth rate of this country so that we have more resources. Provided our legislation is correct, we can have growth virtually without tears, and if we have more growth we can perhaps find more resources for many things, including more hospital building. I sometimes envy my opposite number in Japan who, with his colleagues, is dealing with the disposal of a 12 per cent. annual growth rate, when we had a 2 per cent. rate in the 'sixties, a 5 per cent. rate last year, and a rate this year of perhaps 3 per cent. or 4 per cent. Growth is the ally of the social and hospital services.

All this, I say again, can be no great comfort to my right hon. Friend, and I can give him no absolute assurance on date. But I can tell him that, after the hospitals I have mentioned, Taunton, so far as I understand it from the regional hospital board's intentions, comes next. It will be our intention, for the sake of the people of Taunton and for the sake of placating my formidable right hon. Friend, to make that date as early as possible, and I hope that he will be an ally in helping to get the growth rate that we need so that we can do it more quickly.

In the meantime, I end as I began by paying tribute to those who work in the hospital services at Tauton, by extending to them my recognition of the difficulty of their tasks, and by explaining to them that scores of other hospitals are sharing their difficulties. The only reason why other hospitals are being rebuilt earlier is that the conditions in them are marginally, or much, worse. I regret that I cannot give my right hon. Friend a more comforting answer, but at least he has had a straightforward and frank reply.

Question put and agreed to.

Adjourned accordingly at twenty-two minutes to Eleven o'clock.