ST. PETER'S HOSPITAL, CHERTSEY

HC Deb 03 July 1974 vol 876 cc560-72

11.38 p.m.

Mr. Nigel Spearing (Newham, South)

On a point of order, Mr. Deputy Speaker. At the beginning of the debate—

Mr. Deputy Speaker (Mr. George Thomas)

Order. Before the hon. Gentleman raises his point of order I should indicate to him that he is taking up the Adjournment time of another hon. Member.

Mr. Spearing

At the beginning of this evening's debate Mr. Speaker did not select two admendments on the Order Paper. He said that he would consider the matter in view of the precedent of the debate. I ask you, Mr. Deputy Speaker, to draw to the attention of Mr. Speaker the difficulties that we have experienced.

Mr. Deputy Speaker

Order. I may be the only one, but I am quite clear what has been decided.

Mr. Geoffrey Pattie (Chertsey and Walton)

Mr. Deputy Speaker, I wish to draw attention to the redevelopment plans for St. Peter's Hospital, Chertsey. This is an appropriate time to debate the matter, as many people throughout the country are now having the stresses and strains of the National Health Service drawn to their attention. Throughout the country there are calls on the service for greater expenditure. There are well-merited claims by medical and paramedical staff. It seems that from cleaners to consultants it is only a sense of responsibility and dedication that holds the service together. That is a dedication that we should not take for granted any longer. However, I do not feel that because the National Health Service is in some difficulty an alibi is provided for inaction.

Although I would not claim that St. Peter's Hospital is unique in its problems, I am certain that there cannot be any other hospital that has a worse situation with which to contend. Perhaps the House will allow me briefly to give some of the history of St. Peter's Hospital. The site was purchased in the mid-1930s by Surrey County Council to enable an institution for the educationally subnormal to be constructed. The construction took place and the institution is operating to this day. The institution was built on half the present site.

When war broke out in 1939 it was decided to use the remaining half of the site as a war-time hospital. We then saw that most permanent of all temporary forms of accommodation, the Nissen hut. That remained throughout the war. At the end of the war the hospital was designated as a permanent peace-time hospital. There has since been some upgrading of the accommodation, but it would be apparent to anyone that the staff have been acting under severe limitations and difficulties.

The redevelopment plan for St. Peter's Hospital has five phases. Phase, I was completed in 1967 and phase II in 1970. I stress the extreme desirability of such phases being consecutive—namely, that they should follow one after another as quickly as possible. I do not think that anyone would suggest that a brand-new hospital rising from green fields should be suspended in the middle of construction and should go into service minus, for example, the kitchens, or the operating theatre. But where a hospital is being redeveloped the tendency seems to be to stop after a couple of phases and allow the hospital to muddle on as before. The tendency is to produce a rather lopsided development. That has happened at St. Peter's Hospital.

For example, the maternity services have been concentrated at St. Peter's by throwing in the former maternity services of the other outlying cottage hospitals. The reason for doing so was the recognition of the interdependence of the maternity services, gynaecology and obstetrics. We have the maternity unit on the St. Peter's site yet we have only 24 beds in gynaecology, as opposed to the 64 that are provided for in phase III. Even if work starts later this year it will be four years since the completion of phase II. That is far too long a delay.

St. Peter's Hospital has been designated as a district general hospital. It is required to serve a population of up to a quarter of a million people, yet, in this day and age, it has no intensive therapy unit and no coronary care unit. There are only three beds in the accident and emergency centre. In that centre there is a 24-hour accident service, and I remind the Under-Secretary of State that next Thursday the nearby section of the M3 opens, so the demands on the centre are likely to be even greater.

I want to deal with the phase III proposals in detail and contrast them with what actually exists. In this way, the hon. Gentleman can be reminded of the clear inadequacy of the present facilities at St. Peter's. The centrepiece is a departmental block of 15.000 square metres housing 1 departments. In it it we are to have the pharmacy, occupying 1,080 square metres as opposed to its present 170 square metres in a former Polish Army hut—no doubt of great interest to a military historian but of no use to the hospital service in 1974.

The pathology laboratory, which now operates on two sites of a total of 600 square metres, is to be provided with 2,115 square metres. Radiology is now crammed into 300 square metres but it is to get 1,250.

I have been round the hospital with the consultant psychiatrist, who showed me the linen cupboard where he has to conduct off-ward interviews, in which people have to talk about their problems among the sheets and pillow cases. If Florence Nightingale returned in this day and age, she would have no readjustment problems in St. Peter's.

Also included in phase III is provision for an acute psychiatric unit, with 120 beds, and a day unit. This is very much in keeping with modern thinking on the treatment of the mentally-ill, which is to take them into short-stay accommodation and return them to the community as soon as possible. In our area, Holloway Sanatorium is the long-stay psychiatric hospital, and it is to be closed when the new unit opens at St. Peter's. The staff at Holloway have been told of this fact, but no work has yet begun on the unit at St. Peter's. The problem of recruiting at Holloway can be imagined.

Phase III also includes the very important provision of housing accommodation for hospital staff. Our area is a high-cost housing area, so this scheme will be extremely important.

The hon. Gentleman may say that it is important to keep all hospitals reasonably abreast in terms of development and that one must not go too far ahead at the expense of another. Guildford, Ash-field, Kingston and Frimley Park hospitals, nearby, have all experienced substantial new developments, however, and St. Peter's has become the Cinderella—the poor relation—of the area.

One consultant post is being kept open permanently at the moment and occupied by a locum, since St. Peter's will not give or seek a commitment from anyone while this terrible uncertainty hangs over the future of the hospital. The urgent need is to name a date for the start of phase III.

I gather that the tender was agreed over a year ago and that since then it has had to be brought up to date. I gather, also, that its formula was based on wrong cal- culations. While this is going on, the cost is escalating all the time. I urge the hon. Gentleman to get the parties together and put them in a locked room until they come to an agreement.

The least the House can do for the staff of this hospital—for whom no praise can be too high—is to come to a decision at the earliest date. Every day the staff have to contend with appalling difficulties. They have to exercise determination and ingenuity. They have spent much of their time since 1968 in working parties and committees, planning and working towards not some dream hospital but just a hospital that will do the job for the people in the area.

I ask the Minister not to give the staff of this hospital and the people in the area some sort of flannel, or some hopeful statement about the future. They are beyond that now. They feel bitterness and a sense of frustration. The only thing that will satisfy them is for the hon. Gentleman to name a date when the bulldozers will move on to the site. That will be music to their ears. That is what they want to know: When will the date be?

11.51 p.m.

The Under-Secretary of State for Health (Dr. David Owen)

The hon. Member for Chertsey and Walton (Mr. Pattie) has deployed a powerful case for the rebuilding and redevelopment of St. Peter's Hospital, Chertsey. This hospital, as he rightly says, is basically a war-time hutted building. The South West Thames Regional Health Authority has adopted, in principle, the former South West Metropolitan Regional Hospital Board's plan for a phased development of the site to increase its size from the present 460 beds for acute and maternity cases only to a total of 1,100 beds.

On completion, St. Peter's will become the main district general hospital for the North West Surrey District, which embraces the new local government districts of Runneymede, Woking and part of Elmbridge. The estimated 1981 population for this district is 264,000, which certainly justifies the development of full district general hospital services. As the hon. Gentleman said, at present this district is served by many different hospitals—13 in all and many of them very old.

In addition to St. Peter's there are four small acute hospitals at Woking, Wey- bridge, Walton-on-Thames and Egham. There are three different hospitals for mentally handicapped people, a mental illness hospital—the Holloway Sanatorium, with 457 beds at Virginia Water—and a number of small specialist hospitals.

Even with these 13 different hospitals there are still gaps in the hospital services in the district which are filled by the use of acute geriatric and mental handicap beds elsewhere. It is vital that the long-term pattern is rationally worked out. I sympathise with the hon. Member in some of his criticisms about the way phasing of hospitals has been developed in the past. To a great extent I fear that that reflects the phasing of our economic progress and the unevenness of the growth of our national product since the war.

The new St. Peter's Hospital is broadly central to its proposed catchment area, lying only slightly north-west of the main concentration of population in the district. I give these details because they are the basic background to the decision to make this the district general hospital. My Department shares responsibility with the former regional board for its decision to develop on the existing St. Peter's site, which was, I understand, chosen in preference to other possible sites because it was possible to make full use of the existing hospital buildings in the course of the redevelopment.

As the hon. Gentleman said, current plans are that when complete the new hospital will contain 708 acute beds, 129 maternity beds, 140 geriatric beds, 120 psychiatric beds and 26 beds for the mentally handicapped, with further long-stay beds provided in the existing Botley's Park Hospital, nearby. This should cater adequately for the needs of the population concerned. The development of this important hospital is, however, phased to allow for decanting from and demolition of existing buildings.

It is not necessarily due to financial restrictions, although I do not deny that phasing is an aspect of the financial problem. Phases I and II were completed on time by 1970 at a total cost of £1½million. Phase I comprised four major and one minor theatre suites, associated recovery beds and a central sterile supply department. Phase II made available 120 much-needed maternity beds, isolation beds, special care baby cots and, among other things, accommodation for residential staff. All these additions and improvements to the services are now in full use, but I recognise that the hon. Gentleman is concerned about the future.

No particular difficulties were involved in the execution of either of the first two phases of the scheme. Phase III is the two-part phase consisting of a block to house new X-ray, pathology, physiotherapy, occupational therapy, pharmacy and out-patient departments, a separate 120-bed mental illness unit and a day hospital, to which the Government attach considerable importance.

Part I of this phase—the new departmental block—has suffered a number of setbacks. It was put out to tender in April 1973. Unfortunately, the lowest tender, received in July 1973, was higher than the Department's then approved cost for the scheme, even despite an increase in the Department's cost allowances since the tenders were first invited. It was then affected by the reductions in public expenditure announced last December by the previous Government. Hon. Gentlemen opposite agreed to cuts in public expenditure right across the whole aspect of our public life. There was a reduction of £111 million in the projected hospital expenditure for this current year. A great many of the difficulties that the National Health Service is currently facing stem from those decisions made last December.

Throughout my political life I have advocated higher levels of public expenditure and, furthermore, I have been prepared to tell my constituents and electors that that means that they have to pay taxes to get those services. Hon. Gentlemen opposite will carry more conviction in persuading the House of the need for hospitals in their own constituencies if they ensure, not, perhaps, individually, but collectively, that their attitude to public expenditure and taxation shows a marked change from that which has been common to them whether in or out of Government. It simply is not good enough for the hon. Gentleman and his hon. Friends to agree to cut public expenditure in general and then to advocate increases in public expenditure in particular.

Mr. Pattie

I do not wish to get into a debate with the hon. Gentleman on that point, but I am pursuing the question of the delay which has occurred. I have here a letter which the hon. Gentleman wrote to my hon. Friend the Member for Woking (Mr. Onslow) on 22nd March, in which he said: I know you will he pleased to learn that it is likely that the funds will be available for the next stage of rebuilding St. Peter's Hospital, Chertsey. That is not an absolute commitment, but that letter was written on 22nd March. Three months have gone by and we have had nothing during the period of the hon. Gentleman's administration.

Dr. Owen

That letter reflects the fact that, despite the fall-back in expenditure which started in October last year and the cuts announced by the Conservative Government in December, we were prepared to consider this scheme on its merits, in terms of overall national priorities. I remember looking at this hospital and being impressed by the need, for instance, to provide better facilities for the mentally ill, which is a priority of the Government's overall policy.

I am just pointing out to the hon. Gentleman that it is all too easy to argue for increased expenditure in particular and then not to will the end when it comes to advocating higher public expenditure in other aspects. I know that hon. Gentlemen opposite do not like to be reminded that the basic problems affecting the NHS at the moment stem from the expenditure cuts and the way in which the economy was run during the last three years.

These problems have made it necessary to renegotiate the tenders. The approved cost of the scheme has been raised once more, earlier this year, to take account of more recent increases in building costs.

Phase III was included with a high priority in the regional health authority's capital programme for 1974–75. This was considered by the Department in March, when we gave provisional approval for the scheme to start in the course of the current year. Since then the RHA has been discussing urgently with the tenderers involved the amendments needed to bring the cost within the approved limit. My officials are in close touch with the regional health authority in these discussions and, provided that it is possible to achieve an acceptable tender, it should then prove possible for my Department to give urgent clearance to the acceptance of the tender, in which case this much-needed development can quickly get under way.

The regional hospital authority expects to invite tenders for the psychiatric unit and day hospital in the autumn and hope that work will commence before the end of the financial year.

Inflation is a considerable problem for the National Health Service as it is for practically all services, and, indeed, for many industries. The National Health Service clearly is affected by inflation in terms of building costs. We are not adopting a rigid, inflexible attitude. We recognise that some tenders will be above cost and we have revised our yardsticks. But there are limits on how much we can approve over and above approved costs. We are, of course, answerable to this House and to the Public Accounts Committee. Much though I would like to give the hon. Gentleman—and, through him, his constituents and the people in the area—a definite statement tonight that we are going ahead, I cannot do so until we have looked at the tenders. I believe that discussions have been taking place in the last few days. A lot depends on the outcome of those discussions. I am afraid that I cannot go any further than that, but the Government have recognised the scheme's priority by giving provisional approval. If it could not be kept within reasonable cost limits one would not be able to approve the tenders. I adopt no position on this. Negotiations are going on and it is everybody's wish that the matter should be settled as quickly as possible.

Phase IV. which was originally planned to start in 1977–78, consists of a 480-bed surgical ward block, additional theatre suites and further much-needed residential accommodation. Phase V, which was planned to be constructed during the early 1980s, consists of a medical ward block, including 140 geriatric beds, administrative buildings, a post-graduate medical education centre and the balance of staff accommodation and other supporting facilities.

It must be borne in mind that responsibility for planning hospital services is now primarily a matter for regional and area health authorities—in this case, the South West RHA and the Surrey Area Health Authority, which assumed their full responsibilities on 1st April. In addition, the Community Health Council for the North West Surrey district—members of which have recently been appointed and which will be meeting for the first time during the next few weeks—must be consulted and fully involved in the planning of health services in the district.

These new authorities have a much more comprehensive responsibility for health care than had the old regional hospital boards and must try to plan for the best possible care for all the people in their region or area. This means that the size, scope and timing of Phases IV and V will need to be carefully considered both in relation to what are in due course seen as the long-term needs of the local community and to the authorities' assessments of the priorities in both area and region, in the light of the resources, financial and in terms of manpower and womanpower, which are available to them.

There are far too many imponderables to make it possible for me to say at this stage what progress the new authorities will wish, or be able, to make in realising earlier plans for the completion of this redevelopment.

The hon. Gentleman concentrated on Phase III. I will let him know as soon as I have advice on the tenders. I only hope that it will be possible to contain this scheme within the approved cost.

To sum up, therefore, Phase III will, hopefully, get the go-ahead shortly, but I cannot make a commitment until I have seen the extent of the tenders and how much they are over the yardsticks. But the timing and content of later phases must depend on what are seen and agreed to be the area, regional and, most important of all, national priorities.

My problem is to try to look at the needs across the country. We cannot just look at the matter in terms of even a region, though that is important. It has been the case that St. Peter's, Chertsey, has shown high need within its region. This has been accepted previously.

Mr. Pattie

It is a source of comfort to me to know that I have been addressing my remarks tonight to a Minister who is also an eminent medical practitioner. One knows he sympathises very much with the problem of a hospital such as St. Peter's. If he has not already been to St. Peter's, may I extend to him an invitation to visit the hospital in the near future. It is only 19 miles from here and we can arrange transport very easily.

Dr. Owen

I am grateful for the invitation. I should like to visit many more hospitals.

My primary concern is to try to ensure that in all the conflicting demands we are making on the service now we choose the right priorities. I do not doubt that many hospitals need to be rebuilt. I also do not doubt that there is a need to put an emphasis on primary health care. It seems to have been agreed in debates recently that the staff in the National Health Service must be a first priority. Many of their salaries have not kept pace with the cost of living or with comparable wages in other services and other industries.

We will not get, and cannot reasonably expect, the sort of service that we have traditionally had from the National Health Service unless we put right the problems of morale. The work load for many of the staff has changed quite dramatically over the last 10 or 20 years, but at the basis of a lot of their discontent lies salaries. That means we shall have to pay more for the people who work in the National Health Service. That means that unless we are to get a substantial increase in resources we shall have to choose more carefully some of our priorities.

Capital allocation to hospital building is separate from revenue allocation. Increased capital expenditure always brings increased revenue spending. We have to look very carefully at how much money will be available for capital spending. The capital cuts imposed, unless a dramatic change in the country's economic state takes place, will continue, not necessarily at the same level but a lot will depend on the overall economic position. I do not hold out hopes of a major change. There will need to be considerable stringency in capital allocations over the next few years.

There are valid arguments why one should not disrupt the development of those hospitals aready started, particularly when the phasing has been planned so as to follow on logically from the first two phases.

I hope it will not be long before we are in a position to make a more definite statement about the future.

If the nation wishes for the health service that I certainly wish for, it will have to be prepared to face the expenditure implications. The nation will also have to be prepared to face the implications of taxation, which are part and parcel of the whole attitude to increasing public expenditure.

I believe that the National Health Service faces difficulties of inflation. It is not collapsing. It faces acute problems. There are aspects of the health service which are the admiration of the world. Within the health service now there are standards of care and attention which are the envy of the world. But it needs to be admitted frankly that there are many areas which need more resources, both of money and of manpower and woman-power. Certainly it will be the aim of this Government to restore those aspects of the service which have been neglected in the past, so that we can be proud of all aspects of our National Health Service.

Question put and agreed to.

Adjourned accordingly at eight minutes past Twelve o'clock.