§ 5.31 p.m.
§ Mr. John Cordle (Bournemouth, East)I wish to draw attention to a very serious matter which concerns the Boscombe General Hospital, the one hospital of some note and importance within my constituency.
At present it is planned to begin the work of construction of a new district general hospital at Castle Lane, Bournemouth, early in 1977. That starting date should mean that the first phase of building should be complete and able to receive patients by 1980. I feel bound to draw attention to the grave public disquiet existing in Bournemouth at present and to the fears of its citizens about the situation which would confront the hospital services there if the planned starting date for the new hospital were not adhered to. The present situation in the town has become extremely serious.
Bournemouth has a large and increasing elderly population, and one does not need to be a doctor to know that the incidence of illness rises sharply among the over-70s, leading to the need for more hospital beds per head of population in this area than in almost any other part of the country, but instead of Bournemouth having more hospital beds per head of population, the present position is that the town is well down on the regional norm, with the result that the number of beds is grossly inadequate for the population of the area. It is also short of operating theatres as well.
To serve a Population of 250,000, only 37 beds are available suitable for acutely-ill patients in need of medical as opposed to surgical treatment and in need of 1006 constant nursing. As might be expected, there is a deplorably long waiting list for admission to hospital surgery. The situation has become noticeably worse in the last year; the waiting list for surgery has increased by 63 per cent. Even cases which the surgeons consider to be urgent, such as life threatening complaints like cancer of the breast in a woman or cancer of the bowel in a man, can be delayed up to six weeks before a bed can be found. Cases which require treatment quickly can be delayed up to six months and routine cases are awaiting their turn for about two and a half years.
This shortage of beds means immense pressure on the available beds. The side effects of the shortage are that every day gravely ill patients arrive at the casualty department only to be left lying there whilst desperate efforts are made to find a bed. In some cases, seriously ill people have even been sent home again because no bed could be found.
I will give some further examples of what has recently been taking place. A 72-year-old man with heart failure and retention of urine had to spend seven hours in the casualty department awaiting a bed. Another patient arrived in a pre-diabetic coma and lay in casualty for six hours until a bed could be found for her. A woman in her early 30s committed suicide because of the long wait for an ileostomy operation which had been unavoidably postponed because of lack of a bed for her.
The emergency bed service—and I stress that it is an "emergency" service—has a waiting list which recently has been as high as 30, with patients waiting up to 10 days for acute admissions. There are sudden and unscheduled transfers of patients to different wards in different hospitals in the middle of the night. One patient in only 14 days moved five times, and on two occasions after 10.30 at night. This often means the oft-times too early discharge of patients.
Naturally, all this has a serious effect on the hospital staff. Life for them is one continuous emergency. For the junior hospital doctors, who have to consider the medical details and problems of each patient, there is a continuous game of chess played with each patient who is a pawn 24 hours of each day in a seven-day week. Members of the staff have to 1007 try to make too little spread as far as possible. The result of the strain in doctors and nurses is that it is difficult to recruit and retain staff. Last year 146 nurses left the Royal Victoria Hospital and only 120 were recruited in their place. Too few staff means that the already inadequate number of beds cannot be utilised. That, again, increases pressure on the remaining staff. The vicious circle continues. That circle must be broken in the name of humanity and decency for people in the area.
In the short term the regional hospital board has suggested a scheme to be implemented. It will relieve the pressure to a limited extent, but it is clear that the interim arrangements will not increase the number of beds available for acute surgical cases, and in fact will result in a reduction in the number of beds available for acute medical cases. At present there are 135 beds, and after reorganisation there will be 117.
All concerned are in complete agreement, as the recent work study report showed, that the only solution to the problem is for the new hospital to be brought into operation as soon as possible, and that its building should not be delayed. It is vital for the morale of the medical and nursing staff that this should happen—that the new hospital be brought into operation at the earliest possible moment.
Another point I wish to stress is the need for a scheme of development to include the construction of adequate accommodation for nurses, doctors and other staff who will be required. Many of the staff, in view of the hours which they work, need to be housed close to the hospital. I am informed that the local authorities would be in no position to provide accommodation for all the expected new staff for this essential hospital.
In conclusion I return to the crisis situation which confronts the Royal Victoria Hospital, Boscombe. As one senior surgeon at the hospital put to me this week:
The patients are suffering in Bournemouth, and if we cannot deal adequately with the acutely ill then the service has broken down. The people in Bournemouth are not getting the health service they need and are entitled to.
§ 5.39 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Robert C. Brown)The hon. Member for Bournemouth, East (Mr. Cordle) has put his case with a vigour which reflects the importance he places on the improvement of the hospital service in the Bournemouth area. While I cannot agree with everything he said about the existing service, nor with the gloom of his prognostications, I understand his desire to see that a new district hospital is built to serve the population of Bournemouth as early as possible. Nobody would disagree with that general desire.
Looking first at the existing hospital service, the Royal Victoria Hospital has two branches in Boscombe—Shelley Road and Gloucester Road—with which must be associated the branch at Westbourne. A total of 363 beds, acute and maternity, are provided at Shelley Road and Gloucester Road and 40 beds of the same type are provided at Westbourne. This bed provision cannot be considered in isolation and the total provision for the catchment area, with an estimated population in 1971 of 380,000, is some 2,100 beds of all categories. Of this total, 584 are provided at the modern district general hospital at Poole—271 at Christchurch hospital, 375—mainly geriatrics—at St. Leonards hospital, 100 at the Royal National hospital and the remainder at smaller hospitals in East Dorset.
Since the reorganisation of the National Health Service in April this year these hospitals have been managed by the district management team for the East Dorset health district, which covers broadly the catchment area of the hospitals as it existed before reorganisation with an estimated population in 1981 of 443,000 of which 103,000—a very high proportion—will be aged 65 or over.
I should now like to say something about the background to the facilities which exist at present in the district and in which improvements are contemplated.
In February 1971 the medical executive committee of the former hospital management committee submitted a memorandum to the former regional hospital board which stated that to continue with the facilities then existing for 1009 another 10 years could, in the opinion of the committee, result in a total breakdown of services to patients. The memorandum asked the board to bring forward the construction of a new district general hospital which it had been planned should come into operation in about 1982. The new hospital is mainly to replace the three branches of the Royal Victoria hospital and part of Christchurch hospital, and a site is available for the hospital at Castle Lane, Bournemouth.
In view of this memorandum the board and hospital management committee set up a joint committee to review the hospital services of the hospital management committee in the context that a new hospital was not likely to be available for a period of 10 years; to formulate recommendations to provide the best possible level of patient care until the new hospital was built, including reallocation of beds as appropriate; and to prepare a list of works which would make the best use in the short and longer term of the capital funds allocated in the years 1972–73 to 1975–76 and make the most economical use of medical, nursing and other manpower and revenue funds.
The joint committee formulated plans for interim development of the service on the basis that the hospitals at Boscombe and Poole would have complementary rather than separate rôles in providing a service for the population of the catchment area. This principle was examined late last year in detail by the Dorset area joint liaison committee—a committee of officers in the three branches of the health service set up to prepare the way for NHS reorganisation—before it made its recommendations about the setting up of health districts in Dorset when the National Health Service was reorganised on 1st April this year. The Committee concluded that it was not practicable at that time to divide the Bournemouth, Poole and Christchurch hospital complex in order to establish two health districts serving the eastern part of Dorset, one district containing the district general hospital at Poole and the other containing the district general hospital at Boscombe. The single health district for East Dorset recommended by the Joint Liaison Committee was established from April of this year on reorganisation of the NHS, but the possibility of dividing it into two 1010 health districts will be borne in mind at a later date when the new DGH is built at Bournemouth.
As regards making the best use of capital investments, the joint committee, to which I referred earlier, set up in 1971 to examine the hospital service in Bournemouth, decided that expenditure on hospitals which were to be closed within 10 years should be restricted to commitments which are inescapable during the interim period. The joint committee's views on the sites of the three major hospitals in the complex were that the site of the Royal Victoria Hospital, Shelley Road, Boscombe, was very restricted and it would be impracticable and uneconomic to provide any major additions to the hospital, which was in any case to be closed when the new hospital was built at Bournemouth; that there was little potential for expansion at Poole DGH; and that Christchurch Hospital with its large site provided considerable room for expansion and any new building there could have permanent value.
The main aims of the programme of interim development are, firstly, a better standard of primary care for accident and emergency patients, with an accident and emergency department at Poole DGH; secondly, a greater concentration of medicine and general surgery in the Royal Victoria Hospital and Poole DGH; thirdly, an improved orthopaedic service and a reduction in the orthopaedic waiting list; fourthly, a more positive rôle for Christchurch Hospital in the interim period with a greater emphasis on rehabilitation; fifthly, an improved geriatric service in the Bournemouth-Christchurch area; sixthly, improved and extended junior medical staff accommodation; and seventhly, the concentration of all children's beds at Poole DGH.
To achieve these aims, changes have been initiated in bed allocations in hospitals in the health district and a programme of capital works has been started. The Wessex Regional Hospital Board and its successor regional health authority approved capital expenditure of £1½ million for this interim programme. These interim improvements were of course discussed with the hospital staff before being initiated, and I should like to say something about the progress made with them.
1011 The accident and emergency department has been established at Poole DGH and a consultant appointed to this speciality. The accident and emergency service at the Royal Victoria Hospital, Boscombe will be reduced to a minor service manned by general practitioners in October next.
The transfer of cold orthopaedic services to Christchurch Hospital is in progress, and it is hoped that by the end of this month 55 orthopaedic beds will have been transferred to Christchurch from the Royal Victoria Hospital, followed by the movement of 16 surgical beds and 59 medical beds from Christchurch to the Royal Victoria Hospital in October of this year. This will provide more surgical and medical beds at the latter hospital where a new medical ward has been completed.
The transfer of some children's beds to Poole DGH from the Royal Victoria Hospital has enabled the number of adult beds at the latter to be increased. Unfortunately, problems have been encountered in staffing these additional beds. A new geriatric assessment unit of 50 beds is being built at Christchurch. It is planned that this unit should come into operation at the end of this year when it will make a significant contribution to reducing pressure on geriatric beds.
A major scheme for the provision of a rehabilitation unit at Christchurch and the improvement in out-patient facilities there is planned to start in this financial year. This was one of the priority schemes in the region for which my Department made capital funds available this year. Residential accommodation is being built at Christchurch Hospital and this work should be completed this year. Significant progress is, therefore, being made with the interim programme, but there is no room for complacency about the difficulties which exist, to which the hon. Gentleman has drawn attention, in providing a satisfactory service for the population of the district.
The high proportion—well above the national average—of elderly people in the population of the Bournemouth area not only creates problems for the geriatric services but also contributes to the difficulties in recruiting staff to man existing beds, and those additional beds being pro- 1012 vided through the interim programme of improvements. Strenuous efforts are being made by the hospital authorities to recruit nurses, but this is proving extremely difficult because the higher pay and more socially accepted working hours which are available in other fields of employment naturally attract from the already reduced pool of persons of working age those suitable for work as nurses. In that respect I think that the hon. Gentleman will look forward, as I do, to the results of the independent inquiry on nurses' pay. This also applies to other grades of staff, for example, domestics and ancillary staff. There is fierce competition from the hotel and catering industry and from the expanding range of manufacturing industry which is moving into the Poole area. I understand that an analysis of recruitment carried out in 1973 showed that the Royal Victoria Hospital relies heavily on recruitment of nurses locally; only 26 per cent. of the total number of trained staff employed at that hospital were recruited from outside the area.
The area health authority is making every effort to recruit nurses. "Back to Nursing" courses are held regularly to encourage those who have left the profession to return to it. A register of nurses in the community willing to undertake escort duties in ambulances is maintained so that these nurses can be called upon for this duty to avoid taking nurses away from wards. The major problem arising from the elderly population is, of course, the pressure on geriatric services. The interim programme seeks to improve this service but when completed it cannot totally meet the bed requirement on the basis of the guidelines for geriatric provision issued by my Department. Some 430 beds are available in private nursing homes; these are used predominantly by elderly patients. Further, the local authority provides some residential accommodation but, for the reasons I have already given, it finds difficulty in obtaining staff for its residential homes and for the Home Help Service.
I should like to refer to the new district general hospital. The provision of a new hospital is obviously extremely important, and planning for this was started by the former regional hospital board and is continuing with the new health authorities. The place in the regional health authority's building programme for a 1013 major building project of this size is a matter for the regional authority to determine. It must necessarily have regard to the amount of capital allocated by my Department for health building for 1975–76 and later years. I am afraid I cannot at this stage say what the allocation will be. When this allocation is known it will be for the Dorset Area Health Authority and the regional authority to decide the priority to be given to the building of a new hospital in Bournemouth. In doing so they will take account of the competing claims for other deserving schemes in the area and in the region. Furthermore, the new community health councils, one of 1014 which relates to the East Dorset district, will need to be consulted by the health authorities, and this will provide the local community with a clear opportunity to play its part in planning the health service in the district.
I am grateful to the hon. Gentleman for having given me the opportunity to explain at least some of the difficulties of the hospital service in the Bournemouth area.
§ Question put and agreed to.
§ Adjourned accordingly at seven minutes to Six o'clock.