§ 7.43 p.m.
§ Mr. Jerry Wiggin (Weston-super-Mare)
I am most grateful for this opportunity to raise once again the serious problem of the lack of adequate hospital facilities for Weston-super-Mare and, coupled with that, the difficulties experienced in the constituency of my right hon. Friend the Member for Taunton (Mr. du Cann). We have coupled these subjects because in the order of priorities Weston-super-Mare will have the first new hospital to be built in the South-West Regional Health Authority area. I suspect that the hospital at Taunton will be built or commenced once the hospital at Weston-super-Mare is started.
Since I became the Member for Weston-super-Mare I have personally interviewed at least once, and perhaps more, all the Ministers who have been responsible for this matter. I see that the Under-Secretary of State for Health and Social Security is to reply and I have not interviewed him. I therefore hope that I shall be able to convince yet another Minister about the facts of the case. I know his particular and special interest in the elderly and infirm which may be more appropriately directed towards Weston-super-Mare where the population is somewhat elderly.
This issue has been in the headlines locally for about 19 years when the building of a new district general hospital was first mooted. It would be tedious and unnecessary to go over all the false alarms and starts which never materialised and all the debates about sites, so I shall merely recap on the recent history. The last occasion on which I raised this matter on the Adjournment was at the conclusion of that long night when we voted and voted and voted on the Industrial Relations Bill.
124 Within a few days of that, we were told of the purchase of the site at Uphill. For the local people that was a major step forward. It is an appropriate site for a district hospital and the design team was collected together once more and its work went ahead comparatively smoothly. Tenders were ready for placing to builders in the summer of 1973. May I stress at this point that for me this is not a party political matter but something on which I have met representatives from both Governments and a matter which I shall pursue with any Government of any colour until I get the hospital built for my constituents.
I shall have the special privilege not only of beginning this series of debates on the Bill but of ending them, too, because I have a petition which will be presented at the end of the debate on which have been obtained 45,000 signatures. It demonstrates the great feeling of my constituents about the issue of a new hospital. Petitions have been presented in the past. There were 13,000 signatures to one in 1965 and 20,000 to another in 1969. Some may take the view that a petition means nothing, but surely it illustrates the strength of local feeling.
I refer to a letter from the chairman of the local constituency Labour Party in Weston-super-Mare in which that gentleman indicated his general support for me on this issue, bearing in mind that he does not normally agree with me but saying that everyone should combine to ensure that we get our new hospital. He attended a meeting organised by the medical staff, and he told me in his letter:The picture the Consultants and GPs presented one after another gave a terrifying state of affairs which cannot and must not be allowed to continue somehow we must all find a way to have the existing plans which are ready for tender implemented as a matter of great urgency.The letter was signed by Mr. A. W Gosnall, Chairman, Constituency Labour Party, Chairman Co-operative Party, Member EC, Bristol Trades Council, Delegate, Weston Trades Council.
Other bodies including the ratepayers, the young wives and others put their names in support of the petition. I have two or three letters from medical staff at the hospital. One was from one of the consultants, Mr. A. Hinchcliffe, who said:Before applying for my post last year, I made extensive inquiries at the South Western 125 Regional Hospital Board concerning the District General Hospital at Weston. I was assured that the building would start in October 1973. At my interview I was asked my views on the Weston-super-Mare General Hospital. Having worked for a number of years in Bristol, I was aware of the present inadequacies and replied that I was applying only because a new Hospital was about to be started (an expected completion date for 1978 was given in the detailed advertisement for the post). My colleagues and I have recently learned the reasons for delays and I find it difficult to believe that these could not have been anticipated at the time of the interview. Had more information such as that relating to the priority order of capital building in the Region been available at the time, it is doubtful that I would have applied for my post. However, I came to Weston quite prepared for up to five difficult years before appropriate facilities would be available. After my arrival, it became apparent that the situation was going to be far more difficult than I had anticipated in spite of considerable recent expenditure on the present hospitals to temporarily improve their facilities.He adds:Owing to the good will of its hospital staff, this hospital has used every possible device to ensure a maximum safe throughput of patients. The serious deficit in its facilities means that it can only offer a less than adequate service to a decreasing proportion of the local population.Another surgeon, Mr. Peter Reed, writes:I applied for the appointment of Consultant Surgeon at Weston on the understanding that a new hospital was to start being built during the year of my appointment—that was last year. Although it was clear even at that time that delays in building are always possible, I was and am still prepared to invest a number of years to help establish a new district general hospital. Being involved at this stage in the development of a hospital is an exciting personal challenge and offers tremendous potential rewards in terms of job fulfilment.The point has probably been taken by the Minister, but Mr. Reed repeats it. He says:I do not think it too outrageous to suggest that if this hospital does not start soon, and certainly should it be indefinitely deferred or scrapped, then those members of the consultant staff who still have a significant time to serve in their professional careers would seek work elsewhere. Certainly I would not stay under the present circumstances. Although I have once returned from America to work in this country through choice, I would reluctantly consider emigrating once more, not for primarily financial reward but merely to gain adequate circumstances in which to pursue the work for which I have been trained.Mr. Reed has an MD (Manchester), an MS (Chicago) and an FRCS (London). 126 He is a highly-qualified man, and we are glad to have him in Weston-super-Mare. I hope that he never has to leave us.
The matron has written as follows about the nursing problems:When I was appointed to my present post of Matron in 1968, one of the main attractions of the appointment was the opportunity to serve on the Project Team for the proposed District General Hospital as a Nursing Member …future career prospects for my senior nursing staff and myself are rapidly receding—as the prospect of the new hospital is receding.I believe that those short extracts from letters are enough to show the mood of the staff. I shall present to the Minister a full portfolio of the views of various other members of the medical fraternity, including general practitioners and others.
A document has been prepared for local authorities and other interested people to apprise them of the situation as the doctors and medical staff see it. It says:We must impress on all people concerned that we as doctors are not simply looking for a new building in which to work at a steady pace. We are not seeking refinements or luxury aids to medical care, but basic facilities. This district needs a proper District Hospital now—and not in the time it takes to build one!I confirm that. I believe that the present facilities are inadequate and that the five-year period to build a hospital is far too long.
The South-West has on the whole received a comparatively lesser expenditure of the national cake for hospital building than it has a right to have. We have done substantially less well than London, for example.
We also have the substantial problem of holidaymakers. They are not a problem in terms of industry, because tourism is the most important industry in the South-West, but they create a considerable load on public facilities. The fact that a person who breaks his leg or has a heart attack in Weston-super-Mare has come there on holiday, and is therefore not being ill in Manchester, Birmingham or London, does not lessen the load on Weston-super-Mare General Hospital but immensely increases it. Last summer we had to close one ward because the pressure of work was too great.
127 In the detailed report to which I have referred mention is made of the problems caused by holidaymakers. Until recently the Department always refused to accept holidaymakers when assessing populations for medical facilities, but when people are working out salaries for local authority officials they are happy to include holidaymakers among the population. It is a special problem of the South-West.
I come on to the question of building costs. One of the reasons why the tenders were not put out by the previous Government was that the costs of Barnstaple and Plymouth had greatly exceeded what was expected. I wonder whether the Department's tendering systems are of the best. I wonder whether a fixed price tender, which must at present include a large proportion for inflation is the best way of putting hospitals out to tender, and whether an adjustable charge for inflation should be included.
My right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) told me when he was Secretary of State that he was considering whether the proceeds from the sale of land owned by the regional authorities could be put to capital projects. I understand that in the past the proceeds from the sale of land belonging to a regional hospital board, as it then was, went to the Treasury, so that there was no incentive to sell land, but the rules have been changed, and the proceeds could be put to further capital projects in each region.
I have two other points on the more general issue. First, the prospect of staffing a district general hospital at Weston are very good. The medical people tell me that, if the medical facilities can be provided, staffing does not look like being a difficulty, but at Plymouth, where they are going ahead with stage two of their hospital, there could well be difficulties over staffing. I do not know whether that is taken into account when priorities are being decided, but it should be considered.
We in the South-West have not done as well as other regions. I appreciate that the health service is already short of cash for its current affairs, and that capital works were severely cut by the previous Government, cuts which have 128 been maintained by the present Government. Is it not time to ask whether we should find the funds from another region? That is difficult for the Minister, but we have a cast-iron case of the greatest possible priority at Weston-super-Mare. If the money must come from another region, so be it, but at all costs we must have the hospital.
I may be misinformed, but I understand that the Secretary of State is to make a tour of hospitals in the South-West. I should very much like her to call at Weston-super-Mare and see the present inadequate facilities. If she saw for herself, I am sure that she would appreciate why people are so worked up about it, why we think that it is so important. She would be made very welcome and shown round our hospitals.
I do not want to take more time than necessary, because if I am brief some of my hon. Friends may be allowed to say a word or two. My constituents have used every democratic means at their disposal to show their concern in the matter. I shall go on urging this hospital as long as we do not have a starting date. I hope that the Minister will act to prevent the breakdown of proper hospital facilities in Weston-super-Mare, and will announce this evening the starting and completion date for our hospital.
My right hon. Friend the Member for Taunton, who will urge the case for the Taunton Hospital, and I are in close agreement about the necessity for improving hospital facilities in Somerset. Some of my constituents would possibly be served by a new Taunton Hospital. It backs up what I said earlier, that we in the South-West have been badly treated, when we find that two of the major centres in Somerset are both screaming for a new hospital. I hope that the Minister will be able to help us tonight.
§ 7.58 p.m.
§ 7.58 p.m.
§ Mr. Edward du Cann (Taunton)
Like my hon. Friend the Member for Weston-super-Mare (Mr. Wiggin), I speak with no wish to show a partisan spirit. That is, I have not the least wish to provoke or engage in party political argument. But I speak with all the urgency and emphasis that I can command, for I feel most strongly about the need for a new 129 hospital at Taunton and at Weston-super-Mare.
One recognises well the present burdens on Ministers, not least Ministers in the Department of Health and Social Security. Many of us on both sides of the House have long admired the capacity of the Minister who has courteously come to answer the debate, as we have his immediate colleague, the new Minister of State, whom we all congratulate on his new appointment. We hope very much that he will be able to give us replies to some of the points of significance about which we feel so keenly which my hon. Friend the Member for Weston-super-Mare and myself have already raised and which others of my hon. Friends intend to raise.
Nor do I argue with my hon. Friend the Member for Weston-super-Mare. We are not competitors in any sense. He and I, my hon. Friend the Member for Bridgwater (Mr. King), who is much affected by the matters which we are discussing, and my hon. Friend the Member for Wells (Mr. Boscawen), represent a common cause for Somerset and the people we represent. For those people we demand—and we are determined to achieve—adequate and modern facilities in matters of health as in all else which we can influence for the better. I have no doubt that my hon. Friend the Member for Gloucestershire, South (Mr. Cope) takes the same view in respect of his local people.
I do not dispute the urgent need for a new hospital at Weston-super-Mare. That need does not affect in any way the overwhelming case for a new hospital at Taunton. Both are needed and the requirement for both is urgent. I think that it can be argued that the South Western Regional Health Authority has had imposed upon it by the Government a most unenviable task in deciding priorities. Indeed, it has to exercise almost the wisdom of Solomon in deciding how the slender allocation of funds is to be divided as between, for example, Weston-super-Mare and Taunton or between any of the other many deserving cases in our part of the world.
Incidentally, and I am sure that my hon. Friends and the Minister will agree, I wish to say how fortunate we are in the South Western Regional Health Authority to have the leadership of that 130 distinguished and competent man, Mr. Northcott.
The reality is simply described. New hospitals at Weston-super-Mare and Taunton are equally needed. It has been admitted constantly by the Government that there is a crucial need. I know the case for Taunton better and I have argued it over many years. I had established a file 18 inches thick. It was destroyed by the fire in the Palace of Westminster a little while ago. There have been letters, meetings with Ministers and speeches. The last occasion, as my hon. Friend the Member for Bridgwater will recall, was in October 1973 when the then Secretary of State thought sufficiently of the case to break precedent and to answer the debate himself. It is worth quoting one sentence from my right hon. Friend's reply. He said: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."—[OFFICIAL REPORT, 18th October 1973; Vol. 861, No. 861.]Yet it is necessary to do so and I shall continue to argue the need. I shall do so until in the end we get our way. Obviously I feel this need extremely keenly. I speak of what I know for, like my hon. Friends, I live locally and my family have used the local hospitals.
We have a superb service in Taunton. It is deplorable that the good people who work in the hospitals in Taunton should be obliged to give those services in surroundings and circumstances that are in this year of grace 1974 woefully inadequate. The House will not be surprised to hear me say that my greatest constituency ambition is to see this project begun. Of all constituency matters with which I have been concerned whilst I have been in this House, whether they have been bypasses, the motorway, schools, the Taunton flood scheme or the multitude of personal cases with which any Member becomes involved, I do not believe that I have even been so concerned about any as I am about this matter.
Nor is this a matter merely affecting my own constituency. We are talking about Somerset's district general hospital. At the moment Somerset has no such hospital and it should have one. Its provision is long overdue and Taunton is that opportunity. There is now much talk of community hospitals. There are 131 projects for them in various parts of the country as in our own country. Surely it is appropriate to get the priorities first. We must have the district general hospital first. Community hospitals should take their services, their strengths and their bases from district general hospitals.
Because we have spoken about this matter so often in the past there is no need to rehearse the disabilities of the present situation at any length. In summary let me say that in Taunton we have old buildings. There are four and one of the principal examples is Musgrove. It is a temporary wartime structure that is much dispersed. It is a thoroughly awkward building in which to work. It is an example, perhaps, of the new genteel British poverty which means that we have to make do with old and inadequate buildings. Then there is East Reach, which was built in 1809. It is archaic and with the exception of a new accident centre, which was provided only after I led a deputation some years ago to see Ministers and which is one example, following the remarks of my hon. Friend the Member for Weston-super-Mare, of where we were able to prove the holiday need and to receive some special consideration, the whole place is dreadfully old-fashioned.
There are problems of separation. I do not refer to the simple inconveniences of having to walk a little distance or to get in a car and drive for 10 minutes but the serious inconveniences that arise from the separation of units—namely, the inevitable fall-down in services.
I could quote a number of matters of practical measure which affect people living locally. For example, the library is in one place and there is not immediate access from the other place. The postgraduate centre is also separated. The House will be able to imagine the effect that these circumstances have on recruitment for our hospital in the context of the attractiveness of other places. The House will be able to imagine the inevitable effect upon the quality of medicine in poor conditions.
Then there is the matter of additional expenditure. I have argued before in this House, and I shall continue to do so, that when inadequate capital sums are spent it is inevitable that a waste of 132 public money is involved in patching. The longer the delays in spending capital, the more cash that is required to patch. In 1971–72 there was the authorisation of £500,000 on maintenance at East Reach and Musgrove. That included expenditure on engineering and the provision of certain up-to-date facilities—notably, theatres. I was most interested to hear my hon. Friend the Member for Weston-super-Mare say that the Secretary of State is proposing to visit hospitals in the South-West. I hope that the right hon. Lady will come to Musgrove. She will there see the torn floors, the roofs that leak and the conditions in which people are working.
Although we are spending sums of the sort that I have described, thay are still inadequate and must necessarily be inadequate to bring up to date these old buildings that were never intended to last more than a short time. The disabilities list is long and there have been disappointments. My hon. Friend the Member for Weston-super-Mare spoke of the disappointments that he and his constituents have experienced. It has been the same in Taunton, only possibly worse.
I remember the story beginning when I was first elected. I suppose the most important date was 1962 when we had the regional hospital plan introduced by the then Minister of Health. We found ourselves in one plan and then we found ourselves excluded from the next. In 1966 I took a deputation to see Ministers and we had the plan revised. That was a move forward. In 1970 it was announced that construction would start in 1975–76. The first firm date for that was April 1975. It has not the remotest chance of being kept. The latest date for a start has been estimated to be October 1976. I do not believe that that will be maintained either, but I hope that I am wrong. What does the Minister of State think about that date? Is it the Government's wish and intention to endeavour to keep to it or not?
We were intended to have a large hospital on the Lyngford site in country between the Bridgwater constituency and Taunton—at any rate on the Bridgwater side of Taunton. We were intended to have a large hospital of over 1,000 beds. The original plan was for a first phase 133 of 676 beds and the bulk of the acute services. Then we learnt that it was proposed to divide that phase 1 into two sub-phases, if you please, with no guarantee when phase lb, so to speak, would follow upon phase 1a. So the completion date for the whole has varied between 10 and 25 years.
That takes us up to the year 2000 for the completion of a project which was first considered in 1943 or earlier. Is it any wonder that there is in my part of the country resignation, disappointment and some degree of genuine anger? We simply do not know where we are, and I ask the Minister of State to do his best tonight to relieve our uncertainty.
I want to speak a little about the Department itself and the news we have received from it. The position has frequently been equivocal, in my opinion, and sometimes plainly discouraging, I am told that there are no fewer than 160 doctors and 52 nurses in the Department to look after the regions. No doubt they are devoted people but it seems that too often the sum of the activity as it goes out to the regions is one of cumulative vagueness, which is a worry to those who are on the receiving end of the decisions.
I give an example of this in the position regarding Harness. We were told at Taunton that we should have Harness, that the idea of the standardisation of construction and design would save money, which would be a good and simple thing to do. I thought that it was an attractive idea. But I am told now locally that Harness may well turn out to be more expensive than the original designs of what was proposed at Taunton. So more time has been wasted.
Then we have not been able to get authority from the Department for planning. The regional hospital authority is therefore pressing on with its own planning, thereby involving itself in great expenditure and cost. I support that course as being a proper risk to take. But even if the Minister of State is unable to do so tonight, I hope that he will later be able to underwrite this expenditure. The reason I feel that this planning which the authority is doing is so significant lies in the fact that I am told that if site work is begun now, costing some £2 million or so, it will still be eight to 10 years before Lyngford hospital is 134 operational—in other words, before the constituents of my hon. Friend the Member for Bridgwater and myself get what other people take for granted.
There is also the problem of the vagueness of the Department. We hear that now a limit of some £10 million has been set on the expenditure. But we know that we cannot have a viable hospital at Lyngford for that money. What is the truth?
We are told also that it is now apparently a rule that no contract should last for more than four years. I do not know how that rule will affect the constituency of my hon. Friend the Member for Weston-super-Mare, but it would seem not to have application to our hospital at Lyngford. What is the reality of the situation? If the Minister is able to clear the air, it will be immensely helpful. He can surely see how the uncertainties which exist in our part of the country are very much added to and felt as a result of lack of clear guidance filtering down from the Department.
I do not want to make only parochial points in the debate but to deal with wider matters as well. There is obviously great competition for Government expenditure. I remember making common cause with the Secretary of State for Social Services when we established the Expenditure Committee in the House and tried to bring judgments collectively of Members in deciding these very difficult and sometimes intractable questions. I think that it would be right for me to say tonight—and I hope that my hon. Friends agree—that if the right hon. Lady and her colleagues in the Department at any time need assistance in pressing the case on the Government for more money to be spent on the National Health Service, they have only to say so and we shall support them for all we are worth.
It was a matter of extreme irritation to some of us, for example, last March, when £1,378 million was returned to the economy by the Chancellor of the Exchequer, that a mere £3 million only was earmarked for the National Health Service, and that for what some people—not I—regarded as a trivial reason, free contraception.
It was a matter of incredibility to many of us to find that the £300 million provided a few days ago for reflating the economy did not include a penny for the 135 National Health Service. I am not trying to make partisan points but I am sure that if one polled people in Taunton, or Bridgwater, or Weston-super-Mare, or Wells, or South Gloucester asking whether they would rather have money spent on food subsidies or on new hospitals, there would be no doubt of the answer. It is incomprehensible that from two Government reviews of expenditure the National Health Service has been so blatantly left out.
I make the same point again in a different way. I have here the documentHealth Care: the growing dilemmawritten by Robert Mawell of McKinsey's. It is a remarkable and important document, worthy perhaps of a debate of its own. No doubt the Minister is familiar with it, and inter alia it contains a number of tables. One of them shows the proportions of gross national product spent on the health services in eight countries, including Scandinavian countries, the United States, Russia and the largest countries in the EEC. It shows that the United Kingdom is the second lowest of all, bottom being Italy, whose health services it is well known are a perfect disgrace. What is more, "Health Care" sees and shows the position deteriorating.
That is a bad national picture. It makes the omission of more money for the National Health Service all the more unsatisfactory. But there is yet a worse feature to come. It is reasonable to consider the West Country in the context of the whole. In my opinion the West Country merits special consideration. I do not say that as a mere partisan point. I think that it is easy to prove.
For example, there is our problem of geography. The northern part of our region is nearer to Scotland than it is to Cornwall—an extraordinary reflection of the situation. We also have great unevenness of population. Exmoor, Dartmoor, Bodmin Moor and other parts of the West, which are underpopulated, are household names in the United Kingdom.
We also have above-average requirements of capital. For instance, out of the 260 hospitals in the region 69 are over 125 years old. East Reach I have already referred to. It was built in 1809 and is 165 years old. Of those hospitals, 109 are between 75 and 125 years old. Look- 136 ing back on it, the reality is that historically Cornwall, Devon and, perhaps, Somerset have not been the wealthiest areas in the United Kingdom. It is not surprising, therefore, that our hospitals are old and have not been renewed.
If a State service means anything, it must mean fairness as between one region and another. It is obvious that extra capital is needed in the West Country to cope with the backlog of building. The need has never been recognised. It should have been recognised.
Then there are other special factors. There is the influx of population, and population drift. I regret to say that we have a higher than average number of people who are aged or who are mentally handicapped. This gives rise to great strains. For example, the ration of beds per 1,000 of the population for the mentally handicapped is 44 per cent. As the Minister will know, that is above the national average. Thus the South-West spends £2 million per annum more than the national average on mental handicap hospitals. The more that is spent on special needs, the less there will be for normal requirements. So our already unreasonable situation is exacerbated in the way that I have described.
Nor, as a matter of fact—not a matter of opinion—is there any scope in the community services to relieve pressure on the hospital services. The regional health authority has been responsible for the hospital services since April 1974 and in our area has had made a very good inquiry. It is plain that what I say is so, at any rate at present funding levels. We find that there is an above-average use of GP beds. There is a long waiting list for surgery.
I quoted the figures for Taunton in the debate to which I have referred. I shall not rehearse the figures. But I repeat what I said then: the degree of human misery involved in waiting for surgery of various sorts is difficult to bear—one, two, four or six years, or longer. The personal hardship that people suffer and the hopelessness that they feel as a result is one of the saddest things that one experiences in one's ordinary Saturday morning routine surgeries. I am afraid that the truth is that there are whole classes of people who will never get treatment in their lifetime—the over60s, for example, 137 who require non-urgent surgery. In most of those cases, that surgery will never be done.
The need, therefore, is evident. We are supposed to supply a service in our part of the world equal to the national requirement, and we cannot provide it. Rather than pursuing this matter further, I merely say that the West Country has special disabilities and needs special help to overcome them. If the Government will not supply the means to enable us to fulfil our responsibility, they ought to say so and come clean, and we ought to he quite clear where we stand. I am not making a partisan point. I would say this, as I have said it in the past, to any Minister. We want to know where we stand.
In this context it is astonishing that the allocations of taxpayers' funds for running the hospital services in the South-West are below the national average—believe it or not. In respect of revenue, it has now been established that there is a shortfall of £4.5 million, or some 4 per cent. in the current year—a formidable amount in this time of financial stringency. These are no fanciful calculations of mine. The calculation made is based on the Crossman formula and is acknowledged by the Department of Health and Social Security to be substantially correct. Indeed, the Department has undertaken to put the matter in order—not at once, as might be thought to be appropriate when we found out that we were not getting our proper desserts, but through an equalisation factor included annually in the revenue development allocation. On the assumption that the application of this formula will correct the situation by 1980–81, the region will have lost no less than £21.7 million by that time. I repeat that this is no fanciful calculation. These are not my figures. They are figures which are agreed between the region and the Department.
We have, therefore, special needs, and we have particular requirements. We are not even getting a fair crack of the whip. As my hon. Friends will immediately recognise, £21.7 million is more than enough money to build a new hospital at Weston-super-Mare and at Taunton, and to leave money over for everything that Bridgwater needs, and Wells, too, and Wellington, Minehead and all the other 138 places about which we are concerned. The situation is simply intolerable.
The next matter I put to the Minister is the suggestion that this money should be paid not over the years, in the way proposed, but as a single amount and without delay. It is harder to provide accurate bases of comparison for capital allocation, but this also requires inquiry. I hope that the Minister will look into the matter. The substantial shortfall in revenue is certainly reason for complaint. If there is a shortfall in capital, that complaint will become very fierce indeed.
Leaving aside that matter—which is not proved; I do not know the situation, although I do know it in relation to revenue—another point requires consideration. There is a close link between revenue and capital in these matters, obviously. The South Western Regional Health Authority was promised finance by Ministers some time ago. That undertaking has been temporarily cancelled by the pressure. That simply will not do. I ask the Minister to restore the position to the status quo ante. On a point of detail, which was also mentioned by my hon. Friend the Member for Weston-super-Mare, I thought that the Minister of State made a very good point when he suggested that properties should be sold. We all support it. However, it is extremely important also that regional health authorities should be able to allocate the receipts to local projects, because such sales would be much better received if matters were dealt with in the way that I have described. That is a small point, apparently, but it would be very helpful.
I hope that I have said enough to indicate the concern of us all. The services of the health service are less good in this country today than services are in some other countries. They are declining in competence. That is a great pity. It is obvious that nuance is inadequate. Inside this scene, in the West Country we have special problems. I believe that we are entitled to special allocations and special treatment. We do not ask for anything more than our proper share. I say that we are not getting it. I hope that the Minister will consider with care what has been said and ensure that both the hospitals in Weston-super-Mare and Taunton can be begun without further procrastination and delay.
§ Mr. Deputy Speaker (Mr. George Thomas)
Order. May I remind the House that there are 45 subjects down for debate. If each subject takes one hour we shall be here until Wednesday. I appeal to hon. Members to be brief.
§ 8.30 p.m.
§ Mr. Robert Boscawen (Wells)
I shall be brief after that brilliant advocacy of the vitally necessary improvements to the hospitals of Somerset, particularly in Taunton and Weston-super-Mare. My constituency is in the catchment area of both hospitals. For far too long we have had to put up with an inadequate, worn-out, old-fashioned, small district hospitals. The last Government promised that there would be some hope from the new community hospital in Wells. However, that has rapidly been receding.
We are now pinning our hopes on something being done as quickly as possible in either Weston-super-Mare or Taunton. I am not asking for a vast increase in Government expenditure on out county additional to the amount which is being spent in the rest of the country. We need to be allocated more of the money which has gone to other parts.
We are badly treated. We started a long way behind, as in so many other things. We are far behind in the provision of primary schools in Somerset. We suffer greatly through being left out in the cold over health service facilities and hospital provision generally. It is often said that we have the finest health service in the world. That may once have been true. I am sad to say that it appears that we can no longer afford to run the health service at anything like the standard at which it should be run.
No doubt we should be thinking seriously of how to bring more of the nation's resources to bear on paying for a better health service. In the meantime, I am strongly advocating that in the West Country with our particular problems of increased populations at certain times of the year we should have a better share of resources than we have had. I fully support the arguments that have already been advanced.
§ 8.32 p.m.
§ Mr. Tom King (Bridgwater)
I am pleased to support my right hon. Friend the Member for Taunton (Mr. du Cann) 140 and my hon. Friend the Member for Weston-super-Mare (Mr. Wiggin). My right hon. Friend and I are old partners in this. I have been proud to support him on previous occasions because my constituents in the main go to the hospital in Taunton. Obviously, I have a direct interest in the quality of services provided there. I have not previously supported my hon. Friend, but another part of my constituency looks to Weston-super-Mare for the more complex and critical of the services provided by the health service.
I am, perhaps, the only Member entitled to speak to the full motion in that I have constituents who are affected by the state of both hospitals. I do not there-for approach this in a competitive spirit. I hope that the Minister will appreciate that recognition of the case for the district general hospitals should not in any way undermine the good case for the local community hospital. There were proposals that the hospitals at Bridgwater, Mine-head and Burnham should be closed. These provide useful services.
My hon. Friend the Member for Weston-super-Mare has referred to the staffing problems and to the amount of voluntary help. The work of the League of Friends in Bridgwater, Burnham and Minehead is excellent. For all the reasons of modern medicine, facilities need to be grouped together on one major site. Part-time nurses and help for other facilities can be obtained from within a community which is willing to support a local activity. It is recognised that modern medicine and the complex facilities required dictate that first-class district general hospital facilities should be available to my constituents and to those of my right hon. and hon. Friends.
This area of Somerset, sadly, does that very badly. Last November, my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) the then Secretary of State answered an Adjournment debate on this subject. That was a measure of the importance attached to this issue because it is the only occasion that I can remember when an Adjournment debate has been answered by a Secretary of State. That was a recognition of the seriousness of the situation. The Minister is now following in that tradition.
My right hon. Friend has said that we do not make this appeal in any party 141 political sense. We were pressing for information from the Ministers in our party just as we press the Minister now. There are obviously difficulties in the capital spending programme and the substantial capital cost involved. But there must be an end to the situation in which neither the people in our constituencies nor the staff of the hospitals know what their future is. We want the facts. In certain respects, they might not turn out to be all that we hoped to hear. But we must know the situation so that people realise where they stand.
§ 8.35 p.m.
§ Mr. John Cope (Gloucestershire, South)
I am grateful for the opportunity to speak in support of my right hon. and hon. Friends. They are right to draw attention to their local problems, but I look at the matter as Member for another area within the South Western Regional Hospital Board. I am a new Member and I do not have the experience of this problem which my right hon. and hon. Friends have. However, the question of hospitals and National Health Service provision in the South-West has struck me forcibly, both as parliamentary candidate and as Member, as being one of the respects in which the South-West suffers from the formulae being applied by central Government.
I find it difficult to believe, but I am told that the formula on which spending, both revenue and capital, on the health service is worked out is as follows: half of the population in the region, a quarter of the cases treated and a quarter of the occupied beds. I do not understand how the beds can be occupied if they do not exist. It is a very peculiar calculation to adopt. If that is the formula, it is extremely crude It takes no account of the age of the buildings. My right hon. Friend the Member for Taunton (Mr. du Cann) drew attention to the age of some of the buildings in the South-West. One in four of the hospitals in the South Western Regional Hospital Board area were built before Florence Nightingale went to Scutari. That is a striking state of affairs.
The formula also takes no account of the suitability of the buildings. At a major hospital in my constituency, the Frenchay Hospital, there are still many hilts left over from the war. The formula takes no account of the summer influx 142 of visitors who come to the South-West, its sunshine and holiday beaches to improve their health. Sometimes it does not work out in that way and they may end up in our hospitals. We are therefore performing a service to people from other regions of the country. The formula also takes no account of old people.
My right hon. Friend the Member for Taunton spoke of the deficiency of £4½ million on revenue spending in the South-West as having been agreed with the Department of Health and Social Security. I too inquired into the capital spending deficiency. I was led to believe that it was currently between £3 million and £7 million. That is a very large bracket. A figure of £7 million is more than twice £3 million. I am not surprised therefore that my right hon. Friend was hesitant about using an estimate, but that is the estimate I have heard, and I should be grateful if the Minister would confirm or deny it.
The South-West region is a very large area. It has special National Health Service problems, particularly in hospital building, yet it seems to be at the back of the queue. We in the South-West region will continue to press until we get a bit further up the queue.
§ 8.40 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)
I congratulate the hon. Member for Weston-super-Mare (Mr. Wiggin) on winning pride of place in what threatens to be a dauntingly long series of debates. The House will have much appreciated the wholly reasonable tone in which he and his right hon. and hon. Friends have advanced their case. I shall do my best to answer as many as possible of the many questions that have been raised.
I should like to state at the outset that the need for new district general hospitals at both Weston-super-Mare and Taunton is not in dispute. My Department has for many years accepted in principle the need for both these projects. The former South Western Regional Hospital Board had given a high priority to the needs of these two areas in its capital programme, and the newly-formed South Western Regional Health Authority has recently confirmed the high priority it attributes to these two hospitals. The need for the new hospitals is not in dispute.
143 Hon. Members will know that the Hospital Plan published in 1962 and revised in 1966 provided the foundation for the planning of new hospitals throughout the country. It envisages a network of district general hospitals with sophisticated facilities in the principal towns, supported by smaller hospitals. In particular it included proposals for new hospitals at Weston-super-Mare and Taunton.
The new regional health authorities have responsibility for the planning of hospital and other health services within the capital allocations made available to them by the Department. The South Western Regional Health Authority is responsible for the health needs of a population of over 3 million, which is greatly increased during the summer months by the influx of holiday visitors, not least from my constituency.
When the South Western Regional Health Authority took on these responsibilities in April of this year it inherited some relatively new hospital provision, such as that at Truro in Cornwall, Yeovil in Somerset and the recently commissioned Wonford district general hospital at Exeter. But it also inherited a considerable ongoing capital commitment associated with the recent commencement of work on new hospitals at Derriford, Plymouth and Barnstaple. Lastly, there are of course a number of small and medium-size hospitals in the South Western Region which have provided excellent services in the past but which in the context of present-day needs are now out of date.
The right hon. Member for Taunton (Mr. du Cann) and his hon. Friends have drawn to our attention the age of many hospitals in their areas. The need for new hospitals at Weston-super-Mare and Taunton is not in dispute. The timing of these developments has to be considered against the background of the health needs of the South-Western Region and, of course, in the context of the present difficult economic situation.
Before turning to the financial background against which the regional health authority has to operate, I should like to take this opportunity to pay a warm tribute to the devoted service being given by the staff of the existing hospitals at 144 Weston-super-Mare and Taunton and, indeed, elsewhere in the region. Ministers are fully aware of the current problems facing the National Health Service, not least the morale of the staff employed in the service. Throughout these difficulties doctors and nurses as well as paramedical and ancillary staff in Weston-super-Mare and Taunton, as in countless hospitals elsewhere, continue to provide a high standard of treatment and care in the face of difficulties from the use of old and inadequate accommodation.
Both the hon. Member for Weston-super-Mare and his right hon. Friend the Member for Taunton have mentioned the numbers of people on the waiting list for admission to hospitals in their areas. The figures they quoted are correct. This too is a problem which exists elsewhere in the country. The major problem with waiting lists is not so much the number of patients on them but the length of time that many with less urgent conditions have to wait before being admitted. My Department is discussing with the Joint Consultants Committee the possibility of issuing general guidance to the new health authorities and it is hoped that this will help towards reducing waiting time.
We must recognise that public expenditure on health and personal social services is unlikely, at least in the immediate future, to increase at the rate many of us had hoped. Indeed, following the drastic 20 per cent. cut imposed by the previous Government last December, the amount available for health capital will be significantly less than in recent years. There is no doubt that the gravity of the economic situation overall means that some reduction in the capital programme will continue for some years.
Another problem is resource allocation. Before this year capital has largely been distributed in relation to future population forecasts. Capital expenditure per head of population in the South-Western Region over the period 1962–63 to 1972–73 has at current prices been about £40, which was the national average. On this basis the region has had a fair share. For 1974–75 a special procedure had to be adopted for allocations and the South-Western Regional Health Authority's main capital programme allocation at nearly £3.35 per head of population was slightly over the national average owing 145 to the above-average existing commitment in the region.
With the aim of finding a better way of spending our money, we are considering the extent to which present methods of allocating resources to regions can be adjusted to make them more responsive to the needs of different parts of the country, particularly areas of health deprivation. It is not easy either to find the right criteria or to effect the necessary changes in the balance of services as quickly as we should like; but hon. Members may be assured that we shall be seeking every possible means of accelerating progress.
I shall now deal in more detail with the need for new hospitals at Weston-super-Mare and Taunton. Weston-superMare has at present some 300 hospital beds in five old hospitals and there has for some years been strong pressure for a new district general hospital. The need for a district general hospital at Weston-super-Mare is accepted both by my Department and the regional health authority. The first phase of the development is planned to provide a total of 401 beds. These are to include 225 acute, 56 maternity, 50 mental illness and 40 geriatric assessment beds. The 1981 population of the area has been estimated at 110,000. It is thought, however, that the potential population growth may increase this to 150,000 or 200,000. The selected site provides approximately 30 acres for building. The building and engineering cost is estimated at £8 million—at 1974 prices—and the scheme is now ready to go out to tender. The work is expected to take three and a half to four years. A further phase of development, at present not programmed, will be needed to complete the hospital.
I recognise the efforts made by the hon. Member for Weston-super-Mare over the years to secure a new hospital for the Weston-super-Mare area. In 1969 he brought a deputation to the then Minister of State to present a petition, containing 14,000 signatures, for the early provision of a new hospital. On 29th January 1971, at 4.57 a.m., he opened an Adjournment debate on the local hospital facilities and pressed for a starting date for the new hospital. He has since discussed the matter on several occasions with Ministers and he has pursued it in correspondence. Throughout, his anxiety has 146 concerned the place of the Weston development in the region's capital programme relative to other major developments. I have noted that the hon. Gentleman will be presenting an even larger petition of some 45,000 signatures tomorrow. This of course will be considered carefully by my right hon. Friend and my other ministerial colleagues.
The position briefly is that while the South Western Regional Hospital Board was able to let contracts for the Barnstaple and Derriford schemes in 1973–74, it was not possible to make a start on the Weston-super-Mare project, the third very large development planned for that year. The former regional hospital board has consistently stated that the Weston-super-Mare District General Hospital was the next priority, and this has already been accepted by Ministers as was made clear in the Adjournment debate on the proposed Taunton District General Hospital on 18th October, 1973.
The regional capital allocations for 1974–75 were established earlier this year following discussion with regional officers. At that time it was envisaged that the capital allocation to the South-Western Region, although relatively large, would not enable the regional health authority to make a start on a new district general hospital at Weston-super-Mare in the current financial year. This was recently confirmed at the last meeting of the regional health authority on 8th July when it was agreed that there seemed no prospect of providing money for a start on the district general hospital in 1974–75. The regional health authority reaffirmed the high priority it attached to this project, and the regional administrator has recently, on 25th July, written to the Department asking for additional funds to make a start this year. Additional capital funds for 1974–75 are not currently available, and in any event adequate finance will be needed for the three to four years that the building of a new hospital at Weston-super-Mare will take.
The hon. Member for Weston-super-Mare has previously asked about the financial prospect of selling land or buildings to increase the region's capital allocation. He raised the matter again this evening. The regional hospital board has reported to the Department the likelihood of land sales of the order of £1 million to £2 million in 1974–75. The intention 147 has been, under new arrangements for hospital land transactions which came into operation in April 1974, to grant regions a supplement to their normal capital allocations over a period of years for the receipt of land sales. While the details of these new arrangements have yet to be worked out, the South Western Regional Health Authority has now advised the Department that in any event a recent examination of potential land sales indicates that it is unlikely that these would yield sufficient funds to enable an immediate start on the Weston-super-Mare project and such money as is obtained will probably be taken up with the acquisition of sites for large developments and expenditure on smaller schemes.
The hon. Member also asked me about fixed-price tenders. In fact, for contracts in excess of two years, as in the case of Weston-super-Mare, the fluctuation clause would be allowed—that is a clause which will take account of increases in the prices of materials and of labour.
The right hon. Member for Taunton mentioned the shortfall of revenue to the South-Western Region. We do not accept the health authority's figures. Officials are meeting officers of the authority shortly to discuss this important matter. In any event, as the right hon. Gentleman accepts, this is revenue and not capital and, therefore, does not affect directly the region's capital programmes.
In summary, the need for a new hospital at Weston-super-Mare is accepted and planning for the hospital is completed, but the South Western Regional Health Authority sees little prospect of a start in 1974–75 unless additional capital funds are made available and until more is known about the capital resources likely to be available in 1975–76 and succeeding years. Also, the funds needed for a new district general hospital at Weston-super-Mare must be considered in the context of the region's capital programme including, of course, the heavy continuing commitment on Barnstaple and Derriford.
I turn now to the need for a new hospital at Taunton. The right hon. Member for Taunton will recall that Cmnd 1604, "A Hospital Plan for England and Wales", published in 1962, indicated that the main hospital service for the West 148 Somerset area would be based on the redeveloped Taunton and Somerset Hospital on the existing site at Musgrove Park, Taunton, to which he referred. A start in the period 1966–67 to 1970–71 was then envisaged. Subsequent consideration by the regional hospital board suggested that the Musgrove Park site would not be suitable, and Command 3000, which revised the Hospital Plan and was published in 1966, reflected the later intention to develop a new district general hospital on a site at Lyngford on the north-east side of the town.
Over the past decade there has been considerable local pressure for the early provision of a new hospital for the Taunton area. The right hon. Gentleman has, of course, played a leading and most distinguished role. He has made numerous representations in correspondence, in meetings with Ministers and in Adjournment debates, particularly the celebrated Adjournment debate to which lie referred this evening. There was local concern at the decisions not to redevelop the Musgrove Park site, but in reply it was pointed out that the new site was in a better location for the catchment area as a whole and provided more space for future development.
The department has never disputed the need for a new district general hospital for the Taunton area. This was stated by the then Secretary of State for Social Services, the right hon. Member for Leeds, North-East (Sir K. Joseph), and I repeat his message tonight. However, for financial reasons and in the light of developments elsewhere in the region which, in the board's view, had a greater priority—for example, major developments at Barnstaple, Derriford and Weston-super-Mare—a start on the Taunton project has not so far been practicable.
In the meantime, to maintain services and provide improvements, capital works costing over £1 million have been or are being carried out at the existing hospitals in Taunton—notably renewal of the engineering services and improvements to theatres at the East Reach branch of the Taunton and Somerset Hospital and improvements to theatres and X-ray facilities at Musgrove Park.
In August 1972, following examination of the board's initial submission, the Department approved the proposals for the functional content of a new district 149 general hospital to be provided in phases. This has been preceded by acceptance in principle of the board's recommendation that in preference to the Lyngford site, which it considered costly to develop, a site known as Nerrels Farm, adjacent to the Lyngford site, should be acquired.
Under the building procedures the next stage called for a submission by the board on matters such as the general shape of the proposed building and the phases by which it would be provided. At the board's request a meeting was held in March 1973 to discuss the difficulties of the very large first phase of building which the board had under consideration and the effect that these difficulties would have on the board's capital building programme.
It was then agreed that the board should review the phasing proposals and other aspects of its plan with a view to reducing the overall size of the district general hospital and in particular the size of the first phase. The planning submission subsequently received proposes that the original large first phase of 676 beds plus supporting departments and services should be subphased, and the new immediate scheme—phase 1A—should provide 344 beds plus outpatient department, accident and emergency department, operating theatres, X-ray and other support departments.
At a current cost of £10 million for building and engineering works this, however, still represents considerable capital investment, and it is questionable whether, with the addition of the cost of the new site and of fees and equipment, perhaps reaching a total approaching £15 million, it should and could be applied to one site in the region.
Factors to be taken into consideration include the uncertainty about the capital resources likely to be available during the period in question, 1976–77 to 1982–83; current capital commitments arising from starts on major developments at Barnstable and Plymouth which will not be completed for several years; the need for capital for other schemes, including Weston District General Hospital which takes precedence over Taunton and is ready to start as soon as capital is available; the latest time which would elapse before any benefit would be available to patients at Taunton; and the fact that 150 contracts of more than four years' duration tend to present management difficulties in the execution of the work and to involve large claims.
The Department accepts the need for a new district general hospital in Taunton. Detailed discussions with officers of the regional health authority are continuing on the building proposals put forward by the former regional hospital board. These include discussion of the apparently high acute bed rates used, aspects of the proposed geriatric and psychiatric provision such as the distribution between the district general hospital and other hospitals and the priority to be given to these provisions, and the need for laundry provisions to be sited at the district general hospital.
Meanwhile the South Western Regional Health Authority is reviewing the factors which I have already mentioned and it will then consider, in the light of future capital resources, when these are known, the future development of hospital services at Taunton. A number of options could be considered including a smaller initial scheme on the previously proposed site at Lyngford or further examination of the earlier proposal to develop the existing, perhaps enlarged, site at Musgrove Park.
I hope that the explanation I have given will clarify the current situation about hospital provision in the constituencies of right hon. and hon. Members. I repeat that there is no argument whatever in principle and that the problem is one of priorities. The Government must and do accept responsibility for the amount of resources made available to National Health Service. In the present economic circumstances this must unfortunately be less than we would wish. However, the amounts allocated to the South Western Regional Health Authority are equitable bearing in mind the needs of other parts of the country.
It is the onerous and unenviable task of the South Western Regional Health Authority to use to the best of its ability the funds we have allocated. Ministers must not usurp this responsibility. To do so would run counter to our policy of giving the new health authorities the maximum autonomy consistent with national policies.
151 The hon. Member for Weston-super-Mare and his right hon. Friend kindly referred to my personal concern with the problems of the disabled and the elderly. I shall of course ensure that my ministerial colleague with special responsibility for health is fully aware of the many points which have been raised this evening. I shall also convey to my right hon. Friend the Secretary of State the hon. Member's suggestion that she should visit Weston-super-Mare. I know that the right hon. Gentleman also suggested a visit to Taunton and I recall that when his right hon. Friend the then Secretary of State visted Taunton last year he conceded that he was the biggest slum landlord in the country.
Right hon. and hon. Members may rest assured that full consideration will be given to all that has been said in the debate on this matter. I am grateful to those who have spoken for having raised this extremely important issue.