§ 4.4 p.m.
§ Mr. Ivor Stanbrook (Orpington)
During the first world war, the Canadian Army constructed a temporary military hospital at Orpington. It consisted of a number of asbestos-clad huts and it did duty for thousands of Canadian wounded and disabled soldiers until after the war, when it was handed over to the British authorities. Since then, it has served the local community, providing some 512 beds in 23 wards spread over a 39½-acre site.
The extraordinary feature of Orpington Hospital is that it is still in its original buildings, the aged single-storey structures more than 60 years old. Still more extraordinary is the high standard of its nursing staff, thanks largely, in recent years, to an outstanding matron, Miss Handcock, and the skill of its medical staff. The very antiquity of the buildings is one of the secrets of its success. This has been a factor in establishing a high degree of staff morale and a singular co-operation between staff, patients and local citizens.
The reputations of hospitals, like those of schools, are not dependent on modern buildings, but there comes a time when the state of the fabric makes further economic use impossible. Orpington 949 Hospital's physical condition is now such that in parts only the paint and patching and the will-power of the staff over 60 years have kept it together. At various times in the past people have said, "It cannot last another year."
The rebuilding of the hospital has therefore naturally been under consideration for many years. My predecessors and I have persistently coaxed, urged and lobbied Ministers about it. A petition signed by over 20,000 local citizens was delivered to the Department of Health and Social Security in 1972. Several public meetings have been held in Orpington, attended by enthusiastic audiences, calling for the early rebuilding of the hospital. A remarkable and almost unique body—the Orpington Nurses and Citizens Association—has been actively promoting this cause.
All these measures of pressure and protest culminated in December 1970 when the regional hospital board gave an assurance that it has no intention of closing the hospital. However, its plans for a future hospital in the area were somewhat vague.
On 24th February 1971, in a letter from my hon. Friend the Member for Barkston Ash (Mr. Alison), the then Under-Secretary of State, I was informed:The South-East Metropolitan Regional Hospital Board, who are primarily responsible for hospital planning in the area, consider that a new hospital will be needed in the Orpington area, but no date can be given for the start of this development because of the priority that has to be given to more urgent hospital needs elsewhere in their region. As you may know, the Board are already developing new hospitals at Bromley and Sidcup and later on they hope to make some improvements to the existing facilities at Orpington hospital.The siting of a new hospital in the Orpington area has not yet been decided and will be the subject of discussions between the Board and the Department.Therefore, ONCA and I naturally pressed harder. To site the new hospital anywhere but in Orpington would be unthinkable. We had a 39-acre site with ample room for expansion, easily reached by public transport, near Orpington railway station and not far from Biggin Hill Airport.
The other hospital in my constituency—Farnborough—is excellent, but it 950 serves a quite different area and is on a smaller and more congested site, with permanent buildings.
The result of further pressure was a decision by the South-East Metropolitan Regional Hospital Board, announced on 28th July 1971 in a statement in which it said:The Board…intends to provide in the long term a new district general hospital on the existing hospital site at Orpington. This proposal will require the approval of the Department of Health and Social Security and, in the light of the claims of other areas in the region for which the Board is responsible and the capital allocation at present available to the Board, it seems unlikely that a new hospital can be provided at Orpington for many years. It will be generally known that major hospital developments are currently being undertaken at Bromley and at Sidcup.The Board is planning to undertake some upgrading of the existing facilities at Orpington Hospital with a high priority for staff accommodation on which it is hoped to make a start within the next 12 months.That was fine so far as it went, and, satisfied that the site would be used, we concentrated on pressing for funds to be made available and plans of the new hospital announced.
A further letter from my hon. Friend the then Under-Secretary of State, on 18th December 1972, gave the position in the light of the pending reorganisation of the National Health Service. He said:In April 1974 we plan to introduce the new authorities, Regional Health Authorities, whose responsibilities will be wider than any of the present RHBs. Regional health authorities will take over the responsibilities of Regional Hospital Boards for planning hospital services. In theory the new authorities will not be bound by the decisions of their predecessors. But they will naturally not expect to see many changes of plan for major schemes to which there was already some commitment.As far as the district general hospital development for Orpington is concerned, I am afraid I cannot really add much to the letter I sent you on 24th February last year except to say that the RHB's present plans envisage the new hospital being developed on the site of the existing hospital. The board have not yet been able to put a starting date on the redevelopment since there are so many other claims on limited capital resources.Meanwhile there had been some development on the site. In 1972, three blocks of staff residences in permanent materials were built by the regional hospital board. There were other major improvements in the period after 1965, 951 such as the cytology unit, the hydrotherapy pool and an intensive care therapy unit, all of which had been provided out of funds raised by local citizens and, notably, by the hospital's own Society of Friends.
In view of what I have already said about this hospital, the House will not be surprised to learn that this society is one of the most successful in the country. Indeed, no hospital could have a greater or more generous band of volunteer kern who not only care for the patients and their visitors and help to transport out-patients, but who have in the last decade provided more than £70,000 for urgently needed features and equipment. During the last 10 years most of the contributions provided. out of public funds were not for improvements but, rather, for the replacement of outworn and outdated equipment at the hospital.
When the new Government had taken office I asked for a statement on this problem. The reply given to me by the Under-Secretary of State caused me and those associated with the hospital a great deal of concern, because he told me, in a Written Answer:The present financial climate of restraint in public expenditure affects the capital allocations which the Government can make available to the South-East Regional Health Authority for health building work, and it is not possible to say when approval might be given to the development of a district general hospital in the Bromley Health Area, which includes Ornington."—[OFFICAL REPORT, 7th May 1974; Vol. 873, c. 83.]The Under-Secretary of State went on to list some of the so-called improvements at the hospital which, as I have said, were financed privately but were not improvements. They were replacements. It was the last sentence which I have quoted which troubled us most. Is it the case that, despite the assurance of the previous Conservative Government, the regional health authority does not accept that the new hospital. whenever built, will be on the site of the existing hospital?
I queried this with the Minister, and he kindly wrote to me on 11th June as follows:I do not dissent from what you say about the former South-East Metropolitan Regional Hospital Board, but I hope you will not mind my reminding you that its successor, the South East Thames Regional Health Authority has 952 wide responsibilities for comprehensive health care which the board did not have. Not only that, but the Bromley Area Health Authority and the Bromley Community Health Council are both in being. It is the AHA which has primary responsibility for health care planning within its area, in consultation with the CHC, while the latter's degree of involvement will be increased with the adoption of the Secretary of State's recently announced proposals 'Democracy in the National Health Service'. As you are no doubt aware, these proposals are intended to secure greater local participation in the running of the reorganised National Health Service. It seems to us that the existing system is out of tune with the needs of local committees, and one of the issues in which we believe the Community Health Councils should be closely involved is the development of health services in their own communities. Clearly, the new Authorities should be allowed to look afresh at the question of providing a district general hospital within the Area. Indeed such a review is already in progress, but it would be wrong of me to commit the Authorities to any particular outcome in advance, in the way you suggest.So I have to ask the Minister: do we have to start this process all over again? Must we start petitions, deputations and lobbies and waste still more time on discussing this urgent problem, the principle of which has already been conceded? Does the formation of a new health authority mean that everything has been put hack to square one?
The regional health authority includes halt the members of its predecessor, the regional hospital board, including its chairman. Are they so unlikely to agree to a commitment by the board? Since it takes five to 10 years to finalise hospital building programmes even after plans have been approved, must we delay this project unnecessarily?
Everyone accepts that funds are not immediately available, but why is there delay in confirming the decision of the board? Why has the community health council not been consulted about this even now? Is this the new democracy of the National Health Service which the hon. Gentleman speaks? I understand that the construction of the new block of staff residences has been deferred. Is this the prelude to the cancellation of the whole project? Is there any truth in the ugly rumour that the site—nearly 40 acres of prime building land in an outer London borough—is wanted by the Government and the Greater London Council for housing? I hope that the Minister will scotch that one today.
953 I hope that the Minister will confirm that all the sweat, toil and tears which have been poured out on producing the decision to rebuild the hospital on its existing site will not have been in vain.
§ 4.17 p.m.
§ The Under-Secretary of State for Health, Department of Health and Social Security (Dr. David Owen)
The hon. Member for Orpington (Mr. Stanbrook) has made a case for a new hospital being built at Orpington. The present Orpington Hospital is clearly unsatisfactory and no one would deny that it needs rebuilding. Much of it, as he said, was erected during the 1914–18 war. The hon. Member has paid tribute to the skilled and devoted care given by staff in those buildings and I would certainly like to associate myself with those tributes. It has always amazed me, and it is a great credit to the staff, how they do not allow the quality of care to suffer, despite often working in old buildings which make care difficult.
For many years, it was envisaged that Orpington Hospital would eventually close, following developments at Sidcup, Bromley and Sevenoaks. But in 1971 the South-East Metropolitan Regional Hospital Board announced that, in view of the growth of population and other factors, the hospital would stay open and ultimately be rebuilt. Substantial interim improvements have been carried out at the hospital since 1965. I pay tribute, as did the hon. Gentleman, to the fact that some of these have been financed by voluntary efforts. It is good that people feel sufficiently concerned about their local hospital to raise funds and to add to its facilities.
A new pathology laboratory, a geriatric day hospital and three blocks of staff residences have already been built. The gas mains and hospital incinerator have been replaced and additional sanitary annexes provided for two wards. Replacement of a substandard operating theatre is in progress, as is the replacement of the hospital boiler and the electrical wiring. A temporary extension of the out-patient department has just been completed and provision of a hydrotherapy pool is under way. It is also planned, when the financial climate permits, to replace the hospital pharmacy. to build a further block of nursing staff 954 accommodation and to make improvements to the X-ray department.
As the hon. Gentleman acknowledged, the health authorities responsible for the Orpington area since 1st April are the Bromley Area Health Authority and the South-East Thames Regional Health Authority. The hon. Gentleman asks whether everything has to go back to square one. I do not think so. As he says, many of the members of these bodies and the officials are the same people, and there is a considerable amount of continuity in planning and information. In addition, there is the Bromley Community Health Council. Its members will be reviewing the question of health service in the area and will consider the whole future of Orpington hospital.
But I think that the hon. Gentleman had read into the letters and Questions many things which are not eligible to be read into them. Firstly, the letter from my predecessor dated 18th December 1972 to the hon. Gentleman makes it quite clear that, though the regional health authorities will take over the responsibilities of regional hospital boards for planning, in theory the new authorities will not be bound by the decisions of their predecessors. That is exactly what he said. They will naturally not expect to see many changes of plan to major schemes to which there was already some commitment.
I re-echo those words. There is no difference between the two Governments over this matter. It is a simple fact of life that I cannot tell the new regional health authority—if we believe in any form of devolution of authority at all—what are to be its priorities. But, given reasonable men, having looked at priorities across much the same area, there is no reason to expect that they will dramatically change those priorities.
As for the hon. Gentleman's suggestions about land, again it is not for us to intervene. If the regional health authority decides that this is its priority and that it wishes to build Orpington hospital on its present site, it is absolutely up to the authority, which must decide what is the first priority within its area.
In the past Orpington hospital has not been the first priority in the area of the old regional hospital board. As the hon. Gentleman conceded, other building projects are taking place fairly close by.
955 Concerning lobbying and raising great petitions, I do not hide from the hon. Gentleman that these are not the key factors in deciding where a hospital is built. They could never be key factors. I do not dissent from the rights of anyone to lobby or to draw up petitions, but essentially there is no point in coming to me first. Their first port of call should be the area health authority and, from there, to the regional health authority. The main task of the citizens of Orpington is to convince the RHA—as, indeed, in the past it was to convince the regional hospital board—not just of the need to build on the present site, which would not necessarily be very difficult, but also that this is a matter of the highest priority, and, if necessary, number one on the list of priorities.
§ Mr. Stanbrook
If that is so, what is the reason for the delay in agreeing to the principle of the re-erection of a hospital on the existing site? That is not a question of priorities.
§ Dr. Owen
As I have said, this is not a decision for me to make. If the hon. Gentleman wishes to raise the issue with the chairman of the regional health authority, he should do so by all means. I gather that it is the same person who was previously chairman. It is for the authority to decide. But, after all, the authority took office only on 1st April, and perhaps it does not wish to make that commitment at present. But the absence of the commitment does not mean that it has changed its mind. There is, perhaps, a tendency to be too worried about that particular aspect. What is possibly behind it is a fear, "Because it may not be or is thought not to be the top priority, what will be the effects of the expenditure cuts on Orpington hospital?" Again, in the first instance this is a case for the regional health authority, to assign the priorities.
What is the rôle of central Government in these issues? The rôle of central Government is to allocate funds by need across the country. It is the rôle of the regional health authority to determine the priority of any particular hospital building project within its area. One of the gravest weaknesses of the National Health Service since 1948 is that because of the way in which we have allocated regional funds to the 14 authorities that we have 956 now, which were previously boards, the funds were allocated on the basis of population and, more recently, weighted population. That has meant, broadly speaking—it is not completely true—that we have been dividing the cake into 14 different segments and have not taken account of the investment of the past.
Sir George Godber, in his valedictory report in 1973 as Chief Medical Officer of Health in the Department, said:…there is great unevenness in the distribution of the funds we have in proportion to population in Great Britain and within England. Some areas started with greater resources of people and of things and a higher level of finance than others. The South-East of England has substantial advantages over the North-East or the Midlands and Scotland has substantial advantages over England as a whole in manpower and money. At the end of 25 years these differences, particularly in the distribution of medical manpower, still exist.I believe that one of the central problems for national Government, particularly for this Government, even though we face difficulties in public expenditure, is to redress what I believe to be considerable inequalities of health provision in the National Health Service.
In a recent article in The Lancet, Professor Peter Townsend drew attention to this and said:A deeper analysis of the persistence and even the widening of inequality may he required.I openly concede, looking back over the past 25 years, that there is in some areas evidence of an actual widening of inequalities in health provision inside the National Health Service.
The Government's task is as quickly as we can to develop sophisticated objective criteria for allocating funds across the country on the basis of need and resources. This may well mean that the South-East Regional Health Authority will not get as much money as it has in in the past, or it may get more if it shows that in comparison with some of the other 14 regions it has relatively greater priority.
There is little doubt that in London, particularly in inner London, there have been very expensive capital programmes, with heavy investment in the centre on teaching hospitals. There is evidence that in the outskirts of London some areas have not received sufficient health care.
I urge on the hon. Gentleman and on the country that we cannot continue to 957 regard health care in the narrow context of hospitals. It is very easy in any area—my own city of Plymouth included—to focus all attention on the provision of a district general hospital, which then becomes the status symbol of health care. Although the district general hospital is an important aspect of health care, some experts are becoming increasingly sceptical about the size of these hospitals. There is an increasing tendency to question the need for such large district general hospitals.
We need to look at health care, not in the narrow context of hospitals—we hope to produce proposals on community health centres—but also in terms of health centre provision. Now that the area health authorities are responsible for health centres, increasing attention needs to be paid to them and also to the family doctor service.
I hope, too, that we shall look at hospital provision as only one aspect of our priorities. I am strongly of the belief that we have not given sufficient attention to primary health care. It is very easy to get a headline story about cardiology or renal dialysis, but the Press devote little attention to the severe problems of waiting lists for those suffering from inguinal hernia, and so on, and the problems of the deputising service in general practice when that falls down. We need to concentrate just as much on those aspects of care and not think always in terms of the intensive care unit or the district general hospital, important though they are.
We have not hidden from the House, and I will not hide from the country, the fact that, if we are to do what I think is now right and pay substantially more to those who have worked for years with a great sense of dedication in the National Health Service—nurses are the most obvious example; I am thinking also of the professions supplementary to medicine and other workers in the hospital and community health service—and to redress their grievances, we shall have to spend much more on manpower and woman power than we have before, and our revenue resources will be much more stretched than they are.
Something must give in this process. I have made no secret of the fact that buildings must give. I am not making a judgment today about Orpington hos 958 pital. It is not my prime rôle to make a judgment on Orpington hospital. That is for the regional health authority. If the regional health authority puts Orpington at the top of its list and, as a result of a capital allocation programme by central Government, that regional health authority has no money in any one year, the responsibility is laid fairly and squarely on the Government. If they decide as a matter of national priority that they would prefer to put their money into a depressed area in the North-East, that is a decision which I am only too happy to defend, if such a decision has to be made—or reversewise, that Orpington should be given greater priority over an area in the North-East. But it is not right for me to determine the priorities of the regional health authority in its own region.
If we are to devolve power out of this House—and that seems to be the broad general consensus, that we cannot accrete all this power into the centre—we must mean what we say and allow the areas to choose their priorities within the limits and overall guidelines which we decide. The fundamental responsibility of central Government is to allocate resources on the basis of need, and to see that in the next 25 years in the existence of the health service we redress the inequalities and restore a truly National Health Service. We may only get that degree of stringency when we face a very severe expenditure reduction.
People in the Press have said that we must be honest with the country. I am proud of the National Health Service. I do not deny that it needs more resources and that there is a difficult financial period which may continue for the next two or three years. But we cannot look at the NHS in isolation. The same can be said of education and of the social services. We have to confront people with the necessity to choose. We cannot in the present economic climate—nor, I think, could we in the last 20 years—escape the necessity to choose. We may well have to present to the country the cost of providing all the different things that everybody wants provided.
When we look at the history of the National Health Service and consider the fact that we take for granted various facilities in the regions and in our major cities which were totally absent at the 959 beginning of the health service, we realise that we have made considerable progress. But we have tended to neglect primary health care and have concentrated too much on a hospital-oriented health service. I admit that hospitals play a very important part. No one denies that—least of all myself, having spent a vast proportion of my clinical time in hospitals.
Equally well, the balance has inevitably been shifted too strongly on hospitals because public opinion has seen the hospital as the hallmark of the health service. It is the visible edifice for 200,000 people. We must concentrate on conditions in small local areas for 20,000 people. I hope that the community health councils 960 will see an important part of their rôle as checking that tendency, of promoting community health and seeing the service in the widest possible context, looking at the whole man and the whole family. In that context Orpington hospital's priority will have to be assessed in future years.
§ Mr. Stanbrook
I am obliged to the hon. Gentleman. Will he come to Orpington to see the hospital for himself?
§ Question put and agreed to.
§ Adjourned accordingly at twenty-seven minutes to Five o'clock.