HC Deb 15 November 1974 vol 881 cc851-64

4.0 p.m.

Mr. Nicholas Winterton (Macclesfield)

I am glad to have the opportunity to raise on the Adjournment the matter of the deferment of the new Macclesfield district general hospital, which is of considerable importance to my constituents and to many others outside my constituency.

I trust that I shall be in order if I make one brief quotation from the Cheshire Life magazine, which sums up the situation in East Cheshire. It reads: Tucked away in the far eastern corner of the county is one of the most attractive districts in Cheshire, known to those in the higher echelons of the National Health Services as the Macclesfield District of the Cheshire Area Health Authority. To look around busy, old world Macclesfield, expanding commuter Congleton, smart suburban Wilmslow, elegant Knutsford and the beautiful villages of Prestbury, Kerridge and Mobberley one wonders what their inhabitants have done to offend those who plan how the National Health Service money shall be spent. It is tempting to think that in such a prosperous and hard-working area where the living is good and where much tax is paid the citizens must enjoy first class hospital facilities. Sadly, this is not so, for the hospital buildings are not even of third class standard, and it is doubtful whether there can be any acute hospital in the country which is more hard-pressed than those in Macclesfield. I wish to draw attention to the serious deficiencies of physical resources in the health services in Macclesfield. There is always a danger in matters of this kind that what I say may be interpreted in some way as a reflection on the medical, nursing and other staff of the district. That is not my intention. Neither is it my intention to criticise individuals or individual bodies and authorities. The standard of medical and nursing services provided within the very limited resources is generally good in Macclesfield and reflects great credit on all the caring professions in the district.

I am referring to physical resources. The main acute hospital services for the district are provided in two Macclesfield hospitals. But perhaps the most pressing problems are associated with the unfortunate but forced divisions of these two units into medical at the West Park branch which was built in 1843 and surgical at the Infirmary branch which was built in 1868. This uneven and undesirable division in itself creates considerable difficulties of liaison, staffing and transport, which are greatly accentuated as neither unit is adequate in terms of the number of beds or supporting services.

According to the Minister's reply to a Question of mine on 20th May this year, the Macclesfield health district has 298 acute hospital beds, which I understand is nearly 100 short of the acute norm even for the present population. This takes no account of the increasing population, which has been one of the fastest growing in the county of Cheshire and which, according to the Cheshire Structure Plan, will continue to grow fairly steadily.

In addition the surgical waiting lists are increasing, not only because of the shortage of beds but because of the shortage of major operating theatres. There is really only one major effective operating theatre in the district, plus another which was upgraded about four years ago but which is still below modern standards. This means that the existing major theatre is over-used, which introduces an element of danger and risk to patients. So far this has been avoided by the dedication and care of the theatre staff.

The under-provision of theatres at the main hospital means that major surgery has to be undertaken at outlying units, which is not in accordance with the Department's stated policy. Because of the breakdown of the theatre at the West Park branch, it has not been possible to carry out surgery at this hospital for many months. The Mersey Regional Health Authority answered urgent appeals for assistance fairly promptly in this latter case, for which I and my constituents are grateful. I understand that it is hoped soon to provide one temporary replacement operating theatre on a rental basis. While this will at least permit some of the operations to continue, it will also mean a temporary loss of gynaecological beds to the district. Nevertheless this rented theatre will serve only as a temporary solution. It still leaves the district short of four or five major operating theatres, which is an unacceptable state of affairs.

Both the Macclesfield hospitals are well over 100 years old, and the major parts of all the hospitals in the Macclesfield district are over 80 years old. Perhaps it is only due to the fact that some of them are built of stone that they have not fallen down. All supporting medical and hotel services in the existing hospitals are well below standard.

I wish now to draw attention to what I consider to be the whole crux of the problem, namely the allocation of scarce resources and relative priorities. What is urgently required is the long-promised district general hospital, but the history of that hospital for Macclesfield makes very sad reading indeed. I shall not burden the Minister with details this afternoon, except to say that promise and procrastination have followed promise and procrastination year after year. Phase one, which should have been completed by 1975, is not yet even in the wind. In a document issued by the Ministry of Health in 1961 called "A Hospital Plan for England and Wales", it was stated that the first phase of the new general hospital for Macclesfield would commence in 1965–66.

Despite the delays, the fact remains that the then Manchester Regional Hospital Board, even within its limited capital resources per head of population, had decided with the full approval of the Department of Health and Social Security to give top priority to the Macclesfield district general hospital. A starting date of April 1976—that is to say, one and a half years from now—was quoted at the time of the National Health Service reorganisation. This top priority now appears to have been completely lost.

I ask the Minister and his right hon. Friend the Secretary of State for Social Services to look first at this complete distortion of established national priorities, which seems to have been brought about simply by an administrative change of boundaries—that is to say, on the transfer of the Macclesfield district from Manchester to the Mersey Regional Health Authority. How can this be justified in a National Health Service?

I appreciated the dilemma facing the Mersey Regional Health Authority. Its priorities were already established within a limited capital allocation, and the amount of manoeuvre left to it was obviously very limited. It therefore followed that unless the Department backed the already established national priorities by transferring financial allocation, its future allocation of finance for the Macclesfield hospital was very difficult. However, I strongly question the Mersey RHA's failure to continue the planning of a hospital which was already well advanced and the consequent loss of fees, which could mean that when the Mersey RHA's relative priorities for its new territory are established the Macclesfield hospital might not then be sufficiently far advanced in planning terms for a start to be made on site.

At a joint meeting in October 1973 between officers of the two regions and the Department, the problem of providing for the transfer of finance to maintain existing priorities was foreseen, but it is understood that no such financial adjustment was made. This seems the reason for Macclesfield hospital losing its top priority. Will the Department now remedy this situation, in accordance with the priorities established so many years ago? Lives are daily at risk, and naturally the local community is becoming increasingly concerned at the repeated postponments and the complete lack of any positive proof that Macclesfield will ever have its new hospital.

The news in 1963, nearly 12 years ago, that a firm of private architects had been appointed to be responsible for the building was hailed in my constituency with a flourish of trumpets in the local Press, and the activities of the project team were fully reported from time to time. During 1973 the Manchester board published in the Press its proposals for the new hospital and invited comments on the proposed siting. All this activity combined to give the public hope that a start was soon to be made on the new hospital, and the news that no money was to be available during the current financial year to enable design work to continue came as a bitter blow.

I note from my local papers that Macclesfield Borough Council and the community health council are to seek an interview with the RHA at an early date to express their deep concern. To suspend design work at this stage is rather like stopping a steam engine in motion, and to get the momentum going again is very difficult.

The effect on the community, however, is as nothing compared to the effect that repeated postponements have had and are having on the senior medical, nursing and other staffs in the district. I would refer also to the severe frustration felt by the consultants, many of whom have become extremely cynical about ever seeing a new hospital in Macclesfield. The morale of the staff in other disciplines has been equally adversely affected.

Perhaps I might be allowed to ask the Minister another question. Why has there been a delay in the full implementation of the recommendations of the Halsbury Committee which were accepted by the Government before the General Election? This has added to the frustration of the nursing profession in my constituency.

Most members of the senior medical, nursing and administrative staff enthusiastically assisted the project team in the preparation of operational policies, schedules of equipment, room data sheets and so on, and they now wonder whether all the additional work which they put in is to be wasted. They wonder too, as I do, whether the considerable amount of money that has been spent on intensive planning since the project team was set up is to be considered as written off.

A recent report of a General Nursing Council inspector has questioned the breadth of experience available for SRN training in Macclesfield, and this is causing considerable anxiety amongst those responsible for teaching and recruitment for the district.

Nothing will ever convince the senior staff that the suspension of design work this year is not the direct result of the transfer of Macclesfield to the Mersey Region on 1st April last. They are adamant that had they remained in the North-West Region the top priority which the new hospital enjoyed would have remained undisturbed, despite the severe economic situation facing the country.

The prospect of the new district general hospital had the effect of restraining requests for improvements, capital schemes and so on over many years, and work of a capital nature carried out since the planning of the new hospital commenced has been on the assumption that the facilities would be necessary for only a limited period. Thus, capital schemes have been carried out at a minimum cost consistent with producing improvements. Many of these schemes are now inadequate—for example, the Geriatric Day Hospital in Macclesfield.

The obvious answer is that reached by the East Cheshire Hospital Management Committee, the Manchester Regional Hospital Board and the Department of Health and Social Security many years ago—namely, a new district general hospital for Macclesfield.

The need for an immediate major improvement is, however, stronger now than ever before, and the population of Macclesfield district, represented by the community health council as well as by myself as their parliamentary representative, will demand that this need be met. Certain statistical information recently published by the Mersey RHA indicates quite clearly the level of activity in the Macclesfield district and shows a high percentage increase in activity for general surgery, orthopaedics and gynaecology. But this cannot be maintained if facilities are not urgently improved.

The shadow of the new district general hospital which has long been cast over Macclesfield hospitals has meant that the district has never received and is still not receiving anything like its fair share of capital investment. As a result, part of the population is being forced to travel well outside the district boundaries for its health services, which in a semi-rural area causes difficulties and extra travelling costs for patients. We all know that these costs will be dramatically increased as from Monday by the Chancellor's Budget proposals.

The serious lack of facilities in out-patient, accident and special units, as well as lack of beds, also has many side-effects. The Hospital Advisory Service on a recent visit has drawn attention to the shortage of geriatric beds and the small size of the geriatric day hospital. When will the Government carry out the pledge which we read in the Gracious Speech to … continue to maintain and improve the National Health Service ", particularly in my constituency, and show that they genuinely care for the caring professions by producing for them sufficient buildings and improved conditions in which to work for their patients?

The people of my area demand their fair share of the limited resources which are available. Other hon. Members have drawn attention to the needs of the health services in their areas. I would draw the Minister's attention particularly to the remarks of another North-West Member, the hon. Member for Ince (Mr. McGuire), in the debate on the Address. He expressed the hope that the North-West …will be given the massive injection of public funds which we so desperately need if we are to catch up—not get in front of, but catch up—the other areas of the country".—[OFFICIAL REPORT, 29th October 1974; Vol. 880, c. 50, 172.] On behalf of the people of Macclesfield, I ask the Minister to recognise the grave situation facing the hospital service there and to ensure that the new district general hospital is included in the earliest possible building programme. I am not asking for somethinig that we do not deserve. We have fallen behind the standard of service which should be expected from the National Health Service. This hospital has been promised for many years. We in Macclesfield are asking only for our fair share. I hope that the Minister will allow me to take some good news back to the people of Macclesfield today.

4.18 p.m.

The Minister of State, Department of Health and Social Security (Dr. David Owen)

The Adjournment debate is a useful way for hon. Members to bring to the attention of Ministers the peculiar problems of their regions. I make no complaint about that, nor of the fact that these debates essentially comprise special pleading. My job is to look at national resources, but let us consider the situation in Macclesfield.

The provision of surgical beds in the district represents 0.87 beds per thousand of the population, compared with 1.14 in Cheshire, 1.71 in the Mersey region and 1.5 in England and Wales as a whole. The overall provision of medical beds represents 0.89 per thousand in Macclesfield, 0.82 in Cheshire, 1.4 in the Mersey region and 1.2 in England and Wales. On 31st December 1973, the waiting list in all specialities in hospitals of the former East Cheshire Hospital Management Committee contained nine people per thousand of the population, as compared with a national average of 10.96.

Against the background of the old and poor conditions in the two hospitals —Macclesfield Infirmary with 103 beds and West Park Hospital with 224 beds—which the new hospital that the hon. Member for Macclesfield (Mr. Winterton) mentioned is proposed to replace, these statistics show the need for new hospital facilities at Macclesfield.

In respect of primary health services, however, the district is not too badly served. The average list size of the 74 general practitioners in the district is 2,247, compared with the Cheshire figure of 2,398 and the figure for England and Wales of 2,444. Generally, I am glad to say that Cheshire County Council is to the fore in the provision of social services, and the numbers of health visitors, home nurses and midwives are generally considered satisfactory. There are at present no health centres in the district, but several are planned.

I give those figures to indicate my approach, which is to look at Macclesfield in relationship to its immediate environment and to the nation as a whole. I am a strong believer that there have been for too long inside the health service considerable inequalities of provision. I am absolutely determined to mark my tenure as Minister of State with responsibility for the National Health Service with a marked shift towards redressing inequalities of provision. To that end a great deal of effort is being made in the Department at present.

The former Manchester Regional Hospital Board, in whose region Macclesfield was until 1st April, has for some years been planning a new district general hospital, as the hon. Gentleman indicated. When the Mersey regional hospital authority took over responsibility for the area in April 1974, it had to consider the whole of its region and whether it could afford the resources for continuing with the planning of this scheme. It had to do so—I must say this frankly to the hon. Gentleman—in the light of the very much reduced capital expenditure available to the region following the December 1973 cuts. It was all very easy when the then Chancellor, Mr. Barber, came to the House and announced these substantial cuts right across the board, but few hon. Members realise the significance they have up and down the country. It is very easy for us to be against higher taxation and in favour of cuts in public expenditure until the consequences of those options come to face us in our own constituencies.

The Mersey RHA is responsible for the health needs of a population of over 2½ million in the Merseyside Metropolitan County and the county of Cheshire. In this area there are two expanding new towns at Warrington and Runcorn, and a substantial programme of urban renewal in Liverpool, all of which result in a move of population away from the areas well served by the old hospitals and open up a need for new hospitals. Much of the hospital stock in the region is old and in need of either replacement or substantial upgrading. I want to emphasise the competing calls for the limited capital resources available to the regional health authority, because I think some of the claims made by the hon. Gentleman do not really stand.

The Mersey Regional Health Authority was bound to consider its capital programme. It took over from its predeces- sor authorities, Liverpool Regional Hospital Board and Manchester Regional Hospital Board, an ongoing commitment for a substantial programme of capital works. This included the new district general hospital under construction at Arrowe Park in the Wirral, designed to replace out-dated and unsatisfactory accommodation in Wallasey and Birkenhead; the first phase of the construction of a new district general hospital at Runcorn, designed to meet the needs of the developing new town, whose population is expected to reach 70,000 by 1981; and the first phase of another district general hospital at Warrington, designed to replace an old and inadequate hospital in the town.

It was against the capital commitments already entered into in respect of these major new developments, and a substantial programme of smaller work to improve hospitals and health services generally, that the regional health authority had to decide how best to allocate its limited capital resources. I have already indicated that we must look at inequalities not just within but also across regions.

I am certainly determined to try to ensure that the regional allocations reflect this. But the allocation to the Mersey Regional Health Authority for its main capital programme in 1974–75 represents £3.36 per head of population, which is above the national average of £3.14. We are not yet in a position to give regional hospital authorities their allocations for 1975–76, but I breach no secret to the House when I say that in the present economic situation there will be very difficult choices and the health service will be one of those which will be affected by the reduction of public expenditure.

The hon. Gentleman quoted from the Queen's Speech. What is happening now is what I expected to happen. The Government, having decided that the health service is in a very difficult situation and that they must give their first priority to people, warned that if we were to redress the substantial injustices in the pay structure of the National Health Service, from top to bottom, that would cost a lot of money and that we should have to pay the price in terms of buildings if the priority were people first and buildings afterwards. Having footed a massive bill for increased wages in the National Health Service we are now, of course, being asked to increase expenditure. I do not complain. I believe that we should spend more on the health service but the Government must look at all priorities, housing, health and education.

The hon. Gentleman asked about the Halsbury award. That was £117 million extra in one year for the nurses. It is true that there has been a delay. The payment was back-dated to 23rd May. We have made arrangements for a partial payment, an assessment of the overall back payment, and this was paid in a lump sum, mostly at the end of September. The pay clerks did a tremendous task and so did the computer staffs in readjusting arrangements.

There has been a further complication in that when the Halsbury award was made it had to go to the Whitley Council dealing with these matters and on a number of points of detail there had to be changes and negotiations. These have been made and letters have gone out to the authorities. We are hopeful that most nurses in the country will have a substantial realignment of their pay at the end of November.

I fear that there will be some areas where this will take place in December and regrettably, in a few cases, it might be a little later. We have a shortage of computer staff and there are great complexities. It is a serious matter and we are doing our utmost to see that the nurses get their full amounts as early as we can.

Coming back to the gut question of the Macclesfield hospital, I think that the hon. Gentleman has every right to make the claims he has and to put forward strong arguments. The Mersey Regional Health Authority had to consider very carefully whether to allow this programme to go on. It was decided reluctantly that expenditure on the design work for the two proposed district general hospitals at Macclesfield and Chester being undertaken by consultant architects and not the authority's staff should be suspended for this year. The saving here amounts to about £500,000 in the current year. Taking a broad forward look, the authority was bound to have to make these decisions.

The hon. Gentleman could well ask what will be done, even in the interim. He said that he thought that some improvements were urgently needed. The regional health authority and the area health authority, after consultation with the district management team, have decided that some projects should be proceeded with as soon as possible in the light of the postponement of the district general hospital. At Macclesfield Infirmary a new operating theatre is needed. That will cost £150,000. One additional 30-bed ward is required which will cost a further £150,000. Both schemes will take about 18 months from the start of design work to completion. The final decision rests with the regional health authority.

Mr. Winterton

Would not the hon. Gentleman agree that this is rather a waste of time? Although these improvements are urgently needed, would it not be simpler, and in the long term produce a saving, to proceed with the district general hospital? Is he aware that the Macclesfield district is the only district in Cheshire without a district general hospital, or any part of one, either in existence or currently being built? Will he give an assurance that no other phase will be permitted in Cheshire before Macclesfield is granted its first phase'?

Dr. Owen

No, I will give no such commitment. I am a believer in the view that a health service cannot operate from a central bureaucratic control in Whitehall. I believe that the people who must make these very difficult decisions about priorities must be the people who live and work with these problems from day to day. To that extent I believe that my job is to make sure that the overall inequalities are looked at. Within a certain allocation of money it is for the Mersey Regional Health Authority, the area health authority in whose area Macclesfield is sited and the community health council to bring the arguments to bear upon this question of priorities. It is broadly speaking for them to decide.

That is not to opt out of my responsibilities. I shall be answerable in this House for them. I think, however, that local people must be able to make these difficult choices. If it is their view that some improvements are necessary in the interim, I am bound to respect that. If, for instance, it is thought that a new operating theatre will make a difference to the waiting lists, which may be large for those areas, that is the sort of interim aim which I would strongly support.

I would also refer to the fact that £46,000 is due to be spent this year on minor schemes in the district, including the upgrading of an annexe and the pro vision of a generator at Parkside Hospital as well as the upgrading of—

The Question having been proposed at Four o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Four o'clock.