§ 10.20 p.m.
§ Dr. Colin Phipps (Dudley, West)
For one brief moment, I thought that this might be the best attended Adjournment debate for some days. However, I see that the House is resuming its normal state for this time of the evening.
I am grateful for this opportunity to raise on the Adjournment the question of the Dudley District General Hospital. It is now almost 20 years since serious deficiencies in the hospital services in the Dudley area were identified and a positive decision taken to build a new district general hospital. This decision was taken after very careful consideration of the alternative, which was to develop the existing small hospitals, had been rejected on the grounds that the service was too fragmented and required rationalising, and that the two largest hospitals were in such a serious state of dilapidation that they should be abandoned.
In 1958, Professor Sheldon, who conducted a survey of hospitals throughout the Midlands, described one of the units as being like Sing-Sing because of its peculiar construction, with cell-like blocks. He stated that it should be demolished and should not house patients. Plans for major upgrading of the wards were abandoned as the result of this report. Although some upgrading has since taken place, these wards are still in use 15 years later because there has been the promise of a new district general hospital.
The Dudley area has been repeatedly disappointed with the planning of this hospital. It has now been planned for three different sites and, as originally conceived, would, by now, have been completed. Unfortunately, as each scheme was developed, so it was abandoned and the planning aborted. In all this time, capital investment within the Dudley area has been strictly limited on the basis that the majority of the hospitals had only a 1374 limited life, and the investment of substantial sums could not, therefore, be justified.
In consequence, patients and staff have endured conditions which would have been unacceptable in other areas. It is to their everlasting credit that the staff of the hospitals have, by their devotion to their work, endeavoured to compensate for the deficiencies that exist in the service. In addition, the public of Dudley have constrained their criticism of the service in the knowledge that a new hospital was imminent and the staff were doing all that was humanly possible for them within the limitations of the existing buildings.
The morale of the staff has been sustained by the relationship they have established with the community and the management authority. After 20 years, however, this is wearing thin, and the latest proposal to defer the commencement of the main portion of the new hospital at Dudley has been the last straw. Physical limitations imposed by the existing buildings not only provide an inadequate environment for the practice of health care but also constrain the authority in the number and grades of staff that can be employed. The strains and tensions created by present conditions have now reached such a point that they place an intolerable burden on the staff, who are being frustrated in their attempts to provide a reasonable service to the Dudley community.
There are more than 300,000 people within this metropolitan conurbation. They reside in six different parliamentary constituencies, of which my own is one. These 300,000 people are inadequately served in virtually every specialty. The investment, in revenue terms, on health within the area is grossly below both the regional and national average. These facts are well known to the Department of Health. The deficiencies have been well documented over the past 10 years, and Dudley is recognised as an area of severe deprivation and fragmentation.
It is no consolation to the people of Dudley that work actually commenced in 1972 for, by mid-1976, all that there will be to show will be a boiler house, stores, laundry and engineering workshops, but not a single bed for patients. In 1968, when the planning on this hospital first 1375 commenced, it was anticipated that over 300 beds would be available by now. Even if the existing programme had been adhered to with a commencement of phase III in the current year, there would have been no accommodation for patients until 1978–79. The delay in starting the next phase can only mean a further delay in the completion of the hospital, and this will place the area health authority in an impossible position, because all the planning since 1968 has been on the basis that there would be additional hospital accommodation available from 1976 onwards.
The increasing workload that the hospitals in this area are being called upon to meet year by year as the area develops has inevitably meant that the resources have been more intensely worked as each year has gone by. Now, however, the position has been reached where there is no longer any room for further expansion. Fragmentation and inadequacy of accommodation has meant that it is increasingly difficult to recruit staff. Consultant appointments remain unfilled, and junior medical staff appointments are no longer attractive, and such posts cannot be filled. Medical, nursing, paramedical and technical staff are reluctant to come into the area, and when staff do become available, working facilities are often non-existent. The shortage of speech therapists, physiotherapists and chiropodists delays or prevents the full rehabilitation of patients, for example, for stroke and injury cases. Residential accommodation for both nursing staff and single doctors is now at a premium and, the recent Whitley agreements having increased their off-duty time, makes additional recruitment imperative to maintain even the present level of service. The dilemma now facing the authority is that. even if it could recruit the staff, it would have nowhere to accommodate them.
The fragmentation of the service with the dispersal of the specialities through so many units means that staff are wasting their time in travelling from one hospital to another, expensive equipment is having to be duplicated, and it is impossible to provide a fully co-ordinated service. Even the casualty services are having to be split between two small hospitals of fewer than 200 beds each, now endeavouring to handle over 52,000 new cases a year. This means that the major portion of their work is confined 1376 to emergencies, so that routine work is suffering. Unfortunately, as there is only one other hospital with operating facilities, the casualty work load is seriously interfering with the waiting list work, and it is impossible to make optimum use of the resources that are available.
The irony of the situation is that, in 1970, the Department of Health decided to adopt the Dudley District General Hospital as its pilot scheme to test the new Harness concept of hospital design. It is this concept which is the white hope of the future health service, and which is referred to by the Secretary of State in her recent letter on planning. It would seem wrong, therefore, when the Dudley project has been used as the proving ground for the planning of this type of hospital, to abandon it because the Department has now moved on to a more advanced stage of the Harness hospital.
Similarly, in 1970 it had been the view of the authority that phase III should provide approximately 300 beds, and it was at the insistence of the Department of Health that this phase was increased to provide a scheme for over 600 beds at an estimated cost now of £15 million to £18 million. It is ironic that it is this cost which is now the major obstacle to the continuation of the project. It would be the contention of the authority that. whilst it recognises the present pressing economic situation, it should have a prior claim on moneys made available for hospital development in the coming years.
It is clear from the programme, recently released by the Department of Health, that there are substantial sums of money being spent on capital works in the National Health Service. The authority recognises that the present situation calls for a reduction in capital activity, and it would have seemed eminently reasonable to it if the present phase had been cut in half. According to the architects, this is a practical alternative. It is indeed unfortunate that, although the area health authority is a member of a joint project team comprising representatives from the AHA, DHSS and RHA, there has been no meeting of this project team for 12 months, and there were no discussions with the area health authority before the decision to defer the scheme was taken. This I believe, if correct, to be inexcusable.
1377 If this phase does not go ahead in its original or reduced form, the only claim the Department can make is to have fragmented even further the service within the Dudley area, because the area health authority will, within twelve months, have another site for which it will be responsible. This will be detached completely from existing units and, as a result, will increase the fragmentation of the already fragmented service. Hospitals which were scheduled for closure, and which have been deprived of both capital and maintenance moneys in anticipation of their closure, will now have to have considerable sums of money spent upon them, and the authority estimates that, in order to prop up the existing services, between £1½ million and £2 million will have to be spent almost immediately if these are not to break down by mid-1978. Relief cannot be provided from adjoining areas which are already themselves hard pressed. We are therefore faced with the prospect of an investment of £2½, million on the site of the new hospital without any hospital services being provided by that unit. This is clearly unacceptable
Unless a decision is taken quickly to provide some sort of support for the services in Dudley the consequences will be disastrous. In recent years the hospital service in the area has been planned on the assumption that the district general hospital would be available some time between 1976 and 1978. Additional consultant appointments have been made in numerous specialities, even though it was known that the facilities in all these specialities were currently inadequate, as it was the intention that the incoming consultants would commence a nucleus of a service in preparation for the opening of the new hospital.
Many of the consultants have accepted appointments in the area in the expectation that modern facilities would be available in the near future. In many cases the consultants are working single handed, and are having to provide a 24-hour cover seven days a week, because it is impossible to introduce additional consultants without the additional facilities for them to work in. Additional consultants are now needed in many specialities—for instance, gynaecology, ophthalmology, psychiatry, ENT, general surgery 1378 and orthopaedics. Such appointments cannot be made because of the absence of adequate operating facilities, outpatient clinic time and general support services. It is currently estimated that there is a deficiency of over 500 beds in this area.
Even this does not paint the full picture. The beds need to be supported by all the other services, and they would be useless without operating theatres, dianostic and remedial services and accommodation for the nursing and medical staff who would have to work in support of the beds. Piecemeal development is out of the question. It was recognised 20 years ago, it was recognised again 10 years ago, and it has been reiterated within recent years, that the only remedy to the hospital problems of the Dudley area is a radical rebuilding. I ask the Minister to accept the revised plans of the authority, and to give the go ahead for a desperately needed facility in an area of extreme hospital deprivation.
§ 10.33 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alec Jones)
I congratulate my hon. Friend the Member for Dudley, West (Dr. Phipps) on having secured an Adjournment debate. Like him, I at first thought that the Opposition benches were full because hon. Members had come to hear my speech, but I was doomed to the same disappointment.
If I were in any doubt about the difficulties of the Health Service in the Dudley area, those doubts would have been swept away by my hon. Friend's speech and by the presence in the Chamber of his colleague, the Financial Secretary to the Treasury, my hon. Friend the Member for Dudley, East (Dr. Gilbert), who has to be silent on these occasions but who has drawn my attention several times to the problems of Dudley.
I am glad that my hon. Friend paid tribute to the staff working in these bad conditions in Dudley. I would say to them, through him, that we are mindful of the difficulties they have today and have had for a long time.
I wish that the shortages and deficiencies in Dudley which my hon. Friend has described were limited to one or two 1379 parts of the country, but the tragic fact is that they can be found only too often in many parts of the Health Service. This is the basis of our problem—that it is not just help for one or two areas but a massive injection of capital that the service needs.
Let me say straight away that neither we at the Department nor, I believe, the West Midlands Health Authority, would disagree with much of what my hon. Friend has said about the need for the new hospital. The main problem at Dudley is that existing provision is divided among too many hospitals for the most economical and efficient management, and some of these are in less than satisfactory buildings. That is probably understating the case at present. It is not a case, therefore, of shortages of beds but rather one of fragmentation in uneconomic units. It was to rationalise this situation and to improve facilities that a new district general hospital was planned.
Planning for the new hospital began in 1969. At that time the Department was in the early stages of developing a standard design hospital, known as Harness, and with the agreement of the former Birmingham Regional Hospital Board, Dudley was chosen as the pilot project. Site preparation and the so-called industrial zone for services such as laundry, workshops, engineering and so on, are already well advanced. The major phase, including the bulk of acute provision, is virtually ready to start, but unfortunately at an estimated cost of £15 million spread over several years.
At the time the decision was made to build Dudley as a pilot Harness hospital, and later when the two main phases were combined to produce the present very large phase, the capital building programme was expanding and there was every reason to expect that the scheme could be accommodated in the forward programme. As the House and my hon. Friend and, I trust, the country know only too well, however, economic difficulties led the then Conservative Government to cut public expenditure, including the hospital building programme, in December 1973.
My right hon. Friend the Secretary of State, in her statement in the House on 2nd December last about the 1975–76 capital building programme, announced 1380 that because of the continuing economic difficulties, we could restore only some of the cuts made by our predecessors, and that very few new schemes, of the very highest priority, would be able to start. We have not yet announced the 1975–76 programme, but I must, unfortunately, tell my hon. Friend quite frankly—for anything other than frankness would be a disservice to him and to his constituents—that there is no possibility of including the £15 million Dudley scheme at present.
As the White Paper on Public Expenditure published in January made clear, there is a continuing need for restraint, in the national economic interest, on the level of expenditure that can be devoted to the health capital development programme. If 1975–76 is ruled out, we must look to somewhat later dates and various possibilities. The fact that the capital programme from 1976–77 onwards is unlikely to be as large as we would wish has general implications, as well as specific implications for individual schemes. Regional health authorities have been asked to review their strategies, knowing that it is likely they will not be able to start as many major schemes as they would wish. They will be deciding how best to use the available resources. A very few major schemes of the highest priority will be able to start, but the replacement of some unsatisfactory buildings will inevitably be deferred. A major element in the review of strategies will be the examination of how these hospitals can best be improved in the medium term, for example, through imaginative upgrading schemes.
The West Midlands Regional Health Authority will thus have to look at regional priorities very critically. I do not wish in any way to anticipate its conclusions, but, as I have already said, the Dudley scheme is essentially to replace existing facilities, seeking to rationalise and certainly to improve them, rather than to provide additional facilities. This is not true of schemes for other districts in the region—for example, the new towns —where there are substantial shortfalls of hospital facilities and where, if there is no new building, the population would have to depend on services in other districts already under pressure and often several miles away. On strict priority grounds it seems unlikely that the Dudley scheme 1381 would figure among the very highest priorities in the region.
While there has been a considerable investment in planning and a substantial amount of preliminary construction at Dudley, the resources simply will not be sufficient to allow the scheme to proceed as originally planned, when due regard has to be paid to the competing priorities in other parts of the region. In these circumstances the health authorities need to turn their attention to ways and means of making the best possible use of the work already completed and planning the future development of the hospital in the light of realistic assumptions as to the resources available. I am pleased to be able to say that the Dudley Area Health Authority has been quick to recognise this and is already considering whether it would be possible to trim existing plans to a much smaller scheme. I welcome this initiative, and if it proves possible to produce a much smaller phase it will clearly increase the chances of the scheme finding a place in the future programme.
My hon. Friend has made the point that the involvement of the Department, by adopting the scheme as a pilot project for Harness, has been a major factor in the present difficulty. The Department's aim. in its research and development programme, has been to develop a standard design for hospitals which could be used nationally in a wide variety of situations. Inevitably problems would arise when a pilot project is being developed. But I must point out that the choice of Dudley as the "guinea pig", as it were, was welcomed by the hospital authorities 1382 concerned and the implications were fully accepted. Nevertheless, I am conscious that its choice as a pilot project has contributed to the present situation. If, therefore, the regional health authority were to consider Dudley as of sufficient priority to justify a place in its forward programme using the present Harness design, but splitting it into smaller phases, the Department would regard it as a development project possibly attracting special support. In other words, we should look on it with some favour.
To conclude, the present situation for the Dudley scheme is uncertain and will, I regret, be so for some months. Much will depend on the level of capital likely to be available to the West Midlands over the next few years, and the regional health authority's assessment of its priorities. I am anxious for the scheme to proceed if possible, because there is clearly a need for the new hospital, but it must be recognised that the hospital capital situation has changed dramatically while the scheme has been in planning. The initiative of the area health authority in investigating the feasibility of a much smaller scheme is very welcome, and if a smaller scheme is practicable the prospect of including it in the forward programme will certainly be much improved. I assure my hon. Friend that my right hon. Friend and I have made a long and detailed examination of the problem in Dudley and that we shall continue to take the closest personal interest in it in the hope that we can bring some help to his constituents.
§ Question put and agreed to.
§ Adjourned accordingly at seventeen minutes to Eleven o'clock.