§ 4.4 p.m.
§ Mr. Roger Sims (Chislehurst)
I am glad of this opportunity to raise a matter which although basically a constituency problem has wider implications.
This is the background to the matter. As a result of the opening of the fine new Queen Mary's Hospital in Sidcup last year, an ancillary hospital in Cray Valley, which is in my constituency, was no longer required and was closed.
For some time plans have been under discussion for other uses for the building, such as possibly an alcoholic unit or a geriatric home. On the other hand, plans have been proceeding for some years to build the River Thames barrage involving 944 the demolition of the Long Reach Isolation Hospital at Dartford and its eventual rebuilding. Meanwhile the regional health authority has been seeking temporary accommodation and last autumn decided that the Cray Valley Hospital was suitable for this purpose. Since mid-February the hospital has been designated as a smallpox isolation unit and stands ready for a use to which we must all fervently hope it will never be put.
I wish in the short time available to me to examine, first, whether the placement for Long Reach is necessary at all; secondly, whether Cray Valley is a suitable replacement, and, thirdly, how the matter has been handled.
The closure of Long Reach Hospital deprives the National Health Service of 40 smallpox beds. There still remain 232 beds in England, of which 24 are at Ipswich and 45 at Solihull. How badly are these beds needed and to what extent have they been used? In the three-year period 1972–74 there were five cases throughout England, all in 1973. I argue that there is ample provision in respect of smallpox within England. especially as the World Health Organisation expects within a few months to achieve complete control of smallpox in the few areas where it still exists and hopes to declare its complete elimination within two to three years.
Some experts believe that there is no need for scattered isolation units but put the case for larger, well-equipped smallpox units. Objections have been raised about the difficulty of transporting smallpox patients over considerable distances. I should like to quote the Minister's letter in which he said:Public safety requires total isolation of the ambulance and its crew;this would be difficult to ensure since there is no ambulance in the country either fitted with toilet facilites or capable of covering the maximum distances which might be involved without refuelling.I do not dispute that that may be so. but I understand that there are suitable vehicles available abroad and the £20,000 which is to be spent on alterations at Cray Valley would go a long way towards the purchase or adaptation of suitable vehicles.
If some sort of replacement is to be found in the area, for Long Reach, were all the other possibilities vigorously pursued? Did the regional health authority
945 consider erecting a simple, temporary building near Long Reach? How carefully did the authority consider the fact that at Denton, near Gravesend, there is a 15-bed ex-Port of London Authority isolation hospital, purpose-built, and now lying unused? The Minister says that he has looked at this matter carefully, but we have had no explanation why it cannot be used.
There are a number of objections to using Cray Valley Hospital as a smallpox isolation unit, thus depriving the locality of a building which could be used for other purposes. A total of £20,000 is being spent on adaptations, yet either the building will lie completely idle for two years or more or if, alas, it is used. at the end of the period it may have to be completely demolished, as the Long Reach building is to be. Either way it seems to be a dreadful manner in which to treat a valuable local asset.
Incidentally, one is bound to feel that plans to rebuild Long Reach within two years are optimistic even at the best of times, especially in the light of restrictions on public expenditure foreshadowed by the Chancellor of the Exchequer earlier this week.
There are practical objections to the use of Cray Valley. It is true that there is an open space immediately adjacent but close to a densely-populated residential area consisting of 10,000 people. The Minister in his decision letter said that the nearest dwelling was more than a quarter of a mile away. I assure him that that is not the case and that there are several homes within a quarter of a mile radius of the hospital. If he wishes me to do so, I can show him the situation on the map.
To the natural concern of local residents about the danger of infection from the hospital is added the problem that this particular area is frequented by gipsies, who tend, alas, to be no respecters of either fences or notices. Whatever vaccination control plans are initiated, it will be very difficult to maintain them with a constantly changing gipsy population.
The final aspect to which I seek to draw attention is the whole manner in which this matter has been handled. The regional health authority knew two years 946 ago that Long Reach Hospital would have to be closed. But the letter to the area authority announcing the proposal to use Cray Valley as a smallpox unit with effect from 1st January of this year was dated 30th October 1974—two months before the proposal was due to come into effect.
On the following day, the area health authority wrote to interested parties requesting views to be submitted by 2nd December, giving just one month. One of the interested parties was the local community health council, which accordingly called a public meeting, which was held on 26th November. Unfortunately, in the absence of the local newspapers due to strike, the publicity for the meeting was limited. Nevertheless, over 100 people were present to hear the regional authority's case. At the end of the meeting, 70 people voted against the proposal, and only five voted in favour.
Certainly my postbag reflects the similar and strong views of local residents. They were particularly incensed to learn that adaptation work at the hospital to the value of about £15,000 or £20,000 was already in hand while the consultation was taking place. It is not surprising that they felt that the authority was simply paying lip-service to the idea of consultation and that they were faced with afail accompli.
On 5th December the community health council sent the area health authority a well-argued letter detailing its objections to the proposal. Later that month the area health authority held a meeting to consider the proposal. Only 10 of the 15 members were present, of whom five voted in favour and four against, with one member, whose property is within the quarter-mile radius to which I have referred, very properly abstaining. The proposal was then sent by the regional authority to the Minister for his final decision.
Also in December, and before a decision was announced, the regional authority issued notices to the effect that Long Reach would no longer be available for smallpox cases after 15th January, that from the middle of January until 18th February any cases were to be sent to Ipswich, and that from 18th February cases were to be sent to Cray Valley.
On 30th January the Minister of State gional health authority knew two years
947 members of the community health council, and me, to meet him. He gave us a courteous and attentive hearing, for which I am most grateful. However, in the light of what had already happened, the House will not be surprised to learn that on 11th February, in a letter, the Minister announced his approval of the proposal.
In her document "Democracy in the National Health Service" the Secretary of State wrote,It is particularly important that Community Health Councils should be consulted about developments in the services in their district at a formative stage when their views can influence decisions.My community health council feels that it was given grossly inadequate time for consultation and regrets that its views did not, apparently, influence the Minister's decision. My constituents feel that this was a decision taken without adequate consideration of the practicalities involved, and that such consultation as took place was simply window dressing.
I hope that the Minister will reconsider his decision. If he will not, I hope that he will be able to give me, and my constituents, some fuller explanation of how and why he took this decision.
§ 4.14 p.m.
§ The Minister of State, Department of Health and Social Security (Dr. David Owen)
The House will be grateful to the hon. Member for Chislehurst (Mr. Sims) for having raised this issue on behalf of his constituents. It also gives me the opportunity of dealing with the whole issue of smallpox which is of concern to his constituents and also to the whole country.
This year, the World Health Organisation expects that smallpox will disappear from the earth as the WHO completes operations in the co-ordinated international eradication programme begun in 1967. We must all hope that that hope is fulfilled. In 1967, the disease ravaged 30 nations of the world and was imported by travellers into many other countries, but by the end of 1974 it was confined to three countries—Bangladesh, India and Ethiopia. The surveillance teams continue to search for any hidden outbreaks and will be on the alert during the following two years after eradica- 948 tion. Surveillance is the key and teams must remain on guard long after what may seem to be the last confirmed case. However, as humans are the only hosts of the disease its interruption will be final when eradication is eventually confirmed.
The smallpox situation in Bangladesh is at present giving cause for concern. Floods and famine have meant that, contrary to the trend in the other two countries, the disease there has been increasing during the annual smallpox "high season" at this time of the year. Efforts have been redoubled by the WHO teams to combat the increase in Bangladesh, and to try to reduce the danger of importation of the disease into adjacent districts of the neighbouring countries. The World Health Organisation is confident that, with strict surveillance and extra contributions to the eradication campaign from member States—the United Kingdom has given an additional £225,000 during the past five months—the situation in Bangladesh can be controlled, and eradication achieved on target. This is obviously important to the smallpox provision that we make in this country.
We can, therefore, be hopeful that, in the future, smallpox will disappear. But in the meantime my responsibilities to the House and the country lead me to warn that we cannot afford to relax our vigilance—not least because of the air traffic for business and pleasure purposes which can quickly bring persons to the United Kingdom from any area of actual or potential infection. As part of this vigilance, we must maintain facilities for the isolation and treatment of suspected or confirmed cases until smallpox has been firmly eradicated.
Until recently the first line facilities for isolating and treating smallpox cases which presented in Greater London and the South-East generally were provided by Long Reach Isolation Hospital, Dartford, but that unit had to be closed to enable works in connection with the River Thames Barrage to proceed. Isolation facilities will continue to be needed to cover all parts of the country, for the reasons I have just mentioned, but the large numbers of people who arrive by air in the London area make an isolation facility in the South-East of particular importance.
949 A new permanent unit to replace Long Reach Hospital is being planned by the South-East Thames Regional Health Authority in the grounds of Joyce Green Hospital, Dartford. This permanent unit will provide isolation facilities not only for smallpox but later for other communicable diseases which may present, requiring the strictest isolation, such as lassa fever, but I confirm that lassa fever cases will not be housed in the hon. Member's constituency, as was at one time suggested. This accords with my Department's policy that smallpox hospitals should be used only for smallpox.
For the reasons which I have given, I have had to reject a suggestion that no replacement unit should be built and that reliance should be placed on the first-line smallpox hospital at Solihull, which serves the Midlands. I have taken expert medical advice, especially in view of the representations made to me personally by the Bromley Community Health Council about the use of Cray Valley, and I have been strongly advised by my Chief Medical Officer that dependence on Solihull or any other relatively distant unit to cover London and the South-East for anything but a brief emergency period would be unsuitable. In the light of that advice, it is not open to any Minister to question it. This is a serious potential disease and the risks are considerable.
I therefore accept that advice, which stems from the public safety requirement of total isolation of the ambulance and its crew and the practical difficulties of ensuring such isolation in conveying patients routinely over long distances, and many other related problems, of which ambulance design is only one aspect.
Other premises in the South-East were considered for temporary use but were found unsuitable. An important factor affecting the selection of premises, other considerations aside, was the availability of an experienced medical and nursing team near at hand.
I should now like to deal with the way in which this issue has been handled. The hon. Gentleman knows that I have sympathy with the plea made by the community health council. I have considerable sympathy, too, with the feeling that this was a fait accompli. It was because of these feelings, the fact that 950 it was not a fait accompli, and because of the well-informed and detailed criticisms of the community health council that I decided to see the members personally and to consider the whole question. This was in no way a window-dressing operation. This was a difficult decision involving a number of complex issues, and I acknowledge that as a result of that meeting we had to look at a number of other factors before I finally made up my mind.
The community health council in its representations to Ministers reflected the philosophy underlying the Government's paper "Democracy in the National Health Service" where we say that if these councils make detailed objections to a major policy change, even if it has been accepted by the regional health authority, the case will go to Ministers, and that if they put up alternative suggestions Ministers will take them seriously. I think the fact that I saw them is part of the new machinery for reflecting local feeling. I understand their disappointment at my decision, but I ask them to put themselves in my position given the facts of the situation.
I believe that consultation is very important for the health service of the future, particularly at a time of limited resources. We shall not carry local opinion with us on any decision, let alone such difficult decisions as introducing a smallpox isolation hospital to an area, unless we are prepared at all levels in the health service—Ministers, regional health authorities and area health authorities to involve local communities at an early stage. I believe that this issue would have been far easier to handle if they had been involved at an earlier stage and had not seen the necessary work being carried out when no final decision had been taken. Many people feel that this is a fait accompli, but I ask the hon. Gentleman to believe that it was not.
The apprehensions of local residents are very understandable, but I should like to take this opportunity of repeating the assurance which I gave to the community health council that every precaution will be taken to safeguard the health of the community during any period when Cray Valley Hospital has to be used.
The hon. Gentleman expressed the views of those who have raised problems, in 951 particular about gipsies. This is a factor that will have to be taken into account in dealing with security precautions for the hospital, and I have asked specifically for that to be looked into.
Concern has also been expressed locally about the risks which might arise from an outbreak of fire in the hospital. The problems for the fire brigade are no different in principle from those attending fires at a laboratory or other place where there may be infection hazards. The health of the firemen who might have to attend such an outbreak would be safeguarded by prior vaccination and any patients would be transfered to another first line smallpox isolation hospital. This has been a complicated and difficult issue, and I look forward to the time when we have permanent facilities available in the London area, with the skilled staff on the spot, at a hospital which is purpose-designed for this purpose.
I should like to pay tribute to the thorough and responsible way in which local opinion has been represented by the community health council and by many others. I hope they will accept that I have demonstrated the Government's concern and importance that we attach to their role, and I very much hope they will think that the contribution they have made has not been diminished by the 952 fact that, in the light of the expert medical advice available to me and for considerations of national public safety, I have had to take a decision which does not accord with the views that they expressed to me.
No local community would take a decision such as this without reasonably asking many serious questions about the issues involved, but I am satisfied that the hon. Gentleman's constituents have nothing to fear from this hospital for a temporary period.
It may well be the case, and I hope that it will be the case, that there are no smallpox admissions to that hospital during a two-year period. If the eradication programme is anywhere near as successful as most of us hope, such admissions may never occur. If we never have any more smallpox, and therefore have no smallpox facilities, in this country, we shall all be able to pay tribute to the work that the WHO has been doing over the years, based on a total eradication programme. It is too early to give firm and definite assurances, but I am hopeful that smallpox will be a thing of the past in the world, and certainly in this country. in future years.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes past Four o'clock