HC Deb 01 July 1975 vol 894 cc1429-40

2.43 a.m.

Mr. Graham Page (Crosby)

The House has been debating an important matter concerning Europe, a continental matter, and it is characteristic that we can move so quickly from a continental matter to a constituency matter.

I want to raise tonight the question of the future of a hospital in my constituency, the Waterloo General Hospital. For many years Waterloo Hospital has provided the in-patient and out-patient facilities for the district and a 24-hour casualty service for the population of Waterloo, Crosby, Seaforth, Litherland, Hightown, Thornton, Formby and many parishes of West Lancashire. That population looked on this hospital with affection, with admiration, and, indeed, with some possessive pride.

Until 1962 the hospital consisted of a not very modern building but it was certainly adequate. Even before the Second World War there were plans for extending the hospital and for having a fairly substantial hospital on the site. The grounds of the hospital are extensive enough to be able to cope with a building of that sort, large enough for a 150-bed modern community hospital with all the ancillary buildings.

In 1961–62 new out-patient and casualty departments were added, together with a spacious day room for patients, and this was looked upon in the locality as a first instalment of the development into a larger hospital. Then, however, in February 1966, the regional hospital board, out of the blue, announced that the new, modern and very well-equipped out-patient department at Waterloo Hospital would be closed. The local council—indeed, the local citizens—protested, and then it emerged that the board intended to do even more than that and close Waterloo casualty department and also eventually all the inpatient services.

This was the start of what appeared to be a deliberate running down of Waterloo Hospital and the transfer of its services to Walton Hospital, which is some distance away. The journey from Crosby to Walton, without a car, is a nightmare. The stupidity in taking all casualties on that journey was crass. The lack of consideration and the readiness to accept a danger in making all out-patients travel that distance was quite unbelievable. The hardship to relatives who had to visit patients was cruel.

I need not detail the whole history of the efforts to destroy the hospital—the closure of the operating theatre, the insistence that casualties and outpatients should travel all that way to Walton, the fact that the hospital would become entirely geriatric and the undermining of nursing morale by these proposals for the future of the hospital.

That was at a time when in the district around the hospital there were very great developments—the development of Royal Seaforth Dock, the container terminal built at the expense of £40 million, the biggest grain terminal in the world, massive road developments, a marina, and very substantial housing development at Formby and Hightown. In fact, the whole area was developing very rapidly, and at that very time there were proposals to close its local hospital.

By 1971 it seemed possible that the hospital would eventually become not a general hospital, as it had been, but a pre-convalescent and long-stay hospital. However, I was not satisfied with those proposals. We needed a general hospital in this area. I had from the Minister of State at the time, Lord Aberdare, something of an assurance that this hospital might be developed into a community hospital. This was in 1972, when the policy was starting to change from the concentration of hospital services within the big hospitals towards the setting up of community hospitals.

I received the assurance in a letter dated 1st June 1972 from Lord Aberdare. He said: We mentioned to you"— referring to the discussion which we had had— another prospective development in policy. Keith Joseph expects to announce in the near future a new policy for the establishment of smaller community hospitals providing a service complementary to that of district general hospitals. Such hospitals, where required, will be sited in close proximity to the communities they serve. That gave me some hope that we might have the Waterloo Hospital developed as the population of the area required because the population had outgrown the hospital, and to meet that by closing the hospital seemed an entirely ridiculous policy.

I had some assurance about that in a letter from the then Minister of State in September. He pointed out that the general rôle of community hospitals was defined as providing medical and nursing care including out-patient and day-patient and in-patient care for people who do not need the specialised facilities of a district general hospital, who cannot be properly cared for at home or in residential accommodation. In general the proposed future rôle for the Waterloo Hospital, as you will note, fits within these broad outlines. That was what I had hoped. I wished to press for the formation of a community hospital by building on to the existing Waterloo Hospital.

Shortly after that, in March 1965, the hospital was closed for fire-precaution work to be carried out. After all the history of this hospital, one could not help but be suspicious about the closure.

The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)

I take it that the right hon. Gentleman is referring to March 1975.

Mr. Page

I meant that. If I said the wrong year, I am grateful to the Minister for correcting me. In March 1975 the hospital was closed for this precautionary work to be carried out. I was suspicious that there was some possibility that the hospital might not be reopened, especially because at about the same time the regional health authority came up with several different propositions for the future of the hospital, none of which included the proposal for the hospital to develop into a community hospital.

Five alternatives were put forward in February 1975. These were put before, first, the community health council for the district. That council showed the alternative which would restore the hospital to its previous bed capacity and would merely carry out the fire precaution work that was necessary.

The Sefton Area Health Authority went a little further than that and proposed that there should be an extension to the existing buildings to provide for 30 geriatric in-patients with the addition of a day hospital for 50 geriatric day patients.

I received that information at the beginning of last month by a letter dated 4th June from the Sefton Area Health Authority. This seemed a possibility as a first instalment, perhaps, towards a community hospital. The Sefton Area Health Authority informed me that in addition the authority would be pursuing the question of the expansion of consultant out-patient sessions for ophthalmology and dermatology and that further consideration would also be given to the involvement that general practitioners might wish to have in operating a minor injuries and redressing centre. That certainly would revive the hospital in a specialised form for geriatric patients. I ask the Minister for an assurance that that can be an instalment towards the eventual development of Waterloo Hospital into a community hospital.

Perhaps I should put on record what I mean by a community hospital. I refer to the document issued by the Department of Health and Social Security and the Welsh Office entitled Community Hospitals: Their Rôle and Development in the National Health Service". From that one can see that Waterloo Hospital fits neatly into the criteria for community hospitals. It particularly fits into the one which I quoted from a letter: In general community hospitals are needed to provide medical and nursing care, including out-patient, day-patient and in-patient care for people who do not need the specialised facilities of the district general hospital and cannot be properly cared for at home or in residential accommodation. The document states specifically that community hospitals may develop on the following lines: 1. They may provide up to half the geriatric beds and most of the beds for elderly persons with dementia needed for the population they serve, up to about 10 beds per 10,000 population served. In my constituency in the area of this hospital there is a fairly large number of elderly people's homes, and the elderly are a large proportion of the general population. Therefore, a geriatric service is appropriate here. Also, we need the general hospital service.

The document continues: 2. They may provide up to one-fifth of the medical and surgical beds for their population. This will consist almost entirely of general medical and pre-convalescent beds and beds used for short-term admissions to relieve families, up to about five beds per 10,000 population served. 3. They may thus contain up to about one-quarter of the future bed requirement of their population, between 50 and 150 beds for a population between 30,000 and 100,000. 4. They may provide up to half of the geriatric day places need for their population and of the day places for elderly persons with dementia amounting together to some 3.5 to 4 places per thousand of the elderly population in the locality as well as some day places for other mentally ill patients. 5. They may provide a considerable number of out-patient clinics. That is the kind of hospital that is necessary in this developing area in the neighbourhood of Crosby. If the hospital closes as a general hospital, there is in the whole area of Sefton metropolitan borough, as it is now, only one hospital, and that is right at the north end of the borough in Southport.

Sefton borough consists of a long stretch along the Mersey coast. It will be extremely inconvenient if that strip is left with only one hospital right at the north of the area, whereas Waterloo Hospital is well placed and comes very much within another criterion mentioned in the document, which says: In all types of area, accessibility and convenience to patients and their relatives are important factors in determining where the community hospital should be located. Thus a study of communications is an essential prerequisite in choosing a site. The availability of staff is also a critical factor, including the willingness of general practitioners who live near the hospital to devote time to working in it. It seems that Waterloo Hospital in Crosby is an admirable hospital to develop into a community hospital. Therefore, I ask the Minister to give me an assurance that if we proceed with the development that the Sefton Area Health Authority desires—at present, the building for 30 geriatric beds and the accommodation for 50 geriatric day patients—this will be an instalment of the proposed community hospital.

I know that if one sets out plans for the building of a hospital by instalments, whether over five years or 10 years, an economic crisis may arise during that period which will mean that we must roll it on. But I want to see this hospital become by instalments a community hospital, and I urge the Minister to give me the assurance that he would like to see that happen. If we are to have the policy of developing community hospitals throughout the country to supplement the bigger district hospitals, here is an admirable place to build one.

Right next door to this hospital is a private convalescent home, the Park House Convalescent Home, which can call on all the finest consultants in the area. They come across the road to Waterloo Hospital and are only too pleased to serve that hospital.

So we have all the facilities there. The hospital is in the right place in the district and it can call on the right services. I hope that I can have from the Minister tonight the assurance that it will eventually become a community hospital.

3.2 a.m.

The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)

First, I express my appreciation to the right hon. Member for Crosby (Mr. Page) for raising this subject for debate. I am grateful to him also for the informed interest he has taken over the years in health services in his constituency. The right hon. Gentleman opened the debate with a full account of the problems which the health authorities have been tackling in relation to the Waterloo Hospital in Crosby, in which he clearly takes a great deal of genuine pride. He has shown a continuing concern for the future of this hospital. I shall do my best in the time available to deal with the points he has raised.

With the reorganisation of the health services, the prime responsibility for managing the health services in its area is vested in the area health authority. It is responsible for providing, or arranging for the provision of, comprehensive health services to the people of its area. In each district, the area health authority works through the officers of the district management team. These officers are responsible for managing and co-ordinating the operational services of the health service within the district. They are responsible also for formulating policies and plans for the services they manage and co-ordinate.

As the right hon. Gentleman knows from his correspondence with us, my Department has followed with interest all recent developments in connection with Waterloo Hospital. We are satisfied that the proposals now being formulated for the future of the hospital have been fully discussed between the district management team, the area and regional health authorities and the community health council. These proposals, in taking full account of the opinions of all three parties, represent the considered views of those who are best able to assess the health of the local population in the light of the constraints imposed by limited resources of finance, skilled manpower in the area and other relevant factors.

There are certain aspects of the developments which are taking place at Waterloo Hospital, which have already been outlined by the right hon. Gentleman, on which I should like to lay particular stress. A change in the rôle to be played by the hospital, in the provision of health services in what is now the southern district of the Sefton area, was first considered by the former regional hospital board in 1969. In that year the board considered the future of overall hospital services in the district after the new 652-bed district general hospital at Fazakerley, then under construction, was completed.

That hospital, which was commissioned in 1973 to 1974, was planned to provide, in conjunction with the nearby Walton Hospital, a full range of acute and accident and emergency services for residents of the district. The plan was to replace a number of small hospitals, many of which were built in the last century. At the time when the hospital board undertook its review the provision at Waterloo Hospital included a small accident department with 50 back-up beds for patients requiring minor surgical procedures. On a number of occasions, however, because of shortage of staff, it has in the past few years been necessary to close the department.

As right hon. and hon. Members will perhaps be aware, following the report, published in 1962, of the sub-committee of the standing medical advisory committee on accident and emergency services at district general hospitals—which was chaired by Lord Platt—my Department has placed special emphasis on the importance of centralising accident and emergency services at departments in district general hospitals. At these hospitals scarce resources of skilled manpower can be concentrated and full back-up services and consultant cover are available to deal with the full range of emergencies which might present themselves at any time of the day and night.

The optimum size of population to be covered by accident and emergency departments has been recommended as 150,000. It is felt that there are very few areas where distances are so great and transport so difficult that a single unit could not provide for such a population. In keeping with this policy, the former Liverpool Regional Hospital Board considered the future of the accident and emergency department at Waterloo. The board also took into account the absence of hospital accommodation for the elderly in the Crosby area. I do not think I need stress the value of providing accommodation for old people requiring longterm hospital care in their home area, where they may be visited more frequently by friends and relatives and so keep better in touch with their local community.

In its proposals for the rationalisation of hospital services in the North Merseyside area, the former hospital board included the closure of three existing hospitals and the conversion of Waterloo to a long-stay elderly and pre-convalescent hospital. There were consultations on these proposals with interested parties during 1971 and 1972. I understand that in January 1972 the right hon. Member himself met the then Under-Secretary of State for Health.

Generally speaking those consulted agreed to the proposals, and in May 1973 the former Secretary of State gave approval to the board's scheme including the change of use at Waterloo. As a direct result, the accident department at Waterloo Hospital was closed on 29th June 1974, and patients requiring accident and emergency services are now being referred to Walton Hospital, about four miles away.

Meanwhile the Sefton Area Health Authority, which took over responsibility for the management of the hospital in April 1974, had been developing proposals for an upgrading of the facilities of the hospital to make them suitable for geriatric patients. For this purpose it consulted the architectural staff at the Mersey Regional Health Authority, which expressed particular concern about potential fire hazards. A meeting was therefore arranged with representatives of the Merseyside Fire Brigade, which concluded that there would be serious fire risks if the authority's plans were put into effect without modification of buildings. This was not the first time fire officers had examined Waterloo Hospital and already a number of improvements had been carried out to meet their earlier requirements. I understand that their advice now, however, was that some substantial alterations would be required to make the premises safe for geriatric patients.

In view of recent tragedies resulting from fires at institutions for the elderly, I do not think anyone would wish to censure either the fire brigade or the health authorities for their caution. The House will not need reminding of the tragedy at the Fairfield Home in Nottinghamshire last December when 18 old people lost their lives in a fire.

Until the building alterations could be carried through at Waterloo, the number of patients who could remain in the hospital had to be reduced to a level that was felt to be impracticably low. It was, therefore, decided that the remaining patients should be transferred to other hospitals.

The regional health authority's architects then arranged for a full structural survey to be carried out. In the light of this survey the regional authority submitted to the area health authority a choice of five schemes both to achieve the upgrading and overcome the fire hazard. The area health authority considered the schemes at a meeting on 30th May and decided in favour of one which would provide 30 beds for geriatric patients and a 50-place geriatric day hospital. The estimated cost is £350,000 of which £150,000 will be required for the day hospital.

I take this opportunity to pay tribute, as I know the right hon. Gentleman does, to the valuable work done over the years by the League of Friends of Waterloo Hospital. Its work is well epitomised in the magnificent day room built by the league as a result of voluntary subscriptions. I understand that the room is being used for the provision of rehabilitation facilities for patients attending the hospital. This may, in the period when there are no in-patients in the hospital, mean that the room is under-utilised, but once upgrading has been completed it will provide a most essential element in the service being provided by the hospital.

I also wish to mention the interest shown by the Waterloo Hospital Action Committee in the future of the hospital. Though members of the committee may feel that the health authorities locally have taken insufficient note of their representations, I can assure them that the views they have expressed have been fully taken into account in arriving at decisions on the future of the hospital.

Moreover, I understand that the secretary of the action committee is herself a member of the community health council for the South Sefton district, which enables her to bring the views of her committee to the attention of both the council and the authority. The authority has throughout its consideration of the future of the hospital given particular attention to the need to keep the community health council in touch with developments. I understand that the chairman of the council was informed of the problems that had arisen over the implementation of plans for the upgrading of the hospital before the meeting with fire officers took place. Afterwards the chairman of the health authority wrote to the council explaining why it was necessary to withdraw in-patient facilities, and also enclosed a note of the meeting.

Inevitably, in a situation where important decisions have to be taken within a limited time, feelings may be aroused that consultation has been inadequate. I am satisfied that the health authorities are fully seized of the importance of giving the community health council the fullest possible opportunity to consider proposals and to contribute ideas from its knowledge of local conditions.

The council is being consulted on—

The Question having been proposed after Ten o'clock on Tuesday evening 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 thirteen minutes past Three o'clock a.m.