§ 4.46 p.m.
§ Mr. George Gardiner (Reigate)
This debate is about the urgent need for a new general hospital at Redhill to serve the East Surrey Health District, which has Reigate and Redhill as its centre and extends west to Dorking, east to Cater-ham and south to Horley—all points outside my constituency. I wish to draw 1971 attention to the dangerous state of some of the medical services provided in this district and to the utterly inadequate provision for possible major accidents at Gatwick Airport or on the M23 and M25 motorways. Finally I wish to ask the Minister when and by what means he hopes to remedy this situation.
The basic case for a new district general hospital was accepted 15 years ago. Building was due to start in 1968. Successive difficulties put the starting date back to 1977. Now there is no sign of a start even then. The result is that the district is served by a general hospital at Redhill which is woefully inadequate, while staff and facilities are scattered over and shared between a number of smaller hospitals several miles apart.
Consultants spend much of their time dashing from one hospital to another, with no certainty that they will end up where they are most needed. Meanwhile, in expectation of a new district general hospital, little other improvement work has been undertaken, with the result that in several cases facilities have fallen well below the standard which the medical staff responsible consider to be safe. It is no exaggeration to say that in East Surrey we have now reached the point at which lives are in danger.
In stating this I am saying nothing the Minister should not know already. He was sent a copy of the report prepared by the district management team for the Surrey Area Health Authority last November which warned of the real danger of breakdown in the medical and surgical services provided in East Surrey.
Since then the Minister and the Under-Secretary will know that the doctors running three separate services—obstetrics and gynaecology, psycho-geriatrics and the accident service—have given notice to the Medical Defence Union, the Medical Protection Society and the area health authority that these services have fallen into such disrepair that they can no longer accept legal responsibility for them.
Let me give a few examples. The management team's report last November said that the standard of care in obstetrics and gynaecology had reacheddanger levels, with an imminent possibility of total breakdown of services at Dorking and East Surrey Hospitals".1972 The Royal College of Obstetricians and Gynaecologists has reported adversely on conditions. The consultant for the Dorking, Crawley and Horsham units wrote to the regional medical officer on 9th June stating that the service at Dorking wasgrossly substandard and dangerous. It is only a matter of time before a mother looses her life because of lack of medical staff cover.Dorking is outside my constituency, although I live in the town. I know that my hon. Friend the Member for Dorking (Sir G. Sinclair) has been deeply concerned about this matter. I mention it because the situation there bears directly on the case for a new Redhill hospital.
If a mother in labour in Dorking suffers some obstetric emergency and needs an anaesthetist, the only one available may be in an operating theatre in Crawley, 18 miles away. The obstetrician may be at a clinic in Horsham, Crawley or Redhill, 10 miles away. The registrar is at Redhill. If a new-born child in difficulty needs a paediatrician, the nearest is 10 miles away too.
This is the kind of lethal situation produced by spreading specialists over a number of hospitals so far apart. It is the result of the years of waiting for a new district general hospital. It can be corrected properly only by the provision of that hospital.
In regard to the surgical situation, surgeons spend much of their time dashing between Smallfields Hospital, where "cold" surgery is undertaken, to Redhill General eight miles away for emergency cases. At Redhill General there are two full operating theatres, on different floors and linked by a non-sterile lift and public stone steps. Work on a further theatre will start shortly but will not solve the problem. According to the management team report,the operating theatres at Redhill General Hospital and the East Surrey Hospital are described by the surgeons using them as grossly sub-standard, and the provision of theatre facilities in general as dangerously low.Redhill General also houses the district's blood bank and chemical pathology laboratories. They are cramped to the point at which efficiency must start to suffer. In the chemical store, of which I have pictures taken by the Sunday Miror, one has to climb over chemicals on the floor to reach those on the shelves. 1973 On a recent visit I found stores piled to the ceiling in the gents' lavatory. The fire risk is frightening.
All this causes deep anxiety to my constituents—hospital staff, patients and potential patients. There are just too many points of stress, too many services near to breakdown.
But there is a wider, national aspect to this too, which must cause the Minister and the Under-Secretary deep concern. For the present, Redhill General Hospital, whose woefully inadequate facilities I have just described, is supposed to provide the major accident service for Gatwick Airport, as well as for the M23 motorway and the soon-to-open M25. The horrifying truth is that there is no adequate hospital provision for a possible disaster at Britain's second largest airport, which last year handled more than 5 million passengers and which is planned to handle three times that number in the next decade.
When I asked about this "Gatwick Gap" on 16th June, the Minister of State replied that he had no doubt that the response of the hospital services to any such disaster would be effective. I must tell him and the Under-Secretary that his bland assurance brought angry responses from almost everyone connected with the medical services in Redhill and East Surrey.
The management team reported in November that Redhill's major accident centre could not cope with more than a handful of serious injuries and that lives would be at risk. On 17th April Dr. Ivan Clout, a member of the South-West Thames Regional Authority, reported to that authority that East Surrey district was incapable of dealing with a major accident except one of very limited proportion.
I have a letter dated 16th May signed by the casualty surgeon at Redhill, members of the Surrey and West Sussex Health Authorities and by Mr. Adam Thompson, Chairman of British Caledonian Airways, warning that they would be unable to cope with a serious disaster at Gatwick unless the majority of those involved arrived at the hospital either dead or only slightly injured.
The Surrey Area Health Authority was sufficiently worried to organise a special seminar only last week on major acci- 1974 dent procedures for Gatwick and the M23. Its report to the regional authority states:Unlike Heathrow, Gatwick is isolated in hospital terms, and additional ambulance support is not so quickly available.…The availability of ambulances and manpower would dictate that casualties from Gatwick could only be taken to the nearest designated hospital.It went on to express its grave concern at the situation. So what would happen if an aeroplane crash at Gatwick produced 20 or 30 serious injuries—a pretty modest estimate given the number of passengers on aeroplanes these days?
The nearest hospital, at Crawley, has operating theatres but no major accident provision. Blood samples would have to be driven to Redhill, nearly 10 miles away, and matched blood ferried back. At Redhill major accident unit itself, the injured would immediately encounter two bottlenecks—in X-ray facilities and in the two proper operating theatres. Further hospitals—at Guildford or Croydon—are a long ambulance drive away along very congested roads.
There is also a physical limit to the type of casualty that could be dealt with at Redhill. For example, the surgeons could deal with abdominal injuries and with fractures, but would have great difficulty in dealing with both in the same patient, as the two theatres are not twinned but are on different floors, with a non-sterile area between. If eye injuries were also involved, the patient would have to be transferred to the East Surrey Hospital a mile away, then possibly back again.
In fact this major accident unit was put to the test in February this year following a coach crash at Ockley, from which 48 people were brought to the hospital. The unit was stretched to its limit but was able to cope—because only two of the injured needed surgery. Yet this is the unit serving Britain's second largest airport—a unit that could not with certainty cope with more than a couple of surgical cases. This is a national scandal. For the safety of millions of future passengers through Gatwick, as well as for the 200,000 people in East Surrey, it is essential that work should start as soon as possible on our long-promised hospital. I appeal to the Minister to acknowledge this before a major disaster overtakes us all. This plea is backed up with telegrams from all our local councils.
1975 Therefore, I ask the Minister what hope he can offer in this distressing situation. When I asked the Minister of State on 20th June when the regional authority expected to complete its plans for the new hospital, he replied that planning was at a very early stage. With respect, this is not true. A plan has already been agreed by the Surrey Health Authority, backed by the district management team—for what is called a best buy mark II. This has already been designed and built elsewhere. A flat site, owned by the National Health Service and already surveyed, is waiting at the Royal Earlswood Hospital. Any review of other options by the regional authority's architects is just to fill in time.
Of course I readily acknowledge that the Minister has no capital funds available at this moment. There is no dispute about that, though one must note that two such hospitals could be built each year with the money to be lost by abolishing pay beds. However, what we need in East Surrey is to break out from this vicious circle in which the regional authority says that it cannot proceed because there is no money, and the Ministry says that planning is at too early a stage. The site is there; the plans are there. I urge the Minister to accept them and put this hospital to the very top of the queue for future capital expenditure as a matter of regional and national necessity. When the money is forthcoming, we must be ready to go.
Finally, may I say that in the East Surrey district we have first-class doctors, nurses and local administrators. I benefited from their care for a month in Dorking Hospital recently. But there must come a point in such adverse conditions when their morale begins to crumble. I appeal to the Minister, in his reply today, to offer them and us some hope.
§ 4.59 p.m.
§ Sir Geoffrey Howe (Surrey, East)
I do not wish to take more than one or two moments of the time available for this short debate. It has been the right and the duty of my hon. Friend the Member for Reigate (Mr. Gardiner), as the Member for Reigate and Banstead, in which the hospital is situated, to raise this important issue in the House.
1976 Although I speak from the Front Bench, I do so not as such but as the Member for East Surrey, because my constituents are also served by this hospital and are equally concerned about the conditions now prevailing.
As the Under-Secretary knows, all the representative bodies have expressed their concern about this situation. The case put by my hon. Friend is fully supported by the Tandridge District Council, which covers my own constituency. The council has expressed to me its deep concern about the present situation and wishes it to be known that it fully supports what my hon. Friend has said today.
Of course, I understand—if I may say so, who better?—the nature and gravity of the economic crisis and the need for economy of public spending. Quite rightly, not all cuts should be borne by the capital sector. In some ways, it is already depressed. It could be helped to some extent if the Government had the courage to resist unjustifiable expenditure in other directions. In any case, we have an assurance in the letter from the Minister of State dated 30th April 1975 thatthe health capital programme does enable a start to be made on those schemes which authorities consider to be the most urgent.On that basis, this project deserves the highest priority. I cannot begin to judge beyond that, but I hope that the regional authorities and the Under-Secretary and Secretary of State will accept that case.
There is a need for a higher degree of apparent candour on the part of Ministers dealing with this matter. It does not do them or the structure of government any good when the local newspapers are able to comment, justifiably, on the answer given by the Minister of State, apparently expressing total satisfaction with the potential effectiveness of the accident services. That answer does appear to suggestremarkable apathy…at the highest level.I do not imagine that either the Ministers or those advising them are as inert, apathetic or inhumane as the answer given might suggest. However, I hope that the Government will acknowledge the reality of the anxiety felt by our constituents, acknowledge the need to do 1977 something about the problem, and recognise the legitimacy of the fear that disasters can overtake this kind of situation if the response is not as energetic as it should be.
I had the unhappy privilege of conducting the Ely Hospital Inquiry and have been involved in other hospital and non-hospital disaster inquiries. There is a disturbing similarity about the ritualistic exchange of correspondence in this case and that in some cases with which I have been concerned. In some way, the system has not yet produced a way of delivering satisfaction. It must be as frustrating for the administrators as it is for the Ministers who preside over it, for doctors and others who work within it, as it is for the people who are served by it. I hope that the Under-Secretary wil acknowledge the reality of the feelings about the matter. We hope that he will be able to break out of the snare in which the system seems to have confined his predecessors.
§ 5.3 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Meacher)
First, I congratulate the hon. Member for Reigate (Mr. Gardiner) on the lucid and forceful manner in which he drew the health needs of his constituents to the attention of the House. The situation which he outlined is serious, and the certain fact that the deficiency in numbers and scattering of hospital beds which he describes is paralleled or even exceeded in other parts of the country does nothing to make potential patients, their relatives and friends, the doctors, nurses, technical and administrative staff working in this district—nor myself or fellow Members of Parliament—any happier.
It has been the unfortunate experience of what is now the East Surrey health district that the constraints of finance and difficult decisions about priorities and design which have followed rapidly on one another over the period of 15 years, to which the hon. Gentleman drew attention, have caused the deferment of plans for a definite start at this hospital from year to year.
However, the situation is now that even if money were available this year—which, I have to stress, it is not—the foundation stones of this hospital on the site which I know is available for it 1978 could not be laid for the next two years. This is partly for financial reasons and partly because the area and regional teams of officers, and the authorities for which they work, have not yet decided the design of the hospital. I know that the hon. Gentleman referred to "best buy mark II". I shall say more about that later.
There is no doubt that in their discussion of design which is now taking place they will be taking into account the considerable and undoubtedly valuable thinking which has already gone on about design over the past few years. Nor is there any doubt that all who are concerned agree that a new hospital is required. The problem, as the hon. Gentleman so rightly said, is purely one of timing.
I am aware of the original intention several years ago to have some kind of "harness" building. A phase 1 functional content was produced, but before long events overtook the plan and, because of capital restrictions, the regional hospital board asked the project team to rephase to meet lower costs. The Department had a priority for "harness" projects, but the design for Redhill was fourth in that list. Much of the work done on the first three would have been used for Redhill and other design tests would have been undertaken there, but the capital cut in 1972 prejudiced the "harness" solution, and it was that more than anything else which prevented the start.
A more recent recommendation, made as the result of deliberations with the South-West Thames Region, which had experience of the district general hospital opened by my right hon. Friend last April, was some application, as the hon. Gentleman rightly said, of the "best buy" principle. Both the Department and the region are now looking at the possibility of other types of development, more in line with the desperate economic situation—and I acknowledge that fully—with which we are currently faced.
I understand that a phased "best buy" solution to the design problem could mean that a start on building the first phase might be possible in about 18 months, although I emphasise that a decision to use such a design has not yet been made. I understand that the 1979 area and the region are due to meet later this month and that they will discuss this matter as a priority item on the agenda.
No one can doubt the real need for new development in this district, and I appreciate the particular difficulties in a district which suffered in some measure from reorganisation owing to the splitting up of some hospitals which were in the former Redhill and Netherne Hospital Management Committee Group, into what is now the West Sussex Area Health Authority. I might mention the deficiencies in the neighbouring Cuckfield and Crawley district, which I understand is desperate for a new hospital.
I am aware that it is in the provision of a new district general hospital, as such, with the attendant benefits of acute services being gathered together on one site so that communication, cross-referral and economy can be achieved—the hon. Gentleman referred to the lack of these advantages at present and the problems that arise—that this district falls down most severely.
The separation of related specialities, in some cases by many miles, contributes to the difficulties. We have no illusions about these, nor about our desire to see that they are remedied within the shortest possible time. In the meantime, however, I have no alternative but to say that the East Surrey district and the Surrey area will have to continue what they have so admirably started—I say that sincerely—namely, a rationalisation which will ensure that the best possible use is made of existing buildings and manpower, with the minimum disruption to patients and staff that can be achieved within the undoubtedly considerable constraints.
I turn to the specific deficiencies cited by the hon. Gentleman. First and foremost are the accident and emergency services—to which the hon. Gentleman and his right hon. and learned Friend the Member for Surrey, East (Sir G. Howe) rightly referred—in any discussion of the specific problems. These have caused considerable concern in the area, owing partly to Redhill's problems, partly to the increased load which is thought likely to result from the siting of Gatwick 1980 Airport in relation to this district and the forthcoming opening of the M25.
On these points there have been some misunderstandings, and I should like to take this opportunity to try to correct them. The major accident plan to which the regional authority has agreed accepts that facilities available in Redhill and neighbouring Crawley are only part of the necessary provision. In the unfortunate event of a major emergency—and one must, of course, plan for that—the ambulance service will endeavour to take patients to any one of six surrounding major units.
Crawley and Redhill would never have to go it alone. I stress that if the Surrey Ambulance Service could not cope I have no doubt that surrounding services would assist. By "surrounding services" I mean chiefly Kent, London, East Sussex and West Sussex. Perhaps I should also make it clear that the major accident plan is co-ordinated by regional health authorities in accordance with departmental policy It is for them to ensure that arrangements for dealing with major accidents are prepared by area health authorities in consultation with the district health authorities, local authorities, family practitioner committees, voluntary bodies, the Post Office, the blood transfusion service, the police and fire services and the Armed Services.
It is the responsibility of the regional authority to prepare and keep up to date a list of hospitals defined as major accident and emergency departments for possible designation in a major accident. Those listed as minor hospitals would fulfil a supporting rôle. This list is supplied to the authorities involved.
I have no reason to think that the existing plan as I have sketched it is inadequate for any disaster which can reasonably be foreseen. I do not think that that is a statement of complacency. However, my Department will encourage the regional authority to ensure that the plans for Surrey and the neighbouring authorities continue to be co-ordinated and continuously updated. The plan takes account of motorway accidents as it does of major aircraft disasters. I understand that Surrey is now reviewing its part of the major accident plan and 1981 that the region will be discussing the resulting report with Surrey.
The hon. Gentleman also made reference to the obstetric and gynaecological services. There can be no doubt that one of the other needs is for co-ordination of these services in the district. I realise that the staff are genuinely concerned at the dangers which they feel may exist when services are provided, as they are at present, over a scattered area. All I can say is that the district management committee is examining whether centralisation is possible, even without any new building, in the year or two that must elapse before the district general hospital building start can take place.
Next, I say a brief word about the pathology services which the hon. Gentleman has also mentioned. Although it is unfortunate that the pathology service of the former Redhill Hospital Management Committee, which was working well prior to reorganisation, is now divided between the two separate districts, I have no evidence to think that this causes any difficulty which good will—which I am sure is present—cannot overcome.
Perhaps I should say a word about operating theatres, another matter to which the hon. Gentleman referred. One of Redhill's two existing theatres has recently been upgraded to a standard described by the area health authority as adequate. The second theatre suffers from design limitaton. A third theatre is to be built using some of the money especially allocated by the Government this year for the reduction of waiting lists. It should be ready for use by the autumn of 1976. The area health authority regards the measures which have been taken over operating theatres as the best possible at present and the results as being as adequate as resources can allow. At the Department's request the authority is providing a report on working conditions in theatres.
1982 In the absence of any assurance that the Redhill General District Hospital will be able to become a reality in the immediate future, the regional health authority's team of officers will put forward to the Department the competing priorities when it submits its capital programme for the next two years.
As I have indicated, the outlook is undoubtedly rather bleak, but some major buildings will still be going on. The region has the difficult task of sorting out the competing priorities of at least three general district hospitals. Croydon has been promised a new hospital for as long as Redhill. At Cuckfield and Crawley there is a substantial planned population increase over the next few years. All this is in face of a heavy on-going commitment to schemes which have already been started.
I recognise that I have not been able to give the hon. Gentleman the full-hearted assurance he would like to have and which I should like to give. But perhaps I could be permitted to conclude by saying that we have the utmost confidence in the hard-pressed staff of the East Surrey district. I know that they will continue working as best they can for the benfit of the patients within the resources available. The Department, my hon. Friend the Minister of State and I will do all in our power, as I am sure will the regional health authority, to see that the highest proportion of money, commensurate with the needs of the people of the rest of the region, is allocated to them. But more than that, at this stage, I cannot say.
§ The Question having been proposed after 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 fifteen minutes past Five o'clock.