§ 1.15 p.m.
§ Mr. William Whitlock (Nottingham, North)
I am glad to have the opportunity of raising in the House a matter which is very important to the hospital service in Nottingham. Over the past 15 years I have repeatedly spotlighted the imbalance in the provision of National Health Service funds as between the old Sheffield Region and the rest of the country. I have pointed out that within the region itself the further south one looks 725 the more unfairly low is the level of funds made available for the hospital service.
The announcement of the proposed deferment of the building of the ward block scheme at the Nottingham City Hospital is yet another example of the long history of unfairness. Perhaps the House will appreciate why I say this when I give the details of the accommodation which the new development is intended to replace.
Facilities at the Nottingham City Hospital for the treatment of burns and plastic surgery cases in a combined unit are inadequate in the extreme, there being no separate purpose-built units. Only the artistic genius of a Hogarth could adequately portray the clutter of beds and equipment which exists there, and such a portrayal would be harrowing were it not for the fact that the visual impact of the scene is softened for the observer by the evidence of the dedication and humanity of the staff and by the efforts of all concerned to brighten the accommodation so far as possible. That same dedication of the staff has ensured that over the years during which these dreadful conditions have existed there has been no infection. This is truly a miracle.
Drawn from a catchment area of over 1½ million people covering most of Derbyshire, the whole of Nottinghamshire and parts of Lincolnshire, there are in this accommodation burn cases, cases of major injuries to face and limbs involving skin loss and cases of skin cancer and of carcinoma of the mouth and jaws. In these cases, where disfigurement produces in-patients a very natural desire for privacy, there is none. All are treated in one ward—burns cases, injury cases, cases of malignant disease. It is true that there is a separate adjacent children's ward for the treatment of burns and congenital abnormalities, but that too is totally unsatisfactory.
Such is the absence of storage space for this accommodation that a fire exit and a sluice have to be put into use for storing equipment of one kind and another.
It must be remembered that, apart from the urgent cases which fill these beds, patients who suffer from less urgent conditions are seen in the out-patient department and are put on a waiting list 726 which has reached unmanageable proportions, being in the region of 15,000 to 16,000 people awaiting in-patient surgery. This means that patients with conditions which cannot be classified as priority are not likely to be operated upon in the foreseeable future. This is a truly shocking state of affairs. It means that with the present lack of facilities we are providing no more than an emergency service for burns, injuries and malignant diseases.
The facilities for paediatrics and neonatal surgery at the city hospital are also grossly unsatisfactory, although every effort has been made to improve premises which do not lend themselves to attempts at additional modernisation. The first floor paediatric medical ward is not served by a bed-lift and the paediatric surgical wards which are in the same block are separated from the operating theatres by a long, unheated corridor.
In neo-natal surgery no special facilities have yet been provided for two consultants appointed in the last two years. As a result the operating theatre of the city hospital's maternity unit is used for these cases, the babies being nursed in the maternity special care baby unit. As my hon. Friend the Under-Secretary will know, neo-natal surgery is a sub-regional speciality, with Sheffield the only other centre in the Trent Region.
Paediatric nurses are in short supply and there is a need to attract more nurses of the right calibre into this side of nursing, where there is a high degree of emotional involvement with the child and the mother. This is yet another reason for the speedy provision of modern facilities to replace the slum accommodation which we have at the city hospital.
Paediatric teaching is also made extremely difficult in present circumstances, and I have seen students crammed into a tiny room, literally sitting at the feet of their tutor because there is no room for chairs.
A decade or so after the Platt Committee's report on the need to provide in hospitals accommodation for mothers so that they may be near their small children, there is in this unit one small cubicle containing one bed, made available on I know not what assessment of priorities among anxious mothers.
In the paedriatrics ward is a small playroom for those children who are 727 mobile, but it serves also as a classroom for children who require lessons, as a sitting room for the staff and the mothers and as a dining room. Storage facilities here are as lacking as those I have described in the plastic surgery and burns wards, and unlikely and ill-suited spaces are just as inevitably used to store equipment as in those wards.
Included in the new ward block development would also be facilities for chronic renal dialysis, and in this field also the area lags sadly behind. The facilities in Nottingham are minimal for regular haemodialysis of patients suffering from severe kidney diseases. A six-bed acute kidney unit is approaching completion at the city hospital and is being provided out of money collected from the people of Nottinghamshire through the Lord Mayor's appeal fund for the treatment of kidney disease. Its limited rôle will be available for patients requiring dialysis and support following transplant surgery, but although it will be useful as an interim provision it is neither designed nor large enough for the Nottingham Area Health Authority's needs.
It is a staggering thought that Nottinghamshire has no designated dialysis beds and no designated kidney transplant facilities, although renal transplants are carried out in "borrowed" beds. Thus the development of the kidney service and the training of patients for home dialysis will be impeded by postponement of the "H" Block scheme, and it will also be impossible to appoint a much-needed additional consultant in nephrology.
It must surely be clear from all this that the delay in the commencement of the new ward block scheme involves not only continued treatment of patients in appalling conditions but perpetuation of long waiting lists in some specialities, total denial to the population of others, a hampering of clinical teaching and a reduced output of doctors. It is, therefore, absolutely imperative that the scheme shall go forward in 1975–76.
Over the years I have at times called at the Nottingham City Hospital for one purpose and another, yet never until recently has anyone drawn my attention to the conditions which I have described in this part of the hospital complex. One might ask why no one long ago had raised 728 protests loud and clear about those conditions and why it was that no one realised that the December 1973 Conservative budget which lopped £120 million off the National Health Service capital expenditure would almost certainly involve the city hospital development among all the projected new building schemes all over the country which would be cut by that budget. I have found that locally people employed in the hospital service seem to have gone along for years blissfully hoping and believing that a replacement of the inadequate facilities I have described was to come fairly soon, and it seems to have come as a shock to them that Conservative cuts meant cuts in their field of interest at the very point where the new ward block scheme seemed at last to be materialising.
But if people at the grass roots of the National Health Service in Nottingham did not appreciate that their much-desired project was in jeopardy, obviously the hierarchy at regional health authority level must have known. About three years ago I referred in the House to all the "generals" at the old regional hospital board level and pointed out that while generals were necessary, we must be careful not to have too many of them, because they do not bear the heat and burden of the day at the point where all the action takes place. Unfortunately, the reorganisation of the National Health Service carried out by the Conservative Government has produced more generals who are even more remote from the needs of the localities. Had they not been so remote, the information at the grassroots level in Nottingham about the need for this scheme would have percolated through to them and ensured that the Nottingham City Hospital scheme was given priority.
Incidentally, I would be very interested to know how much of the sum allocated to the Trent Regional Health Authority is to be spent on improving accommodation for the generals, because I have the uneasy feeling that quite a large proportion of this figure will be spent for that purpose.
In a Written Answer to a Question on 20th February, 1975, my hon. Friend the Minister of State said:We are urgently reviewing the methods of allocating funds to health authorities to make 729 them more responsive to needs."—[Official Report, 20th February 1975; Vol. 886, c. 511.]I shall be very interested to know the result of my hon. Friend's very necessary review, because it is certainly the case that there is a need to make the health authorities aware of the true position at local level.
When in mid-January I learned of the deferment of the new ward block scheme at the Nottingham Hospital I wrote to my right hon. Friend the Secretary of State for Social Services and shortly afterwards twice saw my hon. Friend the Minister of State. He informed me that although the Trent Regional Hospital Authority regarded the city hospital redevelopment as very important, it did not give it priority over several other major schemes in the region, including phase II of the Nottingham University Hospital, and that therefore, despite the fact that the region will almost certainly have the largest regional capital allocation in 1975–76, it seemed unlikely that the city hospital scheme would go forward in 1975–76. He undertook, however, to convey my views to the regional health authority. Later he told me that he had asked the authority to consider its priorities once again in the light of representations I made to him.
I understand that the authority has put forward the proposal that the city hospital scheme will go ahead in 1975–76 on condition that in 1976–77 the projected new hospital at Chesterfield will be started. The Chesterfield project was included in the 1975–76 programme, but I understand that there are reasons why it cannot be started until 1976–77. I hope, therefore, that the Under-Secretary will tell me that we can have the city hospital redevelopment in 1975–76.
Even if in the Trent authority we receive in 1975–76 the largest regional capital allocation in the country, we have a long way to go before we receive a just recompense for the unfair low allocation we in the Nottingham area have received over the years since the National Health Service was brought into being. The building of the new ward block scheme at Nottingham will not correct the injustice which Nottingham has endured for years, but it will make us feel happier as we contemplate the back-log of all that is due to us.
730 On 2nd December 1974 my right hon. Friend the Secretary of State for Social Services, in listing her priorities for the National Health Service, stressed the need to ensure that we maintain our expanding medical student intake and the need to reduce long waiting lists. Both those priorities are involved in the Nottingham City Hospital ward block scheme. Until it is built the expansion of the number of medical students in the Nottingham University Medical School will have to be held back, because paediatric teaching in the middle year of their clinical course is one of the most important subjects. I have explained how difficult it is for that teaching to proceed. Delay in the scheme will mean the continuance of excessively long waiting lists.
In case my hon. Friend suggests that the fact that the university hospital phase II is proceeding has any relevance to the ward block scheme, let me tell him that it does not. With the exception of some of the medical paediatric facilities, none of the other beds and specialities involved in the city hospital scheme has any content in the university hospital.
Another high priority stressed by my right hon. Friend on the 2nd December was the maintenance of present levels of capital expenditure on geriatric, mental illness and mental handicap schemes—three areas neglected over many years. Yet that priority does not seem to have registered with the Trent Regional Health Authority, because with the announcement that the city hospital scheme had been deferred came similar news of the deferment of the building of a new unit at the Highbury Hospital, Nottingham, which would have provided residential accommodation for 96 mentally handicapped adults and a further 115 day places for severely mentally handicapped adults.
There are many handicapped people who cannot attend training centres because they need more care and attention than the centres can provide. At the same time homes for mentally handicapped adults cannot provide permanent homes for people who need a degree of nursing inconsistent with the philosophy of community homes. Thus the new unit at the Highbury Hospital has been badly needed for years.
That is the sorry picture I have to paint. I hope that the new attitude of 731 the Trent Regional Health Authority, combined with my right hon. Friend's approach to priorities, will enable my hon. Friend the Under-Secretary to give me news today which will be welcome in Nottingham.
§ 1.37 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alec Jones)
I am glad that, following the abortive attempt of my hon. Friend the Member for Nottingham, North (Mr. Whitlock) to raise this subject the other night, he has met with success today.
It is right and proper that he should draw the attention of the House to the neglect in health services in the Nottingham area, which has occurred over a long period. It is proper that he should draw our attention to the cuts in public expenditure imposed on the health service by the previous Government which did not help. These situations tragically exist in Nottingham and elsewhere. They are legacies from the past and a reminder of just how much remains to be done before we achieve uniformly high standards of accommodation in the health service.
I am grateful to my hon. Friend for paying tribute to the staff in the Nottingham City Hospital who work under such tremendous difficulties. In view of the publicity which the facilities at this hospital have received, it is right and proper that we should place on record our appreciation of the valuable work done by the staff under these trying difficulties.
It is equally true that the area of the Sheffield Regional Hospital Board was an under-Privileged region. It is known that in 1948 the then Sheffield Regional Hospital Board inherited a region seriously deficient in health care facilities. It is also true that inequality of provision existed within the region and that places such as Nottingham and Leicester required considerable capital improvements. Some large capital programmes are in progress in Nottingham. My hon. Friend is aware of the decision to establish a new medical school at Nottingham. Although I appreciate the point he made, this does not do away with the need for dealing with the specific proposal for the Nottingham City Hospital. I will not pursue that point in view of the time left to me.
732 In her statement to the House on 2nd December the Secretary of State explained the national priorities which were to be observed in selecting the few major building schemes to be started in 1975 –76. She laid down the criteria to which my hon. Friend has referred.
In December last year regional health authorities were given provisional lists of major schemes thought likely to start in the regions in 1975–76. They had been selected by reference to the nationally—defined criteria. Regional health authorities were also notified of the sums of money provisionally allocated to them. They were asked to consider the listed schemes with any others they might have in mind for the coming year and to let my Department know whether they wished to change or to suggest any changes in the national view of priorities. It was made clear that regions could propose any variations within the total sums provisionaly allocated to them provided the new schemes fitted the criteria and provided my Department was satisfied about the financial effects of any variations on 1976 –7 and later years.
In recognition of its deprived status in past years and the presence of two new medical schools, the Trent. Regional Health Authority provisional allocation for 1975–76 is larger than for any other region. Nevertheless, the regional health authority faces a difficult task in determining priorities. In Nottingham alone three major schemes were programmed to start in 1975–76. They were phase 2 of the university hospital, costing £16.75 million, an adult mental handicap unit and day centre at Highbury, costing £1 million and the City Hospital ward block, which my hon. Friend has so passionately described, costing £1.8 million.
The first scheme makes a major contribution to medical undergraduate teaching. The second is high on the list of priorities in terms of client group requirements and the third, the City Hospital ward block, is needed partly to fill gaps and carries a high service priority.
The idea of providing this new ward block was first proposed by the then Sheffield Regional Hospital Board when it was decided in 1971 to abandon a programme that had been in progress for some time to upgrade wards and to move in favour of the development of a new 733 block. I have acknowledged that where provision exists in Nottingham for some specialist treatment the facilities are not of the quality required either by my hon. Friend or myself. Nor are they what the Department would want.
It is true that the City ward block scheme would help to cove the problem outlined so graphically by my hon. Friend, by his reference, among other things, to the artist Hogarth. I assure my hon. Friend that if the City ward block scheme fails to get into the 1975–76 programme, my Department will ask the health authorities to consider as a matter of the utmost urgency what contingency arrangements are necessary. I am not suggesting these contingency arrangements as an alternative but merely to show that I appreciate that we have to take some action to overcome some of the difficulties to which my hon. Friend referred.
My hon. Friend will be aware that some doubts arose recently about whether we have been fully apprised of the Trent Regional Health Authority's views on priorities for 1975–76. To resolve this we asked the authority to review the position and to let us know what its priorities were within the sum provisionally allocated to it and bearing in mind the selection criteria.
The authority met on 10th March. My hon. Friend will have seen the statement it then issued. It again endorsed a number of schemes provisionally selected in December and agreed by it in January. It listed two other schemes which it would like to start in 1975–76 provided sufficient funds could be made available to accommodate them in 1976 –77. The Nottingham City Hospital scheme was one of these added schemes. There is a complication. The regional health authority proposed the scheme subject to the proviso that it should not prejudice a start on the new hospital at Chesterfield which is being planned for a start in 1976–77 and which it regards as its top priority on grounds of service need.
Unfortunately my right hon. Friend has not yet been able to give the regional health authority a provisional capital allocation for 1976–77 and I am not therefore in a position to say whether this scheme can go ahead. I know that this 734 will obviously cause disappointment to my hon. Friend who wanted something specific. All I can say is that I hope to be in a position to reach a decision on this matter of the amount of money available, the question of the Chesterfield Hospital and the effect that it would have on my hon. Friend's proposals within the next week or two. As soon as I am in a position to make an announcement I will ensure that my hon. Friend is the first to receive the information.