HC Deb 01 May 1975 vol 891 cc790-802

6.31 p.m.

Mr. Antony Buck (Colchester)

Mr. Deputy Speaker, I am grateful to Mr. Speaker for having allocated this Adjournment debate to me, thereby allowing me to raise the issue of the provision of hospital facilities in Colchester and the surrounding area. The debate on which we are now embarking is taking place at a different time from that which we had anticipated. In the normal course of events it would have taken place at the close of tonight's business. Had that been so I know that several of my hon. Friends from neighbouring constituencies would have been present. Owing to the alteration in time I know that the House will accept that they are prevented from being present. I am grateful to see the Minister of State in his place. I am also extremely grateful to my hon. Friend the Member for Reading. South (Dr. Vaughan) for being on our Front Bench to support me in this general discussion on the provision of hospital facilities in Colchester and the surrounding district.

Colchester is the oldest recorded town in the country but the length of its history is now liable to be matched by the notoriety of the saga relating to the failure to provide proper hospital facilities in Colchester and the surrounding district. When I became the Member of Parliament for Colchester in 1961 the situation was unsatisfactory. The situation is now appalling. Unless satisfactory policy decisions are made forthwith it is likely to become nothing short of scandalous.

In 1961 there was much talk in Colchester of the need for a new hospital. At about that time the then Member for Maldon, Mr. Brian Harrison, was chairman of one of the hospital management committees. In my early days in the House he talked about the need for a district general hospital. With me he campaigned hard over the years for such a hospital. I am grateful to him and sorry that he is not with us in the House.

In due course a site for the new district general hospital was decided upon and a starting date of 1972 was planned for the commencement of phase 1, although it was hoped and anticipated that that date might be improved upon.

During the following years I tabled Questions, wrote to respective Ministers and had consultations with the appropriate local hospital and health authorities. I shall not weary the House with a detailed analysis of the many exchanges that I had over those years. However, perhaps it is worth noting that in October 1968 the then Minister of Health, Mr. Kenneth Robinson, visited Colchester and gave his views. He commented on the work being done in the hospitals in Colchester and said: Much of the work is done under great pressure in conditions which are less than ideal. There is a good deal of overcrowding but everyone copes astonishingly well. There was then a good deal of overcrowding and there is even more now. Mr. Robinson then said: The only solution to the problem is well known—a new general hospital and the staff are looking forward to a new purpose-built building. That is what the Labour Minister of Health said in 1968. He was right. He was right in commending the work which was being done under difficult conditions to provide those in my constituency and in the surrounding area with a health service of which we could be proud in spite of the difficulties. Perhaps I can add my congratulations to what is being done by the medical staffs—namely, the consultants, who have been under such difficulties and pressures lately, the nurses, and all those who are in the professions which are usually described as ancillary to medicine.

On Monday I paid a visit to the Essex County Hospital, the maternity hospital and the military hospital. As on earlier visits I found that they are providing a splendid service, but are having to do so under the most extraordinarily difficult conditions. The conditions were described as bad by Mr. Kenneth Robinson way back in 1968. Since then the difficulties have become even greater because of increased pressures of population.

I shall not weary the House further with an analysis of the exchanges which I have had. Suffice it to say that the need today for a decision to be made for us to have our district general hospital is paramount. I hope that the Minister of State will be able to assure me that the funds will be made available for the start of the new general hospital. The site is available. the plans are ready, and when the funds are allocated the project can go out to tender almost at once. We are waiting for the off. The Questions which have been answered by the Minister of State's Department recently do not give me cause for optimism.

The situation for the future, if a right decision is not made, is alarming. I am not exaggerating. Let me give the House a short summary. First, there is the shortage of beds. By 1981, excluding the psychiatric beds, the bed need for the Colchester area is estimated at just over 2,000. The more precise figure that has been quoted to me is 2,015. On the present scheme of things the bed availability will be as low as 1,400. That is a shortfall of over 500 beds by 1981.

There is a crying need for an improvement in the position of the obstetric and gynaecology side of our medical services in Colchester. On Monday I visited the maternity home in Colchester. The staff has been working under appalling conditions and yet providing a magnificent service for a very long while. The new intensive care unit, which is at the top of the Edwardian building, is also doing magnificent work, but in completely inadequate conditions. On the maternity side the need for the new hospital indeed makes itself desperately apparent.

The surgical bed need by 1981 is estimated as being about 145. General medical bed needs by 1981 will be 253. The availability is now far less than those figures and comes, broadly, to the figures which I have just given as to the generality.

Where ever we look there is fragmentation of activities in the hospital group. There are wasteful journeys between hospitals. It takes 40 minutes to travel from some hospitals to the Essex County Hospital. This affects nurses' training and makes the process expensive, inefficient and unattractive. Also, junior staff have accommodation which is quite unsatisfactory.

The ophthalmic unit is contained in two rooms, and that again is a wholly unsatisfactory situation. All the way round one sees wasteful fragmentation in the group which makes the situation wholly unsatisfactory from the point of view of the patients and the medical staff. That is the overall situation. Time is limited, but the situation is becoming desperate.

On top of all this we have no indication from the present Government whether we are likely to be given our general hospital—unless the Minister of State this evening makes an announcement that funds will be made available. In addition, we are told in the defence review that the military hospital at Colchester will be closed. That reverses a decision of the Conservative Government, a decision with which I was associated. There was a recommendation to close that hospital but the then Conservative Government decided not to go ahead with the closure. When I was an Under-Secretary of State for Defence I was given a guarantee by my governmental colleagues that there would be no closure of the military hospital in Colchester for at least 10 years. One might be forgiven the thought that the military contingent could have been given facilities in a new general hospital. A 10-year guarantee was enough. The military hospital was rightly described recently in the local Press as "a priceless asset". That asset is now, apparently to be lost.

I tabled a Question recently to the Secretary of State for Defence asking what alternative arrangements he is considering to provide cover for the Service men and their families in the Colchester area on the closure of the military hospital in Colchester; if he will state the earliest date which he has in mind for this closure; and if he will outline what consultations he has had, and what consultations he anticipates having, with the civilian medical authorities in the area, in view of the contribution which the hospital makes to the medical services available to the civil population. The answer I received was as follows: Consultations with the Department of Health and Social Security are proceeding and full account is being taken of the contribution which the Colchester Military Hospital makes in respect of the civilian population. I cannot at this early stage say more."—[Official Report, 7th April 1975; Vol. 889, c. 353–4.] That was no answer, and anyway there was no local consultation. Yet that is a hospital which is making an enormous contribution to our medical affairs, particularly in the sphere of maternity facilities and matters of that kind. The military hospital does a magnificent job for Colchester, not only in respect of its own Service personnel but for civilians too. However, there were no consultations with the local medical authority, although I gather that some discussions are now to be started.

I wish to bring my remarks to a close by saying that there are many unsatisfactory features about the hospital facilities available to my constituents. On the question of isolation facilities, the situation is again most unsatisfactory since patients who should be totally isolated have to be accommodated in proximity to others not suffering from infectious diseases. There are no fit and proper facilities available in respect of the VD clinic. Again there is fragmentation, which is wasteful in many ways. Valuable equipment must be transported from hospital to hospital.

Mr. Kenneth Robinson was right to say that the only solution to the problem was a new general hospital. I am very suspicious of the priorities of the Labour Government—which can pour out hundreds of millions of pounds on buying into profit-making concerns and yet make no money available to ensure that the Government are doing the job they should be doing—namely, providing our citizens in general, and my constituents in particular, with a health service of which we can be truly proud.

The present situation is unfair on medical staff be they consultants, doctors or nurses. It is also unfair to ancillary workers and certainly unfair to my constituents as a whole.

I hope that even at this late stage the Government will have a change of heart and that we shall be given some hope by the Minister of State in his reply this evening. I hope he will be able to announce that he is now prepared to make funds avialable to provide what the former Minister of Health described as the only solution to the problem—namely, a new general hospital in Colchester for which the site is ready and for which plans have been made.

6.46 p.m.

The Minister of State, Department of Health and Social Security (Dr. David Owen)

The hon. and learned Member for Colchester (Mr. Buck) has made me aware—indeed I was already aware—of the widespread anxiety which exists in his locality over the future of the district general hospital. He has also drawn attention to the closure of the small military hospital earlier than expected, although no date has yet been fixed, because of the decision by the Defence Medical Services Inquiry Committee that there should be a reduction in the total number of beds in Service hospitals. That decision has been given urgency by the same financial stringency which has affected both the Armed Services and the National Health Service.

I recognise that the standard of provision in the area is not wholly satisfactory and that there is a strong case—and the hon. and learned Gentleman quoted Mr. Kenneth Robinson, the former Minister of Health—for new hospital provision. However, I must point out to the hon. and learned Gentleman and his Conservative colleagues that it is one thing to be in favour of public expenditure when it affects one's own constituency and another thing to be against public expenditure in general. There is a paradox in that situation. I think the hon. and learned Gentleman would be wise not to make too many party-political points since the hospital and capital development programme was brought to a savage and abrupt end in September 1973 with the then cuts.

The facts of life are that since then we have been living with a situation where we might have had to impose a complete moratorium on all hospital building starts. Because we have been able to obtain some extra public expenditure for the National Health Service in 1975–76 we have been able to lift the moratorium. As my right hon. Friend the Secretary of State for Social Services said in reply to a Question by my hon. Friend the Member for Preston, North (Mr. Atkins), we are now able to start a limited number of major building schemes in the health service and the moratorium will be lifted. We must recognise that there are many hospitals throughout the country which have not been included in the lifting of the moratorium, but the House will be aware of the financial climate in which we are now living.

It may help the House if I explain how the schemes were selected. In December 1974 we gave regional health authorities provisional lists of major schemes which we thought might be started in their regions. Regional authorities were told of the criteria used in selecting schemes and the sum of money provisionally allocated to them. They were asked to consider the provisional selection and other schemes on the stocks and to let us know whether they wished to suggest any changes.

In considering the proposals, regional health authorities were subject to three limitations. The first was that any suggested variations should be containable within the sums provisionally allocated for 1975–76; secondly, that any alternative schemes should fit the national criteria; and thirdly, that we should have to look nationally at the financial implications of their proposals for future years.

The list of schemes which the Secretary of State announced on 15th April, which was Budget day, was affected by the Budget Statement in that we shall not be able to spend as much on the health service in the year 1976–77 as we had previously envisaged. It was obviously important to take this into account when projecting forward the schemes for 1975–76, since these will have considerable effect on 1976–77. In the light of that we were certainly not able to add any schemes to those provisionally selected.

We have already asked authorities to undertake a review of their forward plans, and we shall shortly be giving them planning assumptions for future years on which the review should be based. They will then be able to consider whether and when they can go ahead with the schemes which were not included in the announcement. As indicated by my right hon. Friend's statement, she is also willing to consider proposals by an authority to substitute an alternative to the listed schemes, providing the change can be accommodated within its allocation.

Turning to the situation in Colchester, the North-East Thames Regional Health Authority, while awaiting further guidelines and the planning assumptions to which I have referred, has already started consideration of a regional strategy in consultation with the various area health authorities concerned. I cannot, of course, anticipate what they will propose in the way of priorities over the coming years, but they face difficult choices. In the meantime, we have to look at a number of major capital projects in that region, and outside it, not all of which can be undertaken in the immediately foreseeable future. I must make clear to the hon. and learned Gentleman that, whatever the needs of Colchester, many other areas and regions also have a strong claim. In my view there is an even more pressing need in East London, where Newham is still waiting its new general hospital.

Turning to the situation in the Colchester health district, the need of a new district general hospital there has been pressed and accepted for many years—and I will not deny that to the House today. There are three separate parts of this district, the first being Colchester and its neighbourhood, the second, the coastal strip and its hinterland, and the third, the area around Halstead for which health services have been traditionally provided from Colchester. The district also manages Notley Hospital, outside its borders, and provides psychiatric services for other districts and areas. Colchester is the natural centre for hospital services in an area where the population is rapidly expanding. It was expected that when the hospital was completed it would be possible to close three of the old hospitals, and there would have been some consequential savings.

It was only after lengthy discussions that the site of the hospital was selected. Although plans had been advanced last year nearly to tender stage, there were still important consequential matters to be settled, and it was not possible to enable the authority to go ahead until it was clear whether the scheme could be included in the 1975–76 capital allocations. It has not been possible to include it this year. Assuming that all had been well, however, the scheme could not have been ready before about 1980. Under the original plan this would have been a first phase of 748 beds, which included 360 general acute beds, 120 maternity and 80 pediatric beds, a mental illness unit of 160 beds and 160 day places, with some other miscellaneous beds, and out-patient, accident and emergency departments. The total cost, even at December 1973 prices, would have been over £14 million, spread over five years.

I must tell the House that schemes as large as this tend to attract high tender prices and management difficulties which often lead to contractors' claims. We are beginning to favour contracts of a smaller size, but I agree that this particular scheme is not easy to break down into smaller effective parts. However, since the maternity accommodation which the hon. and learned Gentleman mentioned is needed very urgently, it may be necessary to look into the possibility of building this unit by itself first; but this is by no means an ideal solution.

I come now to the small military hospital which is to be closed in due course for reasons of economy. At present it takes as patients both Service men and their families, and, on recent figures, well over 1,000 National Health Service patients annually, constituting over one-third of the total. Nearly a quarter of the NHS patients were maternity cases. As the hon. and learned Gentleman knows, the Defence Department has entered into consultation with my Department, in view of the contribution which this hospital makes to the medical services for the civilian population of Colchester.

One possibility which is being canvassed would be to hand over the hospital to the health authorities as a going concern. Professional officers of my department have already visited the buildings, and the regional health authority, together with the area health authority, will also be making a full inspection during this month.

Mr. Buck

I heard of that rather belated visit being arranged only after the decision to close the hospital was made. If it is to be taken over, by the health service how is it to be staffed?

Dr. Owen

Its staffing problem will presumably reflect the situation in any large district general hospital if there are staff shortages in the district. I do not claim that it is an ideal situation. There are certain facilities, particularly the maternity accommodation, which it is felt would be very useful to the Colchester area. Until more progress have been made in discussions with the health authorities, however, it is impossible for me to speak about its staffing or whether it would be wise to take the hospital over completely.

Whatever may be the outcome of the negotiations over the future of the military hospital, nobody would claim that it could ever be a substitute for the new hospital which has had to be deferred for the time being. I cannot say when work would be able to start, but in the economic circumstances which confront us there can be no general assumption that it is simply a question of retiming and that all building schemes eventually will go ahead as planned, albeit after some delay. The restrictions on what can be reasonably afforded in the years immediately ahead are such that the authorities inevitably will find it necessary in many cases to consider an entirely fresh approach aimed at securing the maximum benefit, in terms of service to the public, achievable within the limited foreseeable resources. I must tell the House that we shall have to be thinking in less ambitious terms as far as new building is concerned.

The Department, in its own work on designing standardised hospitals, is recognising that this is an important trend and one which I strongly support. It is aiming to produce designs which will provide, for the kind of sum which is likely to be affordable in any one district, the nucleus of a district general hospital which can grow and expand as resources or demand require. This would give the basis of a larger hospital in the fullnes of time when more funds were available. By this means we shall make our own contribution to the building programme in a way which seems to us entirely relevant to the future situation as far as we are able to judge it.

It all very much depends on the financial situation affecting the country. We have already had to make a decision that we shall preserve the revenue allocation for the year 1976–77 so that the National Health Service can keep pace with inescapable commitments and demographic factors. That has meant a further cutback in what we might have been able to put into the capital building programme. If, however, authorities can make a reduction in revenue and use that elsewhere by making sensible choices, we shall look very favourably on suggestions to switch from revenue to capital. But the prospect is not easy for the long term.

As regards Colchester, I would hope to have comments from the regional authority on its overall strategy by the autumn and to be able to make decisions, or at least give some indication then. Certainly, I hope we shall know more about the military hospital and be able to reach a solution on that, as well as taking the maternity facilities into account as one of the most pressing needs. I shall certainly look into this, but I must tell the hon. and learned Gentleman that while I am not denying the need, and I accept that it is great, I do not think we shall get through the next difficult years by people trying to blame any particular party. We have tried to increase public expenditure on the health service at very difficult times and we have been attacked by Opposition Members for allowing public spending to increase. Had we not increased public expenditure, many hon. Members would be having no new hospital starts at all in their areas. As it is, many of them have had theirs postponed.

I do not deny to the hon. and learned Gentleman that there is a problem in the Colchester district, and to some extent this has been exacerbated by the problems of the military hospital. But given collaboration between the regional health authority and the area health authority, and with any help that my Department can give, we shall be able to make arrangements which will look after the hon. and learned Gentleman's constituents and health care in this particularly difficult area. If the hon. and learned Gentleman has any particular suggestions. I shall certainly look into them.

I welcome the tribute that the hon. and learned Gentleman has paid to the staff who have worked for many years under difficult circumstances at all levels—consultants, nurses, ancillary workers and those in primary health care. I hope that we shall be able to achieve a solution to the difficult problems, given the limitations of money, to ease their burdens and make it somewhat easier to cope with the problem.

It is in that spirit that I reply to the hon. and learned Gentleman. I know that my hon. Friend the Under-Secretary of State for Defence for the Army will take careful note of the points that have been raised in the debate. If necessary, I shall consult him about what we can do to ensure—

It being Seven o'clock, and there being Private Business set down by The CHAIRMAN OF WAYS AND MEANS, under Standing Order No.7 (Time for taking Private Business), further Proceeding stood postponed.