§ 11.12 p.m.
§ Mr. Peter Mills (Devon, West)
I am grateful for this opportunity to put before the House a problem that concerns many of my constituents. Indeed, I am grateful to the Minister of State for coming to reply to the debate. I thought that a junior Minister would reply, and I am grateful to the hon. Gentleman for coming here tonight. It shows the importance that he attaches to the problem that we are experiencing in South-West England.
The reason for this debate is the real possibility of many small hospitals being closed in North Devon, West Devon and, indeed, over the South-West as a whole. That is the fear of many people. This is due to certain proposals that are now being made by district health authorities. 591 They are having to cut back on expenditure and not overspend. I am not opposed to that. I am certain that that is the right thing to do, for inflation still rages and the Government have decided not to increase their support to cover the inflation bill.
A frantic search is being made to try to save money, and one can understand that. It is no good Opposition Members asking for cuts to be made if we do not ensure that every avenue is explored to see where money can be saved, though I still think that there are other ways of saving money. Indeed, I think that we must get our priorities right, but in the area as a whole £600,000 overspending is a considerable sum of money.
The hospitals about which I am talking include Winsford Hospital at Hal-will, Beaworthy, Torrington Hospital and Old Tree Hospital, Launceston. Those are the ones that we fear may be closed. Hon. Members who represent other parts of the South-West have fears about other hospitals that may be closed. I gave warning about the dangers of these closures some time ago. I am sure the Minister knows all about it because I have had various letters from him concerning the genuine fears of many people. He gave me an assurance that these small hospitals would not be closed, but, of course, at that time I do not think he fully appreciated the amount of overspending which was going on.
A serious situation exists for the many rural people in my area of West and North Devon. I do not want to cry "wolf" but I believe that people in rural areas have already suffered enough compared with towns. One sees this in the depopulation which is taking place and also in the loss of buses and rail services as well as the closure of many small village shops. Now, to their annoyance, there is the possible closure of their own small hospitals which they have supported so strongly and helped in many ways for many years. Many people, and I agree, are saying this is just not good enough. The reason for their anger and dismay, if these cuts take place, is the difficult position in which rural people will be placed if these hospitals are closed down.
The problem of transport for relatives to visit those in hospital is extremely 592 difficult. It could mean 40 or 50 miles of travelling if one concentrated on the main Plymouth, Exeter and Barnstaple hospitals. It is important for relatives to visit those in hospital, and the cost is expensive in rural areas when there are no buses or trains and one has to beg a lift or go by car.
It is also felt, and I agree, that many minor operations can still be carried out in these small hospitals. They are done very successfully. In emergencies, too, I would much rather be treated in a tiny hospital and have something done quickly than be carted all the way down to Plymouth or Exeter. Everyone knows there are days when one can get to Exeter, Plymouth or Barnstaple quickly but there are days in the summer, when visitors are about, when it is very difficult.
There is also the whole question of waiting time. I am not an expert in these things but I understand that waiting times for minor operations can be considerable, particularly for things like varicose veins and hernias, and which could be done very effectively by a local physician or surgeon in the small hospitals. However, I fully realise that if one has a major illness, something which needs senior people to deal with, one will want to go to the three main hospitals in the South-West.
The fourth reason is one which I feel particularly strongly about and I hope the Minister will not feel I am exaggerating or getting emotional. It relates to terminal cases. I have found that many people go to Exeter, Plymouth or Barnstaple and undergo major surgery and then, sadly, they are told that they are terminal cases. What do they want to do? I would be in exactly the same position—I would want to die in my own small cottage hospital or geriatric hospital.
Many people, I know from experience come to these hospitals in the last days of their life. They are among friends. Relatives are able to visit them quickly. It is a terrible thing if this is denied to them. It is almost immoral that people should not be allowed to die close to where they have always lived instead of 60 miles away, even though it be in an efficient and modern hospital. But it is not the same. I make that point very strongly. 593 I am told by the doctors that in a small town with a small hospital they like to keep their hand in, so to speak. They like to be able to treat their own patients in these 14-bed or 15-bed hospitals. That is to the benefit of medicine as a whole.
There is also the problem of remoteness for maternity treatment.
§ Mr. Mills
Yes. I shall be coming to Old Tree later. That serves my area as well as North Cornwall. My hon. Friend the Member for Bodmin (Mr. Hicks) uses it, of course not personally—or I hope not—but, certainly his constituents do.
I have had thousands of signatures protesting against just one of the proposed closures—Winsford Hospital at Halwill, Beaworthy. The case has been put strongly to me by the chaplain, the Rev. Peter Ince, and by many others who feel strongly about it. The Minister knows about this matter. I hope that he will give some reassurance that this hospital will not be closed. Countless other people and councils have been in touch with me protesting at closures in North and West Devon and elsewhere. I believe that they are right in their dismay. I do not see why rural areas should be penalised.
I should like to give some interesting figures of the costs of a small hospital compared with a major hospital at Barnstaple. The Minister may care to make a note of them.
In 1974–75 at the Torrington Cottage Hospital the cost per bed per week was £74.10 compared with £155.50 per bed per week at the North Devon Infirmary—a difference of £81.40. That is a considerable saving.
If all those in-patients at Torrington Cottage Hospital were treated at the North Devon Infirmary instead, it would have been £39,356 more expensive in one year.
The cost of transporting all the casualties, out-patients and minor operations done at Torrington Cottage Hospital to the North Devon Infirmary casaulty department would have cost up to £29,000 per year. 594 For this small catchment area there would be a difference of £81.40 per bed per week—a total saving in the year of £39,000—and then the cost of transportation of £29,000. It is amazing that there should be any argument about this matter.
The total sum of £68,000 is £22,000 more than the total cost of running Torrington Cottage Hospital and £9,000 greater than the estimated £59,000 saving in closing that hospital. In that one case alone the argument is proved, besides all the social and other advantages which I have mentioned. The case is proved on the cost of just running the place.
I turn now to Old Tree maternity home—a lovely name—which has served the community well for many years, it is near Launceston. I must confess that my wife had to be rushed to Plymouth when our children were born. They were booked into Old Tree, but they did not finally make it. However, Old Tree has served the area most satisfactorily for a long time.
I understand the problems at Old Tree. I am not against its closure because it has many problems—for example, staffing, it has not been modernised, and so on. But a maternity capability must be provided in the area, as I am sure my hon. Friend the Member for Bodmin would agree. Mothers may have to go 50 miles to Plymouth—the "dash to Plymouth". I understand that one baby was born in a lay-by just this side of the Tamar Bridge. Heaven knows what will happen. We do not want a death or something serious. Considering the holiday traffic and the difficulties of the winter, the dash to Plymouth—in spite of Plymouth being the Minister's own area and hospital—is a hazardous game for a mother with a baby on the way.
Provisions need to be made in the area. The journeys are too difficult, and we must have a capability somewhere in the area of Launceston.
§ Mr. Hicks
May I remind my hon. Friend that last year alone there were some 1,000 births in Plymouth and West Devon hospitals to parents who live on our side of the water? Is he aware that we had a similar exercise with the closure of the maternity home at Liskeard? I had an Adjournment debate in 1973, and 595 one of the reasons given then to substantiate the closure of that maternity home was the availability of facilities at Launceston.
§ Mr. Mills
I understand that, and I am sure that the Minister will take note of the point. I now hurry on with my speech because another hon. Member wishes to make a brief contribution to the debate, and we want to give the Minister as much time as possible.
What needs to be done? It is no good just being critical about these things. I am not critical about the cuts. I am critical about how they are being applied. What the Secretary of State has said—and this is most encouraging—is that the South-West has not had a fair financial allocation and that we are to expect a plus-3½ per cent. of revenue growth. This will help. I hope that the area health authority will take this into account before it makes any closures at all. We should be able to save these hospitals and facilities in rural areas because of this. I hope so.
Savings will have to be made, but let us have them across the board, with each part bearing its share and not closures in certain areas. I still believe that there would be savings in administrative costs. In certain areas more could still be done, and some of the minor services could be saved as well.
The window-cleaning example at Yealmpton, about which the Minister will know, was very interesting. A pensioner was doing that job for one-third of the price of the modern contractors who were called in. I say, let the pensioner clean the windows, and save money.
Finally, to close hospitals such as Torrington, Winsford and others is an unacceptable error. If savings are to be made, they should be made over the whole region, rather than damaging one particular community.
I close with an analogy which I am sure the Minister will understand, being a doctor himself. If it is necessary for an overweight person to lose 2 stones, he may do it either by carefully dieting or by cutting off, for instance, one of his legs. Obviously the first course is the most sensible, and the cheapest in the long run. I hope that the area and district authorities will think again before they take such a drastic step as the latter.
§ 11.28 p.m.
§ Mr. David Penhaligon (Truro)
I am sure that the hon. Member for Devon, West (Mr. Mills) knows why my right hon. Friend the Member for Devon, North (Mr. Thorpe) is unable to speak in this debate. My right hon. Friend has asked me to make a few comments about South Molton Hospital.
I understand that South Molton Hospital serves an area of 400 square miles and a population of 13,000. In 1974–75 there were some 1,395 admissions. That represents 10 per cent. of the local population. The 11 beds had an occupancy rate of 10.1, which is really quite remarkable. Between Barnstaple and Taunton and Barnstaple and Tiverton, it is the only hospital.
We all know what has happened to rural bus services. They have been cut and continue to be cut. To Barnstaple on Sundays there are no buses at all from South Molton. This is an area where some industry is being implanted. That is probably one of the reasons why the casualty facilities are so important.
The hospital also offers some help towards geriatric cases and pensioners in the area.
Lastly, but by no means least, all the staff are local people. In an area in which fairly-well-paid jobs are at a premium that is important.
It is not up to my right hon. Friend the Member for Devon, North to suggest where cuts should be made, although he is accepting that some have to be made, but the Devon Area Health Authority has pointed out that the mere non-opening of the Kingsley Hospital could save in a year some £77,000.
I hope that the Minister will bear my remarks in mind.
§ 11.30 p.m.
§ The Minister of State, Department of Health and Social Security (Dr. David Owen)
It gives me pleasure to reply to the debate because it concerns an area of my county of which I am fond and I know many of the small hospitals involved.
The problem is that the Devon Area Health Authority was faced with a considerable overspending—probably between £1 million and £1,500,000. To curb the rate of overspending the management teams of each of the four districts for 597 which the authority is responsible were given staffing reduction targets and, in addition, were instructed to make further savings during the new financial year proportionate to the current excess spending levels. In the case of North Devon the amount to be saved over and above that achieved from not filling a quota of vacancies was about £40,000.
The consultative document did no more than express five options each of which was thought to be capable of providing the reduction in expenditure levels required. Three of these options raised the possibility of closing a single small hospital—in each case a different hospital. Honourable Members will, therefore, appreciate that the present financial pressures on the health authority are unlikely to lead to the closure of more than one small hospital in the North Devon Health Care District, depending on which option is adopted. I am not certain whether it will adopt any of those options.
At this stage the area health authority will have to review the situation, and if it decides to close any of these hospitals it must follow the consultative procedure laid down by my Department. The community health authority would have an opportunity to make its views known, and if there was disagreement the matter would go to Ministers for a decision.
Resource allocations are important. The hon. Member for Devon, West (Mr. Mills) mentioned the South-West, and it is important also in Cornwall. The South-Western Region has turned out to be one of the more deprived regions—a fact which hon. Members and I have unsuccessfully argued for many years. The South-West Region is to receive a development addition, as well as an allocation to meet the revenue consequences of capital schemes, which represents a growth rate of just over 3.5 per cent. in 1976–77. But it is no use merely redistributing resources at a regional level unless it is accompanied within regions by a redistribution of resources to areas and between districts.
I am pleased that the Resource Allocation Working Party is now looking at the allocation to areas and districts and we are expecting regional health authorities to ensure that our commitment to the greater equalisation of resources is fulfilled at area as well as at regional level.
598 The Devon area is to receive an additional revenue allocation of £2.4 million in the current year, and further adjustments will be made in the next few years to remove all disparities between area allocations by 1981. But I urge the Devon Area Health Authority not to drop its proposals to look for sensible economies, because money saved could be used to improve services which will ensure that the adjustment takes place with imagination and flexibility. The new district general hospitals being developed at Plymouth and Barnstaple will require heavy expenditure. But it would be foolish to ignore the fact that there is a different policy for small hospitals in rural areas than for those in urban areas.
The important question is: how can be used to improve services which will munity hospital which is not just a dumping ground for old people? If old people are to have active rehabilitation services they need the commitment of general practitioners. The hon. Member put his finger on the essential point when he said that these hospitals can make a very real contribution in terminal cases. I agree. It is one thing to be diagnosed in an acute district general hospital 20 or 30 miles away—a hospital that has good facilities and high diagnostic skills—but it is quite another to be asked to spend the last months of one's life in such an environment. If it is possible to provide, at reasonable cost, a hospital a little closer to people's homes, I would prefer that. I am prepared to pay a price for having a smaller district general hospital and using it successfully to get a better return on capital invested, and retaining community hospitals in order to help with the accident services or maternity services.
However, there are medical grounds for concentrating these facilities where one has good 24-hours-a-day, seven-days-a-week cover in such services. I know that many mothers wish to have deliveries in hospital. We have to take account of the perinatal mortality rate and the incidence of handicaps to the new-born. We must be prepared to offer facilities of a high standard. There must be the ability for caesarian section immediately, and to call in anaesthetists experienced in giving anaesthetics to pregnant mothers, which is often a highly skilled job.
599 I recognise the problem in Cornwall. It is under discussion at present. I recognise the problems of the Cornish people. Some of them have to go to the district general hospital in Plymouth. One has to have wide catchment areas for each district general hospital. Perhaps in the past there was an objection to going to too large a district general hospital. But some movement across the River Tamar is inevitable. We can economise if we have good community services.
For the accident and emergency services we also need highly skilled staff. We can have a door on which it says "Accident and Emergency Services", but what the hon. Member was asking for was more short-term first-aid facilities, and that can be done in a community hospital. Such a hospital does not claim to provide accident and emergency services, and the ambulance services will know what is happening.
These are difficult problems. It may be possible for a hospital to be closed by concentrating facilities. Hon. Members would be surprised to know how many hospitals are taking patients from catchment areas well outside their own. This may be the case when we consider the five hospitals that have been mentioned. I ask people to consider the problem objectively. There is no question of closing all five. Let us see if we can make a sensible saving, while still 600 improving the hospital services, out of the money that is going to Devon. There is a case for redeployment.
The Devon Area Health Authority has been careful not to increase its administrative staff, and since reorganisation there has been a reduction of about 25 in the administrative and clerical grades, which I welcome. There is much unfair criticism about the growth of administrative staff in the health services. There has been some growth which in present circumstances has perhaps not been justified. We should look for savings elsewhere and particularly in our health care resources, in the hope that if we can make savings in one area we may put resources into another area and generally improve the service.
In reply to the debate in this spirit I am conscious of the need to give special attention to the problems of people living in rural areas—not least to their transport problems. I am sure that the Devon Area Health Authority is conscious of these problems and will do what it can. I cannot say that it will not say that one of these five hospitals will have to be closed, but even then there will be full consultation and every opportunity for people to raise objections if they wish to continue to object.
§ Question put and agreed to.
§ Adjourned accordingly at twenty minutes to Twelve o'clock.