§ 12.15 p.m.
§ Mr. Anthony Berry (Southgate)
I am grateful for the opportunity to discuss this very important constituency matter —the proposed closing of Grovelands Hospital. I am grateful to the Minister for coming here for this debate. He is known to have a sympathetic nature, in many ways, and I am sure that he will give close attention to the plea that I make on behalf of my constituents and many others, too. He will appreciate that the impact of closing any hospital is considerable in an area and that a decision to do so must be taken only after the closest examination when there are no other alternatives.
2313 I should not like the hon. Gentleman to think that I take the view that expenditure cuts are good in principle but wrong when they affect my own area. We know that we have to have cuts in our areas. I do not put that forward as part of my case, although I hope to show that perhaps the economy that it is suggested will arise from closing the hospital will not in fact materialise.
Some of the various bodies that have been concerned have been approached. I appreciate fully that the Secretary of State is in a difficulty here because, as I understand it, his statutory position is that normally he would interfere or give a view only if the local community health council took a different view from that of the area health authority. I admit that it does not in this case. The community health council, I think wrongly, supports the area health authority in the view that it has taken.
In the course of my remarks I hope to show that certain of the information sent by the authority to the health council and to other people concerned, in eluding Members of Parliament, was insufficient. Indeed, I have to go further, because part of the information was inaccurate. Comments were invited to be sent in by the end of July in preparation for a special meeting of the area health authority on 16th August, called to discuss Grovelands Hospital. Normally the authority does not meet in August. However, this was a matter that it was felt should be decided one way or the other, and that is why I was anxious to have this debate today, before the decision was taken.
The information that is being sent out is, in my view, ill informed. As a result, the bodies that have been asked to comment, especially the community health council, are at the moment incapable of taking a decision, because they do not have sufficient correct information on which to base a decision. I feel strongly, therefore, that the decision should be postponed pending investigation of the points that I propose to put to the Minister.
I begin by mentioning briefly the history of the hospital. It is a remarkable building. I wish thatHansard published photographs, because it is a most attractive building. It was built in 1797. The 2314 architect was John Nash. It stands in a lovely public park. There is a lawn in front of the hospital, and a public park beyond into which patients can go. It was a private home until 1916. From 1921, it was a convalescent home. Not surprisingly, it is a scheduled building, and it cannot therefore have any major alterations done to it—certainly not to the outside of it.
As for its more recent history, it was until April 1974 administratively part of the North London Group Hospital Management Committee of the North-West Thames Regional Hospital Board. The committee included the Royal Northern Hospital, which is now administered by the Camden and Islington Area Health Authority. Most of the patients up to 1974 came from the Islington area and elsewhere outside my own constituency.
The hospital has 56 beds, although at the moment only 46 are available, because the 10 on the first floor have had to be closed due to possible fire danger. There is some confusion about this. I understand that the matter could easily be put right. Obviously, with the state of doubt about the future of the hospital, even the comparatively small sum necessary for that purpose has not been spent. There is nothing important in that, and I do not put it forward as part of my case. But at the moment there are only 46 beds available.
During last winter rumours began to go round that the hospital might be closed. On 10th February an informal consultation document was sent to Members of Parliament in the area, and to a number of other bodies, by the acting area administrator of the Enfield and Haringey Area Health Authority. This indicated that, subject to appropriate consultations, it was intended to close the hospital, and comments were invited from everyone on the receiving list by 31st March.
I immediately received, not surprisingly, a flood of letters from my constituents protesting at the proposal. They came from a wide body of opinion—doctors, nurses, former patients, clergymen, hospital visitors, local residents and so on. It seemed to me that my first duty was to visit the hospital and to discuss the position with those in charge there—and with the patients, too. This I did towards the end of March.
2315 Before describing my visit, I refer to one phrase in the consultation document:difficulty is experienced in utilising the first floor (or dormitory)"—this was before the Fire Precautions Act 1971—since there is no lift and, in fact, patients have not been nursed on this floor for some years.That morning I talked to various patients. There was a group sitting at lunch. I asked them in which part of the building they were sleeping. They told me that they were sleeping upstairs. I thought that was odd, in view of what was said in the consultation document. As soon as I got away from them I said to the matron that surely the upstairs part was not used. She said that it was being used and agreed with me that there was a mistake in the document. When I asked her whether there were any other mistakes in the consultation document, she agreed that there were some others.
The document states thatGrovelands Hospital does not accept direct admissions, all patients coming from other hospitals.A number of old people living in the district have to be looked after very carefully by their families, with whom they are still able to live. But the families are not able to look after them for the whole 12 months of the year, so that it is a custom for these elderly relations to go to the hospital for about one month each year in order that they may be looked after there while the relations have a well-deserved holiday. If Grovelands Hospital were to close, that facility would, of course, no longer be available.
I come to another mistake which was pointed out to me. The document states thatCamden and Islington AHA have now confirmed that they will have vacated Grovelands by 31st March 1976.This date was two weeks after my visit, and it was clear to me, having seen the patients, that they were elderly and that there was no question of their leaving the hospital by that date. Indeed, they are still there now, and, if the hospital remains open, they are likely to remain there for some considerable time.
In view of these inaccuracies in the consultation document, I decided that the only course open to me was to ask for 2316 a meeting to be held at the hospital and to ask that everybody concerned should come to it. I therefore wrote to Mr. Alderson, the acting area administrator, who replied immediately, warmly accepting the idea. I make clear at once that my comments about him and the authority are in no way personal. He has always been extremely courteous to me and answered my letters and questions. He has always done his best.
The meeting took place at the very end of March. I now refer to the letter I sent to Mr. Alderson immediately after the meeting. I mentioned the various facts that I had found to be inaccurate. I told him also that the distribution list had not been sufficiently wide, although it covered the Members of Parliament for the area. In my letter I went on to say:I was genuinely surprised that so many of those present at the meeting had not been sent copies in their own right, in particular those intimately connected with the hospital. Even if you were not certain yourself whom to approach, I am sure that Miss Pilson as Matron, together with Dr. Morris as visiting Medical Officer, and Dr. Lowy, as Chairman of the Grovelands Sub-Committee when the Royal Northern Hospital was more closely linked with Grovelands, would have been happy to suggest names which would certainly have included, for example, visiting Chaplains and the various social workers with long and close experience of the hospital.I then went on to discuss the question of the upstairs rooms and the fact that they were being used. I said:Dr. Morris told us—and I do not think you questioned this—that there were still 17 elderly patients from that Authority "—the Camden and Islington authority—at Grovelands, and it was out of the question for them to be moved during the next six days.Then there was a question about the further expenditure of the hospital. I pointed out to Mr. Alderson that there was no suggestion made at the meeting that any major expenditure within the hospital was needed. I referred to some of the points made at the meeting, including the fact that the upstairs rooms were usually full and that there was no equipment for active treatment because the patients there were not in need of it. I referred to the comment that old people sent to Grovelands had lived much longer than expected. Particular tribute was paid to the quality of the food, which I understand is very much higher than in many hospitals.
2317 I mentioned that the point was made about old people coming in for the odd month when their families were on holiday. Reference was also made to the air being very good, the hospital being close to Grovelands Park. It has apparently been particularly beneficial for chest patients and it is ideal for convalescent patients.
Concerning the future occupancy, I suggested that later figures would show that much better use could be made of the hospital.
I also referred to the fact that it was very near to an Underground station and to a bus route and therefore easily accessible to relations, and so on.
I said in my letter that Mr. Moynagh, the orthopaedic surgeon from Chase Farm Hospital, had mentioned the use made of Grovelands, and that I had received a letter from the head occupational therapist at Highlands Hospital urging the retention of Grovelands.
My letter also said:You will no doubt also bear closely in mind the Secretary of State's recognition of the need for community hospitals.I now refer to the report sent to me and to everybody else concerned by Dr. Clayden, who was in the chair at the meeting to which I have referred. He first mentions those who were present at the meeting. They numbered about 90. He also mentions the inaccuracies in the original statements about the hospital. Dr. Clayden's report continues:Mr. Berry suggested to Mr. Harrison that in fairness this error should be remedied and that the various organisations that had been circulated with the incorrect information should have it corrected. Mr. Harrison said he would look into this matter. The AHA and CHC members (with the exception of Councillor Connors) presented the case for the closure of the hospital and Councillor Connors and the medical and nursing members of the staff gave their reasons for the continued use of Grovelands as a hospital. The representative of the local preservation society (a local GP) considered that the building was unsuitable for use as a hospital and would be put to better use as an old people's home or for some other purpose. Apart from this all the other people who spoke supported the continuing function of Grovelands as a hospital. In addition the chairman was presented with more than 200 signatures, largely from local residents not at the meeting, protesting at the closure of the hospital.I have here several papers sent to me, including signed papers from people say- 2318 ing that they wished the hospital to remain open.
The next stage was a meeting of the area health authority. Dr. Morris, who was at that meeting, wrote to me saying that he was very concerned. He felt that not enough attention had been paid to the points made at the earlier meeting. He pointed out that Mr. Harrison had been asked at the meeting how long local patients stayed in Grovelands and that the answer was two weeks. Dr. Morris felt that this was incorrect and that a figure of two months would have been more accurate.
The next stage was when I received a letter stating that the area health authority had considered the earlier meeting and decided to proceed to the formal stage of consultation, as required by departmental regulations and I was sent a copy of a letter dated 27th March. Answers were required on this by the end of July.
The circulation list for this document was almost identical to the earlier one. Indeed it had been produced from that original copy because there is a misprint in the first copy which is apparent on the second one. I was approached by some of the people who had been at the meeting at the hospital and asked whether I would send them copies of the document. More people ought to have been sent copies. My suggestion to this effect was ignored. Many right hon. and hon. Members, including my right hon. Friend the Leader of the Opposition, have taken a great interest in this problem. The Southgate Civic Trust was sent a copy of the document. It put out a statement saying that it felt the information was inadequate and that the distribution list had not been large enough.
The next stage was that the community health council discussed this issue in detail and came out in favour of the closure. I am told that Councillor Mrs. Lyon voted in favour of keeping the hospital open. Everyone who spoke from the floor was in favour of keeping it open. I have received two letters from constituents on the subject. One wrote:At the meeting of the Community Health Council in June Dr. Morris drew the attention of the members to a number or errors of fact in the Consultative Document issued by the Area Health Authority. But although a representative of the AHA was present at the meeting the matter was entirely ignored, 2319 much to the anger of quite a number of local residents present at the meeting.The Consultative Document and the list of errors were published in theSouthgate Gazette of 1st July, and I, in common with several other people concerned, have been wondering what could be done.The writer asked whether something could be done about this issue and whether it was possible to raise it in Parliament.
Another constituent wrote:Much discussion took place … members of the public pointed out the great consideration of the staff for the patients, the extreme contentment of the patients and the advanages of the quiet and delightful surroundings. If this unit were moved it is quite obvious the general atmosphere would be totally lost, to the detriment of all the patients, and I am confident one could not replace such an understanding staff.On 22nd July I wrote to Mr. Alderson and asked him if he would consider having a further look at this document because I felt that there were mistakes in it. I mentioned particularly the question of the upstairs rooms. He said that these had been put into use only in February 1976. I am assured that this is not correct. It was originally said also that patients from Enfield War Memorial Hospital were the only ones who used the upstairs rooms.
Mr. Alderson had said in his letter that he had not meant to indicate the precise location of patients. As we know, the patients were downstairs. He tried to make out that there were only a few people left. There are still six patients who have been there since 1975 or earlier. He also said that by medical definition patients on pre-convalescence would spend an average of two weeks there. He claims that that was the span of time spent by patients from Enfield. Since January of this year over 91 patients have stayed there for two weeks and 14 for over three months. There is clearly something wrong there. He said that if a smaller number of patients from Enfield had stayed for longer periods in the middle of 1975 the figure was so small as not to be worthy of mention. At that time there were 19 who stayed for over two weeks and a further 19 who stayed for less than two weeks.
Mr. Alderson said that the latest occupancy figures were not available. I know that this document was sent out 2320 in May so that the only figures which would then have been available would have been for the first four months of the year. In view of the important point about the use of the hospital it ought to have been possible, shortly after, to provide figures for a six-month period. It certainly would have been helpful. They would not have been difficult to obtain. I know that because I have figures for the seven-month period.
I went on 4th August and obtained the figures up to and including the end of July. I will explain what they show. Admissions from Camden and Islington, which were 69 over the whole of last year, have been 90 for this seven-month period. Admissions from Enfield and Haringey, 125 last year, are already 129 this year. The total for last year was 194 as against the figure for the seven-month period of 219. The average daily bed occupancy last year was 43.7 per cent. while for the first five months of this year it was 72 per cent., and in June and July 76 per cent. Surely those are figures which everyone ought to be told about and asked to comment on. Today there are 34 patients out of a possible 56. We are slightly down on the percentage I quoted but it is August and there are various reasons why there are not so many patients.
Let me give two examples of the sort of patients who have come in to Grove-lands recently. An old lady of 73 at Chase Farm Hospital was due to go home on Monday of last week. Her bed at Chase Farm was required urgently for an operation the previous Saturday. The hospital had tried to contact the family but they were away on holiday. If that patient had remained at Chase Farm the operation could not have taken place. At it was, Chase Farm Hospital rang up Grovelands and asked if the old lady could be taken there and it was so arranged. She spent two days there and then went back home.
The week before a young man from Leicestershire who had had a leg amputated was unable to travel back home but was required to vacate his bed urgently at Chase Farm. The same sort of arrangements were made as before. There are many inquiries of this nature, even while the upstairs rooms are closed.
2321 I know that the area health authority has to save £147,000 this year. If Grovelands could be closed it is said that there would be a saving of £130,000. I suggest that an examination of the figures reveals that very little of the £130,000 would actually be saved. There has been a guarantee to the nursing staff that there will be no redundancies if the hospital is closed. A figure of £90,000 in respect of staff costs would therefore remain. There are costs for equipment, laundry, heating, food and so on which would still have to be met. If we add to that those patients I have described, who still live with their families but who might not be able to do so in future, it is obvious that there will not be a large saving. Admittedly there is the cost of repairing the exterior of the building. With a scheduled building of this kind the cost would have to be borne by someone. I suspect that ultimately it will be met by the ratepayers in one way or another. Therefore, I question whether the real saving would be more than £17,000. When compared with all the other factors that I have mentioned, I am not sure that it is relevant.
I hope that I have shown there is a genuine demand in the area for this special hospital. For whatever reasons, the advantages have not been properly explained, nor the details of the uses being made of the hospital. Those who should be in a position to judge and think they are, although they are not, have been gravely misinformed. I do not think that the area health authority has lived up to its usual high standards in the way in which it has acted regarding its proposals to close this hospital. If the hospital is closed, justice will neither be done nor be seen to be done. Therefore, I ask the Minister in the interests of all concerned—particularly patients both present and future—even at this late hour to act. I believe that 'he would be doing so in the best possible cause.
§ 12.41 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)
The House and the constituents of the hon. Member for Southgate (Mr. Berry) will be grateful to him for raising this important matter for debate. The hon. 2322 Gentleman's speech reflected not only his sincerity and genuine concern, but how industrious he has been in researching and pressing the value of Grovelands Hospital.
I deeply appreciate the extent of feeling that is generated when a hospital closure of this kind is under active consideration. My right hon. Friend the Minister of State has received a petition of some thousands of signatures, which Miss Pilson, the matron of the hospital, has collected. That is a measure of the local support that this small hospital attracts. Local issues are extremely significant in this debate, and I shall return to them later.
The attention of the Enfield and Haringey Area Health Authority will be drawn to the petition, which will doubtless be taken fully into account in the further attention that the authority will be giving to the future of Grovelands Hospital later this month.
As the hon. Gentleman said, other hon. Members have taken a personal interest in this matter. My hon. Friend the Member for Edmonton (Mr. Graham) is present this morning. I know that he has taken a characteristically close interest in this sensitive and extremely important issue in the area which the hon. Gentleman and my hon. Friend represent in this House.
Before I deal in any detail with the local considerations which have led the area health authority to consider the closure of this hospital, I must briefly refer to the economic background against which these purely local decisions have to be taken. This Government are seeking to improve our health and personal social services, despite the severity of the economic climate in which our country now finds itself. As the hon. Member knows, our first and declared priority is to win the battle against inflation and so to establish a firm basis for economic expansion.
This fight against inflation must mean that there are limits to what we can do in improving social provision. But in this case we are not considering a sought-after improvement, but, rather, maintenance of thestatus quo for a small much respected and, indeed, much loved convalescent hospital. Priorities are changing and the service provided by the 2323 area health authority is expanding in other aspects, while the facilities provided from this hospital can now more readily be provided elsewhere.
Opposition Members are often to be heard demanding swingeing cuts in public expenditure. At the same time, we are being continually harried to increase public spending in specific areas. Closure of the this hospital, whose services are no longer needed by the area health authority, would mean that money could be diverted to other and more essential aspects of the health service locally. The problem for the Opposition is not only one of policy but of logic. That may not be true of the hon. Gentleman, but many of his colleagues argue for increase after increase on individual services and at the same time for reductions in public expenditure as a whole, as if they believe that the whole of public spending is less than the sum of its parts.
If economies are not made where priorities in local need have changed, public expenditure cannot even be contained, let alone reduced, if we are to finance the improvements in health care needed for a developing service.
Under this Government, even within the severe restraints on public expenditure which have been necessary in the fight against inflation, we have insisted on giving due priority to the National Health Service. In our first year of office, and in spite of the cuts which were introduced by the previous Administration, the proportion of the gross national product which was devoted to the National Health Service jumped from 4.9 per cent. to 5.4 per cent. This was the largest ever increase in a single year. The expenditure in 1974–75 was then £4.011 million. In 1975–76, this expenditure was still further increased to £5.458 million. Nevertheless, in our present economic difficulties it is even more important that every last penny of expenditure should be made to count. As I have said, the National Health Service must respond to changing priorities, and expenditure must be channelled to reflect those changing priorities.
The Enfield and Haringey Area Health Authority is facing some particular difficulties in drawing up its plans for future action. The revenue expenditure available to the region as a whole is to be maintained at the level of last year's 2324 spending so as to enable such additional money as is available to be given to less well provided regions. In its turn, the North-East Thames Regional Health Authority has been urged to seek the most equitable distribution of money throughout the region. A working party is considering how this may be achieved.
In consequence, the Enfield and Haringey Area Health Authority, like the other London areas within the region, has been asked to make savings of 1½ per cent. of its budget. This will provide a pool for essential capital expenditure and also allow for some redistribution within the region. There are, of course, other demands on the Enfield and Haringey Area Health Authority. I am sure that the hon. Gentleman is aware that a new and badly-needed mental handicap unit at Chace Wing is to open at the end of this year. This important new unit will cost the authority about another £600,000 per year, and the extra revenue has to be found from somewhere.
Grovelands Hospital, a building with a long and colourful history, became a hospital through the Middlesex Voluntary Aid Detachment in 1916. The staff at the hospital have provided most loyal and devoted service. Indeed, the Enfield and Haringey Area Health Authority has paid warm tribute to the skill and dedication which has been shown by the staff. If this hospital closes, the authority emphasises that no redundancies will arise and that transfers to other hospitals will be encouraged and so phased as to cause the minimum possible problem for both patients and staff.
Turning from the economic background to the Enfield and Haringey Area Health Authority's deliberations and discussions and my assurance on the future of the staff, I come now to the nub of the issue we are debating. This is the importance of local decision-making and of local priorities.
The present Government are dedicated to the strengthening of democracy in the National Health Service. In our document on this issued in 1974, the structure and role of the community health councils is explained. That role is of vital importance. The previous Government extensively revised their original proposals for CHCs so as to make them more representative of community interests. The relevant London borough, county 2325 and district councils, together with the local voluntary organisations—selected by the regional health authority after consultation with the appropriate local authorities—now directly appoint five-sixths of the membership of each council.
The councils are also more independent of the area health authority than originally proposed. The CHCs have been given powers to obtain information about the health services in their district and to enter and inspect hospitals. They must be consulted before decisions are taken on any substantial development or variation in services. The district management team, which is responsible to the area health authority for the management of most health services in the district, is expected to establish close working relationships with community health councils, while each CHC has a direct relationship with the chairman and members of the area health authority, who are required to meet the CHC at least once a year.
The CHC makes an annual report on its activities to the regional health authority which the CHC itself publishes. The AHA must publish its comments on the report, including an account of steps taken on advice or proposals put to it by the council. In addition, the meetings of community health councils, area health authorities and regional health authorities are open to the public and the Press in the same way as meetings of local authorities.
These are innovations intended to provide a new means of representing public opinion to the authorities responsible for managing the health service locally and to encourage more public reporting by the Press. The task now is to develop the CHCs into a powerful forum where consumer views can influence the NHS and where local participation in the running of the NHS can become a meaningful reality. It is particularly important that CHCs should be consulted about developments in the services in their districts at a formative stage when their views can influence decisions.
In order to strengthen further the links between CHCs and AHAs, my right hon. Friend the Secretary of State has decided that in future each CHC will be entitled to send one of its members to meetings of the AHA to act as an ob- 2326 server. These observers will have the same rights as members of the authority to speak during meetings, without being able to vote. Neither will observers be automatically excluded from those parts of the AHA meetings which are not open to the Press or the public.
This arrangement for a CHC observer to attend AHA meetings should in no way impair the independent standing of CHCs, but it will ensure that their voice is clearly heard at the point of decision-making and it is hoped that it will also strengthen the development of mutual understanding between CHCs and AHAs. In May of last year further guidance was issued to health authorities on eligibility for membership of CHCs and on the appointment of members.
The position and standing of CHCs is thus clear and the Government are in no doubt that CHCs should have a special responsibility in relation to hospital closures such as the one we are now discussing. The Government decided in 1974 that where the CHC accepts the proposed closure of any hospital, authorisation by the Secretary of State will not be required. In the case of Grovelands Hospital this is the present position.
Informal consultations on this closure were started in February 1976 and, following consideration of all the views expressed, formal consultation on the proposal was started in May 1976. These proposals are not opposed by the Enfield Community Health Council or the Haringey Community Health Council, nor by the two local authorities, the London boroughs of Enfield and Haringey.
The hon. Gentleman referred to the use of upstairs rooms. This would have been a local decision by the matron for her temporary convenience. I am advised that it does not centrally affect the issue. The upstairs accommodation is not regularly used.
§ Mr. Morris
My advice is that it is not regularly used. I suppose that the matter turns on one's intepretation of what is regular. I am coming to the point that everything that has been said by the hon. Gentleman in this debate will be very carefully considered by the meeting of the area health authority on 16th 2327 August. Clearly, this will be one of the considerations.
The hon. Gentleman also referred to direct admissions. Here local arrangements may be made with the matron. Moreover, I am told that holiday admissions could be arranged with other units if Grovelands were to be closed.
The hon. Gentleman went on to refer to patient transfers. I am advised that patients may be moved to other hospitals at any time. I am informed that there are beds available in Enfield.
The hon. Gentleman also referred to consultation. The proposals were well known locally. No attempt to obtain documents has been rebuffed. I am advised that nurses can always obtain documents from their superiors.
The hon. Gentleman referred to occupancy. Since the proposals were published, a limited increase in patients has taken place. At times this has required more facilities than were available. That is the advice I am given. Filling beds perhaps to the risk of patients may not be laudable.
My point here, as I have said, is that all of the issues raised by the hon. Gentleman will be looked at by the area health authority. I understand, as the hon. Gentleman said, that the meeting of the Enfield and Haringey Area Health Authority called for Monday 16th August is a special meeting. There will be special consideration of the views expressed to the area health authority by the many bodies and individuals consulted. It is most unlikely that any reference to the Secretary of State for a decision will be made, but I am sure that all of the points raised by the hon. Gentleman in this debate will be very fully considered.
§ Mr. Morris
I assure the hon. Gentleman that his charge that there are inaccuracies will be fully investigated. My job will be to try to ensure that the area health authority has the most accurate information possible available to it.
2328 I shall need notice of the hon. Gentleman's second question. I shall try to give him the answer at the earliest possible date.