§ 1.30 p.m.
§ Mr. Alastair Goodlad (Northwich)
I appreciate the opportunity of raising in the House a matter of great concern to my constituents. I thank the Under-Secretary of State for coming to the House on the final afternoon before the recess to reply to the debate, and I hope that his holiday plans have not been adversely affected thereby.
Proposals have recently been made for the closure of the Tarporley War Memorial Hospital, the Oakmere Rehabilitation Centre and Davenham Hospital, all of which are situated in the Northwich constituency. It has also been reported that a working party set up by the Accident Emergency Advisory Group had recommended the closure of the Northwich Victoria Infirmary's busy casualty department, but I understand from the Minister's reply to my earlier Questions that such closure is not contemplated. Let me say how very relieved everyone in Northwich is to receive this news. It would make no sense for people in Northwich to have to make the 36-mile round trip to Leighton Hospital for casualty treatment. I should be grateful for the Minister's confirmation that there will be no change of mind about the Northwich Infirmary casualty unit.
The arguments which have clearly weighed with the Minister in deciding not to close Northwich Victoria Infirmary's casualty unit are the additional burden on the bus services, the health factors involved in such travel by people in need of casualty treatment, together with the cost of travelling and the immense waste of time involved. These factors have clearly been carefully considered. I hope that the Minister will bear them in mind when he addresses his attention to the question of Tarporley War Memorial Hospital.
The proposed closures take place against a background of grave concern 2341 about the centralisation of medical resources at Leighton, near Crewe, to the inconvenience of the Northwich population. In the last 10 years the operating theatre of Northwich Infirmary has been closed, the general medical beds at the Grange Hospital, Weaverham, are no longer available. X-ray examinations of the more complicated type, which used to be performed at the Grange Hospital and Northwich Infirmary, can now only be obtained if the patient makes the round trip to Crewe—and I need not delay the House with a discourse on the adequacy or otherwise of rural transport facilities. Moreover, some out-patient clinics at Northwich Infirmary are now held much less frequently or not at all. Apart from the serious difficulties to patients which the proposed closures, particularly of Davenham and Tarporley, are likely to cause, it is possible that Northwich, and indeed Tarporley, might become considerably less attractive places for young doctors to practise.
May I acquaint the House a little more closely with the situation at Davenham? A particularly disturbing aspect is that the committee which recommended the closure of Davenham Hospital did so at a meeting held on 23rd April 1966 prior to any consultation. So far as I am aware, there has still been no consultation. I am sure that the Minister will agree with me that consultation should, as far as possible, precede decisions rather than consultations being undertaken thereafter to justify decisions which have effectively already been made.
Many local bodies, including the community health council, the divisional local medical committee, the Cheshire Area Medical Committee and the Cheshire Local Medical Committee, have expressed opposition to the proposed closure. In addition, a petition opposing the proposed closure of Davenham Hospital has recently been signed by 9,000 people.
Davenham Hospital has 14 geriatric beds, which have enjoyed an occupancy rate of approximately 98 per cent. over the last four years, and 18 maternity beds, which have enjoyed an occupancy rate of between 31 per cent. and 55 per cent. over the last four years. There is agreement by the community health 2342 council that the 18 beds are more than are necessary, and agreement with local general practitioners that the unit should be reduced to six beds. This is a very different matter from saying that the 9,000 or so potential mothers in the Northwich area should be denied the possibility of having their babies near home and under the supervision of their own doctors.
The community health council suggested that the extra space made available by the cutting of the number of maternity beds should be used to increase the present 14 geriatric beds, and that is a sensible solution. The Minister said in reply to a parliamentary Question that in 1975 there were 15 geriatric beds available in the Crewe health district for every 1,000 people aged 65 and over, compared with his Department's norm of 10 beds for every 1,000 people aged 65 and over.
However, that is no ground for satisfaction in the Northwich area, where there is an inadequacy of geriatric beds. It would not be good enough for old people from the area to be accommodated at Arclid, where their relatives would have great difficulty in visiting them if they did not own cars, and where, incidentally, the percentage occupancy last year was 97 per cent. not to mention an occupancy rate of 91 per cent. in the geriatric beds at Leighton. The journey from Northwich to Arclid involves using three buses and the return fare is £1.54.
As the Minister will know, there are about 25 doctors in the Northwich area who, if Davenham were closed, would no longer be able to offer maternity services to their patients. Whilst they would, it is hoped, be offered the use of the maternity services at Leighton, the distance involved would make it impossible for most general practitioners to make use of them. In any event, the waiting list for consultant gynaecologists at Leighton is, according to the reply to my recent parliamentary Question of 27th July, 18 to 28 weeks. Unfortunately, the part of my question on the waiting period for beds was unanswered. At the end of February this year, however, the waiting list for Leighton's gynaecology beds was, I believe, 774 and this would obviously be lengthened if the proposed closure came about.
2343 I am fully aware of the effect of the sharp fall in the birth rate over the last five years on the Department's thinking and of the recommendations of the Peel Report on Domiciliary Midwifery and Maternity Beds Needs published in 1970. I do not think, however, that either of them provides any justification for a complete absence of maternity services in the Northwich area.
I should like to pay tribute to the Crewe Community Health Council, which arranged a public meeting at the Northwich Memorial Hall on Tuesday 20th June 1976. The meeting was widely attended and was almost unanimous in its opposition to the proposed closure of Davenham. I am sure that the Minister will not view the conclusions of that meeting lightly. It would be a serious blow for Northwich if Davenham were closed.
Oakmere Hall was established by the former Miners' Welfare Commission as a centre for the rehabilitation of injured miners. The location was chosen as a central point to service the North Wales coalfields and the Lancashire coalfields being approximately equidistant from the two. In 1973 the properties of the Miners' Welfare Commission passed to the National Health Service on condition that the NHS continued first and foremost to provide a rehabilitation service for injured miners.
The centre now provides physical rehabilitation facilities for many men of working age who have suffered industrial accidents, road accidents and burns and for men suffering from various other medical conditions and the increasing number of young men who have had strokes. Many of the patients have been admitted to Oakmere after long, fruitless periods of visiting local hospitals. As a result of long, concentrated treatment, they have been able to lead useful lives again, supporting thier families, rather than becoming demoralised and feeling themselves to be a burden on their families and the State for the remainder of their lives. Having visited the centre last week, I urge the Under-Secretary, if he has an opportunity to go and see the marvellous work that is being done there and to talk to the patients and staff.
2344 I quote briefly from a letter I received from a mother of one of the patients. She said:My son was a patient at Oakmere between 1968 and 1973 and thanks to Mr. Knowles the surgeon and the dedicated treatment staff at Oakmere he is now able to be gainfully employed and lead a normal life. One of the main reasons given for the proposed closure is lack of use. In answer to this I can quote my son's case as an example.Before becoming a patient at Oakmere, he used to go for physio-treatment twice a week to our local Cottage Hospital. This would involve his being ready for the ambulance at 8.30 in the morning and not arriving back home until about 2 o'clock in the afternoon. Most of this time was spent travelling round the countryside, collecting other patients and returning them home again after treatment After all those hours spent away from home, only about half an hour was actually spent receiving physio-treatment at the hospital.How many patients in the Cheshire Area Health Authority area have to go through this ordeal week after week, and how many CAHA ambulances and personnel are employed doing this work, when these patients could be given intensive physio and other remedial treatment at Oakmere five days a week, thus benefiting the patients for the reasons stated and saving the CAHA expenditure in both vehicles and personnel?Clinical responsibility for the Oakmere Rehabilitation Centre rests with the consultant orthopaedic surgeon based in Wigan who is responsible for admissions. A weekly session is held at the centre, and many of the patients admitted are from the Wigan area. Emergency medical cover is provided by a local medical practitioner. The Cheshire Area Health Authority has expressed concern that, on the retirement of the consultant surgeon this year, difficulties could arise in providing a consultant. However, the consultant surgeon has given ample warning of his impending retirement and has even offered to continue in a temporary capacity until a replacement is found. He has stressed for years that another visiting surgeon should be appointed to broaden the field from which patients can be admitted and has stressed that Crewe, Altrincham, Chester, Warrington and Macclesfield, all within the Cheshire area, are within easy reach of Oakmere so that a doctor from one of those centres, if appointed, would be appropriate.
There is no other centre in the area which provides such a complete range of physiotherapy, gymnasium, hydro- 2345 therapy, swimming, indoor and outdoor games and a competitive and stimulating atmosphere. It would be a very great pity not to continue and expand the centre's use, even if modifications may be necessary.
The Under-Secretary will be aware that the statement of the Cheshire Area Health Authority in support of the proposed closure of Oakmere Rehabilitation Centre, following its meeting on 20th February 1976, contains some serious inaccuracies, and I urge him to read carefully the comments by various members of the staff on the consultative document dated 23rd July 1976, a copy of which I have given him.
I urge the Under-Secretary to recognise that the services of the centre are now far more broadly based than they were when it was first set up. While informal soundings which he or his right hon. Friend has made with the National Coal Board and the National Union of Mineworkers produced no objections from the industry to the closure, I can assure him that the coal miners whom I met at Oakmere last week made very vociferous objections to the closure. Nor do I think that the coal industry social welfare organisations' present programme for rehabilitation centres, with supposedly more up-to-date facilities, including those for industry retraining, which are not available at Oakmere, is necessarily con-elusive. He will be aware that the mock coal faces elsewhere are shrouded in cobwebs from disuse.
There is no other centre in the area which provides such a complete range of facilities. The cost of conveying patients to and from Oakmere is nothing compared with an ambulance service two or three times a week to local hospitals for very short periods of treatment. Nor are the benefits of the latter experience—including, as it frequently does, a good shaking up during the collection trip in both directions—comparable with the benefits experienced at Oakmere. Moreover, with the closure of so many small hospitals around the country, the problems of obtaining treatment at nearly hospitals will get worse rather than better. Rather than close Oakmere, the Department should concentrate its attention on 2346 making sure that its excellent facilities and dedicated staff are much more fully utilised than at present.
The Under-Secretary will be aware that the proposed closure of Oakmere Rehabilitation Centre is being opposed by the Crewe Community Health Council. I have asked his right hon. Friend to receive a delegation of the staff. I and the staff would much prefer that, before he contemplates opposing their view, he or the Under-Secretary will come and see the centre for themselves. If he does so, I am in no doubt whatever that he will ensure that it remains open for many decades to come.
I turn now to the proposed closure of the Tarporley War Memorial Hospital. The House will know that Tarporley is at the centre of a substantial rural area with a population of over 20,000, serviced by nine doctors. The population is still growing. Tarporley War Memorial Hospital was opened after the First World War and was maintained by voluntary subscriptions and the efforts of local organisations. Since being taken over by the Department, it has been a viable unit filling a continuing need in the district. The Minister will be aware that in-patient occupancy rates for the last three years have been well over 80 per cent., and this year well over 90 per cent. The service offered by the hospital is now combined with the community health centre adjacent to the hospital site. The combination has provided an inducement to very good doctors to practise in the area. The closure of the hospital would be likely to have the reverse effect.
A glance at the map will indicate to the Minister that the problems of travelling from the Northwich area to Leighton Hospital would be similar but infinitely worse for people who at present use the Tarporley Hospital were it to close. Bus services are hopelessly inadequate and fares extremely high. There cannot possibly be an economic case for closing the hospital although it would clearly result in a narrowly defined financial saving for the Department. I am in no doubt whatever that its closure would have a very adverse effect on health.
In answer to my Parliamentary Question of 7th July, the Minister stated that no out-patients attended Tarporley War 2347 Memorial Hospital from 1972 to 1975. This information conflicts with that supplied to me lately that the figures were as follows: 1972, 4,123; 1973, 3,825; 1974, 4,471; 1975, 4,770; 1976—up to 9th June—2,540. I should be grateful if the Minister could clarify the discrepancy between the figures for the benefit of the House. I am sure that he will agree that it is essential that the House should be in possession of the right information on such an important matter.
The figures I have given relate to general practitioner consultations—general medicine, accident medicine, the follow up of cases from the main hospital and so on. Perhaps the Minister's figures relate only to consultant statistics. I understand that the possibility of consultant sessions for out-patients at Tarporley is under consideration. Perhaps the Under-Secretary of State could confirm or deny this.
The annual cost of the Tarporley War Memorial Hospital is just under £65,000. I am sure that, if the Under-Secretary of State could find time to visit the area, he would not find anybody, not least within the medical profession, who did not regard the hospital as very good value for money and its closure as an extremely retrograde step.
When the Under-Secretary of State or his right hon. Friend visits the Northwich area—I very much hope that one of them will—I am sure that, like me, he will encounter high praise for the staff and standards of Leighton Hospital, although there have been some local difficulties this year, as he will be aware What he will find, however, is that, while we are, on the whole, an uncomplaining lot of people, we find Leighton extremely inaccessible, particularly for those without cars. I can quite see the cost of running Leighton Hospital between 1974 and 1975 having risen by £1.2 million and the number of patients treated having fallen, that there is cause for departmental concern—although I am delighted that the number of patients needing treatment has fallen. I do not, however, think that cuts in vital services in other parts of Cheshire are as satisfactory answer to that particular problem.
In the brief time available to us today, it has been possible to give only an outline of the situation in a very preliminary fashion. I am grateful to the Minister 2348 and his Department for the detailed replies which have been given to the initial questions which have arisen from the draft proposals concerning Northwich Victoria Infirmary, Davenham Hospital, the Oakmere Rehabilitation Centre and Tarporley War Memorial Hospital. We have, however, only just begun. I am sure that, as his Department's consultations progress, he will be convinced of the folly of closing down Tarporley, Oakmere and Davenham and further centralising all health facilities at Crewe—a very long way from the homes of many of my constituents and virtually inaccessible for those who do not possess cars. I am sure that he will consider the matter very carefully, and we shall be grateful for any assurances and encouragement which he can give the House today.
§ 1.47 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I congratulate the hon. Member for Northwich (Mr. Goodlad) on the skill with which he has marshalled his facts and the ability with which he has presented his case. I am also grateful to him personally for giving me notice of the matters that he intended to raise. The House will appreciate the concern which the hon. Gentleman has shown not only today but also in the long series of Questions he has put down on this matter. My right hon. Friend the Minister of State has answered no fewer than 62 within the past two weks.
I must begin by emphasising the competing calls on the limited capital resources which are available to the regional health authorities, and by reminding the hon. Member that the need to undertake even minor schemes of capital development or maintenance in any particular district has to be considered by the RHA in the light of the needs of other areas in the region. The same considerations apply to allocations by the RHA for revenue expenditure.
There are, moreover, particular difficulties to be resolved in the Mersey health region. That region, as hon. Members may be aware, is one of those which was identified in the interim report of my Department's Resource Allocation Working Party as being "over-provided".
We are determined to remedy what we consider to be the unacceptable imbalance in the geographical distribution 2349 of health service resources, and, as part of the move towards implementing a fairer distribution and employment of resources, the Secretary of State has for this year held the revenue allocations to the Mersey RHA at the 1975–76 level in real terms, plus an additional allocation for the revenue consequences of major capital schemes coming on stream in 1976–77. But within the health region itself there are marked disparities in the provision of services in the various areas and districts.
Regional health authorities were asked, in determining the distribution of the revenue allocations to the areas within their regions, to make allocations as far as practicable in accordance with the principles observed in determining the regional allocations. Much emphasis was put on the need to ensure that health deprivation in particular localities should be progressively remedied, while recognising that the problem of matching limited resources to unlimited demands is one which faces all health authorities.
Within these allocations, which for the Cheshire Area Health Authority amounted to over £56 million for revenue expenditure in the current financial year, very difficult decisions about priorities have to be taken by those who live and work with these problems from day to day. Within a certain allocation of money it is for the Mersey Regional Health Authority, the Cheshire Area Health Authority, and the Community Health Council to bring the arguments to bear upon this question of priorities. It is, primarily, for them to decide.
I make no apology for spending a little time on reviewing the background of limited financial resources which is so crucial to any consideration of the adequacy of health facilities.
I now turn to a more detailed consideration of the health facilities in the hon. Member's constituency, I think he may find it helpful if I briefly set the scene.
The completion of the new 661-bed Leighton Hospital at Crewe has enabled constructive plans to be developed for a district general hospital complex in Crewe based on Leighton Hospital. The precise pattern has not yet been determined, but the Cheshire Area Health 2350 Authority has approved recommendations that Barony Hospital in Nantwich should be retained pending the provision of a community hospital in the Crewe-Nantwich locality and that Crewe Memorial Hospital should be upgraded when resources permit and re-opened for community hospital provision.
The authority's policy is to provide a community-type hospital in the north of Crewe Health District in the Northwich area. The site of the Victoria Infirmary in Northwich is being investigated to see whether it is suitable for development as a community hospital, but there may be difficulties in expanding on that site, because of possible subsidence dangers. In the meantime, the hospital is continuing to provide its existing range of facilities.
The hon. Gentleman referred to the possibility of the closure of the casualty department at Northwich Victoria Infirmary. As my hon. Friend explained on 27th July, the Cheshire Area Health Authority has no plans at present to close the casualty department but the decisions about the future pattern of facilities in the area are primarily for the area health authority.
I turn now to the anxiety expressed about Davenham Hospital. At its meeting in May this year, the Cheshire Area Health Authority announced its intention to start formal consultations with all interested local bodies about its proposal to close Davenham Hospital, in accordance with the instructions in the Department's circular HSC(IS)207Closure or change of use of health buildings.The authority has not yet published its formal consultative document setting out its statement of case in support of the proposed closure, but it expects to do so very shortly.
The authority cannot take a formal decision to close Davenham Hospital until the necessary consultations have been undertaken and the views of all interested bodies have been considered. If the local community health council objects to the proposed closure, the matter is referred to the Secretary of State for Social Services for decision.
I turn to the maternity services in the Northwich area. If Davenham Hospital 2351 were to be closed, the 18 beds in the general practitioner maternity unit would no longer be available. The nearest hospital maternity facilities would then be at Leighton Hospital near Crewe, where there is a maternity unit with general practitioner and consultant facilities. The distance by road from Northwich to Leighton Hospital is some 12 miles.
The average occupancy rate of the maternity beds at Davenham Hospital in 1975 was 31 per cent., and there were 302 births there in that year. The occupancy rate and the number of births have been steadily falling over the vast few years. In 1972, for instance, they were, respectively, 55 per cent. and 411.
The Cheshire Area Health Authority's policy is to provide a community-type hospital in the Northwich area as and when finances permit. The authority will be asked to consider whether general practitioner maternity beds should be among the services and facilities provided in that hospital.
It is proposed that the geriatric facilities in the Grange Hospital in Weaver-ham should be incorporated in the new community hospital. It is, however, impossible to forecast at this stage when resources are likely to become available so as to permit this desirable and rational development of the hospital services in the Northwich area. The outlook for the foreseeable future must therefore be one of the maintenance and improvement of existing facilities and of the economic provision of the necessary services.
The hon. Member raised the question of closure of Tarporley War Memorial Hospital. My understanding on that point is that the AHA have given preliminary consideration to the future of the hospital but have deferred a decision till early 1977. I cannot anticipate what that decision will be, but no doubt local interests will make their views plain to the health authority.
On the question of statistics there appears to be a misunderstanding between the Department and my hon. Friend. During the period covered by the parliamentary Answer on 27th July there had in fact been many attendances for accident and emergency treatment. The figures of such attendances, supplied 2352 by the Cheshire Area Health Authority, are as follows: 1972, 4,311; 1973, 3,835; 1974, 4,471 and 1975, 4,770.
Out-patient attendances are usually taken as referring to attendances at consultants' out-patient clinics. There are no such clinic sessions held at Tarporley War Memorial Hospital. The medical services at Tarporley War Memorial Hospital are provided by general practitioners. I hope that that clears up the misunderstanding.
In June this year, the Cheshire Area Health Authority issued a statement of case in support of the proposed closure of Oakmere Rehabilitation Centre, and requested the submission of comments by not later than 18th September 1976. The proposed closure of the centre will be discussed at the September meeting of the Joint Consultative Committee, which includes representatives of Cheshire County Council and the county's district councils as well as of the area health authority.
Several hon. Members have recently written to my Ministerial colleagues about the area health authority's proposal to close the centre. I fully appreciate the concern of many local people—and of the Crewe Community Health Council—that the useful facilities provided at the centre should not be lost. But in 1974 the 55 places at the centre were only 30 per cent. occupied. The centre was originally established for miners, but I understand that the Coal Industry Social Welfare Organisation now relies upon rehabilitation centres with more up-to-date facilities, including those for industrial retraining, which are not available at Oakmere. And of the 49 patients discharged from the centre in 1974, only seven were miners.
I have read the staff comments on the AHA consultative document on the proposed closure. There will obviously have to be taken into account before the AHA reaches a final decision.
I must reiterate that it is of crucial importance that national health resources should be used in the most cost-effective manner for the benefit of patients. This consideration is paramount in a period of economic restraint, and it must influence decisions on priorities by health 2353 authorities, including those for the continued use, change of use or closure of particular buildings.
The Department's revised guidance on the procedures to be followed when consideration is being given to the possible closure or change of use of health buildings was issued to health authorities in October 1975. The new procedures are aimed at providing for resources to be redeployed quickly and without undue complication, provided that there is full consultation with relevant local interests. If a community health council is unable to agree an area health authority's proposal for a closure, it should submit to the authority a constructive and detailed counter-proposal for the use of the building, and if agreement is still not reached, the proposal will be referred to the Secretary of State for Social Services for his approval.
It may be thought, on a superficial judgment, that the closure of hospitals amounts to the squandering of valuable National Health Service assets. But I remind the hon. Member that it is more than ever necessary to keep down recurrent expenditure. It may well be that unwanted hospitals when sold do not realise anything like the capital sum which it would cost to build them, but the saving in revenue expenditure from rationalising hospital services and disposing of surplus buildings can add up to a very great deal over the years.
But I do not wish to end on a depressing note. Many of the health facilities in the hon. Member's constituency are of more than adequate standard, and of course the devotion and dedication of the staff in the National Health Service is something of which we can all be justly proud. We must never take it for granted and it is good to remind ourselves of their worth.
The Cheshire County Council is well to the fore in the provision of community social services. These facilities are an essential back-up to the present and any probable future pattern of hospital services in the area.