HC Deb 03 December 1976 vol 921 cc1432-44

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]

3.33 p.m.

Mr. Michael Shersby (Uxbridge)

I am grateful for this opportunity to raise the subject of the proposed closure of Uxbridge Cottage Hospital. This is a vital matter affecting the lives and health of my constituents in Uxbridge.

It arises primarily as a result of the need of the Hillingdon Area Health Authority to reduce its expenditure by a substantial amount of about £500,000 to live within the cash limits that have been imposed as a result of Government policy. It is also due to changes in Government policy on how the National Health Service should spend its money, changes based on the report of the allocation of resources working party.

As a result of the changes, money is being allocated so that the so-called poor health authority areas get money at the expense of the so-called rich areas. It is thought by someone in Whitehall that the rich areas include the London borough of Hillingdon, in which my constituency of Uxbridge is situated. One consequence of this policy is a proposal that the Uxbridge and Harlington cottage hospitals be closed completely. It is also possible that there will be a partial closure of the Northwood and Pinner district hospitals.

These proposals are unwelcome and unacceptable to my constituents. They have created anger and resentment on a massive scale. The feeling of my constituents and those of my hon. and learned Friend the Member for Ruislip-Northwood (Mr. Crowder) and those of the hon. Member for Hayes and Harlington (Mr. Sandelson) is demonstrated in the petition presented to the Secretary of State last week. It contains 24,000 signatures against the closure of these hospitals.

This petition was organised by the Hillingdon Community Health Council and the League of Friends. It has involved a great deal of work by local people, including Professor Jackson, Chairman of the Community Health Council, Mr. Stephen Leary, the Secretary, and also by Mr. Jack Ingle, and his colleagues in the League of Friends. I pay tribute to them for what they have done to bring this matter to the attention of the Minister and to express the real sense of grievance and shock which the closure proposals have caused. I hope that when the Minister replies to the debate he will be able to indicate the reaction of his right hon. Friend to that petition which he received last week.

I shall, however, confine my remarks today to Uxbridge Cottage Hospital, the only one mentioned which is actually in my constituency. The cottage hospital is a compact, 24-bed establishment which provides longer-term care for patients requiring surgery and other treatment of a non-emergency nature. It is very well known to me. I have known it all my life and I was a patient there as a child. It is a hospital which provides that very important rather longer-term stay for many patients that cannot easily be provided in a busy district hospital. For example, 134 cases of selected surgery were carried out in 1975.

The cottage hospital is very efficient and economic to run. The daily cost per bed of maintaining the hospital in the year ending 31st March 1976 was only £16.90, compared with £25.86 per bed at Hillingdon, £31.26 at Mount Vernon and £36.15 at Harefield. Moreover, the average bed occupancy at the cottage hospital is very high. It is 75 per cent., compared with 70 per cent. at Harefield, 74 per cent. at Mount Vernon, and 79 per cent. at Hillingdon. Those figures relate to the year ending 31st March 1976. So what, I ask, will be achieved by the closure of an efficient, inexpensive and highly occupied hospital, run by loyal and devoted people, which gives outstanding service to the local community?

In reply to a Question that I put to the Minister of State on 1st November he told me that it would save the relatively small sum of £103,000 a year in terms of expenditure. But what will be the cost to my constituents? I believe that it will be very high indeed in terms of the loss of vitally needed medical care. It will mean longer waiting lists for simple surgery, and goodness knows the waiting lists at local hospitals are long enough already.

In reply to another Question that I put to the Minister of State on 3rd November he told me that the waiting list at the local district hospital—that is Hillingdon Hospital—is two to six weeks in cases of intermediate urgency, nine months or more for men and six months or more for women and children, and that, I believe, in all conscience is long enough for anyone to have to wait to undergo the kind of treatment that is often so necessary in difficult and sensitive cases involving non-emergency surgery.

In the same answer the Minister of State told me that the likely effect on the Hillingdon Hospital waiting list had not been calculated but it was expected to be only marginal. Expected by whom, I wonder. It is a shocking thing that no estimate has been made of the effect on the Hillingdon Hospital waiting list of closing the cottage hospital. Surely these things ought to be known before proposals of this kind are put forward. I can tell the Minister that my constituents have calculated the likely effect pretty well. They know, as the Minister must know, that the effect will be substantially to lengthen the waiting list at Hillingdon Hospital and to place on a busy district hospital the additional burden of having to accept non-emergency cases.

What a deplorable situation this is, bearing in mind the fact that there is rarely a spare bed available at Hillingdon, which, because of its location, might at any moment have to cope with a large number of emergency cases if, unfortunately, there were a major accident at nearby London Airport. Hillingdon Hospital occupies a special position in relation to one of the world's busiest airports. I beg the Minister to take that into account when thinking about this problem and about the allocation of resources in Hillingdon.

At a meeting on 4th November organised by the community health council in Uxbridge to discuss the proposed closure, Dr. Salmon said that not a single medical bed was available at Hillingdon Hospital at 11 o'clock on that day. That is a situation which is not uncommon, so it is not difficult to see that if the cottage hospital closes, there will be little hope of treatment at Hillingdon Hospital.

The proposed closure will not only affect the interests of patients but will keep general practitioners away from Hillingdon. General practitioner beds in cottage hospitals attract GPs to the area, and that incentive will go if Uxbridge and other local cottage hospitals are closed.

As I said, a major reason for the proposed closure is the report of the Resource Allocation Working Party published earlier this year and entitled "Sharing Resources for Health in England". The working party said that the NHS resources should be shared around the country, and that means that London regional health authorities will have substantially less. For the North-West Thames Regional Health Authority that means a severe contraction of available resources.

The basis for a reduction of resources in London is that the area is over-provided for. I recognise that there has been a substantial movement of population away from inner London in recent years. As the Minister is also a London Member, he will be well aware of that, but, as he will have seen from the figures that I have quoted about the length of the waiting list, it can hardly be said that Uxbridge is well provided with hospital care.

The movement of population has been from inner London outwards to such areas as Hillingdon. The population of Hillingdon has increased, is increasing and will increase substantially as a result of that outward movement. Figures in the Register of Electors, relating only to adults, show that in 1966–67 the combined electorate of the three parliamentary constituencies comprising the borough of Hillingdon was 154,904. It has risen this year to 171,240 and the official estimate for 1980 is 174,615—an increase of nearly 20,000 in 10 years.

Surely that is an important factor which should be recognised by the working party in determining the allocation of resources for the North-West Thames region, particularly when we have a falling birthrate and an ageing population, which means that the need for medical facilities in hospitals, particularly such hospitals as Uxbridge Cottage Hospital, will increase. I have noted no stress on that factor in the working party's paper.

I turn to a comparison of expenditure in the Hillingdon AHA for the six months from 1st April to 31st October 1976. This shows that for Uxbridge Cottage Hospital the expenditure was £62,138 compared with an allocation of £65,846—an under-spending of £3,708. Hayes Cottage Hospital had an expenditure of £76,000 and an allocation of £77,000. This compares with expenditure on the Hillingdon Hospital of £4,053,449 and an allocation of £3,943,030.

It will be seen that the taxpayer as well as the patient is getting a good bargain from the cottage hospitals. It can hardly be claimed that they are the last of the big spenders and should be cut. It is clear that they give wonderful value for money, and the cost of keeping them going is less in expenditure terms than for many other hospitals in the area.

When an area health authority is faced, as Hillingdon is faced, with the difficult circumstances that now prevail—I sympathise with the area health authority, which has to tackle these difficult and human problems—there is always the temptation to make cuts in units which secure a quick and substantial saving. The closure of Uxbridge Cottage Hospital would represent a saving of £103,000 a year, whereas to close one ward in Hillingdon Hospital would save only £41,000 a year. There is a big difference.

If one ward of Hillingdon Hospital is closed, the hospital remains with its resources, and in a happier climate there might be an opportunity to reopen the ward. Once a cottage hospital is closed, it will never reopen, and the expertise and resources which exist there will be lost to the community for ever. It is important for the Minister and the area health authority to take that into account.

The country cannot afford the loss of expertise that would result from the closure of cottage hospitals. Even in today's difficult economic climate we cannot afford to be subservient to the bureaucratic planning of resources by the Resource Allocation Working Party. Nor do we agree that the man in Whitehall necessarily knows what is best in terms of resources for Hillingdon.

I have known the Minister, who is a sympathetic and friendly man, for a long time. I hope that he will take to heart what I have said this afternoon. I have not conducted the debate on a party political basis. I have sought to give him the facts and figures relating to the cottage hospital. I hope that he will be able to give me a cast-iron assurance that this matter will be looked at again, and that he will carefully consider what I have said today in support of the 24,000 people who petitioned his right hon. Friend and on behalf of all the people in Uxbridge.

3.48 p.m.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Eric Deakins)

I have a great deal of sympathy with the case advanced by the hon. Member for Uxbridge (Mr. Shersby), and I am grateful for the way in which he advanced it. I am probably the first constituency Member of Parliament to have been faced with the situation with which the hon. Gentleman is faced, that of a closure. The case for the closure of my hospital in Walthamstow, North-East London, has come to the Secretary of State for decision after having been disputed by the community health council. I know all about the efforts of people in a local community, including Leagues of Friends, who do not want the closure of a hospital. That applies to my hospital as to his.

The hon. Gentleman referred to a petition signed by 24,000 people. That is an excellent effort. We had a petition containing 29,000 signatures. It has been put to my right hon. Friend, and I will return to the point later.

The hon. Gentleman spoke very eloquently of the service provided by the Uxbridge Cottage Hospital with its 24 acute beds. I can well understand that many people in his constituency share his feelings and would not like to see it closed.

I should not wish to give the impression that because the hospital is small its future is unimportant. Staff, patients and the public at large become very attached to their local hospitals. We have to accept, however, that if the National Health Service is not to ossify, and if we are to take a more objective view of priorities and the most appropriate distribution of resources, there are bound to be changes, particularly as the limitation on new resources makes new developments dependent upon savings elsewhere. I assure hon. Members that health authorities do not lightly make proposals or reach decisions on closures.

It is primarily for area health authorities to decide on the most appropriate local use of their resource allocations. Thus, discretion on closure is in the main delegated to them. They do, however, receive national and regional guidelines as a framework within which to work. In doing so, they are expected to show much openness, consulting very widely. Their success depends upon the objectivity with which their plans and proposals are considered. The area health authority, with its one-third local authority membership, is already constituted to allow for the expression of local opinion on resource utilisation.

Concerning closures, there are recognised procedures which call for extensive local consultation, with the community health council acting as the catalyst for the comments received. If the council wishes to object to the proposals of an area health authority, it should put forward counter-proposals. In doing so, it is expected to pay full regard to the factors, including constraints on resources, which have led the authority to make the original proposals. If such counter-proposals are made and are not acceptable to the area health authority or regional health authority, it falls to my right hon. Friend the Secretary of State to act as arbiter.

Nothing I say should be construed as prejudging the issue on which I understand the Hillingdon Area Health Authority decided only this week to proceed to formal consultation. While, therefore, I should not wish to talk in detail about the proposed closure of Uxbridge Cottage Hospital—for example, the points made by the hon. Member on the effect on waiting lists elsewhere, and the situation in relation to London airport, which is a special factor which does not apply in some other parts of London—there are some important general points to make.

First, concerning resources, the House will know that, despite the difficult economic situation, the Government have been prepared to increase the allocations to the National Health Service. Thus the proportion of the gross domestic product spent on health has risen from 5 per cent. in 1973 to almost 6 per cent. in the current year. As recently as July, when my right hon. Friend the Chancellor of the Exchequer announced some cuts in public expenditure, the forecast allocations for the day-to-day running of the health services were protected. This was a firm demonstration that the maintenance of a strong and effective National Health Service is high on the Government's priority list.

We have, however, been taking a close look at the way in which the resources available to the NHS are distributed. It has long been acknowledged that there are major inequities in the system, and the Government are committed in principle to a redistribution of resources and a determined move towards the ending of the inequalities.

One of our first steps was to set up a Resource Allocation Working Party, mentioned by the hon. Gentleman, which has produced two reports. The first, an interim one, served as a guide for allocating money to health authorities for the current financial year. The second, entitled "Sharing Resources for Health in England", is now the subject of consultation, and my right hon. Friend the Secretary of State expects to reach decisions on its recommendations shortly. In this connection I take note of the hon. Gentleman's points about anticipated changes in population.

The report, by the application of objective formulae which is acknowledges need further refinement as research progresses and more information becomes available, indicates a wide disparity between regions and makes recommendations on how a phased programme of adjustment might be pursued.

The existence of sub-regional disparity between areas and health districts, which the hon. Gentleman mentioned, is also recognised, and proposals are made for making the comparisons and effecting change. At this level, particularly, it makes it abundantly clear that there can be no strictly mathematical approach. Judgment will have to be exercised in deciding on merit what is feasible. Much depends on the overall money available and the practicalities of adjusting patient services.

As my right hon. Friend said in the House on 25th November, The tighter funds become, the more difficult it is to make a rapid shift."—[Official Report, 25th November 1976, Vol. 921, c. 319.] However, equity demands that we make a determined effort to move in the right direction as the possibilities of adjustment allow.

As far as North-West Thames is concerned, the region, like the other Thames regions, was asked this year to operate on a standstill basis after an allowance for the revenue consequences of major capital schemes coming on stream and for anticipated inflation. The regional health authority felt unable to make any significant sub-regional adjustment but set up a regional reserve by withdrawal of funds from all but the most deprived area to meet the consequences of small capital schemes in the region. Area health authorities also had to face some unexpected new developments without further money in the knowledge that the discipline of cash limits means that any overspending, which they have been exhorted to avoid, becomes a first charge on next year's allocations.

Hillingdon Area Health Authority can be no exception to the effect of these decisions and it has, I know, been reviewing its financial position, which has been on course for an overspending of some £¼ million or more, knowing that it is unlikely to receive an increase and perhaps even a reduction next year. As I understand it, the closure of Uxbridge Cottage Hospital would produce a saving of some £103,000 per annum. The authority considers that this would be less detrimental to patient services than other options for securing the same economy.

The hon. Member spoke about statistics involving the cost per bed, per day. These figures are rather misleading, particularly comparisons with Mount Vernon Hospital and Harefield, where there are some major extensive regional and supra-regional specialties. It is not possible to make a strictly accurate comparison between the costs in the different hospitals.

Mr. Shersby

I am grateful to the Minister for his explanation of the fact that these figures may be misleading. I am sorry that, when his hon. Friend gave me these figures in answer to a parliamentary Question on Thursday, he did not point that out. These are the figures given at that time relating to those hospitals.

Mr. Deakins

In defence of my hon. Friend I must point out that there is a note at the end of the Answer saying: These figures are not comparable because of the different caseload at each hospital."—[Official Report, 1st November; Vol. 918, c. 516.] I have tried to elaborate a little more on that because "caseload" is a compendious word. I have tried to show precisely why the comparisons do not stand up.

Secondly, this is the first year of a new and comprehensive planning system for the National Health Service. National guidelines place considerable emphasis on improving primary care and community services and on increasing facilities for certain priority groups such as the mentally ill, mentally handicapped, elderly and physically handicapped—to some extent if necessary at the expense of acute services. For the latter the regional health authority has promulgated interim planning ratios to be used alongside national norms for some of the other groups in planning local hospital bed provision. Health authorities have also been asked to work towards a situation where hospital beds are concentrated in district general hospitals; in community hospitals serving populations of up to about 100,000; and in units for the mentally handicapped. It is incumbent upon authorities to have this guidance in mind when financial circumstances require economy so that, hopefully, some rationalisation of services can be achieved simultaneously.

One may surmise that it has been such considerations which have led the Hillingdon Area Health Authority to its conclusions on Uxbridge Cottage Hospital. We shall, however, need to await its formal consultation document, which will be copied to the relevant Members of this House, for the details of its reasoning and intentions. We do know, however, that according to the statistics submitted to the Department there were 1,200 acute and geriatric beds in the area at 31st December 1975 apart from those providing a regional specialty service. Yet the population served would suggest that a figure of about 800 might be more appropriate, subject to some clarificaion of catchment area boundaries, which, as the hon. Member will know—representing a London constituency—complicates the business of distribution in the London area.

There has been some suggestion that if there have to be bed closures they should not be at the expense of the small cottage hospitals which provide a local and convenient service. This one can appreciate. There are however counter-arguments on both medical and cost grounds. A 24-bed hospital cannot be expected to provide the more extensive supporting and emergency services that would be available in a larger hospital where the beds can be used more flexibly in providing a range of services to the community. As regards costs, my right hon. Friend told the hon. Member for Uxbridge in a Written Answer on 1st November that the area health authority estimates that closing a 30-bed ward in a district hospital would save only £41,000 in a year compared with the £103,000 I mentioned earlier.

In sum therefore it would seem that the area health authority has reached its provisional conclusion on both planning and financial grounds.

It being Four o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Thomas Cox.]

Mr. Deakins

The debate however is essentially a local one into the detail of which it would be improper for me to enter for the reasons given at the beginning of my speech. In any case it would be quite impossible for Ministers and this House to debate every rearrangement of services by a health authority.

There is however no point in baulking the point that a number of NHS authorities now, and others will in the course of time, have to face up to the possibility of closing small hospitals as we seek to provide a more up-to-date and more equitably distributed service. As my right hon. Friend told representatives of community health councils on 3rd November: the cost of keeping a small hospital open must be weighed against the use of the money elsewhere in the district. Many of them have a homeliness and cosiness which some large hospitals lack. But we cannot afford to keep a small hospital open at the price of empty beds in a larger one. What I hope Community Health Councils will do is press for the same personal care and cosiness to be reproduced in all large hospitals as it is in some. What I do ask is that you consider the most efficient use of resources in the health district as a whole". I hope that members of this House will support us and their local health authorities as they strive towards that goal.

Question put and agreed to.

Adjourned accordingly at one minute past Four o'clock.