HC Deb 16 July 1976 vol 915 cc1243-54

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

4.11 p.m.

Mr. Robin Corbett (Hemel Hempstead)

People have the right to an adequate standard of health and hospital care. That, after all, was why the Labour Government, 30 years ago, fought so hard to establish our National Health Service. Indeed, one test of a caring community and country is how well it looks after its sick, alongside its young and old, both of which groups are, in any event heavy users of hospital services.

By that test the people of Hemel Hempstead and its surrounding towns and villages are badly served. A hospital on two sites which coped with a population of about 40,000 about 30 years ago now has to try to cope with the changed and heavier demands of a population of over 120,000. That has been the effect of the development of our new town.

The present hospital service is inadequate. It puts at needless risk the health and perhaps even the lives of patients and imposes severe burdens on staff, whose care and devotion helps to cover the present deficiencies. The physical conditions in which patients are treated and staff at all levels have to work are a disgrace to the face of our new town and its area.

Thirty years after our new town was designated, years after some 13,000 new homes have been built, alongside roads, schools, a town hall, library, police station, fire and ambulance station, court and health centre, our split-site hospital stands testament to a gross confusion of priorities.

Which is the more important—a triple-lane motorway on our eastern boundary or a hospital good enough to cope with the needs of our local community? It must be the hospital. How is it that years after money was found to provide the factories to give the incoming new towners jobs the cash has yet to be found to ensure that the people who work in them, and get ill or injured in them, are adequately served by our hospital? These are the priorities of Bedlam. Because of the generally high standard of new town development, the present hospital—united in name only and sited in two wings one mile apart—is a stark contrast, which is daily reinforced by those who use those wings or pass their doors.

Let me outline some of the problems, many of them highlighted in a district management team's report a year ago. First, the two wings are a mile apart, which means the hurried and often risky transfer of patients and specialists and other staff, often at times of critical emergency. I wonder how many lives might have been lost through this or how long recovery may have been delayed because a transfer ambulance has been held up in rush-hour traffic. Secondly, the accident department has only one entrance in which to receive all casualties, and inside there is a dreadful shortage of consulting rooms. This means that children with minor injuries are mixed up with the victims of the latest carnage on the motorway. Thirdly, there is no adequate intensive care unit with its surrounding facilities. Fourthly, the pharmaceutical services are housed in poor conditions and split between the two sites.

Fifthly, the report said of the 40-year-old operating theatre: The accommodation of the twin operating theatre unit is totally inadequate for demands made upon it. The ancillary accommodation is also totally inadequate and needs upgrading urgently. It added: A hospital without accommodation or facilities to give intensive care to desperately-ill patients, including road traffic victims, is to be highly deplored. I could go on. What this adds up to, however, is not simply that facilities are poor and should be improved at some time but that the present facilities are totally and hopelessly inadequate for the needs of our community and that the people of my area are being, as they have been for too many years, denied their entitlement to an adequate hospital service.

I say this not in any selfish sense to push the claims of Hemel Hempstead over those of other parts of the district, the area or the country. I state it as a matter of fact. I believe that our campaign for an improvement, led by the Dacorum Hospital Action Group, is part of a growing insistence by people in many places that they shall have a proper hospital service. In our area this means that the services must be local, not on the north bank of the Thames or in Central London. For too long this has been an escape route, and it is one which is no longer tolerable or just. Hospital care must be where people work and live.

It is right that I should pay tribute to a campaign run last year by the Evening Echo to expose the deplorable state of hospital facilities in Hemel Hempstead and elsewhere in the district, a campaign which did so much to arouse the local community.

Bad as present conditions are, there is the prospect of their becoming worse. The north-west district of the Hertfordshire Area Health Authority faces a deficit of about £750,000 this year. It has been thinking of closing wards, but happily in the past few days—I like to think, in response to pressure from those within the hospital and organisations outside—it has rejected this answer as unaceptable.

The threat is so serious that the North-West Hertfordshire District Medical Committee, speaking for hospital doctors and consultants, has warned bluntly that patients will die if the cuts go ahead. The Dacorum Hospital Action Group, the Hemel Hempstead Trades Council and many others have made plain to the area health authority that cuts in the present inadequate services are unacceptable. How can an area with such a miserable level of existing provision now be asked to have even those slim facilities hacked to pieces?

It is perhaps typical that in an atmosphere of contemplation of more public spending cuts there should be this mindless Treasury thinking about cuts across the board without looking at where they are falling and ways in which they may be refined. I know the Government's argument for shifting cash to less-well-off regions. But there is a need to look at services within districts and areas within regions before attempting on a regional basis to rob an already poor Peter to pay an even poorer Paul.

What we have to face—and I believe it to be acceptable—is that, if need be, we shall pay more for an adequate hospital service rather than face the dismantling of the service. The cuts under consideration locally would strain the present level of services to breaking point.

Already our hospital faces problems with staff. On the weekly-paid side there has been an annual turnover of up to 25 per cent. in staff. On the monthly-paid side the turnover is up to 50 per cent. Because of physical conditions and the state of the facilities in which staff are required to work, the hospital is getting into a position where it faces increasing difficulties in attracting and retaining the staff it needs. One has only to think of the waste that occurs from this high turnover of staff. That could be saved, and I suspect that money could also be saved from a review of the administration imposed under the last Government by their top-heavy reorganisation.

That is only the small change of the argument. The fact is that our hospital is being asked to cut into the quick rather than to trim its nails, and that is not acceptable. It was as long ago as 1966 that a hospital plan came to the conclusion that the need for a new hospital in Hemel Hempstead was, and I quote, of more than usual urgency. That was 10 years ago, and work on the first phase was due to begin in 1975–76 as a result of a campaign led by the then Councillor Jack Johnstone and others. Subsequently that slipped back to the summer of 1977. The Barber cuts of December 1973 worsened an already bad situation and put a stop to hospital building. But the priority recognised in 1966 remains. Nothing has happened, except to make urgency the more urgent. If the Minister or others now say that they are back to square one in the determination of priorities, this is an argument we shall not accept. All that has changed is that the situation for the people of Hemel Hempstead has worsened, while we insist that our priority remains where it was put 10 years ago.

My constituents need no lectures on the intricacies of the rôle of the community health council or the area health authority, with which our campaign has good relations and from which we have received support. Furthermore, we do not need lectures from the North-West Thames Regional Health Authority, which is being so blushingly coy over meeting representatives of the action group and which gives the impression that the patients for whom it is supposed to care are a nuisance.

We are tired of the bureaucratic wrangle over the question whether a hospital should be called a district general or a nucleus hospital. The name does not matter; what matters is that a firm and early starting date should now be fixed for the first phase of our desperately-needed hospital.

Last night my constituents and I were able to meet the Minister of State and to hand over to him a petition signed by 20,000 people calling for support for our new hospital. I thank the Minister for his time and patience. As he saw, we are both angry and determined. We are angry that, 30 years after our new town was begun, we now have worse hospital facilities than existed then, and we are determined to protect our present services and secure a reacceptance of our established priority. The land is there and some money is still being spent on new buildings. In the name of the 120.000 people whom I am proud to represent and fight for, I now claim a slice of that money to get the first phase of our new building under way.

If the Minister believes that I have been overstating the case I can assure him that that is not so. Let me make an offer. Let him meet the staff at all levels and see their facilities. Let him talk to elderly patients, housed 26 to a hut—a hut put up 30 years ago to give shelter from Nazi bombs to the children of Great Ormonde Street Hospital. They were called "temporary" buildings when they were put up and 30 years later they are still temporary.

No praise is high enough for the staff of this hospital. Without their care, devotion and patience, the physical conditions would make the recovery of patients that much more difficult or perhaps less likely. Their skills and talents need and deserve proper and adequate facilities in which to be exercised.

It is to their voice and that of past and future patients that I want the Minis- ter to listen and respond. I beg him to contact the regional health authority and the area health authority to avert the threat to our present inadequate level of services. Alongside that, I want him to agree that our priority claim for the staff of a new hospital will now be recognised anew. We have waited 30 years. I make it clear that for as long as I am the Member of Parliament for the constituency there is no intention of waiting another 30 years or anything like that.

4.26 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)

I should like first to congratulate my hon. Friend the Member for Hemel Hempstead (Mr. Corbett) on the skill and diligence with which he has been pursuing the interests of his constituents in this important matter. It is wholly characteristic of my hon. Friend that he should have argued this case today with so much feeling and genuine concern. He is respected in all parts of the House for his deep concern to ensure that the people he represents have a proper level of facilities and services available to them. He has been corresponding with my right hon. Friend the Minister of State on the subject of this debate for several months.

Last night, as my hon. Friend mentioned, he and a group of his constituents presented a petition of nearly 27,000 signatures to the Minister of State. My hon. Friend has referred to a figure of 20,000. My information is that it was 27,000. My right hon. Friend very much wanted to be here today. The petition is a measure of the strength of local support for a new hospital in Hemel Hempstead. I congratulate the Dacorum Hospital Action Group on all the hard work that it has put into making such a strong case.

My right hon. Friend the Minister of State readily undertook to ensure that the views expressed to him last night would be drawn to the attention of all the authorities concerned and that they would be given every possible consideration. For my part I shall, of course, arrange for the case which has been presented today by my hon. Friend to be given the same consideration. I shall also ensure that particular attention is paid to my hon. Friend's suggestion of a ministerial or other official visit to the hospital.

Before turning to deal in detail with the specific points raised by my hon. Friend I must refer briefly to the general economic background against which the Government have been seeking to improve our health and personal social services. As my hon. Friend knows, our first priority is to win the battle against inflation and establish a firm basis for economic expansion. The fight against inflation means that there are limits to what we can do in improving social provision. Conservative Members often argue that there must be swingeing cuts in public expenditure. At the same time they are continually harrying us to increase public spending in specific areas. For them the sum is not greater than its parts. Indeed, when it comes to public expenditure they appear to believe that the sum is less than its parts.

Thus, the problem for Opposition Members is one not only of policy but of logic. They argue that we can increase expenditure on each individual service at the same time as reducing public expenditure as a whole. For the Government it can be said that, even within the severe restraints on public expenditure which have been necessary in the fight against inflation, we have insisted on giving priority to the National Health Service.

The proportion of the gross national product spent on the National Health Services increased steadily from 3.6 per cent. in 1955 to 4.9 per cent. in 19–74, In our first year of office, notwithstanding the cuts introduced by the previous Administration, the proportion of the gross national product devoted to the National Health Service jumped to 5.4 per cent. This was the largest-ever increase in a single year. The previous Conservative Administration had proposed to spend £3,756 million on the National Health Service in 1974–75. We increased that figure to £4,011 million. In 1975–76 we increased expenditure still further, to £5,458 million.

I take this opportunity to pay tribute to my right hon. Friend the Minister of State, the Member for Plymouth, Devon port (Dr. Owen), and to my right hon. Friend the Member for Blackburn (Mrs. Castle), the former Secretary of State, for their success in protecting and improving the National Health Service in economic circumstances of daunting difficulty. It goes without saying that my right hon. Friend the present Secretary of State is doing and will go on doing everything humanly possible to ensure that a very remarkable record is maintained.

Of course, we have not been able to do all that we have wanted to do to improve the National Health Service. I can will understand the disappointment of my hon. Friend's constituents as the prospect of the new hospital seems to recede yet again. They are not alone. There are numerous other districts in the country whose hopes have been frustrated by the recent curtailment of our capital building programme.

I should like to put on record my appreciation of the many NHS staff who continue to provide outstandingly loyal and devoted services in conditions that we should all like to improve if we can conquer the basic economic problems facing the country. Naturally, I wish that I could give my hon. Friend some positive news about the proposed new hospital at Hemel Hempstead, but it would be premature to make a statement. All that I can do today is to assure my hon. Friend that all the points that he has argued will be raised with the appropriate health authorities to be taken fully into account as they devise their strategic plans for the future.

Mr. Victor Goodhew (St. Albans)

Can the hon. Gentleman say anything about the rumour that is circulating in St. Albans—where we do not suffer as gravely as people in Hemel Hempstead but are still short of vital parts of a hospital, like the addition of two operating theatres—that there may be a decision to make one hospital serve the two areas? This rumour is causing some anxiety. Can the hon. Gentleman enlighten us in any way?

Mr. Morris

If there is time I shall refer to St. Albans later in my speech.

It has long been the intention, as my hon. Friend said, to provide new hospital facilities for the people of Hemel Hempstead. The hospital building programme published in a White Paper in 1966 said so, but subject to the availability of resources. No specific starting date was given, and the inference was the late 1970s or early 1980s. Moves to this end were taken by the former North-West Thames Regional Hospital Board, whose outline proposals for a new hospital were approved in principle by the Department just before the reduction in capital allocations interrupted the design work. It was then only at the sketch plan stage. But it was already showing signs of being unable to keep within the recognised cost limits, partly because of the nature of the site.

There was, therefore, some need for rethinking. In any case, reconsideration is a natural consequence of NHS reorganisation. A comprehensive planning system has now been set in motion to work on an integrated service basis. The planning units are larger, which should enable us to benefit from economies of scale. There is increasing emphasis on primary and community care, limiting the demand on expensive hospital services, and we have issued strategic guidelines not only on priorities but also on how the various aspects of the health services should be co-ordinated, including some initiatives on prevention.

Partly because of the economic situation and partly perhaps because of over-emphasis on complete replacement of hospitals in recent years, we are also urging health authorities to look for ways of improving existing stock and securing additional facilities through small schemes. Major new hospitals are not, however, precluded where they are the only way to remedy a gap in services. In such circumstances, we are looking for the development of district general hospitals that serve a whole health district.

It is difficult to justify local provision of the full range of facilities for smaller populations. It is beneficial to total patient care that, wherever possible, such facilities should be brought together.

Hemel Hempstead itself does not have sufficient population to justify a full district general hospital on current criteria. On the other hand, the whole of the North-West Hertfordshire Health District, including St. Albans, whose hospital facilities are also inadequate, does meet the criteria. But Hemel Hempstead and St. Albans are some six miles apart. Thus, the health authorities have some difficult planning decisions to take. They will also need to consider the place of local community hospitals in providing those services which do not need the sophisticated provision of a district general hospital.

Whether the building of new hospitals can be supported in current circumstances and, if so, where and when they should be built are matters primarily for the health authorities to decide. The North-West Thames Regional Health Authority has already recognised that the North-West Hertfordshire Health District is one of the most under-provided locations, in terms of hospital beds, in the region.

We shall not know what will be done about that situation until the Hertfordshire Area Health Authority and the regional health authority have produced their first strategic plans within the planning system that I have already mentioned. These are due for completion by about the end of the year and will be subject to much local consultation, particularly through the community health councils.

I am told that the area health authority intends to issue a consultative document by the end of the month. A copy will be sent to my hon. Friend, who will no doubt help to ensure adequate public debate. I understand that he is to discuss the position with the regional hospital authority chairman on Monday next. This marks the point that the regional health authority is concerned about the provision of adequate facilities for patients.

In drawing up that strategic plan the authorities in the North-West Thames Region face some particular difficulties. Apart from their much curtailed allocation of capital moneys, they have been asked to contain their revenue expenditure in the region as a whole at the level of last year's spending, to enable such additional money as is available to be given to the less-well-provided regions. The regional health authority has been urged to seek the most equitable distribution of that money throughout the region, but decisions on changing the pattern of spending cannot be lightly taken, affecting as they do the use of existing plant and buildings and the position of staff.

The regional health authority has set up a working party with its area health authorities to study the situation with a view to adjustments starting next year. They will take into account any savings within the region as a result of the major exercise that we have launched to reduce administrative costs. It will clearly be essential for some such redeployment of resources if a new hospital in North-West Hertfordshire is to be viable. If it is to provide the extra facilities that appear to be necessary, it will cost more to run. For instance, it was estimated that the hospital at Hemel Hempstead, agreed in principle in 1974, would cost about £800,000 extra per year at September 1972 prices. In current terms that would now be about an extra £1.6 million per year.

To sum up, I do not want to raise any false hopes. On the other hand, I assure my hon. Friend that the situation is under very active review by the health authorities. I am sure that they will take what he has said fully into account. They have some hard decisions to make, but the planning system now in operation should ensure that they are made as objectively as possible. Finally, I congratulate my hon. Friend again on the deep concern and sincerity of his advocy in opening the debate.

4.39 p.m.

Mr. Laurie Pavitt (Brent, South)

I congratulate my hon. Friend the Under-Secretary of State—if I may point in the tail end of the debate—on dealing so fully with such an important local matter. The debate has had the result of getting on to the record a good deal of important background material that is helpful for all of us in similar circumstances and situations to those of the hon. Member for St. Albans (Mr. Goodhew) and my hon. Friend the Member for Hemel Hempstead (Mr. Corbett).

I shall make two quick points, First. I welcome the fact that it has been possible to put on record the fact that my right hon. Friend the Member for Blackburn (Mrs. Castle), when Secretary of State, was able to obtain an increase of £880 million in these difficult economic times. That is a tribute to the way in which she cared for the service. Secondly, the background to the debate has been that the Government have been prepared to put people before buildings. I believe that to be the correct policy. That means a problem for many of us who have local treasurers who concentrate not only on new hospitals but on the extension and improvement of old hospitals. However, it is right that the salary of nurses, pysiotherapists and ancillary workers should have been given priority. Over the past two years, for the first time for many years, we have seen a breakthrough in that regard.

I was delighted to hear the background case put forward by my hon. Friend the Under-Secretary of State. I know of his special interest not only in making an improvement on the institutional side but in improving domiciliary care, especially for the disabled. However, if that sort of thing is to be done for the elderly in the community, there must be a balance between that and what we are able to do for our hospital service.

Question put and agreeed to.

Adjourned accordingly at nineteen minutes to Five o'clock.