HC Deb 21 July 1976 vol 915 cc1971-80

Motion made, and Question proposed, That this House do not adjourn.—[Mr. John Ellis.]

12.14 a.m.

Mrs. Renée Short (Wolverhampton, North-East)

I am delighted to have this opportunity—[Interruption.]

Mr. Deputy Speaker (Mr. Oscar Murton)

Order. Will lion. Members who wish to leave the Chamber please withdraw quietly.

Mrs. Short

I am delighted to have this opportunity to raise the whole question of the completion of the district general hospital in Wolverhampton. I shall paint a rather grim picture. I hope that my hon. Friend the Minister will listen carefully to my arguments and not simply read out the departmental brief, which probably will not answer my points. We face a serious situation, and I hope that we can get some assurances from my hon. Friend that action will be taken without further delay to see that the completion of this hospital goes ahead.

The important thing to remember is that the Wolverhampton Area Health Authority has eight hospitals under its wing. These are the New Cross Hospital in Wolverhampton, which is the largest with 1,091 beds; the Royal Hospital with 316 beds; the Queen Victoria Nursing Institution with 48 beds, which are mostly private beds and some dermatology beds; the Parkfields Hospital, which has 66 beds; the Children's Hospital with 30 beds; the Patshull Rehabilitation Centre with 60 beds; the Wolverhampton and Midland Counties Eye Infirmary with 103 beds; and the Women's Hospital with 12 beds.

Those hospitals serve a large population and all of them, except for the New Cross Hospital, as my hon. Friend will appreciate, are small units which are difficult and uneconomic to run. They serve an official population of 268,000. Twenty-four per cent. of the population is under 15 years of age—we have a large number of children—and 10 per cent. of the population is over 65.

As I shall show presently, the population which those hospitals actually serve is very much larger because we have large areas outside the Wolverhampton boundaries, in the West Midlands as a whole and in Shropshire, which look to the Wolverhampton hospitals, and have done for generations, for their hospital services. An important factor to bear in mind when deciding a site for a new district general hospital for the whole of the West Midlands area is that those specialties are sub-regional centres as well.

The potential in-patient cases for ENT, including the Wolverhampton population, total almost 500,000–424,000 to be exact—which is 58 per cent. more than the official catchment area of 268,000. If we consider the ophthalmic catchment area—this is one of the sub-regional specialties—we serve a population of 894,000, which is a very large population indeed.

If we look at the waiting lists—I have the figures for 31st March 1976—we find that a serious position is reflected. It indicates the need for more development, more beds and more special provision to be made in this district general hospital. As far as general surgery is concerned, the waiting list at the Royal Hospital is 558. At the New Cross Hospital it is 510. Thus, for general surgery we have over 1,000 patients on the waiting list, and some of them have been waiting for a very long time indeed.

There are 91 tonsils and adenoids cases on the waiting list at New Cross Hospital, and at the Royal Hospital the number of cases on the waiting list for ENT operations is 94. There are no fewer than 217 orthopaedic cases on the waiting list at New Cross Hospital. Some of those concern specialised operations for hip replacement. I have patients in my constituency who have been waiting for two years or more. They are elderly patients, and two years is a long time for such patients to wait for this particular operation.

The ophthalmology waiting list at the Eye Infirmary, which is a specialty for the region, totals 807. Many of those are also elderly patients who are waiting for cataract operations. To have to wait many months, or even a year, is a long time for that type of operation. The gynaecology waiting list at New Cross is 420 patients.

Clearly we can prove the case for completion of phase two of the hospital on the grounds of population served, need, and waiting lists for urgent cases.

The building programme stems from way back in 1962, when the Minister of Health of the day produced his Hospital Plan for England and Wales. The purpose was to give to the hospital services of England and Wales both the physical equipment and also the pattern and setting which will everywhere place the most modern treatment at the service of patients and enable the staffs who care for them to exercise their skill and devotion under the best circumstances". Although that was as long ago as 1962, we are a long way from realising that ideal situation in Wolverhampton. The plan proposed a new major district general hospital built on the New Cross site. It was envisaged that when that new hospital was completed the Royal, the Wolverhampton and Midland Counties Eye Infirmary, the Queen Victoria Nursing Institution, the Patshull Rehabilitation Centre and the Penn Children's Hospital would be closed. All the small units to which I referred at the beginning of my speech, those with a small number of beds—old and inefficient to run and, as I shall show, highly uneconomic in broad terms—would be closed; we would have a new district hospital which would embrace all the specialties and provide the present number of beds and more in one hospital.

We have built the first phase of the redevelopment. That is complete. We have a maternity unit, a geriatric unit, a new boiler house, an area laundry, kitchens and dining room and a splendid education centre, which is greatly used and appreciated, and there is additional staff accommodation. But the difficulties which I want to describe are the result of the delay in building the second phase.

I wrote to the West Midlands Regional Health Authority last April and had a reply from the regional administrator to say that when the authority considered the 10-year building programme up to 1985–86 it was regretted that it was not possible to include phase two of the general hospital at New Cross in the programme. That is indeed a black prospect. We are talking of another period of 10 years, at least, of existing in the same deplorable conditions as we now have to suffer. I submit to my hon. Friend that this is a disgraceful situation.

Being optimistic, the area health authority, hoping that the New Cross development would take place on schedule, pursued a policy of operating the Royal Hospital and New Cross as one unit to facilitate the transfer of services from the Royal to New Cross. One has to remember that the hospitals are not particularly close to each other. New Cross is on one side of the area, in my constituency, and the Royal is across the town in the other constituency. This means that we have many departments in these hospitals which are divided, not only between New Cross and the Royal but between them and one or two others as well. My hon. Friend can imagine the difficulties faced by medical staff in shuttling around between two or three hospitals to see patients, both in-patients and out-patients.

The departments which are divided between two or more hospitals are general medical, thoracic, dermatology, paediatrics, general surgery, orthopaedic surgery, ENT, urology and dental surgery. That means that it is extremely difficult to give consultant cover in every place where it should be given, to deploy junior medical staff adequately and to provide emergency services, which have to be duplicated and sometimes triplicated. It means that nursing and administrative services have to be duplicated. There are additional costs in transporting staff, specimens, medical records and so on.

When we are concerned, as I am particularly as Chairman of the Social Services Expenditure Sub-Committee, with the increasing cost of running the National Health Service, we should be especially concerned about these conditions. We are wasting an enormous amount of money on this kind of duplication and triplication, money which should be spent on improving the service to patients.

That is one side of the question, the immediate problem. In the near future we face wasteful expenditure which should go towards the completion of this hospital. There is a serious situation in out-patient accommodation in the old hospitals which affects the area as a whole. Plans are being produced to build the first phase of a new out-patient department at a cost of £300,000.

The laboratories at the Royal and New Cross Hospitals need extending. Specimens often have to be taken from New Cross Hospital across town by taxi or other transport to the laboratory at the Royal. That again is nonsense. We need a new chemical pathology laboratory at New Cross Hospital which will cost about £60,000. The New Cross X-ray department needs extending at an estimated cost of £150,000.

I have seen all these problems for myself. The conditions at the Eye Infirmary are scandalous: one cannot swing a cat there. If it is to function in future it will have to be replaced, at a cost of over £500,000, yet it will have to be demolished when the hospital is ultimately absorbed into New Cross Hospital. The main kitchen at the Royal Hospital is unsatisfactory and unhygienic, yet expenditure on it will also be wasteful when ultimately the hospital will be closed. But a new one is needed at a cost of £340,000.

The cobalt therapy machine at the Royal Hospital, on which the radiotherapy department is totally dependent, needs replacing—again, in an old hospital which will eventually be closed—at a cost of about £110,000.

In all, that is expenditure of £1½ million on old hospitals for some make-shift development at New Cross Hospital, which will eventually be replaced or absorbed by the new plans. In addition, we need new beds for orthopaedic and accident surgery, for geriatrics, psycho-geriatrics and radiotherapy. This is formidable expenditure, which is likely to be necessary very soon.

A further complication, which the Minister probably knows about, is the question of the future of the RAF Hospital at Cosford. If it is closed—there is pressure for it to be closed on grounds of economy—many of the patients currently admitted there will obviously look to Wolverhampton for hospital care. This would require an additional operating theatre, more beds, two wards, and more residential accommodation at New Cross—all at a cost of possibly £600,000. We face possible additional expenditure of £3 million.

The Secretary of State or the Minister of State should accede to my request and visit Wolverhampton to look at the prob- lems on the ground and discuss them with the staff who have to struggle with them. I have asked my right hon. Friend to do this, but I have not yet had his reply.

There should be a proper assessment of the service given by the Wolverhampton hospitals to a wide area of the West Midlands, far beyond the boundaries of Wolverhampton, to see exactly what the service is, what population is served and what specialties should be developed in the region and sub-region.

We should look closely at the expenditure position and at the folly of spending nearly half the cost of the new phase two of the district general hospital on patching up the old hospitals that should have been pensioned off years ago but are still being used. We should draw from this the lesson that if we go on cutting NHS expenditure it will be counterproductive, because building proposals and projects that are withdrawn from building lists cost more when they are eventually built, as we have seen from 1962 onwards. That happened again in 1972 when the cuts took place. No saving is made because the cost eventually is very much greater.

I hope that my hon. Friend will be able to give me assurances on these points and that he will say that we are developing phase two of the district general hospital without further delay.

12.32 a.m.

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

I congratulate my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) on securing the Adjournment debate tonight and on the forceful way she has set out the problems facing the hospital service in Wolverhampton and drawn attention to the need for phase two of the New Cross development.

I certainly accept that hospital services in Wolverhampton are under pressure. According to a statistical report prepared by the West Midlands Regional Health Authority, at 31st December last 860 patients were waiting for general surgery, 348 for ENT operations, 255 for traumatic and orthopaedic treatment, 444 for gynaecological treatment and 731 for ophthalmic treatment. These are formidable figures. Further, as my hon. Friend said, if my right hon. Friend the Secretary of State authorises the closure of Cosford Hospital, the Wolverhampton Area Health Authority estimates that it will immediately pick up about half the case load—nearly 2,000 in-patients and 10,000 out-patient attendances per year.

The truth of the matter is, however, that nearly all hospital facilities in the region, and indeed the country, are under heavy pressure. On waiting lists, as my hon. Friend stressed, the situation in Wolverhampton is comparatively favourable compared with the West Midlands Region as a whole. Of the 22 districts in the region, at 31st December last Wolverhampton was the sixth most favourably placed in terms of general surgery, third in ENT, fourth in trauma and orthopaedic, ninth in gynaecology and third in ophthalmology.

I do not set too much store by these comparisons, because waiting lists are notoriously difficult to use as indicators of pressure on services. Of course, at present they are particularly difficult because of the distortion caused by the differential impact of the doctors' industrial dispute. Nevertheless, the figures I have quoted at least suggest that Wolverhampton's position in the West Midlands is not particularly unfavourable.

This becomes even clearer when relative levels of provision are considered. On its native population of about 270,000 plus the 30,000 people who live in the Seisdon part of Staffordshire, who are expected always to look to Wolverhampton for hospital services, Wolverhampton has adequate acute, maternity and psychiatric beds, though it is short of geriatric and mental handicap beds. The problem is that at present Wolverhampton is serving a rather larger population, perhaps as high as 370,000, and this is generating the pressure. I shall return to this problem in a moment.

Before doing so, I should like to answer the point made by my hon. Friend that existing facilities are split among several hospitals and that a more efficient and economical service could be provided if the bulk of facilities were concentrated on the New Cross site. I entirely accept this point but emphasise that in having facilities spread among several hospitals Wolverhampton is by no means unique. The Redditch/Bromsgrove district of Hereford and Worcestershire and several other districts in the region suffer from the same difficulty, for the many reasons given by my hon. Friend. In the present difficult economic climate, rationalisation of services, desirable in itself, must take second place to meeting major gaps in the services.

It may be claimed that because many of the existing facilities are sub-standard, partly at least because maintenance has been deferred in the expectation of phase two of New Cross, facilities have been lost. I have not visited Wolverhampton myself, though my right hon. Friend the Minister of State hopes to go there in the autumn, but I am advised that conditions at some of the hospitals are by no means ideal. In comparative terms, however, the Wolverhampton hospitals come out fifth best of the 22 districts within the region on an analysis by the regional health authority of the quality of buildings.

I turn now to the key issue—namely, pressure on the existing facilities in Wolverhampton. With a population of around 300,000, the area is sufficiently provided with acute and maternity facilities, but I acknowledge that at present Wolverhampton is serving a far larger population. Indeed, at present it is estimated that 30 per cent. of the patients treated in Wolverhampton come from outside the area. The reason for this is that, compared with Wolverhampton, the neighbouring areas of Staffordshire, Dudley, Walsall, Sandwell and East Salop are poorly provided for in terms of hospital facilities.

At its meeting in March, the West Midlands Regional Health Authority considered the needs of the 22 districts and drew up an outline strategy for major capital developments in the region over the next 10 years. This strategy includes major developments in Stafford, Dudley, Walsall and Telford. These schemes, together with major developments at present under construction in Sandwell and Shrewsbury, will greatly reduce the pressure on Wolverhampton from people living outside the area. At the same March meeting, however, the RHA clearly judged that it would not be possible to start the next phase of New Cross in the next 10 years.

The House will not need to be told that at present the money available for hospital building is far lower than we would otherwise wish. Indeed, there is considerable speculation that the situation may get worse before it gets better. It is by no means certain that the West Midlands RHA will be able to start all the schemes in its outline strategy in the next 10 years, and I must say quite frankly that there seems no possibility whatsoever of a start on phase two of New Cross for many years.

It is thus clear that the hospital service in Wolverhampton will continue to be under heavy pressure for some years, though the situation should be eased progressively as new developments in the neighbouring areas come on stream. There will also undoubtedly be significant improvements to Wolverhampton hospitals through minor capital works programmes delegated to the area health authority or run by the RHA.

Further, I accept the need for propping-up schemes. Clearly, if old buildings have to continue in use when ideally they should be replaced, some maintenance and replacement will be necessary. Ideally this money should be used as part of the cost of completely replacing the old facilities, but at a time when capital is tight health authorities often have to opt for the cheap solution in the short run when it might not be cheapest in the long run. I must make it clear, however, that while accepting the principle of the need for propping-up schemes, I am not accepting any particular "shopping list". This must be for the RHA to consider.

The outlook for acute services in Wolverhampton in the foreseeable future is, therefore, one of the maintenance and improvement of existing facilitites rather than of major new development and rationalisation. The prospects for Wolverhampton are not entirely gloomy, however.

As I said earlier, there is an acknowledged shortfall in geriatric provision. To remedy this, a development is currently under way at Penn which will provide 84 beds by 1978. Further, another 84-bed scheme, West Park, is being considered by Ministers as part of the 1976–77 capital building programme. These two schemes together would make a very significant improvement on the level of geriatric provision in the area.

I recognise that what I have said tonight about the prospects for phase two of New Cross will be disappointing to many people, although I hope that substantial improvement in the geriatric service will be welcomed. I know that the second phase of New Cross has long been cherished, and, of course, it is little consolation to those working in less than ideal conditions to be told that there is no likelihood of a major improvement in the next 10 years and that what money is available will be spent elsewhere.

Nevertheless, as a Government we are committed to a policy of concentrating resources on the most deprived areas. The West Midlands RHA has concluded that in the context of major capital developments Wolverhampton is not one of the most deprived areas in the region, and on the information available to me I am bound to agree. But because of the likely developments in neighbouring areas that I have already described, the pressure on the existing facilities at Wolverhampton should be progressively reduced over the coming years. With the improvements that will take place through minor capital works programmes, including undoubtedly some propping-up schemes, I am sure that the overall situation will become progressively much more satisfactory.

Question put and agreed to.

Adjourned accordingly at nineteen minutes to One o'clock.