HC Deb 11 June 1976 vol 912 cc2022-30

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

5.50 p.m.

Mr. Cyril D. Townsend (Bexleyheath)

I wish to draw to the attention of the House the possible closure of Bexley and Welling Hospital. I should immediately make it clear to the Minister that this is a matter of much public concern in Bexleyheath, and in my view rightly so, because it would be a severe blow to the town.

Last December the Greenwich and Bexley Area Health Authority produced a discussion document on health services in the area. This document suggested that the only two hospitals in my constituency might be closed. I should much regret the closing of Bexley Maternity Hospital, mut I shall confine my speech this afternoon to the case for retaining Bexley and Welling Hospital. This splendid hospital was built by public subscription 91 years ago to meet a public need. In my view, there remains a clear public need.

Our hospital has three main rôles. It handles acute cases, it looks after the elderly, and in particular it takes in elderly patients for short periods. This allows their relations a brief holiday each year and, of course, it produces considerable savings for the public purse. It takes patients from larger hospitals after operations, thus freeing beds for more urgent cases.

From my frequent visits and from the overwhelming evidence of my postbag, it is obvious that the hospital has an excellent matron and a professional, dedicated and compassionate staff. Many have given the hospital long service, and there is a waiting list of people who wish to work there. It sets the highest standards for efficiency and for the relief of suffering. It receives real support from people in all walks of life in Bexleyheath and Welling. It has an active group of friends giving it encouragement and financial aid.

The closing of this hospital has been opposed at public meetings, and a petition containing 12,000 signatures has been presented to the area health authority. My right hon. Friend the Member for Sidcup (Mr. Heath) supports my case. The hospital is very well known to him and was in his previous constituency. The London borough of Bexley supports my case, as does the Bexley health district. My local newspaper, the Bexleyheath and Welling Observer, has done a first-class job championing the hospital's survival. I can name no important individual or organisation in my constituency opposing my case.

I ask the Minister to confirm this afternoon that in his view small, so-called cottage hospitals will always have a unique and vital rôle in the nation's health service, particularly when they have the advantage of strong and healthy roots within a local community. I cannot believe that, with all his experience, the hon. Gentleman considers that a bigger hospital is invariably a better hospital.

We have a big hospital in the borough—Queen Mary's—but as far as my constituents are concerned it is in the far corner of the borough and is notoriously difficult to reach by public transport. I know that the area health authority is well aware of the strength of this argument.

I do not feel that I need speak for more than a few minutes, but there are a number of other important considerations that I should perhaps mention. For historic reasons, our area is not well placed for hospitals. I am told that of all the districts in the South-East Thames Region the Bexleyheath health district is the worst provided with hospital services and is likely to remain so. Even by 1981 only 39 per cent. of the resident population will be served by hospitals in the district. Greenwich does better. The population of Greenwich is likely to fall while ours in Bexley is likely to rise.

Our hospital, which has 28 beds, is used by no fewer than 30 GPs who have their surgeries within a radius of a mile and a half. The opportunity to care for their own patients in hospital is valued by many doctors. Their patients appreciate it and the standard of practice in the area is raised. The area is classified as under-doctored, and the loss of these beds would make it that much less attractive to those thinking of entering practice in Bexleyheath. It is often said that GPs should be brought into hospitals. At our hospital they are there and we wish to keep them there.

I have reservations on the economic arguments put forward by the area health authority. It is not an expensive hospital to run. Indeed, it is agreed that the costs per bed, at £62 a week, are the lowest in the area. How much saving will there be over the years if the more expensive district hospital beds are to be used instead? Of course, much capital has been invested in Queen Mary's. I doubt the economic wisdom of closing down less expensive beds to pay for more expensive beds. I hope that the Minister will comment on this.

Let us admit to past planning errors in the size and siting of Queen Mary's but let us not compound the errors. We are told that the area has a surplus over other areas in so-called acute beds. Many local doctors, knowing the difficulty they experience in having patients admitted, would question that surplus. From time to time my constituents ask me why others should not in due course be raised to our standard rather than that our standard should be lowered to theirs. May I make the obvious point that it is relatively easy, should the need arise, to reopen wards that have been closed in our giant hospitals. If a hospital like Bexley and Welling is closed, it is never likely to be reopened. I have been assured that no plans have been made to use the hospital for any other purpose.

At present, widespread improvements are being carried out to the building. I hope that the Minister will make it clear what procedure is to be followed should the area health authority, from which I have had every courtesy, go against all local opinion and decide to close our hospital. What further action would be open to the Bexley health district and the London borough of Bexley and myself? Does closure still depend ultimately on the Secretary of State's approval? Will the Minister accept my invitation to visit the hospital before a final decision is taken?

I fully understand the need to contain costs in the National Health Service at a time of unprecedented inflation. Nevertheless, for the general reasons I have put forward this afternoon—and I will willingly follow them up with more technical, medical argument in writing if the Minister wishes—I trust that ultimately it will be found possible not to close this splendid hospital which doctors, nurses, their patients and patients' relatives and friends have found so convenient over the decades.

Bexley, as all of us in the constituency know, is not rich in amenities. It is my task, and one which I willingly undertake, to fight in Bexley and Westminster to preserve the few that we have.

5.59 p.m.

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

May I say how much I appreciate the spirit in which the hon. Member for Bexleyheath (Mr. Townsend) has spoken? It was a model speech for a constituency Member of Parliament. I have every sympathy with his point of view because in my constituency I have a similar hospital which is, possibly threatened with closure, although things have gone rather further there than they have in Bexley. The arguments he has advanced could well be advanced in respect of the hospital in my constituency and of hospitals in other parts of the country.

I appreciate that the hon. Member has felt bound to express his constituents' natural concern when the future of this well-loved cottage hospital seems to be threatened. At the same time, it may be worth noting that the policies and procedures which bear on the matter are essentially a continuation of those in force when his own party last held office. There have, however, been certain modifications which among other things should lead to some shortening of the time-scale for implementing decisions. In addition, there is the added impetus of current constraints on National Health Service expenditure and the determination of this Government to ensure that the resources available to the National Health Service are more equitably dis tributed over the country and between different types of patient.

I am not in a position this afternoon to give the hon. Gentleman any assurances about the future of this hospital. Indeed, it would be inappropriate for me to attempt any discussion of the merits of the particular proposal, since it is still the subject of deliberations and consultations which are a necessary precursor of consideration by the Department of Health or by Ministers. What I should, however, like to do is to explain what the Greenwich and Bexley Area Health Authority is trying to do and why, the processes of local consultation which are going on at present and the way they aim to ensure that no relevant factor or point of view is overlooked.

Following the then Secretary of State's statement to the House in December 1974 about reviewing the general strategy for development of the reorganised National Health Service in the light of the Government's decision to slow down the expansion of public expenditure, the Department wrote to health authorities in March 1975. Among other things, it was suggested that to achieve a better balanced and integrated level of service some redeployment between existing and new buildings might be necessary; a reduction in the total number of hospitals could lead to resources being released for other essential purposes.

The Greenwich and Bexley Area Health Authority was already aware that the need for such a review was particularly pressing in its area, since the availability of major new hospitals at Greenwich and Sidcup meant that they were well-endowed with modern in-patient facilities. Indeed, the number of acute beds available in relation to the population of the area—a population, moreover, which appears to be diminishing in total, though there may be variations in diferent parts of a local authority's area—is well above the numbers available over the South-East Thames region, the country as a whole, which are in turn generous by comparison with the ratios which we now adopt when planning new provision.

According to the health authority's calculations, the Greenwich and Bexley area currently has 3.05 acute beds per 1,000 population, as against the regional level of 2.8 beds and the national level of 2.64. Cuts in 1976–77 resource allocations were anticipated, perhaps for the region as a whole but certainly—in the interests of equalisation—for selected areas. For these and other reasons, therefore, the AHA in the latter half of 1975 embarked on an in-depth study of existing hospital provision throughout the area and how it could best be rationalised. The outcome of this study was the production in December 1975 of a "Discussion Document on Services in the Area", which was distributed to all interested parties and well covered by the local Press.

Its declared purpose was to stimulate informal comment and discussion, leading in due course to the production of concrete proposals which would then be subject to formal consultation. This was in accordance with the procedure laid down in the circular on "Closure or Change of Use of Health Buildings" which the Department had issued in October 1975. Among the alternative reasons which that procedure allows an authority to advance, in justifying a suggested closure or change of use, are, first the service can be more efficiently provided elsewhere; secondly, the facility is no longer required because of new development; thirdly, redeployment of services is essential having regard to the resources of manpower and finance available.

Cost-effectiveness in the use of NHS resources is paramount in this time of economic constraint, and this must be an important factor in AHA planning for the best use of facilities. Nevertheless, the procedure does require a round of formal consultation with local interests, which is intended to lead to final conclusions within the reasonable period of six months.

This consultative procedure recognises the importance of the role now played by community health councils. The hon. Gentleman did not mention them, but I imagine that in his case the local community health council was also "on the side of the angels" in opposing the possible closure.

The members of community health councils are appointed to represent the community interest in the provision of health services in the various health dis tricts throughout the country. Area health authorities are required to give the appropriate community health council the opportunity to consider and offer observations on any hospital closure proposal provisionally adopted by the authority and, in the event of general disagreement or specific objections, to put forward reasoned and viable counter-proposals before a final decision is reached. Should this situation arise, the matter is referred to the regional health authority, and if it cannot accept the community health council's alternative, the case is submitted to my right hon. Friend, without whose specific authorisation in those circumstances the hospital cannot be permanently closed.

I assure hon. Members that should it be necessary to invoke that procedure for any projected hospital closure—whether in Bexley or elsewhere—the relevant facts and representations will be subjected to very careful scrutiny and consideration before my right hon. Friend arrives at a decision. Among the special factors in this case will, of course, be the availability of public transport, which I believe is limited in certain respects.

As the hon. Gentleman has said there has been a strong local reaction to the AHA's tentative proposals. Those who have expressed their opposition will need to bear in mind the desirability of making a constructive contribution to the development of a pattern of services in the area which will best meet the need of the population while at the same time requiring no more than the population's fair share of the resources available to the NHS as a whole.

Developing such a pattern is not, of course, merely a matter of rationalising the general hospital services. The AHA will also need to find resources for improvements and additions to other services, such as community health services and services for the mentally handicapped.

It is particularly important to view the local reaction against the background of the new planning system and the recently-issued Consultative Document on Priorities for Health and Personal Social Services. There is a paragraph in that document which bears directly on the matter, and I would like to quote it in full. It is headed "Use of Beds" and says: An important part of the suggested strategy will be to identify those areas and specialties which have more acute beds than are needed to provide efficient services, with particular attention to areas and specialties where provision is markedly above rational averages. Some units can be closed without replacement of the services they provide, or their function can be changed either to treat the same number of patients less expensively (e.g. in day surgery units or in five day wards where practicable), or to provide services for the elderly or mentally ill. Views are sought on the extent to which this can be done without detriment to the overall effectiveness of medical care. Ministers recognise that this policy will, in the short term, adversely affect the convenience of some patients and their relatives and may therefore be unwelcome locally. But they hope that Community Health Councils after considering this document will support authorities where closures or changes of use can lead to greater efficiency and a better use of resources. Ministers have already made it clear that where health authorities and CHCs agree they will allow closures to go ahead without reference to them. Local protests will only be given serious consideration if they are accompanied by realistic alternative solutions within the expenditure limits. Without wishing to prejudge any of the individual proposals, I suggest to the House that the health authority deserves commendation for the way it has tried to observe those principles, even before they were crystallised in print, and I urge all local interests to keep them in mind during the months ahead.

The authority has received numerous comments and representations about its proposals, either directly or via hon. Members' letters to my right hon. Friend. The necessary rationalisation of area services is being reformulated in the light of those comments and other relevant factors, and I understand that a special meeting of the authority on 12th July will be considering firm proposals with a view to initiating formal consultations. I am hopeful that the local people will then be able to see whether the Bexley and Welling Hospital can continue to provide some form of worthwhile service to the community.

One of my officials has visited the hospital and confirmed that it is a delightful place in every respect, with contented staff and patients. As in so many of such cases, a decision to change, or even perhaps terminate, the caring service which it has given for the past 90 years would only be taken, if at all, with the greatest reluctance and. I assure the hon. Gentleman, after the fullest possible consideration of all the points and suggestions put forward during the consultations which have already taken place and the further consultations which the area health authority will be undertaking.

Question put and agreed to.

Adjourned accordingly at ten minutes past Six o'clock.