HOSPITAL SERVICES (WALSALL) (Hansard, 4 May 1976)

§ Mr. Bruce George (Walsall, South)

This is the third time in less than three months that I have had the opportunity of raising, on the Adjournment, some of the numerous and fundamental problems concerning Walsall. I have raised the issues of Walsall's housing need and its industrial decline, and now I wish to expose the serious defects of our hospital services and the need for a new general hospital to be constructed on the site of the Manor Hospital.

As in so many facets of life, Walsall has not had its share of national funds. I wish to show that the inadequate hospital service in our town is the product of the accumulated neglect of decades. The Minister of State, Department of Health and Social Security spoke recently on hospital building and said: There was hardly a town of any size or city in the country that was not encouraged to believe that a new district hospital was soon to be built. However, many of these hopes have yet to be fulfilled, and perhaps will never be fulfilled. Hospital planning in Walsall was never "bedevilled by optimism", to use the Minister of State's phrase. Indeed, until recently, it was widely held that it would be 10 or 20 years before our much-desired and much-needed hospital would be constructed.

One must be realistic to appreciate the financial constraints under which the Government are working. We must be aware too, of the changing philosophies of hospital construction, the move away from the concept of large district hospitals 1266 to nucleus and community hospitals, about which we have heard a lot lately. I wholeheartedly welcome the provision being made by the Government to eliminate the wide disparities between the regions in expenditure on health.

Of even greater interest is the complex question of sub-regional allocations, where there have been enormous variations in expenditure. The West Midlands, despite the myth of prosperity, has been identified as a middle-ranking region by the Resources Allocation Working Party of the DHSS, with Walsall occupying about the bottom rung of the ladder within the region. I go further, and say that until last year the allocation of public funds to general hospitals and community health was the lowest in England. I refer the Minister to an article by Mr. J. H. Rickard, of the Department of Health and Social Security, entitled Per capita expenditure of the English area health authorities", published by the British Medical Journal on 31st January 1976.

In this article Mr. Rickard shows that in 1973 expenditure per head on general hospitals in Walsall was £11.06, while the average for England as a whole was £19.03 per head. Only Leicestershire had less expenditure per head than Walsall. Expenditure on community health in Walsall was £3.04 per head, hardly compensating for low expenditure on hospitals. The average for England as a whole was £3.74. There is no doubt which town is bottom of the list in community health provision—Walsall.

If the Minister were to analyse the figures in the decade before 1973 he would realise why the condition of hospitals in Walsall is so critical. I urge him to study the table in a document produced by the West Midlands Regional Health Authority called "Consideration of major capital building strategy: 1976– 77/1985–86". He will see the gross under-provision of medical and hospital facilities in the area. He will see the high standardised mortality rate, despite our relatively young population.

A contributory factor, I suggest, is the shortage of acute medical and surgical beds which causes excessively long waiting times for in-patient treatment. The tables in this booklet reveal that in terms of bed availability and patient access we 1267 in Walsall are classified by the region as "very poor". Of the 22 areas in the region, in terms of acute beds we are eighteenth, in terms of geriatric beds, seventeenth, and in terms of maternity beds, fifteenth. There are no mental illness facilities. This report by the regional authority is a damning indictment of the allocation to Walsall over the past decade and longer. I am pleased that this is changing.

There is a shortfall of beds, on the basis of the population of the town being 283,000. The deficiency in acute beds is 187; for geriatric beds it is 129; for mental illness beds it is 142; and for maternity beds it is 48. A revenue deprivation exercise by the regional health authority shows that Walsall falls short of the calculated norms by £92,000 in the sphere of primary care and £2,207,000 in the sphere of secondary care. This deficiency in revenue terms makes Walsall the most deprived area in the West Midlands, falling short of its target allocation by 22 per cent. The next, in order of deprivation, is Staffordshire, at 15 per cent. The consequence of this neglect is evident. The waiting lists are enormous and the time that people have to wait to see a consultant, or to be operated upon, is quite appalling. In answer to a Parliamentary Question last December the Minister of State, Department of Health and Social Security pointed out that The waiting time for surgical admissions varied between 18 to 30 months, according to the kind of operation required."—[Official Report, 4th December 1975, Vol. 901, c. 726.] The consequence of industrial action over the last 12 months has, in my opinion, exacerbated the problem of those long waiting lists. In my surgery each week I see constituents who feel frustration and anger at the long waiting time to see a consultant. In some cases it can be over a year. Another consequence is that the fabric of our hospital is generally antiquated. Indeed, the division of facilities between two hospitals—the Manor and the General—one and a half miles apart is causing considerable problems in itself. The Manor Hospital was originally built as a workhouse to provide for the destitute in 1838, and many of the Victorian buildings remain. The General, or Sister Dora Hospital, is rather more modern, having been built in 1867! However, most of this mid- 1268 Victorian edifice is remaining and still in use, albeit unsatisfactorily.

We have a famous figure in Walsall, namely, Sister Dora, a 19th century matron. If she could return she would find little changed in the hospital named after her. The buildings are old, despite some additions. Without being too alarmist, I can say that the operating theatres are officially described as "deplorable" in the General and "poor" in the Manor. The out-patient facilities for the accident and emergency department are, in the General, housed in what was a converted laundry. The demand for maintenance work is causing a great deal of concern.

A further result of the deficiency and neglect is the enormous difficulty in attracting and retaining staff. I pay tribute to the dedication of the staff in our hospitals—medical, para-medical and other staff. Indeed, to work in Walsall hospitals one must have sense of missionary zeal, because of the difficulties and because of the much better hospitals situated on the periphery of the town, in Birmingham, West Bromwich, Sutton Coldfield and Wolverhampton. In Walsall there are few facilities for attracting staff, and first-class facilities attract first-class staff. I believe that the staff in our hospitals provide as good a service as we can expect, indeed, better than we have a right to expect under the circumstances in which they are operating.

I have no time to elaborate on the number of bodies, like the British Medical Association and the General Nursing Council, which have inspected our facilities and found them wanting. I could go on indefinitely, but the late hour and the time available prevents me from doing so.

In the two years for which I have been a Member of Parliament I have been campaigning to have our hospital facilities improved and I have been working alongside the hon. Member for Aldridge-Brownhills (Mr. Edge), but the campaign to get improved facilities is not just an official campaign by ourselves, by the area health authority and the community health council. It is very much a grass roots campaign. I emphasise that many members of the public are showing frustration at the defects of the system. One of our newspapers, the Walsall Observer, started, 1269 with two members of the public—Mrs. Hirtenstein and Mrs. Benton—what it called the Sister Dora Fund, which raised a lot of money and resulted in a large petition, which I presented to the Minister of State. I have been on two delegations to the Minister of State and will soon go on another to see Mr. Perris, the chairman of the regional health authority, together with representatives of the area health authority and the community health council.

In Walsall we are all delighted that at long last a district general hospital is in sight. A recent report by the regional health authority put it in the "middle of programme phase"; it said that phase I would start in from five to seven years and would cost £5 million. We are told that the plans are not ready to start immediately. The area health authority has stated its intention to speed up the planning as much as possible so that a start can be made as soon as the go-ahead is given.

The replacement of the general hospital by phase I will save over £1,200,000, which will be made available as a contribution towards the annual maintenance costs of the new hospital, but even with phase I implemented the number of beds available will probably be no different, although they will probably be used more efficiently.

I have extended an invitation to the Secretary of State to visit the hospitals in Walsall. He is a Walsall man, and clearly knows the problem at first hand. I hope that he will be able to come to our town to inspect the hospitals and see at first hand the situation that we face.

I again urge the regional health authority and the Department to recognise that the case for a substantial capital investment in the form of a district general hospital to alleviate the deprivation and the deterioration of the health care services in Walsall is overwhelming.

I know that the Government have already taken some steps to remedy the situation. It is the view of the area health authority, the community health council, myself and, most important, the general public in Walsall, that it is absolutely essential that a start should be made as soon as possible. I shall not 1270 stop campaigning until we in Walsall have a hospital service adequate for the needs of our citizens.

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

I must begin by congratulating my hon. Friend the Member for Walsall, South (Mr. George) on securing this Adjournment debate and on the care with which he has presented his case. His deep concern about the deprived state of the health service in Walsall and his determined efforts to bring his concern before the House are well known.

I have not had the good fortune to visit Walsall, although my officials have visited the area on several occasions and my right hon. Friend the Secretary of State, whose personal connections with Walsall are well known, intends to visit the town later this year. Nevertheless, let me say straight away that I entirely accept my hon. Friend's case that Walsall is a deprived area in health service terms.

My hon. Friend referred to the accumulated neglect of decades and quoted comparative figures to show its extent. There is no single definition of deprivation against which the circumstances of particular areas can be measured, but whatever criteria of deprivation one looks to, Walsall comes out as deprived. In terms of the numbers of beds available against those needed on crude national planning norms, Walsall has a shortfall of about 140 acute, 40 maternity, 40 geriatric and 140 mental illness beds. Within the West Midlands region only Sandwell and two districts of Staffordshire are more deprived of acute, maternity and geriatric beds. Studies by the West Midlands Regional Health Authority have shown that, of 22 health districts in the region, the population of Walsall has the second lowest level of access to hospital facilities, and that, with Staffordshire, it is the most deprived area in terms of revenue funding.

Whilst the statistics about waiting lists that my hon. Friend has quoted show very long waiting lists indeed for many forms of treatment, they are not good indicators of deprivation. The way in which waiting lists are maintained differs between hospitals, and, as he said, at 1271 present many lists are inflated as a result of recent industrial action by medical staff. It is, therefore, virtually impossible to establish the relative deprivation of various health districts simply by a comparison of waiting lists.

As my hon. Friend has made clear, though, Walsall's problems do not stop at a shortage of facilities. A substantial part of the existing hospital provision is unsatisfactory. Acute services are provided mainly at the Manor and General, or Sister Dora, Hospitals. Conditions at the General, in particular, leave a great deal to be desired. Many wards have no day rooms attached to them; essential supporting facilities such as sluice rooms, bathrooms, lavatories and store rooms are cramped and rather primitive; the operating theatres have no air conditioning, and in summer they become unbearably hot; and the out-patient department is a source of major concern.

As my hon. Friend said, despite the major shortcomings of the general hospital as a building, the staff achieve a very high standard of service, and I would like to associate myself with the tribute my hon. Friend has paid to them.

The fact that Walsall is deprived in health service terms, both by a lack of facilities and the poor quality of some of the existing facilities, is beyond dispute. What, then, is being done to remedy the situation?

The regional and area health authorities and ourselves all agree that the key to improving the standard of health service facilities in Walsall is the provision of new acute beds at the Manor Hospital. For many years it has been the intention to develop the Manor site, and indeed some development there has already been completed. This includes an important scheme to provide a boiler-house and laundry to support the new acute beds; the provision of geriatric wards and a day hospital, and an outpatients department. As a result of decisions taken by the regional health authority on 17th March, planning of the next phase of development—about 180 acute beds and an accident and emergency department, which will enable the General Hospital to be closed—is now beginning in earnest. This is the key scheme for 1272 Walsall. The important question is timing.

Last July the regional health authority issued a consultative document, "Strategy for Health 1976–86", which, among other matters, set out for public scrutiny the authority's preliminary views on major capital developments for the decade. On 17th March the authority considered comments on its consultative document, analyses of deprivation in the region, and such information about likely future resources as we were able to give it. The authority decided that immediate priority should be given to two schemes—Stafford and Dudley—which were already well advanced in planning, and both of which are badly needed. The development of the Manor Hospital, Walsall, was, however, included with two other schemes—Telford and Nuneaton or Rugby—as having the next highest priority. It will take three years or so to plan the Walsall scheme, and the probability is that building will start around 1980.

I must emphasise that I am not giving a firm commitment for a start in 1980. The exact starting date will depend on the level of capital available to the regional health authority in the late 1970s and early 1980s; the progress made in planning the Walsall development; and, possibly, the relative priority of Walsall against Telford and Nuneaton or Rugby. The broad intention is, however, that the Walsall development would start around 1980, in other words almost as soon as it is fully planned.

It may be asked why, given the acknowledged need for new facilities, plans are not already advanced, as they are for Stafford and Dudley. The answer is that the priorities of the regional health authority, as set out on 17th March, do represent a shift of emphasis from those of its predecessor, the Birmingham Regional Hospital Board. The authority regards it as important that areas should have adequate acute beds for their population, rather than have to look to facilities in regional centres, such as Birmingham. This means greater priority is being given to developments in relatively deprived areas such as Walsall and Solihull, and lower priority to further developments in

While the major acute development at the Manor Hospital is clearly the key Birmingham, Wolverhampton and Stoke. 1273 scheme in improving facilities in Walsall, I have no doubt that in due course the regional health authority will be considering further developments at the Manor Hospital, and the provision of a community hospital at Aldridge—a scheme that I know is dear to the heart of my hon. Friend the Member for Aldridge-Brownhills (Mr. Edge). These other major developments seem certain to come after the acute development at the Manor Hospital, however.

In addition to the major development at the Manor Hospital, Walsall will, of course, have the benefit of many smaller building schemes. Some are already in progress and others will start in the current financial year. Among those expected to start in the current year are substantial additions to the intensive therapy unit and the out-patient department at the Manor Hospital. Further, in following my right hon. Friend the Secretary of State's policy of beginning to redress the inequalities of health provision, the West Midlands Regional Health Authority has allocated a substantial part of its revenue development addition for the current year on the basis of relative deprivation. Walsall and Staffordshire 1274 were by far the main beneficiaries. The addition was relatively small in the context of the total revenue allocation to Walsall—£278,000 out of a total of £11.4 million. Nevertheless, basing revenue allocations partly on relative deprivation is an important step forward, which I am sure will be continued in future years.

To sum up, my hon. Friend has demonstrated clearly that Walsall is a deprived area in health service terms. This is fully accepted by the regional health authority and the Department. Walsall is clearly going to benefit by the distribution of revenue, partly on the basis of relative deprivation, by the major capital development planned for the Manor site, and by other smaller capital schemes. I hope that this will give those who work in the National Health Service in Walsall, who have put up with inadequate and second-rate facilities for so long, and to whom my hon. Friend paid tribute, as I do, the encouragement to maintain the standard of service already provided until the new development is in operation.