HOSPITALS (FIFE) (Hansard, 7 May 1976)

§ Mr. William Hamilton (Fife, Central)

It has been recognised for a considerable time that the County of Fife is deficient in certain basic hospital facilities, especially in geriatrics and psycho-geriatrics. Those deficiencies have been identified and quantified, and provision has been made for them in the major building programme. An added impetus to development in the long-stay field has been given by the publication of the Government's paper, "The Way Ahead", a paper that laid down six guidelines for the future, one of them being: Continued improvements in hospital and community health services for the elderly, the mentally ill, the mentally handicapped, and the physically handicapped. The projected building programme for Fife reflects the known deficiencies and the Government's views on how the health service should develop. I want to put before the House three of the Fife board's major schemes, and I hope my hon. Friend the Under-Secretary of State will reply to each point that I make.

First, there is the New West Fife District General Hospital. The board took a conscious although difficult decision that the phase I development of that hospital should consist of long-stay rather than acute beds. The scheme as approved consists of 240 long-stay beds for geriatric, psycho-geriatric and psychiatric patients, with associated clay hospital facilities.

The second major scheme is the Glenrothes scheme, which consists of 60 geriatric beds and 20 day hospital beds 1739 for geriatric patients. There are also 12 beds for general practitioner use. The provision of these beds accords well with one of the other guidelines contained in "The Way Ahead", namely, the improvement of primary and community care service.

The third scheme of the board, to which I wish to refer—in some ways this is not the least important—is the Whyte-man's Brae development, in Kirkcaldy. This scheme consists of 180 mainly long-stay beds, 90 psycho-geriatric, 60 geriatric and 30 short-stay psychiatric beds. There are associatel day hospital facilities in that field.

I turn briefly to the problems associated with each of these schemes. The situation in respect of the West Fife District General Hospital is satisfactory, in as much as the board recently was given approval in principle for the phase I development of this project at a cost of £6 million. It would be churlish of me not to thank my hon. Friend and the Department for that. The general problem remains, that it takes an inordinate amount of time to plan anything in the health service. A start on the site on this project is not planned until early 1980. I hope that my hon. Friend is taking a firm view about the building of hospitals, or anything connected with the health service. I refuse to believe that it should take 10 years or more to build a hospital. There must be something wrong with the professions or the Department if that remains unchanged or unchallenged.

I understand that the Glenrothes project will cost about £1 million. This scheme is currently with the building division of the Common Services Agency, which provides a technical and professional service to local health boards. I gather that the scheme is running into cost problems. The final cost limit should have been provided in March this year, but with the delay it is difficult to see how the start on the site date of April 1977 can possibly be maintained. I should like some assurances on that matter.

It is estimated that the Whyteman's Brae development at Kirkcaldy will cost about £2 million. It has been known for many years that this was a difficult site 1740 on which to build a project of this size. Nevertheless, according to the board, Kirkcaldy is the obvious and best site for a 180-bed development, and we know from experience that other sites are unlikely to prove any easier or cheaper. Furthermore, its proximity to the Victoria Hospital means that a number of services can be supplied from there, rather than provided separately for the new development.

The building division spent a great deal of time and effort in devising a design solution that took account of the site constraints, provided a workable unit, and represented good value for money. In these circumstances, it is extremely disappointing to find that the architects of the Scottish Development Department are unwilling to commend the scheme to the Scottish Home and Health Department. They simply say "No" and keep on saying "No", without suggesting any alternative to the proposal. This will only result in substantial delay, and could conceivably kill the scheme as it is envisaged at present. It also raises the question of the rôle of the building division of the Common Services Agency. It was hoped that with the reorganisation of the service the building division would be the only body subjecting schemes to technical scrutiny. Instead, we find that the architects of the Scottish Development Department are carrying out this function on behalf of the Scottish Home and Health Department.

I recognise that my hon. Friend has today played a threefold role, as Lord Advocate, Secretary of State for the Department of Health and Social Security, and as the Scottish Health Department, I recognise his ability, humour and humanity. I do not think that Cabinet status can be long delayed for him. I think his expertise lies not least in public relations.

With genuine sincerity, therefore, I assure my hon. Friend that I am sorry to see him deprived of the responsibility for health services—I mean no disrespect to his successor—but I hope that he will make a name for himself, at least in Fife, by giving me a reply as though he were still in control and that, in any event, he will use his considerable charm and influence within the Department to kick somebody's behind there in order to get things 1741 moving in Dunfermline, and the geriatric service in Fife in particular.

§ The Under-Secretary of State for Scotland (Mr. Frank McElhone)

After such endearing words, one could hardly fail to respond to the blandishments of my hon. Friend the Member for Fife, Central (Mr. Hamilton). I should say that in my experience, such as it was, looking after the health service in Scotland during the first six or seven months after I became a Minister, I was all too well aware of my hon. Friend's persistent interest in Fife generally, and in the hospital service in particular. I should put on record also that our two hon. Friends the Members for Dunfermline (Mr. Hunter) and for Kirkcaldy (Mr. Gourlay) have written to my hon. Friend who has now succeeded in health responsibilities on matters to which my hon. Friend the Member for Fife, Central has referred.

The first visit which I made under the health services umbrella was to Fife to look at the Victoria Hospital and other hospitals and to make myself aware of the problems in Fife. I had a very good discussion with the Fife Health Board. I can fairly say, therefore, that my interest in hospitals generally, and in Fife in particular, started at the beginning of my time as a Scottish Office Minister. I am, therefore, delighted to stand in for my hon. Friend, who is away on other parliamentary business in Scotland, and to attempt a reply which will go some way to meet the concerns expressed in this debate.

My hon. Friend directed special attention to three matters, and I listened carefully to all he said. Before I give specific answers, however, perhaps I should say for the record that the health boards and the building division of the Common Services Agency and the Home and Health Department of the Scottish Office are at one in wishing, once approval in principle has been granted for a hospital building scheme, to make as rapid progress as possible through the planning and design stages to the actual construction and commissioning of hospitals in whichever area they are started. I should add that I was myself concerned to learn that it was taking something like 10 years from planning stage to completion on district general hospital projects in 1742 Scotland. My right hon. Friend the Secretary of State has initiated among officials in the Scottish Office a study to try to speed up the planning and building of district general hospitals and of all hospital projects under the Scottish Home and Health Department. I know that my hon. Friend the Member for Fife, Central will be at one with me in a desire to see the speeding up of these projects.

I turn, first, to the Whyteman's Brae project, the most contentious of the three to which my hon. Friend referred. I am sure that he will acknowledge that there are exceptional site difficulties. Indeed, I learned from my visit to Fife that because of the mine workings in that area it is extremely difficult to find suitable land on which it is easy to construct projects. This has caused a great difficulty for the health board and for the building division of the Common Services Agency which acts as agent for the boards.

This meant that to the basic cost of the project there would be an addition of about 80 per cent. for building on-costs. This led to concern, naturally, in the Department. Many discussions have taken place, particularly since last September, to try to get an alternative plan that would come within reasonable cost limits and meet the aspirations of the people of Fife for the building of a new unit for geriatric beds. We have to be convinced as a Department that, commensurate with the amount spent, we get the best value for money and provide the type of unit we would all like to see for elderly people in the 1970s.

Perhaps I should try to concentrate on the position in relation to the Fife hospital building programme. In addition to the major schemes which have been incorporated in the national programme the Fife Health Board receives an ordinary capital allocation—over £1 million in 1976–77—to meet the cost of other schemes to which it attaches importance and wishes to include in its own programme.

The programme for Fife is not, of course, geared only to the concept of a fair share of resources. So far as practicable, it also takes account of the specific needs of the area. If I have learned anything in my short time of responsibility for health services in Scotland it is that the different health boards have different 1743 needs even in a country as small as Scotland in terms of population.

The most pressing need in Fife appears to be for more geriatric beds, and in an attempt to meet that deficiency we are trying as quickly as possible to get the Whyteman's Brae scheme off the ground. It will provide 60 geriatric beds, and 90 psycho-geriatric and 30 psychiatric beds.

The Glenrothes unit, another major project, will provide a further 60 geriatric beds, along with 12 general practitioner beds. In the third major scheme to which my hon. Friend referred, the West Fife District General Hospital, my right hon. Friend the Secretary of State approved the first phase very recently.

My hon. Friend is concerned that we should move as speedily as possible, and I certainly do not deny the genuine concern there is not only in the Fife Health Board but amongst the elderly people of Fife and their families. In consultation with my advisers I have attempted to get as good an answer as I could for my hon. Friend and for other hon. Members representing Fife, because I think that an Adjournment debate means nothing if one just gets ambiguous answers and an offer of letters as a follow-up. I think that when an hon. Member secures an Adjournment debate he does so in all seriousness. Not only is he looking to advertise a problem as a constituency Member, but he is looking for some indication that the Department concerned is treating the matter seriously and is dealing with it as quickly and as humanely as possible.

I want, therefore, to tell my hon. Friend about two things in relation to the Glenrothes and Whyteman's Brae projects. On the development at Glenrothes, the board has arranged to meet the building division next Monday, when they 1744 will consider informally how the plan is evolving. The design under consideration may give rise to ward areas in excess of the normal, and that, in turn, could cause difficulties in meeting the cost limits. However, I am sure that with common sense, good judgment and getting round the table in discussion, the matter will be resolved satisfactorily. The fact that the meeting is to take place as early as next Monday shows that my hon. Friend has made some progress, and has had some success in securing this debate.

But the most contentious matter—the one most discussed in Fife—is the Whyteman's Brae project. The building division of the CSA has prepared a further revised plan designed to meet the reasonable cost limits required by the Department. The building division, as agent for the health boards, will discuss the plan informally with the professional officers of the Scottish Development Department. That will be done next week. That will no doubt please my hon. Friend and his constituents. In this revised plan the building division has tried to reduce the on-costs—the additional costs, as most people might best understand them.

The third major factor was the West Fife District General Hospital. My right hon. Friend has approved in principle the development of the first stage.

I hope that I have repaid my hon. Friend's generous expressions about my short term in the Scottish Office by providing this information and accepting the urgency of the matter, which is important not only to my hon. Friend and his colleagues but to everyone in the Kingdom of Fife.