§ Mr. SpeakerI call the hon. Member for Liverpool, Scotland Exchange (Mr. Parry).
§ 10.35 p.m.
§ Mr. Robert Parry (Liverpool, Scotland Exchange)The proposed closure—[Interruption.]
§ Mr. SpeakerThe hon. Gentleman had better wait a moment. It is hard for him to be heard because of hon. Members leaving the Chamber.
§ Mr. ParryThe proposed closure of the Mill Road Maternity Hospital, which was announced in a consultative document issued by the Liverpool Area Health Authority in September 1973 has met with a hostile reception. An action committee was set up by the workers, and although they are small in number they have presented me with a petition bearing nearly 9,000 names, protesting at the hospital's closure. The petition also includes the names of hundreds of people who live near the hospital and who have been confined there or have received ante-natal treatment there.
Also, a petition has been sent to me, which was signed by more than 200 general practitioners, protesting at the closure. Doctors are not normally to the forefront in signing petitions. Other names on the petition include 40 city councillors, and Merseyside county councillors, as well as the leader of the Merseyside County Council, Councillor Bill Sefton.
A written reply last Thursday stated that among the hon. Members who have made representations to the Secretary of State are my right hon. Friend the Member for Huyton (Sir H. Wilson), my hon. Friend the Member for Liverpool, Walton (Mr. Heffer), my hon. Friend the Member for Liverpool, West Derby (Mr. Ogden), and my hon. Friend the Member for Toxteth (Mr. Crawshaw). I understand that my hon. Friend the Member for Liverpool, Garston (Mr. Loyden) has also made representations to the Secretary of State along the same lines. I am sorry that my right hon. and learned Friend the Member for Liverpool, Edge Hill (Sir A. Irvine) did not see fit to 1374 support the representations as the hospital is on the other side of West Derby Road from his constituency, and many of his constituents will be affected by any closure.
The Royal College of Midwives, Liverpool branch, and the National Union of Public Employees have written to the area health authority objecting to the proposed closure. Yesterday I received a letter from the NUPE East District Nurses Branch, enclosing an emergency resolution.
The letter says:
Dear Mr. Parry, I refer to the enclosed emergency resolution from the staff of Mill Road Hospital. I would appreciate your intervening in the current position. The closure of the hospital will be highly detrimental, in view of the first-class facilities offered at this hospital.The emergency resolution reads:The staff of Mill Road Maternity Hospital, Liverpool, deplore the Area Health authority's decision to run down services for patients as from 1st July, 1977. This decision clearly will lead to the closure of this first-class gynaecological hospital serving a considerable number of people in Liverpool. We therefore request our M.P. to intervene and investigate this deplorable state of affairs, and bring pressure to bear on the Secretary of State for Social Services.The quality as well as the quantity of the objections should be considered seriously by the Secretary of State. He should immediately halt any further run down of the facilities until all the factors have been investigated. I understand from the community health council that a further consultative document has been prepared which speeds up the closure proposals. I urge the Secretary of State to reject any indecent haste on this important issue.Mill Road is the largest maternity hospital in the United Kingdom. It has first-class facilities, including a premature baby unit. The oxygen bank was extended recently, and a new teaching unit has been built in the last few years for the university. There are rooms for visiting medical staff and student lecture rooms. The staff dining rooms were recently carpeted at a cost of £1,000, and the wards were fitted with extra baths and showers, a fitted kitchen and tiled floors. The A1 ward has been fully fitted with new carpets, dining chairs and tables and the premature baby unit has been fitted with a 1375 fire escape and double glazing. There is an expensive new incubator, a deep freeze for baby milk, new air conditioning and new wall oxygen cylinders. A new Gregory box and resuscitation equipment has been fitted. Every piece of equipment in the X-ray department has been changed in the last eight years. The pharmaceutical department is fairly new and has been designed and purpose-built as a pharmacy. A stores area has been built, as well as a quarantine area and a component washing room, and also expensive equipment has been purchased, including washing and mixing machines. Will my hon. Friend the Minister say how much this equipment has cost in recent years for the operation of the hospital?
The hospital includes a modern maternity theatre, with lifts to all floors. The hospital is centrally situated in Liverpool and is well served by public transport to all parts of Liverpool, and there is a large car park for visitors in the grounds of the hospital.
Six large new housing estates have been built in the adjacent area in recent years housing hundreds of young families. Also attached to the hospital is an artificial limb and appliance centre which serves patients from a wide area, including North Wales and the Isle of Man. Is there any money available to move the centre elsewhere, and has this point been fully considered by the area health authority?
The recent cost of upgrading the Mill Road Hospital and of providing maternity services at Broadgreen Hospital is economic madness in the present climate of financial stringency and public expediture cuts. I quote from page 4 of the Consultative Document:
The Area Health Authority recognises that there will have to be significant capital investment at Broadgreen Hospital before the whole of Mill Road Hospital, including the outpatient department, can be closed, and it is, therefore, proposed to effect hospital's closure in two stages.I understand that the estimate for the provision of maternity facilities at Broad-green is, at the lowest £600,000. At present inflation rates, that figure will probably be greatly exceeded. Broadgreen is situated about five miles from Liverpool city centre and many patients from the inner areas will have to use at least two buses. Also, if extra travel becomes 1376 necessary, this will mean that many patients will not be able to book early in pregnancy or to attend the ante-natal clinics regularly. We must remember that the number of clinic visits paid by pregnant women is ten.My right hon. Friends the Secretary of State for the Environment and the Minister for Housing and Construction have made major public speeches outlining changes in Government policies on renewal of the inner areas of large cities. I was born and bred in the inner areas of Liverpool, and I still live there. I warmly welcome the change of heart and minds of the Government, because it is long overdue. The people of the inner areas over the years have seen their communities torn apart and suffer as a result of fly-overs and under-passes, the construction of the second Mersey Tunnel and the building of major roadworks.
Recently the Archbishop of Liverpool, the Right Reverend Derek Worlock, at a civic service, said of the inner area and the new housing estates,
It is no use the limbs thriving if the body has a hole in the heart".I fully agree with his Grace, and I feel that is a telling and appropriate point to make in this debate.In the near future we shall see the closure of the Liverpool Royal Infirmary, the Royal Southern Hospital and the David Lewis Northern Hospital. All are in my constituency and all are situated in the inner areas of Liverpool. I am sick and tired of the urban vandalism which has taken place over the years in Liverpool and the planned urban rape of the facilities. I served as a councillor for 11 years and raised this matter on a number of occasions in the Liverpool City Council as applying to inner areas. I shall continue to oppose the planners and bureaucrats who do not consider the general public.
I have not supported the Government in cutting public expenditure and I have no intention of supporting them in any other cuts, bearing in mind that in the constituency that I represent there are areas containing deprived and underprivileged people.
The Minister has received representations from other organisations, and other right hon. and hon. Members have also raised the matter. Let us hope that in future we shall not have to say that the 1377 myopic vision of the Liverpool Area Health Authority in closing Mill Road Maternity Hospital has led to the spending of hundreds of thousands of pounds more of public money and has also resulted in the removal of that important service from the city centre.
In conclusion, I congratulate Mrs. Beattie and Mrs. Davies and their small number of co-workers on the sincere way in which they have gone about the work of organising opposition to the proposed closure. I also congratulate West Everton Community Council and other organisations that have written to me on the matter. Let us hope that their efforts will not have been in vain.
§ 10.47 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)I should like to begin by congratulating my hon. Friend the Member for Liverpool, Scotland Exchange (Mr. Parry) on the ability with which he has presented his case. The views that he has expressed are, I know, widely held because staff, patients and the public as a whole develop very strong feelings of affection for their local hospitals. Indeed, I have a great deal of sympathy with the feelings of my hon. Friend since I am probably the first Member of Parliament to have been faced with a hospital closure in his own constituency. May I also say how much I appreciate the concern that my hon. Friend has often shown for the health services in Merseyside generally and about this proposed closure in particular.
The hon. Gentleman has made it clear that the staff of the hospital and many of his constituents are also concerned and opposed to the possible closure of the Mill Road Maternity Hospital, with its 72 obstetric and 25 gynaecology beds. My hon. Friend has also referred to two petitions signed by nearly 10,000 members of the public, general practitioners, midwives and local community leaders that was put to my right hon. Friend the Secretary of State last week.
If we are to ensure that standards of patient care within the National Health Service can continue to rise—an aim to which my right hon. Friend and myself are committed— and if we are to take a more objective view of priorities in terms of health care and the distribution of 1378 scarce resources, then there are bound to be changes. This is particularly so as the limitation on new resources makes new developments dependent on savings made elsewhere. To this end the reorganisation of the National Health Service in 1974 was aimed, among other things, at the creation of a structure more suitable for the planning of future services and the development of a comprehensive and integrated health service. Health authorities established in 1974 are now in the process of reviewing in detail the inherited pattern of services that they now provide with a view to rationalisation. We are positively encouraging health authorities to reduce wastage of any kind. At the same time we are proposing measures aimed at securing a fairer distribution of the limited financial resources available to the NHS.
Liverpool Area Health Authority (Teaching) has been concerned for some time about the low bed occupancy in maternity hospitals and units in the City. This has become more marked in recent years due to the falling birth rate. For example, in 1975 the bed occupancy at Mill Road Maternity Hospital was as low as 40.5 per cent. The authority has been considering ways of matching maternity services more closely to need.
As I understand it, the Liverpool Area Health Authority (Teaching) originally conceived its proposal to close the Mill Road Maternity Hospital as part of a phased rationalisation of maternity services in the area in response to the fall in the birth rate, compounded by a declining population in Liverpool itself, the sharply rising cost of providing obstetric services, and the competing needs of other services in the area at a time of financial stringency.
§ Mr. Eddie Loyden (Liverpool, Garston)Will the Minister give way?
§ Mr. DeakinsI have only five minutes left in which to reply to my hon. Friend's points. It would be unfair not to press on. I apologise.
The continued retention of existing obstetric facilities is thus felt by the Area Health Authority (Teaching) to be unjustifiable. Indeed, in-patient services were concentrated in August last year with the closure of two wards containing 44 obstetric beds. The decision of the Area Health Authority (Teaching) to 1379 rationalise its maternity services follows tentative national guidelines issued by this Department. These are based upon the recommendations in the consultative document "Priorities for Health and Personal Social Services in England". This document concluded that in general the hospital maternity services have attracted too large a share of resources and that the minimum aim should be to lower the cost of this service by about 7 per cent. by 1979–80 or an average annual decrease of somewhat under 2 per cent.
We are, of course, well aware of the difficulties which those responsible for the management of the service have to face—the pressure of cash limits, the task of running-in the reorganised structure of the service and its consultative arrangements and the problems of developing a planning process adequate to cope with change and uncertainty.
The Government's commitment to a more equitable redistribution of Health Service provision remains and can be promoted only by the rationalisation of currently under-used facilities, thereby releasing funds for other more urgently needed services. The Liverpool Area Health Authority (Teaching) has estimated that, based on November 1976 pay and prices, its rationalisation proposals for obstetric and gynaecology services will amount to a saving of £1,150,000, of which the closure of the Mill Road Maternity Hospital will account for £1 million.
These savings are all the more important when it is considered that the Mersey Regional Health Authority has stated that its top priority over the next 10 years is to reduce the marked disparities in Health Service provision available to the general public within the region. Since the per capita expenditure in Liverpool on general and acute services in 1972–73, for instance, was the highest in the region, Liverpool AHA(T) will be unlikely to benefit from any future sub-regional redistributions. The savings become more important still when one considers that area health authorities have also had to face some unexpected new developments without additional money, in the knowledge that the discipline of cash limits means that any overspending which they have been exhorted to avoid becomes a first charge on next year's 1380 allocations. Liverpool AHA(T)'s overspending on cash limits to January 1977 stood at £287,000.
I have drawn hon. Members' attention to the consultation procedure on proposed hospital closures during previous Adjournment debates, but I feel that its importance cannot be overstressed. This procedure requires an area health authority to prepare a consultative document covering such matters as the reasons for its proposal, an evaluation of the possibilities of using the facilities for other purposes or the disposal of the site, implications for staff, the relationship between the closure or change of use and other developments and plans, and, of course, the effect on patients who might be affected by the proposal, particularly in relation to transport facilities.
Comments on the proposals in the consultative document are invited within three months from such bodies as the local community health council, the associated local authorities, joint staff consultative committees and other staff organisations, family practitioner committees and local advisory committees. Hon. Members whose constituents would be affected would also be informed of the proposals and there is nothing to prevent hon. Members or the community health council at that stage from asking the area health authority for such cost figures as are available.
If the community health council, which is given the opportunity to study the comments of the other bodies consulted and the area health authority's views on those comments, objects to the proposals, it is entitled to submit to the authority a constructive and detailed counterproposal, paying full regard to the factors, including restraints on resources, which led the authority to make its original proposal. If the authority is unable to accept the counter-proposal the matter is referred to the regional health authority. If it, too, is unable to agree with the community health council and wishes the closure or change of use to proceed, it falls to my right hon. Friend, the Secretary of State to act as arbiter. It is not his function to intervene during the consultative process in the way that my hon. Friend suggested.
Nothing I say today should be construed as prejudging this issue in any particular case, least of all the situation 1381 with regard to the Mill Road Maternity Hospital where the Liverpool Area Health Authority (Teaching) is expecting comments on the proposals set out in its consultative document by 23rd February.
§ Mr. DeakinsIf there is to be a further consultative document, that will delay the process. I am going on the basis of the original consultative document.
Until the comments are received and the views of the community health councils for Liverpool and Sefton and other interested organisations are known, it will be impossible to indicate the likely outcome of this proposal.
The procedures governing the closure or change of use of health buildings may appear complex, ponderous, even overelaborate and a deterrent to the optimum deployment of health care resources with maximum speed. Indeed in a period of economic stringency, a premium is placed on the cost-effective use of resources. However, the NHS must be responsive to the local views of patients, staff and 1382 hon. Members if it is to work at all. Thus the system seeks to balance the need for local —and exceptionally national—consultation with that for speed in rationalising services.
Another aspect of all closures with which I know my hon. Friend is particularly concerned is the implications for the staff employed at the particular hospital or other units concerned. In the case of the Mill Road Maternity Hospital, the Area Health Authority (Teaching) is well aware that any discontinuation of in-patient or out-patient services would have a considerable effect on the authority's manpower requirements. Indeed, a policy for the redeployment of staff surplus to requirements as a result of the closure of two wards during August 1976 was agreed with staff side organisations and arrangements were made for all the staff displaced—
§ The Question having been proposed after Ten o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker, adjourned the House, without Question put, pursuant to the Standing Order.
§ Adjourned at five minutes to Eleven o'clock.