NORTHWOOD, PINNER AND DISTRICT HOSPITAL (Hansard, 20 January 1977)

§ Mr. F. P. Crowder (Ruislip-Northwood)
I am glad to have the opportunity to raise the subject of the future of the Northwood, Pinner and District Hospital. I shall endeavour to do so in a short time and at a speed with which the shorthand writers can cope—in contrast to the previous two speeches which, although excellent, were like turning on both bath taps at the same time—though I appreciate the problems facing both hon. Members.
We have only a short time for this debate and my parliamentary neighbour, my hon. Friend the Member for Harrow, West (Mr. Page) wishes to intervene. I apolgise to the Chair and to the servants of the House for raising this subject at this late hour. I know that the House did not rise until about 6.20 yesterday morning.
A dark cloud and a very nasty threat—both of which are due to the economic circumstances—appeared over the future of the Northwood, Pinner and District Hospital in the autumn. I have been in contact with the Government and the Ministers concerned and I should like to take this opportunity of thanking them for the courteous and sympathetic manner in which they have dealt with the various problems which I have raised and entreaties which I have placed before them.
An area management team of the Hillingdon Area Health Authority was asked to investigate the implications of a partial or total closure of the Hayes Cottage and the Northwood, Pinner and District Hospitals. There are certain extracts from the team's report to the area authority to which I should like to draw attention. The most important is this: In brief, however, it is clear that at present the closure of either hospital would adversely affect the health service offered by the authority to an extent which the Area Management Team would not wish to countenance. Particular attention is drawn to the large surgical case load at both Hayes and Northwood Hospitals and to the difficulty of transferring any surgical work to other 814 Hillingdon hospitals where operating time is already committed, or to Mount Vernon, where the three theatres off "C" Block corridor have been closed for some time.
It is understood that if a new operating theatre were to be provided at Mount Vernon, the cost would be about £450,000.
Another important factor which was taken into account by the area management team was the very strong preference of the public in that area to being treated in smaller units. That view is supported by a large correspondence.
I shall explain the principal reasons against the closure. The district hospital is already a community hospital, right in the midst of an established and growing population. Thereby, it avoids inconvenient travel for old people, patients and visitors. The building and equipment is in first-class condition. I have been round the building on numerous occasions. It has an extremely efficient staff, supported by local general practitioners. Perhaps most important of all, it is a memorial to those who died in the First World War and was erected by public subscription.
A well attended meeting of residents was held about the matter. Petitions may not mean much, but about 14,000 signatures were collected in protest at the possible closure of the hospital.
I am concerned about the indication that nothing shall be done to close the hospital "at present". I suppose we are faced with an economic situation which must spell out such indications. Those were the words that concerned me. They led me to raise the matter on the Floor of the House. I hope that the words will be removed and that I shall convince the Minister accordingly.

§ Mr. John Page (Harrow, West)
My constituents and I are grateful to my hon. and learned Friend the Member for Ruislip-Northwood (Mr. Crowder) for having arranged this Adjournment debate through the usual channels. The continuing operation and existence of this little hospital is of passionate interest to my constituents in Harrow, West which is across the border from my hon. and learned Friend's constituency.
The petition, with so many names, confirms the local enthusiasm for the 815 hospital. A cheer has gone up that this well-loved institution is to remain and continue to give the friendly, efficient, approachable and unfrightening service which it has given for the last 50 years and which we hope it will continue to give for the next 50 years. In-patients and out-patients will be extremely glad. Consultants, general practitioners, nurses and physiotherapy and administrative staff will be relieved and grateful that they can continue, in this atmosphere, to serve the public.
Now that this grey cloud has disappeared over the horizon, temporarily anyhow, I believe that it would be approriate for me to mention to the Minister, and bring to the attention of health authorities throughout the country, that it really is time for more information about comparative costs of services in small, old-type parish hospitals and services in the great new cathedrals of medical technology.
Rather bravely, I have said previously, inside and outside the House, that those of us who demand cuts in public spending must have the courage not to bellow when cherished local institutions are up for slaughter on the altar of economy. However, if we are to show this courage, which I know that my hon. and learned Friend and many hon. Members in all parts of the House would wish to do in the national interest, we must be given the figures on which financial judgments are made.
As a business man of some years standing, I am confident that if the servicing of new capital expenditure debt were taken into account, the public would find that it was getting better value for money at this small hospital and others like it than if the same surgical and medical treatments were given in great new hospitals. On 9th December the Minister of State told me, in a Written Answer, that comparative costs of treatments at different types of hospital were not available. However, I believe that it is impossible to make a proper economic judgment without having those figures.
I should like to give just two examples in connection with this hospital. The physiotherapy unit is housed in a little prefabricated hut, which was probably put up in the 1940s for about £1,000. In that hut a devoted, friendly staff have 816 looked after over 1,000 contented patients this year. In the tiny X-ray unit, we learn, from the answer to my Question, that 47,600 treatments were given.
I have a feeling amounting to a certainty that such treatments given in North-wick Park, Mount Vernon or one of the bigger hospitals must cost about three times as much, because of the infrastructure and other matters.
We are extremely grateful that the threat has been removed from this hospital. In being able to say "Thank you' to the Minister for that tonight—and how grateful we are—I hope that he will likewise consider seriously the necessity of providing more figures.

§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
The hon. and learned Member for Ruislip-Northwood (Mr. Crowder) has spoken eloquently about the virtues and the services provided by small hospitals generally and made particular reference to the one which serves his own constituents—views which were strongly supported by his hon. Friend the Member for Harrow, West (Mr. Page). The views which they have voiced are I know widely held, for staff, patients and the public at large do become very attached to their local hospitals.
I say that feelingly because I am undergoing the same sort of agonies in my constituency, where our local hospital is to close at the end of this month in spite of all the efforts that have been made to save it. A small hospital, by its very size, and often because of its ready accessibility, does have an attraction all its own even when there is a district general hospital nearby with a full range of resources. The hon. and learned Gentleman has made it clear that many of his constituents are concerned and opposed to the possible closure of the Northwood, Pinner and District Hospital, with its 36 general practitioner beds. My right hon. Friend the Secretary of State was in fact well aware of this feeling for he received some weeks ago, a petition, to which the hon. and learned Member referred, signed by about 14,000 people, and there have been numerous representations both from Members of this House and elsewhere.
817 One of the major aims of the 1974 reorganisation of the National Health Service was the creation of a structure more suitable for planning and developing a comprehensive and integrated health service. The new authorities are now well established and are beginning to review in some detail the services which they have inherited with a view to rationalisation. Indeed, we are pressing them to do so. Simultaneously, we are taking positive steps to share out the financial resources available more equitably than the present distribution.
Decisions on closure or change of use of health buildings rest primarily with the appropriate area health authority—Hillingdon Area Health Authority in the case of Northwood, Pinner and District Hospital. I would here point out to the hon. and learned Member that, in line with our aim of providing for a more democratic health service, more sensitive to local needs, we have decided that area health authorities should have one-third local authority membership. The authority is therefore constituted to allow for the expression of local people on resource allocation.
Authorities are expected to reach their conclusions within the framework of a new planning system recently devised for the NHS and whose introduction is in an early evolutionary stage. Within this the Department issues national guidelines which at present are somewhat provisional in that they are based upon recommendations in the consultative document, "Priorities for Health and Personal Social Services in England". From these, regional and area health authorities develop regional and area guidelines in relation to a particular region or area. Following the general principles of such guidelines, strategic plans are prepared for 10 to 15 years ahead. These are to be regularly reviewed and updated and will form the basis on which each year operational plans for implementation over two or three years will be prepared.
Throughout this process there is much consultation, both formal and informal, so that plans may take full account of local views. It is from that process that we expect in due course that most proposals for closure or change of use of health buildings will emerge. 818 Nevertheless, because of the importance which we attach to full consultation before such decisions are taken, there is a recognised procedure for further consideration by all concerned when the time for decision has been reached. 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 or use and other developments and plans; and also, 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, including the local medical committees. Hon. Members whose constituents would be affected would also be informed of the proposals and, if I may say so to the hon. Member for Harrow, West, there is nothing to prevent hon. Members or the community health council at that stage 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 counter-proposal, 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.
Nothing I say today should be construed as prejudging the issue in any particular case; least of all the situation in relation to Northwood, Pinner and District Hospital where, as the hon. and 819 learned Member has already explained, the Hillingdon Area Health Authority has decided not to proceed, at least for the time being, beyond initial informal consideration. This aspect of the procedure is one which I would ask hon. Members to note, for it means that it will rarely be possible in this House to indicate in advance the likely outcome of any proposal.
The planning arrangements to which I referred earlier are, as I said, in an early stage of development. A number of proposals for closure or change of use currently coming forward have not therefore been subjected to that process. They are rather the result of some immediately pressing problem, albeit that the solutions proposed are strongly influenced by the planning guidelines already evolved. In these instances area health authorities are expected to conduct a substantial round of informal consultations in the first instance. If this produces a specific proposition the detailed procedures which I have already outlined for formal consultation and for submission to higher authority if necesary still apply.
Proposals in respect of Northwood, Pinner and District Hospital never reached this stage. The Hillingdon Area Health Authority, under pressure to find economies, asked its officers to explore the implications of closure. The officers' report led the authority last week to a decision not to proceed further.
Set out in this way, the procedures for effecting change may seem somewhat complex. Indeed, I know that in some quarters they are considered overelaborate and a deterrent to the redeployment of resources with maximum speed. It is essential, particularly at this time of economic constraint, that there should be no unnecessary barriers to impede the cost effective use of resources. On the other hand, the NHS must be responsive to the local views of both patients and staff, and to hon. Members. The system seeks to balance the need for speed with that for local and, where relevant, national consultation.
As I understand it, the thoughts of Hillingdon Area Health Authority turned to the possibility of closing Northwood, Pinner and District Hospital as part of a package of measures to overcome an overspending position which at one time during the year seemed to be on course 820 for an excess of £250,000 or more. In part, this derives from our having taken the first major step towards correcting some of the long-acknowledged inequities in the way in which resources available to the NHS are distributed.
In its desire for a more equitable system, an early move by the present administration was to set up a resource allocation working party, which has produced two reports. The first, an interim one, served as a guide for allocating money to health authorities for the current financial year. The second, entitled "Sharing Resources for Health in England", is now the subject of consultation; although my right hon. Friend the Secretary of State has decided on the extent to which it should influence allocations for 1977–78.
The report, by the application of objective formulae which it acknowledges need further refinement as research progresses and more information becomes available, indicates a wide disparity between regions and make recommendations on how a phased programme of adjustment might be pursued. The existence of sub-regional disparity between areas and health districts is also recognised and proposals made for making the comparisons and effecting change. At this level, particularly, however, it is made perfectly clear that there can be no strictly mathematical approach to allocations judgment will be needed in deciding on merit what is feasible. Much depends on the overall money available and the practicalities of adjusting patient services. As my right hon. Friend the Secretary of State for Social Services said in the House on 25th November: The tighter funds become, the more difficult it is to make a rapid shift."—[Official Report, 25th November 1976; Vol. 921, c. 319.] However, the Government are committed in principle to redistribution, and equity demands that we make a determined effort to move in the right direction as the possibilities allow.
To this end the North-West Thames Region, in which Hillingdon lies, was asked this year to operate on a standstill allocation after an allowance for the revenue consequences of major capital schemes coming on stream and for anticipated inflation. The regional health 821 authority felt unable to make any significant sub-regional adjustment, but set up a regional reserve by withdrawal of funds from all but the most deprived area to meet the consequences of small capital schemes in the region. Area health authorities 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 allocations. Hillingdon could be no exception to the effect of those decisions. Hence the search for economies, knowing that it could not anticipate any significant increase and perhaps a decrease in resources in 1977–78. In the event my right hon. Friend, in announcing on 21st December 1976 his decision on regional allocations for that year, has promised a slight increase to North-West Thames as a whole. It is, however, too early to say whether Hillingdon will benefit, for the regional health authority has not yet decided how to distribute its allocation, the precise amount of which has not yet been determined.
In looking for savings, authorities are expected to bear in mind the planning guidelines to which I have referred. These place considerable emphasis on improving primary care and community services and to increasing facilities for certain priority groups, such as the mentally ill, mentally handicapped, elderly and physically handicapped—to some extent, if necessary, at the expense of acute services. For the latter, the North-West Thames Regional Health Authority has promulgated interim planning ratios to be used alongside national norms for some of the other groups in planning local hospital bed provision. Health authorities have also been asked to work towards a situation where hospital beds are concentrated in district general hospitals, in community hospitals serving populations of up to about 100,000, and in units for the mentally handicapped.
In such circumstances, it is, perhaps, not surprising that the Hillingdon Area Health Authority should have asked its officers to explore the possibility of closing Northwood, Pinner and District Hospital. At present in the area there are about 870 acute medical and surgical 822 beds, compared with a need for about 500 when measured by the regional yardstick for the population resident in the borough. There is at present, however, a substantial cross-boundary patient flow, and the authority claims that the theoretical need may well be about 750 if the external catchment areas are to remain its responsibility.
However, exploration has shown, I am told, that, although much of the work at the hospital could be absorbed by the main hospitals of the area, there would be considerable difficulty in dealing with some parts of it. In particular, there was no readily available solution on how the surgical caseload could be dealt with elsewhere, this being the main argument for the authority's decision not to take further action for the time being. Before reaching that decision, the authority also had before it the informal views of among others, the consultant medical staff and the general medical practitioners.
Whether the authority has reached the right balanced judgment is not for me to say, particularly as it had already decided to proceed with formal consultations and calculations on the closure of other small hospitals in the area, on which my right hon. Friend may be called upon to adjudicate in due course. Nor is it clear whether, in the absence of closure, the authority will be able to balance its books. All I would say at this juncture is that its decision demonstrates how the procedures we have evolved work.
Consultation is a meaningful process. Each case is decided on its merits on the light of local prevailing circumstances. In this way, we may expect that the National Health Service will be responsive objectively to changing needs and changing ideas on how health care services should be delivered. It is essential that this should be so. Otherwise, the service would ossify.
Thus, the retention of a small hospital cannot be axiomatic. Everyone is aware of the value that the general public place on the intimate and friendly atmosphere that often exists, where they often know the staff and can receive continuity of care from their family doctor. Where such facilities have to be withdrawn, either because they are not viable or because a more satisfactory overall provision of service can be organised in some other way, 823 there is no reason why the same personal care and friendliness should not be reproduced elsewhere, as it already is in some large hospitals. The main consideration must always be the most efficient use of resources in the health district for the benefit of the population as a whole.
I am sure that that is a consideration which hon. Members will bear in mind, 824 just as my Department does and will bear it in mind when considering the proposals which come forward, as they are bound to do in the next year or two, from various area health authorities throughout the country.