HC Deb 23 May 1977 vol 932 cc1150-62

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

10.0 p.m.

Mr. Jerry Wiggin (Weston-super-Mare)

I think that this is the third occasion on which I have had the privilege of raising the subject of Weston-super-Mare Hospital in an Adjournment debate.

I begin my saying how grateful I am that the Secretary of State was able to see a delegation of my constituents that I led this afternoon to discuss with him the problems of the Weston health district. The Secretary of State opened his remarks to the delegation by saying that his Department thought that we should be entered in the "Guinness Book of Records" for having raised this matter more consistently than any other area.

I make no apology for having broken any records by raising this subject for a third Adjournment debate. Normally these debates take place after midnight, and until about 90 seconds ago I thought that the same thing would happen tonight. I am extremely glad that we can have the debate at a more civilised hour.

I appreciate that no decision has been taken on the health district, and it is not my job to press those arguments, which have been well rehearsed. My concern is not to interfere, as a Member of Parliament, in the day-to-day operation of the area health authority, but I think it right that I should exercise my democratic function to reflect the views of local people where they do not have any statutory right or obligation. The health and district councils have that right and obligation and have stated their purpose, as have other bodies in my constituency.

Here I should state that the area of influence of Weston-super-Mare, in medical terms, extends far beyond the boundary of the old borough. It goes deep into my constituency and in some places over its boundary. It is not just about one small town, it is one great area—the catchment area of doctors who send patients into Weston for treatment. Our difficulty about the district is that we foresee, in a vast geographical area spreading from Bristol to the south of Weston-super-Mare, one or more hospitals, and the Department saying that they are adequate for the health district. Unhappily, that takes account only of lines on maps. It does not take account of what people want, how people can and do travel and, indeed, where patients come from for medical attention. I have consistently pursued and intend to pursue this evening that aspect of the district argument.

The case for the Weston-super-Mare Hospital started as early as 1945, although there are those who will say that it was earlier still. That is the date used by the old regional hospital board just before disbandment, when, at its own expense, it produced a most powerful argument for a new district general hospital at Weston.

In researching my comments for tonight I came across a letter that I had written to a constituent four or five years ago, in which I said: Do not worry, Madam. The Weston-super-Mare hospital will be complete in 1978. That I have been told. At that time the then regional hospital board determined to press ahead and delayed the start for 12 months in order to complete it a year earlier—so went the theory. In practice, with the tendering documents going out to builders in June or July 1973, the then contraction in the Conservative Government's spending programme led to cancellation of the project. But no other circumstances has altered. The requirements are precisely as they then were. The number of people who will be ill is the same as it then was. Those who would like to serve medicine in Weston-super-Mare are still there, but they are disillusioned by cancellations, alterations and prevarication.

I am the first to say that no one Government should carry the can for this situation. It is a particularly bad example of endless bureaucratic delay, and perhaps, in all fairness, I should say that the delays were not all bureaucratic. Ministers have some considerable part to play in this.

I will not retail the episode in which the right hon. Member for Blackburn (Mrs. Castle), as Secretary of State, came to Weston-super-Mare and in a moment of generosity allocated about £200,000 to ameliorate the deteriorating medical conditions. That money was grabbed by the area health authority and allocated to Ham Green Hospital, just south of Bristol, which is a long and expensive journey from Weston-super-Mare.

Much as we appreciate the allocation of one ward to patients from Weston-super-Mare, it is not the same as having facilities provided in the town, and it never will be. And with the threat of the change in the district status we can see, not for the first time, and not only in health matters, that we shall be run from Bristol. Weston-super-Mare is not a part of Bristol.

I could go over the battles about the county boundaries. I was one of the few Conservatives who opposed them. But this all comes back to the simple fact that Weston-super-Mare is an entity. If it were not on the coast, which fact causes it to lose half its catchment area, its numerical position would look considerably better than it does. On the question of numbers, Weston-super-Mare has a holiday population of staggering proportions, but numbers are probably not our strongest point.

I have always made it clear that the people of Weston-super-Mare want a new hospital. I have deliberately not used the word "new district general hospital". I could go all around my constituency, because the feeling is the same, whether it be in Burnham-on-Sea, Cheddar, Axbridge, Congresbury Churchill, or anywhere else in or near the constituency. The people want a new modern hospital at Weston-super-Mare because that is their centre.

I am concerned at our relationship with Taunton. I have always made it clear that Taunton has an excellent case for a new hospital, and nothing I say tonight should be construed as seeking to reduce that case one iota. But it has been accepted until now that Weston-super-Mare has an even better case and that its priority is greater.

I turn now to the booklet that was produced by the old regional hospital board. I hope that if the Minister has not seen it he will arrange to have a copy on his desk in the morning, so that he may consider it and see the case that the old hospital board thought it fit to produce. This propaganda was distributed to civil servants, Ministers, Members of Parliament and any others who might be able to influence the decision. It set out the priority that should be afforded to Weston-super-Mare in the whole of the western region. I hope that tonight the Minister will confirm that that priority remains, and if it does not I want him to say why not. If the arguments were good then, they are good today.

There are those who will say—there is no evidence for it and I should expect the Minister to deny it—" The chairman of the regional health authority comes from Taunton, so the priorities have been altered for internal political reasons." I hope that I shall never have to say that. But I must warn the Minister that if the people of Weston-super-Mare see a greater priority in terms of urgency or total allocation being given to any other hospital in the area they will deeply question the reasons for this alteration in priorities. It was not just our voice that gave this hospital priority; it was that responsible body which preceded the present one which used all its resources to give Weston-super-Mare priority and argued for that priority.

Now it is being argued that the Uphill site, 36 acres of ground purchased for a new district general hospital, should be sold—soon. It will never be needed, it is said. I do not particularly mind the precise location. This is something that we must leave to the planners. It may well be that a site nearer the motorway would be more convenient and would serve the district better. But it will not be understood if the Uphill site is sold and no alternative site is found. I would go further, and say that the alternative should be found first. I have not heard one person who knows the centre of Weston-super-Mare and knows the present hospital site who truly believes that it is a sensible or practical alternative to build a new hospital on the site of the old. The area is constrained by two roads. It is almost completely built on.

I know that the technicians argue "Oh well, an old hospital is cheaper to run than a new one." The Minister ought to have a look at that argument, used by those technicians, and exercise his political muscle to find out why it is that we cannot reflect modern technical achievements. Or could it be that the standards are so high that the cost has become unreasonable? These are questions to which the hon. Gentleman must know the answer better than I. I cannot conceive of people erecting a new factory or new plant if the costs of production were to be higher than in the old one. This is a fairly simple business principle. The Minister, as a business man, will bear me out on that.

It can be argued that capital is short and that there are no funds for investment in hospital building. We have even thought of that. We have obtained a consortium, which says that it will build a hospital and lease it to the regional health authority. I cannot say whether the proposition is a good one financially. The consortium is prepared to build a 500-bed hospital for £10,712,000 and let it to the Department on a 20-year basis at an annual rental of £1,700,000. The consortium is prepared to provide alternative arrangements—a 250-bed hospital at £900,000 a year, or other alternative permutations.

No doubt the Minister will say that we have not got the revenue, let alone the capital. That is the root cause of the problem. I must tell him that the Government will have to decide about the revenue. People will have to go to hospital somewhere. If the Government do not have the revenue for Weston-super-Mare how is the same sick person to be treated somewhere else? The same amount of money is needed. This is a question not only of efficiency but of service, locality, all sorts of things. I could argue, too, that if the distance from Weston-super-Mare to anywhere else is considered to be insignificant—and it is said that with the motorway Westonians can get to Bristol relatively easily—Bristol people can come to Weston just as easily. What a good idea for having a major new investment on this lovely site. It would attract staff and would be set in an ideal atmosphere, in a resort which was originally founded for the health-giving properties of its climate.

I have no wish to take up any more valuable time tonight. I end by reminding the hon. Gentleman of the unanimity of view that exists in my constituency on this matter. The passion that has been aroused and the demonstrations that have taken place occur because so many people believe that Weston-super-Mare is inadequately served by its existing buildings. That cannot be said about the staff. No one has anything but the highest praise for the way in which the medical staff carry out their tasks. However, they do so under grievous difficulties.

Morale has been destroyed. I fear that careers have been destroyed. A number of specialists came to Weston-super-Mare knowing that there was to be a new hospital. Their hopes and aspirations have now been removed. The nursing school has been steadily downgraded. In the past, recruitment of nurses in Weston-super-Mare was good. The nurses now have to go to Bristol, which they do not like. These are the problems that are attached to a decline in the medical services.

I hope that tonight I have reflected, yet again, the unanimity of view that somehow and somewhere, in spite of our national situation, which we all well understand, something must be done to improve hospital facilities in Weston-super-Mare.

10.17 p.m.

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

The hon. Member for Weston-super-Mare (Mr. Wiggin) is to be congratulated—I mean that sincerely—on securing this Adjournment debate and on the clear and concise way in which he has presented his argument. As he said, it is not the first time. I have in my background file a copy of his Consolidated Fund debate of July 1974 on a similar subject.

The subject of new hospital provision in Weston-super-Mare has been a bone of contention in the hon. Gentleman's constituency for many years, as he rightly pointed out. And it has in recent months again come into the limelight chiefly because of the proposals developed by the Avon Area Health Authority (Teaching) for merging the present Weston District with the Bristol Teaching District.

These two issues are, of course, to a certain extent inter-related, but it is perhaps necessary to look at them separately to understand fully the present situation. I will take the hospital issue first, and should perhaps refer to the National Health Service planning system which is just approaching the end of its first full year of operation. The system ensures that the identification of needs and priorities for health services is done successively and jointly by the three tiers in the NHS—district, area and region—within guidelines laid down by my Department and augmented to suit local conditions and situations by further guidelines issued by regional and area health authorities. This system thus ensures that the bulk of planning is done in the local situation where the people concerned have immediate knowledge and personal experience of the problems and needs existing. My Department through its guidelines can and does select only national priorities.

Coming back to the local situation, I think that I can fairly say that no one doubts the inadequacy of the present hospital facilities in Weston-super-Mare. This has been recognised as a major problem over many years. It is the solution that is proving difficult.

As the hon. Gentleman will recall, the former South-Western Regional Hospital Board had intended to start building a new district general hospital at Weston-super-Mare in 1973–74 after letting contracts for schemes at Barnstaple and Plymouth. In the event the Board was thwarted in its intentions because of a cutback in public expenditure imposed by the then Conservative Chancellor of the Exchequer, which considerably reduced the NHS capital building programme.

Since then, mainly because of the continuing commitments of the Barnstaple and Plymouth schemes, the South-Western Regional Hospital Authority has not been able to finance any major development in Weston-super-Mare or, indeed, elsewhere in the region. And in April 1976 the Authority announced that, in the light of anticipated capital and revenue resources, it would be impracticable to proceed with the plans for a new district general hospital in Weston-super-Mare in the foreseeable future. It has since expended this to the extent of not envisaging such development before the end of the century.

Faced with this change in expectations, the Avon Area Health Authority decided to re-examine the concept of the Weston Health District as a management entity and consider how a comprehensive health service for the population of the district could be provided by forging stronger clinical links with other hospitals and how best these should be managed. The area team of officers prepared a consultative paper which explained that, the essential problem of the Weston Health District is that it cannot provide within its own boundaries the essential support of a District General Hospital for its population and that, without a considerable strengthening of the medical staff at the Weston General Hospital, it cannot even provide a reliable and satisfactory satellite hospital service in the basic DGH specialties for the immediate population of Weson-super-Mare". This passage clearly spells out the seriousness of the situation and shows that the authority is fully seized of the difficulties.

I agree with the hon. Gentleman that urgent action is unquestionably called for. In its deliberations the authority accepted that the Weston General Hospital needed to be provided with support of both consultant and junior medical staff in the basic specialties, namely, general medicine; general and accident surgery; obstetrics; gynaecology; and the medical care of the elderly; with supporting anaesthetic, pathology and X-ray departments. The authority also recognised the need to improve and extend out-patient facilities to enable more of the population to be referred for consultation and examination locally even though they may have to go elsewhere for treatment. For these reasons, the merger proposal evolved as it was realised that improvements relying on substantially strengthened clinical links with other hospitals could not be achieved in any other way.

My understanding is that the need for improved clinical links is generally accepted locally at least as a short or medium term solution. However, the proposal to merge the two districts has resulted in considerable opposition and a number of deputations have been received by Ministers. Indeed, one led by the hon. Member for Weston-super-Mare was seen by my right hon. Friend the Secretary of State earlier today, and my right hon. Friend will be meeting another on Thursday. My right hon. Friend also called in at Weston-super-Mare as recently as 22nd April further to acquaint himself with local opinion. The bodies leading the opposition are to be congratulated on the way they have prepared their cases against the merger, and I can repeat the assurance given to all deputations that their views will be taken fully into account by my right hon. Friend before he makes a final decision on the merger proposal.

More generally, the Government's attitude to proposals for changes in district or area boundaries has been made clear on a number of occasions. We were critical, when in opposition, of the form of reorganisation imposed by the previous Government. We considered that it would be unwieldy and bureaucratic, and experience has shown that—despite the best endeavours of staff to operate the new structure—our fears were well founded. We took office three weeks before the reorganisation came into effect—far too late to change it—and we decided very early on that a further general reorganisation would not be in the interests of the service. The Royal Commission on the National Health Service will, I hope, in due course put forward proposals which will enable the service to be better and more effectively managed. In the meantime, we are not prepared to countenance a general or fundamental change in the structure of the service.

This does not mean, however, that we believe that there should not be any change at all. We recognise that there will be cases where the boundaries of health districts could now be changed in ways which might achieve greater economy, coupled with improved management efficiency in the delivery of services. My right hon. Friend has therefore made it clear that he is prepared to consider proposals for the merger of existing districts. Any such proposals would, however, require his specific approval, and he would need to be satisfied on three counts: first, that the proposal would lead to more effective delivery of services and improved management efficiency; secondly, that there had been full and adequate consultation with staff interests, with district management, with local authorities and with community health councils; and thirdly, that both regional and area health authorities approved the proposal.

The specific proposal from the South Western RHA is being examined stringently against these criteria. It would be premature for me to comment in detail until this examination has been completed. It is important, however, that a final decision on the proposal should not be long delayed and my right hon. Friend is well aware of this. He will make an announcement as soon as possible.

Mr. Wiggin

One of the great problems at Weston-super-Mare is that the county boundary allows the Avon Area Health Authority to operate only up to the boundary of the town. If in medical terms the region could take in a larger area, it would go some way towards meeting my point.

Mr. Deakins

I shall consider that matter and draw it to the attention of my right hon. Friend in case the delegations have not done so already. It involves local government reorganisation which happened at about the same time or just before the Health Service reorganisation, and we are trying to cope with the consequences of both.

Earlier this year, the South-Western Regional Health Authority published its strategic plan indicating long-term objectives and priorities for the development of a full range of health services within the resources likely to be available within the next 10 years. The sum of £10 million has been set aside in the plan for improvement of existing facilities in Weston-super-Mare and Taunton on existing sites. I hasten to assure the hon. Gentleman that such improvements are recognised in the plan as top priorities. More recently, at its meeting on 14th March, the authority reaffirmed that it was not possible to build a new district general hospital at Weston-super-Mare this century and therefore decided to declare the previously earmarked site at Uphill as surplus to requirements. The authority is now to undertake a feasibility study. This will examine how the service can be improved by development on the existing site of the Weston General Hospital—extended as necessary by purchase of adjoining properties—or on the Royal Hospital site, because there are two, or on both.

I can well understand the disappointment that must be felt locally as the long-promised and long-awaited new district general hospital slips further away from reality. In the current economic climate, however, many projects throughout the country are having to be postponed. My right hon. Friend has not been able to avoid a further cut in the NHS capital programme this year as part of the package of economies that have had to be made in the construction field. In the Public Expenditure White Paper published in February 1976, Cmnd. 6393, the Hospital and Community Health Services capital programme for England was set at about £280 million—1976 Survey prices—for both 1977–78 and 1978–79. The combined effects of the cuts announced by my right hon. Friend the Chancellor of the Exchequer in July and December last has been to reduce the programme to about £260 million in the current year and £265 million in 1978–79. But in spite of the economic difficulties facing the country, the Government have honoured their pledges to protect the elderly, the sick and the poor. There have been no cuts in NHS services to patients, or in social security benefits and pensions.

The efforts made by the hon. Member to secure a new hospital for his constituents over many years are laudable. He has always been rational and responsible in these efforts. This is the third occasion on which he has raised the subject in this House. He has also seen Ministers several times and pursued the case by correspondence. He has championed the cause well. There must be some considerable disappointment for him personally, but he should not be too despondent. The proposal to redevelop existing facilities seems to me to be a realistic one in the present climate. As I understand the regional health authority's intention, it is to build a hospital of about the same size as the existing Weston General Hospital which has 135 beds. In this way there should be no additional revenue costs for the area health authority to meet.

This kind of development in the relatively near future will undoubtedly provide a better service in Weston and, with new facilities at Ham Green Hospital becoming available for Weston patients shortly, it is apparent that a great deal is being done to improve the admitted inadequacies. I know that many people locally have feared that these proposals will lead to the closure of hospitals in the town, and that patients would have to travel to Bristol for all hospital facilities. I can categorically assure them that this is not so. The intention of the authorities is to improve facilities in the town.

I very much hope that the proposal for redevelopment will now be accepted by the people of Weston as realistic and, bearing in mind the full seriousness of our economic situation, the only practicable solution to a very difficult problem. It is unfortunate that more resources cannot be made available to the NHS. That is a Government decision and we accept the responsibility. It means that Weston-super-Mare and a number of other places throughout the country, where improved hospital facilities are urgently required, have to be disappointed and accept something less than ideal. I must emphasise that in the "reorganised National Health Service" there is a policy of maximum delegation from the centre which places on authorities the extremely difficult task of determining priorities within the limited funds available. Ministers do not intervene in such decisions, but my Department ensures that authorities' actions are broadly consistent with national policies.

I am very glad that the hon. Member has again raised this subject in the House—I congratulate him on his timing—and I very much hope that what I have said has helped to clarify the issues involved.

Question put and agreed to

Adjourned accordingly at twenty-nine minutes past Ten o'clock