HC Deb 16 November 1977 vol 939 cc727-36

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

10.21 p.m.

Mr. Ioan Evans (Aberdare)

During the last two days the House has been discussing the devolution Bills, and today we have had the guillotine motion. I assure hon. Members that the matter I am raising on the Adjournment is of far greater consequence to my constituents than are the other matters that we have been dealing with today.

Recently, between 5,000 and 8.000 people attended a rally and meeting in Aberdare. On 4th April, during Welsh Question Time, I raised the question of the future of hospital services in the Cynon Valley, particularly the casualty services. At this point I pay tribute to my hon. Friend the Under-Secretary of State for Wales—the hon. Member for Flint, East (Mr. Jones)—who has shown great interest in Welsh constituency matters, but I am very disturbed at the way in which the Welsh Office has dealt with this subject.

In a letter dated 26th April the Under-Secretary said that he had under consideration proposals submitted by the Mid-Glamorgan Area Health Authority for the reorganisation of the health services following the opening of the new Prince Charles Hospital. While the new district general hospital had been welcome as an essential improvement to the total health services in the Cynon Valley, Merthyr and the upper part of the Rhymney Valley district, there had been numerous objections to the proposed changes at the existing hospitals.

The objections had been made by the community health councils, particularly of Merthyr and the Cynon Valley, and local authorities in the area, particularly the Cynon Valley Borough Council, which is the largest borough council concerned in the area. The Cynon Valley Trades Council and other trade union organisations in the valley, particularly the trade unions involved in the reorganisation, also expressed concern.

The Under-Secretary met a deputation which included representatives of the Cynon Valley Community Health Council supported by my hon Friends the Members for Caerphilly (Mr. Evans), Bedwellty (Mr. Kinnock) and myself. I realise the difficulty in which the Under-Secretary was put, but I believe that a letter sent out on 26th August by the Secretary of State has added greatly to these difficulties. Definite assurances for the future of the hospital service in the Cynon Valley are now required.

In the letter of 26th August reference is made to the proposal of the Mid-Glamorgan Area Health Authority that the existing St. Tydfil's Hospital at Merthyr and the Aberdare General Hospital should act in supporting roles. In paragraph 7 of the letter reference is made to the desire to have Aberdare General Hospital rather than St. Tydfils designated as the main support hospital. In paragraph 8, however, the letter states that the Secretary of State regrets that he cannot support that desire. It adds that he supports the idea of a developing St. Tydfils in Merthyr as the main support hospital to Prince Charles Hospital.

I wrote to the Secretary of State on 12th October, stating that The difficulties have been seriously aggravated by the statement from the Welsh Office where reference is made to the Aberdare Hospital having a minor role. I pointed out that the Prince Charles Hospital is situated in the Merthyr Tydfil area and that to situate the main hospital in the same area was a planning monstrosity.

I also pointed out that the population and the land area of Merthyr and the Cynon Valley are as follows: the population in the Cynon Valley is 69,575, and the area amounts to 45,000 acres, covering 70 square miles; in Merthyr the population is 63,205, less than that in the Cynon Valley, and the area in Merthyr is only 28,000 acres, and covers 43 square miles.

Despite the fact that the Cynon Valley covers a larger population and a larger geographical area, Merthyr has been given not only a major new hospital but a proposed major support hospital. I find that proposal impossible to accept, and it has certainly not been accepted by the people in the Cynon Valley, who have demonstrated in large numbers—namely, 5,000 of them in a march and 8,000 at a rally—showing how deeply they feel at the decision that was taken.

In a letter dated 26th October, the Secretary of State said that there was no difference between the Welsh Office and the Mid-Glamorgan Area Health Authority, but I have received correspondence from that authority stating that it believes that the right way of putting the question has not been dealt with by the Welsh Office.

Today I met representatives of the action committee in the locality, who suggested that the Mountain Ash Hospital should be retained and upgraded to a fully operational community hospital. They stated that Aberdare Hospital should retain surgical facilities, and should have a paediatric ward, a medical ward with an intensive care unit, a full-time casualty officer, a special baby-care unit, and a geriatric unit attached to the day unit. They hoped that the training of pupil nurses would be retained, with full provision for their gaining experience in all fields.

I hope that those suggestions will be considered by the Minister and that this evening I shall be given a definite assurance that Mountain Ash and Aberdare Hospitals, in the Cynon Valley, are to be retained. I hope that my hon. Friend will state categorically—this is the crux of the complaint of the people I represent, who are united in this matter, whether they be members of religious denominations, trade unions or political organisations—that the Aberdare Hospital should be recognised as the main hospital in the Merthyr and Cynon Valley area. We welcome the new hospital facilities that are coming to our area, but if the present situation is not put right, I feel that the people in the area will be let down.

I hope that my hon. Friend will be able to give me those assurances. He has been sympathetic on a number of matters in the past, but on this matter the Department has not come out very well. I hope that he will be able to assist me on this occasion.

10.28 p.m.

The Under-Secretary of State for Wales (Mr. Barry Jones)

I am very glad to follow the remarks of my hon. Friend the Member for Aberdare (Mr. Evans). I am sorry that he feels that in this instance the Department has not given him all he wants. I hope that I can persuade him to the contrarry later in the debate, because I believe that the Department has acted well.

I want to put on record the fact that I am glad that my hon. Friend has raised this matter, and also the fact that he has been a strong and persistent fighter for his people in the valleys and communities he represents.

Let us be clear about the matter that is before us. I do not think that this question can be limited to the Cynon Valley. The question must be what is the best way to provide hospital services to the Merthyr and Cynon Valley and Rhymney Valley health districts as a whole.

I want to get to the heart of the matter quickly. My hon. Friend has implied that St. Tydfils should not have been chosen as the principal support to Prince Charles Hospital. My hon. Friend has consistently raised that point with me.

St. Tydfils will provide facilities which do not exist in the new hospital—geriatrics, obstetrics and a special-care unit for babies—and as it will form part of a single hospital complex, "principal support" is not a misnomer. The area health authority now sees the rôle of this hospital as complementary to that of Prince Charles Hospital. The Aberdare Hospital will provide surgical, paediatric and maternity services in addition to those at Prince Charles and St. Tydfils Hospitals. It will have 25 children's beds, 30 general surgery beds, 15 trauma and orthopaedic beds, 20 beds for gynaecology and 30 for obstetrics; that is 120 beds in all, and in very active specialties. It is quite wrong, therefore, to speak as if it will not play an important role in providing hospital services in the Cynon Valley; indeed, for acute services it will be the main support hospital to Prince Charles Hospital.

I have seen a recent Press report with statements attributed to the Chairman of the Mid-Glamorgan Area Health Authority, Mr. Jess Warren, which confirmed that there has never been any disagreement between the Welsh Office and the area health authority about what was approved by the Secretary of State over the proposals of the health authority, which were accepted 100 per cent. There is no conflict on this issue. The decision letter reflected what was contained in the health authority's consultative document.

Mr. Ioan Evans

In the letter that went to the Secretary of State from the Mid-Glamorgan Area Health Authority, the authority suggested that there should be two main support hospitals—St. Tydfils and Aberdare. However, in the letter from the Secretary of State that was circulated by the health authoriy it appeared that the Department was selecting Aberdare as opposed to St. Tydfils. The whole purpose of our argument is that if the main hospital is to be Prince Charles we have the right to say that the other main hospital must be Aberdare.

Mr. Jones

I follow that argument and I have said that for acute services Aberdare will be the other main support hospital to Prince Charles Hospital.

Taking a little further the point that my hon. Friend has made, he said that in its decision letter the Welsh Office assigned a rôle to Aberdare Hospital different from that which was proposed by the area health authority. This is a complete misunderstanding. The AHA's proposals were accepted 100 per cent. and there is and has been no conflict. What the chairman said to a deputation earlier this week in no way contradicted that. Nothing is being taken away from Aberdare, and there are no proposals for running down Aberdare Hospital. I have done my research well and I have here the South Wales Echo of Tuesday, 15th November in which there is a picture of a militant-looking Mr. Warren addressing some of the action committee supported by my hon. Friend.

It is said that Prince Charles Hospital should have been built in Aberdare and any future development of the hospital complex should be in Aberdare. We cannot turn back the clock on the Welsh Hospital Board's decision of some 16 years ago. The new hospital is at Gurnos and there can be no question of creating anything like a further district general hospital in the Cynon Valley. Nor would it make medical or financial sense to create a district general hospital complex in two incomplete parts.

My hon. Friend would have liked the special-care baby unit to be sited at Aberdare instead of at St. Tydfils.

Ideally, the special baby-care hospital should be at Prince Charles Hospital. A special-care baby unit requires 24 hour cover by expert and experienced doctors and nurses. Until such a unit can be added to the Prince Charles Hospital, it is best to locate one in a central position, where it is reasonably convenient for all three valleys. This is why Merthyr has been chosen. A special-care baby unit in Aberdare would not be well placed for the mothers of the Upper Rhymney Valley.

It has been said that children's beds should be retained in Mountain Ash Hospital. Modern policy is to avoid putting a child in hospital if at all possible. If the child must be hospitalised, it must be in an environment and with facilities suitable for the treatment of children. Prince Charles Hospital has a paediatric department with complete scientific back-up services, but some children's beds have been retained in Aberdare because not enough could be provided at Prince Charles. I must accept the medical and nursing advice that there should not be children's beds in Mountain Ash Hospital.

I am answering these points because every one has been made by my hon. Friend in a strong and committed fashion. I take seriously everything that he says and seeks to obtain for the people of his community.

My hon. Friend has suggested that there should be proper casualty facilities at both Merthyr and Aberdare. There is a lot of confused thinking about this. In fact, it is not proposed to take away anything that these hospitals have had in the past. They have a GP casualty service, and this will continue as long as the GPs are willing to provide it. The major accident department at Prince Charles will have 24-hour cover by consultants in all necessary specialities. Medical advice is firmly that this is a better way of providing treatment for accidents and emergencies than multiplying the number of accident units at the expense of providing comprehensive care.

The most insistent demand is that the Secretary of State should pay more attention to the demands of those who claim to represent the Cynon Valley and should change his proposals. Let me say firmly and clearly that the Mid-Glamorgan Health Authority's proposals for the development of hospitals in these districts, as approved by the Secretary of State, will bring about a substantial improvement of the hospital services available to the people of the Cynon Valley equally with the people of Merthyr and Upper Rhymney Valleys.

Before the area health authority's proposals were approved by the Secretary of State there was the fullest consultation with the public and study of all the implications. I can assure the House—especially my hon. Friend, who is always fighting for his area—that all the points that have been raised since the Secretary of State's final decisions were fully expressed in the process of consultation and were taken into account. I think that my hon. Friend knows that the Prince Charles Hospital will open in a few months' time and that further delay in implementing the health authority's plans would be wasteful.

As for the longer term, proposals for development in the hospital services are the responsibility of the health authority in the first place. Any material change of hospital use must be the subject of the full consultation procedures. Those procedures are safeguards for my hon. Friend and the community that he so ably represents.

I can state positively that there are no proposals for changes of use at Mountain Ash or at Aberdare beyond those already agreed in the authority's consultation document.

I am glad to have had the opportunity to put the record straight on this subject, which is of such close concern to the people of the Cynon Valley. I well understand the feelings that my hon. Friend has so ably represented, but I hope that I can persuade the House that the facts show that the Cynon Valley will be well served by the. Prince Charles Hospital and the new deployment of the Aberdare and St. Tydfils Hospitals.

It is clear to me that the health authorities have a most difficult task not only in making the best possible use of the resources at their disposal but in carrying with them the various and often differing local opinions. In my experience few subjects arouse so much passion in the House as the future of local hospitals, and my hon. Friend has demonstrated much passion to me in the Welsh Office and in the Chamber over the past year or so. Within their limited resources the health authorities have a difficult job of reconciling the provision of health care to each district with the often competing demands of local feeling and—this is important in South-East Wales—community pride.

I hope that I have shown that the needs of the people are in the forefront of our minds, and that the question at issue is the best way of meeting the needs of the Cynon Valley within the resources that the country can afford. I hope that I have demonstrated the great pains that have been taken by the area health authority and my right hon. and learned Friend the Secretary of State for Wales to arrive at the best answer to this difficult problem. However, it is not the end of the task. The work of providing health care continues. If they have not done so. I urge all the interested local groups and individuals to take an active interest in the work of their community health councils and to make their feelings and opinions known to them. That is the best and most effective means by which the man in the street, whom my hon. Friend represents, may ensure that his views are known by his health authority, and, equally, that he better understands its work.

It has occurred to me that it is perhaps particularly appropriate that this evening's Adjournment debate should be on a Welsh matter. I do not think it is a bad thing to be reminded that the stuff of politics is concerned at least as much with tending our own gardens, with more than the sweep of national and internations affairs. I think that my hon. Friend has clearly and sympathetically voiced the concern and the anxiety of his constituents.

I am not unaware of the traditional rivalry between the Merthyr Valley and the Cynon Valley, which is expressed on the sports field and elsewhere. I hope that they will be able to concentrate a little more on their common interests and their need for mutual support rather than on their differences. If the total available investment were spread equally between the Merthyr, Cynon and Upper Rhymney Valleys, I do not think that there could be a viable modern hospital capability in any of them. I have found that to be a medical and financial fact.

A new district general hospital costing about £9¼ million and containing 362 beds, with full supporting diagnostic and treatment facilities and out-patients and major accident and emergency departments has been built at Gurnos, just to the north of Merthyr and immediately adjacent to the Heads of the Valleys road. I think that it will start admitting patients early next year.

The opening of the new Prince Charles Hospital will vastly improve the facilities for hospital treatment available to all the people of the district, including Aberdare and Mountain Ash. The new services are worth £2½million a year more than the existing services in the catchment area. A total of 118 additional beds are being made available, and extra staff will be taken on. In the Cynon Valley there are no hospital closures.

The decision to build this hospital was taken by the former Welsh Hospital Board in 1960–61. The intention was to provide a hospital of more than 800 beds covering all major specialties. That was too much for a single building scheme, so the first phase was designed excluding certain specialties and containing rather fewer beds in some other specialties than were needed to serve the whole catchment area. Thus it was known—there was wide publicity—that certain existing hospitals would have to provide facilities for the specialties excluded from the first phase of the new hospital and support in those specialties which were not yet fully provided in the new hospital.

It was also known virtually from the beginning that when the new hospital came into operation there would have to be changes in the use of some hospitals and that some would have to be closed. The difficult question that met the new Mid-Glamorgan Health Authority after reorganisation in 1974 was what changes it should recommend.

I want to say a few words about consultation to my hon. Friend, who until recently had been part of the administra- tion in the Welsh Office for some years. Succeeding Ministers have always attached the greatest importance to consultation with all bodies and persons affected by proposed closure or change of bed use, and a detailed and exacting programme of consultation, explanation and consideration of comments must be carried out by the area health authorities. This is matched, after the areas take their decisions, by a further period for representation, this time direct to the Secretary of State, and the most careful consideration of all proposals and comments by officials and Ministers. Many of us burned a good deal of midnight oil over this reorganisation plan before it was approved by the Secretary of State.

I want to stress the respective rôles of area health authorities and the Secretary of State. The Secretary of State distributes money, promulgates advice, controls the major building programme and monitors the performance of health authorities, but the area health authority plans and provides health services. It is important to understand who does what. The health authorities must obtain the Secretary of State's approval for certain purposes, but the plans and decisions are initially those of the responsible health authorities.

In July 1975, after a great deal of detailed research and informal consultation, the Mid-Glamorgan Area Health Authority produced a formal consultative paper, which contained 18 foolscap pages of detailed explanation and statistical tables setting out its proposals for reorganisation when the Prince Charles Hospital opened. It sought—

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 nine minutes to Eleven o'clock.