§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Tinn.]
§ 12.31 a.m.
§ Mr. George Rodgers (Chorley)I very much value this opportunity of explaining to the House and the Minister the anxieties that beset my constituents in Chorley, Leyland and a score of surrounding villages about the future of the Chorley Hospital.
It may be helpful to my hon. Friend the Minister if I point out that there exists a unique bond of affection between the local community and this hospital. In the days before the last war, working people contributed weekly through the trades council towards its upkeep, and even today local residents and local organisations raise considerable funds to provide comforts and amenities at the hospital.
It is important that I emphasise this happy relationship which has existed for many years, otherwise it might be thought that my represenations tonight reflect only the views of a few malcontents who are reluctant to accept change and progress. In truth, the threat to the standing of the hospital has generated an angry and quite spectacular response throughout the Chorley constituency. On one day of protest, the commercial and industrial activity of the whole area was practically halted as more than 10,000 people marched in protest at the curtailment of the hours of service by the accident and emergency unit at the hospital. Public meetings objecting to proposals designed to further diminish the available facilities have been crowded, and petitions of protest have been signed by tens of thousands of people.
654 The local weekly paper—the Chorley and Leyland Guardian—has covered the compaign on behalf of the hospital in great detail and concludes that full support must be given to a crucade to retain and enhance the range of services provided at Chorley. A special investigation covering all aspects of the hospital crisis was undertaken by the Lancashire Evening Post. This has resulted in a demand for a higher rate of financial investment in the local health services and an accelerated advance towards full district status for the Chorley Hospital.
The two local authorities, Chorley and South Ribble, have come out firmly in support of the public crusade for the retention and extension of services at Chorley, as has the community health council, which, of course, was created to enable the views of the public and the consumer generally to be taken into consideration when matters of this nature were being discussed.
It is against that background of widespread protestation that I wish to focus attention on four aspects of the situation that warrant urgent investigation. If those with responsibility are prepared to examine these issues and are willing to act on them where it is apparent that there is cause for concern, I am confident that good will can be restored and anxieites about the future of the Chorley Hospital set at rest.
First, I wish to comment on the strategic plan for hospital services in the Preston district—an envisaged programme which contains many sound and enlightened proposals. Unfortunately, there is some confusion when it describes the future role of the Chorley Hospital. In the original draft, there was no mention of the intention to close the children's ward at Chorley; this proposition has been introduced as an afterthought, probably as a consequence of the Rochdale inquiry. I have studied the report and recommendation and can well understand that those who are employed in this area of the Health Service should wish to avoid the possibility of another child dying in similar tragic circumstances. The attitude is correct and commendable. However, it is clear from the report that the death of the child was not due to the absence of a paediatrician or of any item of special equipment but occurred because 655 things went terribly wrong and unbelievable errors were made in clinical judgment.
I do not wish to dwell upon the case but only to say that it would be folly to relate the sad events of that night in Rochdale to the position in Chorley. Indeed, if the recommendation that all children from a wide district who are in need of hospital care should be under one roof regardless of their degree of illness is carried out, it is not difficult to recognise that those children furthest away from the roof in question could be placed at risk by having to make a long journey before their needs could receive attention.
There are obvious delays and dangers in having to transport a sick child to a distant hospital. In the case under review the nearest alternative children's ward would be at Preston some 10 miles from Chorley. The route is the scene of long and frequent traffic hold-ups, and, of course, some points of the present Chorley Hospital catchment area are much more than 10 miles from Preston.
The child would often be separated from parents and family by worse than miles and distance. The journey into Preston by public transport is desperately expensive, and for families without their own transport, who are still the majority, the cost of hospital visiting is an expensive item. The importance of this consideration to the well-being of the young patient should not be lightly shrugged off; the presence of friends and family can be an important factor in the recovery of a sick child. Clearly, the small children's ward at Chorley does a valuable job and should be retained. Already there as suspicions that children are being directed to Preston when they could be accommodated at Chorley, the purpose being to provide an impression that the children's ward is under-occupied. I am reluctant to believe that this is the case, but I am disturbed by letters I have received from the parents of children who have been sent to Preston for treatment that has previously been available at Chorley.
I must make it clear that I accept absolutely that for specialised and particular treatment it will be necessary for the sick child to become a patient at a hospital outside the immediate area. That is 656 common sense, and we are not without that commodity in Lancashire. We also believe that it is common sense to retain the children's ward in its present setting where it provides a useful and popular service to a growing community.
I turn now to the accident and emergency department. This is a well-equipped unit which is situated conveniently close to the motorway system but which has functioned only on an "office hours" basis since 1974. This is not one of the many casualty departments throughout the country that have closed, or face closure, because of a rationalisation of the service. The position here is that the regional and area health authorities are anxious to see the unit operating on a 24-hour basis and have made this clear on numerous occasions.
Unhappily, the restriction on the hours of service is in force because of the inability of the health authority to recruit qualified medical personnel. It has been said that the reason for this is the poor career prospects in this discipline. If this is so, I must ask my hon. Friend what is being done to remedy the problem. Another theory given for the seeming reluctance of doctors to man the accident department is that they would prefer to be employed in units attached to the larger hospitals where the range of activity and of equipment is greater. To laymen such as myself, it would seem that doctors should serve a group of hospitals rather than one, which would overcome the problem. If this brings complications, let us by all means hear about them.
It is quite ludicrous that a casualty unit located in an area of population growth and amidst heavy industrial development should be closed during evenings and weekends. Qualified staff must be recruited so that building and equipment are utilised in a sensible fashion. The Government have wisely acted to increase the numbers in the medical profession by encouraging a greater intake of students, and this should improve the situation in coming years. Though the blame for current problems may lie with previous Administrations, a determined effort must be made immediately to correct a position which allows instruments and premises to stand idle while injured people are carried past the hospital gates in search 657 of an accident unit which is adequately staffed.
I must mention one other point before I leave the question of the casualty department. When the initial closure took place, the unit was closed entirely. Subsequently it has reopened, though, as I have indicated, it has not yet resumed a round-the-clock service. Incredibly, when the unit closed down completely, the public were informed by a notice posted at the hospital entrance. The local authority was neither consulted nor advised. Such off-hand behaviour inevitably creates resentment and hostility. Fortunately, the lines of communication between the health authorities and local government have since improved considerably—and not before time. Nowadays, there is a massive exchange of correspondence and a multitude of meetings, but I cannot pretend that the problems that afflict the hospital have diminished—indeed, in many respects, the situation in recent months has worsened.
My third area of concern is the pace of advancement towards full district status for the Chorley Hospital. On this there is no dispute at all with the regional health authority on the principle. In fact, the authority is advocating that the hospital be upgraded at the earliest date possible. Any differences lie in how quickly district status can be achieved, and the rapidity of the accomplishment is largely dependent on the availability of resources.
The Registrar General's population figures show a growth in the population of Chorley from 79,490 to 83,100 and in South Ribble from 87,330 to 92,000 during the years 1972 to 1976. Ironically, a substantial growth in population is under way in the immediate vicinity of the hospital. Several thousand new houses have already been constructed under the auspices of the Central Lancashire New Town and many thousands more are being built at the present time or are in the pipeline. All new town development of any consequence is taking place south of the River Ribble, yet hospital facilities are being concentrated at the northern end of the territory.
It would be ridiculously parochial if one disadvantaged area of the North-West were to begrudge another area much-needed Health Service provision, and I do not intend to tread that road. None 658 the less, circumstances have changed since plans were laid for new hospital development north of the river. If the formula on which the plans were made has become obsolete, logic demands that the plan be changed. To concede that one is wrong is merely to say "I am wiser today than I was yesterday "—and this applies to vast organisations as well as to individuals. The modified plans of the Central Lancashire New Town mean that the incoming population will be accommodated in the Chorley and Leyland districts; therefore, hospital extension must take place in that area. The Chorley Hospital has an abundance of land at its perimeter available for development. In short, everything points to the desirability of a swift progression to full district status in the early future.
My concluding observations are about the financial implications of meeting the problems that I have outlined. I appreciate that it is very easy to leave this calculation out of the debate entirely, which might enable me to make an emotionally attractive speech which could appeal to my constituents but which would be cowardly in evading the realities of the situation.
The reality is that the Health Service could consume the nation's entire budget, such is the cost of sophisticated equipment, of new buildings and of maintenance and running costs. Even if the Government were to abandon investment in education, welfare provision, transport and everything else, giving all our funds to the Health Service, it would still not be sufficient to meet all needs, and clearly there is no question of finance on this scale ever becoming available.
However, accepting the overall limitations, I am convinced that our resources can be allocated more sensibly and more fairly. Already the Department of Health and Social Security has taken bold and decisive steps to divert funds from the more prosperous regions of the country and direct them towards disadvantaged areas such as the North-West. I approve and applaud the decision to implement the recommendation of the Working Party on the Allocation of Resources. This will mean that over a period of time the most hard-pressed regions will receive additional support to meet their formidable, almost overwhelming, problems in the field of health care.
659 The North-West Region has generated the wealth of the nation. It still puts more into the national kitty than it gets out. It has a higher death rate, a higher incidence of disease, a more polluted atmosphere and a greater proportion of decayed housing stock than any other region. Unemployment is higher than the national average, and there are fewer doctors and dentists per head of population than elsewhere. It is small wonder that a weighted allocation of funds is a desperate necessity.
An enlightened Government are now endeavouring to bring some justice and decency to a deprived region. I suggest that what is being done is insufficient, and my concern is shared by the leader of the North-West Regional Health Authority, Mr. Sidney Hamburger, who complains that the pace of reform is too sluggish and that there is still too much indifference in Whitehall to the needs and entitlements of his hard-hit region.
I took to my hon. Friend to convey to the Secretary of State the anger and resentment of folk in the North-West, and especially in Lancashire, at the imbalance of wealth and resources within our own country and amongst our own people.
Finally, when the strategic plan for hospital services in the Preston district has been assessed and approved by the various health authorities in the North-West Region, it will be forwarded to the Secretary of State for final decision. I hope that the criticisms that I have felt compelled to make on behalf of my constituents will have been needed and the plan amended accordingly. If not, I call upon my right hon. Friend to reject the proposals as they affect the Chorley Hospital because they do not reflect the needs and desires of the people—and that, after all, is the whole point and purpose of our health and hospital services.
§ 12.46 a.m.
§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)I am glad that we have the opportunity to debate this issue, which I know is of very great concern to the inhabitants of Chorley.
I pay tribute to the vigour with which my hon. Friend the Member for Chorley (Mr. Rodgers) has argued the case for Chorley Hospital over a number of years. 660 He sent my right hon. Friend the Secretary of State a copy of the formal objection which he addressed last October to the North-Western Regional Health Authority about plans which had been put forward for the future of hospitals in the Preston district. In December he took part in a meeting which was arranged between representatives of the regional health authority and of the Chorley and Ribble borough councils. Going even further back, in April 1975 he led a deputation to my predecessor, who is now Foreign Secretary, which presented a petition signed by a large number of Chorley residents, to which he has referred, expressing the same view.
The main issues which have exercised my hon. Friend's constituents were set out in the petition which he laid before the House on 13th December last. My right hon. Friend's observations on the petition have been circulated. Tonight I have the chance of dealing fully with some of the issues that my hon. Friend has raised.
One issue is that of the accident and emergency service at Chorley. It is restricted. It was restricted in 1974 from a 24-hour service to a 9 a.m.-5 p.m. service. As my hon. Friend rightly divines, the problem is one of insufficient medical staff to provide the essential medical cover. This is still the factor preventing the extension of this service, and it is a problem that is not peculiar to Chorley but one that I find up and down the country in quite a number of places. The area health authority has reaffirmed that it will continue to make every effort to recruit the appropriate staff to enable the hours of the service to be extended.
The problem is that the accident and emergency service at Chorley is one principally for minor accidents, as it has been for many years. This means that, because of the need to have available the full range of back-up facilities which are required to deal with serious accidents, a full accident and emergency service is at present provided only at the Preston Royal Infirmary. Although the journey to Preston, or, indeed, to Wigan—which is about eight and a half miles from Chorley—may take longer, the problem is that the longer journey and the risks attached to that have to be weighed against the risks of taking people to an accident and emergency centre, 661 such as that at Chorley, which is not fully equipped to deal with serious cases.
I am fairly sure that what will happen is that, as Chorley Hospital develops into a full district general hospital, full consideration will be given to the need for a full accident and emergency service and department at the expanded hospital.
In the meantime, the department is too small to attract the services of a consultant, which is the main grade for providing medical care, and registrars cannot work without consultant supervision. Secondly, as my hon. Friend says, the personnel being persons under training, the accident and emergency department at Chorley does not provide the appropriate range of accident and emergency work or, indeed, the equipment to give them the breadth of experience necessary to enhance their skills.
In the long run this particular problem may be remedied, but in the short run, although I am sure that all that can be done will be done to ensure proper medical staffing, we have to rely on the willingness of doctors to work at Chorley and other accident and emergency departments of similar size up and down the country. I have indicated why doctors may not always be willing and why those who are willing may be hard to find.
I turn to the question of the children's ward at Chorley Hospital. I do not want to go into too much detail, because there is the possibility that the matter will be referred to my right hon. Friend for a decision and our position has to be reserved. He would not want his decision prejudiced by anything I might say. The issue is also rather different because it is really one of deciding what deployment of services will be in the best interests of the population served.
At present the hospital has a 10-bedded children's acute ward. Last year the Lancashire Area Health Authority published proposals for the future use of hospital accommodation in the Preston district. One proposal was that, on completion of phase two of the new hospital, the children's ward at Chorley should be closed and the service continued in the much larger children's unit at Preston. It is possible that after the consultation the AHA may drop or modify the proposal. On the other hand, if it goes ahead 662 in the teeth of opposition from the community health council, the House knows that the procedure we have laid down for dealing with proposed closures provides that the matter is referred to my right hon. Friend for a final decision. I know that my hon. Friend and those for whom he speaks are taking a full part in the local consultations and I can assure him that, if the matter is referred to my right hon. Friend, the arguments that he has advanced so persuasively will be taken into account. We may need to refresh ourselves as Lo their content nearer the date of the decision.
My hon. Friend referred to children who have to go to Preston when beds appear to be free at Chorley. This situation may arise because of the requirements of individual children. If they require the specialised treatment that only the larger hospital can provide, doctors sometimes think that, despite the vacant beds at Chorley, it would be better for the children to go to Preston.
Finally, I should like to look at the case argued by my hon. Friend for Chorley Hospital to be advanced to full district status. The principle here is not in question. The argument is purely and simply about the timing of such a development, and this is something that has to be seen in the context of the other pretty heavy pressures facing the North-Western Region. The region has inherited some of the oldest hospital buildings in the country. Two-fifths of them were built before the turn of the century and more than half before 1918. There are also pockets of serious under-provision in certain services and certain localities. They are worst in services for the mentally handicapped, the elderly, especially those suffering from severe mental infirmity, and the mentally ill, but, looking at the region as a whole, one finds that there are deficiencies in some places almost right across the range of services.
The strategic plan which the regional health authority published just a year ago sets out a comprehensive programme for trying to remedy these deficiencies. The view that the regional health authority has taken is that the filling of outright gaps in the level of services must command the highest priority and that replacing old buildings and correcting the mislocation of services, desirable though 663 both these aims are, must take second place.
Chorley is part of the Preston district. For hospital purposes it divides itself into two parts. The northern part, comprising Preston borough and part of South Ribble borough, looks to Preston for its hospital services. In 1981 it has a planning population of about 200,000. The other part of Chorley and the remainder of South Ribble, for which Chorley is the natural centre, will have an estimated 1981 planning population of about 150,000. That figure takes into account the projected increase in the population of the Central Lancashire New Town.
The district has under construction a major new hospital at Fulwood to the north of Preston. It will be the region's first entirely new large hospital since the start of the National Health Service. The first phase will be completed this year. The second phase will be completed in about 1980. There will then be a total of over 700 beds. In all this planning, the region took into account the deficiencies in certain of the district's services, especially general medicine, children's services, geriatrics, accident and orthopaedic services. All these will be provided at the new hospital.
There is also a need to replace some of the wards of the old Preston Royal Infirmary, which is more than 100 years old. When this is all done, there will be a total of about 1,060 acute beds in the district. Apart from the children's unit, the opening of the new Preston hospital will not affect services at Chorley.
The trouble at Chorley, of course, is that its services will to a large extent be off-centre. At Preston and Chorley, patients will be obliged to go to Preston. Although there is a reasonable level of public transport, which I do not underrate, there will be considerable inconvenience for patients and visitors. I am afraid that that has to be accepted as one of the problems. The region intends that Chorley will be developed into a full district general hospital in time.
It will be clear to my hon. Friend that the problems of Chorley, as with so much of the North-West, stem directly from at least 30 years of neglect of the area's problems in favour of lusher medical and hospital pastures elsewhere. As a course 664 to be followed—I cannot call it a policy—I find it indefensible.
As my hon. Friend has recognised, we are the first Government to have recognised fully the needs of the North-West and to have started the region on the road to getting its fair share of the National Health Service budget. This year the region has had a growth rate of 3.2 per cent. in its revenue allocation, which is higher than any other region and more than twice the national average. Under this Government, a similar pattern will be repeated in future years. However, because the region has been so badly deprived of resources in the past, it will still take time to meet all the needs that have been recognised.
I cannot accept, as my hon. Friend reports Mr. Sidney Hamburger feels, that the region is ignored in Whitehall and Westminster. My right hon. Friend and I have spent more time in the North-West than in any other part of the country. Our whole policy is designed to come to its relief. We have incurred much criticism in other parts of the country in following that policy, not least in the areas that we represent as Members of Parliament. I appreciate that the pace of help must appear painfully slow to the people of Chorley, but 30 years of neglect, not only of Chorley but of the surrounding towns, will take a little time to correct. However, we shall do our utmost, so long as we have power, to keep faith with the health service in that part of the world.
I might not be able to give the answers that my hon. Friend would most like to hear, but I hope he will understand the extent to which the matters we have been discussing fall within the responsibility of area health authorities and regional health authorities and will accept that they must have reasonable discretion to take decisions in the light of their knowledge of the local picture. I hope I have persuaded him that those decisions are not taken lightly and that the authorities do their best to strike a fair balance between competing claims with a finite amount of resources. On any matters that are referred to us, we shall give as fair a hearing as we can to both sides of the argument.
§ Question put and agreed to.
§ Adjourned accordingly at One o'clock.