HC Deb 27 January 1978 vol 942 cc1919-34

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

4.15 p.m.

Mr. Michael Marshall (Arundel)

I am glad to have the opportunity of raising this important matter. I express my appreciation that my hon. Friend the Member for Chichester (Mr. Nelson) is here to support me because the matter that I intend to raise is crucial to the Chichester District Health Authority, which covers both our constituencies.

In the limited time available I intend to use a certain amount of shorthand. I know that the Under-Secretary of State, with his customary diligence, will be totally familiar with the details of the case that I am about to enunciate and will have had some opportunity to rake in some of the points that I intend to make.

I must tell the hon. Gentleman that I mean him no disrespect when I relate my remarks a good deal to his hon. Friend the Minister of State, as he will be aware that I have been corresponding with his hon. Friend for the past 12 months. Indeed, this whole subject cannot be divorced from similar conversations in respect of the closure of the Zachary Merton Maternity Hospital, which is also within my constituency. That is, therefore, part of my immediate concern in raising this matter.

My constituency is now facing a grave crisis with the cutback in hospital facilities at both ends, as it were, of the constituency, and falling within the two health districts of Chichester and Worthing. It is part of my contention that we are facing some of the difficulties because the various health authorities—the district and area authorities, for example—do not relate to parliamentary boundaries. I believe that that raises problems.

I turn to the problems of my constituency, which I shall deal with in some detail. First, over half the electorate are pensioners. If I cannot claim that that is the highest ratio in any constituency, it is certainly in the first half-dozen.

Mr. Russell Kerr (Feltham and Heston)

Hear, hear.

Mr. Marshall

I am grateful to the hon. Gentleman for his support, knowing the scene as he does.

Secondly, Bognor Regis is the largest centre of population in the Chichester Health District. There are approximately 50,000 people within Bognor Regis and district. The Bognor Regis War Memorial Hospital has to serve that sort of number. Summer visitors increase the total to about 75,000 to 100,000. That is a figure that is confidently expected to increase as the new Bognor Regis centre comes into operation in about a year's time.

Therefore, we are concerned with two streams which require special casualty treatment—the elderly, on the one hand, who are clearly in the worst possible position to fend for themselves in respect of emergency treatment, and visitors, many coming down from London for the day on coach trips, who are equally likely to be confused and unable immediately to assess how to obtain treatment because they do not know the area and do not know the local GPs.

The other aspect is that the nearest treatment that is available if the closure goes ahead for casualties would be at the St. Richard's Hospital, Chichester. I know that my hon. Friend will confirm that it is already considerably overstretched. The hospital is seven miles away. Whether it be for visitors or local old-age pensioners, given the nature of our terrain it has to be said that the bus services are inadequate, involving two changes to get from Bognor Regis and the surrounding areas to Chichester and on to the hospital. We are talking about fares of 41p, which have become a major consideration for pensioners. Therefore, there is a real problem. Added to that, we have the problem of large industrial estates and two large comprehensive schools in the area, all of which are served by the Bognor Regis War Memorial Hospital. The hospital handles about 7,000 cases per annum.

The work of the hospital cannot be divorced from the activities of the Red Cross, which in addition handles about 1,700 cases per annum on the sea front. It provides an essential back-up service at Bognor as the Bognor Regis War Memorial Hospital's casualty department operates only five days per week.

The evidence of the Red Cross is of especial significance. In a letter to me of 2nd February 1977 it states: The casualties treated at this first-aid post far exceed those at any other of our first-aid posts, stretching from Rye to Selsey"— which is the whole of East and West Sussex— and make up almost half the total number of casualties treated throughout the county at all the numerous first aid posts provided for special or sporting occasions, and the withdrawal of the close support of the professional casualty service will place an intolerable strain and burden on the volunteers. That speaks for itself, but it is not simply the local Red Cross that is concerned. There is concern about whether St. Richard's, Chichester, can handle the extra traffic. The area health authority has made it plain that it will regard that as a major difficulty, a major strain on resources at Chichester.

It was against that background that the Chichester Health Council made a statutory objection on 28th March last year, when closure was mooted in the consultative document issued by the West Sussex Area Health Authority. The authority in turn referred the matter back to the district management team on 7th July, and on 4th August the area health authority confirmed that the casualty department would be retained to meet the community health council's objections and the clearly expressed community opinion.

A total of 20,000 signatures had been collected in Bognor Regis, out of a town population of about 37,000. There were protest marches through the streets and a unanimous expression of view by many people. The local branch of ASTMS had made representations, as had many local clubs. The efforts had been co-ordinated by the Friends of Bognor Regis Hospitals, an active organisation with an outstanding record in sustaining the hospital with voluntary aid, providing equipment and giving it the kind of community spirit that is an essential part of my argument.

In the light of all that, people in my constituency were shattered when on 1st December the area health authority reversed its decision. This change is very difficult to understand. The circumstances have in no way changed. The agricultural needs are still the same. In a moment I shall turn to the arguments advanced by the authority and now apparently endorsed by the Minister. There seems to be no difference between them and the arguments accepted between March and August, when the authority first changed its mind.

The new decision has caused deep resentment, and it is perhaps over the whole question of finance that resentment is felt so strongly. The casualty department was clearly part of the district management team's package in effecting substantial savings in the Chichester district. This in turn—and this is where the Minister must accept the direct responsibility—was part of the Government's cutback in public expenditure during the financial year 1977–78. It was proposed that within the Chichester district savings of almost £250,000 should be made. The area health authority has further proposed that the entire weight of those savings should fall on Bognor Regis.

It was proposed first that the Bognor Chest Hospital should be closed, with a saving of £200,000. It was additionally proposed that the operating theatre at the Bognor Regis War Memorial Hospital should be closed, with a saving of £12,000. Finally, it was proposed that the casualty department of the Bognor Regis War Memorial Hospital should be closed, with a saving of £18,000.

All the many organisations that I have mentioned, the local clubs and the Friends of the Hospitals played a constructive role in persuading local people to accept the first two recommendations. Matters were aired very widely. We have all been much concerned. It was agreed that the chest hospital should go, thus providing the major savings, together with the operating theatre in the War Memorial Hospital. The real sticking point in everybody's craw is the closure of the casualty department, for the reasons I have already given.

The casualty department is the real community link, the way in which the local hospital services tend to meet most of the local community in the most pressing and urgent circumstances. In this sense my constituency, particularly Bognor Regis, has already accepted a massive cutback to provide savings.

The local council, the Arun District Council, has been most active in the matter, and the chairman of the health advisory committee has been active in arranging meetings. The clincher was put on the financial argument when all these people put to the health authorities only last Tuesday the offer to underwrite any additional finance that might be needed within the £18,000 and were told "This is not really the argument. Money is not now the problem."

The argument therefore has to be looked at on other grounds. What are they? In a letter to me on 19th January, the Minister of State sets out the area health authority's two principal reasons for recommending closure. He said: The West Sussex Area Health Authority decided to close the casualty department in view of the need to rationalise services in the Bognor Regis area and of the difficulty in providing adequate medical cover at the department. Let us consider those reasons. I have explained the problem that has been brought into imminent view for my constituents, especially the young people who have been hit by the impending withdrawal of the maternity facilities at the other end of the constituency. Surely the rationalisation that we are facing is one of stripping our area of the two most important and pressing medical needs—maternity needs and emergency casualty treatment.

The rationalisation that is proposed cannot be divorced from the proposals that are in hand for making the Bognor Regis War Memorial Hospital a community hospital. Local people understand that this is the intention. There is talk of switching the main proposal of the hospital to geriatric use. We understand that, but it is baffling when we see in the British Medical Journal of 8th January that the BMA considers that there is a strong case for casualty departments being part of community hospitals. Surely this is a left hand-right hand situation. We are threatened with the closure of a casualty department in what will become a community hospital and will therefore need a casualty department. It seems ludicrous.

The second reason given in the Minister's letter is that we have to find a way round staffing. This is a complex subject and I hope that the Minister will understand if I do not spell out the whole argument now. There is cover provided by the area health authority in terms of consultant supervision and insurance provisions. It is clear that alternative arrangements can be made. If the casualty department is to be staffed by general practitioners—and I shall come back to this matter—it is part of the Government's responsibility in relation to the future of GPs and community hospitals. The Minister knows that the Regional Association of Community Health Councils called on his Department on 29th November to review the staffing of all casualty departments in the region. Clearly this problem is not confined to my constituency.

The Minister must accept that his Department is totally responsible for the problems that we face in my constituency. I have considerable sympathy with the district management team, the area health authority and the regional health authority which were asked to make cuts and had to look around to see where they should fall. In addition, they are expected to carry out confusing and contradictory instructions from the Department.

We have already borne the whole brunt of savings in our district in my constituency. We have said that we are willing to meet demands to top up the figure to £250,000, or even more if that has to be achieved.

The staffing question and the consultant cover is in the Department's hands. It must resolve this problem. I realise that it is a national problem. Equally, if alternative GP staff were regarded as adequate, this again comes back to the responsibility of the Department because it must come to an agreement with GPs or the BMA on the staffing and remuneration of staff in community hospitals. The hiatus over pay and the uncertainty of the threatened closure is affecting the whole staffing picture in my constituency.

May I take this opportunity to correct a misconception which is crucial? The Minister may think that the view of the district management team in the note of 21st November that local GPs had endorsed the closure is significant. I agree that it would be significant, but it arises from a direct misconception. At the meeting last Tuesday the GPs representing the Bognor Regis Medical Association confirmed that they were opposed to the closure of the department. That is a significant recommendation. Knowing, as I know from bitter experience, the way in which the Minister's Department is heavily swayed by professional opinion within its ranks, there is a need to show that the processes of consultation mean what they say.

In parliamentary Questions I have discovered that since the community councils were formed four years ago there have been 27 hospital closures for which statutory objections went through the district medical team, the area health authority, and the regional health authority to the Minister. In every case but one the Minister upheld the proposals. In the case of Cosford a different view was taken. It was simply to postpone the closure for one year. The Minister must understand that there is grave concern whether we have a process of consultation which is more than a rubber stamp. I have raised the matter for that reason.

I hope that the Minister will not say that he cannot answer while the matter is still with the regional health authority. I hope that the regional health authority will also take on board what I have been saying and exercise its view on the significant arguments and the changed circumstances. The Minister has ample powers.

Let me tell the Minister specifically what he should do. I shall put three proposals to him. I am sorry if I am running a little late but this is important. First, will the Minister authorise the area health authority to provide consultant cover until the future of the Bognor Regis War Memorial Hospital is determined as a community hospital? Secondly, will he ask the regional health authority, which will be looking at the matter on 8th February, to leave the present recommendations on the table. Thirdly, will he show the Department's good faith by telling us that if necessary he or one of his colleagues will receive a deputation as he did about Zachary Merton Hospital? Will the Minister accept an invitation to visit the hospital? There is a distinguished precedent because the former right hon. Member, Kenneth Robinson, visited the hospital not very long ago and thought highly of it.

This argument could apply to the experience of many hon. Members. There but for the grace of God they go. This is a matter of democracy in the National Health Service. The Minister has the opportunity to live up to his role this afternoon.

4.33 p.m.

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

I congratulate the hon. Member for Arundel (Mr. Marshall) on securing this opportunity to debate this matter which is clearly of concern to his constituents. I am grateful to him for giving me notice of the issues he wished to raise. I know that he takes an active interest in the development of health and social services and I welcome this opportunity to try to explain the current situation fully.

I should first like to devote a few words to clarification of the precise stage which the area health authority's proposal to close the casualty department at the Bognor Regis War Memorial Hospital has reached.

The West Sussex AHA set out proposals for the authority's two hospitals at Bognor, which included the closure of the casualty department at the War Memorial Hospital on 22nd March 1977. In accordance with our guidance, this document was sent to a number of interested bodies including Chichester Community Health Council, the local authorities, staff organisations, advisory committees and the hon. Members for Arundel and Chichester (Mr. Nelson).

Following the three-month period required for consultation, the area health authority considered carefully all the comments received on its proposals, paying particular attention to the opposition of the Chichester Community Health Council to the closure of the casualty department, which it considered at its July meeting, and, in the light of this opposition, it discussed the matter again with the Chichester District Management Team, the casualty department meanwhile remaining open. At its December meeting I understand that the authority gave very detailed and careful consideration to the possibility of overcoming the difficulty of securing staff to enable the casualty department at Bognor Regis to remain in operation but was forced to conclude that it could not alter its earlier proposals.

As community health council maintained its objection to the closure, the area health authority, in accordance with the formal consultation procedure, referred the matter to the regional health authority, which will be considering the area's recommendations at its next meeting on 8th February. I must emphasise, therefore, that nothing I say today can possibly be taken as prejudicing the issue which they will be considering then.

If the RHA supports the area's proposals and considers that the proposed closure should proceed, it will then be for Ministers to make the final decision. It goes without saying—or perhaps I should say it, in view of the hon. Gentleman's closing remarks—that if this happens it will give this matter the careful consideration it deserves and will take full account of all the evidence available to it, not only from the health authorities but from the community health council, local Members of Parliament and the other organisations and individuals who have expressed views.

I must refute the hon. Gentleman's point that Ministers are acting merely as a rubber stamp. In the context of contested closures eventually agreed by Ministers, which are very few in number, we are talking only about the relatively small number of cases in which relevant issues have not been resolved satisfactorily during consultation at area and regional level, and in some cases following reconsideration of specific issues. My right hon. Friend is, therefore, merely asked to decide on cases where, after a great deal of thorough consultation at local level, health authorities remain fully convinced of the proposal's merits. I assure the hon. Gentleman that my right hon. Friend will agree to no closure unless he is satisfied about the alternative services which will be provided in the area concerned.

I have to emphasise, therefore, that we are debating the proposed closure of the Bognor Regis casualty department. It is for this reason, as I am sure the hon. Member will understand, that I cannot prejudice the situation by commenting in detail on the merits of the case at this time. It might, however, serve a useful purpose if I set the authority's current proposals in the context of its overall development of health services in the area.

The closure of the casualty department was only part of the authority's proposals for the change of use of the Bognor Regis War Memorial Hospital, to enable it to become a community hospital. This is to facilitate an overall change in emphasis of the services to be provided in the hospital so that it can in future provide mainly services for the elderly, together with rehabilitation, physiotherapy, X-ray and pathology services and an out-patients' department.

This package of proposals cannot, as I am sure the hon. Member will realise, be seen in isolation but must be seen as an important part of the health authority's plan for the development of services in Chichester health district and throughout the West Sussex area.

In this connection, I wish to say a few words about the new NHS planning system in general. The NHS, of course, always made forward plans for its services, but the present planning system, which, we hope, will prove to be a great improvement on earlier arrangements, is not yet fully developed. The system aims to ensure that the identification of needs and priorities for health services is achieved successfully and jointly by three tiers in the National Health Service—district, area and region, within guidelines laid down by my Department which are amplified by the issue of further guidelines from regional and area health authorities to suit local conditions.

It is hoped that, by use of this system the bulk of planning will be done within the local situation where the people concerned have immediate knowledge and personal experience of the problems and needs which exist in their localities; but it must still be based on the guidelines.

The change of use proposals for this hospital must, therefore, be seen as part of both the Chichester district's and the West Sussex AHA's plans for the development of services, in the context of national priorities.

In 1976, as hon. Members will no doubt be aware, my Department published a consultative document, entitled "Priorities for Health and Personal Social Services in England" which set out priorities for service development over the country as a whole. This was followed last year by another document entitled "The Way Forward", which built on the earlier paper.

Both those documents put the care of the elderly, and provision of acute and community services for them, near the top of the list of national priorities in recognition of the fact that this group is forming an ever growing proportion of the total population. Even with constraints on the development of health and social services as a whole, therefore, there must be growth of services for the elderly.

As the hon. Member is only too well aware, in West Sussex the needs of the elderly are even more pressing than they are throughout the country as a whole. In recent years, many people have moved to the South Coast to spend their retirement there, and this has resulted in a far greater proportion of elderly people living there than in other parts of the country.

Mr. Michael Marshall

rose—

Mr. Deakins

I am sorry. I have only four minutes left, and I have not yet begun to answer the hon. Gentleman's points.

In 1976 nearly 21 per cent. of the population catered for by West Sussex AHA was over 65, compared with a national average of around 14 per cent. Along the coastal strip itself, where the Bognor Regis War Memorial Hospital is situated, the percentage is even higher, as the hon. Gentleman himself emphasised.

It is not surprising, therefore, that at the top of the list of priorities set out in West Sussex AHA's strategic plan published last year stands the care of the elderly. There are waiting lists for geriatric beds in the area, as there are for local authority old people's homes. The area strategic plan, therefore, gives high priority to the examination of services for the elderly in each district, with particular emphasis on the co-ordination of hospital and community services and close collaboration with local authority social services.

The Chichester district strategic plan recognises the lack of adequate facilities for geriatric services as its greatest disadvantage, and the district has consequently set up an active care of the elderly planning team. One of the proposals in the authority's plan for meeting these needs is the establishment of two community hospitals—one at Bognor Regis, to provide 92 beds, and one at Midhurst, to have 50 beds. It was originally planned that both these hospitals should come into use some time between 1979 and 1982. This is where the specific matter we are debating today fits in with the overall plan. The change of use proposals for Bognor Regis War Memorial Hospital envisage it providing additional beds for the elderly and rehabilitation services as the first step towards a community hospital in Bognor, and in meeting what has been recognised as the most urgent needs of this district.

I should explain here that community hospitals are likely to play a very important role in the care of the elderly in future. They are in the main small local hospitals, many of them unable to provide specialised services as efficiently and economically as the new district general hospitals. They are, however, especially suited to providing for elderly patients who need nursing and medical attention, but not specialised care. Because they are small they are more homely and less forbidding than larger hospitals and their location enables patients to be cared for near their homes and within their own community, where it is easy for their families and friends to visit them. Staff tend to be recruited locally and so get to know both patients and their families. The priorities document which I mentioned a few minutes ago recognised the contribution which community hospitals can make and suggested that authorities do all they can to include their development in their plans. "The Way Forward" accepts that if authorities are to develop community hospitals some measures of rationalisation involving the change of use of hospitals, such as those proposed for the Bognor Regis War Memorial Hospital, will be needed.

If we now turn to the question of the provision of accident and emergency service at Bognor, the West Sussex AHA has stated its intention that patients who would at present be treated at the casualty department of Bognor Regis War Memorial Hospital by a clinical assistant who has been kept on there by special arrangement would in future be treated by its own general practitioner or, where this is more appropriate, would be referred to the accident and emergency department at St. Richard's Hospital, Chichester, seven miles away. This is where all serious cases, such as the victims of road accidents and ambulance cases, are already referred at once. The district management team is also currently having discussions with the local Red Cross about the possibility of co-operation in the provision of a first aid post which it runs in the summer. It is a very busy post. As I have said, it would not be right for me to discuss in detail the merits of the authority's proposals today as they are at present subject to the decision of the regional health authority and possibly that of my right hon. Friend the Secretary of State. However, it might be helpful if I set out my Department's policy on the provision of accident and emergency services. This bears on the letter in the BMA Journal.

This policy is derived from the report, published in 1962, of a sub-committee of the Standing Medical Advisory Committee—the Platt Report. The most important of the recommendations in this report was that services should be concentrated to provide a regional pattern of accident and emergency units staffed and equipped to deal immediately with major injuries and other emergencies at any time of the day and night; each unit serving a population of at least 150,000. Some hospitals not designated as accident and emergency centres should, however, continue to provide for the treatment of minor injuries. In particular, in remote areas, cottage hospitals might have to give first aid treatment to major injuries and deal with minor ones; an effective rota of general practitioners able to attend at short notice to give the treatment that was necessary. It was an essential part of the Platt recommendations for such a pattern of services that accident and emergency services should deal primarily with serious cases and that the flow of minor cases would be reduced by the operation of an adequate general practitioner service at all times.

The basis of the Platt recommendations is that it is necessary in the patient's interest to concentrate accident and emergency services into major departments. The object is to ensure that there are available all the medical and nursing skills, the supporting services and the equipment needed for expert diagnosis and immediate and life-saving treatment, for treating injured patients and other emergency cases.

My Department commended the recommendations of the Platt Report to hospital authorities as a basis for planning the development of accident and emergency services. In our view, to ensure a high quality of service in the best interests of patients, there is scope and need for further concentration of services. It is recognised that there are special needs and problems, for instance, in holiday areas—I have taken careful note of all the points made on this issue—but for the reasons given there continues to be scope for further rationalisation and it is my understanding that this is what is being attempted at Bognor at the present time.

I repeat my assurance to the hon. Member that the views of the constituents who have made representations to him will be taken into account fully and sympathetically not only by the regional health authority when it considers the West Sussex Area Health Authority's proposals for the future provision of casualty services next month—but—should disagreement continue—when the proposal reaches my Department. In this connection I will carefully consider the three points the hon. Gentleman put to me, together with my hon. Friend the Minister of State responsible for health matters. In particular, I will bear in mind the point he made about the visit and receiving a deputation. I speak feelingly on this subject because I had a hospital—

The Question having been proposed after Four 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 fifteen minutes to Five o'clock.