§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]
§ 11.37 p.m.
§ Mr. Speaker
Order. An hon. Member is trying to raise a point of order. I hope that those who are leaving the Chamber will withdraw quietly, because we are taking the point of order out of the Adjournment time.
§ Mr. Rhodes James
The point of order that I seek to raise, Mr. Speaker, is the one that I was trying to raise during the Division. The ruling that you gave, Mr. Speaker, was that the order of the House of 16th November 1977 overrode Standing Order No. 44. That is the implication of what you said.
May I ask you to consider this matter again and to make a further statement 414 tomorrow? This is a serious implication, that a vote of the House may override a Standing Order of the House.
§ Mr. Speaker
I clearly followed the same precedent that my predecessor did, but if it will make the hon. Member feel happier, of course I shall repeat the statement tomorrow, with the greatest of pleasure. But I have followed the practice that has been followed hitherto with regard to the motion tonight. Of course I shall make a brief statement tomorrow, when we also have other business.
§ Mr. Speaker
Order. Will the hon. Member wait a moment? He was obviously speaking under difficulties. Will right hon. and hon. Members who are leaving the Chamber do so quietly?
§ Mr. McNamara
I was saying, Mr. Speaker, that it is a rare occasion when 415 an hon. Member, even in an Adjournment debate, raises a subject that he knows has the full support of the community that he represents, fellow members from all parties, his local authority, and all the voluntary groups associated with the subject that he is raising. Yet this is the case in relation to the proposed closure of the Hull hospital for women and the Townend maternity home, both situated in my constituency but serving the needs of the constituencies of Kingston upon Hull, West Haltemprice, and parts of Kingston upon Hull, East, all of whose Members join me in their condemnation of this insensitive decision, indifferent to public opinion and, as I shall show, contrary to the best interests of the women patients and good medical practice. It has succeeded in uniting all shades of political opinion, right, left and centre.
To recap the proposals of the district management team, they are to close the Townend maternity home, so that all maternity cases are dealt with at the Hedon Road maternity hospital and to close the Hull hospital for women and transfer all gynaecological work to the south annexe of the Hull Royal infirmary, at a total estimated saving of no more than £100,000.
A busy group of general practitioners, in a practice covering both my constituency and that of my hon Friend the Member for Kingston upon Hull, West (Mr. Johnson), said in a letter to the area health authority:At present our normal obstetric patients are sent to the GP obstetric unit at Townend. If this unit were removed to Hedon Road, our obstetric practice would necessarily have to be seriously curtailed because during busy times of the day traffic conditions in the City centre would render it impossible for us to journey to Hedon Road for emergencies occurring during surgery hours. In the event we should have to give up attending the delivery of most of our obstetric cases, which means, as you know, that eventually we would not he allowed to undertake obstetric care …Furthermore, we cannot agree that the proposed five-bed unit is big enough to be an adequate alternative to Townend for GPs "—and they then make an important and telling point:As the number of GPs practising obstetrics declines, the fewer opportunities there will be available for young doctors to gain general practice obstetric experience, which will in turn lead to less obstetric practice overall. The real 416 issue to be weighed is whether the suggested administrative/financial solution is worth it to the general public at the cost of the damage it will do to medical care. We do not think so.My hon. Friends and I do not think so either.
In order to understand the enormity and strange character of this decision it is necessary to appreciate the geography of Hull. The city lies in a half circle on the north bank of the Humber and is dissected by the River Hull. The threatened hospitals lie in the centre of my constituency and are on convenient public transport routes. The Hull Royal maternity hospital is an old fever hospital and, as befits such an institution, is on the periphery of the city with difficult public transport access.
It is a nightmare to reach when the traffic is congested. The southern annexe, which is also in East Hull, is difficult to reach.
The Hull city council, in its representations to the area health authority, bitterly and pointedly said:It would appear that this move has been treated almost entirely as a financial exercise and has not taken account of the very considerable inconvenience, firstly, to the residents in the northern area of the City who have now much further to travel, and secondly to the City as a whole in view of the overall reduction in their facilities. In October 1977, the City Council resolved that the location of any new services provided by the Health Authority should be related to the natural lines of transport communications within the City. Clearly, the present proposals would be quite contrary to this suggestion for the more convenient location of hospital premises.A unique decision has been taken by the management team. Not only are all the GPs against it but the medical committee and the community health council are against it. None of my hon. Friends has received representations in support of the decision.
The general practitioners' committee says, in its representation to the area health authority:General practitioners in Humberside are opposed to the proposed closure of the Hull Hospital for Women and the Townend Maternity Home, and have doubts that the estimated savings would be £100,000.Patients are of primary importance, and they do not want the closure, they like continuity of treatment by their own doctor. The Townend Maternity Home is a good General Practitioner Hospital, and has been for a number of years … Closure could cause a 417 subsequent increase in home confinements, which many doctors consider a retrograde step.Speaking of the Hull hospital for women, the committee states:Humberside General Practitioners are completely opposed to the idea of closing down a perfectly good, fully equipped and functioning hospital with operating facilities which only requires £10,000 expenditure in a town with a waiting, list as long as three years in some specialities, and two years for routine gynaeocology …The cost of a delivery at Townend is currently £246 per delivery as against £249 at Hedon Road.There is some strange financial saving there. The committee breaks down the figures and suggests—and I agree—that there is no proof of a real saving. The committee also examines the question of bed occupancy and the decline in facilities. The details are contained in the document which I am sure the Minister has seen.
I wish to make one important point. A lot of the emotion and the reasoning behind this matter has concerned the cut-down at the maternity home. I urge my hon. Friend to consider the situation in the Hull hospital for women. A woman would have to wait 70 weeks there for general gynaecological treatment. At the Hull Royal infirmary, to which it is proposed the women should now go, the waiting times, depending upon the consultant, are 136 weeks, 330 weeks, 232 weeks or 160 weeks. So it is possible for a patient to wait six years. Is that the sort of progress that the district management team is considering when it talks about improving the facilities for patients in Hull? They cannot even clear a waiting list in six years.
Other problems have not been dealt with. They concern, among other things, what will happen to the community midwifery services. I asked my right hon. Friend the Minister of State about this. He said:Humberside Area Health Authority plans to provide the appropriate level of community midwifery services which will become necessary."—[Official Report, 14th February 1978; Vol 944, c. 113.]What is that level. There is no provision in any estimates put forward by the hospital management team. It is very poor on proposed capital expenditure, although it can wax lyrical about proposed savings. The case made out by the district management team is riddled with holes. No one is in favour of it.
418 I come now to an even more serious point. The area health authority is clue to meet next Thursday to consider the proposed closures and the representations that have been made. Yet already decisions have been taken which seek to pre-empt the scope of the decisions of the area health authority. In the case of conflict between the area health councils and the area health authority, should the authority agree to the closure, the hands of my right hon. Friend the Secretary of State, who will have to adjudicate, are being tied. This is being done by sharp administrative practice which makes a mockery of the whole idea of consultation. The area health authority meets next Thursday. Decisions have already been taken on the proposals.
From Monday 19th June the Hull hospital for women has been made from a seven-day hospital to a five-day outpatient organisation. This decision was taken without reference to public representatives, to community health councils, or even to the trade unions representing the people who work at the hospital. I spoke only this evening with Mr. Martin of the National Union of Public Employees. He tells me that the first he heard about the proposal was in the middle of the week preceding the 191h. He learned about it when his members told him that they had new duty rosters and asked what they should do.
That is typical of the team's attitude to employees in the Health Service, and it is typical of the way in which it is riding roughshod over the representations made by my constituents, by numerous organisations, by Hull city council and by the community health council. It has gone out of its way to take decisions which are directly contrary to the best interests of my constituents. This is a shocking example of administrative procedures, and I trust that it will cause my hon. Friend to rap severely the knuckles of many of those who are involved in this exercise in the Hull area.
These people made this decision, not just the week before, which would have meant a shortage of time in which to inform the unions or other people, but on 6th April, more than two months earlier. The decision was made in a minute headed to the effect that the consultation period was over. What does consultation mean in that case? Does it 419 mean getting people to make representations, and no more? Certainly the area health authority had not considered anything about this. The decision was announced by these people to press ahead with their own previous decision, a decision which was minuted but not announced—they did not have the courage to do that.
They go on to say that the redevelopment of the maternity service on the Hull Royal infirmary site had been planned. I am assuming that that is not the Sutton annexe. So they are closing two good hospitals and are planning unexplained capital expenditure for three other institutions and then they decide to have a maternity service at a new hospital as well.
This is bureaucratic saving gone mad. These people represent no one. They are appointed to do a job by a non-democratic body. In Westminster Great Hall at the moment is an exhibition commemorating the fiftieth anniversary of women achieving the vote. But no matter how they voted, they would not get rid of this district management team. But if they could vote, they would sweep them and their proposals out of office.
§ 11.51 p.m.
§ Mr. James Johnson (Kingston upon Hull, West)
These beginnings of an attempt to eliminate—almost liquidate—these Hull hospitals is monstrous. As my hon. Friend the Member for Kingston upon Hull, Central (Mr. McNamara) said, it is almost a sin against democracy. I support everything that he said.
All in Hull—save apparently two or three consultants on the district management team—are opposed to this measure. My own West Hull doctors are opposed to it. They will have to cross the city to Hedon, as will the women patients. When they get to the hospital, they will find it wedged between two cemeteries, opposite a large cargo docks.
The community health council is solidly against the proposal, but it cannot oppose it. It is merely invited to offer its suggestions for alternative uses for the hospital. Sir John Dunning and his colleagues on the district authority apparently cannot overrule the management team. The Hull city council is against closing the hospitals, as are the trade 420 unions and the family practitioner committee.
Who is for the closure? Who sits on the management team? I am told that it consists only of medicals and officials—in other words, consultants and administrators. There are perhaps four or five of them, including Dr. Dunlop, the district community physician—or, to give him the old-fashioned title, the medical officer of health. There are no lay members.
The unions have assured me that there will be no redundancies, so it is difficult to see where savings will be made. Wage packets, especially in the public sector, account for 60 or 70 per cent. and more of overheads. The unions are often attacked for desiring workers' control. I ask the Minister whether this is not a blatant case of two or three professional consultants and perhaps two administrators pushing about Hull city and the whole of North Humberside and its womenfolk. Hull people do not like it. I ask the Minister to institute a public inquiry.
§ 11.54 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I am most grateful to my hon. Friend the Member for Kingston upon Hull, Central (Mr McNamara), for giving me the opportunity to speak about the future of the Hull hospital for women and the Townend maternity home. I know there has been a good deal of local concern, some of it expressed here tonight, about the proposals to close these hospitals and in fact my hon. Friend the Member for Kingston upon Hull, Central has made a number of representations to the Minister of State about this matter. Moreover, he has written to my right hon. Friend recently about the decision by the Hull district management team to restrict the service at the Hull hospital for women on a five-day week basis with effect from 19th June. I appreciate that this concern is shared by both my hon. Friends and their constituents.
I want to make it quite clear at the outset that I have not and nor has my right hon. Friend the Secretary of State been formally asked to act as arbiter on the future of these two hospitals. Indeed, I understand that the Humberside area health authority, which is responsible for 421 the administration of both the Hull hospital for women and the Townend maternity home, has not yet finally decided whether it wishes to adopt the proposals to close the two hospitals. I am told that the matter is to be fully considered at the area health authority's next meeting on 13th July and it would be quite wrong therefore to make any assumptions at this stage about the future of the two hospitals concerned. Indeed, I would emphasise that nothing I say today should he construed as prejudicing the issue in the case of Hull Hospital for women and the Townend maternity home and, in this context, I think it might be helpful if I describe the procedures for the closure or change of use of any National Health Service building.
Following the reorganisation of the NHS in 1974 and the introduction of new planning procedures, the procedures for the closure or change of use of health buildings were reviewed and my Department issued revised guidance in 1975. The aim of the new procedures is to enable scarce resources to be redeployed with the maximum speed and simplicity consistent with adequate, local and, where necessary, national consultation. The rightness of this approach seems especially relevant at a time of economic restraint, when it is absolutely essential that no unnecessary barriers should stand in the way of the cost-effective use of resources.
In general, responsibility for determining the closure or change of use of health buildings rests with the appropriate area health authority which, in the case of the Hull hospital for women and the Townend maternity home, is the Humberside area health authority, provided that the community health council is in agreement. Where there is general local agreement, it should be possible to effect a closure or change of use within a period of six months.
If, having discussed informally a particular closure or change of use with the interested organisations, an area health authority considered that such a measure would be beneficial, it would have to initiate formal consultations. In this event, the procedures require the authority to prepare a consultative document covering such matters as the reasons for its proposal an evaluation of the possibilities of using the facilities for other purposes, or the disposal of the site; 422 implications for the staff; the relationship between the closure or change of use and other developments and plans; and the transport facilities for those patients who might be affected by the proposals. The area health authority would invite comments on the proposals contained in the document, within a period of three months, from such bodies as the community health councils, local authorities, joint staff organisations, family practitioner committees and local advisory committees, including the local medical committees. Hon. Members whose constituents were affected would also be informed of the proposals.
The area health authority would then seek the community health council's views on the comments it received and on its own observations on those comments. The authorty would then review its original proposals in the light of the comments received and, unless there was strong local opposition, it could then implement its original proposals provided that the community health council agreed. The regional health authority and my Department would be informed of the decision.
However, if the community health council object to the authority's proposals, it is required to submit to the authority a constructive and detailed counter-proposal, paying full regard to the factors, including restraints on resources, which led the authority to make its original proposal. The matter must then be referred to the regional health authority. If the regional health authority is unable to accept the views of the council and wishes to proceed with the closure or change of use, it falls to my right hon. Friend the Secretary of State to act as arbiter. I must repeat, therefore, that nothing I say today should be construed as prejudging the issue, on which the consultative procedures I have described are still in progress.
Having outlined the consultative procedures generally, I should like to say a few words about the particular proposals contained in the Humberside area health authority's consultative document on the future of the Hull hospital for women and the Townend maternity home.
In January this year the Humberside area health authority issued its consultative document proposing that both the 24-bedded Hull hospital for women and 423 the Townend maternity home with its 17 GP beds be closed and that consideration be given to the possible alternative use of the buildings for health service purposes. The consultative document refers to two underlying reasons for the proposals. One is the need to make financial savings wherever possible in the district so that scarce resources might be redeployed more effectively elsewhere—and I will say a little more about this later. The second reason concerns the wish to rationalise under-used acute services and to concentrate them where there is a full range of back-up facilities available so that patients receive a better service.
The document suggests that both these objectives might be achieved by absorbing the gynaecological work currently carried out at the women's hospital into the Hull Royal infirmary, known as the Sutton, and by transferring the GP obstetric work from the Townend maternity home to the Hull maternity hospital, where a new GP unit would be established. The consultative document states that, while the proposals involve redeployment of services, there will be no actual cut in the level of services.
As for the Hull hospital for women, the area health authority's consultative document mentions two more immediate reasons for proposing its closure. One on which I shall be expanding later—this has a bearing on my hon. Friend's major point—is the retirement of the consultant gynaecologist who worked principally from the women's hospital, and the unlikelihood that his successor will wish to continue this commitment.
§ Mr. McNamara
I specifically put a question to my right hon. Friend the Minister of State on this point in order that the new terms and conditions should cover service from that. I received a very woolly, indecisive answer from him. My hon. Friend is going over procedures that we all know about. We have all read the documents. The point is that a material change of use in the maternity home has already been made.
§ Mr. Deakins
I shall be coming to my hon. Friend's point, if that is possible in the time that remains to me.
424 The second reason relates to the low bed occupancy rate at the hospital. As my hon. Friends may be aware, there has been a decline in the gynaecological work load at the hospital in recent years, and latest available figures—June 1977—show that the average daily bed occupation is some 51 per cent.
The view expressed in the consultative document is that it will be possible to meet on a more effective basis all the needs of the district's gynaecology service at the Sutton hospital, provided bed numbers are increased slightly and the outpatients' clinic is extended. Although it is considered that existing theatre facilities will be adequate, perhaps with some rearrangement if necessary, I understand that the district management team wants to develop twin operating theatres as soon as possible.
Like that at the women's hospital, the obstetric work load at the Townend maternity home has also been declining in recent years. a reflection on the general fall in the birth rate. Indeed, the AHA's consultative document shows that bed occupancy rates at the Hull maternity hospital and the Townend maternity home were 76.3 per cent. and 47.1 per cent. between January and June last year. The document suggests that the proposed closure of the Townend maternity home will not only mean that better use will be made of facilities at the maternity hospital but that patients will receive a better service. In this context I should mention that the maternity hospital has the advantage of full medical—including anaesthetic—cover readily available, as well as modern sophisticated equipment and a 24-bedded special care baby unit.
I understand that if the closure proposals are accepted it is intended to upgrade two wards at the maternity hospital at a cost of about £20,000. One of these would be used to provide a replacement unit for GPs and there would be 12 beds available to them. In the longer term the AHA's objective is to transfer the maternity hospital to the Hull Royal infirmary. Suitable space is not available at present, but the area health authority expects that further land will be acquired in due course.
As I mentioned earlier, one of the principal reasons for the proposals to close 425 these two hospitals is to make financial savings, and I think it might be appropriate to say something about the financial position of both the Humberside area health authority and the Hull district. The consultative document estimates that by absorbing the beds at the women's hospital into the Hull Royal infirmary and by transferring the beds at the Townend maternity home into the Hull maternity home it will eventually be possible to achieve net revenue savings of about £100,000 per annum.
As my hon Friends will be aware, the Humberside area health authority is an under-funded area within an under-funded region according to the criteria recommended by the Resource Allocation Working Party. In 1978–79 the area's revenue allocation is some £57.4 million. This amounts to 94.82 per cent. of the AHA's target allocation under the RAWP formula. It should be mentioned that over the next 10 years the AHA will have to find additional funds to meet the revenue consequences of four major capital schemes, including the new district general hospital at Grimsby, which is due to be completed in 1981.
The Hull district's revenue allocation for the current financial year totals some £21.9 million. This amounts to virtually 100 per cent. of the district's target allocation under the RAWP formula, and it is expected that the district will receive only about ½per cent. growth money over the next three years. I am told that the district is already in some financial difficulties because of slight overspending last year and it will need to find funds to meet the running costs of a new geriatric day hospital which is due to open within the next year, together with additional funds to meet the revenue consequences of four other small schemes. For these reasons, both the area and district are anxious to make savings wherever possible, without of course seriously affecting the level of service provided to patients.
I hope that what I have said has given my hon. Friend an indication of what the Humberside area health authority's proposals are. As I said earlier, the plans have been made public, and I understand that a number of local organisations have commented on them. In particular, the Hull community health council has raised objections, which have 426 been mentioned by both my hon. Friends tonight, and has submitted counter-proposals whereby patient services would be transferred to the Townend maternity home from the Woodgates maternity home, where bed occupancy rates are also low. The CHC's view is that this would ensure fuller use of the Townend maternity home, with any excess in patient demand being taken up by the Westwood hospital in the Beverley health district.
In the case of the Hull hospital for women, the CHC proposes that the hospital should operate on a five-day week basis for the treatment of gynaecology patients. In the longer term, the CHC accepts that once the new surgical facilities at the Hull Royal infirmary are completed gynaecology services would transfer there. It proposes that the women's hospital should then be used either as a home for the elderly or a convalescent home.
The CHC's views, together with all the other comments received on the proposals, are to be considered by the area health authority at its next meeting on 13th July, and it would certainly not be proper for me to comment further at this stage. However, I know that the particular concern of my hon. Friend the Member for Kingston upon Hull, Central is the decision by the Hull district management team to restrict the service at the Hull hospital for women on a five-day week basis. I know he regards this decision as pre-empting the discussion by the AHA at its meeting on 13th July, and I want therefore to let him know the facts on this matter.
Two points that need to be clarified straightaway are that the hospital has not closed, nor is it being run as an outpatients department. As I explained earlier, one of the reasons behind the proposal to close the Hull hospital for women was the retirement of the consultant gynaecologist who worked principally from there. It was originally thought that he would retire at the end of this year, but he decided to do so at the end of May. This left the Hull district management team in difficulty over the question of consultant cover at the women's hospital.
What has happened is that ever since the retirement of the consultant was announced, the district management team 427 has been negotiating with the other gynaecology consultants to try to avoid a hiatus arising when he actually left. The point here is that the retiring consultant was the only consultant who would use the hospital for women; the others would not treat patients there in view of the level of facilities available, the fact that there is no house cover, and because of the distance from the main gynaecological department at Hull Royal infirmary, Sutton. However, they have now agreed 428 to run it on a five-day week basis, and this the district management team accepted as an interim measure pending the authority's decision about its future.
§ The Question having been proposed after Ten o'clock on Tuesday evening 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 seven minutes past Twelve o'clock.