WHITTINGTON HOSPITAL, NORTH LONDON (Hansard, 19 July 1978)

§ Mr. Michael O'Halloran (Islington, North)

I am pleased to be able to raise the subject of the Whittington hospital tonight. The Whittington, one of North London's best known hospitals, is basically three hospitals in one, being divided by two major roads. It was built more than 100 years ago. During those years it has served the people of Islington, Hornsey and North Camden well. It is 715 also a designated university hospital giving tuition and careers to students from all over the world. It comprises 41 wards, about 900 beds and more than 2,000 staff, and it has its own academic centre.

Today there is general demoralisation among staff. There is an atrocious standard of maintenance. Being a regular visitor to the hospital, and once a patient, I have seen the rapid decline. Over the past four or five years, less than one ward has been repainted per year. There is no proper wall-washing programme. At the present rate of progress, wards would be painted once every 50 years. Some wards still have only one toilet, and again there are some with no wall lights. No wards have been programmed for a proper upgrading in the current year. The Whittington suffers from decades of neglect and planning blight.

I could go on and on. It is no wonder that both staff and patients question what is happening at the Whittington. Major surgery to the buildings of the Whittington and the spending of many millions of pounds is essential. The appalling conditions, even in the short term, mean that whole departments and specialties will be lost, wards will have to close and the people of Islington and Hornsey will suffer.

We have already temporarily lost neurosurgery, and I understand that other departments are under threat because of the poor physical conditions in which they are housed. Mothers say that the care and treatment they get in the Whittington obstetrics department are as good as anywhere, but they cannot stand the physical conditions and vote with their feet. Bed use is less than 50 per cent., and the future of our North London school of midwifery is threatened.

Islington has been classed as a deprived area and is in partnership with central Government. Much has been done in housing to overcome this deprivation, and we wish to have the same effort put in to ending the deprived standard of our hospital services.

Regretfully, I am informed that relations between the Camden and Islington area health authority and the North East Thames regional health authority are among the worst in the country. There is little co-operation or agreement and the sufferers are the local people and the 716 patients. Such a state of affairs must in no way be allowed to continue. I hope that my right hon. Friend the Minister will investigate the situation fully.

Various plans, proposals and counter-proposals may be in mind for the Whittington, but I feel that the time has now come for the fullest consultation at the highest level. Definitive plans must be put forward for a new district general hospital for Islington and Hornsey. I want to see the present level of services retained and the return of the neurosurgical department, which has been temporarily transferred to the Royal Free at Hampstead. This transfer has contributed greatly to the present demoralisation in the Whittington and was a result of lack of maintenance and strong management.

Islington and Hornsey—part of the district—have twice the population of each of the Camden districts in the area, but less than one-third of the area's total resources. In the revised strategic plan, the area suggests that 460 local acute beds should be provided for in-patients. North East Thames region suggests 527 beds; the district management team says 546 beds. Islington community health council suggests that 663 beds will be required in a new complex. Its studies are based on the impending rationalisation proposed for the City and East London area and declining use of University College hospital by Islington patients, plus proposed changes in the Enfield and Haringey area which will make the people of Tottenham increasingly dependent on the services of the Whittington. All these combined underline the need for any development to be at least 650 local acute beds, bearing in mind in addition the increased number of patients that will be attracted to a new Whittington hospital.

The people of Islington and Hornsey are demanding that hospital services of an adequate level and standard to serve their entire population be provided so that patients can exercise a genuine choice, and that they should not be left to the mercy of the strong interests of the teaching hospitals which corner resources.

One of the main points of reorganisation was to bring the teaching hospitals under the control of area health authorities, but in Camden and Islington those strong interests continue to prevail so that 717 the teaching tail is wagging the service dog, to the detriment of local people. Local people will not be satisfied with becoming an adjunct or being used as a "piece of elastic" to solve problems of resource allocation and bed distribution with which the area health authority is not prepared to come to terms. In its revised strategic plan, the AHA states that It has no power to compel the medical schools to accept less than they request nor any ability to disprove their bed demands. Local people will not accept reductions in standards or levels of service below their needs to satisfy outdated patterns of medical teaching. The Whittington has long provided teaching and patients to University College hospital students—and this should be increased by the transfer of academic units to the Whittington. If reductions below service needs are seriously considered—they are seriously proposed—there will be a fight to save the Royal Northern hospital, the other arm of our district general hospital services, which will rival the present struggle to save the Elizabeth Garrett Anderson hospital.

My right hon. Friend the Secretary of state visited the Whittington hospital just prior to Christmas last year. He cannot be impressed with everything he saw—a run-down building and two major roads running through, with not even a connecting underground tunnel or bridge to get from one to the other—and I am sure he fully realised this.

I hope that in the time available I have outlined not a picture of gloom but the stark reality of the serious problems at the Whittington.

I should like to pay tribute to all the staff who, out of sheer dedication, do a magnificent job under very difficult circumstances. I hope that the Minister can reassure me and my constituents, the many people who avail themselves of the services at the Whittington and the staff who work there that the utmost priority will be given to building a new district general hospital for Islington and Hornsey.

§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I am grateful to my hon. Friend the Member for Islington, North (Mr. 718 O'Halloran) for giving me the opportunity to discuss a number of problems relating to the Health Service which are a microcosm of the complex choices that have to be faced by health authorities and Ministers responsible for social services.

I have no hesitation at the outset in commending the considerable activity of my hon. Friend in continually bringing before the House the many problems of Islington's health. If we are not fully aware of the problems, it is certainly not because of any inactivity on his part.

I start by placing the problems in a wider context. We have had a difficult economic situation for the past three or four years and we have had to place controls on public expenditure. Even so, we have sought to protect the National Health Service from the full impact of these restrictions and our record in maintaining real growth in the resources available to the Health Service has been good. Every year, even in the most difficult circumstances, we have had a real growth in resources to the NHS, but that is not to say that those resources must be used in maintaining the status quo at all times in all places.

The North-East Thames regional health authority has taken the view that the rationalisation of services in its inner London areas requires the investment of capital to provide new accommodation around which services can be reorganised and concentrated. In the face of the clear need for the provision of facilities elsewhere this was a sensible decision, which my Department has accepted.

Change is clearly needed. It will take some years to achieve it so that inner city areas such as Islington can have a hospital service which is based on an improved standard of buildings and is more appropriate to the distribution of beds between the various specialties. I take the point that the standard of buildings at present is not good enough.

Turning to the details of the present problems in Islington, there are two major acute hospitals. The Whittington hospital is an amalgamation of three hospitals, Archway, Highgate and St. Mary's. These three hospitals were originally managed by the boards of guardians of three different boroughs, and they were appropriated from the Poor Law organisation in 1930 by the London County Council. At that time there were 719 more than 2,000 beds and, as one would expect of buildings dating from the nineteenth century, many were in poor repair. The process of integration has been going on since the NHS was founded in 1948, but it is a slow process because of the size of the institutions. In the past 30 years we have brought the hospital to its current size of about 800 beds. It is quite a large hospital by today's standards.

Since the war, medical schools in the centre of London, particularly the University College hospital, have been looking to the Whittington for assistance in teaching problems. Increasing links have been developed between the staffs of UCH and the Whittington and a significant proportion of the teaching of medical students from UCH is undertaken at the Whittington. This is likely to increase.

As my hon. Friend has said, the Whittington hospital is now regarded as a university hospital although it does not have a medical school of its own. The fact that it is so regarded is a considerable tribute to the staff at the Whittington, whose skills are the main argument for teaching medical students at the hospital. As I have indicated and as my hon. Friend has argued, it is not the standard of the buildings that attracts us to use the hospital in that way. The reputation of the staff is high and they have published a text book of medicine under the hospital's name.

There have been some recent developments. There is a new clinical sciences block and a new psychiatric unit has recently been built. There has been a continuous programme of ward upgrading.

The other acute hospital in Islington is the Royal Northern, which has about 180 beds. It has a reputation for postgraduate teaching. In common with the Whittington hospital, there have been some redevelopments since the war with the addition of new out-patient facilities, X-ray departments and theatres. A new nurses' home has been built.

The two hospitals are very near to each other and they undertake much the same type of work, but perhaps on differing scales. Within the district there is the City of London maternity hospital, which provides facilities which are replicated at the Whittington. I think everybody agrees that in maternity services at 720 least there are too many beds. As it is important for the Camden and Islington area health authority to obtain the maximum value for money spent on its acute services, to switch surplus resources into longer-stay hospitals, especially for the elderly, the mentally ill and the mentally handicapped, and to improve poor facilities in many of the wards of the two acute hospitals, there have been lengthy discussions between the area health authority and the regional health authority.

At present there is no agreement on the strategy to solve the problems that I have outlined about redeploying resources. It is fair to say that both authorities are working constructively towards reaching agreement on the best way to develop the services. It is because the agreements are still going forward that I cannot give firm objectives for acute beds that will eventually be required in the Camden and Islington area.

The position has been helped by the agreed priority on all sides that there has to be a major capital start in Camden and Islington. It is the area health authority's policy that a scheme at the Whittington, around which the bulk of the population lives, should have the highest priority. The hospital has, therefore, a long-term future. The present intention is to turn it into the district general hospital for Islington. I think that in the not-too-distant future that will be the answer to the problems of poor fabric to which my hon. Friend has drawn attention.

University College also has its problems. That is where the bulk of the teaching of medical students is taking place and where adequate facilities are needed to support the training of doctors for the future, upon which the Camden and Islington and the whole Health Service depend.

It is not clear at present what form the new development at the Whittington should take. There will be a development at the Whittington. That will be to the advantage of Islington, and that is the general desire. Any new development must be phased. As a result of the problems of demolition, there will be the decanting of patients from existing wards into other wards. There will be construction. Action is already taking place to improve some of the older operating theatres at the Whittington.

721 Following my recent discussion with my hon. Friend and representatives of Islington community health council, I am aware that the local community wishes to have neuro-surgery included as a high priority in the new development at the hospital. There is a whole range of problems involving paediatrics, ophthalmology and otorhinolaryngology. The decisions must be a matter for discussion and consultation. Some of them must be taken in a wider context.

The problems of Islington cannot all be solved in merely a local context, because they necessarily affect the provision of services in contiguous areas. The North-East Thames regional health authority and the North-West Thames regional health authority have the provision of neuro-surgical facilities under consideration. It may be that the decision of one regional health authority will affect decisions to be taken by the other.

That is particularly so in the case of the regional neuro-surgical unit for the western sector of the region. My Department has a submission from the North-East Thames regional health authority, which wishes to establish a permanent unit at the Royal Free hospital. That is a matter of great difficulty. I do not think that it can be resolved quickly.

When I met the Islington community health council last week, I said that before any final decision was taken I should be prepared to see the delegation from Islington again. My hon. Friend will be aware that discussions are to be renewed, under the chairmanship of senior officials, on the practicability of reproviding an Elizabeth Garrett Anderson facility at the Whittington hospital.

Many of these questions will be resolved through the National Health Service planning system which was introduced in 1976. That seeks to devolve the maximum amount of responsibility for deciding the way in which the pattern of health services should be developed to health authorities within the context of guidelines issued annually by my Department. The planning system is also designed to ensure that local circumstances are brought into the picture so that services can develop not only in ways which encourage the most effective use of resources but for the benefit of those who use them.

722 There are two levels of planning—strategic and operational. The strategic is based on decisions fundamentally arrived at by the regional health authority and is projected over a term of about 10 years. The operational plan is projected over a shorter period of about three years and aims to put the strategic plan into operation during that period.

Operational plans are rolled forward annually and originate at district level. They are then incorporated into the area health authority's plans. Strategic plans are formulated at area health authority level, with an input from the district. They are then blessed by the region and combined into the regional strategic plan, which takes account of all the strategic plans for the areas. The region is then responsible for discussing it with my Department.

The planning system needs to be related to the specific context of the Camden and Islington area health authority. The area strategic plan has not yet been accepted in its entirety by the regional health authority. That has had an impact on the resolution of many of the difficult issues currently facing the area. Many of these problems—such as the siting of the neurosurgical unit and relations between Whittington and University College hospitals—are inevitably inextricably intermingled. There is a clear need for an overall strategy for the area. Only in that way can the various problems that I have outlined be analysed rationally and collectively and solutions reached.

We must await agreement between the regional and area health authorities on the area's strategy before decisions on the new hospital facilities can be taken. Nevertheless, I hope I have indicated that there are strong grounds for believing that the future of the Whittington hospital—the key hospital mentioned by my hon. Friend—is assured in the area, that developments will take place and that they will be substantial and important.

When we come to consider the regional strategic plan early next year, I and my Department will certainly bear in mind the points made by my hon. Friend and ensure that they are taken into account.