§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Tinn.]
§ 11.0 p.m.
§ Mr. Clement Freud (Isle of Ely)
Over the years, Adjournment motions have been vehicles for going through the motions of flogging a dead horse or resuscitating it from wherever dead horses go, predominantly for the benefit of local newspapers and one's supporters. I should like to say that this Adjournment debate is not in that category. In the town of Wisbech in my constituency we have three hospitals. Notwithstanding the march of technological innovation, my constituents and I intend to see that we retain such hospital services and such hospitals as the community needs.
If I speak for more than the traditional 50 per cent. of the time which initiators of Adjournment debates normally take, I trust that the Minister will forgive me. I distrust instant politics. I have no desire to hear pretty phrases like "How good it was of you to raise this subject". However, I give the Minister one opportunity here and now: if he will indicate that the Government have no intention of meddling with the hospital situation as it now is in the town of Wisbech, I shall sit down at once. No nod seems to be forthcoming.
My purpose tonight is to bring to the attention of the Minister the apprehension of my constituents in respect of their local hospital situation. I want to highlight the instance of people trapped by the recommendation of what is to them a totally unacceptable consultative document and to tell the Minister of their anger and presentiment as they await long-range decisions from an area health authority with which they have no affinity.
I got from the Library a pamphlet called "Democracy in the Health Service", which I rather expected would be even shorter than it was. I thought it might come under the record of the shortest books in company with "Who's Who in Puerto Rico". But it was a longish volume. I found that the community health council's remit was quite simply to represent the interests of the 818 community. It is perhaps with this that I should like to take issue.
The population of the Wisbech area is immensely forunate in having a hospitals action group of highly intelligent, motivated and knowledgeable people. I am lucky in having a body which briefed me so well. I should like to pay tribute to Mrs. North, who is the chairman of the CHC, and Sir Arthur South, who is the chairman of the area health authority, both of whom, at considerable risk to themselves, I would have thought, attended large meetings of hostile people and listened with courtesy and compassion to my constituents' case.
In the Cambridegshire county strategic plan, Wisbech has been chosen for industrial development. It is an area of socio-economic deprivation and has a scattered, low-density population. We have 33 per cent. of our working population unskilled or semi-skilled. It has the highest unemployment rate in Cambridgeshire, and we have poor public transport, with many villages served by, at most, two or three buses a week. Moreover, 40 per cent. of households have no cars.
Our pride in being chosen as an industrial development area was slightly blunted by the fact that we have lost our railway, we have lost much of our bus service, we have lost our Crown court and we no longer have a main DHSS office, and it is hard to attract industry without that, especially as we are not a development area. The Minister will know that any factory in my constituency wishing to move elsewhere would get an 80 per cent. grant to move from us to an area which probably has no higher unemployment than we have.
In Wisbech we have three hospitals. The North Cambs. flourishes as a small, independent, general hospital and has done since the establishment of the National Health Service. All the rest—the out-patient department, laboratory, operating theatres, X-ray departments and medical wards—are modernised to a very high standard, and this is in part due to considerable voluntary donations. I shall come to these, because there is no question but that it would be a moral disservice and villainy if people left money to a particular hospital only for that hospital to be closed. The running costs in 197–6 were £841,000.
819 The Clarkson Hospital is a converted former public assistance institution. It is geriatric and pre-convalescent, with 123 beds. There is great experience and devotion among the hospital staff and the community. On 11th January this year it was flooded, but members, volunteers and staff turned out to help despite the fact that many of their own houses were also flooded. They worked round the clock, and the patients were moved back one week later. Running costs here are a fraction less than £500,000 a year.
We have Bowthorpe Maternity Hospital, which is a purpose-built maternity unit and special care baby unit completed in 1953. Additional ward accommodation was provided in 1967. The running costs in 1975–6 were £231,000.
With the possible exception of Clark-son Hospital, in some aspects only, these hospitals cannot in any way be described as obsolete, outmoded, wasteful or inefficient. Indeed, they are not so described by the district management team.
I should also mention the existence of two GP teaching practices in Wisbech. I have mentioned the amount of voluntary donations by local people, including a £100,000 bequest yet to come but which was expressly left to the North Cambs. Hospital for the purpose of supplementing work on a theatre, for the construction of which the same benefactor had made a substantial donation previously. The bequest was made after express assurance that the theatre in North Cambs. would continue in full use as in 1972. Also, the friends of the hospital are very active.
In November last year, the Norfolk Area Health Authority draft consultation document proposed the closure of the Clarkson and Bowthorpe Hospitals and the retention of the North Cambs. to provide geriatric and mentally infirm beds, pre-convalescent beds, a few day surgery beds, out-patients, minor casualty 9 a.m. to 5 p.m., and some undefined X-ray services. No alternative plans were given.
I want to quote, if I may, from the minutes of the Wisbech hospitals action group:20th January, 1978: Three surgeons wrote to Norfolk Area Health Authority advocating the retention of ' intermediate surgery on straightforward cases' at North Cambs. Hospital with night and weekend cover agreed to be given by one practice of 4 GPs. They 820 said they made the proposals because they felt that 'the new District General Hospital will be unable to cope with the surgical requirements of the district and that it is essential to have a secondary backup service to relieve pressure on the waiting list for straightforward operations'. The letter also referred to the excellence of the theatre and its very high throughput of patients compared to the average.On 13th February 1978. all Wisbech and district GPs decided to give wholehearted support to the proposals of the Wisbech hospitals action group, saying that they wouldparticularly support the continuation of a Consultant/GP Obstetric Unit and the continuing use of the North Cambridgeshire Hospital Theatre for intermediate use".They added that patients in this area merited a claim on the budget equal in priority to that of the district general hospital.
Two days later, on 15th February, the King's Lynn Community Health Council called a public meeting in Wisbech on a night of freezing fog. The attendance was more that 2,000 people in a town with a population of 17,000. A near unanimous vote was passed rejecting the consulation document. The two people who did not vote in favour were the loyal husband of Mrs. North and the secretary of the AHA. Thirteen out of a possible 28 members of the community health council attended, six of whom were from Wisbech. Mrs. North described the Wisbech hospitals action group proposals as "a very constructive plan".
Six days later, the King's Lynn Community Health Council called a public meeting in King's Lynn. Twenty members of the public attended, four of whom were from King's Lynn. The others were from Lincolnshire and Wisbech, protesting against the proposals for Wisbech. Seven members of the CHC attended.
Support for the Wisbech Hospitals Action Group has also come from the Fenland District Council, the Wisbech Town Council, the March Town Council, 18 parish councils, friends of Wisbech Hospitals, and several other local organisations, including the National Farmers' Union, which has pointed out that the size of the administrative staff of the Health Service has doubled in 10 years.
If we fail in our reasoning against these recommendations, what will happen to the Wisbech hospitals? First of all, 821 we shall lose the geriatric service. I believe that it is crucial to old people to be hospitalised as near as possible to their families and to people who would visit them. This applies particularly in geriatric cases because old people find travelling, particularly in East Anglia, exceedingly difficult.
Secondly, we shall lose a certain amount of surgery. Three consultant surgeons and an anaesthetist who serve the North Cambs feel strongly that intermediate surgery—waiting list surgery that is not as serious as acute surgery or as minor as day surgery—can and should be carried out at the North Cambs in addition to day surgery. It is important to note that at present there are 440 people on the waiting list for operations in Wisbech and 2,537 people in King's Lynn. There are no plans for increasing facilities at King's Lynn theatre.
On paediatrics, the Wisbech hospitals action group writes:With great regret we accept that, in accordance with medical opinion, paediatric beds must be centralised. However, we would urge that a few beds are maintained in Wisbech to cater for long stay cases (for example, a child in traction) where it is proving difficult for the family to visit in King's Lynn.We must also consider the position of maternity cases. This is what brought the action group into being. The first threat was to Bowthorpe Maternity Hospital, which is the senior of the two hospitals. March Hospital depends on it, and this was a threat of closure to both.
The loss of Bowthorpe is a matter of grave concern as there is a real danger of a return to home confinements. Consultants and GPs are very reluctant to attend home confinements. In Norwich, where there is one central maternity unit, 11 per cent. of mothers elected to have home confinements in 1976 and 12.8 per cent. in 1975. In King's Lynn health district, 2 per cent. of all confinements were at home.
One consultant believes that it is possible to provide a safe place to be born in a small unit and that there is little advantage to be gained from centralising services. "At risk" mothers and special care babies can continue to be transferred to King's Lynn as at present 822 although the action group is now working on the question of more paediatric cover.
The Bowthorpe is recognised both nationally and internationally as a centre for excellence. The question of bed occupancy becomes irrelevant if the number of obstetric beds is reduced and, say, two wards were to be used for gynaecology.
The French have estimated that the cost to the community of just one handicapped baby born, say, in an ambulance or during a domiciliary confinement with complications is about £150,000. This is more than the extra annual costs we roughly estimate.
I am no believer in instant politics, and I should like to give the Minister some carefully considered questions. I will send them to him, and I shall be grateful to have his answers at his leisure. I shall read them out now.
The first question is, on what basis is it now suggested that the Bowthorpe be closed—financial, staff, paediatric cover, genera! policy or fear of litigation?
My next questions are the most crucial. How much support from the people, the doctors, the local councils and other organisations is necessary before the CHC and the AHA must reject the consultation document? Is the Minister satisfied with the attendance at CHC meetings by members? What proportion of CHC members must be in favour of rejecting the consultation document before the whole council must reject it? What alternative plans were costed? What are the reasons for the proposed change in the use of the North Cambs—financial, staffing or general policy?
The consultation documents states that the proposals were made with the purpose ofoperating a hospital service within the … financial restraintof £5,623,000. Continuing the present hospital services and not commissioning the district general hospital would cost £255,428 less. Must the DGH be commissioned merely because it is there? Should commissioning not be left until such time as the financial resources are available to support the DGH and the other hospital services required by the district?
823 What account is taken of the cost to the public if the consultation document proposals are accepted in terms of time, money, loss of work time, and emotional disturbance at having to travel to King's Lynn for treatment or visiting?
The King's Lynn health district receives only half the national average of revenue funds per capita. In view of its being in general a poor, rural area, cannot some redistribution of funds within the region be made to bring the district more into line? What has happened to the bed need within the district since 1972?
Paragraph 5.40 of the consultation document shows that the planning has been done by looking at the services to be provided by the DGH and then placing any remaining needed services in Wisbech, regardless of the effects on the district as a whole and regardless of whether that is the most efficient solution. Is this a matter of policy? Should it not be policy to decide first what the hospital needs of the district are and then to allocate them between the hospitals in the most efficient and humane way?
Over the country as a whole, the public are reacting against centralisation. Why is the DHSS still centralising, and how does this fit in with democratic principles?
The level of funding has been stated as the cause for closures, which is apparently due to the financial constraints placed by the Resources Allocation Working Party recommendations. But the district as a whole is receiving half of the national average in funds. How can this be reconciled?
How can the statement in paragraph 3.3 of the consultation document relating to the BMH be reconciled with the statement in paragraph 5.67 about higher quality of care at the DGH, especially in the light of Cambridgeshire AHA comments that facilities, however good their quality, cannot be regarded as available if distance deters patients from using them?
Why does the DHSS work unilaterally without taking into account transport difficulties, cost to individuals and firms in terms of cost of travel and time cost from work and to the country in terms of redundancy payments?
It is now proposed that all acute beds be based on the DGH. What has caused 824 this change in policy between 1972 and 1977?
At a time when the Minister is concerned with waiting lists, what is the value in replacing an economic, efficient, well-staffed and medically safe unit with the overall scheme?
I have tried to give the background to an argument. In the time provided one cannot do much more. I should like briefly to mention two things. One is the community spirit and the pride of the towns and the other is the possibility of a disaster. We have had disasters in the area. We have had one disaster in Cambridge when Bowthorpe Hospital was used as an overflow maternity hospital, when there was a virus at the Mill Road hospital. We have also had the floods disaster. If there were more floods or if a fire occurred at the DGH, it would be absolutely essential to retain the hospitals at Wisbech. I know how difficult it is to equate health with finance. The cash we are asking for represents no more than a couple of hours' loss by the steel industry.
The Department of the Environment has offered 75 per cent. for every 25 per cent. that my local authority raises for flood relief, but the Department must know that the council will find it difficult to raise the £120,000 that is needed—the product of a penny rate—before it can claim the 75 per cent. assistance.
My plea is simple. The people of Wisbech are proud of their hospitals. We want our young to be born there and our old to be within reach of their relatives. As for our sick, we are not yet convinced that there is an argument, clinically or economically, for the closure of sections of our hospitals.
Let us have an assurance from our doctors that any change is one that will benefit the community rather than simply boost someone's empire. We appreciate the advance in technology, but our case is sound and the council and the authority are set up for the good of the community—and the community demands to be heard.
I close with the last sentence of the action group's pamphlet:The Wisbech Hospitals Action Group, supported vigorously by the people of Wisbech, is not prepared to stand idly by while Wis-bech's assets are bled to transfuse King's Lvnn hospitals.
§ 11.21 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
The hon. Member for Isle of Ely (Mr. Freud) has raised a matter that is of great concern not only to him but to many of the people who live in and around Wisbech who are rightly interested in their local health services and, in particular, their hospital services. I can assure him that I have taken careful note of all the points he has made.
The Norfolk Area Health Authority has recently issued to community health councils and other locally interested parties, including hon. Members, a document in which it has set out its proposals for the rationalisation of hospital services in the King's Lynn health district, including the completion of the new district general hospital in King's Lynn in 1980. The proposals put forward by the authority involve changes in use and even closure of some hospitals in and around Wisbech, and my right hon. Friend the Secretary of State for Social Services is aware from representations made to him that these proposals have given rise to strong protests among some of the local population. However, for reasons which I will shortly come to, it would not at present be appropriate for me to comment on the proposals, nor to intervene in the consultations currently being carried out by the health authority.
Following the reorganisation of the National Health Service in 1974 and the introduction of new planning procedures, the procedures for the closure of change of use of health buildings were reviewed and my Department issued revised guidance in 1975. In general, responsibility for determining the closure or change of use of health buildings rests with the appropriate area health authority. 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, implications for the staff, which are particularly important, the relationship 826 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, 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.
Following this stage of consultation, the authority reviews its original proposals in the light of the comments received. It could then implement its original proposals provided that the community health council agrees. The regional health authority and my Department would be informed of the decision.
However, if the community health council objects 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. He may at that stage receive representations from interested parties, including local Members.
I remind the hon. Member that under the formal consultation procedure which we have laid down for proposals involving closures, or changes in health services, we regard community health councils as having a vital role to play. So important do we regard the role of the CHCs in this context that no health authority can proceed with closure proposals to which a community health council objects.
It is precisely for that reason, and in case of such disagreement on the proposals affecting Wisbech that I must keep an open mind on the issues raised, and it would not be proper for me to comment on them now. However, should this matter prove to be one on which a decision is called for by the Secretary of State, in reaching his decision he will weigh very carefully all the points put 827 forward to him from all parties concerned, both for and against the proposed changes. The community health councils will, however, be aware that when Ministers consider local protests about changes in the way health services are provided they must be accompanied by realistic alternative solutions within whatever resource limitations apply. It may be helpful to the hon. Gentlemen and to the people of Wisbech to know what sort of constraints Ministers have to take into account when in such matters they are called upon to make a final decision, and what sort of objectives the health authorities have been set in managing the NHS.
Resources for the NHS are limited. We have to ensure that no community is deprived in the sense that its population has substantially less opportunity for access to health care than the rest of the country. In the past there have been grave inequalities in some areas of the NHS because of an inequitable distribution of the available resources. We are committed to correcting this imbalance. The Resource Allocation Working Party formula will ultimately be to redistribute resources more equitably between regions. There can be few people in East Anglia who are unaware that their region has been shown to benefit under our policy of resource redistribution.
Since 1962 it has been the policy of successive Governments to establish a national network of fully equipped and comprehensive district general hospitals to provide the focus of hospital services for their district. The concentration of specialities and services in such hospitals enables patients to have the benefit of a wide range of diagnostic facilities and to receive the specialist treatment they need. I am bound to acknowledge, however, that travelling is a problem and that it often looms large in the minds of elderly people in particular. If Ministers are required to make the final decision on the Norfolk Area Health Authority's proposals, I can assure the hon. Gentleman that they will need to have the fullest possible information on the travelling implications for people living in or near Wisbech.
I do not want to give the impression, however, that the Government's policies for development of health services envisage only provision of district general 828 hospitals, and a concomitant abandonment of smaller, local hospitals. We recognise that not all categories of patients require the concentrated facilities of a district general hospital, and for patients whose main need is for care in an environment easily accessible to their family, my Department's policy is for such patients to be cared for in a community hospital. Since community hospitals will not provide the specialist facilities of a DGH, they can be small and local, and most of them will be provided by making use of existing small hospitals.
I know that one particular type of closure which generally gives rise to a good deal of concern in many parts of the country is the closure of small maternity units. Bowthorpe is a good example. We regard the safety and health of mothers and babies as a matter of the highest importance and it is for this reason that our aim is that wherever possible mothers should be delivered in well-equipped and fully-staffed obstetric units in district general hospitals. This will make birth as safe as possible since there will be available the full range of facilities for monitoring the progress of labour and the well-being of the baby before and during delivery. The full range of supporting facilities will be on hand to deal with any emergency which may arise.
By making delivery as safe as possible, not only are we saving lives but we are helping to avoid those handicaps which have their origins in the perinatal periods. Between 1975 and 1976 there was the biggest drop in perinatal mortality in 30 years, and our aim is to secure even further reductions. At the same time, I can assure the hon. Gentleman that no decisions to close a small maternity unit is ever taken lightly either by the health authorities concerned or by Ministers where a decision rests with them.
Politicians, planners and members of the general public all have an interest in making sure, in so far as we are able, that there is proper and efficient deployment and use of NHS resources. Whatever our standpoint or approach may be, there are nevertheless certain basic considerations touching on questions of resources and priorities which none of us can afford to ignore. For what I hope will be the benefit of those who may now be involved in discussions about the proposals for the King's Lynn health district, 829 I have attempted to outline to the hon. Gentleman some of these considerations, though these are by no means the only ones, and each individual case has to be considered in the round. Clearly, however, it is not enough merely to say that proposals are unsatisfactory. Anyone who objects to plans drawn up by a health authority, which the authority genuinely considers will produce benefits for the whole community it is appointed to serve, must suggest alternatives, and any alternative must bear examination against the sort of considerations to which I have referred earlier. We are conscious of the problems of isolated rural communities—the hon. Gentleman's constituency is a good example—and we are determined to ensure that they have reasonable access to good standards of health care. But good standards are essential and Ministers must test alternative arrangements which are suggested to them against a variety of criteria. People in the Wisbech locality 830 will, I am sure, take an objective and constructive approach to considering the proposals made by the area health authority for rationalising services in the King's Lynn district.
I was impressed by the hon. Gentleman's well-researched case. He has asked a large number of detailed and pertinent questions and we shall do our best to answer them so that he has available all the facts and figures that will enable him and his constituents to argue out the case, if necessary, against a particular form of proposal in the consultative document, and to assist them in putting forward rational and constructive alternatives. I think that that is the best way to proceed at present. I am grateful to the hon. Gentleman for the care with which he has presented his case.
§ Question put and agreed to.
§ Adjourned accordingly at half-past Eleven o'clock.