§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Graham.]
§ 4.3 p.m.
§ Mr. Timothy Raison (Aylesbury)The subject that I wish to raise today is that of the current grave conditions at Stoke Mandeville hospital. I say straight away to the Minister that, for once, the subject that I raise, although a health matter, has nothing to do with industrial action. I want to draw attention to a very different anxiety.
The House knows that Stoke Mandeville hospital is synonymous with the treatment of spinal injuries. However, I must make the point here and now that, although the treatment of spinal injuries is a very important part of the work of the hospital, it is only a part and that the hospital carries out the normal vital activities of a district general hospital, in the course of which it does some very distinguished work, which is also jeopardised by what is going on there at present. However, I intend to concentrate to some extent on the spinal injuries side of the hospital's work.
As it happens, last night there was a party at Stoke Mandeville to celebrate the thirty-fifth anniversary of the admission of the first patient on the spinal injuries side in 1944. It was held in the stadium for the paralysed and other disabled, and this stadium is really a monument to much that is best in our life here in this country.
As the Minister no doubt would expect, it was in many ways a cheerful party, as I think is any function that takes place in the stadium. It is a place that we should visit if we want to know about the indomitable spirit of men. Behind that spirit lies the peculiar achievement of Sir Ludwig Guttmann and his successors.
1935 There was a somewhat sombre and ironical background to the party. Sir Ludwig spoke, and said that he had recently been to the opening of a new national spinal injuries centre in Israel. He had to make a contrast between that apparently splendid new set-up and the sad physical conditions at Stoke Mandeville.
I shall tell the Minister a little about what has been happening at Stoke Mandeville hospital in the past week or two. I have been told by the district administrator, who does an excellent job, that four wards are closed because of problems in the supporting structure for the ceilings. Since the bad weather at the beginning of January there have been numerous problems with the freezing of the water service and subsequent bursts.
During the weekend of 13 January a spinal ward had to be evacuated because of water coming through the ceiling. On 17 January attention was drawn to sagging of ceilings in that and other wards in the National Spinal Injuries Centre. As a result of an immediate inspection by the building officer, three further wards were taken out of use. Of the four wards that are out of use, three are spinal wards and one is a geriatric ward which happens to be housed in the spinal unit corridor.
Arrangements were made for patients to be evacuated to other accommodation. It was fortuitous and perhaps ironical that because of nursing shortages in the remainder of the hospital there were two wards closed on the general corridor, one general surgical and one general medical. The wards were used one for spinal patients and one for geriatrics. Other spinal patients were accommodated in other parts of the National Spinal Injuries Centre, some of that accommodation being extremely inadequate. The sanitary annexes of the general wards are entirely unsuitable for paraplegic patients. That is an important matter, which has been referred to in an earlier debate.
That is the sombre picture at an institution that has a fame that is unquestionably world-wide. The only bright spot is that after these happenings took place and the ceilings showed trouble there has been a first-rate effort on the part of all concerned, including the unions, 1936 to take emergency steps. A number of persons have commented on the high state of morale that has been in evidence in the hospital in dealing with these serious problems. Even so, patients are having to wait for admission.
I have been asked to say by the chairman of the spinal injuries unit that it is felt generally at the hospital that although the troubles are real and serious spinal injury patients in other areas who need admission to specialised care should not be put off by what is happening. The special expertise accumulated at an institution such as Stoke Mandeville is extremely important.
Patching-up work on the wards is proceeding. However, more radical action must be taken by the Government as a matter of great urgency. The buildings in which the spinal injuries unit is housed are long past what must have been their expected life, when they were erected during the war to deal with the possibility of a large influx of wartime casualties.
It is not merely a spinal injuries problem. Other wards are in the same decaying condition. Obviously, the spinal injuries unit must not draw off an unfair share of resources from other parts of the Aylesbury hospital complex.
It is not only a matter of the ceilings caving in at Stoke Mandeville. There are other defects that must be overcome, including the heating service pipes in the wards, which are old and must be replaced, the lagging, which must be renewed, the energy conservation measures, which must be improved, and the electrical services, which must be rewired. More importantly, I am told that the main engineering distribution services to the whole hospital have been deteriorating over the years. The cost of renewing these will be substantial and will strain the scarce resources. There are many difficulties with the boiler system.
Money is vital to meet this need. Where will the money come from? I believe that this can only be dealt with as a national problem. As far as the spinal injuries side is concerned, we are talking of an institution known as the National Spinal Injuries Centre. It is not the only centre that we have in the United Kingdom but it is the only one in the South of England. It therefore plays far more than a regional role. It is a 1937 national institution in that sense and in the sense that it is known throughout a large part of the world as one of the areas where British medicine has achieved great triumphs. Although there is to be a further institution at Odstock, that is still some way off.
In spite of that, we have seen a reduction in the number of beds in the hospital for spinal injury patients from 196 in 1966 to 156 today. Not all the beds are in use, due to staff shortages. It is not only a building problem. There is a shortage of nurses, although it is not grave, but there are other serious shortages. There is a shortage of physiotherapists, who have a particular role to play in the treatment of spinal injury patients. There is a shortage of medical social workers, which is partly due to the financial position of the county council. These workers are of great importance in the delicate operation of returning people with spinal injuries from hospital to the community.
Capital and revenue are needed. On revenue, the Minister will recall that about a year ago he visited Stoke Mandeville and was told of the problems. Following his visit, it was agreed that there should be a change in the formula by which money was allocated to regions and areas and that a special spinal weighting factor should be introduced to provide more money. It was expected that this new factor would produce an additional £400,000. None of this money has appeared, and the staff at Stoke Mandeville are anxious to know what has happened to it. There is a horrible feeling that none of this money will appear. Although the notional allowance has been made, the Oxford region is spending up to its so-called RAWP level and the £400,000 is a mythical book-keeping transaction. In other words, the decision in practice was meaningless.
My main point concerns the building programme. Should we go on patching up indefinitely an old building, or can we go all out for a new building to be erected as soon as possible? That is bound to take time, probably four or five years. But until 1974 such a building was firmly in the programme. Since then it has had to be taken out. I hope that the Minister will say when we can expect the new building and whether the Government will 1938 provide funds for it. In providing funds, it must be made plain that we are talking of a national institution.
The region has other great calls on its resources, and it is not possible for it to find this extra money. It has to make hospital provision for the growing city of Milton Keynes. That is siphoning off a good deal of money which one hopes might otherwise have been available for Stoke Mandeville. Of course Milton Keynes must have hospital provision, but somehow or other the Minister must take on board the crucial need to provide additional funds.
In doing this, the Government should accept the responsibility for the fabric of the new building. Perhaps we should look to other sources of revenue. For example, the case of setting up a research unit under the auspices of the Medical Research Council is a very good one and I should like the Minister's comments on that as a source of additional money.
If the Government will come forward with money on an effective scale, I have no doubt that the great army of well-wishers of Stoke Mandeville would also chip in with money themselves. We could get a good fund-raising effort going to match anything the Government could provide. But the Government must provide. They must realise that this is a place of national importance and that it requires a national contribution to get it back on its feet.
I hope that the Minister will make an affirmative statement that he sees this as a matter of national importance. I hope that the spirit that has always permeated Stoke Mandeville, ever since Sir Ludwig Guttmann founded the spinal injuries unit—"We will not take no for an answer"—will not be lost on the Minister and that we shall get a response from him worthy of this important matter.
§ 4.16 p.m.
§ Mr. Lewis Carter-Jones (Eccles)I should like to identify myself totally with the remarks of the hon. Member for Aylesbury (Mr. Raison). In my role as British chairman of Rehabilitation International, I have been impressed in my trips round the world by the esteem in which Stoke Mandeville is held by people who were trained by Sir Ludwig Guttmann years ago and who have named 1939 wards after him and after Stoke Mandeville. It is sad to see what excellent buildings those people have and how grateful they are to Sir Ludwig and Stoke Mandeville for their training.
As the hon. Gentleman said, this is a national institution capable of great work. There are easily obtainable solutions along the lines that he suggested. I hope that the Minister will give his full backing to the rejuvenation of the buildings, premises and facilities at Stoke Mandeville.
§ 4.17 p.m.
§ The Minister of State, Department at Health and Social Security (Mr. Roland Moyle)I am grateful for this opportunity to say something about the backlog of maintenance work at Stoke Mandeville and the measures being taken to improve the situation, because this is a matter of great concern to the people of North Buckinghamshire, to the nation and, to some extent, internationally. I have no hesitation in saying that I can put my support entirely behind measures to renovate Stoke Mandeville. Of course, how we do it is another matter altogether.
Stoke Mandeville is mostly hutted accommodation dating from the early 1940s. It has the National Spinal Injuries Centre there, but it is also a district general hospital. The intention of the Oxford regional health authority and its Buckinghamshire area health authority is that there should be a phased replacement of the accommodation as part of a process of developing Stoke Mandeville as a district general hospital. A new wing of about 100 beds was constructed in 1975. The next major capital development on the Stoke Mandeville site—the hon. Gentleman particularly inquired about this—will begin in 1985–86. This will be the second phase of the district general hospital and at today's prices will cost £1.8 million.
I shall come back to the building and maintenance work, but there is no doubt that Stoke Mandeville is under heavy pressure because of expanding population in the northern part of Buckinghamshire, associated with the new town of Milton Keynes, which, pending the development of its own hospital facilities, depends upon Stoke Mandeville and Northampton.
1940 There was a proposal from the health authority to reduce the number of beds devoted to spinal inqury patients, and it was in connection with that that I visited the hospital in April of last year. I rejected that suggestion because there remains a shortage of spinal injury beds in the South of England. This is another cause for the strain being placed upon Stoke Mandeville. However, the shortage of beds will be ameliorated by two new specialist units to be built, one for the Odstock hospital in Salisbury and the other at the Royal National orthopaedic hospital at Stanmore.
As for the pressure from Milton Keynes, a new purpose built 102-bed community hospital for the town will come into use later this year, and that should provide a little immediate relief. Later, there will be the 260-bed first phase of the Milton Keynes district general hospital, which should come into operation at about the middle of 1984. That will provide further relief for the pressure on Stoke Mandeville and Northampton.
In anticipation of this eventual replacement, there is no doubt that the authorities have attempted to minimise all maintenance costs in recent years, particularly in view of the claims of other hospital building and capital projects in the region. It has now become increasingly clear—the current incidents have dramatised this—that substantial expenditure will be necessary to maintain existing buildings.
The Buckinghamshire area health authority has been aware of the maintenance problem at Stoke Mandeville for some time. For example, in May last year the area works officer placed a report before the authority saying that the hospital's roofs required attention, that the boilers and associated plant would have to be replaced over a period of time, that part of the gas supply needed to be renewed and that some wards needed to be rewired and upgraded. Although the process had already begun at that time, this maintenance work is estimated to cost a little over £2 million out of an estimated maintenance work bill for the whole county on hospitals of about £3.5 million.
The maintenance backlog at Stoke Mandeville was brought sharply into 1941 focus last month when, as a result of the bad weather, some water pipes burst and brought down sections of the ceiling in three wards in the National Spinal Injuries Centre and in one geriatric ward. At the same time it became evident that the roofs of a number of other wards would need early attention because of problems associated with the deterioration of the supporting joists.
The four wards immediately concerned have been evacuated and the necessary repair work has already been set in hand. The health authority expects that patients will be able to return to these wards fairly soon. In the meantime, the 75 or 80 patients involved have been transferred to other wards in the hospital. None has had to be transferred to another hospital or sent home.
A press statement was issued by the Spinal Injuries Association on Monday. The basic facts in the statement are correct, but the slightly passionate conclusion that there were no beds and few amenities for the patients and staff, with little hope of any immediate change, and that the hospital was being starved of money is obviously untrue against the background of the facts as I have stated them.
Work on the wards is well on the way to completion. They should soon be reoccupied by patients. In 1977–78. £375,000 was spent on maintenance of Stoke Mandeville. That was more than half the health district's expenditure of £716,000, and it is estimated that a further £430,000 will be spent in 1978–79 out of the maintenance budget of £810,000.
There has been a certain amount of public confusion in the matter. For example, there was a reference to this problem on the "Thames at Six" television programme which was screened on Wednesday evening. Here again, the facts are correct but they should be put in context. Doctors who were interviewed referred to a halt of non-emergency admissions, reduction in emergency admissions and the problems of patients who had to wait in other hospitals before they could come to Stoke Mandeville. This is correct, but these are longstanding problems resulting from the intense pressure to which Stoke Mandeville is subjected—as a result of the shortage of spinal injury beds in the South of England and the pressures of 1942 the growing town of Milton Keynes. They do not have any direct relationship with the recent maintenance problems to which I have referred.
I should like to set out in greater detail the various developments and improvements which the health authorities plan to carry out at Stoke Mandeville, in addition to the major redevelopment in the mid-1980s to which I have drawn attention. These are already outlined in the capital programme of the regional health authority, drawn up in 1978. One of the hospital boilers has been replaced and a second is being replaced. A third will be replaced in the near future. Work on upgrading the laboratory started in June last year and should be completed in May this year. The other principal work on the building site is the construction of a 40-bed geriatric unit which was started in July 1978 and is scheduled for completion in July this year, although that will not be an additional source of beds. The beds will be used to provide acute geriatric services for patients who will be transferred from the nearby Tindal hospital. Although these beds will be additional on the Stoke Mandeville site, the number of geriatric beds in the district will not be increased.
The hon. Member for Aylesbury (Mr. Raison) referred to the hospital engineering services. The sum of £200,000 is to be spent on these and work is planned to commence in the financial year 1979–80. There is an extension planned to the kitchen but I understand that the district management team has recently suggested that the renewal of the hospital's electrical mains distribution system should take precedence. Area and regional health authorities will have to consider that problem and decide which is the most important priority. The hospital pharmacy will have to be upgraded, starting in 1981–82, to play its part in taking the additional workload off the Milton Keynes district general hospital when that comes on stream in 1984.
The hon. Gentleman asked whether the Department should make special additional funds available for Stoke Mandeville hospital. It was the crucial part of his case. There are two arguments. The first concerns the need to deal with the backlog of maintenance.
I do not consider that it is appropriate to make available to health authorities 1943 special additional finance to enable them to overcome particular local problems of that nature. I do not see why the policy should be changed in the case of a backlog of maintenance at Stoke Mandeville. Maintenance work is fairly predictable and financial planning, budgeting and programming should take account of it. Contingency funds for these purposes are not held centrally. It is for the Oxford regional health authority and the Buckinghamshire area health authority to provide for the maintenance requirements at Stoke Mandeville, as at other hospitals, from their capital and revenue allocations.
The Department does not hold any money back, apart from some small grants for research purposes. It hands all its money to the regional health authorities on the basis of the resource allocation working party formula. The regions are expected to provide the appropriate money to the areas within their boundaries on the same principle. The authorities are free, within those budgetary limitations, to apply the money as they think fit to provide the service for which they are responsible. This provides a way in which management is given the maximum freedom to manage locally, subject to general guidelines from the Department and the budgetary limitations on funds. They must provide for maintenance out of those funds.
The other argument is that the Stoke Mandeville spinal injuries unit is a national centre of excellence and therefore should be nationally financed. This is an argument that could apply to several hundred other units in the NHS. To the extent that any specialist unit is involved in treating patients from outside the region—and in this case it is to a considerable extent—an appropriate annual addition is made to the region's target revenue allocation calculated in accordance with the criteria laid down by the RAWP.
Patients who flow in to Stoke Mandeville from outside the Oxford region are regarded as Oxford region patients and 1944 are funded according to the formula. This influences the actual allocation made to the regional health authority, which should increase the AHA's target allocations by appropriate amounts. In the case of Buckinghamshire and Stoke Mandeville, the region has acted as indicated; indeed, the special weighting to which the hon. Member drew attention will come into effect for the 1979–80 financial year. It is up to the region to make allocations to the Buckinghamshire AHA accordingly.
The Buckinghamshire AHA will meet on 7 February to consider a report on the most recent problems arising at Stoke Mandeville. It will be for the AHA to discuss with the Oxford RHA any case for additional funding either to accelerate the programme, or to replace the hutted accommodation or implement a new programme to refurbish the building. The plans to which I have referred are within the region's current capital programme, and the fact that a good deal of work has already been put in hand clearly demonstrates that the health authorities have been aware of the need to develop and upgrade Stoke Mandeville site for some time.
The regional chairman and senior officers visited the hospital on 24 January and the regional health authority was now fully conversant with Stoke Mandeville's problems. I am confident that both the RHA and the AHA will co-operate effectively to ensure that the necessary remedial works and the new developments planned are accorded the appropriate priority within the Health Service in the Oxford region. I assure hon. Members that I share their concern for the welfare of both—
§ 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 twenty-seven minutes to Five o'clock.