HC Deb 05 February 1979 vol 962 cc87-97

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

6.31 p.m.

Mr. George Robertson (Hamilton)

At an unusual hour in the evening I wish to raise on the Adjournment the question of the Lanarkshire health board's ability to administer the area under its jurisdiction. A large number of people in the part of Lanarkshire that I and my right hon. Friend the Member for Lanark (Mrs. Hart) represent have serious misgivings about the ability of the health board in this respect. Our concern arises over two specific aspects. The first is the developing crisis at Stonehouse hospital. The second is the future provision of maternity facilities in Lanarkshire as a whole. I hope that this evening I can show that nothing less than a full inquiry is needed into the way that the health board has conducted itself on these two issues.

Stonehouse hospital is a large general hospital situated in the village of Stonehouse. It has 435 beds and it is a fine general hospital with a good staff of high morale. It provides a full range of medical services and is situated close to the A74 and the M74. Up until last year it provided a full emergency service. It is a training hospital and it has one of the finest and newest ophthalmic units.

However, on 31 July last year the services of anaesthetists were withdrawn—temporarily, it was said—from the emergency services at Stonehouse, and no anaesthetic services are now available after 5 p.m. That has caused concern to many people, and it should worry everyone throughout the West of Scotland.

Stonehouse hospital is now facing a massive rundown of facilities. This can inevitably lead only to a number of eventualities which the local population believe must end with the closure of the hospital.

The first consideration is that Glasgow University will inevitably fail to recognise the pre-registration training of house officers in posts in Stonehouse hospital. The second consequence of a long-term shortage of anaesthetists will be that nurse training will cease to be recognised by the General Nursing Council. The third consequence has already occurred. The Royal College of Obstetricians and Gynaecologists has already withdrawn its recognition of Stonehouse hospital as a training centre.

My right hon. Friend the Member for Lanark, my hon. Friend the Member for East Kilbride (Dr. Miller) and I all agree that this continued shortage of anaesthetists can serve only to jeopardise the long-term future of the hospital, thereby robbing that part of Lanarkshire of a major medical facility. Even now the consequence of having no emergency anaesthetic service is that ambulances pass by this fully equipped general hospital, taking emergency patients to Law hospital about 25 miles away.

Ophthalmic patients, who could benefit from the most modern ophthalmic facilities at Stonehouse, are, after normal working hours, taken 22 miles away for treatment at hospitals in Glasgow. Few people would come to any conclusion other than than ultimately this hospital will close. The widespread concern expressed to all Members of Parliament in that area by the councils, the community councils, the local professional organisations and the local political parties shows that the assurances given so far are belied by the existing situation.

But perhaps the most disturbing aspect of this alleged temporary withdrawal of emergency anaesthetic services must be the allegations now being made that people are dying as a result of being transferred from Stonehouse hospital to Law hospital. Already two cases are being investigated by the Procurator Fiscal in Scotland, and it would not be proper for me to mention either of those cases in the House this evening. However, neither of the cases has been identified, and my right hon. Friend the Member for Lanark and I have had representations indicating that there is at least a possibility that other people have died as a result of being transferred.

I have a statement signed by the senior consultant surgeon at Stonehouse in which he describes circumstances surrounding one patient. I believe it to be important to put this case before the House this evening. The surgeon writes: I went to theatre to try to arrange operative treatment for her —that is, the patient. The gynaecology list had finished and the theatre was free. I spoke to … the Senior Consultant Anaesthetist from Law and told him the findings. He said that she sounded as if she needed operation. I thought he would have made some arrangement about her but he just left the theatre and hospital with no further word. When I found he had gone I 'phoned Dr. T. Fraser at Law Hospital and he said he would send the Duty Anaesthetists to see her. When I told —the lady— that she might have to be transferred to Law Hospital she was very upset and begged me not to send her. The Duty Anaesthetist … came to see her in the early afternoon and gave the ward staff the impression that she would have been willing to do this lady at Stonehouse hospital but that she had been told not to and accordingly had her transferred to Law Hospital. That was one of the patients who died. A senior and eminent surgeon is indicating that in his opinion that death would not have occurred if that individual had remained at Stonehouse hospital.

Other cases have been quoted to us. The Procurator Fiscal is investigating, but how many more people have to die through being transferred from a fine hospital before urgent action is taken by the health board? I do not believe that enough is being done by the board. How many advertisements has it placed for anaesthetists in Lanarkshire? I am told that "precious few" is the answer. It is possible that there were only two advertisements in the medical press last year. Why does not the board use locums? It is interesting that consultant anaesthetists are available outwith normal working hours at Stonehouse hospital to provide vasectomies—for a fee—to patients willing to attend in the evening. They are not available to provide emergency treatment for patients who might need it.

I am told that anaesthetists from Law hospital are also available to do locum work at Bellshill maternity hospital, again during the night and again for a fee. Why is it that Lanarkshire area health board does not reorganise the anaesthetists' department at Law hospital to give to Stonehouse hospital the cover presently available at Bellshill, as is presently supplied to anyone needing a vasectomy after five o'clock? Why is it not possible for some emergency measures to be taken to provide this good, comprehensive district hospital with the standards required by the people of the area?

I believe that the area health board is not doing its job and has not treated this matter with the urgency it deserves or with the urgency that the people of the catchment area of Stonehouse hospital feel that it should receive. The point is emphasised by the fact that a number of local organisations have written to ask for meetings with the health board. They have written to question the assurances given to my right hon. Friend the Member for Lanark and to my hon. Friend the Member for East Kilbride that there is no possibility of Stonehouse hospital being closed as a result of this supposed temporary shortage of anaesthetists.

Hamilton district council, the authority most concerned, and in whose area the hospital is situated, has, apparently, been told that a meeting would serve no useful purpose. The community council, representing the whole catchment area of Stonehouse hospital, asked for a meeting through the East Kilbride and Hamilton local health council. It was told, as late as this week, that its request for a meeting would be considered by the Lanarkshire area health board at its next meeting—on 22 February.

I suggest that that indicates the degree of urgency being shown by the Lanarkshire health board. Stonehouse hospital has a valuable contribution to make, not because of the 600 or 700 jobs that it provides in the area but for the valuable medical facilities that it affords. We are not talking about a cottage hospital which has to be protected, nor are we talking about a medical facility which has, perhaps, outgrown the area in which it operates. We are talking about a facility which is apparently being starved of one of its most vital medical components, thus rendering it non-viable and thus making it a prospective candidate for closure.

The people of Stonehouse and Larkhall, the people of Strathavon and the area served by Stonehouse hospital expect that a full inquiry will be made into the allegation that deaths have occurred and into the long-term future of the hospital.

However, it is not just the maternity provision with which we are concerned. There is also a very important aspect affecting maternity provision in Lanarkshire. Recently in my constituency, the Lanarkshire area health board closed Beckford Lodge maternity hospital, which dealt with over 200 births during the past year. Yet during a year of maximum controversy, when the Lanarkshire health board closed that hospital, sending another 200 people this year to other maternity hospitals, the board's annual report published this year covering 1977–78 manages only three lines about the closure of Beckford Lodge. It manages not one line about where the extra births in Lanarkshire are to occur. This is at a time when Lanarkshire has the highest perinatal mortality rate in Scotland. In 1971, Lanarkshire had 27 deaths per thousand live births. Scotland had a figure of 25 perinatal deaths per thousand live births. In 1977, Lanarkshire had 25 perinatal deaths per thousand compared with an average in Scotland of 18 per thousand. This is an area with one of the best maternity hospitals and which is facing a potential increase in the birth rate from 7,567 in 1977 to 8,287 in 1980, and to 10,742 in 1984. Yet the area health board is saying nothing about future maternity provision for people in the area.

Bellshill maternity hospital is now the location for most of the births in my constituency. With the closure of Beckford Lodge, the majority of births in my constituency and those surrounding it will take place in Bellshill, which is the busiest maternity hospital in Scotland and possibly the busiest in Great Britain. It has more deliveries than any other hospital in Scotland and its ratio of 37 births per staffed bed per annum compares with 25 in the rest of the maternity hospitals in the West of Scotland. At the same time as that situation prevails, at a time when the area health board says nothing about long-term maternity provision, 51 beds have been closed for several years in Bellshill maternity hospital as a result of the shortage of midwives and a shortage, yet again, of anaesthetists. What is being done about it? What is being done to find out why midwives will not work at Bellshill? How much consultation has there been with the consultants there and with the unions? What is the area health board doing about the long-term future of anaesthetic cover?

A letter from the consultants at Bellshill maternity hospital to the Social Services and Employment Sub-Committee of the Expenditure Committee of this House says: Also the emergency/night time anaesthetic cover at Bellshill has been in the past shared with other hospitals, so that when the duty anaesthetist is called elsewhere, Bellshill maternity hospital has had no anaesthetist available. This has recently been responsible for about two perinatal deaths each year. Those are the words of the consultants. What is the Lanarkshire health board doing urgently to rectify this position?

I ask the Minister to answer these questions. Why is there a lack of advertisements for anaesthetists throughout the whole of the area? Why is there no emergency temporary cover for Stone-house hospital, and why is not the same locum service being used as in the past? Why is the health board, apparently, postponing meetings with the people in the area, and why is it, apparently, making no reply to representations and suggestions from the medical staff in the hospital which would help to improve the situation? Why, at the end of the day, does not the board simply instruct the anaesthetists presently on the staff to do the job they were employed to do?

Why has no study been made by the health board to find out why the hospital cannot get and keep midwives? Is it true that the shortage of anaesthetic cover is causing additional perinatal mortality? Why is there no mention of long-term provision of maternity services, given the increasing birth rate mentioned in the area health board's annual report? Why, above all, has the board produced no reply following the assurance given by my hon. Friend the Under-Secretary of State for Health and Social Security in December last year to the effect that he would obtain from the board the reasons why long-term maternity provision was not mentioned? There must be an answer, and to get an answer I believe that we must have a full and open inquiry. How many other calamities must occur before this board will act?

6.50 p.m.

The Minister of State, Scottish Office (Mr. Gregor MacKenzie)

I know that my hon. Friend the Under-Secretary of State would have wished to be here tonight to hear the cogent speech made by my hon. Friend the Member for Hamilton (Mr. Robertson). I know that my hon. Friend is most concerned about the health services in Lanarkshire and I am sure that my hon. Friend the Under-Secretary would have liked to have responded to him.

I apologise on my own behalf in that, as my hon. Friend knows, this is not a subject with which I deal on a day-to-day basis. I shall certainly report the speech made by my hon. Friend to the Under-Secretary, along with other comments, private and public, made to me by my hon. Friend and my right hon. Friend the Member for Lanark (Mrs. Hart) recently.

I stress to my right hon. Friend and my hon. Friend that the Under-Secretary has said that he is ready to pursue with the Lanarkshire health board those issues which have been raised and which justify further attention. I know that my hon. Friend will take up these matters as quickly as possible. That assurance has been given in recent days.

I know that my hon. Friend the Under-Secretary would wish me to add that, while he will raise these matters with the health board, it is the Government's view that it would be wrong of Ministers to interfere too frequently. However, I accept that the points raised tonight are important. Before the reorganisation of local government in Scotland I had a much closer link with some of these problems. Many of the people whom I now represent have certain services provided by Lanarkshire.

It will be realised that many of the problems are not of the board's making. Lanarkshire was a new health area at the time of the 1974 reorganisation, in that hospital services had previously been administered by the Western regional hospital board. Traditionally, a significant part of the population had looked to Glasgow for acute services, although some long-stay beds located in Lanarkshire served, and still serve, a small part of the Glasgow population. Some steps to rationalise the services were already in hand in 1974—for example, the construction of the new Monklands district general hospital which is now in use—but others have still to be faced, such as the redeployment of psychiatric and geriatric beds. Another complication has arisen in recent years with the dramatic fall in the birth rate. One cannot overlook, either, the difficulties being encountered by the Health Service generally at present in recruiting the numbers of qualified staff—particularly nurses and the professions supplementary to medicine—it would like to have This is due not, I should emphasise, to lack of money but essentially to the non-availability of the required personnel. In this situation it is the areas such as Lanarkshire, which are not in a position to provide the same attractions as the major centres of medical training and specialised medicine, such as Glasgow, Edinburgh, Dundee and Aberdeen, which encounter greatest difficulty.

I do not wish to suggest that Lanarkshire has insuperable problems—quite the reverse, because there have been substantial improvements in the area since 1974. The board's performance should, however, be assessed against this background of change and challenge. Within the short period of its existence the board has probably had to tackle more rationalisation of existing services—arising from the commissioning of the new Monklands hospital and the reduced demand for maternity facilities—than any other health board in Scotland. As we all know, changes which have an effect on existing facilities are prone to give rise to at least some concern, and often quite strong objections.

My hon. Friend raised an important point when he talked about the question of consultation. The best method of ensuring that proposals for change are properly understood is to make certain that there is adequate consultation about the various options and the factors which should influence decisions. My hon. Friend has suggested that sufficient consultation has not always been undertaken in Lanarkshire. I assure him that I shall raise this point with the Under-Secretary. I am certain that he will investigate the instances referred to by my hon. Friend.

It is, however, often difficult to determine the appropriate time at which wideranging consultations should be put in hand because boards have, of necessity, to develop their ideas to some degree before proposals can be disseminated if the consultation is to be meaningful. This inevitably creates the impression that decisions have already been taken. Whatever my right hon. and hon. Friends may think, health boards have been advised that such consultation must be undertaken, not only when changes are imminent but at the earliest stages in planning when new facilities are envisaged.

For example, Lanarkshire health board is planning a new district general hospital, to be built at Motherwell. It is required to develop proposals now for the effect which this will have on existing facilities such as Law and Stonehouse hospitals. Obviously, given the lengthy time scale for a new hospital of this size, any propositions now put forward and approved by the Secretary of State will have to be subject to reconsideration in the years ahead as technology advances and methods of treatments or patients' requirements change.

I come now to the main point raised by my hon. Friend, namely, the adequacy of anaesthetist staffing in Lanarkshire health board's area and, in particular, the anaesthetic service currently available at Stonehouse hospital. Lanarkshire has encountered difficulty for some time in recruiting the number of anaesthetists it would like and which it considers necessary to provide an adequate service. It should be said, however, that since 1974 the number of consultant anaethetists in the area has risen from seven to 12.

I am sure that my hon. Friend appreciates that the existence of a major teach- ing centre nearby in Glasgow is an important factor. Despite what my hon. Friend has said, I am assured that continued efforts have been made by the Lanarkshire health board to recruit consultants. I understand that there are now two unfilled consultant anaesthetist posts in Lanarkshire. In addition, in the latter part of 1978, there was a temporary reduction in the number of experienced junior staff. It was this factor which precipitated the recent difficulties at Stonehouse hospital. Since the latter part of last year I understand that the situation among the anaesthetist staff has slightly improved and the number of junior staff in post is now up to establishment. The availability of these extra staff should help to ease the difficulties, but the health board is not able to say when full emergency cover will be restored at Stonehouse.

The anaesthetist staff in Lanarkshire are organised into two main divisions—one, in the north, based at Monklands district general hospital, and the other in the south, based at Law hospital. The hospitals chiefly covered by the division at Law hospital are Law hospital, the William Smellie maternity hospital, and Stonehouse hospital. The division centred on Monklands covers this hospital and mainly Bellshill maternity hospital. The additional work load created by the new Monklands hospital could utilise all the increased manpower so far recruited. In this situation Lanarkshire health board has had the extremely difficult task of allocating the available staff to achieve the best possible cover for the area as a whole. In the southern division there are two acute hospitals, at Law and Stonehouse, and, with the shortage of consultant anaesthetists, the Lanarkshire health board had little option but to maintain full cover at one of these and accept that only more limited cover would be provided at the other. The health board has made arrangements for emergencies which would in the normal course of things have been admitted to Stone-house to be admitted to other hospitals.

I can tell my hon. Friend that the chairman of the health board would not, nor would board members or senior officials in Lanarkshire, wish to see this arrangement continuing for any longer than necessary. I am told that they are keeping up their efforts to recruit the additional suitably qualified staff.

My hon. Friend has raised two or three cases of which he has heard when patients have died. I know that he will not want me to comment on these matters at present.

I stress my opening remarks. These matters will be reported to the Under-Secretary, who is more than willing to raise these issues, about which he is as much concerned as my right hon. Friend and my hon. Friend.

It being Seven o'clock, and leave having been given to move the Adjournment of the House under Standing Order No. 9 (Adjournment on specific and important matter that should have urgent consideration), further Proceeding stood postponed.