VICTORIA HOSPITAL, ROMFORD (Hansard, 23 May 1979)

§ Mr. Michael Neubert (Romford)

My first pleasure is to congratulate the Minister for Health on his appointment, to wish him well in his years of office and to thank him for coming to the House tonight to answer this short debate.

My purpose in initiating the debate is to highlight the threat to the Victoria 1186 hospital in my constituency and to bring it to the new Minister's attention at the earliest opportunity. This is a propitious time to raise the question of the closure of a small hospital, because we meet on the morrow of the decision to save the Elizabeth Garrett Anderson hospital, a small specialist hospital providing treatment for women by women. Many people concerned for the future of the National Health Service will have been encouraged by that decision. Great hopes will have been pinned on the Prime Minister's declaration in her speech in the debate on the Address on Tuesday of last week, when she said: … I have great sympathy with the cause of small local hospitals and hospitals with a special role, such as the Elizabeth Garrett Anderson hospital. There is no such thing as a free service in the Health Service. It must be made more responsive to he needs of patients."—[Official Report, 15 May 1979; Vol. 967, c. 81.] That is very much the theme that I shall take in making my case this evening.

The proposal to close the Victoria hospital is still subject to consultation. Submissions on that proposal have been invited to a deadline of 30 May. We are now told that the report of the Royal Commission on the Health Service will be available in July. It might be thought appropriate to await those findings before any irreversible decision is taken, and in the likely run of events that is how it will be.

If the decision to close the Victoria hospital is confirmed by the area health authority and if that decision is supported by the North-East Thames regional health authority, and if there is continued opposition from the community health council—and of that we can be quite certain—the case will eventually go to the Secretary of State for a ruling. I understand that the Minister, in his quasi-judicial capacity, will not therefore wish to prejudice his eventual consideration of the case this far in advance by commenting too specifically tonight. However, I hope that he will indicate in general terms what his policy is likely to be towards the retention of small hospitals.

For the same reason, my argument will be of a broader character of observation, but there are one or two special features relating to this hospital which I want to bring out.

1187 The Victoria hospital was opened on 24 May 1888 by one of my predecessors to commemorate the jubilee of Queen Victoria. It was built on a site donated by a local benefactor who, at his own expense, enlarged it five years later. There were further extensions of the hospital in 1912 to commemorate the death of King Edward VII and in 1924. In passing, I should mention that a Diamond Jubilee commemoration fund raised the then princely sum of £845. Public donation is very much the message of this case. Then in 1939 Lady Neave laid the foundation stone of a three-storey building on another part of the site.

This hospital, therefore, has now served the community of Romford and round about for very nearly 100 years. But the area health authority, the Barking and Havering area health authority, has had increasing doubts about its viability in the recent past, and it has now come forward with firm proposals for the closure of the hospital and its conversion to other uses, which the authority indicates as being for a psycho-geriatric day unit, a luncheon centre for the elderly and office accommodation for the community health service staff.

With all the charity in the world, that can be seen for what it is a dog's break-fast—and inevitably there has been a public outcry. A petition was raised to which 40,000 signatures have been appended. It was presented to me at a meeting held at the town hall, an overflow meeting from which more than 100 people were turned away, and opposition to the proposal has been widespread—from parliamentarians on both sides of the House, the political parties locally, trade unions, townswomen's guilds, trades councils, and the London borough of Havering, whose members voted without a single dissentient against the proposal to close the hospital. There has been countless correspondence, and, above all, the two community health councils have opposed it.

This hospital is in the Barking district but, naturally, the people of Havering, represented by their CHC, have a direct interest in the hospital, which stands in Havering, in Romford.

So democracy has been in action, and democracy is not the least important aspect of the case which I am making, 1188 because this decision was taken by a vote of only seven to five members of the area health authority, and against those seven who voted in favour of closure there are the 40,000 signatories to the petition and the express wishes of many thousands of other people in the locality.

One needs to look at the nature of the area health authority. Its members are appointed, not elected. They are qualified—some eminently qualified—but they are not directly answerable. Their meetings are held in public, but they are little advertised and therefore little known, and they are held in an inconvenient location.

However distinguished the members of the AHA may be, and however clear-sighted they may be in their proposals for the Health Service in our community, they should be reminded that ultimately they stand to serve the people of Barking and Havering. Although their announced purpose is to achieve the best possible service within the available resources, their proposals are not what the public want.

The public of Romford and round about rightly want what they call their hospital. As I have explained, it was provided by their money or their fathers' and grandfathers' money, and, as they are the people who paid for it and are continuing to pay for it as taxpayers, their views should be heeded.

However, faced with increasing pressures on its budget, the area health authority, which has a very difficult task—no one denies that—has appeared to acquiesce in an administrator's answer, namely, contraction, centralisation and concentration—a series of ugly words for an unpopular process.

In this case the authority, at a time when public expenditure was flowing freely as from an unstaunched wound, committed itself to an over-ambitious redevelopment of Oldchurch hospital. Now, with tightened budgets and with the reallocation of resources within the region, its only plan is to contract, close, and concentrate on Oldchurch to justify and consolidate the already committed development on that site. For this, the authority is prepared to throw away the priceless asset of a small human-scale hospital which earns nothing but praise 1189 and which has the homely, friendly atmosphere so reassuring to those who are ill and those who visit them.

There is the problem of the logic of planning ahead for the Health Service, and in its strategic plan the regional health authority acknowledges that the preferred pattern of hospital provision in each district is almost certain to conflict with varying local needs and circumstances, and it is this that we see in Romford in relation to the Victoria hospital.

A new approach is needed to be more responsive to the needs of patients. Small hospitals are local, more convenient and more acceptable than massive health factories. Their staffs are intensely loyal and have a greater sense of identity with the hospitals that they serve and the service that they give. In passing, it is worth mentioning that to concentrate the resources of the Health Service is to open up an increased vulnerability to industrial disruption. It is significant that during the dark days of last winter the staff of the Victoria hospital stayed at their posts throughout.

Instead of recognising the value of the hospital and the degree of appreciation of it by the public, the area health authority has allowed the hospital to decline—whether deliberately, inadvertently, or because it felt that it had no choice is neither here nor there. When the hospital was taken over by the Health Service in 1948 it had 101 beds. Now it is down to only 32. Inevitably it means that the hospital is not giving the same cost-effective value that it could.

It is an ironic comment in the debate on public ownership that a hospital that was provided with public money by private appeal, and was taken over by the National Health Service, should ultimately be faced with abandonment by that self-same so-called publicly owned National Health Service.

The hospital stands on a substantial site. The land is very valuable in such a desirable residential area, but is under-used. What a crying waste it has been. In other circumstances, all the arguments would be for the expansion of the hospital, yet it has been deliberately restricted and gradually contracted.

The area health authority has been entrusted with a precious asset. It is a 1190 trustee both for the past and for the future. I believe that it should be fighting for the survival of the hospital, not reluctantly accepting a lowering of standards. These proposals, far from being an ideal solution, are expedients, and highly unsatisfactory expedients at that. In its consultation paper no solution has yet been found by the health authority to the problem of the large number of X-rays that are carried out at the hospital each year, many of them on GP referral. No solution has been found, either, to the problem of the out-patient services which are provided at the hospital.

At a time when hospital waiting lists throughout the country are at their highest since the Health Service was founded about 30 years ago, waiting lists in this health district are substantially worse than the national average. There are, for example, 1,152 ear, nose and throat cases awaiting admission. Many of these will be children, and cases have come to my attention in the course of my constituency work in which the delays in waiting for the necessary operations have risked permanent damage to health or retarded education.

In some of these cases, parents have been able to find other means of seeing that their children have received the attention that they have needed, but it is most unsatisfactory for the people of Havering to have to face these unpleasant facts. They have been greatly alarmed, not to say angered, by the closure of the children's ward at the Victoria hospital, with the transfer of its cases to another hospital in the district.

The decision to close the hospital when the service is under strain and standards are slipping is dismal. There is still time for a change of heart and for renewed determination to serve the public in the way that it wishes to be served. It does not have to be a question of cash alone. Cash is, of course, at the heart of this dilemma, as is inevitable. There may be arguments for a fairer reallocation of resources than has yet been proposed, since the Barking and Havering area is undoubtedly underfunded compared with other parts of the region, but not with the county of Essex, next door.

Let us examine other ways to make savings. Few that I meet either outside or inside the National Health Service 1191 doubt that there are ways to make savings. I hope that the new Administration will take the course of exploring the opportunities to make savings in this direction. If our resources are limited, it is vital that they should be applied for the greatest possible benefit.

One illustration that is inevitable is administrative costs, which amount to about £1½ million per year. Are these costs unavoidable? Is there no scope for saving there? Could we not involve voluntary support? Is that such an outrageous suggestion? Is it too imaginative an idea? The hospital was provided by private generosity and public appeal. Support for it has remained strong throughout the years. Many look upon it lovingly and are prepared to put their moneys where their mouths are. The support for it could be tapped to bridge the budget gap.

As an example of what has been achieved, £150,000 has been raised locally for the foundation of a hospice. The idea is not impossible, and I appeal to those in the Health Service and responsible for taking decisions on the future of the Service not to rule out the possibility of harnessing concrete public support and potential financial support. Of course, that does not fit in with the contents of manuals of hospital administration that they have been taught. However, it may be the one way out of our dilemma. It is remarkable that of the 22 new body scanners in the United Kingdom no fewer than half have been provided by philanthropists or by public appeal even though they cost £300,000 each.

It is understood that there is the implication of continuing revenue costs after capital purchase, but that indicates that the public will respond in a popular cause and that there are other ways of solving our problems than always asking for more money from the State. Given the will, the Victoria hospital can and must be saved. It is a community asset which should be exploited and expanded rather than run down. I hope that the debate will contribute towards its survival. If it does, it will be a good night's work.

§ The Minister for Health (Dr. Gerard Vaughan)

I thank my hon. Friend the 1192 Member for Romford (Mr. Neubert) for his good wishes. I have noted carefully what he has said and I congratulate him on the cautious and reasoned way in which he has presented his case for keeping open the Victoria hospital.

This is the first Adjournment debate on health in this Parliament and I am grateful to my hon. Friend for raising such an important local matter—the question of the future of the Victoria hospital, Romford.

My hon. Friend knows that he is not alone in his anxiety over the closure of a small hopsital. A number of hon. Members are concerned because in many areas there are small hospitals similar to the one under discussion whose future is threatened.

Not everybody seems to be clear over the procedure for closing hospitals. First, responsibility for the closure or for changing the role of health premises rests with the area health authority. If it wishes to close a hospital, it has to follow the procedure set out in a guidance note issued by my Department in 1975.

First the authority is required to prepare a consultative document covering such matters as the reasons for the proposal; an assessment of the other possible uses of the facilities or the disposal of the site; implications for the staff; and the relationship between the closure or change of use and other development in the area. There are also the questions of transport facilities for those patients who might be affected by the proposals.

When that has been done, the area health authority invites comments on the proposal from a wide range of local interests, including the community health council affected. Hon. Members whose constituents are affected should also be informed of the proposals, and I understand that Barking and Havering have sent my hon. Friend a copy of the document in relation to the Victoria hospital. Where the community health council objects to the proposal, it is expected to produce a constructive counter-proposal for consideration by the area health authority.

If agreement cannot be reached the matter is referred to the regional health authority, and if necessary to the Secretary of State for a final decision.

1193 In the case of the Victoria hospital, the Barking and Havering health authority has issued a formal consultation document on its proposals and is asking for comments by 30 May. The health authority proposal is still subject to this local consultation, so that nothing that I say tonight should be taken as prejudging the issue—we must wait to hear its proposal after these consultations have been completed.

I would like, however, to say something about our general approach to the future of small hospitals, such as this one. Many of these hospitals have played an invaluable role in health services for very many years by providing specialist services supplementary to those provided in district general hospitals, by providing services locally for patients whose medical condition does not require the full services of a district general hospital, or by caring for those who no longer require full specialist facilities but are not well enough to go home.

The policy of recent Governments has been to concentrate acute facilities in large district general hospitals, where possible on a single site, and to limit the role of the small hospital in acute medicine while at the same time expanding its role in the care of the longer-stay patient, particularly the elderly. We need to think carefully about the danger of hospital services becoming too remote from the local communities that they serve, especially in rural areas where patients and their friends and relatives may have to travel many miles to the district general hospital—and at considerable cost. When we dealt with the reorganisation of the National Health Service in Committee, there was a good deal of discussion about the hidden costs of ambulance services and of relatives having to travel and stay overnight. That disadvantage has to be weighed very carefully against the medical advantages of concentrating services in one place.

The overall advantage will not be the same everywhere, and I see a need for considerable flexibility of approach to deal with differing local circumstances. So I would say to hon. Members that we see a continuing place for the small local hospital, where there is a useful and satisfactory role for it in the total pattern 1194 of hospital provision in a district, whether it be rural or urban. We see this as an important part of restoring a local approach to the care of patients.

So we approach the question of small hospitals with considerable sympathy, and I intend to have an urgent, close look at present policy in this field. This will take a little time, since one cannot look at small hospitals in isolation, and I shall also want to take views from a range of National Health Service and professional interests. But I ought to make it clear at this stage that I am not announcing a general intention to preserve all small hospitals or to retain their functions unchanged. Some have reached the end of their useful lives, both structurally and functionally. It may no longer be possible to provide a satisfactory standard of care with the buildings and facilities available. Some are very difficult to staff now. They may be hopelessly uneconomic in their demands on finance and staff. The problem of effective use of limited resources is always with us. In some cases new facilities have been provided which were specifically planned to replace existing hospitals, and these cannot be used unless staff and money are freed by closures. Each case must be looked at in its own particular circumstances.

In this regard, I am particularly pleased that the future of the Elizabeth Garrett Anderson hospital has been safeguarded by a solution that illustrates the points that I have made. A new and very exciting role has been found for the EGA which meets a genuine need not currently being met by the health services in that part of London—that of a women's hospital dealing with women's disorders. The community, too, has a significant part to play, in that the many individuals and voluntary organisations who have expressed support for the EGA can now contribute to the establishment of the hospital in its new role.

For the reasons that I have already explained, I would not wish to comment—I am unable to on the Barking and Havering area health authority's proposal concerning the Victoria hospital.

I do not know what will be the area health authority's conclusion when it comes to consider the Victoria hospital proposal again, or, if the matter is referred to the North-East Thames regional health 1195 authority, what view that authority will take. I can, however, assure my hon. Friend that if my right hon. Friend the Secretary of State is asked to make the final decision on this matter, the greatest 1196 care will be given to all the points made by my hon. Friend tonight.