HC Deb 24 October 1979 vol 972 cc588-600

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

11.35 p.m.

Mr. Gerald Kaufman (Manchester, Ardwick)

I am grateful for the opportunity to raise the important matter of the Duchess of York hospital for babies. I hope that the House will give a hearing to the problems facing this hospital. The behaviour of Conservative Members at this moment does not indicate that they wish the House to hear about them.

The Duchess of York hospital has been serving Manchester for more than a century. The troubles afflicting it have been causing local parents profound concern for about two years, that is, ever since word got around as a rumour that the area health authority planned to discontinue the surgical facilities at that hospital, with, as was proposed at one time, the surgical services transferred to Manchester Royal Infirmary.

The area health authority met on 19 December, and as a result it issued a proposal which was eventually approved by the North-West regional health authority on 27 February of this year. That proposal was stated in a letter dated 12 March to me from the regional administrator. He said that the proposal was to discontinue the surgical services at the Duchess of York hospital in favour of providing a service for mentally handicapped children. I am totally in favour of providing the best possible facilities for mentally handicapped children, and I should not be seeking to raise this matter in the House, as I have elsewhere, if I thought that doing so would in any way disadvantage mentally handicapped children. I am the president of the South Manchester Society for Mentally Handicapped Children and I contend—and in this I am supported by large numbers of people—that the closing of a unique and valuable surgical unit is not the way to help handicapped children.

We have reached the situation that the proposal has gone through the area health authority and the regional health authority and is now before the Secretary of State, and only the Secretary of State can save the Duchess of York hospital as a surgical hospital for children. This is a small, local, specialist hospital. It has 115 beds and is the only exclusive children's hospital in South Manchester and the surrounding districts. It has the only paediatric operating unit in the area, and it is regarded as vital to paediatric services in South Manchester. Within the past few years the operating department has been rebuilt and upgraded at a cost of £33,753, and another £53,174 has been spent on building a unit to extend the surgical accommodation for older children.

The hospital has one of the only two paediatric nurse training centres in Manchester. It has been argued—this is one of the cases put forward by the area health authority—that the facilities at this hospital are not full utilised. There are arguments whether the calculations by the area health authority have been arrived at validly and on a fair basis. But in any case, there are reasons for any under-use that may have taken place. First, the surgeons had to take the work elsewhere when the operating theatre was being modernised. Second, there was the problem, in addition, that no surgical registrar had been accredited to the hospital. Even so, in the year 1977, 1,026 children received in-patient surgical treatment at the hospital. Later quarterly figures that have been made available have shown an increase in the use of the operating theatre of, in at least one quarter, up to 91 per cent.

The case put forward by those who wish to save this hospital is that the most serious consequences could follow the closure of surgical facilities. If the House would allow me I should like to quote at a little length from the most authoritative letter that I have received, from a highly qualified member of the department of anaesthetics at Withington hospital. It is a lengthy quotation but it is from an expert person who can put the case far more expertly than I. He writes: The AHA proposals recommend that:'…in the short term all surgical work should cease' at the Duchess of York. The surgical cases will have to be transferred elsewhere. If transferred to North Manchester, where the paediatric surgeons will continue to operate, the children and children's parents on the south side of Manchester will suffer unnecessary serious inconvenience and even hardship"— and, I would add, expense— by the very difficult additional cross-city travelling imposed when visiting hospital. As there are no paediatric surgeons who will continue to operate in South Manchester, surgical cases remaining in general hospitals in South Manchester will be operated on by surgeons without training or experience in paediatric surgery. This could have serious consequences in the case of surgery on infants and small children, and particularly when surgery may be performed by inexperienced junior surgical staff. The Duchess of York is the main centre in South Manchester for the training of anaesthetists in paediatric anaesthesia and for the continuing experience of anaesthetists practising paediatric anaesthesia. It is also the only centre with proper paediatric anaesthetic facilities. Discontinuation of surgery (and anaesthesia) at the Duchess of York will mean a serious lack of training facilities and experience in paediatric anaesthesia in South Manchester and in future, therefore, an ever increasing risk of children requiring anaesthetics being attended by anaesthetists without paediatric experience. This could have very serious consequences and it is not improbable that this could result in an increase in anaesthetic mortality amongst children. This, of course, would be intolerable. This gentleman goes on: The loss of acute medical and surgical beds at the Duchess of York will mean an inevitable increase in the number of children who have to be accommodated in adult beds on adult wards in general hospitals in the Area. It is generally agreed by those concerned with the hospitalisation of children that this is a most undesirable practice. However, it is a practice which unfortunately is already too prevalent in South Manchester, particularly at Withington Hospital. In January 1978, 43 children were admitted to adult wards in Withington. This figure is quite atrocious. The loss of beds at the Duchess of York, particularly for surgical cases, will inevitably mean an increase in this undesirable practice. The AHA report states: 'The implications of these proposals will ensure that, in accordance with the policy of the Area, children are not accommodated in adult beds'. This assurance is inconsistent with the proposed recommendations. The standards of accommodation must also be considered. He goes on to compare the standards of accommodation at this hospital with those elsewhere, greatly to the advantage of this hospital.

These grave possibilities, which have been stated with such authority, have aroused unprecedented reaction among local parents. They have formed an action committee. That is a remarkable thing to have taken place among people who previously had been completely inexperienced in any kind of public action. A petition has been circulated and has obtained more than 45,000 signatures. Exactly a year ago this weekend, a protest march took place. People who had never taken part in any kind of overt or public protest activity joined in. We have been bombarded with letters from constituents and from local organisations. I should like to quote from two of them, both from parents who have had children in this hospital.

One lady, living in Levenshulme in my constituency, has written to me: While my child was in hospital, I was able to visit him any time I so wished, and was encouraged to do so by all the dedicated staff, which is vital to both parents and children. Mothers who live some distance away are offered sleeping accommodation in the mother and child unit, again so necessary for the child who needs reassurance". Another parent wrote thus: Recently my daughter, who is 19 months old, had to go into the Duchess of York for the third time, this being for her second operation, and therefore I do have personal experience of the excellent staff and treatment which is given to babies of this establishment…I would have thought that at the present time, when the Health Service is acutely short of money, it is very wasteful to close down an existing and extremely good babies' hospital and spend a considerable amount of finance on changing its use". Concern about this matter has continued right up to the present day. It was discussed with me in my constituency at the weekend and has been raised again with me by correspondence in a letter I received only yesterday. I repeat that under the statute only the Secretary of State can now save the Duchess of York hospital for babies and its surgical facilities.

The Minister of State told the Conservative Party conference two weeks ago that the Government believed that small hospitals which were efficient and vital to local communities must not be closed, and I quote his words at that conference. He said: No closure of a small unit or hospital will be agreed by us"— that is the Government— unless we are certain it is unavoidable and in the best interests of patients in that part of the country". The Prime Minister herself said, in the debate on the Address: I have great sympathy with the cause of small local hospitals and hospitals with a special role."—[Official Report, 15 May 1979; Vol. 967, c. 81.] Speaking again a little later in this House, the right hon. Lady said of her Government that we approach the question of small hospitals with considerable sympathy."—[Official Report, 24 May 1979; Vol. 967, c. 1226.] It is four months since the Minister saw the action committee in a delegation and promised an early decision. Obviously, we do not wish to push him to any particular date and we shall certainly not say that, because it was four months ago, some decision must be announced immediately. But the Secretary of State wrote to me recently and assured me that a team from his Department visited the hospitals in the area on 25 June, so his Department has had four months in which to consider the outcome of that visit.

I welcome the Under-Secretary of State to his role in replying to the debate. I remember an earlier Adjournment debate, when he first entered the House, and I had the good fortune to be sitting in his present position and to reply to a case that he raised with me. I say to him that we now look to the Government to be as good as their word, in view of what the Minister of State and the Prime Minister have said about the Government's regard for small hospitals. We look to the Government in that light to save the Duchess of York hospital as a surgical hospital. In that spirit I look forward confidently to the Minister's reply.

11.50 p.m.

The Under-Secretary of State for Health and Social Security (Sir George Young)

The right hon. Member for Manchester, Ardwick (Mr. Kaufman) has made a powerful speech on behalf of what is clearly a popular local institution.

Proposals by health authorities to close or change the use of hospitals are about the most controversial and hotly felt of the issues which come before us as Ministers. The history of the proposals about the Duchess of York hospital in Manchester, which we are considering this evening, is particularly confused, and it may help the House if I spend a few minutes explaining something of this history and the exact situation that has now been reached.

Manchester, as the right hon. Member well knows, is and has been from time immemorial the major hospital centre for the conurbation which surrounds it. With its university and medical school it has a concentration of skills and expertise which makes it one of the country's main centres of excellence, and the present-day Manchester area health authority (teaching) serves patients from far beyond its own boundaries. With this concentration of excellence there goes a concentration of beds, and this is true of paediatrics as it is of other specialties. At present there are over 600 children's hospital beds in the Manchester area. These days—and it is something for which we must all feel profoundly thankful—many fewer children than in earlier years get illnesses for which they need hospital treatment, and those who do need not stay in hospital for nearly as long as they used to. The health authority takes the view that the present 600-plus children's beds are a great many more than are justified by the needs of the area they serve, and to support this view it has cited the fact that on average the beds are only 60 per cent. occupied.

Mr. Andrew F. Bennett (Stockport, North)

It seems to ignore the fact that a substantial number of children from the Stockport area use the Duchess of York hospital.

Sir G. Young

The occupancy rate of the Duchess of York hospital is lower than the average. The 60 per cent. occupancy figure for these beds includes children from outside Manchester.

That generally is the background against which the area health authority decided on a fundamental review of the whole organisation of its hospital services for children. It has now published two sets of proposals on the future shape of these services—the first in a consultative document issued in December 1977 and the second, which took account of reactions to the original proposals, in a revised document published in July 1978. It may be that some confusion has arisen over the differences between the two documents, so I shall mention them briefly.

Although it is the future of the Duchess of York hospital which concerns us this evening, the area health authority's proposals cover a much wider canvas involving six of the area's hospitals in all. However, it is only that element of the proposals which relates to the Duchess of York which my right hon. Friend has been asked to approve. The reason is that it is the only one of the six for which the proposals involve a substantial change of use. As the right hon. Gentleman said, where a health authority proposes to close or change the use of a hospital, and the local community health council objects, the change cannot be implemented without my right hon. Friend's approval. That is the position in this case.

Now I come to the area health authority's specific proposals as they would affect the Duchess of York, drawing the distinction between the two successive versions of its plan. The December 1977 document proposed a two-stage operation in which, first, the surgical beds would be phased out, to be followed at a later date by the medical beds, though there was a caveat that some medical beds might be retained if experience showed them to be needed. The surgical wards would be taken over mainly by a new paediatric surgery unit to be built at St. Mary's hospital in the central district, while the medical work would be divided between a number of the existing hospitals in the area. The accommodation at the Duchess of York would be adapted to provide residential, assessment and day facilities for physically and mentally handicapped children.

The North and South Manchester community health councils, as well as a number of the other interests consulted, expressed strong opposition to the proposals in their original form as they affected the Duchess of York, and the area health authority responded by making significant modifications to its revised document published in July last year. Briefly, the new proposal was that the medical beds at the Duchess of York should continue in use but that the 44 surgical beds—just under half the hospital's total complement of 115 beds—should be phased out, the space vacated being used to provide 25 beds for mentally handicapped children together with assessment services. That again is somewhat different from the original plan under which the new unit would have served physically as well as mentally handicapped children. As part of its case for the change now proposed the health authority adduced the fact that the occupancy of the surgical beds was as low as 25 per cent.—much less than that of the medical beds which has remained at 50 per cent. or more.

Notwithstanding that the authority had now conceded the case for retaining the medical beds, the two community health councils—as is their prerogative—sustained their opposition to the phasing out of surgery from the Duchess of York. In accordance with the procedure laid down by the Department, the area health authority referred the issue to the regional health authority. The regional health authority decided to support the area health authority's proposals, and it is at this point, in March of this year, that it referred the question to my right hon. Friend's predecessor for a decision. I can understand the right hon. Member's feeling that events since then have moved a little slowly, so I shall explain to him exactly where our consideration of the proposals now stands.

The submission by the regional health authority was overtaken fairly swiftly by the announcement of the May general election, with the result that this was one of the problems waiting for us when we came into office. As the right hon. Gentleman said, he joined in a deputation of members of the Duchess of York action group, led by my hon. Friend the Member for Manchester, Withington (Mr. Silvester), whom I am pleased to see present, which my hon. Friend the Minister of State met in June. I have seen the record of that meeting and am aware of the main points which the group put forward in support of its view that surgery should remain at the hospital. The delegation presented a petition to my hon. Friend which contained some 45,000 signatures, so there can be no doubting the strength of the local support for the hospital and the affection in which it is held. My hon. Friend has told me how impressed he was by the way in which the delegation presented its case, and he promised it at the time that he would pay careful attention to what it had said in coming to his decision on the proposals.

There are two other things which happened at about the same time. First, arrangements had already been made for a team of my Department's officials to visit Manchester at the end of June and to see at first hand the Duchess of York and the other hospitals affected by the proposals. The impressions which they have reported from the visit are a further piece of the jigsaw which my hon. Friend will take into account when he makes his decision. Second, we were asked in a letter from the chairman of the authority that he and some of his senior officers should have the chance of meeting my hon. Friend and explaining to him their view of the matter before the decision was finally taken. In common fairness, this was something to which my hon. Friend was bound to agree, but unfortunately it has, for various reasons, taken a long time to arrange the meeting. It will, however, be taking place on 5 November, and my hon. Friend intends to announce his decision just as soon as possible after that.

The right hon. Gentleman will understand why at this juncture I cannot really be forthcoming about the direction of our thinking. There are, however, two points I should like to make about our general view of the matter. I am conscious in the first place of having so far described the history rather from the health authorities' viewpoint. I am partly obliged to do so by the eloquence with which the right hon. Gentleman argued the case of those who object to their proposals. Let me now redress the balance by saying that we fully respect the strength of the local feeling which has been expressed in support of the Duchess of York continuing in its present form.

I mentioned the petition signed by 45,000 people, but in a way it is all summed up in a letter—charmingly illustrated—sent to my right hon Friend by a 9—year—old girl who has been having treatment there for the past five years. She told us quite simply what she felt about the hospital— it's a great hospital and it's like home from home". Views like that which have been expressed by many children and their parents are certainly not the least of the factors that we have to consider. As a Government we have made it very clear that we do not favour excessive centralisation of hospitals and that we see the continuation of small hospitals, complementing and strengthening the services provided in the district general hospitals, as an important means of restoring a local approach to patient care. Indeed, the right hon. Gentleman emphasised that in his speech.

However, I should like to make one thing absolutely clear, because there still seems to be some misunderstanding. No one is talking about closing the Duchess of York. When the right hon. Gentleman spoke of those who wish to save the hospital, I felt that there was some confusion creeping into the debate. What we are considering is a partial change of use, and the question of how best to provide children's surgical services in an area such as Manchester involves a whole range of issues—finance, the physical ade- quacy of facilities, patients' travelling times, which the right hon. Gentleman mentioned, staffing and the availability of supporting services—to which there is no simple or automatic answer.

My second and final general point concerns the alternative use which the area health authority has proposed for the present surgical wards at the Duchess of York. At present there is no in-patient accommodation for mentally handicapped children anywhere in Manchester, and they are mainly cared for at Calderstones hospital which is 25 miles away at Burnley.

There is an undoubted need, as the right hon. Gentleman conceded, to develop services for these children in Manchester, and it does credit to the opponents of the area health authority's proposals that they have been at pains to say that they are not opposing such a development, so long as the Duchess of York can continue as it is now. There are in fact aspects of the health authorities' proposals for mentally handicapped children that my Department would want to discuss with them further if the proposed phasing out of surgery were agreed.

At this point I simply want to make it clear that the case for doing more for the mentally handicapped will not of itself determine our handling of the immediate issue before us. What we have to decide is whether the continuance of surgery at the Duchess of York is justified by the needs of this service. The question of an alternative use, however desirable in itself, arises only if we are satisfied that it is not.

The right hon. Gentleman will, I hope, understand that I cannot give him this evening the kind of assurance that he and my hon. Friend the Member for Withington and those for whom they speak would most like to hear. What I can assure him is that, when proposals like these are before us, we examine them as fully and impartially as we can. Certtainly, we do not accept the arguments put forward by health authorities without subjecting them to the most careful scrutiny and satisfying ourselves that they are absolutely sound. In the process we give equal weight to what is said on the other side of the question, and certainly what the right hon. Gentleman said tonight will be fed into the machine.

The area health authority's estimate of the savings from the proposed change is one thing that has been challenged, particularly on the question of capital investment at other hospitals. Whatever our decision, we shall do our best to ensure that it rests on an absolutely sound financial assessment. But the most important consideration is that relating to the patients—the children. We must be satisfied that the deployment of the surgery service now provided at the Duchess of York is that which will, within the available resources, best serve their interests in the largest sense. That is the real yardstick against which these proposals have to be judged, and I can assure the right hon. Member that it is that consideration which will be uppermost in our minds when my hon. Friend's decision is made.

Question put and agreed to.

Adjourned accordingly at one minute past Twelve o'clock.

Back to