§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Mather.]
12.53 am§ Mr. David Mellor (Putney)I am very pleased to have the opportunity on the Adjournment to speak on this very important topic. I should make clear at the outset that I am raising this issue with the full concurrence of the constituency Member, my hon. Friend the Member for the City of London and Westminster, South (Mr. Brooke), who is precluded by his membership of the Government from speaking in the House on this subject but is present in the Chamber for this debate.
I have two interests in raising this matter. First, I have the honour to be a co-opted special trustee of Westminster hospital. Secondly, for many years, Westminster hospital has enjoyed a very close and fruitful association with Queen Mary's hospital, Roehampton, in my constituency, a relationship which my constituents and the staff of Queen Mary's wish to continue. Obviously my purpose in raising this issue is to try to ensure that that happens.
We are concerned with two different reports: first, the Flowers report of London university on the future of university medical education, which, among other things, recommends the closure of the Westminster hospital medical school; and, secondly, the report of the London Health Planning Consortium on the reduction of the number of acute beds in London hospitals, which recommends, inter alia, the deletion of about 400 acute beds at Westminster hospital so as to reduce the hospital to one of about 100 beds only and to turn it into an annex of St. Thomas's hospital.
I should say straightaway that I accept that my hon. Friend the Under-Secretary has had no part in the preparation of either of those reports, and that he inherited the consortium report from the previous Government. However, he is now in the unenviable position of having to decide, with his colleagues, the proper course to adopt.
I turn to the Flowers report. As I have indicated, the recommendation is that a hospital medical school with one of the finest traditions of any medical school in London should be closed. Last year, it 1582 had the best academic record in the university at the lowest cost per student. It is said that the benefit would be a substantial saving in funds. Obviously, I do not object to savings in funds, but I rather think that even the least inquiring of minds would be unconvinced by the reasoning in the Flowers report. Even if savings of the order proposed were to be found, if it means the closure of such a medical school, one might think that it would be bought at too high a price.
I turn to the consortium report. In effect, if it were implemented, it would amount to the destruction of this fine hospital. Of course, it can be said that it will continue to exist, but only in so emasculated a form as to be a pathetic attempt to prove that there is life after death.
This hospital has been a national, if not a world, leader in many branches of medicine and one to which many dedicated men and women have devoted their fives. It is a hospital of international renown, and it is a matter of bitter regret to me that its future should be called into question in the manner in which it is.
In the limited time available, I do not want to embark on the merits of the policy of RAWP. I shall content myself by saying that I am an opponent of RAWP, and I regret very much that the Government seem to have embraced that concept. It is equally right and fair to say that the right hon. Member for Norwich, North (Mr. Ennals), to whose work on behalf of Westminster hospital in recent months I pay tribute, is himself an adherent of RAWP. However, in some of the time available, I hope that he will argue that, even if one embraces the principles of RAWP, it is possible to pursue that policy while retaining Westminster hospital in its present form. I believe that that is crucial to the argument.
It may be said that it would be a good thing if resources were to be allocated out of London and if the real effect was that a centre of excellence similar to Westminster was established somewhere else. But a Labour Member, coming from a constituency in the North-West which is badly served by NHS facilities, indicated to me at lunchtime that he was unconvinced, although he would wish it to be otherwise, that the closure of a hospital such as Westminster would be of benefit 1583 to the people in his part of the country. Therefore, one is driven irresistibly to the conclusion that, whatever view one takes of NHS policy and however one approaches this problem, the proposal to remove this hospital from the map is neither sensible nor tenable.
There is one essential point I want to advance tonight before I sit down so that other hon. Members may have the opportunity of expressing their views. My right hon. Friend the Secretary of State has indicated that the Flowers report is a matter for the university and that no imminent decision is to be expected from the Government on the consortium report. Indeed, he indicated to the right hon. Member for Norwich, North in a letter that I have seen that it might even be slightly premature for some of us who are concerned about the matter to go to see him. However, the problem is that those of us who have had meetings with people from London university hear them say that one of the fundamental reasons for the Flowers report proposal is that it was believed that the consortium would recommend the dismemberment of the hospital, and there was no point in retaining a medical school in a hospital that would lose 80 per cent. of its beds.
Flowers is to be decided and determined by the university within the next three or four months. If the Government do not speak out now, the decision may well go against Westminster medical school. If it does, how much easier it will be for people in the DHSS to say " Westminster has lost its medical school, so why do we not chop it up altogether in accordance with the consortium, and what would be the loss?" That is why I say to my hon. Friend that it is imperative that the Government speak out on this issue, particularly for the reason I have given. But there is another pressing reason why it is essential that the Government should speak out. Many senior staff, men and women with other important duties to perform, are finding that an increasingly dominant part of their lives is taken up by having to act as agitators on behalf of the hospital—a position in which, in my respectful submission to the House, they should never have been put in the first place.
1584 I appreciate that my hon. Friend has an unenviable task, but I must tell him quite frankly that I should not care to be in the position of any Minister who had the blood of this fine hospital on his hands, and I should not care to have to try to justify this to a public which will rightly look upon it with extreme scepticism. I could not personally accept such a position and would both vote and campaign against it, although what I do is perhaps not a matter of great significance. But I have been greatly heartened by the support I have received both from hon. Members present tonight and from others who are not present but have told me of their great misgivings. This applies throughout the House, among senior and junior Members alike.
I do not think that there is a majority in the House for this proposal, and I hope we shall be able to avoid quite unnecessary bloodshed and strife on this issue. I hope that, if not tonight at least soon, we shall have some words of comfort from the Ministers at the DHSS so that we can all turn our attention to more fruitful matters and not find ourselves in the invidious position of having to defend a hospital that should not need any defending in this House, having regard to the services it has rendered to its Members over the years.
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§ Mr. David Ennals (Norwich, North)I am most grateful to the hon. Member for Putney (Mr. Mellor) for raising this subject and for the way in which he has done so, and I want briefly to support everything that he has said. I must declare a personal interest. I am a patient at the hospital and have been one for a considerable time. I have no doubt that I owe my life to Westminster hospital, but that is not the point.
I believe that there is great strength of feeling on both sides of the House and in both Houses of Parliament, about this proposal. Westminster hospital has a world-wide reputation. Its academic excellence is recognised by everyone, and not only does it produce the best results in terms of a medical school but it does so at less cost than any other in the country.
I want to touch on the central point that was made by the hon. Member for 1585 Putney. The vice-chancellor of the university yesterday met a group of us who are deeply concerned about the future of the hospital, and he made it clear that there would be no question of closing the most efficient and cost-effective of all London teaching hospitals unless it was understood that there would be a loss of 410 beds. Obviously, if it is a hospital of 100 beds, there is no possibility of a medical school. This is why it seems to me that the hon. Member for Putney is absolutely right in saying to the Department that it must take a decision first. I think it would be quite wrong for the university, in view of the difficult position in which it is placed, to take a decision on Westminster hospital on the assumption that 400 beds will go when no decision has been taken about whether 400 beds will go. I hope that the Secretary of State will receive a deputation, that the Under-Secretary will concern himself with the matter and that any final decision will be postponed.
Not only is there opposition in the House, but the area health authority opposes the closure, and it would be a tragedy if a hospital with such a reputation and a medical school of such academic excellence were to close. I am grateful to the hon. Member for Putney for giving me the chance to add my weight to what he has said.
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§ Mr. Mark Wolfson (Sevenoaks)I am grateful to my hon. Friend the Member for Putney (Mr Mellor) for giving me the opportunity to participate in the debate. I support his view that the Westminster hospital should not be run down and that the Westminster medical school should not be closed.
I oppose the proposals for several reasons, first from a philosophical point of view. The hospital and the medical school are centres of excellence, and it is surely no part of the Government's policy to close such centres. Secondly, I oppose the proposals on grounds of size. Surely we have learnt by now that big is by no means beautiful. Part of the plan for closing the Westminster medical school would be to enlarge other schools. We need to learn that lesson and not go down the road where mistakes have been made before with nationalised industries and local government in schools.
Thirdly, I oppose the proposals because 1586 of the record of the medical school. Not only was it top last year in terms of academic record, but the Westminster is top of the list over a 10-year period, and those high standards have been achieved economically. Figures will help. It costs £14,500 to train a doctor at the Westminster. At St. George's the cost is £29,000, and the average cost is £22,000. I suggest that the school is an economic jewel in a rather costly crown.
For the Westminster medical school, the demand for places is up 70 per cent. over the past eight years, against a slightly falling market for medical school places overall. That reflects the stated desire of students to learn in a small, personal environment where close relationship can be established among students, patients and staff.
One of my constituents originally alerted me to the problem that he faced as a student currently at the school. He wrote of the qualitative aspect of the school:
This aspect is probably best appreciated by a visit to the medical school. I think that it is sufficient to say that when I was choosing which medical school to train at, I chose Westminster above all others very much because of the atmosphere which even on a cursory visit can be seen to be one of warmth and friendship amongst students, staff and patients.I turn to the future of the hospital. It is not enough for the Under-Secretary to tell us that the Flowers report is not his responsibility. The recommendation of the report has to be taken in conjunction with the proposals in the discussion document " Towards a balance ".I suggest that that document should be considered with much caution, considerable scepticism and very thorough probing. It is unsigned, we have no way of knowing whether it is an agreed document, and the consortium, whatever that term may mean, appears to have been composed of two-thirds bureaucrats and one-third academics. The weight of practising medical opinion was horrifyingly lacking. Despite the title " discussion document ", the paper makes a clear recommendation for the rundown of the hospital, as has already been described most graphically, from 520 beds to a 100-bed hospital acting merely as a support unit.
Relatively, the Westminster hospital is up to date. It was built in 1938. It is cheap to run. heat and maintain. Many 1587 modern buildings cause great cost headaches. The tower at Guy's hospital is an example.
High-grade medical developments are going forward in the Westminster hospital. The accident and emergency department is new and heavily utilised. The operating theatres are being completely modernised at a cost of more than £1 million. Some rationalisation of existing London hospitals might be necessary, but surely it has never been, nor should it be, Conservative Party policy to take out a centre of medical and teaching excellence such as this hospital represents.
§ Dr. Brian Mawhinney (Peterborough)I am grateful to my hon. Friend the Member for Putney (Mr. Mellor) for allowing me to intervene. I shall concentrate on the Flowers report, which was the basis of the decision to do away with the medical school which is linked to the proposals for the hospital.
The report does not bear examination. I shall deal with three aspects of it. We are told that it is proposed to save £3 million. But, in the next sentence, the report says that it is impossible to judge how much money, if any, will be saved by the implementation of the report. I learnt today that the university is not prepared to give to the advisory committee, for its Friday meeting, any financial evidence from the report That means either that no financial evidence exists or that it is so weak and paltry that it would be an embarrassment to reveal it. There is no financial nor academic basis for the report. The report recommends closing the pre-clinical schools at King's and the Royal Free, of which I am a member of the academic staff. The two schools represent the epitome of the multi-faculty institution type of preclinical education and integrated education. Yet both are to be disbanded. There is no academic thread running through the report.
The effect of the report is to increase the size of class to the detriment of academic teaching. We no longer believe that big is beautiful, and yet the organisation envisaged by the report is of mammoth groupings with super-deans and sub-deans galore. That is inimical to the education process. 1588 Why should any of the medical schools be put at risk on the basis of a report which does not stand examination on a financial, academic or organisational basis? On Monday, I put to the vice-chancellor personally that Lord Flowers was picked, at least in part, to lend the eminence of his name to the report so that it would carry greater weight. That causes perplexity because we do not understand why the people involved in the report would want to be associated with something which is so hard to understand on the face of it. What was behind the report?
There might be a case for rationalising medical education, but not on the basis of the report. I oppose the closure of the medical school and the Westminster hospital.
§ The Under-Secretary of State for Health and Social Security (Sir George Young)I have answered a large number of Adjournment debates in the past year—more, it feels, than any other Minister—but never yet has any Adjournment debate that I have replied to had such a large and distinguished audience. I interpret the remarks that have been made in the debate, from both sides of the House, as a warning shot across the bows.
I am grateful to my hon. Friend the Member for Putney (Mr. Mellor) for raising the question of the future of Westminster hospital, and I compliment him on the way in which he has presented his case, reinforced as he was by two of his hon. Friends and a former Secretary of State. The hospital also has a friend who is, perforce, silent in this House but who is active in the interests of the hospital outside the House, my hon. Friend the Member for City of London and Westminster, South (Mr. Brooke), who is in his place at the moment.
This is a subject which has caused much public concern, and I see that the subject is reported yet again in this evening's newspapers. Westminster has a long and distinguished tradition both as a hospital and a medical school. Many hon. Members have reason to be grateful to the staff of the hospital for the help and treatment that they have received, and some, as we have heard this evening, even owe their lives to the hospital.
Eighteen months ago, I had occasion to visit the hospital with a cracked rib. 1589 I was given excellent personal service by the staff. Owing to my unusual height, three X-rays of my rib cage had to be taken, but it would be churlish of me to hold that against the hospital.
I am aware that many right hon. and hon. Members have signed an early-day motion on the subject. Nobody can deny that Westminster is a much-loved and valuable hospital. My hon. Friend, as a special trustee of the hospital, knows this better than I do, and he has eloquently drawn our attention to the contribution which the hospital has made in many areas. I endorse what he said about the fine record of the hospital.
I equally understand the anxieties which the staff and patients at the hospital and those at the medical school must feel. The efforts which they have put into the campaign to save the hospital is evidence of their commitment to it, and I must say that they have conducted that campaign with commendable restraint and intelligence. I know that for them this is a difficult time, and I sympathise with them.
However, it is important that a legitimate and serious debate should be allowed to run its course whether or not one agrees with the remedies that have been proposed. I can assure hon. Members, and indeed the staff, that the points which have been put in this debate will not be ignored. I accept that there is a strong case for resolving as soon as possible the planning blight which has descended on the hospital. I hope that we can resolve it without, in the words of my hon. Friend, " bloodshed and strife ".
In response to what my hon. Friend the Member for Sevenoaks (Mr. Wolfson) said, may I say that there is a complex relationship between medical education and the provision of health services? This relationship is described quite well in the report of the consortium. My right hon. Friend will have to make any decision that falls to him in full knowledge of that relationship. I make it clear that the Government have taken no decision to close the hospital.
May I explain briefly what the position is? We are concerned with two reports. The Flowers report was produced by a working party set up by the University of London under the chairmanship of Lord 1590 Flowers. Its job was to look at the way in which resources were used within the University of London for medical education and to suggest what changes were needed. The report proposed that radical changes should be made in the organisation of the medical schools and the postgraduate institutes. From a total of 34 separate institutions, the report envisages the creation of six new combined medical and dental schools. In this process, it envisages the complete closure of Westminster medical school.
Although the report is of widespread interest, it is concerned with the internal organisation of the university and, as a self-governing body, the university must decide itself how far it wishes to pursue the proposals. It would be wrong for me to comment at this stage on the proposals to close the Westminster medical school. None the less, the vice-chancellor has said that he wishes the report to be carefully considered and has invited anyone who wishes to submit views to do so within the next month. The report, and the views expressed on it, will then be considered by the appropriate machinery within the university before it reaches its decisions. I understand that a decision will be reached by the university by the end of July.
The second report, which appeared in parallel, was produced by the London Health Planning Consortium. As my hon. Friend said, that was set up in 1978 and was made up of officers of the main bodies concerned with the Health Service and medical education in London. It has produced a number of reports, the latest being entitled " Towards a balance ". This document suggests that major changes are needed in the level of hospital services in London and gives the consortium's views on how those changes should be brought about. It identifies a framework of major hospital groupings for each part of London around which health services might be planned in future. The consortium proposes that one of these groupings should be formed by linking Westminster hospital with St. Thomas's hospital. It proposes that the majority of acute services within this grouping should be provided in the new St. Thomas's hospital. There is no suggestion in that report that Westminster hospital should be closed. But it would be envisaged that the role of the hospital 1591 should be different, and the report suggests that it should provide a different range of services.
The hospital has good facilities which have been developed and improved in recent years. As has been said in the debate, the facilities will need to be used effectively, even if for some other purpose than at present. I shall not speculate at this stage on what that use might be, because consideration of that report is at an early stage and no decisions have been taken. The report has been issued as a basis for discussion, and my right hon. Friend has made it clear that he wishes to see the fullest public debate before he considers the proposals. I shall return to the way in which that report is to be dealt with.
The consortium has asked to be informed of the views of health authorities, the university and others, but it would not be for the consortium to decide what action to take. It has no executive role and can only make planning proposals, as it has done so far. I understand that it will be giving consideration during June and July to representations. Its revised views will be referred to the London advisory group in about August, and Ministers will be advised some time in September or October.
The Government's views on the structure of the NHS are well known. We intend to move towards a simplification of the structure over the next two or three years. We are determined that changes should take place in London on the same time scale as the rest of the country. Some of the most urgent and difficult structural problems are to be found in London—I say that as a London Member. But, before decisions about the future structure of the Health Service in London can be taken, it will be necessary to know what the strategic pattern of hospital services should be. It is important, therefore, that the issues 1592 raised by the consortium should be resolved. That does not mean that its proposals will necessarily be pursued, but we must be satisfied that we have the right basis on which to develop London's hospital services over the next 20 years.
Clearly, there are major issues to be resolved and important decisions to be taken. My right hon. Friend is anxious that the decisions that he takes are based on an appreciation of the full range of views and evidence which may be expressed. He is concerned that, in reaching these decisions, he should have available to him broadly-based advice reflecting the views of all interested parties. For this reason, he has decided to establish a London advisory group which will be called upon to consider not only the issues raised by the reports of the London Health Planning Consortium but the proposals which will be made by the regional health authorities for the restructuring of the Health Service. The group will not advise on the Flowers report which, as I have said, is a matter that, in the first instance, the university must resolve.
However, it will be the advisory group's task to look at the whole range of views which have been expressed on reports by the consortium. It will act as a " jury " weighing the evidence—not just the conclusions of the consortium, but any other proposals put up by people in the field—and considering everybody's views. I undertake to ensure that all the views expressed in this debate will be available to the advisory group. The group will then advise my right hon Friend on the best course of action. But, in the final analysis, he will be the judge. He will make the final decision on the Health Service issues. But I know that at the forefront of his mind he will have some of the points that have been made in this important debate.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-three minutes past One o'clock.