SKIPTON GENERAL HOSPITAL (PATHOLOGY DEPARTMENT) (Hansard, 1 February 1980)

§ Mr. John Watson (Skipton)

I am grateful for the opportunity to draw the House's attention to the problem that will face my constituency of Skipton if the proposal of the Bradford area health authority to close the pathology department at our local hospital proceeds. This is a relatively straightforward matter. We have a general hospital in Skipton which has a pathology department. Five miles away in Airedale there is a larger hospital with a pathology department, which is bigger than ours. There is now a proposal from the Bradford area health authority that clinical testing facilities should no longer be made available at Skipton and that everything should be transferred to Airedale. The proposal has been supported, after much discussion, by the Airedale community health council and one or two other related organisations.

Unusually, the proposed closure of the pathology department at Skipton is not 1829 caused predominantly by financial considerations. It is true that there will be a slight financial saving if the closure goes ahead, but that is not uppermost in the minds of those concerned. The reasons are associated with the methods of analysis.

There are two tests which, until recently, were carried out at Skipton. These were the vitamin B12 analysis test and the folic acid test, which cannot be carried out now because the materials used for them are no longer available. Therefore, these tests have been transferred to the pathology department at Airedale, five miles away. The proposal of the health authority is consequent on that change. The authority says that if the tests are removed, there is no economic scope for continuing the employment at Skipton of two technicians in the pathology department. It claims that their standards of accuracy are likely to suffer and that all clinical testing should be moved to Airedale, which has the benefit of radio-isotope equipment.

If this proposal has been supported by the community health council, it has also been opposed by a considerable number of other organisations, particularly the Craven district council. Every local parish council which has expressed an opinion is opposed to the change, and every one of the 23 doctors concerned in the local area has been anxious to express opposition—and express it in print.

I have received a petition with approximately 5,000 signatures on it. That bears adequate testimony to the astonishing strength of feeling that such a relatively small proposal has generated in Skipton. It is that depth of feeling, more than anything else, that leads me to believe that the Minister should address his personal attention to the proposal.

May I ask the Minister to address himself to four aspects? First, I ask him to consider convenience and travel. Five miles may not seem a particularly long distance. However, that must be seen within the context of the great distances that apply to my Pennine constituency. If the testing facilities are removed to Airedale, some people will have to travel to Airedale—at a rate of about one per day—instead of to Skipton. If they come 1830 from the far north of the Craven district, that will involve a round trip of about 70 miles. I submit that that is a considerable degree of hardship.

Secondly, there is the "thin edge of the wedge" argument. We have already lost the ear, nose and throat clinic at Skipton general hospital. We have lost our skin clinic as well. It is easy to envisage the pattern of events that might flow from the closure of the pathology department. Ultimately, it would mean losing all our consultancy services. Questions would then be asked about whether Skipton needed a hospital at all. It is distressingly significant that the new system for the collection of samples and sample taking in Skipton has been guaranteed only for one year.

Thirdly, there is the argument of technical analysis. From consulting local doctors it is apparent that there are three types of pathological tests that doctors require from the local hospital. First, they require the vitamin B12 and folic acid tests that I mentioned earlier. Those tests were done at Skipton, but they have now been moved to Airedale for understandable reasons. Those tests represent about 5 per cent. of all testing. Another 20 per cent. of tests involve those upon blood chemistry and related analyses. Those tests have already been carried out by the radio-isotope method at Airedale for several years. About 75 per cent. of required pathological testing is for testing haemoglobin, white blood cells, and pregnancy samples. Of all tests, it is that 75 per cent. that the area health authority is proposing to move to Airedale.

Everyone will acknowledge that the organic methods of testing that are currently employed at Skipton are not as accurate or precise as the radio-isotope methods that would be employed at Airedale. However, the advice of all local doctors is that while the method of analysis might be superior at Airedale, these tests do not need the extra degree of sophistication that Airedale can give. The doctors say that haemoglobin, white blood cells and pregnancy tests require a relatively simply "Yes" or "No" answer. There is no need for the expense and sophistication of radio-isotope testing for such cases.

My final point justifies ministerial attention, because it involves the simple 1831 weight of opinion. I have been a Member of the House only for a relatively short time, but during that time I have never experienced any constituency case upon which I have received more letters. I have never known my telephone to ring so frequently and noisily as upon this issue. Why are people so angry and upset about the proposal? Are they merely worried about travelling five extra miles? Are they just worried that two technicians will no longer be employed in Skipton? I conclude that they are not merely worried about those aspects, but that many people in Skipton are concerned that this is just one more service that has been provided in Skipton but that, for all sorts of administrative reasons—understandable in themselves—is to be moved to a greater center of population.

The underlying, almost unspoken, anxiety that this promotes in people is that in the town of Skipton, which has for generations been a center of commerce, distribution and service for the whole of the mid-Pennine region, we are gradually finding ourselves subordinated to the interests of Airedale, Bradford, Leeds and other places in West Yorkshire.

I very much hope that today the Minister will bear in mind that the policy of this Government is to keep our Health Service as locally based as possible, and will remember the words of my hon. Friend the Minister for Health when he says that it should be possible for local people to go into their local hospitals and meet there someone who has the power of decision. I entirely agree. If the present proposal of the Bradford area health authority is allowed to proceed, I do not believe that that will remain the case in Skipton.

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

I have listened very carefully to what my hon. Friend the Member for Skipton (Mr. Watson) has had to say about the proposals by the Bradford area health authority to transfer the pathology work from Skipton general hospital to the Airedale general hospital at Steelton and to close the pathology department at Skipton. My hon. Friend wrote to my hon. Friend the Minister for Health about this matter on 14 January, 1832 and I know from his letter that he shares the concern felt by many of his constituents. They are fortunate in having such a persuasive advocate in this House. It is because of that concern that he has spoken so forcefully today, and I am glad to have the opportunity to comment on some of the points that he has made.

Perhaps I may start by saying that it would be inappropriate for me at this stage to take sides in this debate. I make this point because I know that the Bradford area health authority has not yet finally decided whether it wishes to confirm its proposals for transferring pathology work from Skipton to Airedale. In fact, the period for submitting comments to the authority on its formal consultation document did not expire until yesterday. I am told that the matter is to be fully considered at the area health authority's meeting later this month, and it would not be right for me, therefore, to make any judgment at this stage about the merits of the proposals.

At this point, I think that it might be helpful to my hon. Friend if I say something about the procedures for the closure or change of use of Health Service buildings. My Department has laid down guidance on the procedures that health authorities are expected to follow in such circumstances. The procedures are designed to provide for a full process of consultation among health authorities, community health councils and other local interests on permanent or temporary proposals which amount to a substantial variation in local services.

Where, however, a health authority considers that urgent action is essential in the interests of the Health Service, it may truncate or dispense with local consultation, provided it keeps its community health council informed of its decisions.

Recently, the decisions of some authorities which have had to make urgent substantial temporary closures with little or no consultation because of the need to make financial savings have been challenged in the courts. As a result my Department issued further advice towards the end of last year. The aim of this was to confirm the existing guidance, clarify the procedures for temporary closures, remind authorities of their statutory obligations to community health councils, and make it clear that where closure is 1833 a matter of urgency, health authorities should consult as fully as possible in the time available. It also emphasises that a temporary closure cannot become permanent without proper consultation.

In most cases—where there are no grounds for urgent temporary action—formal consultations should generally be preceded by a period of informal consultation with local interests, linked to the planning procedures. Once this informal consultation has been completed, it is up to the area health authority concerned to decide whether to initiate formal consultations. If it decides to proceed, the AHA is required to produce a consultation document setting out the reasons for closure and the implications for patients and staff. This is sent to a wide range of local bodies, including the community health council and representatives of staff interests for comment. Health authorities are also required to inform Members of Parliament of the proposal at this stage.

If the AHA wishes to proceed with a proposal opposed by the community health council, the issue must be referred to the regional health authority, and, if the RHA supports the area health authority, to my right hon. Friend the Secretary of State for final decision. Where other local interests object to a proposal on which there is agreement between the area health authority and the community health council, my right hon. Friend the Secretary of State and I would hope that it would be possible to resolve the points of contention locally and we would not normally wish to intervene.

I have described the consultation procedures in some detail because I want to show that, for the most part, decisions about particular proposals can be made locally following a period of consultation. It is only in exceptional cases—for example, where there is strong local opposition supported by the community health council—that my right hon. Friend the Secretary of State is required to act as arbiter. Placing the emphasis on local decision-making seems essentially the right approach to me. It ensures that all those most directly concerned have a full opportunity to consider each case on its merits and to respond objectively to changing needs and ideas. I believe that that is the best way to make the most 1834 efficient use of the available resources for the benefit of the local community.

Having outlined the consultation procedures generally, I should like to say a few words about the reasons behind the particular proposals contained in the Bradford area health authority's consultation document on the transfer of pathology services from Skipton general hospital to Airedale general hospital, and here I believe that there is little dispute between myself and my hon. Friend on the facts of the case.

Until last year the pathology department at Skipton general hospital provided a service for the whole of the Airedale health district in testing vitamin B12 and folate levels in the blood—tests which are used in the investigation of anaemia. However, because of changes in the very complex techniques involved, it was becoming increasingly difficult to provide that particular service. In November last it became necessary to transfer that part of Skipton's work to the Airedale general hospital some eight miles away, at Steeton.

On the advice of the Airedale district management team, the Bradford area health authority decided that there was insufficient work remaining at the Skipton pathology department to enable it to function as a viable unit, especially since a full range of facilities was already available at Airedale general. Moreover, the authority took the view that there was likely to be greater confidence in the quality of the results of the tests in the larger laboratory at Airedale and that better use could be made of the two technicians working at Skipton in a larger laboratory than in a small and perhaps underused one. Looking at it positively, it is possible there would be a small amount of revenue funds accruing from the closure, if it took place, available for redeployment, and the pathology department could be used for some other health service purpose.

Accordingly, at its meeting in November, the Bradford area health authority agreed in principle to transfer the remaining pathology work from Skipton to Airedale and to close the Skipton pathology department. A formal consultation document was issued early in December seeking the comments of local interested groups. As I have already 1835 mentioned, that formal period of consultation has only just expired, and it would be inappropriate for me to comment on the merits of the proposals or to discuss in any detail the reaction of the local bodies consulted. I can say, however, as my hon. Friend confirmed, that the Airedale community health council, the North Yorkshire and Bradford family practitioner committees and the North Yorkshire local medical committee have supported the authority's proposal to transfer the pathology services from Skipton to Airedale. However, as my hon. Friend pointed out, other important local bodies have opposed the proposal.

As I have already said, it would be wrong of me to comment in detail on the proposals, but I can pass on some of the comments that I have obtained from the Bradford area health authority on the points raised by my hon. Friend.

The first point that I want to make is that the area health authority has stressed that the aim of the proposed transfer of the pathology work is to produce a better technical service and is not essentially a money-saving exercise. It would be wrong of me to pretend that Bradford area health authority is not facing financial difficulties, and I know that there are particular difficulties at present in the Airedale health district. I am assured by the authority, however, that the reasons underlying the present proposals are that Skipton general hospital pathology department does not have the modern facilities to undertake certain tests satisfactorily. It would not only be costly to improve the present facilities but to do so would be to duplicate facilities that are already available at the Airedale general hospital.

In addition, the authority considers the reduced work load could not be carried out economically. It strongly denies the suggestions that have been made that the proposals are the thin edge of the wedge and that further closures are planned for the Craven area. The authority tells me that it has no plans to reduce any of the health service facilities currently available in the Craven area, including facilities at Skipton general. It makes the point that the proposed transfer does not involve a reduction in the service provided to those who visit the hospital.

1836 The area health authtority has said that a number of Health Service improvements have taken place recently, or are planned, in the Craven area. I am pleased to learn that they include new X-ray equipment, which is currently being installed at Skipton general, and a recently completed capital scheme to improve facilities at the Raikeswood Lane geriatric hospital. In addition, I understand that work on the new health centre at Settle is due to be completed later this year and that there are plans to provide an extension to the Bentham health centre.

My hon. Friend mentioned more broadly the role of the hospital in the future of the Health Service. He will know the emphasis on "Patients First" in local decision-making. We shall shortly publish a document on hospital policy, in which his sentiments are reflected.

I very much hope that this information about the area health authority's efforts to improve health care provision in the Craven district is of some assurance to my hon. Friend and his constituents. I should like to comment on the area health authority's response to the other points that he has made today.

I appreciate local fears that the transfer of the pathology work to Airedale general will cause a deterioration in the service which general practitioners in the Craven district have hitherto enjoyed. There is no doubt that specimens for analysis, and, in some instances, patients will have to travel an additional distance to Airedale general, but the authority says that that will not affect the speed or efficiency of the service currently provided to general practitioners. In addition, the area health authority has made the point that Airedale general is only about eight miles from Skipton and that it estimates that at most only 20 patients a month will have to travel to Airedale general from the Craven district for tests. The majority of patients will still have tests taken at Skipton general, which will then be transported to Airedale for analysis. Moreover, the present arrangements for collecting specimens from general practitioners will continue, as will the blood collection service at Skipton.

The area health authority is aware that a number of general practitioners are concerned about difficulties in telephoning 1837 Airedale general. It has assured me that it is looking at the matter and, if it proves to be a problem, the area health authority will consider how best to overcome it.

The area health authority has assured me that every effort will be made to find suitable alternative posts for the staff employed at the Skipton pathology department. In particular, my hon. Friend may like to know that the two technicians working at Skipton will be offered posts at the Airedale general hospital.

My last point concerns the contention by some of my hon. Friend's constituents in general practice that most of the work currently dealt with at the Skipton pathology department is routine and does not need the specialist facilities available at Airedale. Although the area health authority agrees that much of the work being done at Skipton is of a fairly routine nature, its view is that a more reliable and more efficient service will be available at Airedale. I understand 1838 that it is often difficult to maintain consistently good quality control in a relatively small pathology department.

I said at the outset that I did not intend to take sides on this issue. I have tried not to do so, and I have concentrated instead on describing the background to the consultation procedures in general, and the reasons behind the specific proposals which are being considered by the Bradford area health authority. Of course, I have made some comment on some of the specific points of concern made by my hon. Friend, but I stress that they are the views of the area health authority, and should not be regarded as my opinion. I shall ensure that the area health authority is made fully aware of my hon. Friend's anxieties on this issue by forwarding to it a copy of his forceful speech on the subject so that it can look carefully at them before reaching a final decision.