HC Deb 28 February 1980 vol 979 cc1705-14

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

10.16 pm
Mr. Robert Edwards (Wolverhampton, South-East)

I greatly appreciate the opportunity to raise on the Adjournment a matter of vital importance. I realise that it is something of an anti-climax after a debate on the economy, but it relates to the matters that we have been discussing. We have been concerned today with the need to increase the totality of wealth production, and many Government Members referred to the effect of industrial disputes on production.

I wish to deal with the proposed closure of a specialist hospital that deals with rheumatoid arthritis. More working days are lost each year through rheumatic diseases than through industrial disputes. The latest figures show that in one year 24 million working days were lost in this country through certified rheumatoid arthritis. During the same period, only 9,100,000 days were lost through industrial disputes.

If there is any such thing as an English disease, it is rheumatism. We do not know enough about it. We do not do enough research. We do not know whether rheumatic diseases are hereditary or due to environment or working conditions. We do not spend enough money on the problem.

We are today facing the closure of one of our best hospitals, which for many years has specialised in treating people suffering the agony of arthritis and rheumatic disease. The hospital is not in my constituency, but many of my constituents are patients there. Indeed, 71 patients from Wolverhampton have been treated in this hospital. More than 100 patients from Bilston, which was previously part of my constituency, and more than 200 patients from Birmingham have been treated there. It is not simply a local hospital. It covers the whole of the West Midlands. Patients come from London, Birmingham, Liverpool and South Wales to be treated there. If any hospital in the country has a specialised knowledge of the disease and its associated agonies, it is this hospital.

The hospital keeps data on the patients, and it uses specialised drugs. It knows everything about the disease. To close it would be a dastardly crime. It would be the nth degree of human stupidity. A saving of £200,000 is involved. As the local committee has suggested, there will be no redundancies, so that sum could be cut by half. Therefore, a trivial sum of, say, £100,000 is involved. It is nothing compared with the work of the hospital. At present only the local committee at Bromsgrove has suggested the closure, and the matter still has to go before the area health council that meets tomorrow, Friday 29 February. That is why this short, modest debate is so appropriate.

I do not wish to bore the House at this late hour with a recital of the problems, but I feel compelled to read extracts from some of the letters that I have received. I have had scores of letters from constituents and from people all over the country. A petition, organised by the Friends of St. John Ambulance, has been signed by 3,000 people.

I should like to read extracts from one or two letters. A man aged 36 wrote: I urge you to do all you can to keep this hospital open as I was unable to walk with rheumatoid arthritis until I spent 8 weeks in the hospital, and as I am only 36 years of age this has meant that I have been able to resume full-time work as a sheet metal worker for the last 12 months. It is of vital importance to people like me that there is a place like this where we can go to be treated. Another constituent, an older lady who served in the WAAF during the war, wrote to me. Who knows—nobody knows—whether her contribution to the war effort was the cause of her problem? She says: I could not move a bone in my body at that time without being in great pain. At my arrival at St. John's I was given a thorough examination, put to bed. After having several blood tests I was found to have rheumatoid arthritis.…So you may have some idea of how ill I was. I could not lift my arms to feed myself. However, they did everything possible for me, giving me suitable drugs, and after 7 weeks of their care and treatment I was able to walk out of the hospital. I have received a petition from the patients in ward 7 at St. John's hospital which states: If St. John's is forced to close, it means many hundreds of people…are getting progressively worse, and could end up either chair-bound or house-bound, with more calls on other social services. Most important is the confidence a patient has in the treatment given by the staff…How will the patients manage, some coming from so far afield, as there is no hospital in their areas who do this specialised work. I received another composite letter from the patients in ward 3 of the hospital: The close work and the detailed attention given to the treatment of the disease in this hospital is beyond praise. The expert staff treat patients from all parts of the country with a high percentage of success. I could go on quoting from detailed letter after letter.

I also received a note from the major doctor in the hospital, Dr. Popert, who says that he feels that the suggested transfer of patients to another hospital in Bromsgrove would not be practical and would virtually mean the end of this specialised treatment. He is a doctor who knows more about these diseases, in my opinion, than any other man in the country.

Having stated the local position, I should like to say a few words about the national position, to highlight the nature of the problem that we are dealing with in this modest localised debate. In 1973, 22,200,000 working days were lost by working people suffering from rheumatic diseases. In that year, only 11,800,000 working days were lost through strikes. In 1974, 21,400,000 working days were lost through rheumatic diseases, whereas in that year only 9,700,000 days were lost through strikes. I can go on. In 1976, 24,300,000 working days were lost through rheumatic diseases as against 5,500,000 lost through strikes. The latest figures I have are for the year 1977, when 28,100,000 days were lost by people who were certified to be suffering from rheumatic diseases as against 9,500,000 that were lost through strikes.

Of course, the media talk about the evil British disease—the industrial disease of strikes—yet here we have the real cause of the reduction of wealth production in the country—certified sickness. If anybody doubts that, let me give the House the latest figures that I have. In the year 1977, 353 million working days were lost through sickness and of that figure 28 million were lost through rheumatic diseases. In those circumstances, how can any Government reduce and diminish what is being done to treat rheumatic diseases? We do not do enough. We do not know enough. We have to spend more money, not less.

The hon. Member for Bromsgrove and Redditch (Mr. Miller), who is not in his place, has, to his credit, taken up this matter, as was his duty, and has asked the Minister to visit the hospital and discuss with the people concerned the proposed closure. The Minister has so far not been able to make a visit. I do not blame him. He has been involved each Friday, in his limited time, with the Abortion (Amendment) Bill. However, I hope that he will take an early opportunity to visit the area.

I hope that the Minister will take account of the committee that has been set up to defend this hospital—the League of Rights for St. John's Hospital—and the petition with 3,000 signatures from local people representing local opinion. I hope that he will end the nonsense of cutting back on important specialised hospitalisation which is doing an important job for people whose lives are a nightmare of pain. Many people have been relieved of that nightmare and are now able to lead a healthy, active, working life.

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

I congratulate the hon. Member for Wolverhampton, South-East (Mr. Edwards) on securing this debate, giving me, as it does, an opportunity to clear up some of the misunderstandings that may have arisen about the future of St. John's hospital, Droitwich. I hope to allay some of the concern that has been expressed. I also thank the hon. Member for letting me know in advance some of the issues that he intended to raise tonight.

The hon. Gentleman spoke with knowledge and feeling about the subject, read some very moving letters from those who suffer from rheumatism and presented the House with some interesting statistics about days lost from rheumatism contrasted with days lost from industrial disputes.

Although it might be an exaggeration to say that my Department has received a deluge of complaints and representations about St. John's, there has certainly been a steady shower. Reflecting, I am sure, the work done at St. John's, the showers have been fairly widespread across the West Midlands and beyond. It would not, I fear, be practicable to refer to all hon. Members on both sides of the House and to all the organisations who have made representations to us, but I should like to mention especially the concern expressed by the League of Friends of Droitwich Hospitals and by my hon. Friend the Member for Bromsgrove and Redditch (Mr. Miller).

I also have an obvious and clear duty to report the views of my right hon. Friend the Member for Worcester (Mr. Walker), in whose constituency the hospital is situated. He has conveyed to me the anxieties of his constituents, the patients and the staff at the proposed closure of what he sees as a fine hospital with a great reputation. I shall pass on to my hon. Friend the Minister of State the kind offer of a visit which was extended.

Mr. Iain Mills (Meriden)

I am grateful to my hon. Friend for allowing me to add to his list in my brief intervention. I have recently received a petition, comprising signatures of people from as far from Droitwich as Chelmsley Wood, testifying that they have benefited enormously from the services of St. John's hospital. Droitwich. I humbly beg my hon. Friend to do what he can in this respect.

Sir G. Young

My hon. Friend the Member for Meriden (Mr. Mills), who I am pleased to see in his place, underlines what I have just said. The importance of this hospital extends far beyond the boundaries of the constituency in which it is located.

I should like to state categorically at the outset that no decision has been taken to close St. John's, nor, indeed, is any final decision imminent. I shall be referring shortly to the various stages that have normally to be gone through before a hospital can be closed. As the final stage might involve a decision by Ministers in my Department, it would not be proper for me to pre-empt that decision or the decision of the relevant health authorities at this very early stage. What I should like to do is to set out a framework giving some of the factors that we will take into account should the issue come before us. The area and regional health authorities might also like to take these factors into account.

St. John's hospital, which has 57 beds, and Highfield hospital, with 63 beds, together comprise the Droitwich Centre for Rheumatic and Locomotor Disorders. They jointly provide a sub-regional service in rheumatology and rehabilitation. Although both are located in Droitwich, and thus within the geographical boundaries of the Worcester health district, the two hospitals are administered by the Bromsgrove and Redditch health district. Bromsgrove and Redditch health district is one of four within the Hereford and Worcester area health authority.

In 1978, St. John's hospital treated something like 600 patients. Of these, only 4 per cent. came from the Bromsgrove and Redditch district itself. Some 25 per cent. came from other districts in the Hereford and Worcester area health authority, and no fewer than 56 per cent. came from other areas in the West Midlands region. The remaining 15 per cent. came from outside the region. The same story applies to Highfield hospital, where the number of cases treated is slightly higher. At the Droitwich centre there is a specialist medical staff made up of three consultant physicians and a consultant rheumatologist, all of whom have beds at St. John's.

In addition, three orthopaedic surgeons with a number of sessions at the centre carry out hip operations in their respective theatres and return their patients immediately for post-operative care at St. John's or Highfield. A general surgeon carries out hand surgery on St. John's patients and also holds an out-patient clinic at the hospital. There are a full-time physiotherapist and occupational therapist at St. John's, each having a separate room to treat their patients.

At Highfield, there is a team of seven physiotherapists with four helpers to carry out hydrotherapy and physiotherapy on patients from Highfield and St. John's. Similarly, there are six occupational therapists, an aide and a technician to carry out splint-making and undertake assessments so that the patients may return to their homes to carry out housework and so on with aids adapted to their particular condition.

The Droitwich centre is one of seven centres designated for rheumatology in the West Midlands region at present. These have been developed on a sub-regional basis. Rheumatological treatment is undertaken both by specialist rheumatologists and by physicians with a special interest. The specialty of rheumatology is characterised by its high outpatient work load.

Rheumatic disease is prevalent at all ages, but its incidence increases with age. Rheumatic diseases affect not only bones and joints but may affect tissues in the body including blood vessels, kidneys, skin, eyes, brain, heart and lungs. Some rheumatic diseases result from infection. Although there is no evidence that the incidence and prevalence of rheumatic disorders are any less in the West Midlands than nationally, there are many fewer consultants in rheumatology per head of population in this region than in any other region.

Similar deprivation is illustrated by the fact that proportionately eight times as many new out-patients are seen in the four Thames regions as in the West Midlands region. Thus, we have a picture of a relatively low level of development of rheumatology services in the region with respect to estimated demand. Indeed, the recently published regional strategic plan of the West Midlands regional health authority suggests that rheumatology should be accorded a higher priority than the other medical specialties. That is clearly a major factor that will have to be taken into account in considering the possible closure of St. John's.

I understand that the initial proposal to close St. John's hospital arose from an examination by the Bromsgrove and Redditch district management team of the district's financial position. In common with a large number of other districts, the team is having to look critically at its budget to see what scope there is for savings to keep within financial allocations. A large range of options have been and are being considered. Many of these do not involve a reduction in the level of patient services.

In suggesting that St. John's might be a possible candidate for closure, the team had in mind that the expenditure might be transferred to Hill Top hospital in Bromsgrove. This would, it was felt, assist in the commissioning of Hill Top as an orthopaedic and rheumatology unit, in conjunction with Highfield hospital, and there would, of course, be significant savings—of between £100,000 and £150,000 a year—in overheads from the St. John's buildings and services. It would also enable a more intensive and efficient use of the buildings, including the upgraded theatre, at Hill Top. But there would be an overall reduction in services of around 25 per cent., and I am sure that everyone would wish to avoid such a reduction if at all possible.

I understand that the district management team has started informal consultations with the staff. No doubt it will have been told in no uncertain terms of the strength of feelings on the issue. Detailed proposals are contained in the district plan which is to be submitted to a seminar of members of the Hereford and Worcester area health authority, tomorrow, Friday 29 February. As the hon. Gentleman implied, that seminar is not empowered to take decisions.

Any decision to involve the full closure procedure will have to be taken by a full meeting of the authority. I understand that the next meeting is due to take place on Friday 21 March, by which time, I am sure, the members will have had an opportunity to study the record of our proceedings here tonight.

It might be helpful if I make one or two general remarks on the financial situation facing the National Health Service and our attitude to closures in that context. In the national context, it is the Government's firm intention to continue the redistribution of resources in favour of the needier regions, and the West Midlands, as a relatively deprived region, will continue to be among those receiving a higher share of the available additional resources. The rate of progress towards equity will depend, however, on the level of additional resources that can be afforded to provide for the NHS. And this in turn depends, of course, on how soon the national economy responds to the Government's policies. It will also be affected by the intention that the process should be one of levelling up as far as possible. It is inevitable, therefore, that there will be some slowing down in the rate of progress over the next few years.

The Government attach the greatest importance to controlling expenditure and have stressed the need for health authorities to stay within their allocations. Many authorities are now searching for ways to save money, and to some it will seem that the temporary closure of a hospital is the only answer. I do not rule this out as a last resort, but such a decision must be reached only after the most careful exploration of all other possibilities. Where there is a need to cut back in order to avoid overspending, this must be done in the way that has least effect on patients. Closures always have an adverse effect and so must be avoided wherever possible.

Perhaps I should say that while we reluctantly accept that some temporary closures may have to be made for financial reasons, my fellow Ministers and I will not agree to permanent closures as a way out of short-term difficulties. Every permanent closure reduces the Health Service's precious stock of hospitals at a time when the country can ill afford to make good the loss, and the cumulative effect of a number of small closures can be substantial. Thus we are quite firm that permanent closure should occur only as a part of agreed long-term plans for the development or rationalisation of health services in a particular area.

Proposals for permanent closure will normally first appear in strategic plans well in advance of the intended closure date. These plans are widely consulted upon before being accepted for implementation by authorities. Nearer the time, the authority must undertake separate formal consultation on the closure in accordance with procedures laid down by the Department. These procedures are rather complex, but I shall try to summarise them.

Briefly, the AHA must issue a formal consultation document setting out its pro- posals to the community health councils and local authorities involved and to staff and professional interests. Three months are allowed for comment, and all comments must be passed to the CHC for any furthed observations it may wish to make. If the CHC does not object to closure, the AHA considers all the comments on its proposal and decides whether to close. If the CHC objects, it has to submit a counter-proposal to the AHA, which, if it wishes to proceed, must refer the matter to the RHA. The RHA, if it supports the case for closure, then submits the case to Ministers for a final decision.

I hope that my observations here tonight will have done something to reduce the concern so clearly felt about the future of St. John's.

It is, of course, right that the future should be widely discussed. But there is an unfortunate tendency now to believe that, because possible closure is being considered by local management, that course is inevitable. As I indicated at the outset, it would not be proper of me to give a firm decision here tonight about the future of St. John's, but I hope I have shown that there can be no question of a precipitate decision on closure being taken.

I am quite confident that the Hereford and Worcester area health authority and, if appropriate, the West Midlands regional health authority will look at this issue most carefully bearing in mind not only the local feeling expressed so forcefully here this evening and elsewhere but also the wider regional and national considerations to which I have referred.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Eleven o'clock.