§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Mather.]11.59 pm
§ Mr. Esmond Bulmer (Kidderminster)
I welcome this opportunity to put before the House the problems facing the Kidderminster hospital in pursuing its development programme. I have no need to emphasise to my hon. Friend the Under-Secretary the importance attached by my constituents to an efficient, well-equipped local hospital.
Kidderminster general hospital is a developing hospital which, over time and phasing, will from new buildings provide the bulk of all secondary care services for the Kidderminster health district.
I pay tribute to the staff of that hospital. The hospital has established an outstanding reputation for patient care. It has not enjoyed the capital investment that has been available to some neighbouring hospitals, and the staff have shown great imagination and dedication in meeting the difficulties placed upon them both by their Victorian inheritance—many of the buildings date from that period—and by the delay in the implementation of desirable new projects.
The purpose of seeking this debate is to bring to the Minister's attention two specific problems—the future character of maternity provision and the need for a new twin operating theatre. The first has been the subject of protracted, not to say excessive, deliberations and the second is a matter of budgetary priority to the health authority but a matter of life and death to my constituents.
1394 I turn first to maternity provision. There is great local concern about where mothers will have their babies in the mid-1980s. Looking at the figure for bookings in the Kidderminster health district over the period from June to November 1979, of the 630 bookings made, 305 were to hospitals outside the district. Bromsgrove took 190, Worcester and others 89, and the Queen Elizabeth, Birmingham, 26. Of the 320 booked into the two local maternity homes—the Croft and the Lucy Baldwin—157 were transferred to Bromsgrove and Worcester before labour commenced and 59 women were transferred while actually in labour.
I am sure that my hon. Friend will agree that it is highly undesirable for women in labour to be transferred considerable distances to outlying hospitals. He will also no doubt agree that it is highly desirable for Kidderminster to be able to offer a complete range of maternity services to its population. If the proposed unit is not given the go-ahead in the near future, even the present unsatisfactory arrangements will deteriorate. The Bromsgrove unit is moving to Redditch. It is certain that it will not be able to take the present number of maternity cases coming from the Kidderminster district.
The Birmingham and Worcester hospitals have indicated that in the future they will be unable to continue to provide the service thatthey are offering at the moment, and Dudley has also made clear that it will not be able to offer beds to Kidderminster on any scale. The strategy document prepared by the West Midlands regional health authority states thatA district general hospital should provide for the whole population of its district a full range of specialised treatment including a maternity unit.1395 As my hon. Friend will know, a development control plan for Kidderminster has been in existence for many years. Despite inevitable revision as the development has progressed, the plan has always contained provision for a consultant obstetric unit to serve the district's catchment population. This provision was never in question until about 18 months ago, when the related development of GP maternity services became the subject of consideration and consultation within the area.
The area health authority proposed that all GP maternity services should be centred on the general hospital site as part of phase 5, with their ultimate inclusion with the consultant unit, which will be provided within phase 6. At this point, and for the first time, the regional health authority, which had previously been committed to the development control plan, raised fundamental questions about the viability of a consultant obstetric unit because of the size of the catchment population—just over 100,000—and the annual number of births. These are currently above 1,300, rising to between 1,500 and 1,600 on projected population figures.
Because of various issues involving obstetric services, including the move of the consultant obstetric unit at Bromsgrove general hospital, which currently serves Kidderminster, to the site of the new Redditch district hospital at Woodrow, proposed for 1986, and the need to redevelop the maternity facilities in Worcester, the regional health authority asked the area health authority to produce an area strategy for obstetric services. The area health authority responded by establishing a sub-committee to give detailed consideration to the problem. The sub-committee confirmed the original strategy to house GP maternity facilities on the general hospital site and established that the Kidderminster district should have a consultant obstetric unit.
Those recommendations were unanimously accepted by the area health authority. The regional health authority's response was to give the matter "unresolved issue" status within the context of the regional strategy, as the AHA's resolution ran counter to the regional policy for obstetric units—that is, a minimum of 1,500 births per annum.
1396 It is the AHA's contention that the Kidderminster district should have a consultant obstetric unit, first, because the district is self-sufficient across the range of main facilities, with this one fundamental exception. Secondly, the Kidderminster district has a discrete natural population, with about 90 per cent. residing within the urban area of Bewdley, Kidderminster and Stourport. Indeed, that is the largest concentration of population in the whole of Worcestershire, and it is expanding. Thirdly, the present consultant service provided from Bromsgrove general hospital, about 15 miles away, will cease when this unit, designed exclusively in any case for the Bromsgrove-Redditch catchment area, moves yet further away to the new district general hospital on the Woodrow site at Redditch. Fourthly, there are no other options for the provision of this vital service outside the Kidderminster district which present as effective a solution as that originally proposed by the AHA—that is, to provide a unit on the Kidderminster general hospital site.
It is of particular concern that no firm decision has yet been made. The AHA has proposed that a consultant obstetric unit should be built as part of phase 6 of the main hospital development, but it is as yet unprogrammed within the region's 10-year strategy. Phase 5 is likely to be completed in 1982. The Woodrow development is due for completion in 1986, and by then Kidderminster should have an effective alternative service, which, in the AHA's view, should be within the district.
The absence of a decision on this pressing issue will lead to the real possibility that a large number of Kidderminster mothers-to-be will have to seek consultancy facilities from any one of a number of centres outside the district and even further a field than now.
I understand that the present opposition to a unit in Kidderminster is based on standards established by the Royal College of Obstetricians and Gynaecologists and the British Paediatric Association. While there is an undeniable need for high standards of obstetric care, these recommendations need to be applied within the context of the hospital needs of particular populations.
I am aware, as is the AHA, of the arguments set out against the authority's 1397 policy. It is important to emphasise, however, that the AHA's commitment is a considered policy, arrived at after due account had been taken of the problems, as well as the obvious advantages. I can see no good reasons why the authority's view should not prevail. The absence of firm decision not only creates considerable uncertainty and conflict but leaves the Kidderminster community with the fear that no adequate provision will be made in time to meet its obvious needs.
This fear is compounded by the concern that further reorganisation of administration in the Health Service may for a period make it more difficult to obtain the necessary decisions on time. I hope that my hon. Friend will be able to allay such fears by confirming that an early decision will be made. I trust that that decision will confirm the area's view that Kidderminster should have a consultant unit.
I turn now to the urgent need for increased theatre capacity at the hospital. This is particularly urgent if Kidderminster is to have a consultant unit in future. A survey in 1979 showed that the existing theatres were grossly overworked. There is a 91 per cent occupancy, which is the highest in the region. The number of cases handled has doubled in the last 10 years. The problems created are severe. If nothing is done, the consequences are likely to be catastrophic, with a real fear that life will be endangered.
I should like to spell out some of the problems to my hon. Friend. The first is the distress caused to individuals. Recently a 10-year-old girl was admitted in the morning with acute abdominal pains. Because of the work load, she could not be operated on until 8 pm, by which time she was hysterical. If any of us paused for a moment to put ourselves in the position of the parent of that child, I think that we would feel that we would move heaven and earth to see that that experience was not undergone by anybody else.
On another morning when a major accident casualty was taken to the theatre, four orthopaedic cases were cancelled, one of which was a Charnley hip replacement, and the patient had to be turned back from the theatre.
1398 The staff have been forced to take cases—which should have been dealt with in the main operating theatre—either to the minor operating theatre, which is totally unsuitable, or even to the wards. Pressure on the theatre means that it is virtually impossible to carry out a planned programme of maintenance as scheduled. This in turn means that there is a real risk to health from infection and that an excessive use has to be made of antibiotics.
The staff are under pressure because of the number of hours that the theatre is working, and there is the added pressure of all specialties working in two theatres. Home life is disrupted and holidays are lost. The conditions are such that the Royal College of Surgeons has commented unfavourably.
Mr. Roper Hall, in his report on the hospital, said:I am sorry to have to inform you for the reasons given in the visitors' report that recognition cannot be granted at the present time for an S.H.O. post in ophthalmology.He went on:The theatre accommodation is limited to two operating rooms of the four originally planned. This has disadvantages which have already been commented upon in a report by Mr. Wakeley of the Board of Surgical Training. It has the unfortunate result that the use to which each theatre is put is multiple and there is no separation to allow elective clean surgery to be performed in a theatre allocated for that purpose. This has already been criticised in respect of orthopaedic surgery. As far as ophthalmology is concerned one of the consultants operates in one theatre and the other in the other. It would be helpful if the theatre complex were completed by the addition of the two additional theatres, one of which could be devoted to the requirements for ophthalmic microsurgery shared with other suitable disciplines.Mr. Wakeley commented further on the work load:The waiting lists are also increasing in size and this is due to the fact that there are only two operating theatres for the whole of this hospital. There is no doubt that the two further theatres planned for this hospital should be put in hand as a matter of the highest priority. This would not only allow more operating to go on and give a better service to the patients but it would also allow the orthopaedic surgeons to do their hip replacements in a more favourable atmosphere of their own theatre. It would further enhance the fact that more gynaecology and obstetrics could be done at Kidderminster thereby improving the training for the trainee anaesthetists. I have, therefore, no hesitation whatsoever to say that the implementation of 1399 putting two further theatres in this hospital should have the highest priority.He concluded:I feel that these jobs should be recognised for 2 to 2½ years and then re-inspected to see that there is implementation of the theatre project so that there are two further theatres.Should the new operating theatre not be introduced shortly, Kidderminster is faced with the possibility of the withdrawal of recognition by the Royal College of Surgeons, with all the implications that that has for future staffing. Prospective consultant surgeons were deterred by the present inadequate facilities from applying for a recent vacancy.
Should recognition be withdrawn, the hospital will not attract doctors of sufficient calibre to maintain its present high level of service and junior staff presently employed there will obviously start to look round for jobs in hospitals with better facilities.
In a letter to the chairman of the surgical division at Kidderminster hospital, the chairman of the area health authority accepted the urgent need for additional theatres in Kidderminster but said that the capital resources currently available were not sufficient to allow this project to be included in the next five-year allocation.
I know that my right hon. Friend the Secretary of State and the other Ministers in the Department are determined to see that more money is available for patient care even if some of it has to be obtained by reducing the number of those currently employed in Health Service administration. I believe that among my constituents a new operating theatre would come top—or close to the top—of the list of projects on which they would wish their taxes to be spent. I believe that they understand the difficulties facing my right hon. Friend in funding the requirements of the Health Service at the present time and I know that they are right behind him in demanding a rigorous examination of priorities.
I welcome the proposed visit by the Secretary of State to Worcestershire later this month when he will visit Kidderminster hospital. He will have the opportunity to talk to those involved and to acquaint himself at first hand with their problems. If, after a further examination of the priorities of the authority, the Secretary of State is persuaded that the 1400 money for new operating theatres cannot be made available in the next two years, I hope that he and the health authority will consider the possibility of joint funding. Many people in my constituency will be prepared to contribute to the cost of the new theatres. We need them badly and we are determined to have them.
§ The Under-Secretary of State for Health and Social Security (Sir George Young)
I congratulate my hon. Friend the Member for Kidderminster (Mr. Bulmer) on securing this debate. Perhaps some might say that the first Adjournment debate of the new decade is only a minor milestone in the history of the House. What is certain is that for the people of Kidderminster this is a major debate, directed as it is to the future devolpment of their hospital.
I thank my hon. Friend for letting me know in advance some of the topics that he intended to raise. I thank him for making his case so cogently and persuasively. I appreciated in particular his kind words about the staff and I know that they will also appreciate them. There is little dispute about the facts of the case, which my hon. Friend has researched diligently.
It might be helpful if I said a few words about past developments at the Kidderminster hospital and then gave some details of the scheme that will be started shortly, and finally looked a little further into the future.
As my hon. Friend will know, acute hospital provision in the district, which serves a population of about 100,000, of which 90,000 are in Kidderminster, Bewdley and Stourport, is based on the general hospital. This hospital is split on two sites—the larger Bewdley Road branch, of about 270 acute beds, and the Mill Street branch, with out-patient, day hospital and long-stay geriatric facilities. There are additionally two small general practitioner maternity hospitals and a cottage hospital at Tenbury, just over the border with Salop. Future development at Kidderminster is planned for the Bewdley Road branch.
Up to now there have been four recent separate developments at the Bewdley Road branch of the Kidderminster general hospital. Phase 1, which was completed in 1968, consisted of twin operating theatres and X-ray suites, with administrative accommodation, a sterile supply 1401 unit and medical stall accommodation. Phase 2 comprised 116 acute beds, with a kitchen and dining room complex, stores, boiler house and workshops. Also included in this phase were nurses' residential accommodation and a training school, which was completed in 1972. Phase 3 comprised a psychiatric department of 60 beds and 80 day places. It was completed in August 1977 and forms part of the Worcester development project which my right hon. Friend is due to open formally later this month. Phase 4 provided a further 64 acute beds in May 1978. The proposals for phase 5 include a three-storey ward block of the design type known as "Nucleus", consisting of 34 children's beds, with assessment and outpatient facilities, 48 geriatric assessment beds and 28 general practitioner maternity beds, with an ante-natal clinic.
There will also be a new telephone exchange and facilities for uniform exchange and staff changing rooms. The ward block is essentially a replacement for an old block, which is structurally unsound and has a limited life, rather than an expansion of existing provision. Its content was the subject of protracted discussions at and between the area and regional health authorities, which were, I understand, resolved to the satisfaction of all parties.
It is hoped that work on this latest scheme, which will cost about £2 million, will start soon and be completed in 1982 or 1983. I think that it can be fairly said that the developments that I have described represent a quite steady rate of progress towards the modernisation of Kidderminster's acute hospital service.
Indeed, when I was told of these developments my reaction was that Kidderminster seemed to have done well as compared with some other parts of the country, although, as my hon. Friend the Member for Kidderminster said, other hospitals in his area may have done even better. But what of further phases at the general hospital? Here, the nub of the problem is whether Kidderminster should have its own consultant obstetric unit.
Perhaps I might at this point digress slightly to describe the difference between a consultant obstetric unit and a general practitioner maternity unit. In the former the expectant mother comes under the 1402 care of a consultant obstetrician who works from a particular hospital or hospitals. She may well attend ante- and post-natal clinics run by the obstetrician and his staff, and the delivery of her baby will be supervised by his team, which includes resident medical staff.
Such care is desirable when it is anticipated that the special skills of a consultant obstetrician and full hospital facilities, such as an aesthetic, paediatric and pathology services, are, or might be, needed. Where this is not the case, mothers-to-be may remain in the care of their general practitioner throughout their pregnancy, and the delivery and appropriate hospital facilities are often provided for this. Usually in a general practioner unit there is no resident member of medical staff.
Currently, patients from Kidderminster look to Bromsgrove, Birmingham or Worcester for consultant obstetric services, with the majority going to Bromsgrove. Consultant out-patient clinics are, and will continue to be, provided at Kidderminster, however, and this cuts down quite a bit of the travelling. Many mothers, of course, make use of the general practitioner maternity units at the Croft maternity home in Kidderminster and the Lucy Baldwin maternity hospital in Stourport-on-Severn.
The consultant unit at Bromsgrove is to be transferred to the first phase of the new Bromsgrove and Redditch district general hospital, which is to be built at Woodrow, on the outskirts of Redditch, about six miles further away from Kidderminster. I might say in passing that approval to proceed with the new Bromsgrove and Redditch hospital has recently been given by my Department, although, in view of the consequential changes that I have mentioned, I could well understand if that news was treated with rather less acclaim in Kidderminster than I expect it has been in Redditch. Because where will Kidderminster patients go when the Bromsgrove unit moves?
The Hereford and Worcester area health authority has, I understand, looked at all the possible alternatives and has concluded that consultant obstetric facilities should be provided at Kidderminster, as my hon. Friend said in his speech. It has therefore resolved that a consultant unit should be included in phase 6 of the 1403 Kidderminster general hospital development. The AHA also urges that the opening of such a unit should coincide with the transfer of the existing unit at Bromsgrove to Redditch.
The West Midlands regional health authority, which is responsible for major NHS capital developments throughout the region, considered this issue during the preparation of its recently published regional strategic plan, which covers the period up to 1988.
Unfortunately, this is one of a small number of issues that it has been unable to resolve. Apparently, on projected annual births, Kidderminster does not satisfy the RHA's criteria for a separate unit. The RHA is also concerned that the birth rate figures do not justify the appointment of the consultants which it feels is the minimum requirement to provide cover for such a unit, and problems are envisaged over the capacity to train sufficient midwives for units at both Redditch and Kidderminster.
§ Sir G. Young
I will make further inquiries about the date on which these forecasts were made and write to my hon. Friend. If it appears that he has more recent information which casts doubt on these projections, it is right that the matter should be looked at again.
Because of these doubts, the RHA has not felt able to include phase 6 of the Kidderminster general hospital in its proposed strategic capital programme for the period 1979–80 to 1988–89. I can well understand the concern of my hon. Friend and that of his constituents, but we are not, I think, at an impasse, and I have therefore to say that I do not believe that it would be appropriate for Ministers to intervene on this issue at present.
As I understand it, discussions on this issue are currently being held between regional, area and district officers, and I am sure we all hope that a solution can be found that will be acceptable to everyone. At member level there can be no doubt that the regional health authority will return to this question, either as part of its consideration of the results of its consultation on the regional strategic plan 1404 or separately as one of the unresolved issues.
I fully appreciate that my hon. Friend and the people of Kidderminster are pressing for an early decision and I understand the concern expressed in his remarks. I have no doubt that the regional health authority will take fully into account both the need for urgency, particularly in view of the progress in the planning of the new hospital at Redditch, and the general arguments put forward tonight with such conviction by my hon. Friend, and any new information that emerges on forecasts.
I know that my hon. Friend is concerned also about the provision of a twin operating theatre suite at the Kidderminster general hospital. I am told that the need for additional theatre capacity is recognised and that the development plan for the Bewdley Road site includes a further two theatres. I had enormous sympathy with the story that my hon. Friend told the House about the child waiting for her operation. Having recently emerged from hospital after a minor operation, I understand the concern that that child felt as she waited to be wheeled into the operating theatre.
The area strategic plan of the Hereford and Worcester AHA envisages that twin theatres at Kidderminster will be built during the current 10-year strategic period, but I understand that in the face of competing claims for other schemes this development cannot take place within the next five years.
Whilst I understand that there will have been disappointment over this, particularly in the light of the visitors' report from the Royal College of Surgeons, to which my hon. Friend referred, I hope that he will understand that Ministers are reluctant to dictate to authorities the order of priority to be accorded to schemes of this kind, because it is our firm intention that local people should be given more, not less, say in decisions over the provision of their health services.
Towards the end of his speech my hon. Friend mentioned the possibility of voluntary contributions playing a role in the provision of these facilities. He will know that the Health Services Bill, currently before the House, makes it easier for health authorities to tap additional sources of income of this kind.
1405 On Second Reading of the Health Services Bill, my right hon. Friend said:We all recognise that the Health Service is unable to meet all the demands made upon it. All Governments in recent years have found and every Secretary of State has had to make speeches explaining that there are waiting lists and that important projects must wait and why there is not enough money available. … At the same time, there is undoubtedly great public concern about the well-being of local hospital services, and there are welcome signs that more people want to do something about it. Of course, leagues of friends and other similar bodies can raise substantial sums and channel them into the Health Service. But it really seems absurd that health authorities themselves should not have power to appeal for funds to supplement what they get from my Department."—[Official Report, 19 December 1979; Vol. 976, c. 662.]My right hon. Friend was right to raise this option in his remarks, and I hope 1406 that those concerned will pursue it vigorously.
I am sure that tonight's debate will have been most useful, in that it has allowed a full discussion of the issues involved in hospital provision in Kidderminster and will be useful background information for the visit to which my right hon. Friend is looking forward to paying towards the end of this month.
For my part, I shall certainly directly draw the attention of both the regional and area health authorities to the points made in the debate, and they may wish to look at both these urgent matters again in the light of what my hon. Friend has said.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-seven minutes past Twelve o'clock.