HC Deb 30 June 1980 vol 987 cc1263-74

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

12.11 am
Mr. Fergus Montgomery (Altrincham and Sale)

In the previous debate hon. Members have spoken in the interests of their constituencies. I am pleased to be able to raise, even at 12.11 am, a matter of great concern to my constituents—South Trafford district hospital. That project has been subject to a great deal of delay. I wish to discover why the hospital development has not been approved in principle by the Department of Health and Social Security. I hope that my hon. Friend can end the uncertainty in his reply.

The first formal planning submission to the DHSS was made in June 1978. A revised stage 1 submission was made in May 1979. Further information in support of the submission was presented to the DHSS in March 1980. That information described in considerable detail the need and the nature of the proposed development.

I understand that my hon. Friend the Minister for Health is undertaking a review of all major hospital developments awaiting approval in principle. He apparently has certain criteria against which the developments are to be judged. First, there is a proposed upper limit of 600 beds for district services. Secondly, any consequential closures of small hospitals should be taken into consideration. If the South Trafford district hospital is judged against those criteria, the plans submitted will pass with flying colours. The total number of beds on completion would be 546, which is below the limit set. When phase 1 is completed, Denzell hospital with 19 geriatric beds will close. The premises of that hospital are on lease from the local authority. That lease is due to expire shortly.

No other closures are envisaged because of the need to maintain and expand local provision for the elderly, the elderly severely mentally infirm and the mentally handicapped. Those facilities are in great need in the South Trafford area. Ministerial approval has not been forthcoming, and I am curious to know why the decision has been delayed by the DHSS.

While the first formal planning submission was made to the DHSS in June 1978, the new hospital had been allocated a place in the regional health authority's capital programme as long ago as April 1976. It is more than four years since it went into the region's programme. At that time, the expected starting date for phase 1 of the scheme was 1980–81. By May 1980, the programme starting date had been put back to 1984–85.

The further delay is attributable, in part, to the regional health authority's adjustments to its capital programme to take account of the present financial climate and the additional delay also reflects the lack of a positive decision by the DHSS which has effectively held up detailed planning throughout the past year. It is not without significance that the plan has been firm in all major respects since 1977 and therefore the subsequent delays cannot be attributed to changes of intention or any other local circumstances.

I do not think that my hon. Friend the Under-Secretary or anyone else in the DHSS will deny the need for a new hospital in the South Trafford area. The project was being talked about in the 1960s, when it was felt that there was a need for a new hospital in the area.

In the submissions made to the DHSS the main objectives were, first, to make good the considerable existing deficiencies in hospital beds and day places in Trafford; secondly, to reorganise the acute services on a more efficient and economical footing, so that ultimately they will all be provided at Park hospital and the South Trafford district hospital—all will be provided in the area made up by Trafford—and, thirdly, to confirm that certain services—maternity, accident and emergency services—will continue to be provided for South Trafford residents in Manchester hospitals.

The need for the new hospital has been acknowledged by the RHA in its regional strategic plan of 1979 which stated that there was a well-defined need in South Trafford. It said: Even with the enhanced capital programme now intended for the North-Western Region it is impossible to contemplate the total rebuilding of any district general hospitals in the foreseeable future. This means that the phased redevelopment of district general hospitals on their existing site is, for the most part, the only possible proposition. However, in one or two cases where there is a well-defined need (e.g. South Trafford) or where the existing general hospital is already very large (e.g. Victoria Hospital, Blackpool) additional district general hospital sites will be required. Nothing could be more clearly stated.

The main alternative to the new South Trafford hospital would be to extend Wythenshawe hospital in Manchester, which would become a hospital of about 1,500 beds—a project that I should have thought would be totally at variance with the 600-bed limitation on size proposed by my hon. Friend the Minister for Health. The new South Trafford hospital is intended to complement the developing facilities at Park hospital in the constituency of my hon. Friend the Member for Stretford (Mr. Churchill) in meeting the major part of Trafford's future district hospital needs.

I recognise that certain services will continue to be provided from Manchester hospitals, but the plan will remedy directly the existing gross deficiencies of provisions for the elderly and the mentally ill. Indirectly, it will enable local hospital provision to be made for the mentally handicapped, where none now exists, through the alternative use of existing small hospitals and it will put the provision of acute services on a secure footing for the future.

The provision of a sound basis for acute services in South Trafford is a vital feature of the total plan, but the DHSS apparently finds it difficult to accept that feature of the plan. The debate about acute services has, in consequence, overshadowed and detracted from the force of the plan in recifying, at an early date, the acknowledged deficiencies in the priority services for the elderly and the mentally ill in Trafford.

We have also to consider the question of cost. In 1978, when DHSS approval was first sought, the cost of phase 1 of the hospital was about £9 million. Today it stands at approximately £15 million. Costs will undoubtedly escalate alongside any further delays.

Other excess costs, both direct and indirect, also derive from the uncertainty about future plans. For example, there are a large number of small acute hospitals in the Trafford area. Apparently it can be proved that the cost per inpatient day in an acute hospital with fewer than 50 beds is higher than in an acute hospital with over 300 beds. This is a measure of the relationship between fixed overheads—for services such as boilerhouse capacity, kitchen facilities, and so on—and the number of beds available.

For example, the 29 acute beds of the Sale and Brooklands hospital could be absorbed within one ward of a larger district general hospital, with virtually no increase in fixed overhead costs. However, the cost of maintaining the Sale and Brooklands hospital for long-stay geriatric patients would reduce considerably. A use of that kind for the hospital and for other existing hospitals in the Altrincham area would be much more appropriate to their size and location within the community. On the regional average cost figures for 1979 it is estimated that, for example, the cost of operating Sale and Brooklands hospital as a geriatric unit, instead of an acute unit, would show a saving of about £210,000 a year.

The absence of a decision about the South Trafford hospital inevitably leads to indecision elsewhere, since most of the plans for redevelopment of existing services are linked inextricably with intentions for the new hospital. This is of particular significance with regard to the small hospitals for which a change of use is planned. Like many of the hospitals in the North-West of England. they are old and in urgent and continuing need of renovation. The form of renovation adopted, however, will be different depending on whether the hospitals are to continue as acute units or are to be converted for long-stay purposes. Functional requirements are different, but, while capital investment must be maintained in the buildings if they are not to become dilapidated, the area health authority is not in a position, because of the uncertainty, to decide how best to invest.

I believe that the residents in my constituency are the recipients of a patchwork hospital service. Some parts of that service will continue by design to be provided in hospitals in other areas. But the present situation whereby residents from Altrincham and Sale are having to use geriatric and mental illness hospitals in Knutsford and Macclesfield causes serious problems.

I know of at least two elderly constituents who journey every week at great difficulty to Macclesfield to visit their respective spouses. It is a considerable journey for people who have no car and who have to make it by public transport. I cannot help feeling how much easier it would be for them if there were suitable hospitals in the South Trafford area.

The provision of those and other related services on a properly integrated basis within Trafford is bound to produce savings for the National Health Service, but, more important, a new South Trafford hospital will bring with it direct social benefits of a kind envisaged in the recent DHSS proposals, "Health Services—The Future Pattern of Hospital Provision in England". For the first time the people in the South of Trafford will have a central point of focus for their hospital services, and their existing hospitals, which are so well supported by voluntary effort, will largely continue in use.

The new district hospital would not serve only the people who live within the boundaries of South Trafford. It would also be of great value to the people living in the area of North Cheshire. Both Trafford council and the community health council have welcomed the prospect of a new hospital. No doubt they both realise that it will mean the provision of truly integrated health and social services within Trafford.

In a foreword to the consultative paper on the hospital services, my hon. Friend the Minister for Health says In the past Government has tended to prescribe a single basic pattern for the whole country. This is both unrealistic and undesirable. Different circumstances demand different solutions. Our aim is to establish a set of broad policies acceptable to the professional and other interests concerned and then to give health authorities the greatest possible discretion within these policies and within their financial allocations to arrange their services in the way best suited to their local circumstances. The area health authority and the regional health authority are in agreement that their financial resources should be used to build a new hospital in South Trafford. It has been shown that the hospital would comply with the broad policies of the DHSS. I feel, therefore, that the case is unanswerable. I hope that my hon. Friend, in his reply, will be the bearer of good news and give us in South Trafford the signal to go ahead with this scheme.

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

I am glad to have the opportunity of debating an issue which, I know, is of concern to the constituents of my hon. Friend the Member for Altrincham and Sale (Mr. Montgomery). He put his case eloquently and displayed a deep knowledge of health issues in his constituency, as those who know him would expect.

I hope that I shall be able to cover all the issues which my hon. Friend has raised, although I think I should say at the outset that I shall not be able on every point to give the definitive answer which I believe he would like to hear. There are good reasons for this, however, as I hope to show.

My hon. Friend has emphasised that there is a need for a decision to be made urgently on the proposed South Trafford district general hospital so that the starting date envisaged by the North-Western regional health authority of 1984–85 can be achieved. He suggested, politely, that discussions between the Department and the region have been unnecessarily protracted without reaching any firm conclusions.

I should like to answer this point first by going back for a moment over the history of the scheme. As my hon. Friend knows, a development in South Trafford has been under discussion for many years. Late in 1976, it was agreed that the region would prepare proposals for a new hospital there to be submitted to the Department. This submission was received by the Department about 18 months later, but, because of doubts about the scheme which had been proposed, this was withdrawn by the region and a second submission was made in May 1979. Since then, discussions have continued between the Department and the regional health authority with the aim of resolving a number of fundamental problems associated with the scheme which still remained.

These discussions merged into the review of hospital schemes initiated earlier this year by my hon. Friend the Minister for Health and to which my hon. Friend referred, and my officials gained the impression that the region had decided to regard the South Trafford scheme as non-urgent and, indeed, had taken it away to consider it afresh. However, I now understand that this is not the case and that discussions are to be resumed in the near future in the wider context of the long-term strategy for health services in Greater Manchester.

Before turning to the specific problems which I have mentioned, I should like to set the scene briefly by relating the services in South Trafford to those in what has been called inner Greater Manchester. The Trafford area health authority lies to the West of the city of Manchester and contains two main centres of population, divided by the River Mersey—Stretford and Urmston in the North, and Altrincham and Sale in the South. The Trafford metropolitan district to which the area health authority corresponds is an amalgamation of a number of metropolitan boroughs and urban districts in Cheshire and Lancashire, and, unlike most of the Greater Manchester authorities, lacks any historic identity.

The 1981 hospital planning or catchment population for the Trafford area is estimated by the regional health authority as 220,000. For hospital purposes, the area divides into two main parts which are defined by the distribution of the population and the lines of communication. Historically, geographically and socially, the two parts are quite distinct and communications between them are relatively poor for an urban area.

The northern portion looks for its services to the Park hospital at Davyhulme, which at present has 360 acute beds and is being developed into a district general hospital over a period of years. The RHA's capital programme includes schemes to add geriatric beds and beds for the elderly severely mentally infirm, which will bring the total number of beds to just under 500. There is no major hospital centre at present in the South of the area and some services are provided by a number of small local hospitals.

There are 164 acute beds at Altrincham general, the Sale and Brooklands memorial hospital and St. Anne's ENT hospital and 38 geriatric beds at Denzell hospital and Ashton-under-Mersey. The residents of South Trafford receive a substantial part of their acute services from Wythenshawe hospital in the South district of Manchester AHA, including maternity, accident and emergency and children's services for which there is no provision in South Trafford itself.

As my hon. Friend pointed out there are no mental illness beds in South Trafford and no geriatric beds other than the 38 which I have mentioned. Mental illness beds for North and South Trafford are at the newly upgraded Bridgewater hospital, which is in the Salford area but is managed by the Trafford AHA. Bridgewater also has geriatric beds, but I understand that these are at present used mainly by North Trafford residents.

The area as a whole exports 50 per cent. of its geriatric cases to Withington and Wythenshawe hospitals in south Manchester and 20 per cent. to the Merseyside region. South Trafford probably accounts for the bulk of these exports. But although patients are going to hospitals outside their own area there can be no doubt that relative to the region as a whole the population of Trafford enjoys a high level of service. Some of the hospitals which receive them are relatively close by.

As my hon. Friend has pointed out, the case for siting a new hospital in South Trafford rests most importantly on the need to remedy these deficiencies in geriatric, ESMI and mental illness provision in the area as a whole. I recognise the strength of local support for these objectives and regard them as entirely acceptable in themselves.

Let me say at once that I fully accept in principle the need to site these services locally and to provide, so far as is possible, acute geriatric and mental illness services in the same location as other acute specialties. I recognise that the RHA's plans to include 100 geriatric and ESMI beds, together with 80 day places in all, in phase 1 of the development would represent a substantial step towards remedying the gaps in provision. I am also aware that its proposal for 150 mental illness beds and 170 day places in phase 2 would enable the needs of the whole Trafford area for mental illness facilities to be met. My hon. Friend the Member for Stretford (Mr. Churchill), has also approached me on this subject.

I should like to confirm that the ultimate size of the new hospital as envisaged by the RHA does not conflict at all with our recent thinking on hospital size. At 489 beds, it is well within the range that we regard as viable.

When all this has been said, however, it is necessary to consider in a wider context the region's wish to accord high priority to a new hospital for South Trafford. It must be seen, first, against the background of the RHA's own declared strategy and in the light of the implications for other parts of the region of committing £12 million to a major capital development in this location. Secondly, any solution for South Trafford must find its place in the overall strategy for the inner part of the conurbation.

Finally, the number of closures which in the long term would result from the opening of the new district general hospital indicates that all the available options must be given the most careful consideration before being rejected. I will take each of these points in turn.

As I am sure my hon. Friend will agree, the pressures facing the North-Western region are considerable. The region has inherited some of the oldest hospital buildings in the country. Two-fifths of them were built before the turn of the century and more than half before 1918. There are also pockets of serious under-provision in particular services and particular localities. Some of the worst deficiencies—as in South Trafford—are in services for the elderly, especially those suffering from severe mental infirmity, and the mentally ill, and in facilities for the mentally handicapped.

Looking at the region as a whole, it is clear that in some places there are deficiencies almost right across the range of services. The strategic plan which the regional health authority published in July last year sets out a comprehensive programme for putting these deficiencies right. The region's declared aim—which I entirely commend—is that the filling of outright gaps in the level of services must command the highest priority, and that improving the location of services and replacing old buildings—desirable though both of them are—must take second place.

Against this background, it must be borne in mind that Trafford is the only area in the region which is significantly over-funded in relation to its resource allocation working party target. The proposed development would have the effect of giving priority to injecting extra resources into the area, while the residents of other areas face deficiencies in their services across the spectrum. I should need, therefore, to hear more convincing arguments than I have yet heard that relocation of beds in South Trafford is so vital in relation to the level of services which the residents at present receive, whether within the area or in South Manchester, that this priority can be regarded as equitable. After all, it is on the same principle of equity that the north-western RHA as a whole benefits under the RAWP arrangements in relation to the South-East.

I have already indicated that I find persuasive the case for developing geriatric, mental illness and ESMI services in the long run within the Trafford boundaries. Nevertheless, at a time when resources are constrained, developments which are desirable in themselves cannot all be given equally high priority. I am less clear about the region's plans to provide 140 acute beds—196 after phase 3—at the proposed hospital. The over-provision of acute beds compared with a shortage of long-stay facilities in Manchester is a well-recognised and thorny problem to which there are no easy or short-term answers. In my view, it can properly be considered only in the context of the strategy for the health services of the conurbation. I am therefore asking my officials to take forward, as a matter of urgency their discussions with the region on the future of Greater Manchester.

I turn to the question of closures. I must say that I feel some disquiet on learning that six or seven small hospitals would ultimately close as a result of opening the proposed district general hospital.

Mr. Montgomery

Which hospitals will be closed if the new district hospital is given the go-ahead?

Sir G. Young

I obtained the information from the RHA which will have the list of the six or seven hospitals which, in its view, will have to close. I shall ensure that my hon. Friend has that list as soon as possible.

On the face of it, this seems to run counter to our thinking on the development of hospital services, and I would certainly wish to be assured that all possible options had been explored before I could approve the South Trafford development as presently envisaged. Such options would include the possible development of community hospitals in the area and of other hospitals outside the area but accessible to Trafford residents. These are all matters to which I would expect the Department to give thorough consideration.

I realise that my hon. Friend the Member for Altrincham and Sale may find some, indeed most, of my answers disappointing, but I am sure he will agree that the commitment of £12 million can be approved only after thorough consideration, taking into account the broader aspects of Health Service policy which I have outlined.

To sum up, the issues which I am having explored as a matter of urgency are these. First, has the South Trafford scheme been given the priority which is merited by the relative needs of Trafford as compared with other areas in the region? Secondly, to what extent do the RHA's proposals make sense in the context of a strategy for Greater Manchester, taking into account the convenience to patients of crossing area boundaries? Thirdly, do the concomitant closures make sense? I have asked for the review of the long-term strategy for Greater Manchester to be carried out with all possible speed.

I agree about the need to resolve the uncertainty and blight that further delay would cause. My hon. Friend has served a useful purpose in outlining the consequences of continued indecision. My Department will do all that it can to come to a decision on these vital issues as quickly as possible.

Question put and agreed to.

Adjourned accordingly at twenty-one minutes to One o'clock.