§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Cope.]2.32 pm
§ Mr. Toby Jessel (Twickenham)
I am grateful for the opportunity to raise the subject of local hospital provision in the Twickenham constituency. Local hospitals are of great importance in any community and nowhere more than in Twickenham, which has several local hospitals which are greatly loved and valued.
The Minister for Health, my hon. Friend the Member for Reading, South (Dr. Vaughan), has repeatedly acknowledged and paid tribute to the work of small local hospitals. It is not just that many of them have excellent medical and surgical records; nor is it just that the beds are needed and that if they are closed room has to be found elsewhere, probably in district general hospitals and probably at roughly double the cost. Nor is it just that a small local hospital can save time and energy on the part of local general practitioners, patients or visiting relatives or save public money on transport costs. There is also the fact that local hospitals can involve the local community, and so help to cement the fabric of local community life. Thus, they have a social value in addition to their medical value.
All three of the hospitals that I shall mention in a moment have first-class leagues of friends, who do marvellous work in raising money and in giving moral support to centres of community life. I hope that my hon. Friend the Under-Secretary of State will reiterate the Government's attitude in support of the merits of these hospitals.
The three to which I wish to draw attention are St. Mary's hospital, Hampton, the Teddington Memorial hospital, and St. John's hospital, Twickenham.
Last autumn, St. Mary's, Hampton, seemed to be threatened with closure for economic reasons by the Kingston and Richmond area health authority. However, local doctors, councillors, the league of friends, trade unions, myself and other well-wishers got together and there was an eleventh-hour reprieve following a meeting that I arranged with my hon. Friend the Minister for Health and 1900 other meetings with the area health authority.
The trade unions' domestic staff members found that they could save £5,000 a year by using fresh instead of frozen vegetables, although it meant more work peeling them. The league of friends is raising £10,000. St. Mary's hospital is held in great affection. I hope that it may continue working for a very long time.
That also goes for the Memorial hospital, Teddington, which recently celebrated its fiftieth anniversary. That hospital has about 50 beds, which are nearly always full. It is a central and essential part of the local scene in Teddington, which is a community-minded place. The hospital goes in for a good deal of medium operations—the lesser major or larger minor operations—such as appendix, hernia, varicose veins and others. In June, building will commence on additional rooms financed by the league of friends. The hospital has a wonderful staff, contented patients and excellent liaison with local doctors.
All this is equally true of St. John's hospital, Twickenham. Last year, that hospital celebrated its hundredth anniversary. St. John's hospital is well established in Twickenham, which is the largest community within my constituency. That hospital, too, is regarded with great affection by local people. Those of my constituents who have been patients or have relatives who have been patients there always seem happy with the treatment that has been received. Those who have been patients are always full of praise for the medical and nursing staff.
Now I turn to general hospitals. Twickenham is served by two district general hospitals—the West Middlesex hospital at Isleworth and the Kingston hospital at Norbiton to the east of Kingston. Each hospital has a justifiably high reputation for both medical and surgical treatment. Each is about one mile outside the boundary of my constituency.
The majority of my constituents prefer to use the West Middlesex hospital, with which there are traditional links, because from three-quarters of my constituency there is relatively easy access, whereas at peak traffic hours, which now seem to comprise about four hours each day, ac- 1901 cess to Kingston hospital is more difficult. That is because, in order to get to the Kingston hospital, one has to cross a busy Thames bridge and go through a busy town centre. Many of those who seek to travel to Kingston hospital by bus have to change buses to do so.
National Health Service districts and boundaries are about to be reviewed, with the phasing out of one tier of the NHS administration. Will my hon. Friend assure me that the fullest local consultation will be carried out with the medical, nursing, community and local government interests in the areas before any decisions are taken?
Will he also assure me that those who want to go to the West Middlesex hospital or whose doctors wish to send them there may continue to do so and that the smaller number who wish to go to the Kingston hospital or whose doctors wish to send them there may likewise continue to do so?
I understand that the medical staff at the West Middlesex hospital fear that they will be put into a big new district with the new Charing Cross hospital, which is between Hammersmith and Fulham.
The West Middlesex hospital does not want that. Those concerned fear that it will be detrimental to the services to their patients from Twickenham, Hounslow and other places in its catchment area, because Charing Cross, as one of the great national teaching hospitals, would get the lion's share of available revenue. It would be like a bone with a big dog at one end and a smaller one at the other. I understand that the Charing Cross hospital does not want this arrangement either. I hope that it will not happen. I went to see the chairman and the chief administrator of the North-West Thames regional health authority two weeks ago, accompanied by my hon. Friend the Member for Fulham (Mr. Stevens), who agrees with me on this matter.
The Twickenham constituency technically is now within the Kingston and Richmond area health authority. Except for the districts of Hampton, Hampton Court and Hampton Wick, it is handled on an agency basis—sometimes called an overlap area—by the Ealing and Hounslow area health authority. That overlap has caused, as well as solved, 1902 some problems. It seems sensible that future district boundaries should reflect what actually happens—that is, that the majority of my constituents regard the West Middlesex as "their" general district hospital for major acute cases.
May I draw attention to two points in the document "Patients First", published last December and signed by my right hon. Friends the Secretaries of State for Social Services and for Wales? At the bottom of page 2 are the words:Where chance is needed, it should accord with the local needs of local communities. Therefore there must be flexibility both on what changes are made and on the timing of change.Later, at the bottom of page 10 and the top of page 11, one reads that the Government propose that the criteria for defining the districts should be as follows: first, social geography, secondly, catchment areas of local hospitals, thirdly, the size and range of facilities, and fourthly—I repeat, fourthly—links with local government. It is significant that the links with local government should be fourth.
However, the London Boroughs Association seems to be arguing that the health district boundaries should never cross borough boundaries. That policy is called "coterminosity". It is a monstrous word, but that is what it is called. I hope that the Minister will be able to assure me that, in accordance with the order of criteria in "Patients First", coterminosity will not be the main criterion.
I have learnt in discussion with the chairman and chief administrator of the North-West Thames regional health authority that they share my view on this. I hope that their recommendations to the Department later in the year will take that into account.
In any case, I hope that there will be no question of applying coterminosity in any doctrinaire or inflexible way. My constituency is in one sense unique. The Twickenham division comprises a little over half the London borough of Richmond upon Thames. It is the only one of the 32 London boroughs to straddle the River Thames and the only one which, under the 1963 Local Government Act, was made up from parts of two former counties—in this case, Middlesex and Surrey. All the others came entirely from within one county.
1903 I have consulted the London borough of Richmond upon Thames on this matter. I spoke yesterday to its leader, Councillor Morel, who had just been discussing the matter with the chairman of his social services committee and with his town clerk and director of social services, who were in the room with him when he telephoned me.
I understand that, although they would pay some regard to the concept of coterminosity, they share my concern that the strong links should continue between people of Twickenham, Whitton, Teddington and Hampton Hill and some of the people of Hampton with the West Middlesex hospital, which is particularly well geared to their needs. If such links were placed in jeopardy, I sense that the council would not wish coterminosity to be the paramount criterion. I emphasise that the needs of the people should take priority over administrative tidiness.
It would seem logical for the River Thames to be the boundary between the North-West Thames and South-West Thames regional authorities, perhaps with Kingston providing for Hampton and Hampton Wick on an agency basis, if that is what the people there want.
I have one reservation: I wish to be sure that nothing is done that may adversely affect the position of the three small local hospitals that I mentioned.
I wish to refer finally to Normansfield hospital, the mental hospital at Hampton Wick, which has gone through a deeply troubled period with a massive national inquiry. However, I shall not dwell on the past. Great efforts are being made by a dedicated staff to improve conditions for the patients, and I hear good reports of what they are achieving. I pay tribute to the staff, and to the Kingston and Richmond area health authority, who are striving to improve conditions for the patients.
In conclusion, will my hon. Friend tell the House about what is happening at Normansfield and how he sees the future of that hospital?
§ The Under-Secretary of State for Health and Social Security (Sir George Young)
My hon. Friend the Member for Twickenham (Mr. Jessel) has spoken with force and knowledge on these im- 1904 portant issues. I welcome this opportunity to comment on them.
My hon. Friend spoke warmly of three local hospitals in his constituency, and I should like to start by saying something about the Government's general approach to the pattern of hospital services. For the past 20 years, the policy of successive Administrations has been to develop district general hospitals, usually of between 600 and 900 beds, to provide specialised hospital services. The role envisaged by that policy for small hospitals outside the district general hospital has been severely limited. There has been a substantial number of hospital closures, leading to withdrawal of beds, change of use or reprovision in larger hospitals. In 1969, just under one-quarter of all non-psychiatric beds in England were in hospitals of more than 500 beds. By 1978 that figure had risen to one-third. Over the same period, the number of non-psychiatric hospitals with fewer than 50 beds fell by 138.
There are sound arguments for concentrating services in large district general hospitals. They are primarily clinical arguments, based on the premise that better medicine will be practised in these hospitals. New treatments and diagnostic techniques have been developed, enabling the services to identify and treat a wider range of clinical conditions than in the past. Those new techniques have been paralleled by increasing specialisation among doctors. To achieve optimum results, so the argument runs, those facilities need to be brought together in one place, namely, the district general hospital.
The Government understand that view, yet at the same time we are concerned that the drawbacks of concentrating hospital provision have not been given adequate weight by health authorities in drawing up their plans for services. First, there are the problems associated with large hospitals. They are often remote from a substantial part of their catchment population. They are often impersonal, which can be distressing for patients and visitors. They can suffer from poor internal communications, leading to low staff morale and industrial relations difficulties.
The second, and more significant, set of drawbacks to that policy of concentration concern its effect on communities 1905 that have come to rely on their small local hospital, and that was the argument developed by my hon. Friend. If that hospital is closed, patients and visitors may face lengthy and difficult journeys to reach the new hospital. That is true not only of rural areas. Communications, particularly public transport, can be poor in urban and suburban areas, too. Even where a local hospital is retained, the range of work it can undertake in future may be severely limited.
In short, the Government want to see a readjustment of the balance between clinical considerations on the one hand and the wider social implications of hospital policy on the other. We shall shortly be publishing a discussion paper setting out specific proposals for shifting this emphasis, and we hope that the paper will be read and considered widely.
Closure of a hospital has another effect, perhaps even more serious, namely, the loss of community pride. The Government believe that the wider role of the local hospital in the community has been seriously underestimated. One needs only to think of the immense amount of voluntary effort that goes into a local hospital to appreciate its importance to local people. We want to encourage this sort of effort as a valuable resource which should not be lost to the NHS.
Of the hospitals to which my hon. Friend referred, two—Teddington Memorial, and St. John's, Twickenham—would not be affected by the proposals that have been put forward by the Ealing, Hammersmith and Hounslow area health authority. I endorse the kind words of tribute that my hon. Friend paid to the staff and others associated with the work of the three hospitals.
My hon. Friend's tribute to the work of leagues of friends leads me to the question of voluntary work, which will always find a place in the hospital world, whether we are considering the small cottage hospital, the modern district general hospital or the large mental illness or mental handicap hospital dating from the last century. We recognise and gratefully acknowledge the past efforts of all volunteers, whether they have given of their time actually in hospitals or generously contributed to fund-raising appeals such as may have been organised by leagues of friends. I shall discuss later 1906 the Normansfield hospital and its league of friends, but for the moment I pay particular tribute to the league of friends of St. Mary's hospital, Hampton, who, faced with possible closure of their hospital, have offered a substantial sum of money as a means of assistance in keeping that hospital open. I commend the role that my hon. Friend played in initiating that appeal.
We recognise that there are gaps in service provision and an unevenness of standards across the country, much of which is perpetuated by financial constraints. On the other hand, there remains a great reservoir of good will and willingness to help, whether by voluntary work or voluntary financial contributions. There is little doubt that people can and do make efforts to improve local services. Apart from providing assistance to enable standards to be raised and gaps filled, voluntary effort helps to bring the hospital service nearer the community. People feel that a hospital to which they have made voluntary contributions is "their" hospital. I must reiterate that, whilst we wish to give every encouragement to volunteers who wish to help hospitals, it is no part of our policy to seek to use them to the detriment of the employment prospects of paid staff.
My hon. Friend has referred to the structure of the Health Service in his constituency and district general hospitals which care for his constituents, and he has detailed some of the changes he would like to see made. In general, we share his preference for small, locally based health authorities, responsive to the needs of the populations they serve. This is reflected in the proposals that we have set out in our consultative paper "Patients First". Consultations are now well under way; the closing date for comments is 30 April, and we hope to announce firm policy in the summer.
I can give my hon. Friend the two assurances that he sought. First, there will be full local consultation. Secondly, there will be freedom of GPs to refer patients to whichever hospital they wish, as at present.
If our proposals are confirmed after consultation, we shall ask regional health authorities—in the case of my hon. Friend's constituency this will be the South-West Thames regional health 1907 authority—to review area health authorities within their regions. In conducting the reviews, regions will be required to consult all appropriate local interests and make representations to Ministers, taking all comments fully and explicitly into account.
§ Mr. Jessel
Will my hon. Friend also obtain the view of the North-West Thames regional health authority?
§ Sir G. Young
Yes. I accept that part of my hon. Friend's constituency is served by the Ealing, Hammersmith and Hounslow AHA, which falls within the North-West Thames RHA. It would be appropriate for it to be involved as well.
I know that difficulties have been caused by the "overlap" in Twickenham, whereby many health services for the locality are provided by the Hounslow district of the Ealing, Hammersmith and Hounslow area health authority, whilst Twickenham itself is in the London borough of Richmond and geographically situated within the boundaries of the Kingston and Richmond area health authority. I am told that the main difficulty that this situation has caused is in collaboration between the health and local authorities, because so many authorities must be involved.
On matters such as jointly financed projects and joint planning generally, the London borough of Richmond, for example, has to deal with Kingston and Richmond area health authority, Hounslow health district and Roehampton health district, since there is a further overlap in the Barnes area. Clearly, this can be time-consuming and can be an obstacle to quick decisions and effective planning of services.
A further difficulty is that the localities which the two area health authorities serve do not coincide exactly for the different services provided. For example, acute services in Hampton are provided by Kingston and Richmond but services for the elderly are provided by Ealing, Hammersmith and Hounslow. This does not assist efficient bed management and it makes planning of services a more difficult and complex task.
I should not wish to pre-empt discussions in either South-West Thames or North-West Thames by commenting any more specifically this afternoon on the 1908 detailed points which my hon. Friend has made. I am sure that his views will make an important contribution to the consultations undertaken by South-West Thames and North-West Thames regional health authorities and will be given careful consideration when recommendations are being formulated. I will see that my hon. Friend's remarks are brought to their attention.
If my hon. Friend is dissatisfied with the terms of any recommendation ultimately made by the regional health authorities, it will, of course, be open to him at that stage to make representations direct to my right hon. Friend the Secretary of State, with whom, subject to parliamentary approval to the existing subordinate legislation, the final decision will rest. I can endorse what my hon. Friend said about coterminosity. This will not be a paramount consideration when we draw up the new boundaries.
The problems of restructuring in the Greater London area are likely to prove difficult. The Health Service in London is faced with a number of major issues which transcend the existing regional boundaries. Foremost among those is the problem of reconciling the decline in local populations served by the London teaching hospitals and the level of clinical facilities required for teaching purposes by their associated medical schools. The London health planning consortium, which was formed to tackle London planning issues and which comprises senior officers of the Thames regional health authorities, the postgraduate boards of governors, the University of London, the University Grants Committee and the DHSS, has recently published a series of reports which examine these issues in detail. In parallel, the University of London has issued the report of the Flowers committee on the future pattern of medical education in London.
Those reports call for decisions, many of which will be difficult and some contentious. Many will inevitably have implications for restructuring in London. My right hon. Friend the Secretary of State proposes to establish a high-level advisory group in London to assist him in reaching decisions which fall within his responsibility, including those arising from the university's decisions on the Flowers report.
1909 The group will include representatives of the DHSS, the University Grants Committee, the University of London, the four Thames regional health authorities, the postgraduate boards of governors, the Greater London Council and the London Boroughs Association. It will also include a small number of independent members, including the chairman. The membership and terms of reference of the group will be announced in due course.
My hon. Friend has spoken about Normansfield hospital. It would not be right for me to finish without mentioning some of the developments there since the hospital was last in the headlines when the committee of inquiry reported a year and a half ago. The committee of inquiry succeeded admirably in its daunting task of identifying the shortcomings at Normansfield, analysing a complex situation and recommending measures to be taken to put the hospital back on its feet again and ensure that there was no repetition of what happened there in the mid–1970s. Inevitably, the inquiry also led to a good deal of uncertainty which affected morale at the hospital. I am glad that we can put all this behind us now and look positively to the future.
The area health authority began to respond to the inquiry's findings before the report was published. In September 1978 it set up a task force whose objective was to see Normansfield through the difficult period following the publication of the report. The task force consisted of three experienced and motivated people: Dr. Joan Bicknell, a consultant psychiatrist, Mr. Terry Wood, a divisional nursing officer, both of whom moved from Botleys Park, a larger mental handicap hospital in Surrey, and Mr. Colin Edwin, an administrator.
I should straight away like to pay tribute to their unfailing commitment and hard work, which has done so much to put Normansfield back on the right road. The immediate task at Normansfield was to restore leadership and purpose to the hospital, and it is here that they have made the biggest contribution, without which nothing else could have followed.
When they started work, Normansfield had the services of a locum consultant psychiatrist, an acting senior nursing officer and an acting administrator. Low morale had left the hospital understaffed 1910 in all disciplines. They therefore set out straight away to recruit staff to bring their numbers nearer the level required to provide a decent service to Normansfield's residents. Their record has been impressive. Starting with primary medical care, there are now four general practitioners who have been specially trained in mental handicap, who each do five sessions at the hospital and also provide general on-call cover.
At the specialist level, consultants in paediatrics, ophthalmology, rehabilitation and other specialties are now all involved in the medical management of patients. These improvements have raised the standard of medical care given to Normansfield's residents and have made them better fitted to participate in recreational and educational activities and occupational therapy. There have been improvements on the nursing side under Mr. Wood, who has taken up the post of divisional nursing officer, which makes him responsible for nursing services at Normansfield and for the community nursing team based there.
One of the causes of the crisis which led to the inquiry was the collapse of communication and co-operation between staff. There is now a hospital management team at Normansfield, consisting of the task force members and Mr. John Parsons, the new hospital administrator, and one of its functions will be to ensure that all the staff at the hospital work together in caring for the patients. Proper channels of communication have been developed to facilitate this.
We are increasingly trying to place the emphasis on community care for the mentally handicapped now, and a community mental handicap team consisting of nurses, social workers and the consultant psychiatrist has been established and has initiated a good deal of work in the community. Out-patient sessions at Normans-field have started again and five short-term care beds have been made available to provide relief for families and for similar purposes. There are also four day places for those unable to attend adult training centres.
There have also been tremendous improvements in the physical environment at Normansfield, but, in view of the time that I have left, perhaps I can write to my hon. Friend and describe them in more detail.
§ Mr. Jessel
I am not sure whether I devoted a sufficient portion of my speech to the view of the West Middlesex hospital that it does not want to be linked with the Charing Cross hospital. I hope that my hon. Friend can assure me that he will give that matter very full weight.
§ Sir G. Young
My hon. Friend explained the reservations about placing both the West Middlesex and Charing Cross hospitals in the same health district. I can assure him that those reservations will be passed on to the regional health authority and that they will be taken fully into account.
I cannot let this opportunity pass without mentioning the new toy library at Normansfield, opened earlier this month by Mr. Brian Rix and paid for with funds raised by the friends of Normans-field. This is just one example of the friends' devotion to and hard work for the hospital, which is very much appreciated. We value highly the contribution of groups such as that, not only for their tangible achievements in fund-raising but for what they do for the morale of the hospitals which they support.
The task force has a good deal to be proud of. Its initial job of reconstruction complete, it has now been disbanded as such, but its members will continue their work as the hospital management 1912 team. But I am sure they would be the first to agree that, without the unfailing support and determination of the chairman and members of the Kingston and Richmond area health authority, as well as the officers, their task would have been so much more difficult. The authority is, I know, anxious that the new air of confidence and optimism should continue, but, in all fairness, I must point out that this authority, like many others, particularly in the London area, is having to consider very carefully the extent to which developments should take place against the background of the resources available to it. In many cases this has led to difficult and sometimes contentious decisions having to be made. Although it is too early to be precise about this area's plans for the coming financial year, certainly it will have difficult decisions to take in determining priorities in the area as a whole.
If further developments at Normans-field do not materialise at the same pace—
§ The Question having been proposed after half-past Two o'clock and the debate having continued for half an hour. Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at three minutes past Three o'clock.