§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Cope.]11.30 pm
§ Mr. Walter Johnson (Derby, South)
I wish to draw attention to the Minister's decision to transfer the neuroservice centre in the Derbyshire Royal infirmary to the University hospital, Nottingham.
The Minister will recall that a few weeks ago he met a deputation consisting of the chairman of the area health authority, three hon. Members, and the administrators of the area health authority and the district health authority. We were all convinced that we had made a very good case for the retention of the services in Derby. In fact, we were confident that the Minister would find in our favour.
All of us have been shocked to receive the Minister's reply to what we regarded as a very successful deputation. We were shocked not only by the fact that he has rejected our appeal but by the reply that we received, which we considered to be tardy and not to deal with the main issues raised with him by the deputation.
The Minister tries to minimise the effects of the change in his letter by stating that the regional health authority plans to retain 15 beds and specialised equipment in the outpatient department in Derby. Let me tell the House what the situation really is.
In the Derbyshire Royal infirmary there are 36 neurosurgical beds. In the Derwent hospital there are two neurosurgical beds. In the children's hospital there are eight neurosurgical beds. That makes a total of 46 beds. They are supported by up to six beds in the intensive care unit. If the neurosurgical provision at the Derbyshire Royal infirmary is transferred, the beds at the Derwent and children's hospitals will remain, but there will be no major neurosurgical operations at the Derbyshire Royal infirmary. The beds at the Derwent and children's hospitals will be used for investigations prior to operation and post-operative recovery.
It is envisaged that there would be one or two outpatient neurosurgery sessions per week, and to support these and the diagnostic investigations of inpatients at the Derwent and children's hospitals the present brain scanner and the specialised neurological and neuroradiological equipment at the DRI will be retained.
An important factor is that the consultants in neurosurgery would move their base from the DRI to the Queen's medical centre, which means a substantial loss of their presence in the DRI and day-to-day contact with consultants in other specialties—general medicine, general surgery, and so on.
The present provision is 16 neurological beds at the DRI, and it is envisaged that there will be a loss of one bed in due course. The consultants in neurology would transfer their base from the DRI to the Queen's medical centre. Again, that would mean a reduction in outpatient clinics at the DRI to one or two per week.
In addition to the loss of the presence, on a day-to-day basis, of the consultants in neurosurgery and neurology, there would be a similar loss of consultants in associated specialties, such as neuroradiology, neuroanaesthesia, neuropathology and neurophysiology. The loss of these 367 consultants represents a real loss in terms of expertise, which at the moment is readily available to consultants in all other specialties.
The net effect of this transfer of neurosurgery and associated specialist input simply means that the Derbyshire Royal infirmary would be regarded as a peripheral unit of the Queen's medical centre for these purposes and that there would be a consequent loss of status in the neurosciences to the DRI—a status that it has built up over the last 30 years.
In paragraph 18 of the consultative document on the proposed transfer of the neuroservices centre from the DRI to the University hospital, Nottingham, it is reported that theNottinghamshire AHA(T) have indicated that they would be unwilling recipients of the service, not because they do not want it, but because they consider the concentration of basic acute services in Nottingham to be a higher priority.It is apparent that subsequently, however, following the Minister of State's visit to the Queen's medical centre last year, the Nottinghamshire AHA(T) reconsidered its previously expressed view, having regard to the criticism by the Minister of the inability of the Nottinghamshire AHA(T) to open further phases of the QMC. It is therefore apparent that the transfer of the neuroservices to the QMC was seen as a way of utilising a large part of the QMC and meeting to some extent the Minister's criticisms.
When we met him the Minister indicated to us that he was very concerned about the non-opening of certain phases of the QMC and wished to be persuaded by us against his then provisional decision that this unit should be transferred in order to open further parts of the Queen's medical centre. It seems, therefore, that this approach has overridden the views of a large number of the public in South Derbyshire, bearing in mind that of the bodies consulted by the regional health authority 29 opposed the proposed move and 19 supported the move—a majority of 10 in favour of retention.
In the report by the regional team of officers—a report that was considered by the regional health authority on 11 August 1980—the team's views are that the proposals are evenly balanced between transferring the centre to the QMC and leaving it at the Derbyshire Royal infirmary.
Against that background one is drawn to the conclusion that the Minister's decision has been very considerably influenced by the views of the consultants, who would prefer to move to the Queen's medical centre, where they would be in close association with the medical school and supporting facilities, particularly for research purposes. However, the AHA has consistently argued that there is really no reason why the unit should not be developed as a teaching unit in association with Nottingham university, whilst being retained in the Derbyshire Royal infirmary. Indeed, the authority suggested that a chair in neurosurgery be established to further develop these links.
The RHA's proposal to transfer the neuroservices department from the DRI to the QMC is against the established policy of the RHA, which is to secure the distribution throughout the region of sub-regional units in major centres of population. Derby is clearly a major centre of population. Indeed, the recent decision of the Secretary of State to establish a district health authority in South Derbyshire, for a population in excess of half a million, adds to rather than detracts from this argument.
I wish to draw my remarks to a conclusion to allow the hon. Member for Belper (Mrs. Faith) and my hon. Friend 368 the Member for Derby, North (Mr. Whitehead) to take part in the debate., because they were also part of the deputation.
Bearing in mind our representations to the Minister a few weeks ago. I am very unhappy with the reply that we received, which did not answer the very effective case put by the deputation. I believe that the Minister is swayed by the fact that the Queen's medical centre in Nottingham is not being used effectively, and that he has not looked at the issue in the light of those circumstances. The Minister said that he has made a decision. I ask him to look again at the matter before a final decision is made and, if necessary, to consult the Secretary of State before the move takes place.
§ Mrs. Sheila Faith (Belper)
I am very grateful to the hon. Member for Derby, South (Mr. Johnson) for allowing me to participate in this debate, which is on a subject that is most important to my constituents, too.
I agree with all the points that have been made by the hon. Gentleman. I think that I am even more disappointed than he is by the Minister's decision, because I have to face the fact that it is a Conservative Minister who has taken this wholly regrettable decision. I am joined in my remarks by my hon. and learned Friend the Member for Burton (Mr. Lawrence).
Whilst Derbyshire is a deprived area in terms of health provision, the Derbyshire Royal infirmary is a beacon of light relieving an otherwise gloomy situation. It is one of the finest hospitals, and it maintains a very high standard. If ever there was an institution of proven worth it is the Derbyshire Royal infirmary.
On this point, I should like to refer my hon. Friend the Minister to the decision of the Secretary of State for Education and Science not to allow the Manchester local education authority to reorganise secondary education in that city because established schools would be damaged. The removal of the neuroservice unit from the Derbyshire Royal infirmary can well be likened to the removal of the sixth form from a comprehensive school, with all the diminution in status that would follow. It is surely the policy of a Conservative Government to preserve and not to damage in any way an institution that is giving such a wonderful service so satisfactorily.
In my privileged position as a member of the Select Committee on Social Services I have ascertained that the medical profession believes that specialised units should be established in district hospitals and not always placed in the teaching hospitals. It has been agreed by all that the dissemination of facilities would be of great value to doctors, nurses, patients and students; and yet here we have the very reverse process taking place. I hope that the Minister will tell us tonight that he will reconsider his decision and re-examine the facts.
§ Mr. Phillip Whitehead (Derby, North)
It falls to me to conclude the case for the prosecution in this sad business.
§ Mr. Whitehead
I apologise to my hon. Friend. I shall make three points in the three minutes at my disposal, after congratulating my hon. Friend the Member for Derby, 369 South (Mr. Johnson) and the hon. Member for Belper (Mrs. Faith) on their contributions. On this matter we are all at one in Derbyshire, in the area health authority and in the medical profession.
First, does the Minister agree that there should be a case—at both national and local level—for the equalisation of resources, where possible? Does he agree that that policy should allow those areas that are relatively deprived within regions that are relatively deprived to hold to those things that they do well? As the hon. Member for Belper said, they are—to cite the Manchester example in another sphere—of proven worth. Does the Minister agree that centres of excellence, such as the Derbyshire Royal infirmary is, and has been for many years in neuro surgery, should be maintained wherever possible? If the Minister agrees at the outset to those two questions, I shall find it hard to see what new factors came into his mind before he confirmed his decision.
In the Minister's letter to me, announcing that the decision must stand and that the provisional was to become the permanent, he adduced no further reasons to show why the arguments that we advanced in the deputation and beyond had not prevailed.
I conclude with my third point, which is plain. The undoubted sympathy that the Minister showed at an earlier stage has been overborne by the feeling that Nottingham and the Queen's medical centre have extended what Robert Ardrey calls the "territorial imperative". They have laid claim to facilities and have built more ambitiously and in a more grandiose manner than was necessary. Now that the National Health Service has fallen on hard times the Minister may feel trapped, and feel that he must fall in line with the decisions that have, in effect, been pre-empted by the building of these facilities at the Queen's medical centre.
We will not change the Minister's mind tonight. I wish that we could. His decision is profoundly mistaken. Perhaps we could at least have a reiteration of the fact that centres of excellence should be preserved and that the Department of Health and Social Security has learnt its lessons as a result of this dreadful business and will not look so favourably on ambitious schemes such as those launched at the Queen's medical centre, when it is clear that bad consequences—as well as good—will inevitably follow what the Prime Minister has done in that locality.
If we at least have that assurance, I for one will feel that this debate and campaign have not been wasted and that other centres of excellence, such as the Derbyshire Royal infirmary, may be preserved in future.
§ The Minister for Health (Dr. Gerard Vaughan)
I am grateful to the hon. Member for Derby, South (Mr. Johnson) for having brought this matter to the attention of the House and for putting his views of the case so fairly. I am also grateful to my hon. Friend the Member for Belper (Mrs. Faith) and to the hon. Member for Derby, North (Mr. Whitehead).
I strongly support the development and maintenance of centres of excellence. I appreciate that the Derbyshire Royal infirmary is a centre of excellence. However, I should like to ask hon. Members to assist us at times and to understand when we wish to resist the building of very 370 large hospital complexes, which often carry with them all sorts of implications for other hospitals in the surrounding area. We are discussing one such hospital tonight.
The deputation was very good and it was a very good hearing. I am only sorry that hon. Members feel as they do about the outcome. I am glad that I have listened to the speeches, since it has fallen on me to resolve this difficult decision. It was also my decision, on behalf of the Secretary of State, in the matter of the Derby health authority, so the same person has dealt with these issues.
I ask hon. Members to face what appears to me to be the reality. The question that arises is not whether a new unit should have been built at Nottingham, because it has been built as a major new centre for neuroservices associated with the university departments at a cost of £5 million out of the total of £39–8 million spent on the second phase of the Nottingham university hospital.
The present issue, now that the new unit, rightly or wrongly, has been designed and built, is whether it should be converted into some other kind of unit and whether more money that could be well used elsewhere in the Health Service should be spent to convert a unit that has never been used for the purpose for which it was intended.
If the decision is that the unit at Nottingham must go ahead, the question that arises is whether this will do great damage to one of the finest hospitals in the country, the Derbyshire Royal infirmary. This is a serious matter that needs to be examined carefully. Hon. Members have put forward a strong argument. If we were starting again, it would be right to consider other possibilities, but we are not starting again.
There is no question but that more neurology and neuroservices are needed in the Trent region. No one doubts this. The facilities will be available in Nottingham in 1983. If, on the other hand, they are developed at Derby, the cost, I understand, would be in the region of a further £4 million. This additional money would not be available for picking up. It would have to be taken from some other development in the region—by stopping, in fact, something else. To agree with what hon. Members have suggested would mean the spending of additional money. It would also be 1987 or later before the new services came into operation. Other capital projects planned for Derby would be likely to be delayed. It is not simply a matter of Derby or Nottingham.
The suggestion has been made at various times that the Trent region is sticking obstinately to a decision made many years ago. I do not accept this. In 1977, a working party containing a Derbyshire member examined the matter. Its view was that the unit should be developed at Nottingham. This report was circulated for consultation in September 1979. There were objections, some from Derbyshire, but at that time no counter-proposals were submitted from Derbyshire.
Because of the importance of the matter involving a change of use, the region, as required, put out a document for consultation in December 1980 taking into consideration comments and objections. Derbyshire health authority objected and this time submitted counter-proposals. Because of the conflicting views—the community health councils also objected—the whole matter came to me on behalf of the Secretary of State for examination. I was glad to receive the deputation the other day.
There are considerable advantages for Nottingham, Derby and the surrounding area if the unit at Nottingham is opened. It can be fully operational by 1983. At present, 371 I am informed, the combined Derby-Nottingham units have 80 beds, 48 neurosurgery and 32 neurology. The estimated need is 122 beds. By moving to Nottingham there would be 107 beds in all—that is, 27 more beds—64 neurosurgery and 43 neurology, of which 15 neurology beds would remain in Derby.
Later, the new unit will mean an increase in out-patient services. At Nottingham, facilities for neuroradiology will be increased for the whole region. There is already one CT scanner at Derby, which would continue, and there would be a second scanner at Nottingham—a new one. Neuropatholgy would be expanded. The neurophysiologist who is at present at Nottingham could move into properly equipped accommodation. It would also mean improved service in nuclear medicine. There would also be improved accommodation for paediatric neurology, and there would be a direct link with the medical and basic sciences—physics and biochemistry—in the university, which I am told would be of great value in providing a research background to the unit.
I am sure that hon. Gentlemen will agree, looking at the matter from that point of view, that this is good news for patients in the region as a whole. It has been put to me that Nottingham will be more available for a greater number of patients. I must be frank and say that I do not know that for a specialty of this kind I would put so much weight on that argument. Also it could mean an increase in travelling time for patients coming from Derby, as the hon. Gentleman told me with the deputation. Those are the arguments for Nottingham.
Clearly, improving the service and putting it at Nottingham should not be allowed to damage Derby. It is argued that there would be a damaging loss of prestige at the Derbyshire Royal infirmary. That is an important consideration. I understand why people in Derby feel so strongly about the matter. The Royal infirmary has a great reputation. As the hon. Member for Derby, North said, it is a great centre of excellence, it is one of our national centres, and it has done work of high quality over many years. It has great traditions which show in the pride of its staff and in the standard of care that it gives to its patients. So on every count it would be tragic if that reputation were damaged inadvertently.
372 However, if this move goes through, two good district general hospitals will remain in Derby. Additional money will be available in the near future for these hospitals—the Royal infirmary and the City hospital—which will mean exensive improvements and additions to the service there. Neurology will continue there. There will still be the 15 beds, of which 10 will be part of the regional specialty and paid for by the region. So finance will come from the region into the district health authority. The brain scanner which is there at present will continue there, and outpatients in neurology and neurosurgery will continue there.
§ Mr. Walter Johnson
I said earlier that I hoped that the Minister would reconsider his decision in view of the representations that have been made since, and also in view of our debate this evening. Is he prepared to give that assurance, and is he prepared to talk to the Secretary of State before the move actually takes place?
§ Dr. Vaughan
I shall continue, because I was about to say that although the work of the Royal infirmary will continue in other fields, we felt that the matter was so serious that when the papers were brought to me I went through them very carefully. I decided that it would be irresponsible to close down a completely new, unused department costing £5 million, spend more money converting it to another use, and spend more money elsewhere in providing the service which is needed. Also, I could not ignore the argument that new services are urgently needed in the region. I thought that it would be wrong to delay for another four or five years, if the move to Nottingham were stopped.
However, before reaching a decision, I was particularly glad to meet the deputation from Derby, and I was very impressed by the strength of feeling and the sincerely and deeply held views. So I promised at that meeting that, before coming to a conclusion, I would go over the possbilities again and see if some sensible way could be found——
§ The Question having been proposed after Ten 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 Twelve midnight.