§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Newton.]
2.30 pm§ Mr. Reg Race (Wood Green)The subject of this debate is dear to the hearts of my constituents, of the people of the London borough of Haringey and of those who live within Haringey's health district in the London borough of Enfield. I seek to raise a long-standing problem. Indeed, it is so long standing that we have been fighting the closure of the casualty department at the Prince of Wales hospital in Tottenham for many years. The situation became so grave that the Minister for Health accepted an invitation from my hon. Friend the Member for Tottenham (Mr. Atkinson) and me to visit the hospital on 6 March, and he made some useful proposals and comments. We thank him for his initiative.
The accident and emergency department at the Prince of Wales hospital is now closed from about 5 pm every day and throughout the night. It reopens only in the morning. At the weekend, there are intermittent closures. The problems in Haringey health district arise primarily as a result of that.
In passing, I should refer to the hospital's wider problems, which were the subject of the Minister's visit on 6 March. After the Minister for Health had visited the hospital, he issued a statement to the press and to us to the effect that the area health authority should not contemplate any changes in the services at that hospital until the new district health authority had taken office in April 1982.
Unfortunately, in the past few months, a substantial number of administrative decisions have undermined the Minister's statement. Medical staff have been withdrawn from the hospital and some beds have remained empty, despite the fact that three wards in the hospital have now closed. People in Haringey are very concerned about that aspect of the hospital's problems.
The area health authority and others argued that there should be only one casualty department in the health district to cater for the needs of that part of the London borough of Haringey and of Enfield that is covered by the health district. It was argued—and accepted by the area health authority—that the service should be provided by the North Middlesex hospital in Edmonton. Those Members of Parliament concerned, members of the area health authority and of the community health council and many others in the borough pointed out that such a concentration of services at the North Middlesex hospital was bound to lead to major problems.
Unfortunately, those problems have been realised. At the time we argued that, as the distance between the Prince of Wales casualty department and the accident department at the North Middlesex hospital was about three miles, enormous difficulties would be involved in transferring patients—whether by public transport or by ambulance—from the Prince of Wales hospital to the North Middlesex hospital. We pointed out that those difficulties would become worse during the rush hour or when traffic was bad.
We pointed out that patients might turn up at the casualty department of the Prince of Wales hospital and have to be transferred by ambulance to the North 599 Middlesex hospital to receive emergency treatment. It was also possible that they would be transferred again, by ambulance or by other means, to the Prince of Wales hospital or St. Anne's hospital in Tottenham to be received by the NHS and allocated a bed. That was primarily because of the third reason for our concern—the poor facilities at the North Middlesex hospital. It did not have sufficient back-up acute care beds to cope with two casualty departments. Also, it had an inadequate casualty department to deal with the problems.
Since then the closure of the accident and emergency department at the Prince of Wales hospital has gone ahead and three wards have been closed. Of a total bed complement of about 200, only 115 are now available for use and abut half of those contain patients.
That has posed many problems. Last weekend the North Middlesex hospital was shut because the main boiler system failed. In addition the back-up boilers were out of action because they were being maintained. The Prince of Wales hospital casualty department was opened to cover that weekend. We are grateful for the actions of all the staff who supported the move. There are also serious problems with the kitchens at the North Middlesex hospital.
Another problem is the bussing of patients. At the time of the closure of the Prince of Wales hospital emergency ward at night, it was difficult to see how patients could be treated other than by bussing them to and from the North Middlesex hospital. We have had difficulty in identifying the number of patients transferred from the Prince of Wales hospital to the North Middlesex hospital and back again into the southern sector of Haringey health district. It would be helpful if the Minister could explain the extent of the problem, because it is a major difficulty for patients in the area.
Another major problem about the casualty departments in Haringey health district is the existence of major industry close to the Prince of Wales hospital. Just down the road there is the main Gestetner factory, which employs several thousand people. The Lea Valley industrial park is also close to the hospital. It extends from Edmonton to Hackney. We argued that the closure of a major accident department so close to such a major centre of industry was a mistake because of the problems that might be created if there were a large industrial accident or, on a day-to-day basis, for individuals who may have industrial accidents.
There is now no emergency surgery taking place at the Prince of Wales hospital, only cold elective surgery. The operating theatres are being used for only half the time. The problems in the health district are compounded because two operating theatres at the North Middlesex hospital have been shut for upgrading. The situation is ludicrous, because the Prince of Wales hospital has the most modern operating theatres in the health district. That is the background to the problems that we face in Haringey. It causes serious concern to all sections of the community.
I turn to the problems that arose on 21 November. I shall not refer to the incident at the Seven Sisters station in any detail because proceedings relating to that matter are still before the courts. However, one person was fatally injured in the crush on the escalators. The injured were taken from Seven Sisters to the Royal Northern hospital casualty department at Holloway, several miles away. Why were they taken there, and not to the North 600 Middlesex hospital? It may have been possible—although I do not claim this—to have saved that person's life had he been taken to the North Middlesex hospital. I hope that the Minister will shed some light on that point as it is of great concern to local people.
There are special problems in north and south Tottenham because of the Tottenham Hotspur football ground. On many Saturdays during the football season, 30,000 fans come out of 'White Hart Lane on their way home, many of them going down Tottenham High Road and past the Prince of Wales hospital to the Seven Sisters station. That poses a major additional risk for the casualty services in the health district. Given the existence of the football crowds, the existence of major industry in the area and all the other problems to which I have alluded, will the Minister say that we can seek a reopening of the Prince of Wales hospital casualty department on a permanent basis?
On 21 November the fans were taken to the Royal Northern hospital. We know that the intensive care unit at the North Middlesex hospital was full on that clay. That again shows the problems of back-up facilities for that hospital. The real point at issue is that the Prince of Wales hospital is situated only 400 or 500 yards from the Underground station. Had the accident department been open, it would have been possible to take the injured fans across the road to the hospital and give them immediate treatment. We know, because it has been the subject of a previous Adjournment debate, that the Royal Northern hospital accident department, where the fans were taken, is under threat of closure. Where would those fans have gone had the Royal Northern and the Prince of Wales hospitals been closed and the North Middlesex hospital not available? The Minister may say that the Whittington hospital would have taken the major accident cases. The problem is that its accident department is not capable of looking after patients from two or three major casualty centres, following the possible closure of the Royal Northern and the closure of the Prince of Wales after 5 pm
Following the incident a new situation has arisen. A resolution was passed by the area health authority at its December meeting in which it agreed to approach the regional health authority and the Minister to highlight the difficulties of allowing only one casualty unit per district, especially in Haringey. That resolution was moved by councillor Maureen Dewar, a member of the authority and the chairperson of Haringey local authority social services committee.
Does the Minister agree that, where appropriate, two casualty units should operate in one district because of the risks that I have outlined? We hope that he will recognise that the risk associated with a concentrated urban population and the presence of heavy industry and football crowds gives rise to substantial problems and could be grounds for having two casualty departments in one health district.
I hope that the Minister will agree to invite the area health authority to reopen the Prince of Wales hospital casualty department forthwith. It is in a particularly good position to cope with major accidents problems that occur in the locality. The outpatients department, which is next door to the accident and emergency department, can be used as an overflow if problems occur. If the Minister will agree to that proposal, it will help the people of Haringey, 601 who are extremely concerned. It will also assist the new district health authority in its consideration of these matters when it takes office next April.
It has been said that it will be up to the new DHA to decide on the shape of health and other services in the district. That is right, but the position is so urgent and people are so concerned about the problem that we hope that the Minister will say something today, first, about the future of the casualty services in the district, secondly, about the possibility of there being two casualty units, and, thirdly, give encouragement to the district health authority when it takes office.
This is central to the problems of Haringey as a deprived urban area. We hope that the Minister will recognise that in these circumstances there is a strong case for retaining the best possible health service that can be made available and ensure that people are not shipped many miles in ambulances when they are seriously ill.
I hope that the Minister will respond positively and give some hope to the people of Tottenham and Haringey who are extremely upset about the partial closure of the accident and emergency department at the Prince of Wales hospital.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)I know that the hon. Member for Wood Green (Mr. Race) has taken an interest in accident and emergency services in the Haringey health district for a long time, and has been a strong advocate of the health needs of his constituents. It is important that the nature and level of the accident and emergency provision in Haringey should be understood in the context of health provision as a while in the district and its future planned development.
First, in case there is not sufficient time later, I should like to deal with the hon. Gentleman's specific point about the recent incident at Seven Sisters, because it is important that the facts should be made as clear as possible. He queried whether, if the Prince of Wales accident and emergency department had been open at the time of the Seven Sisters incident, a better service might have been provided. There is no evidence that that is true.
What happened on 21 November is as follows. At 17.20 the London ambulance service central control was alerted to an incident at Seven Sisters station. Preliminary arrangements for a major accident—designated as a yellow alert—were instituted and the duty co-ordinator designated the Royal Northern hospital as the accident and emergency department to which casualties should be taken. Although that hospital is slightly further from Seven Sisters than the North Middlesex, the police were able to guarantee a quick route to the Royal Northern, the route to the North Middlesex being congested by football supporters. However, the North Middlesex was designated to provide a back-up. Six ambulances were on the scene by 17.32, and 11 people were removed to the Royal Northern. The London ambulance service declared the alert closed at 17.54.
Of the 11 people involved, four were discharged, five were admitted to the Royal Northern, one was referred to University College hospital and one was found to be dead on arrival. As the hon. Gentleman said, it would not be 602 right for either of us further to comment, as a coroner's inquest is in progress and a court appearance by the man charged with the manslaughter of the deceased is pending.
My information is that the casualties received satisfactory treatment. If the accident had reached such proportions that it had been designated a major accident, there are two major accident centres in the area—the North Middlesex and the Whittington. The Prince of Wales is not designated as a major accident centre. That is as far as I can go today on the specific point that the hon. Gentleman raised.
I return to the hon. Gentleman's general case about the overall permission. Like so many other London health districts, Haringey has a considerable level of social deprivation, including poor housing and a lack of basic amenities. Social deprivation increases people's susceptibility to illness and makes it more difficult for the community to support the sick, and particularly the old, at home. In addition, Haringey has a declining population.
The major problem facing the responsible authority in planning future provision is the maldistribution of resources between the different areas of health care. Although Haringey is well provided in the acute sector, improvements are needed in the so-called Cinderella services—the primary care services and services for old people, the mentally ill and the mentally handicapped.
As the hon. Gentleman will be aware, a number of recent reports have drawn attention to the maldistribution. The reports of the London Advisory Group and of the London Health Planning Consortium indicated that the district should make a substantial reduction in the number of acute beds provided. The resources thus liberated could then be used to improve the so-called Cinderella services.
Both regional and area health authorities are aware of the need to reduce over-provision in the acute sector and to shift resources to other sectors. One of North-East Thames region's major strategic objectives is
To continue, either through the use of growth monies or by transfer from the acute sector, the increase of funds available for primary care and the long stay sectors.I fully support that objective.In April 1979 the regional health authority agreed a strategy for Haringey district which attempted to achieve that aim. The proposal was that, of the four hospitals providing an acute service in Haringey, the two largest, the North Middlesex and St. Ann's, should form a twin-site district general hospital, and that the other two, the Prince of Wales and Wood Green and Southgate, should become supporting community hospitals, providing a service mainly for the elderly.
As the hon. Gentleman rightly said, the proposal involved the closure of the accident and emergency department at the Prince of Wales hospital and the provision of an extended and improved department at the North Middlesex which would be capable of assuming responsibility for the work load of both the original departments. It was seen as part of a current trend for accident and emergency departments to be concentrated on major hospitals where the full range of supporting facilities are available. The trend is not new; it is the outcome of a general line of policy which is largely founded on the 1962 Platt report on accident and emergency services, which recommended centralisation of accident and emergency departments in major units at general hospitals.
The Platt report also stated that, to be viable, a major accident and emergency unit should serve a population of 603 at least 150,000 people. The report has since been endorsed by two further reports—one by the Employment and Social Services Committee of the House of Commons Expenditure Committee, which was summarised in a White Paper in 1975, and, more recently, the 1978 report of the Joint Consultant's Committee.
A number of arguments have been advanced in favour of closing the accident and emergency department at the Prince of Wales' hospital. First, it has been argued that it is hard to justify the existence of two major accident and emergency departments to serve a population that is dropping toward the 200,000 mark.
Secondly, it has been argued that the Prince of Wales' hospital is unable to provide the wide range of back-up facilities which the reports I have mentioned recommended ought be associated with a major accident and emergency unit. Those adopting this line of argument point to the fact that in the past this department has been subject to irregular closures because it does not have adequate numbers of acute back-up beds. Thirdly, some have emphasised the need to cut costs in the district.
In the financial year 1979–80 the area health authority overspent its cash limits by £1.3 million, £750,000 of which was attributable to overspending in Haringey district.
Against these arguments we must weigh the considerable affection which many local residents have for the Prince of Wales' hospital. Apparently there is also a feeling among residents of the district that the North Middlesex hospital, which is just over the border between Haringey health district and Enfield health district cannot be described as a "Haringey" hospital.
Those feelings are understandable. In addition, some have pointed to the central location of the Prince of Wales' hospital, the insufficiency of much of the primary care in the district, and the good quality of some of the facilities at the hospital, as arguments in favour of the hospital maintaining an accident and emergency, and general acute service.
In response to the considerable disquiet expressed locally about the proposed closure of the accident and emergency department at the Prince of Wales', the regional health authority, in April 1979, gave an undertaking that the Prince of Wales' accident and emergency department would not be closed until the necessary provision could be made at, and a satisfactory service given by, the North Middlesex hospital. Work is currently in progress, as the hon. Gentleman said, to extend the accident and emergency department at the North Middlesex hospital and I am informed that this should be completed in the Spring.
In September 1980, after discussions with the hon. Members representing local constituencies, the community health council, and the regional chairman, my hon. 604 Friend the Minister for Health approved the implementation of stage 1 of the district's strategy. Stage 1 consists primarily of a redistribution of specialties among the four acute hospitals in the district, and the implementation of daytime-only opening at the Prince of Wales' accident and emergency department.
As a rider to his approval of the stage 1 proposals my hon. Friend asked the regional health authority to review the long-term future of the Prince of Wales' hospital to take account of the new district structure to operate from April 1982, as well as the consultative paper on the future pattern of hospital provision in England. On 6 March this year my hon. Friend visited the Prince of Wales' hospital. On that occasion he made his position on the future of the hospital, and of the accident and emergency department quite clear. He said
I would expect the district health authority"—when it is no longer a shadow but substance—to take into account the strength of local feeling or, this issue and I shall want it to act urgently as I am very aware of the effects on morale of staff of a hospital which has an uncertain future. Until then there should be no further rundown in the services at this hospital.I shall be grateful if the hon. Gentleman will provide me with any substantiation of the belief that "direction" by my hon. Friend is being overlooked by those responsible.I should like to refer to additional remarks by my hon. Friend to make clear his view. He said:
I shall not agree to any more changes in the nature of the services provided at the Prince of Wales' until the new DHA has been set up and considered what should be done. This will also allow time for the full effects of the recent changes to become apparent. I recognise the difficulties facing professional and managerial staff in the district and know that they will work together to resolve these. For my part I do not want to prejudge decisions which will be taken by the new DHA but will do my best to decide quickly on any proposals which are put to me after the DHA has completed its review.It would not be right for me to comment further at this time on what the new DHA's proposals, plans and arguments might be. Until the new DHA has considered the district's strategy, a daytime accident and emergency service will continue to be provided at the Prince of Wales' hospital every day of the week.If the new DHA produces new proposals they will be subject to local consultation should they involve substantial changes in the proposed pattern of hospital services. If the local community health council objects to any proposals, the health authority will have to seek my hon. Friend's approval before they can be implemented.
§ The Question having been proposed at 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 o' clock.