Hospital Services, Bolton (Hansard, 27 January 1981)

§ Mr. David Young (Bolton, East)

For several months in 1978 and since there has been extensive consultation with the general public through the area health authority and the community health council in Bolton with the object of considering the proposed pattern of hospital development in the Bolton area.

The result of that consultation has been that virtually without dissent everyone locally came down, first, in favour of a single district general hospital in Bolton, and, secondly of that general hospital being based on the site of the Bolton general hospital.

The reason for the choice of that site was that Bolton is a relatively compact industrial town and the Bolton general hospital is situated with easy access to all centres of population and also within a mile of the motorway network. It was felt necessary to locate all the services for those people in need of acute medical and surgical treatment, including acute geriatric and mental illness, on one site, and the proposal was, basically, for a 1,170-bed hospital at the Bolton general hospital site, covering all acute beds, plus maternity, mental illness, some geriatric, and some ESMI, with other beds situated at the Bolton Royal infirmary, the Hutton hospital and the Fall Birch hospital. In the latter three, the beds would cover the post-operative pre-convalescent, geriatric and ESMI cases.

The reason for the choice of the Bolton general hospital site for the district hospital was that it was the only site large enough to accommodate all the concentrations of acute services in one district general hospital that would be necessary to be placed there. Part of the site was owned by the Bolton general hospital, part of it was reserved in the town plan, and all the site has now been purchased.

Already there has been a move towards the creation of a district general hospital by the establishment of a maternity unit, and plans for three major developments are well advanced, covering such things as roads, drainage, boilerhouse, water, engineering services and so on. But, above all, the choice of one district hospital was based on the best use of manpower and the resources that were necessary to give the back-up to such acute services.

Manpower is a scarce resource in the Health Service, and in the foreseeable future there is no possibility whereby one could duplicate the services that are necessary to give adequate acute treatment without providing at best a second rate service, irrespective of the finance that was available.

In May last year the Department of Health and Social Security issued its consultative document "Hospital Services—The Future Pattern of Hospital Provision in England". On the recommendation of the Department, Bolton was asked by the region to accept a different pattern of complementary district hospitals. This would presumably be a base at Bolton general hospital and another base at Bolton Royal infirmary.

That proposal was looked at by the area health authority and was rejected, mainly on the ground that having two district hospitals would duplicate such units as coronary care units, intensive care units and electro-cardiograph departments. It would mean that additional anaesthetists would have to be found, and the service from this scarce 904 body of people is at the most just satisfactory. Any proposal that placed additional strain and required additional anaesthetist consultants would not, in Bolton, be a practical proposition.

Also, additional surgical and operating theatre nursing teams would be required, more energy would be required to be used by utilising two bases, more scarce junior medical staff, extra maintenance costs, extra catering equipment, one extra operating theatre at each major hospital, and a satellite pathology unit at the hospital which did not have the main unit or, indeed, extra transport to make up for the deficiency. There would require to be more supervisory staff; it would affect the male-female bed mix; and it would have implications for the medical records and also for additional transport.

For these reasons, Bolton rejected the suggestion of having two district hospital bases and then resubmitted the proposal for the 1,170 bed district hospital based on the area which is at present occupied by the Bolton general hospital.

The urgency of the debate this evening is that it is not only the pattern of hospitals in Bolton that has to be considered, for obviously there are other capital schemes which either should have been done or should take place within the next few months, and which are awaiting the decision on what the pattern should be. These include, for example, ESMI units, geriatric blocks, pharmacy manufacturing units, staff changing, long-stay kitchen improvements, medical record storage accommodation, and so on.

What we are saying is that we are concerned not only to have a decision on the pattern of the hospitals but that we would also like to have that decision as soon as possible, because each delay on the capital schemes that I have outlined will multiply each month that the delay continues.

I should like an assurance from the Minister that the developments planned in 1978 and receiving unanimous public backing will be allowed to be proceeded with. May I ask him when this procedure will take place? May I assume that the Department will back the concentration of acute services, even though this implies a hospital of 1,170 beds as outlined? May I also ask the Minister to take into consideration the other projects that are dependent on ministerial decision?

I am sure that my colleagues from the district would also support what I have said, although for various reasons they are unable to be here this evening.

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

I am grateful to the hon. Member for Bolton, East (Mr. Young) for raising the question of the development of acute hospital services in Bolton. I know that the subject has been of concern to his constituents for many years. His decision to raise it tonight is a timely one, because I have been studying the development of services in Bolton over the past week.

The hon. Member has put his case very clearly, and he has a thorough grasp of the issues involved. He has detailed the many advantages which he believes would result from the concentration of acute services at Bolton general hospital, for both patients and staff. He has described the extensive public consultation which was carried out in 1978 about the future of hospital services in Bolton, and has laid stress on the overwhelming local 905 support which has been forthcoming for a major acute hospital on the Bolton general site. He has rightly drawn attention to the unsettling effect which renewed uncertainty has had locally, and to the importance of an early decision which will enable much needed capital improvements to go ahead. He has urged me to put an end to the speculation about the future of services in Bolton.

I am pleased to be able to tell the House that I can now do this, and to announce without further ado that I have given my approval to a major acute hospital on the Bolton general site. I believe that this will come as welcome news to the hon. Member. It also comes as welcome news to me, for after about 40 Adjournment debates I am at last in a position to give an hon. Member something for which he has asked.

As has been pointed out, the concentration of acute services at Bolton general hospital will mean an increase in the size of the hospital from 893 beds to well over 1,000 in the long term. I shall not conceal from the hon. Member that my initial reaction to a 1,000-bed hospital in Bolton was that it might be too big, and that some alternative solution must be sought. As the House will know, and as the hon. Gentleman said, my Department has strong reservations about the viability of very large hospitals and their acceptability to patients. These were reflected in the Government's consultation paper published last year—"Hospital Services—The Future Pattern of Hospital Provision in England"—which suggested that district general hospital services could often be provided on more than one site, thus enabling many main hospitals to have no more than 600 beds.

But, as that paper also made clear, I am a firm believer in flexibility and in the importance of adapting to local circumstances. Past Governments have made the mistake of trying to lay down a single solution for the whole country, but we have learnt from that. I believe that the size of hospitals cannot be rigidly prescribed according to a formula but must be tailored to suit the local communities they serve.

When I looked carefully at the question of Bolton, I paid close attention to the local circumstances. I noted, in particular, that Bolton is a compact area, with transport links radiating out from the centre; and that the general hospital is convenient and accessible for its catchment population. I also took into account the views of the local area health authority, which has experience of running acute services from two hospital sites—the Royal infirmary and the general hospital—that they could provide a greatly improved service to patients by bringing related clinical departments closer together and deploying scarce trained staff in a more rational way.

906 The regional health authority has pointed out that, because the Royal infirmary site is almost completely built up, any major development there would involve a lengthy demolition programme, which would seriously inconvenience patients and add considerably to the capital cost. I understand that, even if that were to be undertaken, the small number of beds which could be accommodated on the infirmary site would not enable the beds at the general hospital to be greatly reduced; that could mean providing acute services from three separate sites.

The regional health authority has also put it to me that any departure from the strategy of concentrating acute services at the general hospital could mean substantial delays in improving services for particularly needy groups of patients—the old, the mentally ill and the elderly severely mentally infirm.

As the hon. Gentleman said, the Bolton community health council has given wholehearted support to this comprehensive development of the general hospital, and any change in the strategy, with the subsequent delays, would be regarded by local interests as a serious disappointment.

So, in the light of all these circumstances, we have concluded that a large hospital in which the acute services are concentrated on one site would best serve the needs of the people of Bolton. The hon. Gentleman will, I think, appreciate that this decision means that improvements in services in Bolton can now go ahead as planned.

I have of course, considered not just the future of acute services in Bolton, but the way in which they fit into the health authorities' strategy for the whole area. The development of Bolton general hospital must be seen in the context of plans for the smaller hospitals, and I have asked the regional health authority for an assurance about their future. As the hon. Gentleman knows, I feel particularly grave concern when small hospitals which provide an excellent service to their local population are closed in order to relocate their facilities into a large general hospital which may be much more remote from patients.

I understand that there is no proposal to close Bolton Royal infirmary, which will become a centre for long-stay services, and that the health authorities concerned propose to develop the small hospitals in Bolton as community hospitals. But I would wish to be quite certain that suitable facilities at these hospitals are definitely seen as having a useful future ahead of them, so full agreement to the proposals for Bolton general hospital must be seen in this context and be subject to those conditions.

I believe that my decision is the one which the hon. Gentleman wished to hear, and I am glad to have been able to announce it tonight.