§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Thompson.]10.26 pm
§ Dr. Edmund Marshall (Goole)
For many years my constituents in Goole have looked to the day when they will have a new hospital to serve the locality. At present their general hospital needs are met by no fewer than five separate, fairly small hospitals, three in the town itself and the other two former isolation hospitals, in more rural surroundings. The fact that the five sites are so scattered does not make for efficient running of a hospital service. Certainly it makes visiting arrangements inconvenient.
The largest of the five hospitals, St. John's, is the former workhouse for Goole built in 1872. It is a group of separate buildings not ideally suited to hospital work. The maternity hospital, along the road from St. John's, is a converted large house.
The hospital buildings now at Goole have been extensively adapted and the standards of care provided by medical and nursing staff are high. However, they could be even higher if all the hospital services were provided in a single modern hospital.
At the same time, there is wide interest in the general community of Goole in the local hospital service. That arises especially because the hospitals and health services involve nearly the whole population at some time or another. Also, there is a local tradition of voluntary involvement in the hospital service, a tradition that was built up before the National Health Service came into operation. People from all walks of life in Goole are keenly interested in the scope and the standards of the local hospital service both now and in the future.
A clear sentiment expressed by my constituents is that when the new hospital is built there should be no reduction in the scope and standard of hospital services now provided at Goole. Rather, there should be a widening of that scope and an improvement on present standards. Consequently, all proposed plans for the new hospital are closely scrutinised locally in order to establish how far what is proposed matches the standards of service now available in the five hospitals at Goole.
A the same time, there is widespread local opposition to any suggestion of transferring to another hospital patients who need hospital treatment that has hitherto been provided at Goole. The prospect of such patients being transferred to the district general hospital at Scunthorpe is regarded as most undesirable. Goole and Scunthorpe, together with surrounding rural areas, have recently been joined together in the health district that will come into operation next April.
There is disquiet in the area that that may mean that there is a tendency to concentrate future hospital development on the larger centre at Scunthorpe. The shortest main road distance between the two towns is 22 miles; by motorway, it is 26. Public transport links between them are, to put it kindly, sporadic. There are only four through bus services each weekday in each direction. The journey takes about an hour. There is only one through bus on Sundays, other than the early morning works bus services.
520 A resident of Goole who wished to visit a patient in hospital at Scunthorpe on a Sunday afternoon, which is a standard visiting time, would, according to the present bus timetable, be unable to make the journey by bus, because the last bus back from Scunthorpe leaves at 2.25 pm. Train services are equally inconvenient. There is no direct line. The journey by rail would necessitate changing at Stainforth or Doncaster.
All told, there are strong reasons why hospital in-patients in the Goole district should, if at all possible, be accommodated in Goole rather than in Scunthorpe. They reinforce the argument that the future provision of hospital services for Goole should be at least as comprehensive as the present provision.
Although the decision of the Yorkshire regional health authority to go ahead with the new hospital at Goole on land already earmarked in Woodland Avenue is welcome, as, too, is the Secretary of State's recent approval of the Capricode stage I submission on the project, three key areas remain where the proposed content of the new hospital appears to fall short of what is now available at Goole. It is on those three aspects that I concentrate the remainder of my remarks.
First, the number of beds to be provided in the new hospital is planned at 166. That figure compares with the 227 beds in the existing five hospitals. The difference is mainly accounted for by the reduction in the number of geriatric beds from the present 132 to the proposed 96. The figure of 96 is calculated in accordance with departmental formulae applied to population statistics in the area to be served. However, two relevant factors need further consideration by the regional health authority and the Department.
The first is that the geographical location of Goole, within Humberside, but close to the boundaries of North and South Yorkshire, has led many patients to be accommodated in hospital at Goole who live outside Humberside and outside the catchment area of Goole now used for hospital planning purposes. Therefore, the population statistics used in planning the new hospital may not be completely in accordance with the reality of the population served.
The second factor is the growing tendency for geriatric cases to be transferred quickly from hospital to welfare accommodation provided by local authority social services departments. There may be medical and social reasons for such a transfer, provided that sufficient welfare accommodation exists, but I am afraid that at present the accommodation does not appear to be adequate. Until it is, hospital beds for the elderly are essential to prevent hypothermia and to prolong life. It would be scandalous if elderly patients were discharged from the new hospital at Goole to look after themselves in their own homes, possibly by themselves, simply because of insufficient provision of geriatric beds in the hospital.
The second aspect of the proposed content of the new hospital that shows a reduction in its scope compared with what is now available is the level of ear, nose and throat treatment to be provided. The Capricode submission by the regional authority states:In-patient provision for the designated area specialties, which include ENT, will be provided in the District General Hospital at Scunthorpe.The Minister for Health, in a letter to me dated 4 February stated: 521The collective advice to the Regional Health Authority by the ENT consultants in the Region…has inclined towards the provision of this in-patient service from the larger hospital.In relation to that statement, I received very strong representations from the consultant aural surgeon who at present performs all the ENT surgery carried out at Goole. In a letter to me dated 20 March he completely dissociated himself from the advice quoted by the Minister, and said:As far as I am aware, the only body who could provide this `collective advice' would be the Regional ENT Surgery Working Group, which to my personal knowledge has never formally proferred such advice, nor have I been able to establish that it has by contacting the Regional Headquarters.It appears that on this point someone within the health region is trying to pull wool over Ministers' eyes. I hope that the Under-Secretary of State, whom I am happy to see here tonight, will ensure that the question of ENT provision in the new Goole hospital is fully reconsidered in the Department.
As a layman in medical matters, it seems to me that ENT operations are exactly the kind of surgery that can be satisfactorily performed in a community hospital as planned for Goole. Many such operations are fairly routine, such as tonsillectomy or sinus washouts, perhaps necessitating only a day's stay in hospital. It is easier to arrange such short stays if the hospital is near the patient's home.
What is more, as I discovered two years ago when I was in hospital for a sinus washout, a high proportion of ENT hospital in-patients are children, and it is socially desirable wherever possible to accommodate children in hospital near their homes, so as to reduce home-sickness and enable frequent visits from parents and other relatives. For many young children in Goole, being taken to hospital in Scunthorpe would be like a drastic upheaval to a far-away country.
The third area where the proposals of the regional health authority for the new Goole hospital give cause for concern is the level of pathology provision. What is proposed in this respect is a simple outstation at Goole for specimen storage and selection, whereas the present Goole pathology laboratory provides analytical and investigatory services as well as blood supplies for transfusions. The level of pathology services in any hospital is a major determinant of what surgery consultants are prepared to perform there, and the allocation to Goole of only a pathology outstation would mean that many operations now performed at Goole, and which could be performed in the operating theatre facilities in the new hospital, would not be conducted there owing to a lack of pathology support on the spot.
I ask Ministers to look again at these three aspects of what is proposed for the new Goole hospital. It is not sufficient for Ministers to say that these questions are for the regional health authority to decide, because the RHA in turn claims that its proposals are based on departmental guidelines. Under the National Health Service, the buck really does stop with Ministers. While I am grateful for their decision to go ahead with the new hospital at Goole, I hope that they will be able to provide in that hospital all the facilities which I have mentioned this evening.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
I am very grateful to 522 the hon. Member for Goole (Dr. Marshall) for giving me the opportunity to speak tonight about the new hospital that is to be built in his constituency. I am pleased to try to clarify some of the issues that he has raised about the planning of the hospital and the proposed pattern of health services for Goole, as I know from the researches carried out for me that the hon. Member has taken a close interest in this project over a number of years.
For the purposes of tonight's debate, Goole may be defined as that part of the Scunthorpe health district comprising the former local authorities of Goole metropolitan borough, Goole rural district and Howden rural district.
§ Mr. Finsberg
Howden municipal district. I am sorry. That must have been an urban district.
Goole itself is about 22 miles from Scunthorpe, 28 miles from Hull and 21 miles from Pontefract, and the sector as a whole has a population of just over 40,000. The new hospital in Goole is therefore classified in the region as a community hospital plus. Full district general hospital services for the Scunthorpe health district, including the Goole sector, will be provided in the new Scunthorpe district general hospital.
As the hon. Gentleman has said very clearly, existing hospital facilities in Goole are fragmented and many are in poor accommodation. Studies by the regional health authority revealed that none of the current five hospitals was suitable for upgrading and improvement as the new community hospital plus.
Bartholomew hospital was built in 1912, with out-patient and accident and emergency departments added 50 years later. It has 44 acute beds, which are used mainly for surgical patients.
As the hon. Gentleman rightly said, Goole maternity hospital was constructed originally as a private house and converted to a maternity hospital in 1926. It provides 10 GP maternity beds.
The largest existing hospital is St. John's with 107 beds, 21 of which are designated as general medical beds and 86 for geriatrics. As the hon. Gentleman again pointed out, this hospital was built originally as a workhouse in 1872.
Westfield hospital has 36 beds, of which 16 are for geriatrics, 14 pre-convalescent and six medical beds for general practitioners to oversee. Westfield is a former infectious disease hospital built in 1910 by the local authority. It is only about three miles from the centre of Goole, but well away from public transport routes.
The last of the existing hospitals is Thorpe Road hospital. Again, this is a former infectious disease hospital built in 1910 by the local authority. It is five miles from the centre of Goole, away from public transport routes, and currently provides 30 geriatric beds.
All in all, therefore, the regional health authority decided that in order to implement its strategy a new hospital on a new site was required. I have described in passing the current bed provision in the Goole sector, but I should like to deal with this in a little more detail as it has a direct bearing on the proposals for the new hospital.
Existing in-patient services are split between two sites and are provided by visiting consultants with junior hospital medical support. Major surgery is provided from Pontefract. Geriatric services are based on in-patient 523 provision at three scattered hospitals. There are no local day hospital facilities either for the elderly or for the elderly severely mentally infirm. There are no local facilities for the mentally ill, other than out-patient clinics undertaken by a visiting consultant from De La Pole hospital near Beverley where in-patients from the Goole sector are treated. Services for the mentally handicapped are provided at Rawcliffe Hall and Bubwith. As I said earlier, there is a general practitioner maternity unit in Goole, but consultant obstetric services are provided from Pontefract, although some patients from the northern part of the sector look to the consultant unit in Beverley.
Having outlined the existing provision in Goole, I deal next with the long-term plan for the new hospital. This will be developed to provide a consultant out-patient service in the main specialties and an in-patient service in the main acute specialties. The latter will cover medical cases not requiring complex investigation or immediate access to those diagnostic and treatment facilities that can reasonably and economically be provided only at district general hospitals. These patients may be either under the care of visiting consultant physicians or under the direct care of general practitioners. The in-patient service will cover also surgical cases requiring minor or intermediate operative procedures. Patients requiring major and emergency surgery and major accident cases will be admitted to Scunthorpe district general hospital. In addition, pre-convalescent patients will be transferred to Goole from Scunthorpe.
In general, approximately 40 per cent. of the total number of bee's in the district acute specialties are allocated to the medical specialties, excluding geriatric assessment, and 60 per cent. to the surgical specialties.
Examination of hospital activity data shows that 75 per cent. of medical admissions from amongst local residents are to local hospitals. It is assumed, therefore, that 75 per cent. of the medical specialty beds should be provided in the new hospital with the balance at Scunthorpe district general hospital.
In the same locality, approximately two-thirds of surgical admissions from amongst local residents are currently to local hospitals. Analysis of the operative procedures undertaken there at present suggests that perhaps seven-ninths of those might be classed as minor or intermediate in nature.
It is proposed, therefore, that in the future the community hospital plus should cater for approximately half the surgical admissions from the catchment area and that 50 per cert. of the assessed future surgical bed provision should be located locally. An additional 10 per cent. of the total surgical bed need should also be provided for local patients transferred from the district general hospital for pre-convalescence.
As regards obstetrics, the new hospital will have a general practitioner unit with consultant involvement and cover and having a close operational association with the unit al Scunthorpe. There will be maternity provision for the confinement of patients selected on the basis of clinical policies jointly agreed between consultants and general practitioners. This provision will allow the majority of patients selected for confinement in the district general hospital unit to be transferred to the unit in Goole for the lying-in period.
In addition to the above services, the new hospital will act as a "satellite" day hospital for local mentally ill patients related to the parent district mental illness unit. It 524 will also provide a minor injuries—casualty service, together with appropriate diagnostic rehabilitation and treatment facilities. With regard to geriatric services, these will be associated with the geriatric service in the district general hospital in Scunthorpe.
There will be in-patient and day hospital facilities for the majority of patients requiring assessment and rehabilitation, in addition to provision for care and rehabilitation of the "longer stay" categories of geriatric and the elderly severely mentally infirm appropriate to a community hospital.
In giving departmental approval in principle for the development of the proposed hospital, the question of designating some acute geriatric beds at Scunthorpe district general hospital as being for the elderly population at Goole was taken up with the regional health authority. The RHA has said that such beds will be available in Scunthorpe but will not be designated as such. The new Scunthorpe health authority, when it comes into being next April, will be asked to investigate this point as part of its review of local clinical policies. I would add, however, that the number of acute geriatric beds planned for the new hospital, is slightly above the national guideline for the population of the sector.
Being a community hospital plus, there will be facilities at the new hospital for taking acute geriatric patients, and it is expected that only a minimum number of patients will need to go to Scunthorpe to the more sophisticated level of facilities provided at the full district general hospital.
I refer next to ear, nose and throat surgery. I should explain that the regional strategy indicates that while out-patient services in such specialities should normally be provided in each district, planning of in-patient and consultant services and particularly any of the more specialised aspects of the work should be considered on a wider basis.
Factors to be taken into account in considering the location of in-patient services include the viability of a unit in terms of size, patterns and levels of consultant staffing, levels of junior medical and other staff and use of expensive equipment and geography. Indeed—this point will interest the hon. Gentleman—the majority of the doctors on the ENT working group of the regional medical committee in Yorkshire subscribe to the view that in-patient services should be organised on a supra-district basis and that there should he viable-sized units with adequate junior staff. However, the working group has also acknowledged that the judgment as to adequacy of support staff and hence the scope of ENT operative work that might be undertaken in smaller units was a matter for the individual consultant concerned and the regional health authority has accordingly adopted this approach in its plans.
On the particular question of the allocation of a number of beds in the new hospital for ENT, I am informed that the 1979 data showed an average of 1.4 beds in Goole occupied by ENT patients with 190 discharges during the year. Yorkshire RHA has decided, therefore, that this level of activity could be accommodated with the overall level of bed provision proposed for the new hospital and that the provision of a separate children's ward could not be justified for a population of the size of Goole. However, the design of the ward units to be provided will give full flexibility so that a section could be used for children when required.
525 Let me now deal with the question of the pathology services provision at the new hospital. It is true that the main pathology laboratory will be situated at the Scunthorpe district general hospital, while the Goole community hospital plus will provide a "satellite" specimen collecting station, dealing largely only with those investigations which on the grounds of urgency cannot be undertaken in the main laboratory.
But the regional health authority envisages that there will be daily transport for the conveyance of specimens to the district general hospital. There will also be a teletype terminal for the rapid transmission of reports and local laboratory facilities only for urgent haematology and chemistry specimens, which will include provision for local grouping and cross matching of blood for transfusion.
This proposal is in accordance with departmental policy, which is that as far as possible all laboratory investigation of disease should be concentrated in area laboratories attached to particular hospitals with only a minimum number of satellite laboratories in individual hospitals. The latter should be fully integrated with the service provided by the area laboratory.
The implementation of this policy need not in any way limit the freedom and independence of those working on special projects or research. At the same time, it should provide a sounder basis for laboratory work through the provision of adequate staffing reserves, integrated training, and efficient supporting services and ancillary help in adequate and flexible accommodation.
Moreover, the multi-disciplinary approach, which is important for modern laboratory investigation, will be much more easily achieved in such a background. Some area laboratories will need to be enlarged to serve as national, regional or sub-regional reference centres for the less common techniques and for specialisation in particular functions.
526 Regional health authorities were asked to plan to provide centralised laboratories on a scale capable of serving hospital, general practitioner and local authority needs. The guidance also specifically stated that a proliferation of small self-standing laboratories was to be avoided.
As the hon. Gentleman said, it is generally acknowledged that the proposed facilities will not be of the same level as those currently provided in Goole. However, that is not to say that the investigatory services will be in any way diminished in terms of quality. Indeed, the regional health authority has expressed the view that the standard of service provided at Goole would otherwise fall steadily behind that to which patients nowadays are entitled and that the interests of the patients will be better served by the new centralised facilities at the district general hospital in Scunthorpe.
I hope the hon. Gentleman will feel that I have been able to pick up his three main worries. I understand his modified rapture over the fact that there is to be a new hospital. I hope that I have been able to reassure him on some of the issues. If anything that I have said is contrary to any of the facts—I have to use the word "facts"—in his possession, I would wish to see those facts so that I can try to see what has gone wrong. The hon. Gentleman will know that I can deal only in facts rather than in mythology, although I do not suggest that he tries to put forward mythology. The essential and most important factor is that the special needs of Goole, I believe, have been recognised in the development of the community hospital plus concept. It would not be economic or practicable to duplicate a whole range of district general hospital services that are being provided elsewhere in the district.
I hope that I have gone some way towards reassuring the hon. Gentleman. I hope, too, that he will not need to have another spell in hospital, even in the new community hospital plus, for another sinus washout.
§ Question put and agreed to.
§ Adjourned accordingly at six minutes to Eleven o'clock.