Royal Northern Hospital

HC Deb 23 October 1981 vol 10 cc530-8

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Gummer.]

10.53 am

Mr. Michael O'Halloran (Islington, North )

I should like first to congratulate the hon. Member for Hampstead (Mr. Finsberg) on his new appointment. I am glad to have the opportunity to debate the proposal to close the accident and emergency department of the Royal Northern hospital, Islington, and to transfer its facilities to the Whittington hospital. Over 10 years ago, I had a similar Adjournment debate concerning the future of the whole Royal Northern hospital. The then Under-Secretary of State for Health and Social Security, the right hon. Member for Barkston Ash (Mr. Alison), stated in his reply: The Royal Northern hospital has a promising future".—[Official Report, 23 February 1971; Vol. 812, c. 538.] That was 10 years ago.

But times have changed. There are proposals once again concerning the hospital but this time the proposals are to close the accident and emergency department—a step that would, if it took place, lead to the eventual closure of the Royal Northern hospital as a general hospital.

I must mention briefly that the Royal Northern hospital celebrates its 125th birthday this year. It was founded in 1856 and dealt with 11,718 patients in the first six months. By 1900, it had been extended to such an extent that it was granted a charter of incorporation by the Queen in Council, and the development of the Royal Northern group of hospitals started. This led to the incorporation of the Royal chest hospital in City Road, the Reckitt convalescent home in Clacton, the home of recovery in Earlsmead, Liverpool Road hospital in Islington, now closed, and Hanley Road hospital. In fact, this Royal Northern group formed the basis for the later north-west metropolitan region and pioneered work on self-contained associations, grouping hospitals long before the idea emanated from the Ministry of Health.

In its first report the north-west metropolitan region health board stated: The committee of management of the Royal Northern hospitals must be congratulated for their wisdom and foresight in anticipating the organisation of the present hospital by many years.

In the 125 years of its existence, the Royal Northern hospital has served the people of Islington proudly and indeed still does so today. No words of mine can adequately express how indebted we all are to the medical staff, to the nurses and to the ancillary staff for their tremendous work. Islington is particularly proud of its casualty unit. Its war memorial to the dead of both world wars was erected there to mark the special role that the hospital played at that time.

When plans for the closure of the accident and emergency department were first put forward, there was outrage among the people of Islington. A petition signed by over 60,000 people was collected within a few weeks and was presented to the Minister for Health, the hon. Member for Reading, South (Dr. Vaughan), when he visited the hospital in 1980. There have been numerous meetings since that time but, with the area health authority and the regional health authority both in agreement regarding the closure, I believe that they, in their wisdom, have not considered the full facts. The Minister stated in May 1980 that only some new factors would persuade him to veto the closure. There are new facts that I wish him to consider. With hindsight, it might be regarded as regrettable that the Department of Health and Social Security authorised and funded the building of four new accident and emergency departments in the Camden and Islington area—the Royal Northern, University College, the Royal Free and the Whittington hospitals.

It might also be regarded as regrettable that the Department had a change of heart regarding the overall development of the Royal Northern hospital site. This ideal site of some eight acres was originally planned to have a 650-bed general hospital including an obstetric unit. Site clearance was undertaken with the compulsory purchase and demolition of many dwellings.

The loss of the accident emergency department, the casualty department, signals a fundamental change in the nature of a hospital. The Royal Northern medical staff have been very much opposed to the closure of the casualty department. They have been convinced that the best interests of the patients would be served by maintaining the full range of emergency and other services on the Royal Northern hospital's site. Nevertheless, with reluctance and against their deepest feelings they have agreed that the Whittington and Royal Northern hospitals should form a single district general hospital and that the casualty department of the Royal Northern hospital will eventually close.

Timing is all-important. The Whittington hospital is on three separate sites, the largest being the central site, the St. Mary's wing. The three sites are separated by main roads; and patient communication between them is by ambulance only with all the potential for delays and complexities that this may entail. Within the next year, the 100-bed City of London maternity hospital about half a mile away will be closed and its work transferred to the St. Mary's wing site. In addition, preparations will be put in hand for closing and demolishing a small number of wards in St. Mary's wing in preparation for the building of a 250-bed new surgical ward block.

It cannot, therefore, be the right time for the casualty department of the Royal Northern hospital to be closed, thus throwing on to St. Mary's wing in this critical year an additional 34,000 casualty attendances—figures for the casualty department attendances, which have varied little during the past five years, show that in 1980 there were 33,875, of which 21,368 were new cases—and requiring a major reorganisation of all the junior medical staff appointments in both hospitals. It would also prejudice the continued viability of the Royal Northern hospital as a coherent and highly efficient unit that has many of the advantages and very few of the disadvantages of the small acute general hospital.

In the spring of 1982, a new district health authority will be given the task of managing all the complex problems of Islington's health services. Many of those who have advised me are convinced that the closure of the Royal Northern hospital casualty department at this time will result in a clinical load on St. Mary's wing of the Whittington hospital that will be more than it can bear. It might be regarded as unfair to burden the new district health authority with a decision that is likely to result in a complex and potentially dangerous situation. The medical staff of the two hospitals laid down a number of requirements before they would agree to a decision to close the Royal Northern hospital casualty department. Those requirements were that they should be able to examine all the proposals made by the district management team for the reception of the increased casualty load in St. Mary's wing of the Whittington hospital, for the redistribution of emergency admissions to the two hospitals, for the training of junior staff, for the adequate and safe levels of medical and nursing staffing in the reorganised facilities, and for the ability of the ambulance services and other lines of communication to cope with the altered situation.

Those proposals have not yet been put to the medical staff, so that most important element in the decision-making process has not been completed. The closure of the Royal Northern hospital casualty department will increase the total number of attendances at the Whittington casualty department by approximately 34,000. That will bring the total number of attendances there up to more than 86,000 a year and will, I think, make Whittington attendances the largest in the London area. When it is realised that the flexibility of the site depends on ambulance transport across two main roads and that it is already under pressure from the existing casualty load, it will, I hope, be appreciated that the decision to close the casualty department at the Royal Northern hospital is premature.

The Islington community health council has uncovered new factors, which have been submitted to the Minister as counter-proposals to the plans approved by the area health authority and the regional health authority. Extensive research was carried out, including the interviewing of patients for seven 24-hour days at each of the hospital's casualty departments—a total of 825 patients. Admissions over a month were analysed and investigations made into whether the Whittington hospital could cope with both its own and the Royal Northern hospital's casualties and admissions from casualty. It was found that not only were there not enough beds near the accident unit at the Whittington hospital and that existing beds were full, but also that admission procedures and information systems were already chaotic. Neither the area health authority nor the regional health authority has explained how it will deal with those problems after the closure of the casualty department at the Royal Northern hospital, although they accept the criticisms of the shortcomings at the Whittington hospital.

I recognise the anomaly of needing to support counter-proposals to a proposal—that of the area health authority and of the regional health authority—which would, if implemented, subvert the very objectives it sets out to achieve. The area health authority has said that the purpose of its proposal to close the Royal Northern casualty department is to create a better accident or casualty service and to rationalise it. Islington's community health council's investigations and conclusions are that inpatient services would be less efficient and more costly if the area health authority's proposals were implemented and in the counter-proposals it has shown alternatives that could provide a more efficient inpatient service.

The real challenge to the area health authority's proposals to close the casualty units at the Royal Northern hospital is to produce two complementary hospitals and, in them, the body of one district general hospital. That cannot be tackled through amputation, and it is therefore proposed that the area health authority should implement the recommendations contained in Islington community health council's proposals for immediate improvement in the accident emergency unit and inpatient services at the Whittington hospital. Secondly it is proposed that the district management team and area health authority should review their systems for the collection and transmission of information.

Thirdly, it is proposed that a full statistical and policy study of how our services—inpatient and accident/emergency—are being used should be carried out, together with an assessment of why patients use the services that they do. Fourthly, it is proposed that, on the basis of such comprehensive and detailed information, a plan for the best organisation of hospital services during the development of the Whittington site should be worked out, consistent with the long-term strategy of avoiding duplication of services and creating a two-site district general hospital.

In the absence of such remedial measures, information or plan, the area health authority's proposal to close the Royal Northern's casualty department is, at the very least, premature and destructive of very positive aspects of existing services. Indeed, the proposal jeopardises the level and quantity of our future services.

In conclusion, it will be recalled that the Minister agreed to meet those hon. Members concerned before reaching any decision on the proposals to close the Royal Northern's casualty department. Such a meeting has not taken place, but I hope that I have said enough to convince the Minister that no case whatsoever can be made for the immediate closure of the casualty department and that a case could not be made until the Whittington hospital was in a position to cope with the additional heavy load that the closure would impose on its accident/emergency department and inpatient services.

The Minister's colleague has said that he will listen carefully to all the proposals; until the new Whittington hospital is built, no part of the Royal Northern hospital should be closed.

11.6 am

The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg )

I know that the hon. Member for Islington, North (Mr. O'Halloran) has taken a long and continuing interest in the proposed closure of the accident and emergency department of the Royal Northern hospital and has been a very strong advocate of the health needs of his constituents, as indeed have the other hon. Members with local constituencies, including my hon. Friend the Minister responsible for the disabled, my hon. Friend the Member for Hornsey (Mr. Rossi). This is a complex issue and I want to put this proposal into the context of the local health needs of the district.

I know the area well, as I live locally. In my time, I have visited both hospitals as a patient. I have read the continuing saga of the proposed changes in our excellent local newpaper, the Hampstead and Highgate Express. Although Ministers may sometimes not have had an opportunity to see the subject under discussion, I have had such an opportunity and know the problems.

Islington is an inner city district with a high rate of social deprivation, including poor and inadequate housing, often overcrowded and lacking in basic amenities. These environmental factors have an effect on people's susceptibility to illness and the capacity of the community to support those who might otherwise be cared for at home rather than in hospital. In addition Islington, like so many other inner London boroughs, has a declining population, with the elderly forming an ever-increasing proportion of the total.

It is fair to say that the fundamental problem for the responsible health authority is the maldistribution of resources between the different sectors of health care. For while Islington is well provided in the acute sector, there are serious deficiencies in the primary care services, services for the elderly, the mentally ill and the mentally handicapped. As the hon. Gentleman will be aware, in recent years a number of reports have drawn the attention of Members to these problems. The reports of the London Health Planning Consortium "Acute Hospital Services in London" and the London Advisory Group indicated that the district should achieve a significant reduction in the number of acute beds and from the resources thus released—the hon. Gentleman will accept that this is an important point—aim to improve primary care services and those for the mentally ill, mentally handicapped and elderly. The London Health Planning Consortium calculated that the district had 280 acute beds too many. Both regional and area health authorities are aware of the need to do something to correct this obvious imbalance. One of the region's major strategic objectives, as stated on numerous occasions, 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". The area's strategic plan declares its objectives to be the rationalisation of hospital resources to meet deficiencies in services for geriatrics, mental handicap, and other special categories, while at the same time keeping all services at a satisfactory level", and to develop health care services throughout the area with emphasis on the further development of primary care services".

I fully support these objectives. The Government have been making a positive contribution to this development through the additional money that they provide to inner-city partnerships. While I was at the Department of the Environment for two years I chaired the Hackney and Islington partnership committee at, on occasion, somewhat stormy meetings. The hon. Gentleman is now in a different position from when he started as, indeed, are quite a few of the Islington representatives whom I met on that partnership committee. It provided me with an opportunity to gain an insight into some of the stranger activities of the Labour Party in Islington.

The Health Service problems of the district have been recognised by the Hackney and Islington inner city partnership, of which the Camden and Islington Area Health Authority is a member.

Although the main priorities of the partnership are the promotion of economic regeneration and employment and the improvement of the physical environment, there has always been a substantial health component in its programme and that is directed towards primary and community care. Apart from partnership money, in the current economic climate, Islington health district cannot expect additional resources. If the so-called Cinderella services are to be improved, the money must be found from savings elsewhere—through greater efficiency and through a rationalisation of acute services. It is the responsibility of the health authorities to bring forward plans on these lines. The area health authority and the health district have made great efforts to attempt to save money and to tackle the fundamental imbalance in the district's health services.

The proposal to close the Royal Northern hospital accident and emergency department has to be seen against this difficult and complex background. It arises from the fact that nearly all the district's acute services are provided by the Whittington and Royal Northern hospitals, which are about one mile apart, with some duplication of services including, on each site, accident and emergency departments intended to operate a 24-hour, seven days a week service. As I am sure the hon. Gentleman understands from his knowledge of the area, the district finds it difficult to staff and run two major accident and emergency departments so close together. At times the Royal Northern accident and emergency department has been closed because of these difficulties.

To rationalise the district's acute services, the AHA has been planning to integrate the Whittington and Royal Northern hospitals into a two-site district general hospital, with major redevelopment at the Whittington, to close the accident and emergency department at the Royal Northern hospital and to centralise the district's accident and emergency services at the Whittington hospital.

As the hon. Member knows and has told us clearly today, this proposal has been the subject of lively local debate for a considerable time. My colleagues and I are fully aware of the considerable local affection for the Royal Northern hospital and the worries about its future. My hon. Friend the Minister of State visited the hospital last year to gain first-hand knowledge of local views and he asked his officials to hold discussions with all interested parties.

At that time, in the light of the need to reduce the acute beds in the district, the strategy was to concentrate acute services at the Whittington, reduce the number of beds at the Royal Northern and change the use of the hospital to geriatric care. During a second visit to the hospital in May 1980 my hon. Friend announced that he was determined to see that the Royal Northern continued to thrive and have a major role for the future. He said that he would not agree to any plan for developing the Whittington hospital that did not include keeping a viable, worthwhile service at the Royal Northern hospital.

My hon. Friend thought that the future must lie in treating both the Whittington and the Royal Northern as one district general hospital complex on two different sites and planning the services accordingly so that both hospitals have s sensible, balanced, range of work. My hon. Friend stated that he would expect some acute work to remain at the Royal Northern, particularly so that the good operating theatres could continue to be used.

However, my hon. Friend made it clear that it could not be right to duplicate all services. He could not see any justification for keeping two accident and emergency departments so near to each other. He said that before the accident and emergency department at the Royal Northern could be permanently closed there would be local consultations. He added that if the proposal were not accepted locally, it would be referred for ministerial decision but that unless the consultation procedures produced some major new factors he would have to agree to the closure of the department. This is still our position, and the matter has been now referred to us for decision. Meanwhile, planning for the redevelopment of the Whittington hospital is proceeding on the basis that, with the Royal Northern, it will form a two-site district general hospital.

A working group, including the chairmen of the two hospital medical committees and the chairman of the community health council, has been advising on bed allocations between the two sites. However, the first phase of rebuilding is not expected to be completed until the late 1980s.

The closure or change of use of health buildings is governed by carefully worked-out procedures issued by my Department. These procedures ensure that area health authorities undertake full consultations with a wide range of local interests, including local Members of Parliament and community health councils. If the community health council wishes to object to a closure or change of use, it may submit to the AHA a constructive and detailed counter-proposal. In the event of local disagreement, the AHA must refer the matter to the regional health authority, which, if if supports the AHA, must seek the approval of my right hon. Friend the Secretary of State to the proposal.

The Camden and Islington area health authority issued a formal consultation document in July 1980. The Islington community health council produced a counterproposal and this, together with other comments, was presented to the AHA in April 1981. We have seen copies of the papers considered by the authority. The objections were set out at great length; many of them were reproduced in full, including those of the Royal Northern hospital medical staff committee and the community health council.

The AHA deferred its final decision pending discussions with the Islington district general hospital medical committee on certain necessary arrangements of work, accommodation and staff duties. At its meeting in May the AHA reconsidered the outcome of consultation, having before it the views of this medical committee and further comments from the CHC. The authority decided to reaffirm its proposal to close the department and to refer the matter to the regional health authority as required by the closure procedures.

The AHA claims that the proposed changes would save about £200,000 per annum on the current cost of running the two units and would result in the best possible accident and emergency service for the district. In order to meet some of the objections, the AHA has undertaken that, if my right hon. Friend agrees to the proposal, it will not be implemented until improvements to the Whittington accident and emergency department are completed. These alterations are in progress and should be completed early next year.

The AHA has also decided that the closure would not be implemented until it is satisfied with changes to the administrative system for patient admissions, bed distributions between the Whittington and Royal Northern hospitals and the consequential staffing changes. The authority has also undertaken to ensure that patients arriving at the Royal Northern hospital are directed to the Whittington accident and emergency department and assisted where necessary by the provision of transport and summoning of interim medical or nursing help. The AHA is also seeking, in conjunction with the family practitioner committee and local GPs, to improve access to primary health care in Islington. The regional health authority considered the AHA's proposal in July, decided to support it and referred the matter to my right hon. Friend the Secretary of State for his decision. We have been studying the papers, including the CHC counter-proposal, very carefully. They are weighty documents indeed, but we expect to make a decision soon.

It would not be right for me to comment today on the merits of the AHA's case or the arguments against it. My hon. Friend the Minister of State has undertaken to meet again the hon. Member for Islington, North and other hon. Members to discuss the proposal. I have, as I know the hon. Gentleman will appreciate, listened very carefully to him. I hope that he will accept that his views, which I shall convey to my hon. Friend, and those of others who have commented, will be taken fully into account before a final decision is made. That decision will reflect our judgment of what is in the best interests of all the residents of Islington and the others who use its health services.

Question put and agreed to.

Adjourned accordingly at twenty-three minutes past Eleven o'clock.