§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Thompson.]
§ 12 midnight
§ Mr. Ivan Lawrence (Burton)For the past 20 years of my life as a practitioner in the courts, and for the past eight years as a Member of this House, I have advocated many causes, some good and some bad. The bad causes in the courts have often ended in failure, and that is as it should be. The good causes in the courts and in this place have more often succeeded, although some, as the Minister well knows, have not yet done so. However, they will in time.
In all these years of advocating causes, few have been so manifestly good as the need to save Tadworth Court children's hospital from extinction, and none has attracted in so short a time such massive support from the public, the press, parents, nurses, doctors and the 160 Back-Bench Members who have signed the two early-day motions. That support is clearly here tonight, even at this extraordinary awkward hour.
Happily, the cause of Tadworth hospital has already enjoyed some good fortune. I have had the good fortune to draw this opportunity in the ballot to have this short debate. We have the good fortune that the Member who represents Tadworth is my hon. Friend the Member for Reigate (Mr. Gardiner), and I hope that he will catch the eye of the Chair.
We have the further good fortune of having a Minister for Health who has a well-justified reputation for genuine concern about those who are burdened by suffering in society, and who has already made it clear that this particular decision is too important for him to rush into the quick and seemingly easy way out.
We also have the good fortune of having the support of a number of people engaged either in the financial world or with leading charities who are determined that Tadworth shall not die. I welcome the support of hon. Ladies and, in spirit, hon. Gentlemen on both sides of the House for this cause. We look to the Minister's decision, after due consideration, to bring about the ultimate good fortune for which we are earnestly striving.
My hon. and learned Friend must answer three essential questions. First, does Tadworth Court possess such advantages that every conceivable effort should be made to save it? That answer to that is a very definite "Yes". Secondly, would Queen Mary's, Carshalton, the recommended alternative of the Great Ormond Street board of governors, be an adequate substitute for Tadworth? The answer to that is a very definite "No". Thirdly, what can be done as an alternative to closure to avoid pre-empting an unfair proportion of NHS money that is available for other pressing health needs? The answer to that is "A number of things".
In the short time available to me I want to attempt fuller answers to the first two questions. I know that my hon. Friend the Member for Reigate is well prepared to answer the third.
What is it about Tadworth Court that makes it so indispensable? It is summed up very well in some of the headlines that have appeared in the national press. The Daily Express called it"Heartbreak of happiness hospital".
The Daily Mail stated:
We must fight for this haven of hope".373 The Sunday Times asked "Must the caring stop?" The uniqueness of this hospital is that it is what some hospitals claim to he but few really are—a home. It is a place of happiness, providing care and hope for children who are terribly sick, and for some who have little hope of life.To those children, Tadworth is a second home to which they are happy to return time and again. It is a home where the parents can go to live for short periods with their sick children and be sustained themselves, where they can gain some respite from the despair of coping at home with the most handicapped of children. It is a place where parents whose families are cracking up under the strain can receive friendship, advice and help. It helps to give them peace of mind, because they know that they can trust the staff of Tadworth.
Tadworth is no large, multi-purpose hospital, where the nursing staff come and go, but a home where the same nurses meet the same children returning time and again for help and loving care and the children actually run to greet them. It is a place where bureaucracy and strict timetables are secondary and the needs of the individual child for physiotherapy, intravenous injections or a hot meal at any time of the day or night are paramount. It is a home set in a very suitable, quiet and relaxed environment, surrounded by local people so supportive that in 1976 they raised £60,000 in donations towards the cost of a hydrotherapy pool.
If my hon. and learned Friend the Minister really wishes to see the small, self-contained, local cottage-type hospital for which the Government have called in "Care in the Community", he will find it pre-eminently at Tadworth. What Tadworth offers is quantifiable not by statistical and financial measure but, as the headlines say, by happiness, caring and hope.
Can all this be so simply transplanted lock, stock and a barrel to Queen Mary's hospital, Carshalton? Would that be the ideal solution for Tadworth's cystic fibrosis and mentally handicapped children, as it would doubtless be an ideal solution for the problems of underoccupied beds and underused resources at Queen Mary's hospital?
Nothing that I say should be taken as a criticism of a hospital with such a good reputation as Queen Mary's, still less as a criticism of the dedication of its staff. I also hope that nothing in our campaign will be taken as a reflection on Great Ormond Street hospital—a hospital of the highest reputation and renown into whose care I have entrusted my own daughter as a patient for the past 14 years.
We wish the Great Ormond Street hospital had been able to stick to the decision of its strategic working party, recorded in a minute of 18 November 1981 as follows:
Mrs. Bond (in the Chair) suggested that, in an attempt to reduce the numbers of alternatives for consideration, the Working Party should exclude the possibility of a total closure of Tadworth. She felt that this would be particularly difficult to implement—especially in view of the unique care that was afforded to patients, many of whom could not be treated elsewhere, the staffing implications and the heavy capital expenditure necessary in the Group if Tadworth closed completely. Mrs. Callaghan supported these comments and other members of the Working Party also agreed that this possible course of action be discarded.Too much will be lost to cystic fibrosis and mentally handicapped children, to parents and to staff if the Queen Mary's alternative is adopted—not because Queen Mary's is a bad or inferior hospital but because it is a different kind of hospital. It is a big, acute hospital—a large paediatric centre. It cannot be a serene, quiet hospice. There is no creche for patients. There is no holiday unit. The regime 374 is not of the family kind. The wards are too large and have too many beds to provide the homely atmosphere so vital to many of the children who go to Tadworth. The drugs given via canula drip would not be administered by nurses whom the children love. Physiotherapy would riot be carried out by nurses through the night, nor would food be cooked by parents and staff at all hours. At Queen Mary's, the methods are different and the rules are different. The hospital itself is different.On this the Minister has not the unsubstantiated word of a mere Member of Parliament fighting for a cause that he believes is right, but the most weighty of all opinions in this matter—those of the consultant paediatricians at Great Ormond Street hospital. The considered view of the medical advisory committee which would be making the referrals to Queen Mary's—these men and women are, in a sense, making this judgment against their own personal interest, as Queen Mary's would be more convenient for them—is summed up by Dr. Duncan Matthew, who said that
it would be almost impossible to reproduce the same level of care for these particular children at Queen Mary's.Even if the procedures could be changed at Queen Mary's, one must face the fact that the staff are likely to be substantially different. Queen Mary's is six miles by road from Tadworth. There is no direct public transport. The existing Tadworth staff have made it clear that very few of them would be likely to transfer even if—and it is doubtful—they were preferred to the existing staff at Queen Mary's. Once they go, the parental and children's confidence would be lost. A unique section of the nursing profession might be lost to medicine. For the existing patients at Tadworth the change would not be a happy one. For the patients of the future, the regime of Tadworth, which now contributes so much, would disappear.
There are ways in which Tadworth can be saved—and none of its unique benefits lost. Over the next two months it will be possible for my hon. and learned Friend to examine whether the 37 acres of unnecessary land can be sold and the capital invested, whether money might be saved if there were fewer beds, or more referrals and more beds, and whether alternative ways of raising finance can realistically be adopted.
There are so many good reasons for saving Tadworth. So many options might be adopted to enable it to be saved that all who wish to see this unique children's hospital saved should take heart. The Minister has given two earnests of his good faith. Yesterday, he welcomed a deputation that put our case, and he administered first-aid by giving £300,000 to the threatened hospital.
All that we can ask—and all that we do ask—is that my hon. and learned hon. Friend fully and fairly considers these options and the fact that so many people really care deeply about the survival of Tadworth.
§ Mr. George Gardiner (Reigate)I thank my hon. and learned Friend the Member for Burton (Mr. Lawrence) for curtailing his remarks so that I, as the Member of Parliament within whose constituency Tadworth Court hospital falls, can make a short contribution to the debate. I thank my hon. and learned Friend the Minister for also making available a little of his time.
As one who was aware of the unique service and facility offered by the hospital before I was ever elected an hon. Member, I thank my hon. and learned Friend the Member 375 for Burton for the continued interest that he has taken, not only in the cystic fibrosis cases at the hospital, but in the welfare of all the children and families affected. We are all at Tadworth Court most grateful for the work that he has done.
I pay tribute to the staff of the hospital, who do not see the battle as one—as it often is—of fighting for their jobs, but who are rather fighting to be able to go on caring for children who are regularly referred to them. They are children who, as my hon. and learned Friend said, regard the staff more as family friends than as nurses.
I am also grateful to my hon. and learned Friend for laying the false view that the Minister is faced with a difficult choice between
two half-filled hospitals within a 4 mile radius of one another".It was noteworthy that when our deputation came to see the Minister yesterday a united view was presented by the staff, the consultant side and the parents who are so deeply affected. The united view was that, although they had no wish to deride or knock the excellent work done at Queen Mary's hospital, the type of facilities offered there for this type of child patient would be a most inferior substitute. My hon. and learned Friend the Member for Burton said that there are a number of options for keeping the hospital open and we know that the Minister will investigate them thoroughly.
It has been pointed out frequently in the press that Tadworth Court hospital costs —1.4 million to run. As its bed occupancy has been run down over recent years, that means that the cost per patient is high. The view in the hospital, which I share, is that if greater use were made of the hospital and it was opened to more of the cases needing respite care within the South-East region the economic picture presented by the hospital would be far more favourable.
If the hospital is closed, the Great Ormond Street group will not be £1.4 million in pocket, because it is still offering to pay £400,000 a year to Queen Mary's hospital to take care of those patients. According to the deputy hospital administrator at Great Ormond Street hospital, the savings to the group will at best be £800,000 and at worst £400,000 per annum. That puts the figures into perspective rather better than the press reports suggest.
As my hon. and learned Friend the Member for Burton has said, a number of courses have been suggested and they are not all mutually exclusive. A scheme has been presented by the Spastics Society that my hon. and learned Friend the Minister has undertaken to investigate. The Spastics Society and the other charities backing it stress that its proposals are flexible, and I am convinced that they offer a partial solution which would open up the hospital's respite care facility to more children who need it as well as continuing the hospital's other facilities.
My hon. and learned Friend mentioned the sale of land, which is a factor that has cropped up fairly recently in the mind of the board of governors. According to a report prepared for it by a firm of valuers, if the site was completely developed with low-density housing it could be sold for about £3 million. That proposition is attractive to the Great Ormond Street governors. However, local opinion would regard it as an outrage if the land were sold for that purpose without any direct benefit to or preservation of the facilities available to the children. The 376 report says that the land that is rented for grazing could be sold on the same basis for £1.7 million. That could be put to good use to support the Tadworth unit.
There is great potential for private support to back this National Health Service hospital. The Minister will know that 10 days ago an appeal fund was launched locally. It had to be opened to receive the money that was flowing in from well-wishers across the country. The fund has received £7,000, mostly in small contributions. The Minister will say that even if that sum is doubled it will not go far towards saving the hospital, but it is an acorn from which an oak tree could easily grow. The offers and encouragement that have come from the city and private companies are proof of that.
We have had an offer from a reputable business man in the City to organise a fund that could net more than £100,000 in covenanted income for the hospital. Only yesterday great interest was shown by the Heritage Foundation in the United States in offering a challenge grant to the hospital whereby every pound raised privately could be matched by a pound from the fund to a limit of £120,000. I am advised that a survival fund of ¼ million could easily be within our sight.
All such support hangs on one condition—that my hon. and learned Friend reprieves Tadworth Court and gives it a future. If he decides to close it, the private support will evaporate to the permanent loss of present and future generations of children suffering from cystic fibrosis, varieties of mental handicap or progressive terminal illness. I have a close knowledge of all that the hospital achieves, and I appeal to my hon. and learned Friend to reprieve the hospital so that the sources of finance can be tapped and used for the benefit of those children.
§ The Minister for Health (Mr. Kenneth Clarke)I understand the strong feelings of the staff, the patients and, above all, the families of the children who are treated at Tadworth Court about its future. I understand them very much more having met the deputation brought to me yesterday by my hon. Friend the Member for Reigate (Mr. Gardiner) and my hon. and learned Friend the Member for Burton (Mr. Lawrence).
There is no question but that the services provided to the children and their families should continue. The question facing us, on which I am happy to have the advice of the House, is where and how best to provide them.
Let me explain briefly how the problem has arisen. It does not come from any sudden reduction in financial support to the group of hospitals or cut-back in the financial provision for the vital work of caring for sick children. Tadworth Court is part of a group of hospitals for sick children managed by a board of governors as part of a special health authority. The group consists of the main hospital, the well-known national centre of excellence at Great Ormond Street, the Queen Elizabeth hospital, Hackney, and Tadworth Court.
The resources for the group have been increasing recently because of the steady increase in the amount of work that it does. In particular, the resources have been under great pressure because of the increase in the highly specialised activity at Great Ormond Street, which takes the most difficult and worrying cases from all over the country. In recent years alone we have seen the development there of new methods of treating malignant disease, in the diagnosis and treatment of renal disease in 377 children and in the development of new surgical techniques for the neonate. Many children admitted to Great Ormond Street from all over the country are multi-handicapped and it is the only suitable hospital where all the required specialties are available.
The Government have done what any Government of any political complexion would do; we have put more money into the group to finance the increased activity, particularly at Great Ormond Street, which deals with the most highly advanced and difficult cases. Recently when Great Ormond Street came under extreme pressure the Government made an extra £300,000 available to stop it having to cut back the level of its intensive care to what it was a year or two ago.
The provision of the services at Tadworth Court comes within the group, and it was the governors of the group who suggested that its future might be changed. They clearly are not heartless or insensitive people. They have had to take a realistic look at what is happening at Tadworth Court. There is a Queen Anne building, surrounded by other buildings, set in 62 acres of land of which 25 acres are let for nothing more than the grazing of horses. It is expensive to run. It is under-used with only about 50 per cent. of the beds used for the treatment of patients. The running cost is £1.4 million a year. The value of the whole site is estimated at about £3 million. The sale of part of the site would, of course, release the sort of funds to which my hon. Friend the Member for Reigate has referred.
One therefore has facilities of a very high standard deserving all the praise given by my hon. and learned Friend the Member for Burton, but nevertheless under-utilised and in a very expensive setting. It is necessary to examine the finance involved in caring for these children even with such standards of care. The whole problem of the Health Service is that even when resources are increased there are still demands all over the country that could be met.
The provision of children's services in Surrey is quite extensive. There could be strong demands for improved patient care from other parts of the country. The right hon. Member for Bristol, South (Mr. Cocks) has been present for this debate. I have received submissions from people in Bristol explaining their demands for an expansion of services at Bristol children's hospital. One has therefore to adopt a fairly hard-headed approach towards the resources allocated to Tadworth Court. There are children's hospitals in Bristol, in Birmingham and in many other cities which are doing great work. They are constantly pressing against the limits of available resources. It is therefore necessary to examine the resources going to Tadworth Court.
§ Mrs. Gwyneth Dunwoody (Crewe)It is important for hon. Members to know on what basis the decision is to be taken. Will the Minister give an undertaking that before he makes any decisions the hospital will not be run down, nurses will not be withdrawn, wards will not be closed and pupil nurses will not be removed?
§ Mr. ClarkeYes, I will. I heard some of those complaints yesterday. There is no question of running the 378 hospital down until a decision is taken. The £300,000 that we have given to the board of governors is to make sure that those sorts of pressures do not interfere with our ability to make a considered and sensitive judgment.
There are three choices. No one believes that a state of affairs in which the hospital occupies extensive grounds, most of which are of no use to the hospital, should continue. Various proposals have been put forward suggesting how better use could be made of these resources together with alternative suggestions for exploring how the service could be continued. The board of governors of Great Ormond Street propose the transfer of all the services to Queen Mary's hospital for children at Carshalton. That is four miles away as the crow flies and six miles by road. The health authority there could provide 12 orthopaedic beds with theatre and supporting services, a 30-bedded ward for cystic fibrosis, multiple handicap and respite care, and a holiday relief scheme in what is described as an underused social development centre.
It would also be possible to house all the other facilities, which are not to be derided. There are a zoo, a model railway and other items that are essential to this kind of treatment, at Carshalton.
I have been told about the problems at Carshalton. The environment is plainly different. Many of the differences in nursing practice could be discussed and overcome. The hydrotherapy pool could be transferred. The standard of nursing care at Carshalton is very high. Most of the nurses were trained at Great Ormond Street. The proposal is worth examining seriously. There should not be rivalry between the two hospitals. The issue is where the children can best be cared for.
Other propositions and suggestions have been put to me. Mr. Tim Yeo, of the Spastics Society, leading a group of charities, has put to me an interesting proposal. It is agreed, however, that there is a need to consider the details. To what extent can costs per patient be reduced so as to attract local authorities? Is it right to bring patients long distances from other parts of the country simply to provide a hospital with sufficient patients?
A further group of proposals put by my hon. Fiend the Member for Reigate and my hon. and learned Friend the Member for Burton and the deputation that they led, offer finance and a trust fund. They make constructive proposals about the sale of land and investment. All these matters must be examined. I am sorry, but I do not believe I can take an immediate decision. To rush matters in order to reach a decision perhaps before Christmas would cause concern and discontent among people who would feel that the issue had not been considered seriously. I must visit both the hospitals. We must work up the proposals that have been mentioned. No one wishes to destroy these services. No one wishes to take a light decision. However, uncertainty must not last too long. I hope that by January all the weight of representations will have been considered to enable the right decision to be reached for the children and their parents.
§ Question put and agreed to.
§ Adjourned accordingly at half-past Twelve o'clock.