Shipley Hospital (Hansard, 15 December 1982)

§ Mr. Marcus Fox (Shipley)

My purpose in raising the question of the closure of the Shipley hospital is quite simple. There is deep anxiety and concern among the vast majority of my constituents at this proposal. In my 12 years as a Member of Parliament, no other issue has caused such an outrage as this, as illustrated by the 25,000-name petition that I presented to the Minister of State recently.

I do not blame my hon. Friend the Under-Secretary for these circumstances. He is a friend of long standing, and I know that if this event happened in Hampstead, and he was not a Minister, he would be standing in my place raising these points because I know that he cares about his constituents.

The proposal emanates from the Bradford area health authority, which is composed of local people who ought to know better. Shipley has always prided itself on being an entity. That was prior to local government reorganisation, and local independence took a body blow when that occurred.

A number of other services have been removed over the years, such as the ambulance service, highways and the maternity home. The feeling now is that enough is enough.

Many years ago, two benefactors provided two hospitals, one being Sir Titus Salt, a Member of Parliament, who created a hospital and a village. As if that was not sufficient, the inhabitants collected enough money, not just to provide a third hospital but to buy the land as well. Had it not been for the 1939–45 war, Shipley would have had a third hospital.

The National Health Service created in 1945 put a stop to that, and these assets were appropriated. No one would have thought that an area that could have had three hospitals would today be in danger of being left without one, despite assurances given by the Bradford area health authority as recently as 1979, when the old Salt hospital was closed and it was decided to move it to the old maternity home.

The assurances were given to the doctors in Shipley and Baildon, and the area health authority stated: In considering the usage of this hospital, it would probably have been possible to concentrate the facilities at the larger acute hospitals in the district, thus bringing Shipley into the same relationship with the Health Services as other parts of the urban area. However, this would result in a diminution of health services in the locality, and it is accepted that the services provided at Sir Titus Salt's Hospital has been of the greatest value to the local population and that the aim should be to preserve the type of service developed. The district health authority must have believed that, because it has spent £250,000 over the last four years on this hospital. Only a few days ago, the completion of a new lift was achieved.

It is not too strong to say that to remove an asset of this kind, having spent that sort of money, is not far short of vandalism. It is no wonder that my constituents are asking what the Health Service is about. Surely it is about the treatment of illness and the care of patients. People should be nursed back to health, which as far as possible should occur in the surroundings of their choice. It is hard to envisage a hospital that deserves the title community 457 hospital more than Shipley. Every doctor in Shipley and Baildon can confirm that. Hence their utter opposition to the proposals.

I have received hundreds of letters on the subject. The ones that touch me most are those from the elderly who have had personal experience of the hospital. When I speak as strongly as I can against the proposals, it is necessary to understand the people whom I represent. Many of them have spent all their lives in the area. Never have they had the good fortune to earn the average industrial wage, never mind being well paid. They have been thrifty, law abiding and hard working, most of them having been employed in textiles and engineering. To many of them, car ownership is a dream that has never been fulfilled. That is why the removal of the Shipley hospital would be a tragedy. The cost of travelling to St. Luke's hospital or to the Bradford royal infirmary would be exorbitant, not to mention the inconvenience.

What does the hospital do? It was opened only some three ago to replace the old Salt hospital. It provides 23 beds. I understand that the occupancy last year increased by some 12 per cent. Last year, 11,699 out-patients were treated—an increase of some 70 per cent. on the previous year. I could list all of the other services such as X-ray, the thousands of people who were given physiotherapy and post-operative care. I understand Government policy. It is that high technology hospitals should complement community-based ones. I can do no better than quote from a consultation paper that was issued by the previous Minister of State who is now the Minister for Consumer Affairs. I was delighted to see him at the Dispatch Box recently. It is a pity that he is not here to hear what he said. In the foreword, he said: Yet there is a real risk of concentrating services more heavily than the advantages strictly justify, to the detriment of other considerations such as the accessibility of hospitals to patients and visitors, and the sense of identity which many local communities have with their local hospital. The Minister continued in the consultation paper called "The future pattern of hospital provision in England": Hospital policy for the 1960s and 1970s was to concentrate hospital services in major hospitals with only a limited range of services remaining in small local ('community') hospitals. It is proposed that this policy be changed to place less emphasis on the centralisation of services in very large hospitals and to allow for the retention of a wider range of local facilities. I would love to quote even more. The National Health Service cannot afford to lose assets which are suitable for those patients who do not need the full panoply of investigation and treatment.

My hon. Friend's document continued: The Government has already made clear its wish to retain small hospitals wherever sensible and practicable, though recognising that some closures of old, inefficient or badly situated units are necessary. By no stretch of the imagination could Shipley hospital fall into that category.

My hon. Friend knows that I do not oppose the control of public spending. It must be controlled in line with what we can afford. Therefore, I cannot disagree with the ceiling of expenditure that has been given to the Bradford health authority. My resentment lies in the idea that to save £200,000 in 1983–84, Shipley hospital must close. A saving of £200,000 out of a total budget of £48 million?

458 Someone must be joking. It represents less than 0.5 per cent. of the total. Are we to believe that this is the only way in which that sum can be saved?

I realise that the time has not yet arrived for the Minister to have this issue on his desk. I do not expect his reply to reveal much. I think, however, that I have every right to ask my hon. Friend to examine carefully the options that are available. I select one example of where savings can be made. In the budget of £48 million, the sum for domestic cleaning is £2,655,389. That is not to mention porterage of £935,000 or laundry and linen costing another £1,072,000. These are the figures in the budget announced by the health authority. It is known that private contractors can perform this work at an average saving of at least 20 per cent. If one-third of the cleaning services were put out to such contractors, Shipley hospital could stay open. There may have have to be redundancies. I am not suggesting that the switch from the public to the private sector will not mean one or two. However, there will be redundancies if Shipley hospital is closed. I would prefer that redundancies should not occur in the active area of the Health Service among nurses but rather among ancillary workers.

In the last few days, a new hospital has opened in Redhill. A major award worth £200,000 has gone to a private contractor. The chairman of the health authority has stated: Our decision to appoint a private contractor was based on price and performance. The private contractor was the lowest tenderer—considerably below the in-house quotation—and has been satisfactorily cleaning the existing Redhill General Hospital for at least a generation. The savings are thought to be about £50,000 a year". Is my hon. Friend able to confirm these figures for savings? Will he contemplate issuing a circular giving guidance to health authorities on their responsibilities? Will the Minister make allowances for slippage, if that is the right word, in 1983–84 if district authorities need extra time to sort out financial problems on the basis that privatisation will save money? In the long term, patients would not suffer. Some guidance from the Department would not go amiss. A number of people would be willing to contribute in terms of feasibility studies.

I hope that my hon. Friend will confirm that there is no truth in the statement that the Bradford health authority is under-funded. A figure of £3 million in terms of RAWP has been supplied to me. What is even more worrying from Bradford's point of view is that the Leeds area, it seems, has done far better.

Another area worthy of examination is departmental budgets. Surgeons and doctors would not be averse to guidance on economies. I am concerned deeply about the costs involved in the prescription of drugs. The figures are contained in the budget that I have received. Is it necessary, when patients are discharged, always to prescribe for 14 days rather than for seven? There are those more qualified to decide than myself. I feel, however, that clinical freedom may have gone too far when the only means of making economies is the prospect of closing a hospital such as I have described.

Every area of expenditure should be examined—maternity services, early discharge, use of beds, and so on. The so-called savings from closing Shipley hospital may well be illusory. The district might achieve savings on paper, but higher costs will certainly be passed on to the region. It must be a matter of concern 459 to the central organisation that if savings are made in one area one cannot simply forget that higher charges may be passed on somewhere else. One need only consider the ambulance service to realise that higher costs must result from the closure of community hospitals such as the one that I have described.

The Secretary of State is on record within the last year as saying that due to the enormous expansion in the elderly population in the next two decades a redistribution of financial resources should be made in the Health Service, away from acute surgical services to allow for expansion of services for the care of the elderly.

The case for Shipley hospital is the same case that was made some time ago for Tunbridge Wells. In the May 1982 issue of "Health Care Trends" the case was forcefully made that a district health care plan can be based on a number of community hospitals in conjunction with the high technology hospitals.

We look to the Minister and to the Department to consider not only the Bradford health authority's proposals but all the other options available. The alternative is not simply to close surgical wards, as, I understand, the Bradford health authority suggests. That is the last thing I want. Administration conjures up all kinds of possibilities, but I return to my appeal for specific savings. I know that people in the Health Service are aware of the need to economise. Nevertheless, waste occurs and an overall saving of 2 per cent. could certainly be achieved by the Bradford health authority without any loss of services.

There is a feeling that consultation is perhaps not so thorough as it should be. My purpose in applying for this debate—in good time, before the consultation period ends on 7 January—is to alert the Department to the deep anxiety that has already been aroused by the recommendations. I sincerely hope that my hon. Friend the Minister will keep this matter in perspective, as £200,000 is small beer compared with the total budget, and a hospital should certainly not be closed for financial reasons alone.

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

I am grateful to my hon. Friend the Member for Shipley (Mr. Fox) for giving me the chance to say something about the future of Shipley hospital. I pay tribute to the informed, responsible and effective way in which he has sought to represent the views and interests of his constituents at this unearthly hour.

I know that there has been enormous local concern about the proposal by Bradford health authority to close the hospital. As my hon. Friend the Member for Shipley said, my hon. and learned Friend the Minister for Health was presented recently with a petition containing some 25,000 signatures, and the Department has received a number of letters from local bodies and organisations as well as from members of the public who are my hon. Friend's constituents.

I should begin by making it quite clear that, as my hon. Friend the Member for Shipley has said, neither I nor my right hon. Friend the Secretary of State has been asked at this stage to take any final decision about the future of Shipley hospital. At present, Bradford health authority is consulting widely on a number of proposals which it has considered to enable it to live within its means in the future. Among these are the proposed closure of Thornton 460 View hospital, Queensbury, with its 82 beds for mainly elderly patients and the proposed closure of the 23-bedded Shipley hospital in my hon. Friend's constituency.

Before dealing with the particular circumstances of Shipley hospital and the specific and imported points that my hon. Friend has raised, it is important to outline the procedures under which proposals of this kind are considered.

In general, the responsibility for determining the closure or change of use of health buildings rests with the appropriate district health authority. If, having regard to its long-term strategy for the provision of health services and the resource outlook, a district health authority considers the closure or change of use of a facility to be necessary, it must initiate formal consultations. In that event, the procedures require the authority to prepare a consultation document covering such matters as the reason for its proposals, an evaluation of the possibilities of using the facilities for other purposes or the disposal of the site, implications for the staff, the relationship between the closure or change of use and other developments and plans and the transport facilities for those patients who might be affected by the proposals.

The district health authority then invites comments on the proposals contained in the document, within three months, from such bodies as the community health councils, local authorities, staff organisations, family practitioner committees and local advisory committees, including the local medical committees. Hon. Members whose constituencies are affected are also informed of the proposals. That is the stage reached with Shipley hospital and, as my hon. Friend said, Bradford health authority has issued a consultation document and is seeking comments by 7 January.

Before considering some of the issues behind the Bradford proposals, it might be helpful if I explained the next steps in the closure or change of use procedure. When the comments on proposals in the consultation document have been received, the district health authority must then seek the community health council's views on the comments and its own observations on those comments. The authority then reviews its original proposals in the light of the comments received and, unless there is strong local opposition—from what my hon. Friend said, there is likely to be opposition—it could implement its original proposals, provided that the community health council agrees. The regional health authority and my Department would be informed of the decision.

However, if the community health council objects to the authority's proposals, it is required to submit to the authority a constructive and detailed counter-proposal, paying full regard to the factors, including the resource outlook, that led the authority to make its original proposal. The matter must then be referred to the regional health authority. If the regional health authority is unable to accept the views of the community health council and wishes to proceed with the closure or change of use, it falls to my right hon. Friend the Secretary of State to take the final decision. Therefore, I repeat—my hon. Friend was good enough to make the point—that nothing I say today should be construed as prejudging the issue, on which the consultation procedures that I have described are still in progress.

It may be helpful if I say something about the financial position of Bradford health authority. The district's revenue allocation in the current financial year, as my hon.

461 Friend said, is £46 million. While the district is assessed by the regional health authority still to be about 7 per cent. below its RAWP target, this year's allocation represents a growth in real terms of about 1½ per cent. over 1981–82. That is a clear demonstration of the reckless rhetoric and nonsense that we hear so often from hon. Members on the now empty Opposition Benches when they talk about cuts in the NHS and the NHS being starved of funds. No amount of untrue statements from the Labour Party can get away from the fact that we are now spending 5½ per cent. more in real terms on the NHS than when we took office.

Of course, health authorities are required to contain their expenditure within the notified cash limits. If they fail to do that in any year, they naturally erode their financial position for future years. Therefore, the need to maintain strict controls on expenditure is paramount, but is well accepted throughout the NHS.

During the autumn the Bradford health authority, taking stock of its financial position, concluded that if it were to fund all the proposals in its operational plan in full and at the same time meet its share of the additional costs of the current pay awards, there would be an anticipated shortfall of income against recurring expenditure in the 1983–84 financial year of some £1 million. In the light of that potential deficit, the authority has been reviewing the proposals in its operational plan, as well as the current levels of provision being supported in the district.

My hon. Friend has suggested a number of interesting possible alternative ways in which the necessary 462 economies might be made to allow Shipley hospital to remain open. I was particularly interested in the points he raised about the prospects for contracting out cleaning services in the district; for the tighter control of expenditure on drugs; and also for the prospects of selling health centres to general practitioners thereby making them owner-occupiers rather than health authority tenants. He put forward a number of matters and they will all receive serious consideration.

I am sure also that the community health council will be taking account of those and other points in framing any counter-proposals to the consultation document which it may put forward. I shall in any event ask the Bradford health authority to look carefully into those points which my hon. Friend raised when it comes to consider the comments which have been made on the document.

I must reiterate my thanks to my hon. Friend for raising this important issue and for the constructive approach that he has adopted, which is what I expect of him after 30 years's friendship.

Should the matter be referred to my right hon. Friend the Secretary of State in the future for a final decision—I have told my hon. Friend the steps that must be taken before that happens—we shall certainly all be better informed as a result of today's debate.

I assure my hon. Friend that everything that he has said will be taken carefully into account before my right hon. Friend makes any final decision.