§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Newton.]10.11 pm
§ Mr. Ivor Stanbrook (Orpington)
The great weakness of all Government institutions is their bureaucracy. It is easier and much more convenient for officials, sitting at their desks in remote offices, to treat private citizens as ciphers, mere units in any calculation for the allocation of public resources and better lumped together in groups than regarded as individuals with individual needs. Such an attitude of mind is common in all our public offices. In some it is excusable, but when it affects the personal services it is deplorable and damaging to the proper functioning of our democracy.
All institutions of the National Health Service are in the business of human relations. No one seeks their help who is not already in personal trouble. The alleviation of personal distress, pain and suffering is their business. It is incumbent on those who make their living from the administration of the National Health Service to carry out their functions with due regard to this fact and to speak, plan and act in relation to the public with sensitivity.
I wish to draw the attention of the House to a consultative document, issued last September by the South-East Thames regional health authority on the subject of accidents and emergency services in the 15 districts covered by the authority, extending from southeast London to Kent and Sussex. That body is a rather shadowy figure in Orpington. I rarely hear from it. It chose not to send me a copy of the document it has published. I obtained it from my own area health authority. I once telephoned the office of the regional administrator, Mr. Le Fleming, on a matter of some urgency, and I was told that he was too busy to talk to me. So perhaps I might have known what to expect.
The consultative document was prepared for a body calling itself the Regional Strategies Group, membership of which consists mostly of planners employed by the authority, together with the odd medical man from the field stations in Kent and Sussex, and one solitary general practitioner. There was no one from the Bromley health district.
The document is one of a series of operational plans and proposals that have been published in recent years. In parenthesis, I may say that the plethora of documents of this kind must be the reason why the number of administrative and non-medical staff of the National Health Service is so large compared with the number of nursing and medical staff, because clearly such reports generate a great deal of administrative work.
The report makes a number of proposals concerning the staffing and facilities for accident and emergency services in the region. I am concerned with what it says about the Bromley health district and, in particular, about Orpington.
The report's principal recommendation, to which I strongly object, is that the Orpington hospital should be downgraded to the status of a peripheral unit for the purposes of accident and emergency services, and that, in that context, the accident and emergency department at Orpington hospital should be closed from 8 pm to 8 am on weekdays and all day on Saturdays and Sundays.
1206 The justification given for that retrograde proposal is the need to spread medical resources more evenly within districts, and that as Orpington hospital, which is in the south of the Bromley health district, has a catchment population of 85,400, compared with 207,200 for Bromley hospital, which is in the centre of the district, it should be downgraded—if not closed—and resources concentrated on the Bromley hospital. To the bureaucratic mind, it would appear that that is QED.
In fact, the proposal is misconceived and dangerously wrong for a number of reasons. First, Orpington has had a full accident and emergency service for as long as anyone can remember. To restrict it now to a service functioning only during office hours is to reduce drastically the standard of local medical care which hitherto has been available. Secondly, no one plans for an accident and for the need for an emergency service at a particular time. Such things occur at all times of the day and night, unexpectedly. Closing the service overnight and at weekends is not just a reduction in the service, comparable with a cut in services generally; it is a decision in principle to close down the service. Even a restricted service in terms of the actual facilities available would be preferable to a complete closure for however short a period.
Thirdly, the extra distance and time for ambulances and patients in the Orpington and South Bromley health district area travelling to Bromley hospital will be serious in individual cases. In some, it may mean the difference between life and death. In almost every case, it must mean extra suffering. Yet the report smugly states:We do not consider the distance between Bromley and Orpington hospitals—5 miles—to be—.
I leave out some words because they are not applicable to this case—so great as to incur unreasonable hardship.It is neither equipped nor entitled to make that judgment. It is self-evident that the extra time and distance will result in extra hardship for the accident victim or heart patient concerned. How can any such extra hardship be called reasonable?
Fourthly, the figures given in the document for the so-called "catchment" area are unreliable. The catchment area for Orpington far exceeds the 85,400 figure. My constituency's population exceeds that figure by itself. Much of the surrounding area, in the constituencies of my hon. Friends the Members for Sevenoaks (Mr. Wolfson), who I am pleased to see here this evening, and Chislehurst (Mr. Sims), also depends on the Orpington hospital. Moreover, the population of the southern part of the Bromley health district is constantly rising. It is the growing part of the borough of Bromley. Because it is on the fringe of Greater London, there is a tendency for its population to increase as people move out from central London.
Moreover, the close proximity of motorways such as the M26 and M25, especially when the line between Swanley and Sevenoaks is completed, means that the Orpington hospital is particularly strategically placed for emergencies which may occur in the areas encompassed by those motorways to the southof Bromley.
The report gives the 1979 patients' attendances at the Orpington accident and emergency department as a far higher proportion of Bromley's attendances—27,314 to 42,862, or 53 per cent.—than the 41 per cent. which the purported catchment area of Orpington is supposed to bear to the Bromley figure.
1207 Fifthly, there is almost a total lack of appreciation in the report of the huge expenditure which a transfer to the Bromley hospital of the Orpington accident and emergency department for overnight purposes and weekends would involve.
Bromley hospital is far inferior to Orpington on building space. The extra facilities needed at Bromley would only make matters worse. Bromley district area health authority is considering the purchase of additional land for the purposes of extending the hospital buildings. It is therefore ironic that Orpington, with ample space for development on a green field site already owned by the hospital, should be downgraded while additional money sorely needed to improve and maintain existing services, besides the accident and emergency services, is to be used elsewhere to purchase more land.
I accept the need to restrict expenditure, but it must not be done at the expense of patients' lives, especially when money is still being poured out on building land purchases.
That brings me to my final and perhaps most important point. Many of us believe that the proposal to downgrade Orpington hospital in this way is the thin end of the wedge and that the planners are intent on downgrading departments other than the accident and emergency services. The proposal suits their tidy minds because, being anxious to centralise all the borough's services, they want to concentrate them all in Bromley.
I trust that that is not so, but I warn the Minister that there will be most strenuous resistance to this and to any other proposal which will deprive the citizens of Orpington of the medical services for which they have fought for so many years and which they deserve.
§ Mr. Mark Wolfson (Sevenoaks)
I am most grateful to my hon. Friend the Member for Orpington (Mr. Stanbrook) for inviting me to participate in the debate and to the Minister for agreeing that this would be possible.
The proposed closure of the Orpington hospital emergency and accident unit during night hours and at weekends will seriously affect a great many of my constituents, because Orpington hospital provides the more sophisticated back-up facilities for Sevenoaks and the same consultants work both hospitals. The constituents who will be affected live in Sevenoaks itself, in Dunton Green, Riverhead, Otford, Kemsing, Knockhold, Badgers Mount and Halstead.
As my hon. Friend mentioned, it is unfortunately a macabre but real possibility that as a result of the opening of new motorways in the area not only individual but also multiple accidents may occur. In addition to the motorways themselves, there will also be a number of interchanges, which will also increase the risk of accidents.
Not surprisingly, my constituents are extremely concerned at this proposal, and so am I. The possibility of closure of the Orpington unit overnight and at weekends was discussed by all the general practitioners and consultants in Sevenoaks on 27 January. After lengthy and careful consideration, their opinion is clear. It is: "Any such closure would be seriously detrimental to the interests of their patients, they deplore it and wish their protest to be known at the highest level".
In arguing against the closure, I wish to make five points specifically relevant to my constituents.
1208 First, the figures used in the report are not necessarily accurate. Patients from Borough Green, Ightham and Wrotham also use Sevenoaks hospital casualty unit. If their injuries require it, they are then sent on to Orpington. I understand that that fact was not adequately brought out in the report.
Secondly, the casualty units at Pembury and Kent and Sussex hospital south of Sevenoaks could not handle referrals from Sevenoaks as they do not have the bed capacity to do so.
Thirdly, Bromley hospital, to which my hon Friend has referred, has the necessary bed capacity. But if this hospital took the place of Orpington as back-up for Sevenoaks casualty cases. a most serious factor is involved—that of time. For my constituents, it would add further to an already lengthy journey. Although the additional distance suggested by the administrators is only five miles, that can be five miles of heavily congested road, particularly at busy times of day.
Fourthly, if consultants from Orpington and Sevenoaks had to do follow-up work on patients who were in beds at Bromley—that would be necessary in many accident cases—ambulance costs would be greatly increased.
Fifthly, the alternative possibility of merely downgrading the Orpington casualty unit to a similar level to that at Sevenoaks would, for my constituents, have exactly the same effect as closure. At the moment, it is the more sophisticated service available at Orpington that is so important.
We in Sevenoaks and the surrounding villages need the Orpington casualty unit. We need it as it is now and not in any changed form either of hours of opening or of quality of service. It is my hope and indeed my firm demand that the Minister will heed the medical, patient and public opinion and maintain Orpington as it is today
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
I congratulate my hon. Friend the Member for Orpington (Mr. Stanbrook) on securing this debate about the future of the accident and emergency department at Orpington hospital. In his recent correspondence on this matter with my hon. Friend the Minister for Health he has shown his usual determination to ensure that his constituents' interests are not overlooked, and this debate is further proof that he is succeeding in that objective. I hope that he and my hon. Friend the Member for Sevenoaks (Mr. Wolfson) will forgive me if I do not respond as positively as they might wish.
I say that because the main issue that has been raised is not at the present time one in which it would be proper for me to intervene. As I shall explain, no decision has yet been taken about the Orpington accident and emergency department. In any case, such a decision would be in the first instance for the responsible health authoritie to take, subject, if appropriate, to the procedure under which contested decisions about substantial service changes are referred to Ministers for decision. I shall briefly refer—it may help my hon. Friends—to this procedure during my reply.
It is important to be clear about the current status of the proposal to reduce the accident and emergency service at Orpington and the context in which it arose. In September 1981 the South-East Thames regional health authority's regional team of officers issued a consultative document 1209 on the development of accident and emergency services. The document was distributed throughout the region, asking for comment by December 1981.
In a foreword the regional administrator comments that:Consideration of this document by the regional health authority will not take place until the views of interested bodies are canvassed".In other words, its status is that of a draft strategy prepared by officers on which members of the regional health authority have not yet expressed a view. It is important to keep this point in mind.
The consultation document canvasses the possibility that all serious injury cases in the district should in future be taken to Bromley hospital and that the department at Orpington hospital should become a peripheral department, that is one not providing a 24-hour service. The document comments that such a rationalisation would lead to a better staffed and better equipped major department, providing an improved service to seriously injured people.
It would not be right for me to comment on the merits of this proposal at this stage. The consultation document points out that a change of this nature could only be implemented in the long term and detailed planning would be required. As a first step it recommends that the Bromley area health authority, whose boundaries will remain unchanged when the new district health authority takes over on 1 April, should investigate the possibilities of such a change.
It would then be for the Bromley health authority to decide whether any change should be made in the existing pattern of accident and emergency services in the district. However, I reassure my hon. Friends that, as the regional health authority has not approved the recommendation in the consultation document, that process has not even begun.
To provide further reassurance to my hon. Friends, it might be helpful if I explain the procedures that health authorities have been asked to follow when they wish to close or change the use of a health building. I shall do so only briefly for clarification, as they have been described in many previous Adjournment debates and we are a long way from their possible activation in this case.
First, the appropriate area health authority—after April it will be the district health authority—is required to prepare a consultative document covering such matters as the reasons for its proposals, the implications for staff, and, of course, the effect on patients who might be affected by the proposal, particularly—as both my hon. Friends said—in relation to transport facilities.
Comments on the proposals in the consultative document are invited within three months from such bodies as the local community health council, the associated local authorities, joint staff consultative committees and other staff organisations, family practitioner committees and local advisory committees. Hon. Members whose constituents would be affected would also be informed of the proposals and invited to comment.
Therefore, I can say to my hon. Friend the Member for Orpington that he will automatically be invited to comment, and to my hon. Friend the Member for Sevenoaks that the doctors about whom he spoke will also have a proper say in the consultation.
1210 If the community health council objects to the proposals, it is entitled to submit to the authority a constructive and detailed counter-proposal, paying full regard to the factors that led the authority to make its original proposal. If the authority is unable to accept the counter-proposal, the matter is referred to the regional health authority. If it, too, is unable to agree with the community health council and wishes the closure or change of use to proceed, the case is referred to Ministers for decision.
We have made it clear that where proposals are referred to us, Ministers will not agree to closure or change of use unless it can be clearly demonstrated to be in the best interests of local health services and the communities that they serve.
However, as I have said, the next stage is to see whether the South—East Thames regional health authority endorses the consultative document's recommendations. If the RHA decides to recommend changes to the pattern of services, it will then be for the Bromley health authority to decide whether such changes should be included in its strategic and operational plans and to make any formal proposals to put them into effect.
I have carefully noted the comments made by my two hon. Friends. I have noted with pleasure the Cook's tour on which they have taken the House, through the byways of Kent and the delightfully named villages that many of us know. I assure my hon. Friends that what they have said will be drawn to the attention of the regional health authority so that it can be in no doubt that there is strong feeling on the part of Members of Parliament who represent the constituencies that use the hospitals. When the consultative document is issued, they will have a formal opportunity to put their views.
§ Mr. Stanbrook
My hon. Friend said, "When the consultative document is issued". Surely he cannot be referring to the consultative document that has already been issued. I have not been sent a copy. If Members of Parliament have a part to play in the consultative process, it does not seem to operate in this region.
§ Mr. Finsberg
As I have tried to explain, there is a difference. The document that my hon. Friend has seen is a consultative document issued by the regional team of officials. That does not have the status of the consultative document that I have referred to. That document follows the other document's reference to the health authority for the members, not officials, to consider. When the authority decides that the document should be issued, the health authority, the community health council and Members of Parliament are formally notified and can put their views forward. Local citizens—whose numbers, from what I have heard, seem to be legion—have an equal right to put forward their views.
The debate has been short, but valuable. Although we have concentrated on the Sevenoaks proposal, it may reassure hon. Members to realise that ultimately the procedures give individuals and organisations a wide-ranging power to put forward their views on proposals with which they do not agree. The final decision rests with Ministers. I assure my hon. Friends that Ministers do not take such decisions lightly.
I hope that my comments will reassure my hon. Friends that there is ample time and opportunity to press their case 1211 with the health authorities concerned, if they decide to proceed with the proposals. The House will be grateful to my hon. Friends for raising—
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at nineteen minutes to Eleven o'clock.