Royal Dental Hospital, Tooting (Hansard, 8 July 1982)

§ Mr. Thomas Cox (Tooting)

I seek to try to find out from the Minister what is to be the future of the Royal dental hospital and whether it is to move to the facilities that exist for it at the St. George's hospital, Tooting. The issue is of great concern to that part of South London. I have the full support of the Wandsworth health authority and of the South-West Thames regional health authority for my case.

With the rebuilding of the St. George's hospital in Tooting we thought that we would in time see the development on this site of the Royal dental hospital and a move from its present home in Leicester Square. It is only following a report by the University of London working party of dental deans concerning the future of dental services for London that the future of the Tooting development has been put in doubt. It is a recommendation that is not accepted by many members of the medical profession and it is certainly opposed by large numbers of the general public as they become aware of the recommendations and their effects on dental services in South-West London.

It is my view, having become very involved in the issue as the local Member of Parliament, that a decision has been taken without consideration of the medical needs of the area that would have been covered by the dental school on the ground of possible—I stress the word "possible"—financial savings.

The stupidity of that line of thinking is that already within the St. George's hospital complex are the buildings in which the dental school can be developed. How often do we hear hon. Members saying to Ministers "What we need in our constituencies is the allocation of more money to rebuild or develop new services". St. George's hospital is not asking for that because we already have the facilities in terms of buildings. It is my understanding that no other use is envisaged for these buildings. They were built with this transfer in mind. I ask the Minister how much real consultation there has been with the region and the district health authorities on the issue. I think that there has been very little.

I ask that question because if one lists the reasons why the suggested move to Tooting should be supported, one finds it unbelievable that a recommendation could be made not to move to Tooting. No one can doubt that the present facilities at Leicester Square will not be adequate in the long term, but they would be at Tooting. Dental services in South-West London would suffer considerably if the move did not take place. The people affected would be children, the less well-off members of the community, the elderly and the physically handicapped who make use of the services either at Leicester Square or at Tooting.

If the move does not take place, there will be no major dental hospital in the whole of the South-West Thames region. It will be a departure from the policy of the DHSS to move hospital services from central London to other parts of the capital. The Charing Cross and St. George's hospitals are examples of that policy. If the move does not take place, people who need treatment will have to make long and costly journeys into Central London to get the 558 dental treatment that they need. No one can dispute that that could deter many people from getting the treatment that they need.

That is relevant when I point out that, unfortunately, we already have the worst dentist: population ratio of anywhere in Western Europe. At present, at both Leicester Square and Tooting about 150,000 patients are seen annually. In what is, unfortunately, a relatively poor part of London, we should do everything we can to provide services, not cuts or restrictions.

In 1979 the Flowers committee was asked to recommend what redevelopment of resources should take place for medicine and dentistry to maintain their present standards. In its report of February 1980, it said that the planned move of the Royal dental hospital and school from Leicester Square to Tooting, alongside St. George's Hospital, was to be welcomed and had its support. It believed that these arrangements should be implemented as quickly as possible. What has gone wrong with those proposals? They are just over two years old. They were suggested in February 1980.

The recommendations that the Flowers committee made must have been based on the fact that about £8 million had already been spent on providing the buildings in the new hospital complex at St. George's, Tooting. The British Dental Association report entitled Dental Manpower Requirements for the year 2020 stated—it was considering population trends, among other things—that the conclusion which emerged from these projections was that the number of dentists now being trained was probably not excessive in relation to projected levels of need and demand.

No one can dispute that there is a need. The dental deans said that there could be a merger with Guy's and the resources and students of the Royal transferred to other dental schools. That neither faces the facts nor gives them. It says nothing about the extra accommodation that would be required to take the extra students.

The dental deans at King's are faced with an increase of students from 48 to 64 by 1986. In March they said: This— the increase in the intake— would create many accommodation problems. Even Guy's said in April 1981 that there would have to be some minor alterations to the buildings if they took more students. What will be the cost of those alterations and adaptations? Provision already exists at St. George's in Tooting.

Successive Governments have presented proposals that have not been thought out properly or costed. The dental deans' proposal comes within that category. Their case for making savings by not moving to St. George's has not been proven. There would be no long-term savings, for the reasons that I have given. One could not provide extra dental chairs per clinical dental student without incurring costs in expanding dental facilities. What would that cost be? Will the Minister give me some idea of it?

I have tried to outline why our dental hospital should go to Tooting, as everyone has been led to believe that it would. It is an excellent opportunity to complete the redevelopment of the health services of that hospital. Both the Wandsworth and the South-West Thames health authorities are prepared to meet their share of the costs involved. It would be extremely short-sighted of the Minister and his Department not to allow the development to occur.

559 The Minister should examine every aspect of the issue before making a decision. He should ensure that all the facts about costs and the needs of the areea ar fully considered. I invite him to visit St. George's to meet the senior medical practitioners so that he can familiarise himself with all the issues before taking a final decision on something that is crucial to South London.

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

The hon. Member for Tooting (Mr. Cox) has spoken with his usual vigour about a matter which I know concerns him greatly. I am also aware that a number of my hon. Friends and other hon. Members have received representations about the future of the Royal dental hospital and school. I am therefore glad to have this chance to clarify a number of the issues that have been raised.

The Royal dental hospital of London school of dental surgery is the oldest dental school in the United Kingdom and the second oldest in the world. The school was opened at 32 Soho Square on 1 October 1859, following the formation three years earlier of the Odontological Society of London and the concern about the problem of dental education and the need for a qualification in dental surgery. The House will recall the pictures that one occasionally saw of rather strange, unqualified people with pliers pulling out teeth.

In 1874, the hospital and school moved to larger premises in Leicester Square, but the growth of the two institutions soon necessitated the provision of a new building on an adjacent site. That building was opened in March 1901 and, as the hon. Gentleman knows, it is still used for the treatment of patients and the education of students. The hospital, which has 90 chairs, provides out-patient services in all the different specialties in dentistry. The School of Dental Hygiene is also based at Leicester Square, together with departments of prosthetics and an emergency day clinic.

Pioneer work carried on in association with the Royal dental hospital included the use of nitrous oxide anaesthesia, radiology and electrotherapy in dental surgery and, in later years, the application of clinical photography as an aid to dental education. A further innovation introduced by the Royal dental hospital was the provision of separate wards for dental patients in general hospitals. I understand that the school has always stressed the great importance of providing a general medical background for the study of dentistry.

I hope that the hon. Gentleman will forgive me for having spent a minute or two describing briefly some of the history and achievements of the hospital and school. At a time when the future of both the hospital and the school is in doubt, it is important that we reflect on what has helped to give those institutions the name that they have justifiably earned. With this long history of tradition and service to the public, it is quite understandable that people who are or have been closely identified with the hospital and school should be concerned about its future.

To some extent, staff associated with the hospital and school have lived with uncertainty about the future for many years. Plans for the rebuilding of both St. George's hospital, Hyde Park Corner and the Royal dental hospital and school go back as far as the early 1960s. Before I discuss the immediate future, it is important that I trace the development of plans for the rebuilding.

560 Following the publication in January 1962 of "A Hospital Plan for England and Wales", formal proposals were submitted to the then Minister of Health for the rebuilding of St. George's hospital and the Royal dental hospital, together with their associated medical and dental schools, using the combined Grove and Fountain hospital sites at Tooting.

This proposal envisaged rebuilding in four phases, extending over the period 1967–78, the accommodation for the dental school's pre-clinical departments being included in phase 1, with the main dental hospital and school accommodation in phase 2, which was scheduled for completion in 1970–72. It was agreed with the University Grants Committee and my Department that the school's intake of undergraduate students would increase from 45 per year to 64 per year when rebuilding was complete. In the event, as the hon. Gentleman well knows, planning, contract and financial difficulties extended the programme so that phase 1 was not completed until 1975–76. The pre-clinical school at Tooting provides accommodation and facilities for an annual intake of 64 students, which is in accordance with the plans to increase the size of the dental school.

The dental school's pre-clinical departments moved to Tooting in September 1976, and the pre-clinical course for dental students has been held there since October 1977. The original intention was to re-provide on the St. George's hospital development site all the facilities currently available at the Royal dental hospital in a separate phase starting simultaneously with phase 2A. In 1976, however, further financial restrictions necessitated a re-examination of the plans for phase 2 of the project, in the course of which it was decided that the dental hospital and school could not be incorporated in phase 2 and that no timetable could be decided for succeeding phases.

I can well understand how extremely frustrating this delay must have been for all those whose hopes rested on the original plans. That is not to say that my Department failed to recognise the difficulties under which staff were working at Leicester Square, and in 1978, at the request of my Department, the South-West Thames regional health authority undertook a study of the hospital's premises. Part of its report read as follows: The premises are outdated, overcrowded and inadequate for their present functions. The services are old-fashioned and difficult to maintain. By modern standards of health and safety, working conditions, fire precautions and amenities for staff, students and patients are unacceptable. The study noted a number of essential requirements: the creation of additional clinical space, the improvement of working conditions generally but particularly in technical laboratories; the improvement of facilities for the storage and handling of patients' records; the need for adequate fire precautions, including the provision of storage for flammable materials and gas cylinders and proper protection of means of escape; and extensive overhaul of the building itself. It was estimated that at the then current prices the work would cost £2.75 million and would take about eight years to complete. As I ant sure the hon. Member will recall, in 1979, following further discussions between representatives of my Department, the school and hospital, the UGC and the regional and area health authorities, it was agreed that the financial and other implications of up-grading the Leicester Square premises to an appropriate standard were unacceptable, and that ways be examined of accelerating the move of the dental hospital and school to Tooting.

561 In March 1979, as the hon. Gentleman reminded us, the University of London's working party on medical and dental teaching resources was asked to recommend what redeployment of resources available for medicine and dentistry should be adopted to maintain the standard of medical and dental education and research in London. In its report, published in February 1980, it stated: The planned move of the Royal Dental Hospital and School from Leicester Square to Tooting alongside St. George's Hospital is to be welcomed and has our support. We believe that these arrangements should be implemented as quickly as possible. The hon. Gentleman asked "What has happened as a result?" The report was superseded by events.

A further report in October 1980 by the joint planning committee of the university court and senate led to a working party on medical costs which reported in February 1981. The report was translated into recommendations by the joint planning committee and was accepted by the senate and the court as univerity policy for medical schools. Among other proposals, it was decided to continue the expansion of St. George's hospital and medical school at Tooting. The future of the dental schools was referred to a separate working party on dental education in the University of London which reported in June 1981 with a series of options for the university for the re-organisation of dental education in London. Following that report, the joint medical advisory committee of the university set up in July 1981 another working party consisting of the dental deans of the university.

The working party produced a majority report recommending the merger of the Royal dental school with Guy's hospital medical school, redistributing some of the student load to other schools of the university. There was a minority report recommending the maintenance of the policy of rebuildng the Royal dental school at Tooting in association with St. George's hospital medical school. I understand that the university is likely to reach a final decision soon and that, as the hon. Gentleman knows, is where the matter rests at the moment.

The hon. Gentleman has made it plain that he feels that, had certain recommendations in the past been acted upon more quickly, we should not be debating this evening the future of the Royal dental hospital and school. But knowing the hon. Gentleman fairly well, I believe that he will recognise from the background information that I have given him the complexity of the issues and the need to ensure that whatever the decision, it is taken against the background of the need to ensure the best possible use of scarce capital and revenue resources and the changing needs of dental education.

My Department's position is, I hope, clear. During discussions last year with the South-West Thames regional health authority, it was impressed on my officials the difficulty that the regional health authority would be in 562 without some indication from the Department that it would be able to give more than the normal 35 per cent. of the capital cost of a teaching hospital scheme.

Recognising the region's problems, my Department agreed to increase its contribution to 45 per cent. or 50 per cent. provided—I stress that—that the University of London decides to confirm its original decision to transfer the school to Tooting. Dental hospitals exist primarily to provide facilities for dental education. I am sure that the hon. Gentlemen is well aware that in this country all dental hospitals, with the exception of the Eastman, are associated with undergraduate schools. If the University of London decides not to proceed with the transfer of the school, the need for a dental hospital in Tooting must also be questioned. We have not been convinced that there is a service need for a dental hospital on its own in an area where the ratio of general dental practitioners is really no worse than in other parts of London.

I recognise that if the university decides not to proceed with the transfer of the school, a number of additional important decisions will have to be taken. Arrangements would have to be made to ensure that satisfactory alternative use be found for the space already in use at Tooting by the dental school; and both the South-West Thames regional health authority and the Wandsworth district health authority would need to reconsider their strategy for the provision of dental services in that part of London. I can assure the hon. Gentleman that that will be done, and I will ensure that because of the university's key role in this matter—I cannot stress that too strongly—his anxiety and what he has said during this debate will be brought to the attention of my right hon. Friend the Secretary of State for Education and Science.

From what the hon. Gentleman has said and from what I have said, no one has pretended, or will pretend, that this is an easy decision to make. I have been impressed by the immense personal efforts that have been made by senior staff associated with the hospital and school to ensure its future and by the testimonials from patients, both past and present, to the skilled treatment that they have received there. Whatever the decision, I hope that it will be the right one which serves best the future needs of dental education and of the patients.

That is all that I can say to the hon. Gentleman. He has clearly laid out before the House the problems that he sees arising in his constituency and in his part of London. I have tried to paint for him the wider picture to show him that the decisions are being taken in the light of the University of London's proposals and its belief in how the policy should operate. I have undertaken to see that my right hon. Friend's attention is drawn to what he said, and I hope that what I have said will be of some comfort to the hon. Gentleman and that he will feel that the decision will not be lightly taken.