§ Mr. Michael Neubert (Romford)
The history of the matter that I raise today is a sorry story. As one would expect from a hospital called "Victoria", it was opened nearly 100 years ago in celebration of Queen Victoria's golden jubilee on land donated by a public benefactor, William Mashiter. The hospital was funded by public appeal in the tradition of public spirit and generosity that can be seen today in the money that has been raised and the enthusiasm generated for this hospital under threat.
The hospital was further extended as a memorial to King Edward VII in 1912, and in 1939 the foundation stone of a three-storey building was laid by Lady Neave. Throughout years of service to the community, the hospital has gained nothing but praise, yet it is now proposed to close the hospital as a surgical unit and to transfer the acute in-patient services elsewhere. Most people find that astonishing. The people of Romford provided the hospital by public subscription. They regard it as "their" hospital and, having seen it taken over by the National Health Service in 1948, they now see the work it does threatened with closing.
As their Member of Parliament, I welcome the opportunity of this Adjournment debate on the last day before the Summer Recess to express their outrage and disbelief at the proposals. It is the second time that I have raised the matter on the Floor of the House. I do so because of its importance to Romford. The first occasion was on 23 May 1979, when I took the earliest possible chance of seeking Government support for the retention of the hospital. My hon. Friend the Under-Secretary of State may remember that he was present then but in a different capacity.
The then Minister for Health, now my hon. Friend the Minister for Consumer Affairs, responded to the debate by assuring the House that there wasa continuing place for the small local hospital where there is a useful and satisfactory role for it."—[Official Report, 23 May 1979; Vol. 967, c. 1193.]There can be no doubt about the Government's commitment to small hospitals. Within a fortnight of her historic election as Prime Minister, my right hon. Friend said in the debate on the Address on 15 May 1979:I have great sympathy with the cause of small local hospitals."—[Official Report, 15 May 1979; Vol. 967, c. 81.]On 24 May 1979, in answer to a question from me about the Victoria hospital, 91 years to the day since it was opened by Mr. J. Theobald, MP, who I presume must have been one of my predecessors, the Prime Minister said:we approach the question of small hospitals with considerable sympathy."—[Official Report, 24 May 1979; Vol. 967, c. 1226.]Later that same year the Minister for Health told the Conservative conference:I can assure you that no closure of a small unit or hospital will be agreed by us unless we are certain that it is unavoidable and in the best interests of the patients … We must not have false economies. We must not close down small hospitals which are deficient yet vital to the local community.True to his word, during his three years of office, the then Minister for Health was able to save several small hospitals. It was only his personal intervention last summer, following a visit, that averted the closure of the Victoria and allowed this year's reprieve. I hope that his successor, my hon. and learned Friend the Minister for 1507 Health, will take the same view, will have equal success and will be able to find a way to save Victoria hospital. The hopes of many thousands of people now rest upon his decision.
The value of the surgical unit cannot be disputed. About 2,000 operations are carried out there each year. They are, in the slightly chilling jargon of the medical profession, elective cold surgery—minor operations such as ruptures which are for conditions not of the greatest gravity but painful, disabling and inconvenient.
In all my 13 years' association with Romford, eight years as its Member of Parliament and before that for five years as its parliamentary candidate, I have never heard a single complaint about the hospital, only warm appreciation. Patients come by appointment, make a rapid recovery in the restful surroundings of the cottage hospital and resume their active life with the minimum of delay.
The advantages of a small hospital are evident everywhere. Its human scale is comfortingly intimate, the staff are attentive and intensely loyal, there is little noise at night and sleep is not disturbed by emergency admissions, and the homely atmosphere and attractive garden encourage recuperation.
Why should anyone in his right mind want to close this unit? The answer is that the district health authority and its predecessors have the embarrassment of a spare ward and operating theatre in the district general hospital on which they have unwisely spent an unnecessary amount of public money in recent years and which they desperately need to justify. To that end the district health authority is prepared to discard the proven public asset, Victoria hospital, against almost total opposition from the community that it is there to serve.
The debate is too short to go into all the details of the complex and unhappy history of this matter. As my hon. and learned Friend has kindly agreed to receive a small deputation led by me, with representatives of the nursing and medical staff as well as the general public, before he makes a final decision, it would be more appropriate for me to present our detailed case then.
However, I should like to make one general point which the Government should study as a matter of wider interest; that is whether present procedures ensure democracy in the National Health Service. The division of opinion on this issue can be summarised as: "for" the proposal to close the Victoria hospital as we have known it for almost 100 years—the regional health authority, the district health authority and the community health council, all appointed, unelected bodies that are not directly accountable to the public; "against" the proposal—the Member of Parliament, the Member of the European Parliament, the member of the Greater London Council, and the borough council, all of whom are elected representatives of the public and accountable to them, and 45,000 members of the public themselves who put their signatures to a petition of protest which I presented to my hon. Friend last summer.
Whose view should prevail? Whose Health Service is it, anyway? The defection of the community health council has been a particular disillusionment. From my experience, I cannot now confidently support its continuance. Originally, the Havering and Barking community health councils were foremost in opposition to the proposal. They organised a crowded town meeting 1508 over which they invited me to preside and from which many were turned away, and they set up an action committee to fight the closure.
Later, the CHCs were quietly taken on one side by the area health authority and threatened with the prospect of never getting the child assessment unit and the psychogeriatric unit which they badly wanted, and which are part of the proposals for the re-use of the Victoria, unless they agreed to the closure of the surgical unit. Overnight they did a complete turnabout, disowned their own action committee and proceeded to rewrite their part in the history of the matter in a way equalled only by Soviet historians covering up the enormities of the post-revolutionary Stalinist regime. To explain their volte-face they suggested that the area health authority had changed its policy and that the original proposal was not only to close the Victoria as a surgical unit but to dispose of the buildings as well. That was never the case.
The first proposals, like the second proposals and now the third proposals, were all for re-use, including, to start with, the proposal that part of the hospital should be used for offices for health administrators, an idea so outrageous that the area health authority quickly recoiled from the public anger that it aroused and dropped it in favour of more beneficial uses.
If there is any postgraduate student who wishes to research the struggle between bureaucracy and the public, he could not choose a more revealing case study than this one. He would be able to examine how a hospital which, at the maximum, had 101 beds has gradually had the life snuffed out of it until it now has only 32 beds, how the most recent reduction of 16 beds was the closure of the children's ward in February 1978 at short notice, without consultation and within about 72 hours, how the authority was able to do that because it called it a "temporary" closure, and how it is still closed today, four and a half years later.
That student would be able to study how the same authorities who profess concern for underused assets could leave the resultant empty wards to gather dust for years on end and let the grass grow knee-high in substantial grounds, undeveloped and at prime residential value. He could even calculate how many hundreds of thousands of pounds such stewardship has cost the taxpaying public in wasted opportunity and avoidable expenditure elsewhere.
It would be better to look to the future. There could be positive, alternative plans to include the continuation of the surgical unit at Victoria hospital and there should be. It is clear that if the service is transferred to another ward at Oldchurch hospital, which has seven fewer beds, presumably mixed, and which is vulnerable to the prior claims of accidents and emergencies, hospital waiting lists will lengthen and many members of the public will be inconvenienced and kept off work longer than necessary. Alternative uses could certainly be found for the space at Oldchurch. Already, where previously it was said that two upgraded wards would remain empty, there is now only one. The site is overcrowded and other specialties are in need of expanded facilities. The claimed saving of £40,000 revenue a year is not a small sum, but it is a minor matter compared with the millions spent in the district and in these terms, sufficiently marginal to be capable of presentation to suit the case, without challenge from amateur outsiders.
The Minister will appreciate that the general public has no specialist resources with which to combat such plans, 1509 with which it can test the validity of the financial calculations or explore the possibility of alternative strategies. I hope that the Minister's expert staff can come up with a more acceptable alternative. Neither of the proposed new uses for the Victoria hospital is ideal. The district health authority acknowledges that the psycho-geriatric unit would be better located in the London borough of Barking and Dagenham next door, and to place the child assessment unit at the Victoria hospital rather than in association with a district general hospital is contrary to the recommendation of the Court report and Government policy. There would certainly be space for one of those services if surgery were continued, and the possibility of extra development in the future, given the will.
As long as the district health authority remains dogged in its defence of the original mistaken decision, other constructive alternatives will be stifled, if not stillborn. I hope that my right hon. and hon. Friends at the Department of Health and Social Security will be able to liberate the debate and find a solution that puts patients and public first.
§ The Under-Secretary of State for Health and Social Security (Mr. Tony Newton)
I acknowledge the point made by my hon. Friend the Member for Romford (Mr. Neubert) that, to a degree, we have a common interest in at least some of the hospital services in his area, as many of my constituents use some of the facilities at Oldchurch hospital and its neuro-surgery unit. I vouch from experience for the vigour with which my hon. Friend fights for his constituents' interests. They are lucky to have him as an advocate on this and many other issues.
It is important that the proposed change of use of Victoria hospital should be understood in the context of health provision as a whole in the Barking, Havering and Brentwood district, and the district health authority's strategy. It is also important—I acknowledge this readily in the light of what my hon. Friend said—that full account should be taken of local views when the future of a valued local hospital is being considered. I emphasise that this is not a total closure proposal, but technically a change of use. I hope that we can agree that there is a useful role for the hospital in the future as a small hospital. The argument is about what the role should be.
The new Barking, Havering and Brentwood health authority is served by two district general hospitals, the Oldchurch and Rush Green hospital complex, which serves Dagenham and the western half of Havering, and Harold Wood hospital, which serves Brentwood and the eastern half of Havering. In recent years extensive development has been carried out at Oldchurch hospital in the form of six new operating theatres, an intensive therapy unit, and the upgrading of two wards. At the moment the sixth operating theatre and ward accommodation are unused due to shortage of revenue. Within this overall pattern of acute services in the district, the Victoria hospital in Romford has been playing a small but valued part. Victoria hospital is a 32-bed acute hospital situated on a prime site in a residential area about a mile and a half from Oldchurch hospital. In the main patients have been "intermediate" or "minor"—to use technical terms—surgical cases.
During 1979 and 1980 the former Barking and Havering area health authority consulted on the transfer of 1510 acute services from Victoria hospital to Oldchurch hospital, and on the future of Victoria hospital. The authority's initial plan was to transfer the case load of Victoria hospital to the spare theatre and ward at Oldchurch, releasing revenue to Oldchurch by the closure of Victoria hospital. That proposal was unacceptable to the former Barking and Havering community health councils, and it aroused widespread local concern, which was raised effectively in a previous Adjournment debate by my hon. Friend on 23 May 1979.
In February 1981 a second proposal was advanced which linked the rationalisation of acute services in the district to the development of the priority services. It was proposed that the 32 surgical beds and the hearing aid and orthodontic service at Victoria should still be transferred to Oldchurch. However, out-patient services at Victoria would be retained and transferred from Harefield house, which is situated in the grounds of the hospital, to the main hospital building itself. That would enable the sale of a potentially desirable and valuable part of the site, thus liberating funds for use in making improvements to Victoria hospital. These improvements would be made—my hon. Friend acknowledged this fairly—to provide a much needed 30-place psychogeriatric day hospital and a paediatric assessment unit.
The proposal must be assessed in the context of the district's own financial and strategic position, and the strategic position of North East Thames regional health authority as a whole. Barking, Havering and Brentwood health authority is adequately provided for in the terms of the Resource Allocation Working Party, and cannot expect any growth money in the foreseeable future.
There is therefore a need to make economies in the acute services so that the regional strategy of redistributing resources to make greater provision within the district for the priority services can be pursued. The district is deficient in some aspects of priority service provision. For example, it has no service for elderly people with psychiatric disorders apart from a service provided from a large mental illness hospital. We fully support that basic strategy.
There are also some important local considerations involved in the decision. The district health authority wishes to concentrate all its acute services in the western half of the district on the Oldchurch and Rush Green district general hospital complex where there are appropriate back-up facilities. It is also keen to utilise fully the new capital developments at Oldchurch and Rush Green hospitals. If acute work were to continue indefinitely at Victoria hospital, substantial upgrading would be required there, but capital is urgently required for other purposes, such as those that I have mentioned. In the event, the latest proposals have gained the support of many local bodies and interested parties.
One significant objection to the proposals, which ray hon. Friend mentioned, is the fear amongst some of those involved that there would be longer waiting lists for "cold" surgery if the proposals were to be implemented. However, the district health authority is satisfied that Oldchurch hospital will be able to cope with the increased load. It points out that if the proposals were implemented, surgery would be carried out in upgraded, modernised, and safer buildings, which would lead to greater efficiency. It is also looking at the possibility of reserving 1511 certain beds at Oldchurch for "cold" surgery and the possibility of reallocating one or more extra beds to oral surgery.
I said at the beginning that it was important to consider the strategic context of the current proposals, and I hope that I have shed some light on this aspect of the proposed change of use. My hon. Friend has also, rightly, emphasised the importance of taking account of local opinion in these matters. I believe that that is precisely what has happened throughout the extensive discussions which have taken place on the future of Victoria hospital over the last three or four years, in which my hon. Friend has played a leading and important part.
Local objections from some interested parties, including Barking and Havering community health councils and my hon. Friend, led to the rejection of the former area health authority's initial proposal to close the hospital completely.
§ Mr. Neubert
It is important that I challenge that description of the original proposal. It was not proposed to close the hospital completely. The original proposals were for a change of use, as are the present proposals.
§ Mr. Newton
I note what my hon. Friend says, but I understand that the initial proposal at least came closer to closure than do the current proposals.
In February 1981 the proposal that the hospital should have a new role was agreed by Barking and Havering community health councils, which opposed the original proposals. At that stage, the main opposition came from the Victoria hospital action group, with which my hon. Friend is associated.
The procedures for the closure and change of use of health premises are set out in guidance issued by the DHSS in 1975. The aim of these procedures is to enable resources to be redeployed with the maximum speed and simplicity consistent with adequate local and, where relevant, national consultations. The guidance states that if the community health councils involved agree to a proposal and the Secretary of State has not asked to be consulted further before approval, the health authority—in this case, the former area health authority—may proceed, notifying the regional health authority and the Department of the decision.
1512 In this particular case, because of the local disquiet, the former Minister for Health, my hon. Friend the Member for Reading, South (Dr. Vaughan), took a particular interest in the consultations. On hearing of the area health authority's decision to proceed with the proposed change of use, he visited the hospital to inform himself of the strength of local opinion. He then decided to take the unusual step of intervening in the matter in spite of the community health council's agreement to the proposal. The area health authority was therefore requested to submit its proposal to the regional health authority, which would refer it to the Secretary of State if it supported the area health authority.
Following careful consideration, the regional health authority asked the former area health authority to reexamine its proposals and present the results of its reexamination to the Barking, Havering and Brentwood health authority so that the new authority could give the matter urgent consideration sand report its decision by July 1982.
In the event—this is what has given rise to my hon. Friend's concern and to today's debate—the new authority endorsed its predecessor's view. As my hon. Friend also said in no uncertain terms towards the end of his speech in criticising precisely that decision, the new community health council has also accepted the proposals in their entirety. The proposal has now received the agreement of the regional health authority and has been referred to Ministers.
I am afraid that there is very little that I can add to what my hon. Friend has said today, except to confirm what he said at the end of his speech. My hon. and learned Friend the Minister for Health has agreed to meet my hon. Friend and a small deputation to discuss the whole matter in more detail before he makes the decision that he is now called upon to make. As I am sure my hon. Friend is aware from his knowledge of the Minister—and I happily confirm this—my hon. and learned Friend will give my hon. Friend's representations and what is said at that meeting very careful consideration before reaching his final conclusion.
I shall, of course, also draw my hon. and learned Friend's attention to what has been said today, both about the specific issue which is to be the subject of the meeting and the wider points that my hon. Friend has made about the whole process surrounding proposals for closures and changes of use of hospital facilities of this kind.