§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boscawen.]
§ 10.6 pm
§ Mr. Ray Powell (Ogmore)I should like first to apologise to the House for the fact that I was not present for Question Time earlier today. My absence was unavoidable due to the fact that I was attending a meeting of the Mid-Glamorgan area health authority in Cardiff at 2.30 pm and was unable to attend the House. I hope that the Minister will be able to respond in regard to certain issues affecting the new Bridgend general hospital. A deputation at today's area health authority meeting consisted of a number of people representing organisations within the Mid-Glamorgan area who were protesting about the introduction of pay beds within the area.
The matter was debated by the area health authority. It is significant that a decision was taken by 10 votes to 2 to oppose the introduction of any pay beds in the Mid-Glamorgan area. This is an area that has suffered considerably over lack of hospital facilities that I intend to highlight. I hope that the Minister will accept the decision of the Mid-Glamorgan area health authority and that he will not try to force the introduction of pay beds within Mid-Glamorgan.
It is with great anxiety that I participate in the debate. My anxiety is echoed throughout the Ogmore constituency, the whole of the Ogwr borough area and the catchment area of Bridgend. Members of the area health authority in Mid-Glamorgan, the county council, the borough councils and the community and town councils of the 23 areas have expressed similar anxieties.
Ogwr community health council, whose chairman Harry Davis and his secretary Paul Barker have helped to lead a campaign that has been responsible for highlighting this worrying position, deserves the highest praise for ensuring that the problems are brought to everyone's attention.
The senior consultant at Bridgend hospital, Dr. Powell, who is chairman of the medical staff committee, is also responsible for ensuring that staff opinions are made known to all. I place on record my thanks to him and the other members of the medical and nursing staff, especially Dr. Chappell, who is a colleague of mine on mid-Glamorgan area health authority and who has ensured that the deficiencies of the new hospital are placed on record.
I wish to represent the views not only of the present campaigners but of those who have passed away and who will never see their hopes and dreams fulfilled. I thank all those who for 31 years have devoted their time, effort and energies to ensuring the establishment of a new Bridgend general hospital. I also thank all those who have taken the trouble to explain their fears and doubts about the present proposals and those who have highlighted the suggested deficiencies in the new hospital.
It is not my intention to cast blame on anyone, nor is it my intention to level criticisms. I am sure that the House can and will determine from my submission any faults or deficiencies and that the Minister will show the intention of the Welsh Office to resolve some matters.
On behalf of the future generations that will use the new hospital, I place on record my grateful thanks to Mid-Glamorgan county council which, through the highways department, commissioned road works that helped to 772 finalise a favourable decision, because one could not have a new road leading into a field without embarrassing someone. I applaud their initiative.
The new hospital received planning consent as far back as 1951–31 years ago. Therefore, the House will recognise the numerous changes of Government since and appreciate that my observations are not critical of the present Administration any more than past Administrations. However, when one considers that the present hospital at Bridgend—Quarella Road—was built in 1830 and was at one time the poor law institution, or the workhouse as it was called in Wales, and is still in use as the administrative wing of the hospital, one can have little wonder that a new hospital with modern facilities to provide adequately for health care is long overdue and the subject of anxious and searching consultations by all.
Planning permission was received for the new hospital in 1951. Due to the delay in the land acquisition, the commencement date was given eventually as 1974. In 1972, the Welsh hospital board and hospital management committee agreed on a scheme, and the revised commencement date was 1976–77. It is perhaps significant that a major conference in 1972 between the DHSS and the regional hospital board said that Bangor hospital would be built in stages whereas Bridgend would be built as one major project of 640 beds. However, Bangor hospital has since been built in one stage, the cost far exceeding the original premise of £12.9 million, and Bridgend hospital will now be built in several stages.
It was agreed in 1974 that the Bridgend district general hospital was to be built and designed as a "Harness" hospital, and at that time it was placed third in a provisional capital programme of the Welsh Office for 1975–76 to 1984–85 at a cost of £16.1 million and with a commencement date in 1977–78. Unfortunately, the planning of the new hospital was frustrated by the emergence of new concepts in the planning of the hospital and restrictions on Governmemt spending.
In 1976 the restrictions on public spending resulted in the original estimate of the development of £16.1 million being reduced to £12 million. That was achieved, but demands for a further cost reduction exercise meant that the scheme was reduced to £10 million. It was in December 1976 that the Secretary of State announced a major capital programme for five schemes in Wales with the Bridgend hospital being the first priority. However, the Secretary of State decided that, as the capital programme was so heavily over-subscribed, it was necessary to place on each scheme an upper cost limit related to urgent needs. The outcome was that the allocation for Bridgend was further reduced to £9 million. That meant a further drastic reduction in the Bridgend scheme, to the great disappointment of all concerned.
The effect on the morale of the staff was apparent, and severe criticisms were expressed by the senior medical staff. However, the subsequent cost reduction exercise arrived at a figure of £9.8 million. The authority was placed in an impossible situation and it took the extraordinary decision that the cost of major furnishings and fittings, at about £500,000, would be met out of the programme in the year preceding the final commissioning of the hospital. That reduced the cost to £9.3 million, which gained the approval of the Welsh Office.
That is the background, but the money envelope of £9 million was conceded by the Welsh Office. As a result, the Secretary of State announced an increase in the basic limits 773 of the five Welsh schemes which meant a 10 per cent. addition to the Bridgend scheme, making a total money envelope of £9.9 million. By November 1978 the Welsh Office had indicated that the Secretary of State had expressed the hope that authority could be given for tenders for some of the schemes in 1979–80. In March 1979, the Secretary of State announced that provided all went well the scheme would start towards the end of 1980.
I am pleased to inform the House that, following start dates of 1974, 1976–77, 1977–78 and the end of 1980, work on the main building contract commenced on site on 14 September 1981, when the first sod was cut by the Minister who is to reply. I was present and I wish to place on record my tribute to his excellent skill in managing the JCB.
In 1976, a decision was taken to reduce the allocation for the Bridgend hospital from £16.1 million to £9 million, although the latter figure was index linked. It was therefore necessary for the Mid-Glamorgan area health authority to make a drastic cut in the Bridgend scheme, which in the estimation of many meant the deletion of many of the central features from the modern district general hospital. These features have been listed by the medical staff committee of the Bridgend district general hospital, which have been supported by the community health council. I share the concern of those bodies for the deletion of some of the essential sections of the hospital.
I shall list those features hurriedly to give the Minister time to reply. First, there is no outpatients department. The dislocation caused by the running and staffing of a department on a separate site wil inevitably be considerable and costly. Secondly, there are insufficient acute beds. Thirdly, there is no operating theatre for Caesarian sections. Fourthly, there is no specific coronary care unit. Fifthly, there is no postgraduate medical nurses training centre. Sixthly, there is the split of pathology services. Seventhly, because of the inability to accommodate ENT beds in the new hospital, the existing theatre suite has been retained for ENT surgery alone; grossly uneconomic use of a theatre suite. Eighthly, there is completely inadequate provision of consultant and junior medical staff rooms which, in many departments, will be insufficient to meet the stipulations of various Royal colleges. This, in turn, will lead to a refusal of recognition of training posts, which will have catastrophic results on hospital services. Ninthly, of course, there are the revenue implications.
The mid-Glamorgan area health authority has recognised in the past, and will continue to hold the view, that there are no moneys left in hand and that, as a result of a favourable tendering climate well below the budget cost, it does not necessarily follow that savings will be available to the health authority. It is argued that the Welsh Office controls the major capital programme and has to balance the whole of Wales with overspendings and underspendings, and that it has been the policy of the Welsh Office to redistribute any savings over its total programme among health authorities in Wales on a pro rata basis. That argument might stand up if the Welsh Office had used the established costing planning principle for this development. However, a "money envelope" principle was applied and, consequently, it was argued that this money was allocated to the Bridgend development and, therefore, should be used as such.
There are many generous people in Ogmore. The mayor, councillor Vernon Chilcott, has just announced 774 that the mayor's fund for laser beam equipment in Bridgend hospital raised £25,000. That fund was started by councillor Elwyn Davies, last year's mayor, and displays the degree of public spirit and generosity of the councillors and public in my constituency. That attitude will continue.
I thank the Welsh Office, because the area health authority today received a letter stating that the furniture and equipment costs for the new hospital will be waived. That will mean a considerable saving to the area health authority of which I am a member; and I thank the Minister for the Government's generosity in that long-awaited development.
In conclusion, may I say that it is of great importance to the people of Ogmore and those in the catchment area, that the Minister should consider the whole submission of the area health authority and allay the fears of the general public in the area. He must ensure that promises made and moneys made available are used in the development of Bridgend hospital and he must ensure that all the issues raised by the community health council and the medical staff are not overlooked. That is the only way in which the morale of the staff can be restored and the upsurge of public anger avoided.
My constituents have waited more than 30 years for this development. They have a right to be afforded a modern hospital, with proper and adequate provisions. Whatever the arguments against it might be, I call on the Minister to ensure that the promised basic essentials are provided to the satisfaction of all concerned.
§ The Under-Secretary of State for Wales (Mr. Wyn Roberts)First, I congratulate the hon. Member for Ogmore (Mr. Powell) on securing this debate, having so nearly done so on an earlier occasion. I am grateful to him for raising the matter of Bridgend district general hospital, because I had the pleasure to cutting the first sod to inaugurate the advance works for the hospital. The main contract for the first phase of the hospital started on site last September and I expect it to be completed in 1985.
The hon. Gentleman has raised a number of issues relating to what some people in his constituency consider to be faults or omissions. I am aware of pressure and of a campaign to add works to the present contract to rectify what are regarded as faults, to repair what are regarded as omissions and to advance works from phase II of the project to take advantage of an undefined sum of between £2½ million and £4 million thought to be savings achieved because of a good tendering climate and regarded as being available to the area health authority as the uncommitted balance of an allocation of money to build phase I of the hospital.
The campaign is based on a surprising misunderstanding of the facts—surprising because the people concerned ought to be aware of them, having been involved in the consultations which preceded the decisions on the content of phase I of the project. I believe the pressure to be misguided. It can only serve to mislead the public and sap the morale of staff in the authority. It is clear from a press release issued by the area health authority on 17 March that I am not alone in that belief.
In its press release the authority stated that it wished to make it clear, once and for all, that there are no moneys left in hand for it to use. For my part, I want to make it equally clear, once and for all, that there is not a packet 775 of money left over from the Bridgend district general hospital phase I for use on other works by the health authority at Bridgend or in any other scheme. I shall now explain why.
The Bridgend hospital scheme is one of a number in the major capital works programme for the National Health Service in Wales. There are contracts at Morriston and Wrexham, also at an early stage of construction, others, like Bangor, at late stages, and others, like Llanelli, in planning. The funds which pay for them, and, indeed, for the whole of the NHS in Wales, are not parcelled up into separate envelopes: There is not what one would call an allocation for any particular hospital building scheme.
There is a budget cost—a target estimate based on cost guides for the type of provision that is to go into the hospital. Depending on the market, the tenders that we get can be above or below the target, and, if we accept the tender, that becomes the price which we are working to and which goes into our financial planning over the following years. The budget cost ceases to exist and the agreed contract price replaces it.
The all-Wales capital programme, of which Bridgend district general hospital is a part, is centrally funded, and our expenditure throughout every year is subject to constant revision to account for contracts let above or below the estimate slippage and contingencies such as fire, floods, and site problems. If a contract costs less in any one year than we expected, and is not balanced by others that cost more, we share the saving among all AHAs. Mid-Glamorgan, for instance, received £625,000 recently because of savings in the all-Wales programme.
I turn to the figures for Bridgend, as there appear to be varying views about the difference between the budget and the contract cost. The budget, uplifted to May 1981 figures, was £15.3 million. The main contract was let at £12.5 million, but we have to bear in mind that there were advance site works, roadworks and other works totalling just over £½ million. In addition, we agreed, following discussions with the authority, to move the mortuary at a cost of about £200,000.
We have also been considering representations by the authority about the cost of furniture and equipment, and my Department has agreed to further central funding subject to discussions with the authority's officials. I cannot put a figure to that yet, but the authority has been talking in terms of over £700,000. There is, therefore, at the end of the day not a great deal of difference between the target that we set ourselves and the amount that we are likely to spend. It is about £1 million.
I will turn shortly to the various items that are being claimed as faults or omissions, but I want first to refer particularly to suggestions that those items should be added to the present works. Such a course, I must say straight away, is a recipe for disaster. If there is one factor that causes delays, escalation of costs, contractual problems, and sheer frustration, it is messing about with contracts after they have been let, with the employer having second thoughts—then third thoughts—about what he wants, and adding bits here and there. The Bridgend contract has been let, and the contractor is on the site, and I hope that he will be allowed to get on with it.
As to the complaints, they have been listed in a report in the Glamorgan Gazette of 4 February, which has attributed them to the medical staff committee. The 776 general tenor of the complaint is that certain things were left out of phase I which should not have been left out, and this £14 million development is being presented as a cut-price hospital providing a dislocated service, a real danger of inefficiency, lower standards, and less than ideal patient care.
As a member of the area health authority, the hon. Gentleman will be fully aware that the content of the first phase of the hospital was a matter for the area health authority to decide in the light of its own appreciation of the needs and priorities of the area, and of the likely availability of funds.
There is criticism by the medical staff committee that provision is not made in phase I for an out-patients department. I understand that the authority considered the options either of providing one on the first phase, and consequently providing fewer beds, or of providing more beds and leaving the out-patients department till phase II. My information is that the authority's decision to opt for more beds in phase I and to leave the out-patients department to phase H was taken on consultation with the senior medical staff.
The area health authority is examining the need for a mother and baby unit and a play area, and I believe one possible solution that it is considering is that such a facility could be provided at the existing hospital in Quarella Road.
A commissioning team has been set up by the authority to examine in detail the facilities for health provision in the area following the completion of phase I. That is the usual procedure when a major new hospital is being built; and any decisions taken, including decisions on coronary care facilities, will be made after full consultation with the hospital consultant staff.
§ Mr. Ray PowellWill the hon. Gentleman give way?
§ Mr. RobertsI have a lot to say and not much time in which to say it. Criticism has been made on the ground that there is a lack of Caesarian operating theatres and too few acute beds for emergency medical and surgical patients. I am told that the authority is satisfied that there are sufficient delivery rooms to allow one to be converted to cope with abnormal and Caesarian deliveries, and that, although the number of acute beds is up to standard norm, the authority is considering the possibility of improving the situation even further.
Some of the points of criticism concern facilities which are to be provided in phase II, and I find it surprising that they are being presented as omissions—and, by implication, unacceptable omissions—from phase I. I should like to make it absolutely clear that the senior medical staff have been under no misunderstanding from the very beginning that this is a phased development, that there were facilities which would not be provided until phase II, and that it would be necessary for some time to divide services between Quarella Road and the new site. They have, for instance, been fully aware that a postgraduate medical centre and nurse training unit are included in the provision proposed for the phase II, that an ear, nose and throat department is proposed at an early stage of the phase II works, and that the effect of the division of radiology and pathology departments between the two sites will be minimised by phase II works, when all surgery and acute work will be carried out on the new site.
777 The hon. Gentleman will be aware that my Department has recently approved the design of a scheme for 131 residential units for medical, nursing and other staff, including married accommodation on a communal centre at a cost of £1½ million, which will be finished before the hospital itself.
I want to deal with a criticism which I consider to be extremely ill-conceived and calculated wrongly to disturb both staff and the public. That is the assertion that the allowances for consultant rooms would possibly lead to the Royal colleges withdrawing their approval of certain departments. The area health authority—and I agree with it—totally refutes the idea that this will have any bearing on the educational suitability of the hospital, or that it would lead to the Royal colleges withdrawing their approval of certain departments. I can appreciate the 778 keenness of senior medical staff to try to get as much money as possible allocated to the development of this hospital, but I think that they would be better advised to accept the fact that the contract is let, there is no package of spare money, and that their energies should be concentrated on ensuring that this £14 million hospital provides, as it is intended to, a real improvement in medical facilities.
By a device, the hon. Gentleman managed to begin his speech by referring to the pay beds issue—
§ 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 twenty-four minutes to Eleven o'clock.