Tadworth Court Children's Hospital (Hansard, 7 February 1983)

§ Mr. George Gardiner (Reigate)

I raise on the Adjournment debate alternative proposals that have been put forward to keep open the Tadworth Court children's hospital. It is fitting that a cause that has aroused such deep national concern as this should be debated twice on the Adjournment of this House. The first was on 1 December, when my hon. and learned Friend the Member for Burton (Mr. Lawrence) and I drew attention to the necessity for saving Tadworth Court children's hospital, threatened with closure under proposals from the Great Ormond Street Group governors in their search for ways out of their financial difficulties.

Today's debate is different. It is about how this can be done. My hon. and learned Friend the Minister now has before him a viable scheme to enable these children suffering from cystic fibrosis, or from a range of physical and mental handicaps, many of a terminal nature, to go on benefiting from the unique care provided at this hospital than can truly be said to have stirred the nation's heart.

In the 10 weeks since the last debate much has happened. The Spastics Society, supported by other voluntary organisations, has drawn up a detailed scheme for the hospital to continue to operate, opening up its respite care facility to far more children in need of it, and at less cost to the DHSS.

Meanwhile I have been working to ascertain what existing and potential support is available from private charitable sources. I can confirm that more than £250,000 has already been either donated or reliably pledged, and that a number of city businessmen are prepared to launch a special appeal to companies and finance institutions, with a target of a further £500,000, in the event of the Minister reprieving Tadworth Court.

In the interval my hon. and learned Friend the Minister for Health has himself visited Tadworth and heard the moving pleas from parents in desperate need of a hospital such as this to which they can turn with total trust. He has also seen the alternative proposed by the Great Ormond Street governors, at Queen Mary's, Carshalton. He showed his concern by replying himself to the first Adjournment debate on this subject and he has done so again by his presence today, for which we are all most grateful.

Before outlining the Spastics Society scheme, which I strongly commend, let me explain why the society felt moved to bring it forward. After examining the proposed alternative at Queen Mary's, the society's professional and medical staff reached the same conclusion as the parents, consultants and everyone concerned with Tadworth—that as an option Queen Mary's was inferior in many respects.

Though an excellent acute children's hospital, it is not suitable even with the upgrading of wards for the sick and disabled children now nursed at Tadworth. It is a large unit, with more than half its patients adult mentally handicapped, and with inferior rehabilitation facilities—an inadequate hydrotherapy pool compared with Tadworth's, restricted access for parents, and nothing to equal the summer holiday facility offered at Tadworth for children who will never see a holiday of any other kind.

855 Though a good hospital for other categories of patients, Queen Mary's is large and lacks the homely ambience of Tadworth. The Spastics Society is committed to moving children from large institutions into more appropriate forms of care, as the Government themselves envisage in their policy for "Care in the Community".

I turn now to its alternative plan, the details of which result from extensive consultation with DHSS officials and with health administrators on the ground.

First, Tadworth court would be taken out of the Great Ormond Street group and administered as a separate unit. This could take the form of a special health authority, or a newly formed charitable trust. On these options we have an open mind.

Secondly, savings would be made in the running of the hospital and from removal of the obligation to maintain unwanted properties. The society has already suggested savings amounting to £400,000 a year.

Thirdly, the respite care facility at the hospital would be opened out to take children referred directly to it by local authorities. The Spastics Society's experience here would be particularly valuable. Already it runs a small home for under-16s at Bury St. Edmunds, at a sponsorship rate of £168 per week. This is regularly supported by seven county authorities—proof that when such a facility exists it will be used. A further five neighbouring local authorities have already indicated interest in placing cases at Tadworth court.

Fourthly, the Spastics Society itself will make an input to the management team. I hope that the Minister will agree with the recent comment in the Financial Times that no one is likely to question the administrative or professional competence of the Spastics Society to lead the task. Then there is the question of sale of land. The Great Ormond Street governors want to sell the entire site of 62 acres with outline permission for low density housing development, although I can see great difficulties in them obtaining that. We would prefer to sell the 34 acres not required for hospital use, with the proceeds—estimated by valuers at £1.7 million—used to help support the children at Tadworth court, which would seem to be only just. Planning permission in these circumstances would be much more likely.

The Spastics Society plan would, of course, require a continuing commitment though probably a declining one, from the DHSS. This is estimated at £750,000 for each of the next three years, to be fixed at a lower level thereafter as local authorities refer more cases, which they are barred from doing at present. Seven hundred and fifty thousand pounds a year may sound a lot, but it must be set beside the £400,000 that it is proposed to pay Queen Mary's to care for these children—a figure that many believe to be excessively low. Nor should we forget the capital cost of at least £320,000 required to bring the designated wards at Queen Mary's up to even the minimum standard.

Finally, there is the vast potential for funding from private sources. In the debate on 1 December I spoke proudly of £7,000 in our local Tadworth Court appeal fund. In the weeks since, that has soared to £60,000, without any donations being solicited on our part. I spoke hopefully of a survival fund of £250,000. That figure has now been passed, in donations into different appeal funds and pledges of support from major charitable bodies, including the Genesis Foundation in the United States of America. Now business men are talking of raising a further £500,000 which those with experience of such appeals tell 856 me is certainly an attainable target for a cause such as this. However, I must stress that all these donations will have to be returned, and all these firm pledges will go up in smoke, if the Minister denies Tadworth Court the future that everyone wants.

In conclusion I would say this. Both my hon. and learned Friend the Minister and the Secretary of State have spoken eloquently of the concept of partnership in the Health Service. As the Secretary of State told the BMA last December: We need partnership—partnership with local authorities, particularly their personal social services departments, partnership with voluntary organisations. What better example, what better chance of partnership in practice, could he have than the viable scheme for Tadworth Court before him now from the Spastics Society, involving other voluntary organisations and local authorities, and supported by the income from an endowment fund of some £750,000 raised from private donations?

I do not believe that this is an opportunity for partnership in the aid of sick and severely handicapped children that the Minister can possibly reject. In the name of these children, of others who will need such care in the future, of their suffering parents, of the consultants and of the charities involved, I appeal to him to seize it, and to announce that he is giving Tadworth Court his full support.

§ The Minister for Health (Mr. Kenneth Clarke)

I congratulate my hon. Friend the Member for Reigate (Mr. Gardiner) on raising such an important matter in the House for the second time in 10 weeks. Throughout discussions about the future of Tadworth Court, he has taken a leading part in the public debate, as his own constituents are directly affected. In the intervening period since we last had a debate my hon. Friend, my hon. Friend the Member for Carshalton (Mr. Forman), and I have visited the two hospitals. We all took the view that it would be quite wrong for Ministers to take any decisions on such an issue without having seen the hospitals for themselves.

My hon. Friend the Member for Reigate has also taken the lead in the preliminaries of raising substantial sums of money, which he believes could be available, and that reflects the very considerable concern about the future of the hospital. Among the several meetings that I have had with those directly involved in the problems of Tadworth Court, I have had meetings with my hon. Friend, and he has gone over the way in which he anticipates being able to raise substantial sums if the hospital can be saved.

I should have liked to respond to the plea that my hon. Friend the Member for Reigate made at the end of his speech and to have announced a decision this morning. Last week I was abroad for a brief time and there was newspaper speculation that a decision had already been reached and could be announced this week in the House. That is not the case. No decision has yet been reached. I say that with some regret, because I realise that the continuing uncertainty causes difficulty to everyone involved and we should come to a clear conclusion as quickly as possible.

On the other hand, it has not proved possible to come to that quick decision and at the same time to do justice to the very many arguments involved and in particular, to the efforts being made by my hon. Friend the Member for Reigate and those who are supporting him and by the 857 Spastics Society. The ideas that he puts forward have an obvious attraction, but to ensure that we are not simply continuing uncertainty and that we are judging the best use of funds and resources as objectively as such vast sums require, it has been necessary to study in considerable detail and depth the proposals that are being made.

We have examined the proposals of my hon. Friend the Member for Reigate and the charity's proposals, and today, I have a further meeting booked with Mr. Tim Yeo and the Spastics Society, at which it will be necessary to go over yet further details. The Government and I hope to come to a conclusion as quickly as possible once we have all the necessary information and have evaluated it with the necessary care.

While this anxious debate has been going on, the Government have ensured that services at all the hospitals in the Great Ormond Street group of hospitals continue at their present level, and without interruption, at least until the end of the current financial year. It shows the size of the problems with which the governors of Great Ormond Street and the Government are wrestling when I say that we have devoted £½ million of central funds from the taxpayers' money to keep the present level of services at both Great Ormond Street and Tadworth Court continuing on the present basis, at least until the end of the current financial year.

As I have not taken a decision, it is obviously not possible for me to go into much further depth this morning. However, I re-emphasise—to allay some of the strongest alarms that some members of the public have expressed about the proposal—that the proposal before Ministers at the moment is not, and never has been, the ending of the services provided to the children at Tadworth Court. The proposal put forward by the governors of Great Ormond street would have allowed for the transfer of all services to the Queen Mary's hospital for children at Carshalton, where accommodation is available about four miles away from the present site of Tadworth Court. The proposal always envisaged the children being in the care of the same consultants as care for them now, and would have provided an opportunity for many of the Tadworth nurses to transfer with the children if they wished.

The main issue that has been raised by those who challenge the Government's proposal is whether not only the basic services could be provided by the same people to the children at Queen Mary's, Carshalton, but whether the nature of the care provided at Tadworth is so unique and dependent on the individual characteristics of this small hospital that it could not be recreated in the larger unit. Also, I have been very aware of the great worry felt by parents and children, who are subjected to the stress that families experience in some of the cases at Tadworth Court, at any suggestion of change to well established and sensitive arrangements.

That is the proposal. I should add that some people, in campaigning, have been rather carried away into attacks on the quality of the care at Queen Mary's hospital for children at Carshalton. The people at that hospital have shown great understanding and forbearance in not replying to those attacks. I have visited Queen Mary's, and I was extremely impressed by the dedication and commitment of all the staff there. My hon. Friend said today that he entirely supported my view that Queen Mary's is a highly successful hospital. We have to consider whether the 858 nature of the layout and the environment at Queen Mary's would—or would not—allow a successful transfer of all the qualities of the service at present provided at Tadworth Court.

The charities proposal would of course be supplemented by my hon. Friend's efforts to raise substantial funds for investment. As I said, it is still necessary to appraise the proposal in detail. The fact that we have already spent £500,000 in keeping the present services going while these proposals are worked out shows the formidable nature of the sums of money that are involved. Clearly, no Government, however sympathetic to the case, can accept that Tadworth must continue at any cost. Indeed, no one now suggests that Tadworth Court should continue exactly the same as before. All the proposals presuppose the sale and development of some of the substantial surplus land that is on the site, and include suggestions to improve the occupancy rate of a hospital where at present only about half the places are taken up by patients. We must ensure that the substantial resources, capital, revenue and staff are used in the most effective way, so as to benefit a maximum number of parents and sick children and to keep the highest quality of services in all the hospitals that are involved.

I want to say a word in defence of the board of governors. I have already said a few words in defence of Queen Mary's, Carshalton. The board has been somewhat unreasonably misunderstood at times when people have criticised it for putting forward its proposals. The board is faced with the conflicting needs of the three important hospitals for which it is responsible. The doctors at Great Ormond Street hospital are continually developing highly specialised new methods of treating malignant disease, diagnosis and treatment of renal disease, and the development of new surgical techniques in the neonate. The results of those developments at one of our greatest children's hospitals is that the cost of providing services there steadily rises, and at times threatens to outstrip the increased resources which the Government keep giving the board.

So the board looked at the problems of financing its three hospitals. The board itself originally proposed to reduce the number of beds at Tadworth to improve occupancy and to sell off surplus land. The board's original proposals were similar in some respects to those now being put forward by the charities. However, at the time those proposals were strongly resisted by the Tadworth staff and by local interests. After that, the board, in consultation with the Merton and Sutton health authority, developed the proposal to transfer all services to Queen Mary's, and decided to put the proposal to Ministers. The board has throughout acted entirely properly. Its main motive has been to show how it thought it could make resources available to develop better methods of treatment for more people, while safeguarding the services now provided at Tadworth. I am quite sure that the board's intentions and purposes have been beyond doubt throughout.

The decision now rests with Ministers. I have to consider the moving experience of my visit to the two hospitals and the appeals put to me by those with an interest in the matter. I have also to examine the mechanics, the figures and the viability of the proposals being proposed by the Spastics Society, so formidably and valiantly supported by my hon. Friend the Member for Reigate. I can only repeat what I hope I have already made clear. The main consideration of Ministers in deciding this 859 difficult matter will be to do what we consider to be right in the interests of sick children, their parents and families. The whole purpose of the Health Service, especially in this area, is to make the maximum effective use of resources available to provide for the highest standards of care for sick children and the best levels of support for those families who have sick children within their midst.

That must be our first concern. It is concern for the sick children and their parents that has moved substantial numbers of members of the public to express their interest in the subject and to put so much support behind my hon. Friend's campaign. I am grateful to all those who have taken part in the debate ranging from the hospital 860 governors, those at Queen Mary's and Tadworth Court, my hon. Friend the Member for Reigate, the Spastics Society and members of the public who have sometimes put conflicting proposals to ministers but who are all anxious to do the best for sick children and their families.

A decision has to be made shortly when we have evaluated the various proposals. I undertake to my hon. Friend that he will be among the first to know, although I hope that everyone will know precisely where the future lies for these services within the next few weeks.