Hospitals (Hackney) (Hansard, 12 July 1983)

§ Mr. Brian Sedgemore (Hackney, South and Shoreditch)

I rise to introduce the debate on the closure of hospitals in Hackney. I begin by referring to the tragic comment by a general practitioner at the last family practitioner's committee in Hackney. He said that he was concerned that some of his patients were dying a year earlier than they should because they were having to be kept in the community when they should be in hospital. That general practitioner uses St. Leonard's hospital in Shoreditch, the proposed closure of which will form a major part of this evening's debate.

My first three questions to the Minister are simple. Why are the Government pursuing policies which are leading to the early deaths of elderly people in Shoreditch? What does the Minister propose to do about that and what is his message for that general practitioner? Of course, general practitioners are concerned with more than the loss of hospital beds for geriatric patients in Hackney. The loss of acute hospital beds in the City and Hackney health district over the past decade has been staggering. In 1975 there were 1,183 acute medical and surgical beds in the district. Today that figure has fallen to 867. According to the district health authority's plan, by 1986 it will have fallen to 797. According to the consultative document that I have with me, it will fall to 761. That 36 per cent. loss of acute beds is not the end of the matter, because page 8 of the consultative document of the City and Hackney district health authority shows that there will be a further loss of acute beds when the regional strategic guidelines come into force.

This consultative document, which proposes the closure of four hospitals, St. Leonard's, the Mothers', the German and St. Matthew's, is as shaming and shameful document as I have ever seen. It reflects something of the cynicism and barbarous nature of our times. As I read it, I realise that the concept of the National Health Service that we knew at its inception has completely disappeared. There was a time when the NHS was about disease, illness, caring for patients and access to local facilities. However, in the 1980s we see from the document that there is a new concept. The NHS is about professionalism, increasing specialisation, the needs of consultants and public expenditure cuts. I do not know whether the Minister supports those public expenditure cuts. Perhaps he will tell us tonight. I come here not to ask him or his colleagues for the quality of mercy, because it is not in them, but to ask the Minister for seven specific assurances about that consultative document.

First, will the Minister order—or, if he has not got the power, to order, request—the City and Hackney health authority to withdraw the consultative document, because it lacks integrity and makes it impossible for sensible consultation processes to take place? It should be replaced by a more mature and objective document, which will allow the public to make sensible choices. Secondly, will the hon. Gentleman give a categoric assurance that the new Homerton hospital in Hackney will open in 1986 as a fully operational district general hospital? I ask him to dispel the rumours that, if it does open, it will not open as a fully operational district general hospital.

855 Thirdly, will the Minister confirm that his Government will honour the pledge given by the previous Minister for Health, on 6 May 1981, to Sir Harry Moore, chairman of the North East Thames regional health authority, that St. Leonard's hospital will stay open until the new Homerton hospital comes on stream in 1986? The consultative document invites the Government to renege on a solemn and binding undertaking. Fourthly, will the Minister give consideration to upgrading St. Leonard's hospital even when Homerton hospital is opened in 1986, in order that the people of Shoreditch can get a decent health service? Fifthly, will the Minister tell the management at St. Leonard's that it is not part of the democratic process for it to hint to its workers—however elliptically the hints are given — that if they object to these closures and campaign against them, they may suffer when they look for other jobs in the Health Service?

Sixthly, will the Minister give an assurance that the staff at the German and St. Matthew's hospitals will all have their jobs guaranteed in the future? Seventhly, will the Minister give the House an assurance that the composition, and if necessary the structure, of the district health authority will be changed in order to make it more democratic, its members more sensitive to the opinions of the local community and to make it more responsive to local pressure?

In Hackney, trust in the district health authority has broken down. There is a potentially explosive situation. That situation could live on in the months ahead to haunt both the Minister for Health and the chairman of the district health authority, Mr. Freedman. Let neither of them say that they were not given warning in the House.

I wish to deal with some of those points in more detail. Few people in Hackney believe that this consultation process is real. The public, the staff at the hospitals and a number of the general practitioners do not believe it. A distinguished local GP, Dr. Alex Mills—whom I spoke to at the weekend—told me that he did not believe it. The Hackney health emergency committee does not believe it. It asked the district health authority for 1,000 copies of this document so that they could be distributed to the public. It was told that it would have to pay a vast sum for them. I can understand that the district health authority does not want too many people to examine its shoddy document, but its response was unbecoming to the democratic process.

The Hackney health emergency committee also asked if it could use displays in clinics and the outpatients' department to show what was proposed in the document. It was refused permission by the district health authority.

My main criticism of the document lies in its inherent defects. It is impossible to come to a sensible conclusion about the matters that it discusses. It says that if St. Leonard's is closed savings of £2.7 million will be made per annum. It also totally ignores masses of costs that will be incurred for the community in the proposals.

First, the document fails to calculate the cost of transferring the renal unit from St. Leonard's to St. Bartholomew's. Secondly, it refers to the capital cost of increasing the size of the outpatient's department at St. Bartholomew's but makes no attempt to cost that programme. Thirdly, it talks about a loss of 350 jobs and regards that as a saving, but it pays no regard to the cost that will fall on the community, the Treasury and the 856 DHSS. The economist Mukherjee has produced figures which show that it costs about £6,000 per person per year to keep someone on the dole. The Treasury's economists accept that that is a valid figure. If 350 jobs are lost permanently it will cost the community £2,100,000 a year. That will wipe out most of the so-called gains created by the proposals in the document.

Fourthly, there is no costing of the increased demand for ambulances that is bound to occur if the journies are longer and ambulances travel between hospital and homes which are separated by greater distances. Fifthly, the document recognises that transport facilities in Shoreditch are totally inadequate to get patients and others to hospital and that they will be even more inadequate if St. Leonard's is closed. Therefore, amazingly, the document talks about the district health authority setting up its own public transport system. That suggestion belongs to the world of Alice in Wonderland. If that happens, the cost will be colossal, but the document does not attempt to quantify that cost.

The document contains a curious appendix which suggests that the transport problem is about moving from one hospital to another when the problem is one of moving between patients' homes and hospital. I have yet to fathom the purpose of that appendix.

Sixthly, the document takes no account of the extra pressures that will be put on Hackney hospital with the closures of hospitals round the periphery of the borough. Moving in a clockwise direction, let us consider first the Mildmay hospital in Tower Hamlets. The acute department has closed and the casualty and accident unit is to close. That means more pressures for Hackney hospital.

Let us consider the Prince of Wales hospital in Haringey. The acute and casualty departments are to close. That means more pressure on Hackney hospital. The casualty department at the Royal Northern hospital has closed and the acute department is to close — more pressure on Hackney. At Whipps Cross, Leyton, the administrator has taken the extraordinary decision that he will not accept referrals from anyone who does not live in his area. That is the new open national Health Service.

All those peripheral closures mean more pressure on Hackney's hospitals. No account is taken of that in the document. St. Bartholomew's takes much of the money available in the region. Everyone knows that it is not a local hospital for the people of Hackney or Tower Hamlets; it is a teaching hospital that provides a luxury service for commuters to the City. When the four hospitals close, the people of Hackney will be pushed further and further out, and some will be pushed out of the borough altogether, even when the Homerton hospital opens, because the necessary facilities will not be available.

Seventhly, there is £1 million sloshing around in the document that appears to repeat itself over and over again. On one page that £1 million is being spent on maintenance; on another it is being spent on increasing primary care. That is a wonderful phrase. In the document, increasing primary care has become a buzz phrase for the closure of hospitals. The people know that primary care will not be increased in Hackney. It is extraordinary that there is a suggestion that it will be increased when the Government are penalising the local authority that is partially responsible for primary care.

Eighthly, it is amazing that geriatric beds are being taken away when we do not know the need for such beds 857 in the borough. What way is that for the Minister to plan the Health Service? Flow can people like me make sense of the document's references to geriatric beds when the health advisory service report on that subject has not been published? When will the Minister let us see it?

It is an illusion to talk about savings of £2.7 million a year through closing St. Leonard's hospital. It is a further illusion to believe that there will be another £500,000 saving by the closure of 50 medical beds, some surgical beds and 100 geriatric beds.

My second point relates to the Homerton hospital. I want an assurance from the Minister that it will open. My third point concerns the binding pledge that the previous Minister the hon. Member for Reading, East (Dr. Vaughan), gave to Sir Harry Moore that St. Leonard's would not be closed until the new Homerton hospital opened. In his letter of 6 May he said: I must, however, make it clear that my decision to approve these changes is taken on the assumption that St. Leonard's continues to be a viable acute hospital, with general medicine, day-time casualty, geriatrics, a renal unit, mental handicap and out-patient and chiropody services … I wish the Regional Health Authority and Area Health Authority (Teaching) to ensure the hospital is able to run these services effectively and that staff, patients and the community do not feel the hospital is being run down … All those interested in St. Leonard's Hospital will recognise that the opening of the new Homerton Hospital is bound to have an impact on all the services provided in the District and it will be necessary for the new District Health Authority to develop a fresh strategy covering all the hospitals in the District. It must, however, be understood that until such a strategy is agreed I shall not be willing to approve further reduction in services at St. Leonard's Hospital. If I understand anything about politics, and it is difficult to understand much about the incompetent way the Health Service is being run now, it is that the district health authority and the Government intend to welsh on the pledge given by the previous Minister. If that happens, it will reflect on the very integrity of the central core of Government. It will incense and inflame the people of Shoreditch. That will have calamitous consequences for many years to come.

The document has politicised one of the most reactionary groups of people in Britain — the general practitioners. No fewer than 102 of them have signed a petition protesting against the closure of the hospital. They protest because they know that it is uniquely geared to meeting the needs of the people of Hackney. They know that increased expenditure on primary care will not happen and that a colossal burden will fall upon them. What will the Minister say to those 102 GPs?

The public's criticism is condign and total in their opposition to the proposals. Already there have been public meetings at Stoke Newington, Daiston and Shoreditch. I went to the Shoreditch meeting. The temperature there was extraordinarily high. I am not surprised that 10,000 people have already signed a petition and that by September another 10,000 will have signed. Nor am I surprised that there is to be a week of action leading up to 26 September, when the decision will be taken by the district health authority. I am not surprised that priests are on the march in Hackney or that schools are taking part in the demonstrations. Nor am I surprised that there will be a strike call.

I repeat, there must be no intimidation of the workers at St. Leonard's hospital, and we need assurances about jobs at the Mother's and the German hospital. As for the composition of the district health authority, the voting has 858 always been close on the closure of the hospital. I attended the last meeting. None of those who voted for the closure came from Hackney or Shoreditch. Indeed, none of them lived in those places and many of them literally could not find their way to Shoreditch without the aid of a taxi or a map.

Consultants from St. Bartholomew's hospital combined with two people from the Royal College of Nursing to tell local people that their hospitals would be closed. I was sad to see Lady Richards, who has expressed concern about hospitals in Shoreditch, toe the line of the Royal College of Nursing and make a speech which by any description was duplicitous. She said that St. Leonard's hospital was unsafe. But she has been a member of the very authority which has withdrawn the services which have made that hospital unsafe, if unsafe it be.

We must have more control over what goes on at St. Bartholomew's hospital and over the consultants there. I will give only one example in that context, and then I will resume my seat and listen to the Minister's reply with interest. There is an increasing specialisation going on in hospitals. Mr. Shepherd arrived as consultant obstetrician and gynaecologist. He has a particular interest in gynaecological oncology. He performs controversial radical vulvectomies. I am not here to say whether clinically he is right or wrong, but this increasing specialisation is calling for more expensive equipment and is occupying beds for long periods, and this has not been properly budgeted for. That is happening all the time in teaching hospitals, and smaller hospitals like St. Leonard's are having to close. It is happening at a time when there is a drain on resources and when the Government are taking away £2.3 million over five years in so-called efficiency provisions.

When Homerton hospital opens, money will disappear under the mini-RAWP scheme from Hackney to Essex. Last week the Government announced cuts worth £97 million in hospital expenditure, and more will be announced in the autumn. The people of Hackney are suffering. They will not put up with the attitudes of the patronising middle classes telling them how to organise their lives. The Minister has been warned about these impending closures.

§ Mr. Patten

The hon. Gentleman is fond of trying to hand out punishment both in this Chamber and in the New Statesman. I shall answer in my own way. I shall endeavour to answer in writing the seven questions and the eight issues that the hon. Gentleman asked and raised if I cannot answer orally in the extremely short time that he has left me. If he had had the courtesy to let me know beforehand some of the questions to which he wanted answers, I should have endeavoured to follow them up. I accept that I had the chance to read his remarks in The Standard.

I can understand fully why the hon. Gentleman and his constituents feel strongly about the closure of a much-loved local hospital. I was in exactly the same position myself with the closure of a similar hospital in my former constituency about two years ago. Such hospitals arouse strong feelings and passions among the local people. That is especially so in the hon. Gentleman's constituency of Hackney, South and Shoreditch, which everyone recognises is a deprived inner city area, albeit one suffering from a quite rapidly declining population.

The hon. Gentleman made some wild allegations about my right hon. Friend's policies for the Health Service and about the policies of my hon. and learned Friend the Minister of Health, who is sitting beside me on the Treasury Bench. I shall resist the temptation to respond to those allegations because I wish to deal, first, with the financial background to the situation in the Hackney area and, secondly, to consider the proposed closure in as much detail as I can in the short time that is left to me in the debate.

It is misleading to talk about a diminution in health services in the hon. Gentleman's area. I object strongly to the hon. Gentleman making that assertion. The services administered by the City and Hackney health authority include one of the great teaching hospitals, St. Bartholomew's—the hon. Gentleman does not seem to care much for it—and another centre of excellence—St. Mark's — which provides a unique gastroenterology service for the entire region. There are three separately managed postgraduate hospitals — Moorfields eye hospital, Queen Elizabeth children's hospital and St. John's hospital for skin diseases. All these hospitals are located within or on the district boundaries. As the hon. Gentleman mentioned, there is a brand-new hospital under construction at Homerton, which is being built at a cost of about £21 million. There is some deprivation for the hon. Gentleman's constituents! That hospital is due to open in 1986 and it is on target to do so.

A number of other hospitals will have to close or continue with different functions. I do not think that anyone can argue seriously that we can staff and run new hospitals alongside every hospital that they were designed to replace. The new hospitals were often designed by previous Labour Administrations. If we are to make any progress in developing hospital services within the resources that the country can afford, some of the old hospitals will have to close, however valuable their contributions may have been in the past.

Whatever closures take place after the process of consultation—I hope that the hon. Gentleman approves of consultation as a process—the district will be left with excellent acute hospital services that will be the envy of many other regions and districts in other areas.

860 Before I go into the details of the proposals of the City and Hackney health authority, I shall sketch some of the background. The authority serves a declining population of about 184,000. That is something that the hon. Gentleman failed to mention. The authority is over-provided — I choose my words carefully—with acute hospital beds. By no stretch of the imagination can it be said to be starved of financial resources. That is palpable nonsense.

The North East Thames regional health authority calculates that the revenue allocation of the City and Hackney health authority is about 15 per cent. above its revenue target, which means that in terms of health resources it is one of the best provided districts in the region and throughout the country. Hon. Members on both sides of the House would wish to have such hospital provision.

The regional health authority is following a strategy of switching resources from over-provided to underprovided districts and from acute hospital services to the development of services for the priority care groups—the elderly, the mentally ill and the mentally handicapped who concern us all in the DHSS.

The RHA is trying to effect those changes without damaging existing services. That is entirely consistent with Government policy as set out in our document "Care in Action". It is a document which has been widely accepted and praised in the health care world. It is bound to mean some change in the existing pattern of services which cannot be set in concrete.

In the last two minutes available to me I shall deal with Hackney and the seven questions, eight points, three reiterated questions and further points mentioned by the hon. Gentleman. District health authorities are responsible for the planning of health services in their districts within the resources available to them.

Last year my hon. and learned Friend the Minister for Health and the regional chairman agreed at the regional accountability review meeting that the RHA would produce a plan which would demonstrate how revenue would be found to open the new Homerton hospital—on target for 1986—and improve the priority services in the district.

It was agreed that details of the proposed hospital closures would be provided and that consultation on closures and changes of use associated with the Homerton scheme would begin as soon as possible. It is exactly that consultation process that is taking place now. I reject utterly the hon. Gentleman's allegations of incorrect consultation, of the democratic process being rigged and of the correct procedures not being followed. The correct procedures are being followed.

Throughout the hon. Gentleman's speech there were veiled hints and innuendos about threats to the consultation process in the political undergrowth and threats by the DHA to people who work in the Health Service. Those allegations do not help his case, but, none the less, with the best will that I can compose, I will endeavour to write to the hon. Gentleman and deal with some of his seven questions and some of his eight points.