HC Deb 19 July 1983 vol 46 cc352-8

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Neubert.]

4.13 am
Mr. William Shelton (Streatham)

I wish to raise the question of the proposed closure of the South London Hospital for Women. This hospital is well-nigh unique in the country because it caters for women patients only and is staffed by women. Nevertheless, the Wandsworth health authority has recommended its closure. The decision now rests with my right hon. Friend the Secretary of State for Social Services.

Why has this closure been recommended? It seems that the first reason is that it is desired to save some £5 million a year in running costs, that being what it now costs to run the hospital. Yet within the same health authority it is proposed that tens of millions of additional money should be spent on building and running a new wing at the relatively nearby St. George's hospital.

I am told that in 1989–90 the cost of running that at 1982 prices will be more than £13 million, and of course the capital cost of building it will have its own additional cost. Not only is the additional cost proposed for St. George's at the expense of the South London, but I am advised that the beds in St. George's are at a higher unit bed cost than those at the South London. Moreover, there would be little gain in additional beds in the area, because the proposal would be not only to close the South London, but to pull down the Knightsbridge wing of St. George's in order to build the new wing, known as phase 2A.

The South London hospital borders right on a different health district. It is in the Wandsworth health authority, but it lies alongside the west Lambeth district health authority, which has announced that if the South London is closed, it will look for about 80 more beds, and will look to the Government to fund them. Those on the Wandsworth health authority have said that ii: is no concern of theirs. It may or may not be, but it is certainly the concern of both my hon. Friend the Minister and the Government.

Of course one appreciates the ambitions of those who wish St. George's to be a showpiece, and one of Europe's finest hospitals. No doubt there are some who regard the South London as standing in the way of that ambition. However, I think that hon. Members will agree that ambition must not overrule logic, common sense and financial prudence.

The second reason is that the health authority says that the savings achieved would also be used to increase geriatric care in the authority. Of course that is good, but only three years ago the same authority closed St. Benedict's hospital in Tooting which specialised in such beds. I wonder why it closed that hospital.

The third reason is that it is said that the use of beds in the South London is poor. A comparison is made between the rate of occupancy of beds in the South London and St. George's. That is misleading for the simple reason that the South London does not have an accident unit while St. George's does. Any hospital with an accident unit will automatically show a higher turnover, because of the number of short-stay patients.

The unit cost per bed at the South London is only 57 per cent. of that at St. George's. Indeed, in 1981–82 a DHSS document on national average costs stated that hospitals with between 100 and 300 beds almost always cost significantly less to run than those with 300 or more beds. Therefore, it is also cheaper to run the South London than the new wing at St. George's.

Fourthly, it is said that Wandsworth health authority is "over-bedded", and that there is an unnecessary provision of beds. However, if that is so, why is it that both the accident and emergency units of St. George's and St. John's, in the same authority, have been closed more than once, especially in winter, because they have no spare beds with which to receive new patients. One wonders whether there can be an unnecessary provision of beds. In addition, in 1982, the South London had some 3,600 new gynaecological outpatients. That is 560 more than the number of new outpatients attending St. George's and St. John's together. Thus, if the South London is closed, how can one talk of re-provision? It must be unrealistic.

In an extraordinary way, the whole community has shown its wish to retain and save the South London. There was a petition with more than 50,000 signatures to my right hon. Friend the Prime Minister. Indeed, in the House itself, there was an early-day motion signed by 101 Members. I remind my hon. Friend that in 1980 the DHSS wrote: There is a real risk of concentrating services more heavily than the advantages strictly justify. I entirely agree with that. What is proposed by the Wandsworth health authority reminds me of the past mistakes that were made on schools. Over-large schools were built at the expense of smaller schools of proven worth. That mistake is very much regretted in many areas today. I suggest that this grandiose scheme, this enormous new provision and addition to a large existing hospital, St. George's, is out of keeping with the needs of the day and the needs of financial prudence. It cannot be sensible to build large hospitals that are too expensive to run.

What can be done? Several workable proposals have been put forward. The first is that savings should be made in the Wandsworth health authority. It is one of the largest spending authorities and by the time phase 2, the new addition, comes along, its capital budget will be little short of £100 million. There is talk of proliferation of administration in the health authority. There have been repeated and fervent requests for the postponement of phase 2 while an audit and reappraisal take place. That would be a sensible move.

A second proposal, which has been advanced by community health interests, was to close St. John's instead of the South London Hospital for Women or to withdraw geriatric patients from St. John's and close four wards. That is a possibility and I must tell my hon. Friend that the South London Hospital building is in better condition than St. John's.

The third proposal, which I think should be considered carefully, is to forge a link between our two remaining women's hospitals, the Elizabeth Garrett Anderson hospital and the South London Hospital for Women. It is proposed that a joint trust should be set up and that they should receive super-regional funding, which I believe the Elizabeth Garrett Anderson already does. I have a letter before me from Dr. Ridley, the chairman of the Elizabeth Garrett Anderson hospital medical committee. It says: In principle my colleagues would be in favour of separate funding to involve both hospitals though detailed discussions would be needed to clarify the position. I urge my hon. Friend to pursue this and I hope it will be pursued in other quarters as well. This is a way forward to save this hospital of proven worth, one which the community so strongly supports and one which the community so greatly needs and so greatly values.

I ask my hon. Friend and my right hon. Friend the Secretary of State to consider this matter carefully because if it is shut, an error will be made.

Mr. Alfred Dubs (Battersea)

rose—

Mr. Deputy Speaker (Mr. Paul Dean)

Does the hon. Gentleman have the agreement of the hon. Member who has the Adjournment and of the Minister to intervene?

4.23 am
Mr. Dubs

Yes, Mr. Deputy Speaker. I thank the hon. Member for Streatham (Mr. Shelton) for giving me a few minutes of his Adjournment debate to add my comments to his about the future of the South London Hospital for Women.

It is clear that there has been enormous pressure on the financial resources of the Wandsworth health district. I appreciate the point made by the hon. Member for Streatham about the new development at St. George's and its need for funds. Nevertheless, I sincerely hope that the consequence will not be the closure of the South London Hospital for Women.

The hospital was founded 70 years ago and has served not only the women of south London but the women of London as a whole and, indeed, a wider part of the country throughout that period. It is the only acute hospital in the country that provides a full range of services by women for women. If that hospital were to disappear, never again in our lifetimes would there be such a hospital for those who currently make a great deal of use of it. It is well known that many women prefer the care that only that hospital provides. Some of them may be members of the Asian community, who have special reasons for wanting to use the hospital.

Above all, the hospital has wide local support. Ever since the first move to close it became known, I have been astonished at how passionately people in my constituency and the surrounding areas feel about it, and how anxious they are that it should be kept open. I have been involved in collecting signatures in Balham high road for a petition to save the hospital, and people have rushed to sign it. The hospital has an active friends organisation which, together with the GLC, has only recently provided a laser for the treatment of cancer, something that has been much needed and which St. George's does not have. It says much for the commitment of a local community that they should subscribe so generously to the laser for the hospital.

If the hospital were to close, the people of the area would be denied the significant element of choice in their health care. That would be a pity. I fear that if we allow the hospital to close, it will not be long before St. George's provides the only hospital care in the area. I have a great deal of respect for that hospital, and I am not knocking it. However, it would be a pity to take away that element of choice that should be a feature of health care in our community.

The hospital has a good reputation and a great deal of local support. I urge the Minister to find a way to enable the Wandsworth district council to keep open the hospital. The hon. Member for Streatham suggested possible ways of doing that with the Elizabeth Garrett Anderson hospital. We are having a meeting in the House later today, when many people connected with the hospital will be here. One of the probable conclusions of the meeting will be a request for some form of central or national funding to enable that unique hospital to be kept open.

I hope that the Minister will think seriously about that. I hope that he will take note of the strength of local feeling and the enormous contribution that the hospital has made to health care in London and throughout the country. I hope that he will consider sympathetically the request made by the hon. Member for Streatham and myself and by many thousands of people.

4.28 am
The Under-Secretary of State for Social Services (Mr. John Patten)

I am grateful to my hon. Friend the Member for Streatham (Mr. Shelton) for raising, with his customary elegance, this important issue. I realise its importance to the members of the community that he and the hon. Member for Battersea (Mr. Dubs) represent. The appearance in the debate of the hon. Member for Battersea is an uncovenanted bonus. It is a pleasure to listen to him.

I am aware that my right hon. Friend the Prime Minister and a number of hon. Members have received representations from the area about the hospital's future. I am pleased to have this opportunity to try to explain the current position and to clarify one or two issues that have been raised. I hope that my hon. Friend will forgive me if I do not comment in any detail to 'fight on a possible marriage between the South London Hospital for Women and the Elizabeth Garrett Anderson. That idea is new to me.

I wish to stress at the outset that no decision on closure has yet been taken. In view of the many representations my colleagues and I have received about the proposed closure, I will ensure that hon. Members who are concerned have an opportunity to meet one of my ministerial colleagues or myself to discuss the issue at greater length so that they may have a chance to make their views known. My hon. and learned Friend the Minister for Health will also be meeting the chairman of Wandsworth health authority together with local representatives later this week to discuss the district's financial position as it relates to the closure of the hospital.

Without wishing to sound adversarial—because it is not my intention so to sound—I shall make a number of points about the hospital and set it in the context of health care generally in London. The South London Hospital for Women, which is on the south side of Clapham common but managed by the Wandsworth health authority, has been in existence for about 70 years, having been set up in 1912, with two clear aims. The first was to enable women patients who preferred to be treated by women doctors to get that treatment. The second was to train women doctors as hospital specialists at a time when it was extremely difficult in this country, as it was throughout western Europe, for women doctors to gain appropriate graduate experience and postgraduate training.

There have since 1912 been considerable changes in attitude towards those two issues. It is now possible for any qualified woman doctor to have the opportunity of following whatever form of postgraduate medical training she chooses. This equality of opportunity for women doctors is protected by legislation and currently nearly half of all students entering medical schools are women. Thus, not only is there equality of opportunity for women training as doctors, but it is much more likely, not only in London but throughout the country that a woman who wishes to be treated by a woman doctor will get that opportunity.

I fully appreciate that some women prefer — for religious, cultural or other reasons — to be seen by women doctors. Indeed, it is the policy of almost all district health authorities that when women wish to be seen by women doctors they should be treated in that way, and that is certainly the case in Wandsworth, where the authority arranges for women who wish to be seen by female doctors so to be seen, unless exceptional circumstances make that impossible.

Here I pick up a point made by the hon. Member for Battersea about the national role of the Hospital. Looking at the most recent figures, it is important to realise that the hospital provides an essentially local service, as against a national service. For example, fewer than 3 per cent. of the patients who travelled to the hospital came from the GLC area north of the Thames, and fewer than 2 per cent. who travelled to the hospital came from outside the GLC area, so, as I say, it is providing substantially a local service.

As my hon. Friend knows well, because he has been deeply concerned with the issue, the former Merton, Sutton and Wandsworth health authority envisaged the closure of the South London hospital in the late 1980s, before the opening of phase IIA of St. George's hospital. But a number of factors have influenced the new Wandsworth health authority to bring forward both the consultation programme and the date of the proposed closure of the hospital. These include the need to ensure that the necessary revenue will be available to open St. George's hospital before contracts are let next year, and my department has asked all health authorities throughout the country to ensure that the extra revenue requirements of their new schemes which call for additional resources can be met before contracts are let out to tender. That is essential if we are to avoid the tragedy of having new and much needed hospital developments failing to open because of lack of funds.

Two main factors have influenced the Wandsworth health authority to bring forward the proposed closure from the late 1980s to 1984. First, the authority is properly concerned to take steps to remain within its statutory cash limit, which it must do. Wandsworth has a difficult task in facing a reduction in its revenue allocation. Secondly, the authority is concerned to find ways of improving services for priority care groups throughout the district, particularly the mentally ill. It has therefore proposed the earlier closure of the south London hospital, partly to release extra resources in the interim for these services. Closure of the hospital is expected to yield savings of about £5 million annually. In the short term this will enable the authority to reprovide the services currently provided at the south London hospital at St. George's and St. James's hospitals. The savings would also allow the authority to bring about much needed improvements in services for the mentally ill at Springfield hospital and to meet the authority's reduction in revenue allocations.

Any health authority proposing a closure of any hospital, let alone a much loved hospital that is deeply embedded in the local community, goes through the most careful process and procedures of consultation. That has certainly been so with the proposal that we are discussing. Where the local community health council is not in agreement with the changes that are proposed, the issue is rightly referred to my right hon. Friend the Secretary of State for a final decision. I reiterate that no decision has been taken.

I am sure that my hon. Friend appreciates that very full local consideration and consultation will have already taken place before the issue lands on Ministers' desks. My Department will carefully consider the district's proposals the community health council's alternative proposals and the views of hon. Members and their constituents who have written to us before a final decision is made. The most interesting suggestion of my hon. Friend will be included in that consideration.

I realise that my hon. Friend is especially concerned about the consequences of the proposed closure for some of his constituents. I am advised from local sources that it is the location of antenatal facilities that is causing considerable concern. That is perhaps more significant than the location of inpatient facilities in terms of overall travelling times. The health authority has undertaken to maintain the antenatal facilities in the vicinity of the south London hospital should that hospital close. This means that patients from the Lambeth area and their relatives would need to travel to St. George's hospital only when in need of admittance for delivery or some other form of inpatient obstetric care. There is the guarantee that should the hospital close antenatal services of an adequate level would be provided in the immediate area.

I hope that my hon. Friend will agree that the Wandsworth health authority has taken steps to minimise any hardship to the residents should a decision be taken to close the south London hospital. I understand that there have been continuing discussions between the chairman and officers of Wandsworth and West Lambeth health authorities about the implications of the proposed closure for residents in both districts.

I thank my hon. Friend warmly for raising this important issue and giving it an airing in the House. I assure him that his comments and those of all interested parties will be taken into account before a decision is made on a closure of the hospital.

Question put and agreed to.

Adjourned accordingly at twenty-one minutes to Five o'clock a.m.