§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. David Hunt.]10.27 pm
§ Sir Anthony Royle (Richmond, Surrey)
I am grateful for the opportunity to raise the problem of the Royal hospital in Richmond. The hospital, which has been a community hospital for a long time, has recently come yet again under threat. I have been asked to raise the matter not only by Jeremy Handley, the prospective Conservative candidate for Richmond, who has been doing a lot of work trying to ensure that the hospital is saved, but by Mrs. Freda McNae, the chairman of the friends of the hospital. I have had many approaches from constituents throughout the area asking me to raise the matter in the House, which is why I am taking up the time of the House and which has entailed the arrival of my hon. Friend the Under-Secretary of State to answer my points at this late hour.
The history of the hospital is well known locally but not to the House. I have taken a great interest in it for many years—more than 20 years. Many times the hospital has nearly closed. Some years ago the casualty department was shut. Therefore, the hospital has no longer had a casualty unit. Before the change in the organisation and structure of the National Health Service in the area, many people had to travel all the way to Kingston for casualty work instead of being dealt with locally in Richmond.
The Royal hospital is a community hospital and is still valued by the local residents. At one stage it contained 124 in-patient beds, but that facility was gradually eroded by the former area health authority until in 1977 it was phased out altogether. The closure of the wards was intended to be a temporary contingency so that short-term financial savings could be made. When the rehabilitation units were opened a year ago, the then Minister for Health announced that £2½ million had been set aside for the development of a community hospital facility beginning in 1983–84 with completion in 1987. With the possibility of reorganisation, the former area health authority delayed making a formal decision. Now the Richmond, Twickenham and Roehampton health authority is landed with the problem. They considered demolition. I shall deal with that later.
The statement that followed appeared in a paper that was prepared by the district medical officer, Dr. Hastings Carson, entitled "Service Planning Considerations". It was presented to the Richmond, Twickenham and Roehampton DHA meeting of 15 November. I shall quote the paragraph that has caused the anxiety:There is no prospect in a bleak economic climate of the RTR being able to afford the running costs of re-providing in-patient services at the Royal Hospital, Richmond even if the capital were available to renovate the hospital. For this reason it seems sensible to explore the possibility of using part of the site to provide a modern out-patient/day-patient/community health services complex to meet local needs conveniently and to dispose of the remainder of the land on the Kings Road site. The RHA might be willing to advance a capital sum in such circumstances on the understanding that it would be re-paid when the surplus land was sold.That statement implied that there would be no reinstatement of in-patient beds. If those beds were not be reinstated, patients would have to go to Roehampton or Putney for such a facility. Public transport between Richmond, Roehampton and Putney is bad. It is much too far for visitors, especially old people, to travel to see their friends in hospital. That inability of friends to visit is a 466 quite crucial aspect of the need for the community hospital to remain in Richmond. The population in Richmond is becoming increasingly elderly. Local people would be desolated if the community hospital no longer existed.
After local consultations, the skilful local chairman of the district health authority, Mrs. Earle, for whom I have nothing but the highest praise, managed to put together an impressive alternative plan. The authority agreed the following proposals. First, there should be no reduction of services provided by the district health authority and, secondly, there should be no demolition of the hospital, or part of it, for at least five years—and only then as a prelude to rebuilding. Mrs. Earle's scheme includes improved maintenance services and an extension for geriatric care.
As was pointed out in the document sent to the regional health authority, and as I have described this evening, much controversy has raged in Richmond and there was reference to the alleged plan for the community hospital. The plans always existed, and the former Minister for Health made a pledge, as I quoted earlier in my speech, when he opened part of the hospital just over a year ago.
The fabric, decor and general condition of the former in-patient accommodation has been allowed to deteriorate alarmingly. The DHA said that those conditions cannot persist and that there is a significant gap in the present day-place provision for the mentally ill, the elderly and the severely mentally ill in its area. There are fragmented clinic services, some at the Royal hospital, others at the Kings Road and the Windham road clinic. The DHA proposed:It seems sensible and in line with National policies for the priority groups to consider the Royal site in two phases viz Phase I aim to achieve a modern out-patient/day-patient/community health services complex. The old in-patient buildings would be demolished and the Kings Road site sold on commissioning of that complex (proceeds going towards the cost of that development). Feasibility studies would then be made for a possible Community beds component on the site, as Phase 2.Money must be provided to carry out the plan put forward by the district health authority. The former Minister's pledge to the region only a year ago can be carried out, and to put forward the idea that a large capital sum can be spent and then to say a year later "The capital can be spent, but we do not have the revenue to run the hospital" is not good enough.
I hope that my hon. Friend can assure me tonight that the district can carry out the scheme, because the region will be given the authority to provide the money for it. If my hon. Friend can assure me that the hospital will remain a community hospital and will be helped to thrive, it will give much encouragement to all those who are interested in health care in my constituency.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
I am grateful to my hon. Friend the Member for Richmond, Surrey (Sir A. Royle) for raising this important subject. For a long time he has taken a keen interest in such matters, and I recognise that there is much local uncertainty about the future of the Royal hospital. Therefore, I am glad to have the opportunity to clarify the position.
My hon. Friend referred to various undertakings to provide a community hospital of about 70 beds on the Royal Richmond site, which I know many of his constituents which to see. This proposal was originally put 467 forward in 1979, as my hon. Friend knows by a working party set up by the former Kingston and Richmond area health authority and the community health council to consider the future role of the Royal hospital after outpatient services were withdrawn from the Royal on completion of the new surgical block at Kingston hospital in 1977.
The working party's proposal for a community hospital of 45 geriatric and 25 post-operative and general practitioner beds was accepted by the area health authority and an outline scheme submitted to the South-West Thames regional health authority in 1980 for capital funding. That was, as my hon. Friend said accepted by the region and given a place in the forward capital programme at an estimated capital cost then of £2.75 million. Although in 1980 the Kingston and Richmond area health authority faced severe financial constraints and could not at that stage meet the additional revenue costs of a new community hospital, it was hoped that the necessary revenue could be found by the mid-1980s.
On that basis, a starting date of 1984 for the Royal hospital development was agreed with the aim of completing this by 1986–87. A project team was formed to undertake the necessary planning work. However, it became increasingly clear that the former Kingston and Richmond area health authority had no real prospect in the foreseeable future of meeting the additional revenue consequences from within existing allocations, although the community hospital remained a priority development.
As a result, the proposed development of the Royal hospital—always dependent on the health authority's assurance of revenue funding—was dropped from the region's capital programme, which was in any case overcommitted with major schemes for which revenue funding was assured. I stress that no detailed proposals for building a 70-bed community hospital, other than the outline scheme prepared by the working party in 1979, were ever formally submitted to either the region or my Department for approval as they would need to be. Had that happened, my Department would have been bound to question the revenue assumptions.
I am sure that my hon. Friend will agree that we must take every step to ensure that no more new hospital developments have to be mothballed because of lack of revenue.
§ Sir Anthony Royle
My hon. Friend said that this proposal was not put to his Department or the region. Was I wrong when I said that the Minister's predecessor made that statement when he opened the hospital?
§ Mr. Finsberg
We have no record of his ever having said that or having written to my hon. Friend. I suggest that my hon. Friend talks to the Minister for Consumer Affairs to see what he thinks he said. I took care to find out what assurances had been given.
In view of the problem we found in some areas where authorities experienced difficulty in opening new hospitals because they had no revenue available, it seemed only sensible to err on the side of caution.
At present, health authorities are permitted to invite tenders and let contracts for new hospital developments only where they can demonstrate that the scheme will reduce revenue spending, or not entail any additional recurring revenue commitment, or where the extra revenue requirements of a scheme that will call for additional resources can be met from closures already agreed.
468 Following reorganisation last April, as my hon. Friend has said, responsibility for the Royal hospital passed to the new Richmond, Twickenham and Roehampton health authority. No revenue funds were specifically transferred to Richmond, Twickenham and Roehampton by its predecessor authority to meet the additional costs of a new 70-bed community hospital, and although this remained a priority development the new authority reluctantly reached a similar conclusion about the lack of funds in the foreseeable future to support the scheme, and this remains the position.
If I have spoken at length on these earlier plans for the Royal hospital rather than its likely future role—which is the subject of this debate—it is because I wanted to stress the provisional status of these plans and explain why the scheme was dropped from the region's capital programme. I think such an explanation was called for.
I come to the current plans for the Royal hospital which the authority has drawn up. My hon. Friend referred to the demolition of the existing buildings on the Royal hospital site. I know that much concern has been expressed in his constituency that the present hospital, which provides much needed out-patient and day-patient services, would be demolished without provision for any replacement. Let me assure my hon. Friend that that is certainly not the case.
A wide range of out-patient clinic services, day places for the mentally ill and community health services are provided at this busy and much loved hospital; these will need to continue. Indeed, given the shortfall in day places for the mentally ill and elderly severely mentally infirm in the district there is a case for expanding these facilities at the Royal. At the same time, I think that my hon. Friend will agree that it is undeniable that the existing buildings are in a poor state and the former in-patient accommodation, closed about five years ago has deteriorated alarmingly. The health authority has there fore considered the future role of the Royal hospital in two phases. The aim under the first phase is to achieve a modern out-patient, day-patient and community health services complex on the site, as my hon. Friend said.
The old in-patient buildings would be demolished and, at the very least, the existing level of out-patient and psychiatric day-hospital facilities reprovided in a more modern complex. The capital cost of rebuilding the Royal hospital along these lines has been provisionally estimated at £3.3 million. Feasibility studies would then explore the potential for a possible community bed component on the Royal hospital site, as phase 2 of the development. This would of course, as my hon. Friend will understand, depend on the health authority finding the necessary revenue funding, although, as my hon. Friend knows, this is unlikely in the immediate future.
The South-West Thames region has agreed to a joint feasibility study with the district health authority and I understand the aim is to complete this by 1984–85. In the meantime, the present level of services at the Royal hospital is expected to continue. Once the feasibility study has been completed, I hope an early start can be made on this development and the detailed plans processed as quickly as possible.
I should point out that the capital programme for South-West Thames is already heavily overcommitted both in the short and medium term and the phased reconstruction of the Royal hospital, Richmond, is only one of many competing bids from districts as yet unprogrammed. At 469 present Richmond, Twickenham and Roehampton already has approval for a £3 million capital development starting in 1983–84—the Tudor Lodge health centre—and other bids from this district alone currently total about £8.2 million, including £3.3 million for the Royal hospital. It will be clear to the House that some difficult choices about priorities will need to be made both by districts and the region in the months ahead.
I cannot give the assurance that my hon. Friend would like—a firm undertaking that the phased reconstruction of the Royal hospital will be included in the capital programme at a given date—as this is a matter for the regional health authority to determine, bearing in mind the needs of the region as a whole. I can give him a firm undertaking, however, that demolition will not take place until plans have been agreed for replacement facilities. I recognise the pressures on the region's capital programme and my hon. and learned Friend the Minster for Health will be discussing some of these problems with the chairman of the South-West Thames RHA when he meets him next week. I shall ensure that a copy of Hansard is sent to him 470 in advance of that meeting so that he can read what my hon. Friend said when he expressed the genuine and real concern of his constituents.
I know, from the many years that my hon. Friend has represented Richmond, how much he has cared for those whom he has served. I know how much he has tried permanently to put their interests at the forefront of all his activities, unlike one or two others who claim to represent the people of Richmond but who come and go in raising pavement issues for political purposes. My hon. Friend has never sought to do that. I know that he will not mind if I make him somewhat embarrassed by saying that I know that the House will be sorry not to see him in his place when the new Parliament sits. That can be said even more so on behalf of his constituents, who have been so superbly served by him for a long time.
All that my hon. Friend has said will be passed on to the chairman of the district health authority and the chairman of the region as well as to my hon. and learned Friend the Minister for Health. I hope that I have been able in some small way to give my hon. Friend the reassurance that he sought.
Question put and agreed to.
Adjourned accordingly at thirteen minutes to Eleven o' clock.