§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Archie Hamilton.]
§ 10 pm
§ Mr. Norman Atkinson (Tottenham)I am sorry that our debate will not assure for the Health Service the money increases about which we have just heard. I am grateful to the House for the opportunity to put this important matter before the Minister, in the hopes that he can reconsider the position. My subject is the closure of the Prince of Wales hospital in Tottenham, London, and the closure of the casualty department there and its removal to the North Middlesex hospital site. I shall make a number of pertinent points about that, and hope that I can persuade the Minister to have a look at them.
The Prince of Wales hospital is a part of the three-site district general hospital, made up of the North Middlesex hospital, the St. Ann's hospital and the Prince of Wales. The General Nursing Council and the University of London medical council and pre-registration committee do not consider such matters on a site basis. They judge all hospitals as self-contained entities and not as though they were annexed departments of a whole district general hospital. The Prince of Wales hospital has always been considered in that light by those professional bodies.
My first protest is about the way that the Prince of Wales has been closed—by a creeping process—that has already been described as closure by stealth. This has gone on for two and a half years. On 6 March 1981 the Minister's predecessor, Dr. Vaughan, who was Minister of Health, came to Tottenham to have a look at the Prince of Wales. He was impressed and said that he felt that there was a need within the NHS for some more hospitals such as the Prince of Wales, which has 204 beds and is a self-contained unit. He also said that the future should lie a little more with such hospitals than with some of the big places that have been commissioned in the past few years.
When Dr. Vaughan arrived at the Prince of Wales hospital, he gave some firm undertakings. He told the administration that in no circumstances must anything be done to the hospital such as the removal of any equipment or the closure of any beds or wards that would pre-empt the ultimate decision when the whole strategy was to be renewed at a future date. When Dr. Vaughan visited the hospital, 166 beds were in operation and there are now between 45 to 75 beds being used. There has been an enormous closure of operative beds. Two medical wards remain, as do two surgical wards, both of which are practically unused because of the ban placed on some comparatively new operating theatres. There are two operating theatres in the Prince of Wales hospital which are almost unused, although they are fairly new. When Dr. Vaughan went there two and a half years ago there were 10 sessions a week; they have been reduced to three. There are four general surgeons in the area, but only one has any desire to use the operating theatre. Therefore, the two surgical wards and the gynaecological wing are almost unused. Nearly all the gynaecological cases have been moved elsewhere.
It is pathetic to look at the hospital as it is being run down. All the clinical technology has been stripped from the place. The pathology and microbiology laboratories have gone and the hospital is trying to survive without them. Emergency admissions to the casualty department 1079 have been reduced to a minimum and that department is about to close. It is operating a five-day week, from 10 am to 5 pm. When the casualty department is moved to the North Middlesex hospital the borough of Haringey will be unique in the country in the sense that it will be a borough with a population of over 200,000 without a casualty department within the local authority boundary. That is a cause for concern. Because of the closure of stealth and because the statements made by Doctor Vaughan have been ignored, I demand an inquiry.
§ Mr. Deputy Speaker (Mr. Paul Dean)Order. I am sorry to interrupt the hon. Gentleman, but does he not mean the hon. Member for Reading, East (Dr. Vaughan)?
§ Mr. AtkinsonI apologise, Mr. Deputy Speaker. That was a slip on my part. I have not seen him for some time, but that is no indication that he is no longer a Member. He is a valuable Member and I pay tribute to the work that he does here. It was unintentional on my part to refer to him in that way. It was because I often do so elsewhere.
My first demand is for an inquiry about what has happened since the undertakings were given.
The second question that must arise is whether the North Middlesex hospital can cope following the closure of the Prince of Wales. General medical opinion is that it will not be able to cope. There is uncertainty about its position. In fact, it behaves as though it is under continual, severe pressure. That pressure is there for all to observe. Not only in the casualty department but in most of the wards it is in a stress condition because of the work it has to undertake, shortage of staff and the way in which it operates.
I have discovered that in 1982 there were no fewer than 1,950 patients transferred from the North Middlesex to St. Ann's hospital because no beds were available. That indicates the pressure under which the hospital operates. General practitioners not only in Tottenham but elsewhere in the area say that they repeatedly have difficulty in finding beds for patients over 65, whatever the nature of the treatment that is required. Hospitals are reluctant to take elderly patients even though they should recover. Doctors find it almost impossible to get places for them in local hospitals and certainly not at the moment in the North Middlesex. Because of the nature of the hospital, the Prince of Wales in 1982, the same comparative period, treated 835 patients aged 65 and over. That is another problem. Once the hospital closes, the question must arise of where the patients will go.
Often, patients are turned away from the casualty department at the North Middlesex. When patients arrive there not only on Saturday nights and at the weekends when the pressures are great, but at other times, there is often an average wait of three to four hours, for any patient. Internal inquiries are taking place on why patients must wait so long at the North Middlesex casualty department without being able to see a doctor or receive treatment. The record is not good.
I do not wish to distress families who have suffered because a member of the family has died prematurely at the hospital. I have no desire to name any patients, but in recent years there have been such cases, some of which I have raised. Three young patients under the age of 15 died unnecessarily in the past two years. Three patients between the ages of 30 and 50 also died unnecessarily. 1080 That is beyond description. Doctors admit that there are unnecessary deaths. The health service Ombudsman condemned the hospital in the case that he investigated. There are many other problems. The doctors remain critical.
There is a lack of confidence in the district. Confidence must be rebuilt. It will not be rebuilt on the basis of the strategy proposed for the Haringey health district, set out in its documents, with the shift of the casualty department from the Prince of Wales and St. Ann's to one site only at the North Middlesex. That change will not restore confidence. There will have to be some serious rethinking.
I share a local suspicion. I received a letter from the Minister today saying that the essence of the strategy was to develop the casualty facilities for accident and emergency on one site only, at the North Middlesex hospital. I suspect that that is a prelude to a gobbling up of capital resources. I suspect that a part rebuild is involved, with new work to be done at the North Middlesex, which will syphon off the resources that are supposed to come in the next three or four years to the St. Anne's development. I hope that the Minister will reassure my constituents that that is not so.
It is alleged that North East Thames is the most expensive health region in the country. The average cost of hospital services per head was alleged to be £190 at the last count in 1982, but the cost in Haringey district health authority was less than £170. Therefore, there is a great difference between what we receive and what is allocated to North East Thames. When the London weighting is deducted from £170, we are receiving less than the national average, yet we have longer waiting lists than anywhere else. The average waiting time in Tottenham for joint replacements, particularly hip replacements, is two and a half to three years. Much elective surgery is done after a long wait, which is longer than in most places. On that basis alone, we have a case for arguing against RAWP.
I see some hon. Members present who represent northeast London. They will know that in Haringey, in 1982, one in 11 people entered hospital for treatment. In Enfield, the figure was one in 17; in Essex and Southend and the various other areas of the north-east Thames region, the figure was one in 18. But in my area, with a hospital admission figure of one in 11 in 1982, which is likely to continue and probably get worse, we have access to fewer beds and it is now proposed to shift more resources out of Tottenham and into lusher territory, into the greener grass of Essex and elsewhere, where the waiting lists are shorter, where there is greater access to beds and where patient ratios are smaller. If anyone can explain the sense of the RAWP argument, I would love to listen to it. I am sure that the Minister will not attempt to do so.
Something is wrong with the strategy on which such decisions are based. We are now asked to reduce our ambition to two acute beds per 1,000 of the population. We are already suffering from a worse bed ratio than most areas even with the pressures of my part of north London. I ask the Minister once again for an inquiry into why a shift of resources is taking place. Why are resources being taken from a place of stress and shortage to be given to those areas which are better off in the sense that their waiting lists are that much shorter? I do not wish to make a political point about this. We are not greedy and we are not asking for more than our share.
1081 All we are asking for is equal treatment. We do not have easy access. We do not have a magical method by which our people can find a teaching bed easily. They cannot. Very often they have a poorer chance of a teaching bed than people coming from outside London. That is not part of the argument. We are not asking for more than we are entitled to—we are asking for the average. We are asking for an improvement and not a closure of beds or hospital facilities. We are asking for betterment for our people, and I think that they are genuinely entitled to it.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)The hon. Member for Tottenham (Mr. Atkinson) has argued his case fairly, basing it very much on local circumstances of which he is well aware and of which I am aware to only a small degree, having once visited the hospital to which we are addressing ourselves tonight in the hon. Gentleman's company.
The decision to agree to Haringey health authority's proposals about this hospital was not an easy one for Ministers to take. We gave it long and careful consideration. I met a delegation front the community health council led by the hon. Gentleman. I should like to commend the community health council for the excellence of the case it put, for the careful way it was prepared and for the balanced way it was presented. It was a model of its type. Subsequent to that meeting, the hon. Gentleman invited me to visit the Prince of Wales hospital in his company, which I did. I should like to thank him and his colleagues for the unfailing courtesy that they showed me when I visited the hospital at a time of considerable local emotion about its future. I remember meeting the people who work in the hospital. I remember a long, lively exchange with the manager of the catering department. I certainly profited from my discussions with patients and also with trade unionists, with whom I spent some time talking.
It was not an easy decision. I can remember my own feelings when a much-loved hospital in my constituency was shut three years ago, ironically enough by my hon. Friend the Member for Reading, East (Dr. Vaughan). He did not shut it, but he, along with other Ministers, approved the proposal of the then health authority to permit the hospital to be shut. I understand the feelings of the hon. Gentleman and his constituents.
The decision that has been taken has obviously disappointed local people. I do not seek to deny that. They inevitably see only the closure of a much-loved local hospital with a long and sound tradition of service to the community, but that may turn out to be a mistaken view. Only time will tell whether the recommendation of the health authority and the decision of Ministers turn out to be right. None of us can predict whether our decisions will turn out right; we just try to take them in the best interest of the service as a whole.
It is clear that the pattern of services in the National Health Service must change to meet changing needs. Hospitals are always being built and shut, and that will continue to be the case in the NHS. If I do not, because of time, refer to all the points that the hon. Gentleman raised, I shall write to him as quickly as possible. The background to answering those points is that the services that are now proposed in Haringey will meet local needs better, and I have three grounds for saying that.
1082 The first is that despite what the hon. Gentleman said, we shall have a better concentrated acute service, including accident and emergency, and if I have time I will return later in my speech to the important issue of the accident and emergency service at the North Middlesex.
Secondly, flowing from the decision will come better services for the elderly and others in the area. In the hon. Gentleman's constituency, as in mine, the elderly have not always had their fair share of resources from the NHS. It is critically important to ensure that they get a better share of those resources, particularly taking demographic trends into account.
Thirdly, it is important to recognise that, while a hospital is to be closed, there will remain a considerable Health Service facility on the site; there will be the important development of an integrated community heath clinic, which will provide invaluable health care in Prince's part of Tottenham, helping in particular the elderly as well as families with children, be they families of the husband—wife—children model or single-parent families, who I know are a considerable problem in the hon. Gentleman's constituency.
I must deal first with what the then Minister for Health, my hon. Friend the Member for Reading, East said—or did not say — in 1981. It is not for me to defend anything that any hon. Member says in this House, particularly when he is not present, but I am sure that my hon. Friend will not mind if I try to set the record straight, and in doing so I must comment that I do not think that the Secretary of State would wish to institute any form of inquiry into anything that my hon. Friend the Member for Reading, East said two or three years ago, after he visited the hospital.
The hon. Member for Tottenham referred to undertakings given when my hon. Friend the Member for Reading, East was Minister for Health. The decision that has been taken does not breach those undertakings in any way. My hon. Friend said in 1981 that he would not agree any further changes in services at the hospital unless they formed part of an overall review and plan that was to be prepared by the new district health authority, which was not at that stage operating.
The proposals from the health authority in Haringey are the result of a review and they form a coherent overall strategy, even if the hon. Gentleman does not, for reasons that I understand all too well, approve of that strategy. I do not think that anything my hon. Friend the then Minister for Health said, in letters or statements issued after his visit, can be seen or be taken as constituting a binding guarantee upon this or any other Government who might have come along at a later stage, about the future of that hospital. It is less than just to the health authorities to suggest that this hospital has been closed by stealth, that it has been run down. That is not true. The future of the Prince of Wales hospital has been reviewed on the context of the other two major acute hospitals in the area. The district health authority had to make a series of difficult decisions, because it became clear that patient demand did not support the need for a split site district general hospital, on three separate sites.
I accept what the hon. Gentleman says about split site district general hospitals as one unit. I was therefore surprised when he quoted against the North Middlesex hospital the fact that a number of its patients had been transferred to other component parts of the health system—the other two hospitals in the area. Such transfers 1083 between hospitals are common when there is a split site district general hospital. The critical decision for the health authority was to choose the sites on which to develop the two main component hospitals. The North Middlesex chooses itself. That is clear. It contains major new facilities, and it has room for expansion. The choice between the Prince of Wales hospital and St. Ann's is much harder. I would be the first to agree with what I think is the hon. Gentleman's view, that the Prince is geographically better sited. However, I cannot agree that the Prince is therefore a better site for development, because it is cramped. I have visited the site myself. There simply is not room for the expansion of the existing hospital into a large modern component part of a split site district general hospital. Unfortunately, St. Ann's has the overriding merit of room to expand.
It is important to realise, in the interests of the local community, the importance that Ministers attach to the development of an integrated health care facility on the site of the Prince of Wales and the savings that will be made. They will amount to £2.6 million. Added to that is about £400,000 a year from Wood Green and Southgate, which is to be converted into a facility for mental handicap patients. Of that £3 million global sum, about £1 million will go to meet the district's revised budget, in line with its need to redistribute some of its resources to other parts of the North-East Thames region. The hon. Gentleman has made it clear that he does not agree with that policy. He made some detailed and interesting points about the 1084 regional allocation working party scheme. Unfortunately, we do not have time to debate that aspect tonight, but I shall reply to him fully on the matter. Two million pounds will be used for priority services developments, mainly for the elderly. It is important to realise that the elderly will be the direct beneficiaries of this distribution of resources.
I know the depth of the hon. Gentleman's feelings about this hospital. I know that he and some of his constituents do not like the idea of having to travel as far as the North Middlesex hospital, particularly to the accident and emergency services there. Nevertheless, I ask him to be cautious—as he sought to be in his speech—before shedding any unfortunate light on the facilities that are available at the North Middlesex. After all, considerable capital investment will be made there, as will also happen at the St. Ann's site. It should be remembered that vigorous action has been taken to put matters right at the accident and emergency services there, including the appointment of a new full-time consultant. I hope that that reassures the hon. Gentleman and his constituents about the accident and emergency care that they will get.
I am sorry that I cannot oblige the hon. Gentleman and his constituents in the community health council. The decision has been taken — we believe, in the best interests of the patients—and we look forward to the orderly transfer of the hospital over the next four or five years to the new sites and the development of the splendid new integrated health facilities that will rise up on the site.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o' clock.