§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sainsbury.]
11.32 pm§ Mrs. Marion Roe (Broxbourne)I am grateful for the opportunity to put the case for a new county hospital in the Lea Valley area of Hertfordshire. I shall preface my argument by saying that in my constituency there are no hospital beds for a population of 86,954 in 1981, projected to rise to about 91,000 in 1991. Health care provision for the area is distorted by this simple fact, and it makes proper care for the region that much more difficult by artificially creating stress on the facilities that provide health care for my constituents.
In October 1961, the Cheshunt urban district council produced a report concluding that hospital facilities for the area were inadequate. Although at the time this was thought to be a low priority, by January 1971, the northeast metropolitan regional hospital board had incorporated a hospital for the Lea Valley in its proposals for the future, but reorganisation never saw this proposal become reality.
The reasons that persuaded Cheshunt council over 20 years ago have become even more compelling now. Changes to the local population, both in terms of vastly increased numbers and of age, place greater pressure on existing facilities, and changes to policy have left east Hertfordshire at a severe disadvantage. At a time when, quite rightly, the Government are pursuing a policy to encourage the maximum health care to be provided at district level, circumstances prevent east Hertfordshire district health authority from being able to achieve that.
Part of the problem is of a purely organisational character. East Hertfordshire area health authority provides acute facilities at Queen Elizabeth II hospital in Welwyn Garden City and Hertford county hospital. The eastern part of the health authority area has no real connection with Welwyn Garden City, whether in terms of education, entertainment, employment, or social services. It relies upon Hertford county hospital as a focus for health provision.
Hertford county hospital opened 150 years ago and with a facade listed as being of architectural or historic interest, is on a small site, which has far-reaching consequences. It means that the hospital cannot provide the full range of services and that it cannot be expanded to do so.
Hertford county hospital has no maternity, children's, geriatric or mental illness beds and no ear, nose and throat or ophthalmology in-patient beds: It cannot become a natural focus for acute services locally. GPs and the public choose to use other hospitals outside the district. As time goes on, the hospital's viability must come into doubt.
The future of Hertford county hospital is central to the provision of health care in the area. The East Herts health authority is firm in its belief that the redevelopment of the hospital would be expensive, restricted and a waste of precious resources.
Although such a development might benefit the residents of Hertford, and to some extent of Ware, it would achieve little for my constituents, who already look elsewhere for provision outside the district.
To allow the county hospital to run down without making provision for a new facility would cause the local population to look to Welwyn Garden, Harlow, Enfield and other hospitals outside the district, which would be 271 forced to develop their services to meet the increased workload. Such a move would undermine the possibility of services being managed and provided on a local basis which was, after all, the purpose of recent changes in the structure of the Health Service.
Statistics underline the problem and the need for action. The district provides acute services for only 45 per cent. of its population. That is an insufficient level around which to locate long-stay and day place provisions for priority services. As a result only two thirds of geriatric patients and one third of psycho-geriatric and mentally ill patients can be treated in the district.
About 25 per cent. of ambulance journeys beginning in the district are to hospitals outside Hertfordshire. That has implications, not only for immediate costs but for the way in which resources are stretched and it limits the capacity of the service.
The treatment of patients outside the district also creates problems for families, GPs and outpatients, who are often faced with long journeys without public transport. Examples of public transport difficulties are numerous. From Hoddesdon it takes 40 minutes to get to Queen Elizabeth II hospital at Welwyn Garden city and there are only four direct buses each day. It takes 26 minutes to get to Hertford with only five buses a day. No direct bus service links Cheshunt to Chase Farm hospital, Enfield. The minimum journey time is 40 minutes. Constituents sometimes spend an hour, or an hour and a half, at a return cost of £2.50.
Public transport is needed most by old people and young mothers—the two groups most likely to need health care facilities. Time and expense cause concern. I do not criticise the quality of health care, but such a situation creates an atmosphere which is the reverse of that which the Government seek to achieve — health care close to local needs.
Other complications arise from the confusion about catchment areas in Hertfordshire. There are defined catchment areas for some services such as mental illness, but they do not exist for other services. Where they do exist, they do not necessarily coincide. I shall give an example. An elderly patient in my constituency would receive hospital treatment in Welwyn Garden city for a geriatric complaint, but in Harlow for a psycho-geriatric complaint. However, if he lived in Cheshunt, which is in the constituency, he would not take either course for he would go to St. Michael's, Enfield, or Highlands, Winchmore hill, respectively. Put next to this, the laws on Sunday trading appear simple. The people of areas served by both the East Hertfordshire district council and the Broxbourne borough council depend quite heavily upon health authorities other than their own.
In Broxbourne, 63 per cent. of the population receive hospital services supplied by the Enfield health authority. In east Hertfordshire, 35 per cent. are served by the West Essex health authority. Any changes in health care policy by these authorities will affect those within the East Hertfordshire district health authority. For example, a move away from in-hospital treatment towards community-based care would have a considerable effect upon the follow-up services which are provided by the immediate district health authority, which in this instance is East Hertfordshire. Such a change in policy would have substantial financial implications for it, yet it has no 272 representation on the neighbouring health authority. That is because the East Hertfordshire district health authority is in the north-west Thames regional health authority whereas Enfield and the West Essex district health authorities are in the north-east Thames regional health authority area.
According to current regional norms, there is a major shortfall of beds in the East Hertfordshire district health authority. The most serious part of this is in the provision for local acute services and psycho-geriatric and geriatric services. This shortfall will become more severe in the next 20 years. In 1981, 12.2 per cent. of the population of Broxbourne borough were over 65 years of age. It is estimated that by the year 2000 this will have risen to 15.6 per cent., while the population as a whole will increase as people leave inner London. It is estimated that it will rise by about 10,000. The future expansion of both Hertford and Harlow and the effects of the new M25 will also have to be taken into account.
The overall picture is clear. Health services in east Hertfordshire, and consequently in the neighbouring health authorities, will be placed under greater strain. If there is a shortfall of hospital services now, there will be an even greater one in the near future. Recent closures have not improved the position.
Over past years, the closure of four hospitals in the area and various reductions in the numbers of beds have been offset only partially by expansion of the Queen Elizabeth II hospital in Welwyn Garden City. The net loss has been slightly fewer than 150 beds, which has put extra strain on facilities such as the Hertfordshire county hospital, which are not sufficiently equipped to cope alone.
Decisions need to be made soon. The north-east Thames regional health authority must make provision for Hertfordshire patients and for the increased pressure that these will cause to resources. Obviously it will have to make decisions on capital developments, which will have implications of a permanent nature and could result in there never being proper local services in east Hertfordshire.
The position is one of considerable concern locally. A week ago I presented to the north-west Thames regional health authority a petition containing nearly 11,000 signatures collected in the borough of Broxbourne calling for a new county hospital. A similar petition organised in Hertford town, containing about 4,000 signatures, has also been presented. Other petitions from the area will be presented shortly. Support for the proposal has been given by many local bodies, including the east Hertfordshire district council, Broxbourne borough council, Hertford town council, Ware town council, East Herts district health authority and the community health council, and various parish councils. Those representing professional groups have also responded favourably. These include the Hoddesdon voluntary services council, which represents voluntary caring organisations in the district, and the Hertfordshire local medical committee, which represents local National Health Service general practitioners. Both organisations have written to me in support of the idea.
For over 20 years this proposal has been under discussion. Locally it is agreed that the best plan for the future is a new county hospital to provide for the people of the Lea Valley. It is, of course, suggested in the north-west Thames regional health authority plan for the acute services. But for so long that is all that it has been—a suggestion. Present arrangements for the Health Service in 273 the area and the funding that derives from them mitigate against local decisions being made locally. As people move from inner London to areas in the home counties such as my constituency, such problems will be magnified especially if there is not a corresponding reallocation of funds.
One careful look at the future funding of Enfield health authority is enough to confirm that that is not happening, for the planning assumptions for Enfield assume a fall in population. That, combined with the need for efficiency savings, points towards a steady fall in revenue allocation for Enfield, and that is bad news for Broxbourne, which looks to Enfield for services and where the population is increasing. The Resource Allocation Working Party formula bias is weighted towards the number of people attending as inpatients in hospitals. The present lack of hospital facilities in east Hertfordshire means that its funding is distorted. Lack of resources prevents local people from having a proper say in local health care.
The case for a new county hospital for the Lea Valley is overwhelming. The current arrangement not only detracts from local health care but serves to act as an inefficient, wasteful use of resources. The National Health Service is there to serve the community, and that means that it must be capable of responding to the community's wishes. Perhaps the best way to express how a new hospital would help is in the words of the east Hertfordshire health authority's draft operational plan for the next three years, which states:
The problems of the District can be simply stated. The Authority provides in-patient services for only two-thirds of the geriatric population of the district; half of the acute and maternity population of the district; one third of the mentally ill and psychogeriatric patients … Many East Hertfordshire patients have to travel unnecessarily long distances for routine treatment, and ambulance costs are inevitably higher. There are particular problems arising from a situation where the Authority has no direct control over services provided from outside the district, for example, the earlier discharge of patients from a hospital in an adjacent district simply places East Herts community nurses under even greater pressure.A study is being carried out into the need for a new hospital to serve the Hertford/Ware/Broxbourne area. If it is built, the situation on the eastern side of the district will be transformed. Patients living in Hertford and Broxbourne will no longer be the poor relations, having to look everywhere but their own District for treatment.However, the timing of the new hospital development is of enormous importance. If this district is to take over responsibility for services for the mentally ill and elderly mentally ill in the east sector by the early 1990s, care for increasing numbers of elderly, provide for more of its acute patients as beds in Inner London, West Essex and Enfield reduce, then the phase of the new development must be operational by or before 1990.I am sure that my hon. Friend the Minister understands that the lack of local hospital facilities means that my constituency cannot solve its own problems locally. I trust that he will agree that the provision of a new hospital to serve the residents of the Lea Valley is an urgent requirement that should be implemented as part of the north-west Thames regional strategy, which is about to be issued.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)I listened with great care to what my hon. Friend the Member for Broxbourne (Mrs. Roe) said about the provision of health services in her area. I was moved not just by her characteristic clarity in putting her case but by the evident 274 demonstration of community concern that she showed, especially through the petition of some 11,000 names in support of the hospital that she and many of her constituents wish to be constructed. The figure of 11,000 is formidable — not quite as formidable as my hon. Friend's majority of 17,000 at the general election over her wretched Liberal-SDP opponent, but none the less a formidable number of signatures—and I am sure that that represents accurately the strength of feeling in Lea Valley about the pressing need, in the view of many people in that part of Hertfordshire, for a district hospital to be constructed.
My hon. Friend raised a number of detailed points about provision for various sorts of patients with various sorts of needs, but she will probably agree that central to them all is the strongly held view—locally at least—that the East Hertfordshire health authority is severely under-provided in terms of health care resources. That was the core of my hon. Friend's argument. The only solution seems to be the provision of a new district general hospital to serve the population. Although such hospitals are desirable, my hon. Friend knows that they do not come cheaply, and £20 million, £30 million or £40 million is the sort of expenditure about which we are talking
We must first consider the needs of the residents of the area and of potential patients whom it is the purpose of the NHS to serve. Secondly, we must consider the proper planning of health care resources in the north-west Thames region. I take this opportunity of paying tribute to the recently retired chairman of the north-west Thames regional health authority, Dame Betty Patterson, who served for so long and so well, and who laid down the burden at the end of last month. I wish her successor, Mr. Bill Doughty, the very best of fortune in handling a number of problems which will land on his plate in the coming months, one of which will be the item which my hon. Friend has drawn to my attention.
My hon. Friend was right to say that the north-west Thames regional health authority is currently developing its strategic plan for the 10 years ahead. I shall shortly be meeting the chairman of the health authority, and I shall draw to his attention my hon. Friend's views about the pressing need for the hospital to be built. But this will be a co-ordinated blueprint for the co-ordinated development of health care in the region for the next 10 years, taking full account of the resources which are likely to be available.
We will then have a picture of the demand from residents, patients and potential patients, the planning input which the north-west Thames regional health authority must make, and the finance. It is essential that any development in the east Hertfordshire area must be an integral part of the overall plan, because my hon. Friend will know that there will be many competing demands for the limited resources available to the authority.
In the first instance it is for the north-west Thames regional health authority to decide priorities. I do not think that it is possible for my right hon. Friend the Secretary of State, my right hon. and learned Friend the Minister for Health and myself to take planning decisions about the placing of every hospital in England. That is not within the capabilities of the DHSS, based as it is in London. It is for precisely that reason that the regional health authorities are charged with the planning of provision related to the local environment and local community needs. The regional and district health authorities are best placed to make these 275 important planning decisions. I know that that view is shared by my hon. Friend the Minister for Social Security, who characteristically has come into the Chamber to listen to the closing stages of this debate.
We shall be discussing the strategy for the north-west Thames region with the chairman at the regional review early next year. This is part of the improved accountability machinery that we have introduced, and it has proved an effective way of discussing such issues with regional chairmen.
We firmly believe that within the parameters laid down at national and regional level the detailed planning of the Health Service is best done locally. However, I should like to reassure my hon. Friend the Member for Broxbourne that this is not to say that my right hon. Friends and myself take no interest in such matters. On the contrary, we have taken great pains to increase accountability at all levels in the National Health Service, from the individual unit or hospital right up through district and region to the NHS management board. We welcome the recent appointment of Mr. Victor Paige as the chairman of that board.
This means that plans are best drawn up by those nearest to the planning problems. I am sure that my hon. Friend would not suggest that it would be desirable for Ministers to take decisions in any part of Hertfordshire without taking into account the needs of the local residents and the demands of the local health service. It is that difficult "trick" which the north-west Thames regional health authority under its new chairman, Mr. Doughty, will have to turn in future months and years. If my experience of the last two or three months is anything to go by, Mr. Doughty will soon learn that on every occasion when my hon. Friend meets him she will stress with persistence the need for this hospital to be built in east Hertfordshire. I give that warning to him tonight, for whenever I see my hon. Friend and she stops me I know that it will be, quite rightly, to press upon me the need for this hospital to be built.
The first stage in carrying forward the idea of a hospital in the Lea Valley which my hon. Friend has pressed upon my right hon. and learned Friend and me must therefore be for the district health authority to put forward a detailed proposal to the regional health authority to meet the need which it believes to exist. A great deal of work is taking place in this context, but I hope that my hon. Friend will recognise that the Lea Valley hospital is at this stage a concept rather than a proposal.
Secondly, nobody has yet worked out how much a hospital such as this would cost, were it to be built in that area. There are estimates of how big it should be and how big it would be and how long it would take to build—although my hon. Friend has suggested the 1990s as the lastest possible date by which she would wish this hospital to be constructed— and precisely where it should be sited. I should be asking the north-west Thames regional health authority to earmark an unspecified sum over an unspecified period to build a hospital for which no plans at present exist if I pressed upon Mr. Doughty and his colleagues the need to build a hospital in the way in which 276 my hon. Friend has pressed her case tonight. A great deal more planning needs to be done before any decisions can be taken.
The regional and local health authorities have set up a joint working party to look at the issues and, in liaison with the neighbouring north-east Thames regional health authority, to draw up definite proposals. I expect that we shall receive their report in April 1985. Whatever its recommendations, there will be time for them to be inserted into the regional strategy which is due to be published next summer, which will allow my hon. Friend to continue to make the points as powerfully as she has made them already about the need to build this hospital. But the cost will be substantial.
Because of the likely costs of a project the size of a brand new district general hospital, in due course the proposals would have to be laid before my right hon. and learned Friend and me to consider. This is a careful, painstaking and very important process. I hope that my hon. Friend will appreciate that I could not guarantee tonight sums of money for a Lea Valley hospital, should one be built, until there was a firm indication of cost and of siting and of other proposals which are being made at the same time for other parts of the county by others with an interest. I am seeking not to discourage my hon. Friend from the line that she is pursuing but rather to put before her the stages which have to be passed through before decisions are reached. In all that we shall be helped and guided by what she and other interested parties, such as the Broxbourne district council, have to say. I have seen that council's report and I welcome it.
Ministers in my Department are always pleased to see local authorities taking a keen interest in health matters and joining in debate on local issues. It is essential that health and local authorities work together where and when they can to plan services for the populations that they serve. I am sure that the East Hertfordshire health authority will look carefully at the proposals of the Broxbourne district council and consider them when it draws up its plans.
In conclusion, may I summarise the main points that I have sought to make in what I hope my hon. Friend will not think is a deliberately broad-brush reply to her considerable number of detailed points. I cannot yet give detailed replies to her detailed points because we do not have plans in front of us. There is a concept for a new hospital but there is no plan. The local health authority must first work out a genuine proposal for the regional health authority to consider in the light of its strategy. The proposal will then come before Ministers in my Department. I give an undertaking that I shall meet my hon. Friend, if and when that happens, with any delegation of any size within reason that she chooses to bring to discuss the issues.
I am grateful for the points that my hon. Friend has made. I am glad that she has pressed them on myself and my right hon. and learned Friend the Minister for Health tonight. I ask her to continue to press them on the district and regional health authorities within whose area of responsibility the decision on this hospital lies.
§ Question put and agreed to.
§ Adjourned accordingly at one minute past Twelve o' clock.