§ Motion made, and Question proposed., That this House do now adjourn.—[Mr. Major.]
10.25 pm§ Mr. Ivor Stanbrook (Orpington)I am obliged once again to draw the attention of the House to the accident and emergency services at Orpington hospital, because the threat of closure, which I foreshadowed in debates on 11 February 1982 and 17 March 1983, has become a reality. I hope that my hon. Friend the Under-Secretary for Health and Social Security has had the opportunity to read the record of those debates, as well as that of a debate initiated by my hon. Friend the Member for Ravensbourne (Mr. Hunt) on 22 December 1983 about the closure of the Lennard hospital, Bromley, because if he has he will be aware of the background to this problem.
Orpington hospital was built during the first world war, when Orpington was but a small Kentish village, by the Canadian army to serve as its military hospital. It was composed of Nissen huts, and other buildings in temporary materials, many of which have survived to this day. Over the years, Orpington has grown, and the hospital has grown and modernised with it. Standing on a 31-acre site, the hospital provides all the major services with over 400 beds. It has been designated in development plans as a district general hospital, serving the needs of the southern part of the London borough of Bromley and the Sevenoaks area of Kent. The first phase of its redevelopment as a district general hospital, consisting of a large modern ward block and nurses' quarters, has been completed. Its catchment area is that with the greatest growth rate on this fringe of south-east London, and the proximity of the M25 motorway, which will encompass the catchment area, is almost certain to increase the need for and the value of its services when the local Swanley to Sevenoaks sector of that motorway is finished.
Unfortunately, the great hopes which local people have for their hospital are seriously threatened, and the degree of patient care which we formerly enjoyed has been seriously diminished for what appear to me to be purely bureaucratic reasons.
For administrative convenience, Orpington and its hospital come within the London borough of Bromley and the Bromley health district, with which the borough is conterminous. It was not always so. The district health authority, which is of course supposed to cater for the needs of the whole district, is responsible for a number of hospitals, of which the major ones are located in Bromley town, Beckenham and Farnborough, as well as Orpington. The Lennard hospital, about which my hon. Friend the Member for Ravensbourne spoke on 22 December 1983, is a small hospital catering for elderly people, and is not far from Farnborough.
Beckenham hospital is within the constituency of my hon. Friend the Member for Beckenham (Sir P. Goodhart), whom I am glad to see present at this debate, and who I know, if he catches your eye, Mr. Speaker, would like to make a brief contribution to it. Bromley hospital is on a comparatively small site in Bromley town, in the constutiency of my hon. Friend the Member for Ravensbourne, five or more miles away from Orpington. It has 157 beds and, like Orpington, provides a full range 112 of services, including full accident and emergency services. Like Orpington hospital, it is expected to develop into a full district general hospital.
In recent years, we in the south-east have been deprived of our fair share of resources allocated to the NHS because of the operation of the formula devised by the resource allocation working party, whereby those areas considered to be better off in terms of medical resources are deliberately deprived of funds so that they can go to areas deficient in those resources. The formula has also been applied locally within the region covered by the South-East Thames health authority.
In addition, even more recently, we in the Bromley district have been subjected to the so-called Health Service cuts. In short, Bromley district has been called on to make cuts of £2 million to £3 million in its current expenditure estimate of over £41 million per annum.
It is fair to say that the Bromley district authority has had a difficult task to perform. Whatever savings it proposed, it was bound to run into local criticism. However, I have to say that it has made a mess of its task and has ended up with a series of economies which have been condemned by the local community health council and the local hospitals' medical advisory committee, as well as by public opinion in the areas concerned. The proposed economies total £2.4 million and cover almost every service and hospital in the district. In its desire to be fair, the authority seems to have ensured that almost everyone suffers and that the maximum offence is caused.
My hon. Friends who represent constituencies in the London borough of Bromley may have their own criticisms of the authority and its proposals. I am naturally most concerned about matters in my constituency and the effect of the authority's plans on the development of Orpington hospital. I do not challenge certain changes affecting the hospital wards—Orpington has already suffered many cuts in local health services—but I find appalling and incomprehensible the main decision that the hospital's accident and emergency services should be restricted to daytime hours only—from 8 am to 8 pm.
As the record of earlier debates shows, I have laboured long and hard against previous attempts to restrict those services. Last year, I organised a petition with more than 7,000 signatures against an earlier proposal to cut the services.
The changes made by the authority in September on a temporay basis, including the closure at night of the emergency services, have been put forward as the basis for permanent changes. In accordance with the correct procedure, a consultation document has been issued and comments have been invited by 24 April.
The proposed changes are numerous and involve varying amounts of savings. The permanent restriction on the opening of Orpington's accident and emergency services will, according to the document, save £71,000. Some people believe that the savings will be much less, possibly less than £50,000 per annum. That is out of total savings of £2.4 million and a current budget of £40 million or more. In that context, a saving of up to £71,000 is infinitesimal. Yet, at one stroke, the authority has demonstrated its complete lack of judgment in these matters.
The actual amount involved, after taking account of the extra cost of transporting patients by ambulance to Bromley and other hospitals and the extra pressure on facilities in those hospitals, will probably be less than 113 £50,000 per annum. There were options before the authority which were viable in the opinion of its medical advisers and which did not involve the closure of the unit at Orpington, yet the authority chose to adopt this option, with its wide-ranging effects, rather than any other. It did so, I understand, only by the narrowest of majorities after a tied vote, in preference to an option favoured by the community health council and the medical advisory committee.
The closure of the casualty department and the accident and emergency service at Orpington hospital overnight has had serious consequences for my constituents and, indeed, for those of my hon. Friend the Member for Sevenoaks (Mr. Wolfson), many of whom are affected by these changes and cuts. First, they cannot arrange to have their accidents and emergencies during office hours. There is hardship and suffering involved in the extra delay that is being caused by the need to travel further—five or six miles—to Bromley hospital. A number of cases have been reported already in the Orpington Times recently. These include a citizen who suffered an accident in the grounds of the hospital shortly after 8 pm and who was turned away from the casualty department. In such cases, I believe that there has been risk to life.
Secondly, it is patently absurd that a thriving hospital, in which millions of pounds have already been spent on extension and modernisation as a district general hospital, should so abruptly be deprived of what is the recognised badge and qualification for that status, a full-time accident and emergency service. The implications for the morale and quality of the medical staff at the hospital are serious. Many of my constituents are wondering whether the hospital will, indeed, develop into the district general hospital that the area needs or whether it will remain at the mercy of anonymous members of a committee balancing a myriad in interests at the expense of long-term public needs.
Thirdly, the decision calls into question the suitability of committees of this kind to make decisions for which they appear to lack judgment and experience. None of those who blithely voted for Orpington citizens to be deprived of their casualty service overnight, seem to have distinguished between such a step and, for example, the centralisation of maternity services or the location of a geriatric centre. These are all matters of importance, but the need for a full casualty service is a much more important and, politically and emotionally, a more sensitive matter than administrative convenience. For that single item to be included in the authority's programme, involving a minute proportion of the total savings, yet, for my constituents, dwarfing almost every other item in significance and importance, the authority's judgment deserves to be condemned.
My hon. Friend the Under-Secretary said in reply to the debate on 22 December 1983:
I make it crystal clear that where proposals are referred to Ministers, they will not—I stress the word 'not'—agree to any closure or any change of use unless it is clearly demonstrated to be in the best interests of local health services and the communities they serve. I am "happy to give that assurance." —[Official Report, 22 December 1983; Vol. 51, c. 606.]These proposals as a whole, if not withdrawn, are almost certain to come before him as a result of the view taken of them by the Bromley community health council. When they do, living up to the high standard that he has set 114 himself, my hon. Friend will make sure, I trust, that the full-time accident and emergency service at Orpington hospital will be restored.
§ Mr. Deputy Speaker (Mr. Paul Dean)I understand that the hon. Member for Beckenham (Sir P. Goodhart) has the agreement of the hon. Member for Orpington (Mr. Stanbrook) and the Minister to intervene.
§ Sir Philip Goodhart (Beckenham)I am grateful to my hon. Friend the Member for Orpington (Mr. Stanbrook) and to the Minister for the opportunity to add a few words to the debate.
I support my hon. Friend's complaints about the closure at night of the accident and emergency service department at Orpington hospital. I share his belief that the saving that will be made is considerably less than £50,000 a year out of a total local hospital budget of more than £40 million. I believe that the saving will be less than one tenth of 1 per cent. of our local hospital budget. I know from experience in my constituency that the psychological impact of night-time closure can be considerable on a large number of people.
I also share my hon. Friend's reservations and criticisms of the South East Thames regional health authority. Whether the Government have allocated it enough money from the National Health Service budget for the coming year is a matter of doubt and argument, but there can be no doubt that the South East Thames region has squeezed the Bromley health authority very severely in the year to come and, while there is a standstill allocation in funds to the region as a whole, we face a cut of 5 per cent. in our hospital service.
I do not share my hon. Friend's criticism of the Bromley health authority's answer to this problem. There are some—I am glad that my hon. Friend handled this matter tactfully—who have argued that the best way of tackling this squeeze is to cut all inpatient services at Beckenham hospital. I note that in May 1983—a mere nine months ago—the Bromley health authority, in its district bed strategy for the next 10 years, said:
Bromley Health Authority has as a long term objective the provision of 60 per cent. of hospital services in the North of the District, in line with the distribution of population.That policy was sensible and widely supported when it was published. It would make no sense now, less than nine months later, to close Beckenham hospital, which is the only hospital in the northern half of the district. I believe that the health authority was right when it sought to make the bulk of the cuts in the southern half of our area.I note that a few days ago the Minister replied to an Adjournment debate on health provision in the Medway area—part of the South East Thames region where there is a substantial shortage of hospital beds. Later this week my hon. Friend will be replying to a debate on the maternity services in Thanet, where there is also a shortage of proper accommodation.
We in the Bromley area — in Orpington and Beckenham—are being squeezed to help Medway and the Isle of Thanet, but it will be years before the people in Medway and Thanet see the benefits of this policy, while the people of Bromley are immediately aware of the cuts that they face.
The difficult problem of reallocating the NHS budget on an equitable basis requires sensitive handling. In recent months my constituents have become increasingly alarmed 115 and doubtful about whether we are receiving the careful and sensitive handling that we deserve. I need hardly remind my hon. Friend the Minister that in the months to come my constituents will look to him to defend our hospital and the hospital services in the area which have served us so well in the past.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)My hon. Friend the Member for Orpington (Mr. Stanbrook) has raised an important subject which has drawn four times more Conservative Members to the Chamber than is usual for an Adjournment debate. I am glad that my hon. Friend the Member for Orpington managed to secure a debate on a subject which is important for him and his constituents. It concerns the temporary closure at night of the accident and emergency department of Orpington hospital. Bromley health authority proposes to make that temporary measure permanent. I am also glad that my hon. Friend the Member for Beckenham (Sir P. Goodhart) made his voice heard tonight. He picked on some more general aspects of health policy for the whole of the South-East Thames region, and I hope that he will forgive me if I am unable to answer any or all of his points, as I have only 10 minutes in which to speak.
This debate on the hospital in Orpington is evidence of the assiduous and long-standing interest that my hon. Friend the Member for Orpington has taken in it. My hon. Friend has made clear the depths of his concern, and I shall do what I can to reassure him. However, it will not surprise him to hear that I do not think that it would be proper for me to intervene at this stage. I am sure my hon. Friends will understand that only too well. It is a curious task for a Minister to reply to an Adjournment debate on a proposed closure of all or some constituent part of a hospital before a decision has been taken.
Although my hon. Friends can reasonably and properly pray in aid the interests of their constituents and make points that are vital to their areas—just as I would do if I were in their shoes—it is difficult for a Minister to do anything other than remain politically neutral, to explain some general principles affecting the case, and at all costs to give no clear indication of any decision that might be taken by Ministers later. After all, they are sitting in a quasi-judicial position on the case, which may or may not go to my right hon. Friend the Secretary of State for determination.
Therefore, I hope that my hon. Friend the Member for Orpington will appreciate that, if I say anything that reflects the views of the Bromley district health authority, I am seeking only to put on the record the other side of the story. I am not for one second suggesting that my colleagues or I agree with any part of those views. The decisions to which my hon. Friend referred were made because of an urgent need to bring the authority's level of spending within its cash limit. Temporary closures for urgent financial reasons are properly matters for district health authorities. The Department gives very strict guidance to health authorities on such occasions. The guidance stresses that where there is any prospect of a temporary closure being made permanent, consultation under the established procedures must take place as soon as possible.
116 Bromley health authority has proposed that all the temporary closures which it recently decided upon should become permanent and, in accordance with our guidance, on 19 January it published a consultation document fully explaining its proposals and the reasons for them. My hon. Friend the Member for Orpington has, indeed, already referred to that document. I am advised that the need to decide on such urgent, temporary measures arose for two main reasons. First, nursing costs in Bromley are well above the average costs for the South-East Thames region. Budgets for 1983–84 were set by the authority nearer the regional average, but it has become clear in the course of the financial year that the required reductions were not being made. A forecast of net overspending of £400,000 by the end of this financial year has been made. Secondly, the expenditure changes announced in July 1983 by my right hon. Friend the Chancellor of the Exchequer resulted in a decision by the South-East Thames regional health authority to reduce Bromley health authority's revenue allocation by £455,000. The combination of those reductions with the projected overspending on nursing has undoubtedly created a difficult situation for the Bromley health authority members, and above all, its chairman.
The authority decided to take those temporary measures, and has begun consultations with a view to making them permanent. However, I should like to look not at the overall Bromley district health authority strategy—although my hon. Friend the Member for Beckenham quite properly, in the interests of his constituents, began to lead us down that path—but at the important and emotive issue of the accident and emergency provision between 8 pm and 8 am at Orpington hospital.
The immediate reasons for the closure of the accident and emergency department were the financial factors that I have already outlined. Permanent closure between 8 am and 8 pm is estimated by the local authority to save £71,000 in a full year. My hon. Friend the Member for Orpington disputed that figure in his excellent speech. His unease about the financial calculations was also reflected in the remarks of my hon. Friend the Member for Beckenham. However, that matter must be resolved by the district health authority. That is the sort of fact that Ministers take into account when recommendations are made at any stage in a proposed closure.
My hon. Friend the Member for Orpington said that the savings are small, as they are, in relation to the authority's total budget. But the authority might argue that the amount is not small in relation to the few people who are treated in the hospital overnight. One reason for the closure given in the consultation document was that few people use that department at night. I again stress that, in my difficult position, I am simply relating what I have been advised and am not praying it in aid of any future decision.
Bromley health authority has examined data on patients in 1982, which showed that, over a period of three months, on average only 10 patients per day needed treatment in the night hours, and of those, only one needed admission to the hospital between 8 pm and 8 am. I cite those figures despite the one worrying case outlined by my hon. Friend of an accident that took place in the hospital grounds.
The authority has been monitoring accident cases at night since the temporary closure on 10 October, both at the Bromley hospital and with neighbouring districts. Although this is still a fairly early stage, I understand that there have been relatively few cases. Thus far, there is no evidence that the accident and emergency department at 117 Bromley hospital is being put under any great stress at night. Equally, because of the small number of patients that have been transferred from one hospital to the other, the transport costs have been relatively limited.
One general principle here is the important issue of what constitutes a district general hospital such as Orpington. A 24-hour accident and emergency service is not, and never has been, an essential qualification for a hospital to be called a district general hospital. The lack of that service certainly does not imply a diminution of the standing of the hospital. I know that my hon. Friend recognises that with the opening of the Canada wing—a new, expensive and extremely well-equipped block, with 276 beds for both acute and geriatric patients—the standing of Orpington hospital has been recognised.
It is not for me to judge the merits of the proposal at this stage, but simply to point out the authority's 118 arguments. My hon. Friend has already eloquently and forcefully stated the counter-arguments, enforced by my hon. Friend the Member for Beckenham. The community health council and the district health authority must now address themselves to the problems.
I assure my hon. Friends that we will weigh all the questions and arguments most carefully, as we always do when such decisions are taken. Our minds are not made up. Indeed, the mind of my right hon. Friend the Secretary of State for Social Services, my right hon. and learned Friend the Minister for Health and myself are open. No options are closed. Certainly no guarantee has been given to the district health authority that simply because it has proposed a temporary closure it will be made permanent. I am happy to give my hon. Friend that assurance tonight.
§ Question put and agreed to.
§ Adjourned accordingly at six minutes to Eleven o'clock.