Orpington Hospital (Hansard, 22 October 1984)

§ Mr. Ivor Stanbrook (Orpington)

Orpington hospital was built in 1916 by the Canadian army to serve the medical needs of its troops during the first world war. It was a collection of huts, some of which have remained in use to this day, for the military hospital was converted to civilian use when the Canadians left. The buildings, with some alterations and improvements, have served the people of Orpington well. Despite the state of the buildings, the hospital has over the years provided a full range of medical services for a catchment area extending from Bromley well down into Kent. With the steady growth of the population in this south-eastern fringe of London, and the construction of the M25 motorway which encompasses it, there is no doubt of the need for a district general hospital here. That has always been the plan. The site extends over 30 acres, including green fields, compared with the meagre eight acres of the putative district general hospital in Bromley town, and the even smaller site of the existing hospital at Farnborough, which is also within my constituency.

No wonder, then, that Orpington hospital has been the scene of much development in recent years. Many of the first world war huts have been replaced, new residential staff quarters have been erected and the first phase of the grand development plan leading to the district general hospital — a marvellous new surgical block — was completed last year. Then the blow fell.

In pursuance of the RAWP — resource allocation working party—formula, the Bromley district has been deprived in recent years of its usual share of resources, leading to economies from which no area in the south-east has escaped. Then, last year, the district health authority, whose boundaries are the same as the London borough of Bromley, was called upon to make cuts of about £2 million in its current expenditure estimate of over £41 million per annum.

The Bromley authority had a difficult task to perform. Being composed of people drawn from all parts of the London borough, including Orpington, it was naturally concerned that the so-called cuts should be spread widely over the whole district. Its detailed proposals for economies reflected that desire.

The authority's proposals, published last year, have run into considerable criticism from the community health council, from the public and from the medical profession. There has since been extensive consultation, which is still not concluded, so that some of the changes have not been implemented yet. However, one — to me, most objectionable—proposal which affects the accident and emergency services at Orpington hospital was put into effect immediately. The Minister's consent was not needed for a "temporary" or "provisional" closure of the services overnight, so the authority went ahead and in September last year the accident and emergency services at Orpington hospital were closed from 8 pm until 8 am every day.

As a result of this foolhardy decision, the authority is said to be saving up to £70,000 a year, or a fraction of 1 per cent. of its annual budget, in total disregard of the interests of the local population, and in total disregard of 531 the average of 10 people nightly who previously were treated by the service, 10 people who now have to be taken by ambulance or otherwise the further distance to Bromley or Sidcup hospitals. It is impossible to say that such people are not at risk because of the extra journey and the extra time involved in getting them from places as far away as Sevenoaks as well as Orpington and taking them on to Bromley town. Even officially, the so-called savings amount to less than a fifth of 1 per cent. of the total budget. Measured in terms of patient need, the cost of treating casualty cases overnight was only an average of £20 per patient, at £70,000 for more than 3,500 patients deprived of the service.

How mean and foolish can we get, when such economies are made. There have been innumerable stories of misery and hardship caused by the overnight closure. One cannot plan to have one's accidents and emergencies during office hours: there will always be a need for casualty services overnight. I know someone who, having been injured in a road accident in Orpington at 7.40 am, chose to wait until 8 am before allowing an ambulance to take her to Orpington hospital rather than risk the journey to Bromley or Sidcup. There are many accounts of people turning up at Orpington, including one injured in the hospital grounds, just before 8 am and just after 8 pm and being refused treatment at the hospital.

Local feeling runs very strongly against the closure. When the idea was first mooted by a professional body set up by the regional health authority some three years ago, I organised a petition against it, which was speedily signed by 7,000 local people. The current proposal of the district health authority in regard to the accident and emergency services at Orpington hospital has likewise aroused the anger of Orpington citizens, and next month I will be presenting to the Minister a petition against it signed by no fewer than 16,000 people. What more can we do to show the Minister that this one action of the district health authority is hateful and abhorrent to local people, misconceived, mean and niggardly, and ought to be reversed?

My hon. Friend the Minister, whom I am glad to see on the Front Bench, said in the House 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. 602]. This particular change has not come before the Minister yet, because the authority has chosen to make the closure "provisional" and it has still not become the subject of a formal recommendation to the Minister, because the whole programme of changes including this one, is opposed by the community health council and has not yet been finalised. Yet here is a decision of the most fundamental importance, which concerns local health services and is hotly opposed by the local community, which has been in effect for over 12 months already—and all to save a piffling £70,000—a sum which the authority could easily save on its catering and laundry bills by privatisation. I beg the Minister to intervene now and say that this nonsense must stop.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)

I congratulate my hon. Friend the Member for Orpington (Mr. Stanbrook) on again securing a debate about the temporary closure at night of the accident and emergency department of Orpington hospital. Looking back through Hansard, we find that this is the fourth time in less than three years that my hon. Friend has secured a debate on this subject. It was only a little earlier this year—or so it seems —that he and I debated the subject. On that occasion, as on this, we were glad that my hon. Friend the Member for Beckenham (Sir P. Goodhart), who has a close interest in health care issues in the area, was present.

My hon. Friend's assiduity is evidence of his concern for his constituents' rightful anxiety about the provision of local health services, in particular at Orpington hospital. My hon. Friend has made very clear the depth of his concern. He has illustrated that once before, by bringing to the DHSS a petition signed by many thousands of people, and I understand that in November he will present to me a further petition signed by some 16,000 people. I understand from "The Times Guide to the House of Commons" that my hon. Friend has an electorate of some 58,759. That means that nearly a third of his constituents have signed the petition—a rather higher figure than his unfortunate Liberal opponent managed to achieve during the general election.

Bromley health authority has explained to me the reasons for its recent decision, and I want to explain why it would not be right for me to intervene at this stage. As my hon. Friend pointed out, Bromley health authority decided in September 1983 to take a number of temporary measures—I stress the word temporary—one of which was the temporary closure of the accident and emergency department at Orpington hospital. The decision was made because of the urgent need to bring the authority's spending within its cash limit. I should like to thank the chairman of the health authority for his overall vigorous action in that context.

Temporary closures for urgent financial reasons are properly matters for district health authorities to decide. My Department's guidance stresses, however, that where there is any prospect of such temporary closures becoming permanent, consultations under the established procedures must take place as soon as possible. Bromley health authority has properly pledged that if, in accordance with its plans, all the temporary closures it decided upon became permanent, it would at a later stage have to go out to consultation.

My reply will be brief. There is little that can be said until proposals for permanent closures land on Ministers' desks. I should like to speak both about the theory behind temporary closures and permanent closures — such as this might be recommended to be — and about the practical implications for the particular unit in question. It might be helpful if I explain briefly the procedures that health authorities must follow when they wish to close or change permanently the use of a building. I shall not describe them exhaustively, as that has been done in previous Adjournment debates. My hon. Friend will not be unfamiliar with the procedures. My explanation might be helpful to his constituents who read an account of the debate if they are not familiar with how we ensure that the closure procedures are closely followed.

The appropriate district health authority is required to prepare a consultative document which covers such 533 matters as the reasons for its proposals and the implications for staff. That is important, as staff are anxious when closure proposals emerge. The document also considers the possible effect of the proposals on patients. We must devote most of our attention to patients.

Comments on the proposals in the consultative document are invited within three months from a range of bodies, such as the local community health council, local authorities, joint staff consultative committees, other staff organisations, family practitioner committees and other local advisory committees. Hon. Members whose constituents would be affected by a proposed change are informed of the proposals and invited to comment. If my hon. Friend thinks that any of those procedures have not been followed properly, I hope that he will let me or one of my colleagues know as soon as possible.

If the community health council objects to the proposals, under our ground rules it is entitled to submit to the authority a constructive and detailed counter-proposal which pays full regard to the factors that led the authority to make its original proposal. If the authority is unable to accept the counter-proposal, the matter goes to the regional health authority. If it, also, is unable to agree with the community health council and wants the closure or change of use that the district health authority has proposed to proceed, the case is referred to Ministers for decision. It is self-evident from feelings in the area that any decision on the future of the unit will come to Ministers for determination. My hon. Friend nods assent—that is a clear mark of his determination to ensure that his constituents' interests are served as well as possible.

In regard to the practice, we have consistently made it clear that, when proposals such as these are referred to us, Ministers will not—I repeat what I and my right hon. and learned Friend the Minister for Health have said often in the House, at public meetings and in announcements—agree to a closure or change of use unless it can be demonstrated clearly to be in the best interests of local health services and the communities that they serve or unless there will be saving which will finance developments in under-target districts. I am happy to repeat that pledge.

Bromley health authority's original proposals, on which it began consultations last January, were for the temporary closure of the accident and emergency department at Orpington hospital from 8 pm to 8 am, leaving Bromley hospital with the district's 24-hour accident service—that is the matter which concerns us today. The accident and emergency department was closed at night temporarily from 10 October 1983. The district health authority also proposed the temporary closure of the Lennard hospital, a geriatric hospital of 83 beds, with the transfer of 75 beds to Farnborough hospital, transfer of the day hospital to Beckenham hospital in my hon. Friend's constituency and several other temporary measures, including the closure of 56 medical orthopaedic, and orthopaedic-geriatric beds at Farnborough hospital, with an acute geriatric ward to be transferred to Beckenham hospital.

This was a complex set of closely interconnected measures and proposals. Since the first consultation period of three months there have been further consultations and the authority has tried to respond to local feelings and the local consultation process by amending some of its 534 proposals. It has demonstrated that, as with district health authorities throughout the country, when constructive proposals are put forward, local health authorities try to respond to them.

The Bromley community health council has agreed the main proposal, which is the closure of the Lennard hospital in the constituency of my hon. Friend the Member for Ravensbourne (Mr. Hunt), who is unfortunately unable to be present tonight. Although it has agreed the main proposal, it has opposed almost all of the proposed bed changes in the other hospitals. Because of the community health council's opposition the proposals will shortly be referred to the South-East Thames regional authority under its chairman, Sir Peter Baldwin, and thereafter to Ministers for a final decision.

As a result of the strong feelings expressed in response to its consultation document, Bromley health authority decided at this stage not to propose the permanent closure of Orpington hospital's accident and emergency department at night, nor to reverse its earlier decision. Instead it will make a further careful assessment of the effects of the existing temporary closure at the end of this year when data from a full year since temporary closure will be available. So far so good.

A year's temporary closure is temporary closure. We would not expect a temporary closure of this sort to go on beyond the end of the year. We shall look to the district health authority to make up its mind as soon as possible at that stage as to whether it intends to reopen the unit 24 hours a day or whether it wishes to make the closure permanent, and thus go through the procedure of referring it to the regional health authority and then to Ministers. The health authority must take that decision early in the new year and make it public as soon as possible. It cannot be right in the long-term interests of those who work in the hospital, of patients who wish to use it or of the 16,000 constitutents who signed my hon. Friend's petition, to drag out the process further than that. I make my view unequivocally clear on that.

I understand from the authority that it believes that there is little evidence of any adverse effects from the night-time closure of the accident department. My hon. Friend dealt with that point forcibly in his speech. The authority has been monitoring the position with accident cases at night since the temporary closure on 10 October 1983 both at Bromley hospital and in neighbouring districts. The increase in cases at these other hospitals appears to be manageable and not to have caused difficulties. Bromley health authority wishes to make doubly sure of that and to satisfy public anxiety as far as it can before it takes a decision about recommending permanent closure.

In conclusion, if, having carefully considered all the evidence, Bromley health authority still proposes to make the night-time closure permanent, and if that is still opposed by the Bromley community health council, the final decision will be made by Ministers.

With four Adjournment debates in fewer than three years, two of which I have had the pleasure of answering, should that decision come to me, in whole or at least in part, I should be uniquely well prepared for the task, thanks to the tuition of my hon. Friend in the health care problems of the Orpington area.