HC Deb 01 February 1985 vol 72 cc587-94

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Archie Hamilton.]

2.31 pm
Mr. Guy Barnett (Greenwich)

I am grateful for the opportunity in an Adjournment debate to raise the subject of the Dreadnought seamen's hospital. This is not the time to speak at length of the fine tradition of service of this hospital, stretching back into the last century, towards British seamen and seamen from overseas. Suffice it to say that we in Greenwich are proud to have this hospital in our borough and that nearly 300 people are currently dependent upon the hospital for jobs. However, it has had to face uncertainty about its future over almost the whole period that I have had the honour to represent the constituency of Greenwich. It faces that threat today from the proposal that is currently out for consultation that the facilities should be moved to St. Thomas' hospital and the Dreadnought hospital should be closed down.

At the outset I should remind the Minister of the commitment that was made by the then Minister for Health on 10 June 1981: The Government is committed to retaining the Dreadnought on its present site as a separate hospital for seamen and its future is in no way threatened". The proposed transfer arose as a result of a request from the National Maritime Board. Consequently, the future of the hospital has again been thrown into doubt. The National Maritime Board has a specific responsibility—to ensure that proper facilities for seamen exist. As I understand its position, its members have never been happy ever since the decision was taken, when the National Health Service was reorganised in 1974, that the seamen's hospital should become the responsibility under that reorganisation of the regional area, or, later, the district health authority.

The Minister will recognise that the Dreadnought is a national institution with national and, indeed, international functions and responsibilities. It is therefore not appropriate, to say the least, that it should have to compete for funds within the district or the region, whose responsibilities are local and regional. The previous Minister, the hon. Member for Reading, East (Sir G. Vaughan), recognised that. On 19 January 1981, when he met the National Maritime Bord, he agreed that the Dreadnought needed a separate and identifiable budget and promised further consultation on that point.

I would at this point urge that those consultations should proceed. The future of the hospital cannot be assured unless and until separate funding is accepted. What is more, extra funds, voluntarily contributed by maritime interests, seamen's unions, or other sources are, to a degree, dependent upon the donors being assured that their contributions are being wholly devoted to the Dreadnought. Whether that is now the case or not is not the point. People and organisations will not contribute unless there is a separate budget and they can see the benefits which their contributions are providing for seamen.

The Minister should be aware that the balance of opinion in the National Maritime Board has changed since that board considered the possibility of the move to St. Thomas'. The board is made up of 50 per cent. Shipping companies and 50 per cent. employee organisations. Today, only one employee organisation supports transfer. Nevertheless, I understand that there is a petition in existence, signed by 9,000 members of the Merchant Navy and Air Line Officers Association, in favour of retaining the Dreadnought on its present site. I have heard recently that the Royal Navy Association, particularly the Dartford branch, has formed the same opinion.

But on the employers' side I gather that a number of shipping companies are now concerned about the transfer proposals. I have copies of a number of letters from shipping companies which make it clear that they entertain serious doubts about the viability of the proposed transfer and its effect on the future medical treatment of seamen. I would gladly pass them on to the Minister if he would like that because I am certain that he wants his final decision to accord with the views of the majority of interests which are directly affected.

Why has anxiety been expressed in so many quarters about the proposed transfer? I could speak at length, from personal knowledge, of the unique services which the Dreadnought currently provides and which are geared to the occupational needs of seamen. The staff of the hospital, apart from being dedicated people themselves, have inherited a long tradition of experience in this specialist field. They are experienced in the details of the comprehensive maritime fitness protocols. Their investigation and treatment of patients are established around those regulations.

The proposals for transfer imply redundancies for practically the entire staff and therefore the loss of all that expertise. At no time has the staff at St. Thomas' made any attempt to study those matters and discover whether they are or could become competent to undertake those responsibilities.

Meanwhile, the staff of the Dreadnought have sought independent medical opinion. They approached Sir Reginald Murley, the former president of the Royal College of Surgeons. In a full reply, he says: I intend no disrespect to St. Thomas' hospital in stating that seamen are most unlikely to get as personal and prompt a service as the Dreadnought has provided. The medical gain for the small percentage of seamen who may require more elaborate investigation and/or treatment will not compensate for the loss of facilities, geared to their special needs, which the majority of seamen now enjoy. As I have said, merchant seamen's medical management is a specialist topic. Therefore, it is unlikely to have the attention paid to it in a large hospital with consultants and a rotating junior staff who are all too likely to resent that small group of exceptional patients who do not come into any clear category of management, who are non-medical emergencies, and who yet should have priority over every other kind of patient.

Indeed, it is likely that, within a short time of transfer to a wholly NHS hospital, compromises will be made over the management of those patients, resulting in increased redundancies for seamen, longer periods off work and a dislocation of the routine of the shipping companies and their medical officers. Dreadnought gets seamen back on ship and fit for work. As a result, many of its patients' jobs are salvaged in the middle of their working lives.

The future of Dreadnought is up for consultation and, therefore, it may not be thought an appropriate time to raise this issue in the House. I do so because I think that the Minister should be asked to intervene to get the consultation withdrawn. He will recall that he had correspondence on this subject with councillor Glyn Williams, the chairman of the Greenwich community health council. It has been put to him that under the terms of circular HSC (IS 207) it is necessary for a district health authority, when issuing a consultation document which may lead to a closure, to be aware of the implications that such a change would have for the patients. It is apparent that this was not the case.

Both my hon. Friend the Member for Oldham, West (Mr. Meacher) and I were present at the meeting of the district health authority on 13 November when the decision was taken. It became clear that the members had not seen a copy of the operational policy document of the West Lambeth district health authority, though it is conceivable that the chairman may have had sight of it. I submit that the terms of the circular have not been fulfilled and that the consultation document should therefore be withdrawn.

In the letter that the Minister wrote to Councillor Williams, he claims: neither the Department nor the Greenwich health authority has been shown a document of the Price Waterhouse Report. I have been categorically assured that such a document was sent to the Minister. I have mentioned the report in the House and the Minister told me that he was looking forward to reading it. I shall be glad to send him a copy together with a second report, which should be complete during next month, to ensure that their contents are fully understood within the Department. This is by no means the only communication about Dreadnought that appears to have gone astray within the Department.

The first Price Waterhouse report dealt with costs and savings arising from the proposed move. That is a matter of central importance. The Minister accepted the findings of the feasibility study on 6 June 1983 and so initiated local consultation. That study estimated the savings to Greenwich district as £1.2 million. In the latest consultation document the district health authority admits that the savings would now amount to only £690,000. The difference is considerable.

The Minister wrote to the chairman of the Greenwich health authority saying that he agreed with the authority's figure. That is surprising, as the regional health authority stated in the document issued in December 1983 that there would be a £900,000 surplus to Greenwich if the move took place.

It is ironic that we should be considering the possibility of closing a hospital which makes special provision when other European countries such as Holland and Norway are opening them. Apart from our needs as a seafaring nation, we have international responsibilities to fulfil. We should continue to fulfil them in the only hospital that we still possess that is capable of discharging them. Above all, I am worried, as I am sure the Minister is, about the uncertainty for the members of the staff, which is demoralising for them. They are a dedicated staff in a fine hospital. I hope that the Minister will use every effort to bring the uncertainty to an end and ensure that Dreadnought continues to fulfil the functions that it has carried on for so many years.

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

I am pleased that the hon. Member for Greenwich (Mr. Barnett) has secured this Adjournment debate on the future of a long-standing and important hospital. I appreciate the way in which he has raised his arguments on behalf of the staff, the hospital itself, its traditions and, most of all, the patients. When we are considering changes in the pattern of service—old hospitals shutting and new ones opening and services being switched from one place to another — it is terribly easy to lose sight of the purpose that staff and buildings serve and of the needs of patients. I think that the hon. Gentleman kept his eye very much on the needs and interests of the patients rather than on buildings, for example. I agree with the hon. Gentleman about that. The future of the hospital is close to his heart, judging from the anxieties that he has already expressed to my right hon. and learned Friend the Minister for Health and myself and to the Greenwich health authority. I am also aware of early-day motion 94 which has attracted wide support. I understand that 117 hon. Members have signed it.

I join the hon. Gentleman in paying tribute to the excellent work that has been done for so many years by the staff at the Dreadnought Seamen's hospital. The staff is backed by the local community, the friends and relatives of present and former patients and the Royal Naval Association.

The anxiety is caused by the Greenwich health authority proposal to close the hospital and to transfer medical services for seamen to a specially designated unit at St. Thomas' hospital. The health authority issued a consultative document on its proposal last November and consultations will continue until 28 February. As consultations are proceeding it is not appropriate for Ministers to intervene. I shall try to explain the reasons, although I do not think that they will satisfy the hon. Gentleman.

I shall first explain briefly the procedures that health authorities must follow when they wish to close or change the use of a building permanently. The hon. Gentleman seems to be familiar with the process so I shall not describe it exhaustively, but I shall put it on the record and explain the arguments for and against the proposal.

The appropriate district health authority is required to prepare a consultative document. Comments on the proposals in the document are invited within three months from such bodies as the local community health council, the local authorities, joint staff consultative committees, family practitioner committees, local advisory committees and the general public. If the community health council objects to the proposals it is entitled to submit to the authority a counter-proposal. If that counter-proposal cannot be agreed and the local and regional health authorities want the closure to proceed the case is referred to Ministers for decision.

I shall not go into detail about the issues in this case, but in my experience it is at that stage that arguments to try to reconcile different sets of figures arise and different facts are debated by those who object to the closure. That is the stage at which Ministers should intervene, to try to weigh up the evidence and to act in the impartial and quasi-judicial manner that all health Ministers seek to act.

We have made it clear that when proposals are made to us Ministers will not agree to closure or change of use unless it can be clearly demonstrated that the closure or change of use is in the best interest of local health services and the community or unless savings will result to finance developments in under-target districts and so enhance the nation's health care.

We take the consultative process seriously. After the consultation process is over and the hon. Gentleman wants to see the Minister for Health or myself he has only to ask. We shall be pleased to see him again to discuss the arguments in detail. That is an open invitation. In this case not only local interests are at stake. The Dreadnought is a hospital with a special dimension.

Successive Governments have long recognised that seafarers have special medical needs, the nature of whose employment makes it difficult for them to join hospital waiting lists. They require quick treatment, rehabilitation and discharge, so that they can rejoin their ship at the right time and place.

We remain committed to the provision of adequate medical services for seafarers. The issue is how those services can best be provided—whether in the existing hospital in Greenwich, which the Dreadnought has inhabited since 1870, when it came ashore from the hulk that it had prevously occupied in the Thames, or in a new facility in St. Thomas' hospital.

The idea of a move came in 1981 from the National Maritime Board, which represents the interests of shipping industry employers and the seafarers' union. A unanimous request was made to the then Minister for Health, my hon. Friend the Member for Reading, East (Sir G. Vaughan) that a new site be found for the Dreadnought. Since then, opinions have gone backward and forward, but much of the present situation derives from that request by the NMB.

My hon. Friend the then Minister for Health agreed to consider the request and to look at alternative sites, but the NMB itself entered discussions with the West Lambeth health authority, which manages St. Thomas' hospital, on the possibility of a transfer to that hospital. We asked the South-East Thames regional health auhority to carry out a feasibility study, which was completed in 1982. We accepted the findings of that study and in July 1983, my right hon. and learned Friend the present Minister for Health asked for local consultations to be carried out. They were completed in West Lambeth in January 1984, but are continuing in Greenwich.

I understand that the National Union of Seamen, one of the constituent bodies of the NMB, changed its policy last year, some time after the initial request by the NMB, and now opposes the transfer of the Dreadnought—and we shall have to take account of that fact. I wish to emphasise that the proposal for the transfer was originally made by the National Maritime Board. It has been said that the then Minister for Health undertook in June 1981 that the future of the Dreadnought in Greenwich was secure. However, notwithstanding that undertaking, I do not believe that we could have ignored the request for a move made by the NMB. That would have been wrong.

The consultations on the proposal are in train and will conclude by the end of this month. As the West Lambeth community health council has already opposed the proposal, my judgment is that it is most likely that the matter will be referred through the regional health authority to Ministers for a decision, at which stage all the points raised in this interesting debate can be dealt with.

I cannot give any indication of what our decision is likely to be, but there are arguments for the proposal as well as against it. It is certainly arguable that a higher standard of treatment could be provided for seafarers if the Dreadnought is associated with the specialised facilities of a major teaching hospital. I appreciate the quotations from a distinguished medical source that only a minority of patients would benefit from a closer association with acute facilities and that much might be lost in terms of continuing care, interest, reservoirs of experience and the atmosphere of the Dreadnought. We all know that buildings and hospitals have their own atmosphere and traditions. The balance will have to be struck by Ministers if the matter lands on our desk for determination.

Because of the historic decline in the size of the British merchant fleet, only about half the bed capacity of the Dreadnought is used for seafarers. It is important to make that point.

If seafarers need a unit of about 60 beds—the size of the unit proposed for St. Thomas' — it might well be provided more economically there than at Greenwich. I am not prejudging the issue; I am trying to put the other side of the case as I picked it up by reading the correspondence that I have had with the hon. Gentleman, among others. There are two sides to the question. I am simply saying how difficult it will be for my right hon. and learned Friend to take decisions should the matter reach us.

West Lambeth and Greenwich districts, like other London districts, need to rationalise their acute services. The Dreadnought transfer might help them to do that. The particular needs of seafarers have to be set against the particular needs to rationalise acute services in London.

I assure the hon. Gentleman that we shall consider the proposals in the interests of the Health Service as a whole but bearing in mind, of course, the tradition of the hospital and the particular service that it gives.

2.56 pm
Mr. Laurie Pavitt (Brent, South)

I apologise to the Minister, having heard only his last few comments. I should be grateful if he would consider two further points. I am sure that my hon. Friend the Member for Greenwich (Mr. Barnett) will have put all the pertinent points about the hospital. At the conclusion of his remarks the Minister said, without any equivocation whatever, that there was a need for rationalisation of acute beds. I submit to him that in all the regions, especially the one with which he is concerned here, there is an argument about the need to rationalise.

Bearing in mind the specialties of the Dreadnought hospital, rationalisation could well mean a diminution in facilities. A press report this week spoke of the large number of problems arising from rationalisation where resources are cut. As a result, there is a shortage of certain specialties. When we talk of acute, chronic or geriatric beds, we are giving blanket definitions.

The Minister would appear to be prejudging the case. Although he rightly says that he does not have to judge the case until such time as it arrives on his desk, he also says that there is a need for rationalisation of acute beds in the region. That is an arguable statement. He cannot reasonably say that a case has been fully made out for the rationalisation of acute beds.

I ask for the indulgence of the House, not having been present for most of the debate. I think that the Minister acknowledged that a hospital has its individual personality, ambience, tradition and culture. Too often, on purely financial and economic grounds, after a hospital has developed its own personality and served certain sections of the community for decades, as the Dreadnought has done, it is argued that, provided the necessary technical equipment is available, it does not matter whether a hospital remains as a viable living unit, with its medical and paramedical staff, its culture and tradition. It is entirely wrong that the only considerations should be material ones. I know that the Minister thinks clearly on these matters, and I hope that he will consider the points that I have mentioned.

2.58 pm
Mr. Patten

By leave of the House, Mr. Deputy Speaker, I should like to respond to the two points made by the hon. Member for Brent. South (Mr. Pavitt). I thank the hon. Gentleman for his compliment. We always consider the virtues of particular hospitals and their traditions.

Without trying to introduce a partisan note, I would say only that in my concluding remarks I was not trying to prejudge the issue but simply attempting to set the particular issue of the Dreadnought hospital and its future against the overall context of health care in London. That policy has been advanced by successive Governments since 1976. The then Labour Administration said that acute services needed rationalising and that redistribution of resources should occur. I was seeking to set the particular case of the Dreadnought hospital against the needs of health care in the capital as a whole.

I look forward to getting a chance to discuss the issue further with the hon. Member for Greenwich, who raised this important subject, should it come to my right hon. and learned Friend the Minister of State and my self for determination at a later stage.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.