§ Mr. Ray Powell (Ogmore)I am grateful for the allocation of time during the last sitting before the summer recess to place on record the objections of my constituents in Ogmore and other people in the catchment areas of Aberavon, Bridgend, Pontypridd, and the Vale of Glamorgan, all of whom will be directly or indirectly affected by the proposed closure of Blackmill hospital in the Ogmore valley.
It is a pleasure to see you in the Chair, Mr. Deputy Speaker, for my speech. Blackmill hospital is on the side of the Ogmore valley near the small and delightful hamlet of Blackmill. It overlooks a beautiful area and a picturesque valley covered with trees at one end, and the area spreads out into well maintained sheep farms and grazing areas. The valley starts from Nantymoel and stretches through narrow terraced streets through Tynewydd and down to Blackmill. It is one of four similar valleys in my constituency. Access is mostly by secondary roads, which are convenient and of the sort that one would expect to find in the coalmining area of south Wales.
It is well known throughout the world that the Welsh people are friendly, hospitable and responsive and treat their visitors as members of the family, and their qualities of compassion and care are of a high degree. Against that background and description of the area, all those who will read the debate will realise why it is essential to make every effort to save Blackmill hospital for the service that it provides, for the people it serves and in recognition of the wonderful work and dedication of all the staff for the people they nurse.
Blackmill hospital is renowned throughout Mid-Glamorgan and the Principality of Wales and, I suspect, even further afield. Elderly people are nursed by relatives —sons, daughters, grandsons and granddaughters—and in some instances by neighbours. We all know what is entailed in the nursing of elderly people, and those who do it welcome the respite of a week or fortnight or even longer when their elderly charges are allowed to go to Blackmill hospital and the home nurse can have a holiday.
This social facility is essential. There is a real community need. There is an overwhelming demand and that becomes clear as one reads the statistics for Mid-Glamorgan about the increased number of elderly people. The problem is on the increase and, instead of reducing these facilities, we should be increasing them. We should be developing more Blackmill hospitals and not reducing this vital social facility.
I catalogue all the facts so that everyone, including the Minister, will realise the extent of the feeling and concern and the real rebellion among thousands of my constiuents over the decision to close this hospital. The way to describe this feeling is to compare it with the rebellion this week of 100 Tory Members against the Government's proposals to increase top salaries. We all know the extent of that rebellion, and I claim that my constituents are equally concerned about this hospital closure, if not more so.
Over the years the Minister and I have on many occasions expressed our opinions and debated general hospital services in Mid-Glamorgan. The Official Report could be referred to repeatedly from 1979 onwards. However, I feel that no mileage can be gained from that. 1458 I also have with me the draft consultative document on health services in Mid-Glamorgan published in March 1984. This strategic plan for 1984 to 1993, containing 137 pages, would be ideal ammunition for an all-night sitting of a Committee, but it would not be ideal for today's debate.
However, I must refer to the March 1984 document on the reorganisation of the health services in Ogwr. It was published as a draft consultative document, but, despite many meetings convened by the Ogwr community council all over the borough and the objections to closures from Mid-Glamorgan county, Ogwr borough, 23 community councils and a petition containing 9,937 signatures, the whole planned closure programme will be implemented if the Government are not prepared to relent on their decision to close Blackmill hospital. Surely the significance of this amount of protest will not go unrecognised by the Government.
No doubt the Minister will recall the Adjournment debate on the subject of Bridgend hospital on 22 March 1982—it is now called the Princess of Wales hospital. Hon. Members will find the report of that debate in Hansard of 22 March 1982, at columns 771–78. I ask the Minister to read his reply to that debate and his answer to an oral question on 27 June 1983 on phase 2 of the new hospital.
It is all to do with the closure of many hospitals in Ogwr borough—and the loss of beds, not the increase in accommodation—when waiting lists are getting longer and the elderly are living longer. If I had not secured this debate today I should have been attending a birthday celebration for Mr. Arthur Beaty, in Dwfrig ward at Maesgwyn hospital, Brynceithin, who is celebrating his 100th birthday today. I am sure that the House will want to record its birthday greetings to him. [HON. MEMBERS: "Hear, hear."]
Yesterday, I read through three full files of letters and reports dealing only with Blackmill hospital and the work of the hospital league of friends under the chairmanship and stewardship of Councillor Mrs. Muriel Williams, MBE, JP. I was overwhelmed by the public response to fund-raising efforts to provide for the hospital so many extra facilities and needs not usually available from any other source. I commend Mrs. Williams and her committee for all their untiring efforts. Only last week my wife opened the league's summer fete, which raised well over £500 in one afternoon and was supported by hundreds of the valley's residents.
To view objectively the proposals to close Blackmill hospital, one has to consider the historical background and the significance of the hospital to the community that it serves. The hospital was built in 1903 by the Ogmore and Garw council for the treatment and nursing of infectious diseases. Until 1948 it was used mainly for this purpose, treating outbreaks of infectious diseases such as measles, whooping cough, chicken pox, scarlet fever and many others. An improved programme of immunisation and vaccination, coupled with advanced medical treatment for prevention, resulted in a fall in bed occupancy at the hospital. To improve occupancy, a pre-convalescent ward was established.
I should like to place on record my appreciation of the work of the Ogwr community health council — Chris Johnston, the Secretary, Megan Butcher, last year's chairman, and Jack Thomas, the present chairman, —and the efficent and constructive way they organized 1459 public meetings and a petition which carried 10,000 signatures. I object to the contemptuous way in which they have been treated by the health service's planning officer, Mr. D. M. Chapple. They were not kept fully informed of Welsh Office decisions.
I should like to read a letter dealing with a series of Welsh Office decisions which was sent to Mr. Boulton, the general manager of the Mid-Glamorgan health authority. It said:
In my letter of 7 May I informed you that the Secretary of State has approved the first part of your proposals for the reorganisation of health services in Ogwr. The purpose of this letter is to tell you that he also accepts as part of that reorganisation your proposal to close Blackmill Hospital.The hospital is obviously held in affection by many people in the area and the Secretary of State fully appreciates the regard in which the hospital is held and understands the feelings of those people in the community who have expressed concern at its future. In particular he was impressed by the sincerity of the Friends of Blackmill Hospital who presented officials with a petition to keep the Hospital open.He has concluded nevertheless that the reorganisation of health services which your Authority has proposed are in the best interests of all the people in Ogwr.The penultimate paragraph is the most important:The Secretary of State has noted that the Health Authority would prefer not to dispose of the site immediately, in order to allow further exploration of the potential for its reuse in the local interest. The Secretary of State, having noted the strong local affection for Blackmill Hospital, is agreeable to a delay in disposal, but being conscious of the cost of maintaining the site in a reasonable condition after closure, encourages the Health Authority to have concluded its considerations by 1 November 1985.Earlier today the Father of the House, my right hon. Friend the Member for Cardiff, South and Penarth (Mr. Callaghan), was congratulated by my hon. Friend the Member for Ashfield (Mr. Haynes) on his 40 years' service to this House and to the nation. I urge hon. Members to read his article in today's edition of The Times and to reflect upon the achievements of the Labour Government of 1945. The Nye Bevans of this world, and others, fought long and hard to introduce the National Health Service. It is our duty and responsibility to protect this national asset and prevent the privatisation of medical care. Private medical care is escalating because American-based firms are falling over themselves to cash in on this gravy train.Are the Government reducing the role of the National Health Service? Do they intend to provide only a substandard service for those who cannot find the cash to pay for private care? We will not tolerate this any further. We shall not allow these uncaring, unscrupulous monetarists to smash the National Health Service, as they have been trying to do since 1979. In June 1983 the Prime Minister said that the National Health Service was safe in her hands. Not only the Opposition but also, I believe, many Conservative Members doubt this.
I am sure that the Under-Secretary is not included in the real hard core of those whom I have just criticised. Therefore, I ask him to show a little compassion and to consider the proposal to salvage at least one hospital from the slaughter of the services that I have outlined by the area health authority. I ask him to consider the decision of the area health authority on 22 July 1985,
that before taking steps to dispose of Blackmill Hospital and site they would look favourably at any constructive and feasible proposition to retain the hospital for the benefit of the community if such proposals were to be presented to them. The Secretary of State has allowed until November 1985 for such propositions to be presented to the Authority.1460 May I suggest to the Minister two areas which might be suitable for the undertaking of a feasibility study for the future use of hospital facilities by a local charitable organisation, which would be much-needed community projects. First, one ward could be converted into a flexible day care centre for the elderly. The advantages of such a centre would be to allow greater use of the facility and allow patients to remain in care for longer periods. Secondly, it could use another ward to provide a short-stay holiday home unit for the elderly. If such a short-stay unit were provided, it would go a long way towards allowing relatives some respite for a week or two and would encourage them to accept their family responsibilities. If the proposals were accepted by the health authority and the social services department, referrals could be agreed and funded by the DHSS. I am sure that my proposals would mean that the costings of Blackmill hospital for the year ended 13 March 1984 could be substantially reduced.Last, but not least, the child welfare clinic, the chiropody clinic and other community-based functions are sited at the hospital. They were sited at the hospital because alternative accommodation was not available in the area. Those functions could be retained at the hospital. This local charitable organisation would be able to make repairs and renovations of a high standard without the liability of unreasonable cost.
Finally, may I ask the Minister to give some help to the socially and industrially deprived area of Ogmore by at least allowing this community-based charitable organisation to continue the essential work of Blackmill hospital. If he will do that, I shall willingly and eagerly wish him a pleasant and restful summer recess.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Wyn Roberts)I am happy to join the hon. Member for Ogmore (Mr. Powell) in sending good wishes to his constituent, Mr. Arthur Beaty, on his 100th birthday. I also congratulate the right hon. Member for Cardiff, South and Penarth (Mr. Callaghan) on his 40 years' service to the House.
The House will be aware that the procedures relating to a hospital closure provide ample opportunity for up-to-date consideration of the proposal for change and of any viable alternatives. They applied in the Blackmill case. I must dissent from the hon. Gentleman and assert that we have noted local feeling, but the weight of reasoned argument on service needs must also be weighed. In this case, the balance lies in favour of the authority's proposal.
Blackmill hospital is a unit of 30 beds. In recent years it has provided a pre-convalescent facility, generally for elderly people, some of whom move on to other accommodation. As the hon. Gentleman said, the buildings date from 1903 and occupy a site of about two acres. No beds are designated for consultant supervision. Patients are supervised by general practitioners. Additionally, the hospital is formally described as an isolation facility for infectious diseases.
The health authority wishes to close Blackmill hospital, which costs about £250,000 a year to run. It judges that this revenue could most usefully be transferred as a contribution to the running costs of a reorganised service for Ogwr district, which includes comprehensive care of the elderly. Provision for the elderly would then make appropriate use of the Bridgend general and Maesgwyn hospitals, which are both near the new Princess of Wales 1461 hospital, which is just being commissioned. Whatever the hon. Gentleman may say, the fact is that the reorganisation will provide more beds for the elderly than are presently available. Therefore, it is not true to say that we and the health authority are reducing the number of beds available for the elderly.
The health authority has been thinking about the future of Blackmill hospital for some time. Its first consultative document on the proposed reorganisation of hospital services in the Ogwr health district was issued in July 1979. It drew a significant response during public consultation and the authority duly decided to delay making any firm decisions until much nearer the opening of the new Princess of Wales district general hospital.
I am sure that that approach was right, because the new Princess of Wales hospital at Bridgend will form the focal point of very substantially improved health services for the people of Ogwr. When it opens in October of this year, the new hospital will provide the most modern forms of health treatment. In many respects it will be second to none in Wales. Indeed, extra funds made available by the Welsh Office to the Mid-Glamorgan health authority reflect our strong desire to secure such major improvements in health care
At one point, the Mid-Glamorgan health authority expressed concern that existing guidance on cost allowances for a hospital of the size of the Princess of Wales did not fully recognise the special needs of the district. There was some feeling that this guidance would not permit the introduction of the most recent technological advances. However, I am happy to say that we were able to provide the required funding to satisfy the overall requirements at the new hospital. More than £6 million has been provided for up-to-date equipment items, and an extra allocation of just under £4.8 million recurring revenue moneys has been added to the health authority's allocation especially for the new district general hospital.
All of this is additional to money for the capital development, costing in excess of £13 million, so our commitment to funding the health services in Ogwr should be crystal clear and unmistakeable. But I want to say something in a little more detail about the effect that this multi-million pound investment will have upon the actual health services provided to the people of Ogwr. It is this that has conditioned the authority's approach to the future of Blackmill hospital.
It is axiomatic that services for the elderly should be provided on the soundest possible basis. The development of services for the elderly is given priority attention by my Department. Among other things, health authorities are required to reinvest "good management" efficiency savings amounting to 0.5 per cent. of their revenue allocations for the priority groups of elderly, mentally handicapped and mentally ill people, who are among the most vulnerable in our society.
In this case, I believe that the reorganised health services proposed for Ogwr are likely to be of real benefit to elderly people in the community over and above the services available already. The needs of the elderly in hospital do not just demand concentrated medical and nursing care. There is also a requirement for a range of other specialised services. We look for significant improvement in this area, because, without it, and without the well-judged service intervention that they can provide, 1462 elderly people would otherwise be unable to retain their health, their independence and thus the society of their family and friends. These specialised facilities are precisely those that are available at a general hospital and are unlikely to be available elsewhere.
In saying that I certainly do not mean to disparage the work of the staff at Blackmill hospital. Their devotion to their patients is widely known locally and very well appreciated. However, there can be no doubt that the facilities being made available at Bridgend general hospital, Quarella road, as well as in the associated Maesgwyn hospital, are both superior in themselves and capable of meeting the total needs of the area in a way that Blackmill cannot.
That said, we have agreed with a suggestion from the Mid-Glamorgan health authority that any alternative proposal for the use of the resource represented by Blackmill should be given very careful consideration before any decision is taken on disposal of the hospital site. We fully recognise the great affection which the local community has for the hospital, and we are conscious of the excellent voluntary support that it has received. There is no intention to overlook the service that either has been or could be provided to the elderly at Blackmill. But it is up to the authority to see whether local initiative could support the development of a viable plan for some further future use. I am sure that it will be grateful to the hon. Gentleman for the ideas that he has presented this morning and that it will consider what he has had to say.
The closure of Blackmill will, of course, have consequences for the pattern of service provision generally within the area. For example, general practitioner services are themselves very significant in providing a primary health care service for the elderly. Here, it is the intention that general practitioner beds should be located near to the diagnostic and treatment facilities at Bridgend. This cannot but have a positive influence on the effectiveness of the GP services.
Again, the treatment of infectious diseases will also be subject to reorganisation. When the Blackmill hospital was originally built by the Ogmore and Garw council it was for the care of patients suffering with infectious diseases. Since then there has been a massive decline in the incidence and severity of these diseases to such an extent that a major isolation facility is no longer necessary. The new Princess of Wales hospital has itself been planned to enable the proper treatment of infectious diseases to be undertaken.
It may be said that, despite the care with which the Mid-Glamorgan health authority has planned and consulted, the new arrangements for the whole of Ogwr, which themselves imply the closure of Blackmill, should still not go ahead. It may be said that the 30 beds and Blackmill hospital should be retained. In that event, the further development at Bridgend general hospital about which I have spoken would have to be materially revised. Retention of Blackmill would mean that the resources expended on it would not be available for use elsewhere in Ogwr. This would affect the area plan, and some element of the intended provision for the elderly —planned to be in the region of 120 beds at Bridgend—would have to be omitted to balance the supply against likely demand. By retaining a relatively isolated GP unit, the planned capacity to provide comprehensive care for the 1463 elderly would be limited. Proposals for providing GP access to major diagnostic facilities and other specialist support at Bridgend general would be affected adversely.
It is difficult to see how any authority could justify having such beds in isolation from major support and acute specialties and outpatient services. Nor do I think that even the most ardent supporter of the notion of retaining Blackmill hospital would suggest that such a GP service at Blackmill should actually be replaced at Bridgend. Moreover, there are clear advantages of maintaining beds for the elderly in the most central and accessible location in relation to population. Bridgend general meets this requirement far more effectively than does Blackmill.
Again, so far as beds for the elderly in general are concerned, there must be doubt that Blackmill hospital could possibly hope to offer a service to elderly people of Ogwr superior to that proposed for the new Bridgend general and Maesgwyn hospital. The whole concept of the care envisaged for the elderly in Ogwr is to create a large number of beds in Bridgend with immediate access to major diagnostic and rehabilitative facilities. I make no apology in supporting Mid-Glamorgan health authority in working towards positive patterns of care for the elderly and for Ogwr as a whole. The most fruitful way ahead can only be charted by developing facilities around the Princess of Wales hospital.
I know that some of the few elderly people cared for at Blackmill hospital will initially be concerned at the thought of moving to an alternative location. It will of course be up to the health authority to ensure that this is managed with the care and sensitivity that we have come to expect from staff at Blackmill. Patients will fortunately not be asked to move great distances. Bridgend is only four and a half miles away and Maesgwyn hospital is only three miles away. At either place the distance from close relatives and friends will not differ substantially from that which exists now. They will be assured that all modern techniques available for their treatment and well-being would be close at hand.
All these developments in Ogwr take place against a resource background which Labour Members consistently refuse to recognise and occasionally misrepresent. As I have said many times in the House, and elsewhere, the Health Service in Wales has enjoyed a 16.3 per cent. increase in available growth resources between 1979–80 and 1985–86. This is after taking account of the effects of inflation, and 1983 public expenditure reductions. It is this very growth that has enabled authorities like Mid-Glamorgan to begin to address the problems of old and relatively expensive facilities, and to begin the business of moving to more modern and effective ones.
I do not say that these adjustments can be made easily. They demand great sensitivity, careful planning and considerable thought. There are hard choices to be made, but they cannot be avoided. On any objective standard the improvement in performance across the whole Health Service in Wales since 1979 is striking. Many more patient cases are being dealt with quickly and with a greater range of treatments than ever before, but it will not be possible for authorities like Mid-Glamorgan to continue to enhance their performance—to tackle the problems that confront the service — if scarce resources are used in running facilities that are relatively ineffective in cost and service terms. To cavil at this is simply to close one's eyes to the 1464 realities of Health Service planning and resource needs. We cannot take a relaxed view of any arrangement that uses resources ineffectively and thus diverts them from more and better patient care, particularly when modern, improved and accessible services are available
My right hon. Friend the Secretary of State and I very well recognise that the pressures on the funds that he has made available to the district health authorities are always strong. They are caused, for example, by new technologies and new methods of treatment as well as by pay increases. On this last point I will only say that these have been discussed at the recent round of annual reviews conducted by the executive committee of the health policy board within our Department.
There will be an opportunity for further discussion during the course of today when chairmen have one of their occasional meetings with the Secretary of Stale. Naturally, I cannot anticipate the course of this discussion, or indeed the Secretary of State's decisions as regards funding for 1986–87. What I will say is that we look to health authorities to continue to take effective measures to get the best value for money in the interests of patient care. I cannot imagine that anyone who works in the NHS would want to side-step that imperative. It is essential to the future of the service overall.
I do not in any way discount the financial and other problems of transition that Mid-Glamorgan faces. They confront all authorities to some degree. As things stand, Mid-Glamorgan has benefited from significant growth in its discretionary revenue resources in recent years. Moreover, additional cash loans of some £3 million in 1984–85 and £2.2 million in 1985–86 have been made to help the authority, which has also benefited from special central funding for particular service developments. We are also assisting a consultancy study designed to help the authority to manage the way ahead.
All of this is in support of the considerable efforts made by the authority over recent years to tackle the problems with which it is confronted. It is important to see the future of services for the elderly in Ogwr, and indeed the decision in respect of Blackmill hospital, in that context.
I do not believe that Mid-Glamorgan will be assisted in its effort—which will be to the long-term benefit of all those served by the authority—if every well-founded proposal for change is characterised as "cutting" health services, when in fact such changes represent further significant improvements in patient care. That can only reduce public confidence in the credibility of the service for both the present and the future—to the detriment of patients and the dedicated staff who work in the service.
I conclude by returning to the work of the staff at Blackmill hospital. I am sure that they will help in making the transitional period implicit in the transfer of services to a new location as smooth as possible. The staff's reputation for care gives me the strongest possible hope that the transition will be managed well.
I also acknowledge the work done by individual members of the local community and members of voluntary groups that have taken an interest in Blackmill over the years and the considerable support that they have given to the hospital. I hope that that goodwill will find its proper outlet in the facilities at Bridgend and elsewhere in Ogwr.