§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sainsbury].2.33 pm
§ Mr. John McWilliam (Blaydon)
First, may I thank the Minister for Health for the fair and interesting hearing that the hon. Member for Wycombe (Mr. Whitney) gave to the deputation from Gateshead that came to discuss the closure of the Normans Riding hospital. The Under-Secretary of State took on board several points. Unfortunately, he did not take on board all the points of concern. The Minister for Health wrote to me on 22 January informing me that the hospital was to close. He said that he had concludedthat the interests of patients were best served by allowing the proposed closure to proceed. I am satisfied that by closing the hospital, significant financial savings will be achieved with no reduction in the services provided.That is the point on which I take issue.
In September 1985 the National Health Service health advisory service and the DHSS social services inspectorate reported on services for the elderly provided by the Gateshead health authority and the social services department of the borough of Gateshead. The report raises several problems and difficulties that do not confirm the Minister's view that he kindly set out in his letter to me. Although not directly related to the closure, but related to the cause of the closure, paragraph 5 states:Despite the fact that Gateshead is a deprived District the Regional Health Authority's budgetary distribution does not, in the short term, improve the situation in that the 1985–86 allocation leaves the District even further from target.Gateshead spends only 92 per cent. of what, even by the Government's standards, should be spent on health. Gateshead was specifically mentioned in the Black report. We have severe problems of social deprivation and unemployment and the general difficulties of an area without major teaching hospitals. However, my constituency has a further problem, because it has a large number of former coal miners who worked in one of the dustiest coalfields in Britain. Consequently, the number of those with bronchial and other complaints associated with working with coal is markedly higher than it is in other areas. The fact that we have only 92 per cent. of the resources that we should have can only exacerbate the problems, because people are not getting the health care that they require.
Normans Riding hospital is largely a geriatric hospital. There are 10 general practitioner beds that deliberately have never been used as such. In the report, the general practitioners' view on the provision of geriatric services is as follows:All but one of the general practioners met expressed concern about difficulties in achieving admission to hospital of elderly people with sub-acute illness compounded by sociological and psychological overtones that precluded continued care at home. In such cases, a domiciliary consultation was virtually a precondition of direct admission to a geriatric bed and then usually via a waiting list.It is still via a waiting list.
The community health councils view of the proposed closure of Normans Riding hospital is,that there was considerable under-provision for the elderly in Gateshead with a fear that the needs upon which the Health Authority plans were based did not match the needs in the community: there was deep concern about the closure of Normans Riding hospital.613 That is true. Those needs do not match the needs in the community.
The decision of the district health authority is based on an assumption about the local authority provision, especially part III provision, that can be made. I have consulted the leader of Gateshead authority, the chairman of social work and the deputy chairman of social work. Their problem is that if the local authority increased expenditure to provide the part III provision that is needed to alleviate the problem, although it would not solve it completely, the local authority would inevitably incur penalty under the rate support grant scheme. The DHSS has not taken sufficiently into account the restraints which the Department of the Environment has placed on that local authority.
If we are to do something effective about care for the elderly in Gateshead, the two Departments must come together, and one of them—presumably the Department of the Environment—must admit that the allocation of rate support grant to Gateshead and the grant-related expenditure assessment for social work in Gateshead will have to be increased to meet what the district health authority expects the local authority to provide, because it clearly cannot be provided now.
The Minister's officials also stated:The hospital service relies heavily on the practice of 'swapping' to gain admission to Part III beds. The present allocation system, with no health service input, reinforces this practice which medical have used to gain what they see as a fair proportion of beds for their patients. Between 4 January and 17 May 1985, 35 beds were allocated to the hospitals … of which 20 were 'swapped' with existing hospital patients.It is clear from cases that I have taken up in my constituency that, even in semi-acute cases, people cannot obtain geriatric beds unless something else is seriously wrong with them or unless arrangements can be made with the local authority.
The report continues:The Health Authority have proposals for the closure of the Normans Riding Hospital. In this situation it is inappropriate to dwell on the structural problems observed. However, the toilets and sluices on most wards are most unsatisfactory for elderly patients.They are, but it would be fairly inexpensive to bring those toilets and sluices up to standard. What is more, it would be a fairly inexpensive. job to sort out the structural problems in Normans Riding hospital, because they are not fundamental problems, but problems of construction begun at a time when people were working in a hurry because a war was about to break out. There would not appear to be too great a difficulty. The advice given by the Minister's officials is:If patients are to be accommodated at the Normans Riding Hospital for any length of time, it is imperative thatthe sluices be brought up to date.
The suggestion is that those patients should be transferred to Dunston Hill hospital, which is also in my constituency and which I visited on Monday. I have every regard for the dedication and skill of the people who work an that hospital and for what they are trying to do in difficult conditions, but the advice of the Minister's officials is this:The Health Authority should not transfer patients from Whinney House, Normans Riding and St. Mary's Hospitals to Dunston Hill Hospital until accommodation of a satisfactory standard is available for each group of patients. Application to the Regional Health Authority for special funding to ensure this work is carried out should be considered.
614 Within the last month, the northern group of Labour Members met the chairman of the regional health authority. Although helpful, he could not give the kind of commitment that we want. It will cost £400,000 to bring the wards at Dunston Hill to the standards suggested. If Normans Riding is left in place that expenditure will not be needed.
Two aspects of this annoy me particularly. First, the decision to close Normans Riding was taken on the casting vote of the chairman of the district health authority who is appointed and paid by the Minister. Secondly, I believe that we need both Normans Riding and the upgraded Dunston Hill to meet the needs of our elderly. The assumptions being made about the ability of the local authority to cope appropriately with the problems faced by elderly people in my constituency and in the rest of Gateshead will not be fulfilled unless that provision is made.
The decision to close Normans Riding was a mistake. It is an excellent hospital with special expertise nationally in the care of the terminally ill. I am very upset indeed that the Minister has decided to close that hospital on the casting vote of his paid chairman and against the wishes of the community and the GPs when all the evidence shows that insufficient provision has been made and when it is perfectly clear that £400,000 will have to be spent to provide an alternative.
Finally, Normans Riding is the only purpose-built isolation hospital on Tyneside. It is not connected to the main sewerage system, it has its own kitchens, and so on. I should not like to think of a situation arising in which we would need those isolation facilties, but if we get rid of Normans Riding we shall never again have a facility which — God help us — may at some time be needed. The alternative — the Queen Elizabeth hospital — is in the most densely populated part of the borough and is clearly not appropriate for the provision of isolation facilities in an emergency.
§ The Minister for Health (Mr. Barney Hayhoe)
As I would expect, the hon. Member for Blaydon (Mr. McWilliam) has deployed his case with both case and concern on behalf of his constituents in raising again the decison to close Normans Riding hospital. I have listened with great interest to all that he has said and I will certainly write to him if there are points which, on reflection, I think deserve a further response from me other than that which I can givein this brief debate. I am most grateful to the hon. Gentleman for his kind comments about my ministerial colleague the Parliamentary Under-Secretary of State my hon. Friend the Member for Wycombe (Mr. Whitney) with regard to the way in which the deputation led by the Member for Blaydon was received and the manner in which the matter was dealt with.
To set the closure of Normans Riding in its proper context, I should perhaps begin by referring to the important developments taking place at the Queen Elizabeth hospital in Gateshead. As the hon. Gentleman knows, schemes 1 and 2 of that hospital were commissioned in 1967 and 1972 respectively. Those two schemes provide a full range of radiological diagnostic support services, out-patients' department, and so on, to support the 263 acute and maternity beds. As the hon. Gentleman also knows, scheme 3, built at a cost of some £9 million, will add a further 200 acute beds, six operating 615 theatre suites, six intensive therapy unit beds and further supporting services. Scheme 3 is due to come into use in the next few months and various groups of patients will be transferred to the new facilities. One result will be that facilities at Dunston Hill hospital will become vacant. Patients currently at Normans Riding hospital will be transferred to the vacant facilities at Dunston Hill.
In addition to scheme 3 of the Queen Elizabeth hospital, there are other exciting developments taking place in Gateshead. For example, there is the recently opened community unit for those with mental handicap. There are priority service developments for the elderly who are severely mentally ill.
The hon. Gentleman referred to beds for the elderly and the general provision in his area, and I understand that with the completion of the schemes to which I have referred a number of beds for the elderly will become available. If further beds for the elderly are required, these could be provided at Bensham or at Dunston in a rather more economic fashion than would be achieved by retaining the facilities at Normans Riding.
§ Mr. McWilliam
Does the right hon. Gentleman have any idea of the distance or the transport difficulties that are involved in getting from Ryton, Blaydon or Winlaton to Bensham or Dunston?
§ Mr. Hayhoe
I would not claim any knowledge that meets even remotely that which the hon. Gentleman has of the area which he represents. I intended to say something about transport facilities but, as he will understand, I must rely upon advice that I am given.
Within the general area there is increased provision for patients flowing from the increased resources that have been provided for the NHS. That does not mean — I accept what the hon. Gentleman says on this score — that there is not real pressure on the available resources. As he has said, the district is achieving only 92 per cent. of its target under the RAWP arrangements, though it is moving up steadily as a result of the overall policies that are being implemented. I hope that 100 per cent. of the RAWP target will be achieved over the course of the next decade. This means that health authorities must examine carefully the way in which services are organised to ensure that they are provided in a sensible and efficient manner. If money is tied up in a hospital which is not required, other developments cannot take place.
It was against that background, and with the desire to concentrate services for the elderly at the Dunston Hill hospital site, that the Gateshead health authority considered carefully the need to retain the Normans Riding hospital.
The hon. Gentleman will know much better than I do that the Normans Riding hospital is sited in a relatively remote part of the district away from any real back-up medical facilities. I have read past correspondence and I have found that much has been made of the pleasasnt site of the hospital. I accept fully that that is so. At the same time, I cannot ignore the high cost of upgrading — estimated at £500,000 — that would be required if the hospital were to be retained. The relative isolation of the hospital causes difficulties for patients and staff alike. I am advised that the only public transport to the site is the twice-weekly special bus service that is laid on to coincide 616 with visiting times. On other days, relatives without their own transport must use taxis or make other special arrangements.
§ Mr. McWilliam
The hospital is within three quarters of a mile of one bus terminus, from which there is at least one bus an hour. It is within 500 yd of a bus stop at which buses stop less frequently but fairly regularly.
§ Mr. Hayhoe
I do not think that that detracts from what I have said. The hon. Gentleman has put the matter in a local context, which local people will know.
Patients who require investigative treatment must usually be taken by ambulance to the Queen Elizabeth hospital in Gateshead. Day-to-day medical cover at the Normans Riding hospital is provided by local GPs. Any condition requiring a specialist opinion currently requires a special trip by the consultant.
That overall situation will be greatly eased when the patients are transferred to Dunston Hill hospital where patients and staff will have easier access to important diagnostic and other services. The medical aspects of these matters must loom large in all the attention which is given to them.
I understand that Dunston Hill hospital is served by about 10 bus services, making visiting by most relatives and friends much easier. It is important not to expect old folk to have to walk, perhaps in inclement weather such as that that we have experienced recently, and there is a great advantage in having the public transport going close to the hospital.
Inevitably, much has also been made of what is seen as the loss of a good hospital. I fully appreciate the local anxieties and loyalties that are always amplified when an issue of this kind comes before the public's attention, but perhaps those aspects have been somewhat exaggerated. In practice, only a quarter of the patients currently at the Normans Riding hospital come from the immediate area and the move to Dunston Hill hospital will bring the majority of patients nearer to their homes and families. That is my advice, and I presume that people have looked carefully at where the families and friends of the current patients of Normans Riding live.
§ Mr. McWilliam
I do not want to take up much more of the Minister's time because he has been more than fair to me in giving way, but patients from the immediate area of Normans Riding hospital are being transferred miles across the borough deliberately and patients from miles across the borough are being transferred into Normans Riding hospital to prove the point. It is being done deliberately.
§ Mr. Hayhoe
I am not in a position to confirm or deny that. I have not examined the records myself. As I say, I am advised that the position is as I have given it to the House today.
Two of the four wards at Dunston Hill hospital which will be used for existing patients from Normans Riding have already been upgraded. There has been talk of the standard of accommodation. Plans are in hand to upgrade the other two wards. I should stress that that upgrading is for real; I have seen some suggestions that it is merely a cosmetic operation.
I hope that the hon. Gentleman will have seen for himself on his visit to Dunston Hill hospital earlier this week, to which he referred, the efforts that the authority 617 is making to provide attractive, homely surroundings for the patients. The two wards yet to be upgraded will be upgraded to a high standard and over the next few years attention will be given to landscaping the hospital site and to a number of other significant improvements to parts of the site.
It has been suggested that the developing expertise in the care of terminally ill patients at Normans Riding hospital will be lost as a result of the move. The hon. Gentleman referred to that aspect. The Gateshead health authority is aware of that concern and will be seeking to ensure that that expertise will continue when patients transfer to Dunston Hill hospital. As the hon. Gentleman may know, all the permanent staff at Normans Riding hospital are being offered similar appointments at Dunston Hill hospital. It is hoped that a majority will be able to transfer with their patients, thus providing a high measure of continuity of care.
The hon. Member referred to the health advisory service report which was broadly welcomed by the Gateshead health authority because it contained many helpful recommendations. The authority established a small group of members to look at its specific points. One can quote from a report a sentence or paragraph or two to sustain one position or another. Perhaps the hon. Gentleman will therefore appreciate it if I quote one paragraph to buttress my case, just as I would expect him equally fairly to quote another paragraph that was more in tune with his point. Paragraph 100 states:The policy of integrating geriatric medicine with general medicine on the Queen Elizabeth site following scheme 3 and concentrating facilities for the elderly on fewer sites is commendable and should secure the medical care of the elderly in the mainstream of clinical medicine. This will give all 618 patients, irrespective of age, immediate access to the diagnostic and therapeutic resources of the district general hospital which will improve morale and recruitment of staff to the speciality of geriatrics and last, but by no means least, create the means of introducing the multidisciplinary patient-oriented approach to illness at all ages into the acute sector wards.There is a real bonus in medical terms to be gained from the proposition which I have agreed. Revenue savings will be achieved by closing Normans Riding hospital and transferring the services to Dunston Hill hospital. The savings are estimated at £178,000 in a full year, all from non-direct patient care services — administration, domestic, catering, portering and estate managing services. Those savings are to be deployed elsewhere to improve services to patients.
I have accepted the assurance from Gateshead health authority that the transfer of the facilities from Normans Riding hospital to Dunston Hill hospital will enable the authority to provide the same level of service more efficiently and will release much needed money to improve existing services across the district to the overall benefit of the community who look to the authority for health care.
For these reasons, and after careful consideration, I concluded that I should support the decision of the Northern regional health authority and the Gateshead district health authority by approving the closure of the hospital. Although I have listened with great care and interest to the hon. Member for Blaydon, I am not persuaded by what he said that the closure decision I made was wrong.
§ Question put and agreed to.
§ Adjourned accordingly at two minutes past Three o' clock.