HC Deb 18 July 1986 vol 101 cc1399-406

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

2.1 pm

Mr. Nick Raynsford (Fulham)

I am grateful for this opportunity to discuss the future of the West London hospital, which is extensively used by many residents of my constituency, although it is located just outside the boundary in the constituency of my hon. Friend the Member for Hammersmith (Mr. Soley), who has fully supported my concern and would have wished to be here today but for other commitments. It is appropriate that this debate should take place today as a consultation paper is expected to be published today by the district health authority proposing the closure of the West London hospital in November 1987.

It is important that the House should be aware of the context of that consultation paper. It is being produced by a district health authority which has been told to make cuts of some £33 million in a budget of £120 million by 1993–94—a reduction in expenditure of no less than 27 per cent. That is no reflection of lack of need in the area, which has huge unmet needs—an aging population, long and lengthening waiting lists for many operations and many people suffering poverty and deprivation. Against that background, the National Health Service should be expanding and developing to meet needs more effectively, rather than being told to make swingeing cuts in the budget which illustrate all too clearly the dishonesty of the Government's claim that the Health Service is safe in their hands. The people of Fulham and Hammersmith are well aware how hollow and untrue that claim is. In the face of such cuts in hospital services, the Health Service in West London is far from safe in the Government's hands.

The West London hospital currently incorporates four main units. The obstetrics unit has a national reputation for a very high standard of care. Among women it has a reputation for providing a service that is sensitive to their needs and aspirations, and it has been in the forefront in promoting natural childbirth. There is also a special baby care unit with a particularly high standard of neonatal care —a factor contributing to the good reputation of the area in terms of perinatal mortality, for which the figures are among the lowest in Britain and, indeed, in western Europe. The plan in the consultation paper involves closure of the hospital and loss of the obstetrics unit without replacement, and thus the destruction of one of the country's best maternity units.

Secondly, the geriatric unit provides long-term care for about 50 elderly patients. This unit has done important work in developing understanding and a close relationship between staff and patients. Many of the patients suffer from senile dementia, requiring intensive care and needing to develop trust and confidence in the people looking after them.

The third unit is the psycho-geriatric assessment unit providing 16 beds and also associated day care. The fourth is the genito-urinary unit, which is doing extremely important work in one of the most difficult areas of medicine and, indeed, is currently one of the first places of referral for a substantial number of people suffering from AIDS in Britain. The importance of that work should not be underestimated.

Apart from the four units provided by the hospital, there is also an associated nurses home, Abercorn House, which is providing accommodation for 90 nurses in an area where there is a desperate need because high house prices and exceptionally high rents make it difficult for nursing staff to afford to live. That in turn creates acute problems for hospitals, one of which, the Charing Cross hospital, has encountered considerable difficulty in maintaining its wards because of the absence of nursing staff who simply cannot afford to live in the area.

The proposal in the consultation paper suggests the relocatin of some of those units. The psycho-geriatric and genito-urinary units would be relocated, essentially at Charing Cross hospital, and I would not quarrel in principle with that. It is appropriate that those units should be on a district general hospital site, and the standard of provision could well be improved there.

The geriatric department will be replaced under the proposals with two small-scale nursing homes. Again that is not necessarily wrong in principle, but there are serious potential problems. In the first place, there must be an anxiety about the timetable — whether the new units, which have not yet been begun, could possibly be completed and ready for occupation by November 1987, the date set for the closure of the West London hospital.

Secondly, what will happen in terms of the disruption of the care of the elderly people, whose trust in thieir nurses has been painstakingly built up over a period? We should remember that we are talking only of replacing beds that will be lost. Yet we know that there is an urgent additional need for extra beds, particularly for respite care to help many carers who look after elderly relatives and who desperately need the opportunity to place their relatives in a caring environment so that they can get away for a week or two weeks' holiday from time to time. Those are the units that will, to an extent, be replaced under the proposal. I want now to deal with those that will not.

The nurses home will be lost, and that will be a loss of desperately needed accommodation in the area. The obstetrics unit will be lost without replacement under the proposal. That is clearly motivated by a wish to make savings. There can be no other possible explanation of why that has been put forward. The consultation paper suggests that that will provide savings of approximately £2,250,000 out of the total projected revenue savings coming from the closure of the hospital of £2,750,000. So the lion's share of the total savings is attributable to the closure of the obstetrics unit without replacement.

What possible justification can there be for doing this? It may be argued that the West London hospital building is old, in need of maintenance and repair. It is an old building. It has a long and distinguished history going back 126 years, during which time the hospital has been located on this site. However, I hasten to add that there have been many additions and improvements to the building during that time. It is not simply a building that dates back to the 1860s.

Everyone who has been there or who has accompanied patients there knows what is really important is not its bricks and mortar but the standard of care. The West London hospital's reputation is without equal in that respect. It has an immensely high standard of care and concern for patients. It is also one of those smaller hospitals which can achieve a more friendly and intimate environment than is possible in larger hospitals.

The physical fabric of the hospital might justify the relocation of the unit elsewhere, but it certainly does not justify the closure of that unit without replacement.

What other justification could be advanced for the closure of the unit? Undoubtedly the claim will be advanced—I suspect the Minister has been briefed to this effect—that there is an over-provision of maternity beds in the district". Such a claim can be substantiated only by a juggling of the statistics to suit the argument. There are only two maternity units in hospitals managed by the district health authority—Westminster hospital and the West London hospital. Between them they provide for about 3,000 births a year—about 2,000 at the West London hospital and about 1,000 at Westminster hospital. The birth rate for the Riverside area is about 3,500 and the forecast, based upon a midpoint projection, is about 3,700 a year.

Local needs can be met adequately only because of the two other maternity units, which do not come under the district health authority, but come under the special health authority. I refer to Queen Charlotte's and Hammersmith hospitals. Beds there are not primarily available to local residents. The North West Thames Regional Health Authority's maternity patients flow data show clearly that only a small proportion — about 17 per cent. —of maternity patients at Queen Charlotte's come from Hammersmith and Fulham. Most come from other areas.

There is no catchment area for obstetrics and no priority is given to local patients. Many of my constituents are refused access to Queen Charlotte's hospital. The letter that is sent out states simply: Your doctor has written to us requesting a booking for your confinement at Queen Charlotte's Maternity Hospital. We very much regret that during the time of your expected confinement we are fully booked and suggest that you return to your doctor immediately so that alternative arrangements for your confinement can be made. Letters like that are being sent out in large numbers. According to recent evidence from Professor Elder, 150 applicants a month are turned away by the special health authority. So much for the argument about over-provision.

Furthermore, the argument ignores consumer choice. West London and Queen Charlotte's hospitals are both excellent in their way, but they represent entirely different poles of maternity care provision. The West London hospital has a national reputation for progressive maternity care, for natural child bith and for taking account of the woman's needs and wishes. My three children were born there, so I know of the extraordinary sensitive care that my wife received during her confinements.

The consultation document admits as much. It says: The West London unit is justly famous. It has been in the forefront of the development of more liberal and sensitive approaches to maternity services and has become known as a leading centre for natural child birth. It is also regarded as a major centre for teaching and research. That is a tragic comment on the state of the Health Service under this Government. An outstanding maternity unit is threatened with closure without replacement.

The third argument which might be advanced for the closure is that patients can go instead to Westminster hospital. That involves the loss of the West London unit and its tradition of excellence. It will involve a substantial aditional journey for people in my constituency that is particularly important if their children are in the neo-natal intensive care unit and they have to be on hand to be close to their babies.

The fundamental argument is that even if one of those units has to close because of over-provision, West London certainly should not be chosen. West London is the only unit which satisfies the health authority's criteria for the minimum standards of provision which make the unit viable. The health authority's planners have made it clear that the minimum standard for viability is 2,000 births per year. The West London hospital achieves that, but Westminster does not. Even with the proposed extra provision, Westminster will still have a capacity for only 1,700 deliveries — far below the minimum level for viability. What an extraordinary proposal.

There will be a serious potential impact on Charing Cross hospital and its medical school. The closure of the unit at West London will leave a major teaching hospital without an associatud obstetrics unit. That will create an extraordinary situation and, as the consultation paper admits, it will have a knock-on effect on the gynaecological service. The document states: Some impact on the existing provision of gynaecology services could result. Any reduction in the level of gynaecology services would have to be the subject of separate formal consultation. The paper admits that there will be serious potential consequences and that there will have to be further consultation, yet it is still proposed to go ahead with the closure of the West London hospital. That is nonsensical. Furthermore, this could undermine the viability of obstetric teaching at Charing Cross.

Professor Curzon has said that the closure of the West London unit would have drastic consequences. I shall quote from a paper that he wrote earlier this year, which states: If the West London obstetric unit were to be closed before a definitive solution to the long-term provision of obstetric services had been agreed and implemented, the School's department would have to move to some other temporary site. This would compound the damaging effects of further uncertainties about the future with the considerable turbulence resulting from the move. The only possible sites to which the department could move would be either Westminster Hospital or Queen Charlotte's Hospital. It has already been shown that Westminster Hospital fails to meet the essential criteria of sufficient resources for teaching, and provision of obstetrics and gynaecology on the same site. A subsequent note from the Professor states that Queen Charlotte's hospital will not take the students in question.

There are all these damaging consequences. The cuts will have an effect on patient care, medical education and related health services. Above all, they will fly in the face of public opinion. When the closure was last proposed, there was generated a massive public reaction. There are many who are associated with the hospital, including patients and nurses in the Public Gallery today to show their concern.

I hope that the Minister will reconsider this ill-thought out proposal, which will have damaging consequences. If the Government wish to be taken seriously in their claim that the Health Service is safe in their hands, they must provide more funds to maintain the viability of this hospital.

2.16 pm
The Minister for Health (Mr. Barney Hayhoe)

First, I congratulate the hon. Member for Fulham (Mr. Raynsford) on what I think is his first Adjournment debate. I am sorry that he rather muddied his advocacy of local interests by making a number of highly party political assertions which he scattered during his speech. I repudiate the simplicity of what he was saying in such a party political context.

The West London hospital is a smallish hospital with fewer than 150 beds providing geriatric, psycho-geriatric, obstetric care, in-patient services and a special care baby unti. There are out-patient clinics, which I know are held in high regard. As the hon. Gentleman said, the building is in a poor state of repair and would require major capital investment to bring it up to a reasonable and acceptable standard. It is rather an isolated unit that is away from the associated specialty and support services that are normally found on a district general hospital site. When the hon. Gentleman was commenting about particular units he said that they could gain by being brought into Charing Cross and being close to the back-up services.

The services that are provided at West London are part of the overall service provision of the Riverside district. The Riverside health authority is responsible for planning services throughout the district and has to ensure that they are provided in a sensible and cost-effective manner.

The subject chosen by the hon. Gentleman for the debate is the future of a particular hospital. I am sure that he will understand that it cannot be considered in isolation. Any reasonable consideration must include services in the district as a whole. At present, the Riverside district is undertaking a review of all its services and it is considering the options for future patterns of services. Its budget last year, 1985–86, was over £120 million, and for 1986–87 it has already increased to over £128 million. There is still the share of the additional £50 million that the Government have made available to meet part of the cost of the pay review body awards. There is, therefore, further money coming to the district. The review which the authority must carry out includes the services provided by all the hospitals in the district and takes account of the changing population. The population of Riverside is declining and it is expected to fall by about 10 per cent. by 1994. Future services will need to reflect that decline. The real cuts that are taking place are in the number of people living in the Riverside area. Furthermore, in Riverside—little mention was made of this—there is a need to develop community services to ensure a better balance between hospital and community provision. While I understand why particular pressure groups home in on specific aspects of more general proposals, I believe it important that balanced judgments are made in proper context.

The overall regional strategy within which the district review is taking place has been generally endorsed by Ministers. The region's main broad strategic aims—the improvement of acute services in some parts of the region and the improvement of priority services throughout the region—are in line with national priorities. The region's overall approach to securing the resources needed to achieve those aims requires, first, the release of resources from local acute services in districts such as Riverside and, secondly, greater efficiency in the provision of these and other services throughout the region.

If, as a result of its planning, the district health authority decides that the closure or change of use of Health Service premises is necessary, there is a formal procedure which it must follow. This is set out in Health Circular HSC(IS)207. This requires health authorities to consult widely on their plans and to consider all comments that are made. Community health councils must be consulted and are free to put forward counter-proposals. Any such proposals by the CHC must be carefully considered by the health authority alongside the original plans. If the health authority rejects the counter-proposals and reaffirms its original plans, the matter must be referred to the regional health authority. If the RHA supports the DHA's decision the proposal must then be referred to Ministers for a final decision. There is a long consultation process.

I have gone into general issues by way of background in some detail despite what the hon. Gentleman said and what is implied in some comments I have heard, final decisions have not been made about the future of the West London hospital. I understand that today the district will circulate to health authority members its draft — I underline the word "draft" — consultative document. That document is to be considered by the health authority at its next meeting on 24 July. It has not been published. Obviously, the hon. Gentleman was quoting from a document. I do not know how that document was obtained. The document, in draft form is going to the health authorities for their consideration. It would he wholly inappropriate for me to comment in detail at this stage. If the DHA decides to go ahead, I shall look forward to hearing the results of the consultation exercise.

The hon. Gentleman referred to obstetric care. I understand his family connections in that respect. I am delighted to join with him in paying tribute to the high reputation that the unit has built up, especially under the leadership of Professor Norman Morris, who I believe retired last year. The unit has an innovative tradition. That is continuing. It is known as a pioneering centre for natural childbirth.

I do not accept the rather artificial destinctions that the hon. Gentleman tried to draw between the various hospitals that serve people in this part of London. Queen Charlotte and Hammersmith hospitals are run by a special health authority, but they bring in a considerable capacity for maternity care in that area, in addition to that provided by the Westminster and West London hospitals.

The latest figures that I have seen—they are for 1984—show that about two out of every five mothers involved came from Riverside. Two out of every five women treated in the obstetric maternity areas of those four hospitals were Riverside mums. Over 5,000 came from outside the area. I am sure that some came from my constituency, because there is a close link between some of the hospitals in Riverside and those in my district of Hownslow and Spelthorne.

A balance must be achieved. It is important that we do not deal with these matters in watertight compartments. Perhaps there was too much of that in the past. It is necessary to look at health care, especially in London, and at the facilities provided by the health authorities and the special health authorities. I note, of course, the arguments put forward by the hon. Member for Fulham. I am sure that the health authority will do so also. I am sorry that he was rather narrow in his consideration of these problems and did not take a wider view.

As I have said, at this stage I shall make no comment on the West London hospital. It is for the health authority to come to a decision. It is right that health authorities should be generally free to explore all the options open to them. They must not be hidebound in their thinking but must consider a wide range of alternatives, even when they may involve radical change. When they have done that, there is a formal consultation process to ensure that the views of those affected are taken into account before final decisions are made. This seems to be the right way to proceed and to ensure the proper plan of future health services to meet the evolving requirements of health care in the district and region concerned. We are concerned not with what existed years ago but with making proper plans for the future provision to deal with patient needs.

I wish that there was more reasonable and balanced consideration of these issues. They are not helped by biased and distorted media coverage of NHS matters. I shall mention one concerned with west London hospitals. Recently the letter page of The London Standard contained a letter headlined "Londoners caught in a red alert". It was said that the whole of the North West region had been on red alert since March. The North West region occupies a substantial part of the home counties. The letter was totally untrue.

The administrator of the emergency bed services wrote making the correction that the red alert had lasted not for months but for four days, from 7 to 10 March, yet that letter was hidden away and given little prominence. I wonder whether the original letter was politically motivated and why The London Standard should in this instance, and often in other ways, give prominence to critical stories about the NHS in London, whether they are accurate or not, and ignore or seldom mention new hospital developments and improvements.

The provision of health care for the future and the discussion about it are of immense importance to all concerned. It is right that the hon. Member for Fulham should use the Adjournment debate to raise matters of special concern to his constituents. Having said that, I think that we should discuss them in a sensible and balanced fashion.

I know that the hon. Member for Linlithgow (Mr. Dalyell) wishes to bring forward another Adjournment debate. Rather than reply in more detail, I shall sit down to give him that opportunity, although I am rather surprised that he is not in his place.

2.28 pm
Sir John Biggs-Davison (Epping Forest)

On a point of order, Mr. Deputy Speaker. Will you help the House? The hon. Baronet, the Member for Linlithgow, (Mr. Dalyell) who is not present, has complained that he has not been given time to pursue by debate his personal campaign against my right hon. Friend the Prime Minister. You will observe, Sir, that a Minister of the Crown and my right hon. Friend the Leader of the House are present. A number of hon. Members are here in the hope that we might take part in the debate that the hon. Baronet wished to raise.

Mr. Deputy Speaker (Mr. Harold Walker)

These are not matters for me. The hon. Member for Linlithgow (Mr. Dalyell) has not made any complaint to me.

Question put and agreed to.

Adjourned accordingly at twenty-nine minute past Two o'clock.