Swale District General Hospital (Hansard, 9 May 1986)

§ Mr. Roger Moate (Faversham)

In recent weeks I have received more than 7,000 letters and submissions from individuals on the Isle of Sheppey. By any standards that is a heavy postbag. Indeed, the letters alone without the envelopes weight 22lb. Those letters have come to me because on the Isle of Sheppey, in my constituency of Faversham, and in the borough council of Swale, we face yet another threat, indeed a double threat, to our Sheppey general hospital.

The Medway health authority is planning to remove surgical facilities from Sheppey general hospital. That move has been opposed by virtually the whole local population. Many of them have opposed it and in writing it has now been formally opposed by the community health council. I mention that because I suspect that the matter will undoubtedly come before my hon. Friend the Minister and the Secretary of State for a final decision. At the same time, we are faced with yet another threat, the possible closure of the Sheppey general hospital maternity unit. That arises not out of any plan of the Medway health authority but from the Royal College of Obstetricians and Gynaecologists, which is recommending the withdrawal of recognition of the training of junior doctors.

The people of Sheppey have fought long and hard to preserve their hospital. It is not a small cottage hospital but a 110-bed general hospital. Sheppey is a large community of some 40,000. It is an island linked to the mainland by a lifting bridge. Communication with the mainland is far more tenuous and difficult than most people in the south-east of England can begin to understand.

I make no apology for raising this issue again with the Minister. This is the fifth occasion in less than four years that I have stressed the need for us to maintain our local hospital facilities, at least until we have our new Swale district general hospital. In November 1982 I submitted a petition from 7,500 Sheppey people urging the maintenance of the general hospital until the new Swale hospital is completed. On 15 June 1984, I presented yet another petition signed by 6,500 people again urging that the maternity unit at the hospital and all existing facilities be maintained or improved until the proposed new Swale hospital is completed.

The Secretary of State's reply to that petition was very significant. On 12 July 1984 he gave me an assurance that there had been no decision to run down the maternity facilities. He stated that the authority did not envisage any change to present maternity facilities before 1990. On 20 January 1985 I had an Adjournment debate on resources for the Medway health district. Again, I stressed the need for our second district general hospital to be located in the borough of Swale. I stated then that the Medway strategy included a second district general hospital in the Swale area, and that there was an urgent need to commence planning so that building work could begin as soon as the capital finance was available. The key point is not that we expect money tomorrow, but that we expect some plans tomorrow.

In March 1985 I had yet another Adjournment debate, this time on the Sheppey maternity unit. I again stated that we must have our Swale district general hospital, but in 423 the meantime we had to ensure that our local hospital services were maintained and improved. That is the other part of the issue—if we cannot have our new district general hospital, we must have the Minister's and the Government's support in maintaining the widest possible range of medical services for this very large and often isolated community.

I stress that the proposed district general hospital has been part of the strategy plan for some time. The Medway health authority plan states that Swale hospital is still required and that it will be a long-term aim for the authority to develop in order to provide comprehensive hospital services for the population in the eastern part of the district. It also states that it is urgently necessary to build up the acute services of Sheppey hospital to provide the main eastern hospital base until Swale hospital can be afforded.

It is a tragedy, therefore. that the regional strategic plan for Medway says nothing whatsoever about the Swale hospital. The 10-year plan says nothing about the need for a second district general hospital. In that omission lies some of our frustration. It is fine to talk about these facilities for the long term, but to omit them from the next 10-year plan makes one wonder whether they will be included in the following 10-year plan, or whether we will ever see them at all.

It is clear that the South-East Thames hospital region does not envisage such a hospital this century. That is unacceptable to the whole of the population in our area. There is no planning in sight, there is no site acquisition in view, and, as, far as we can judge, there is not even the prospect of a full option appraisal.

I stress that we are not necessarily talking about new and major additional expenditure. We are essentially talking about the replacement of old fabric and the possible replacement of four—in some cases very old—hospital facilities. It may be that the assets available would in many ways compensate substantially for any additional capital expenditure. It worries me greatly that as a society we cannot plan, at least within a decade or so, to develop in a businesslike manner facilities that, generally speaking, most of the people involved agree are necessary.

Medway is the most under-provided district in the south-east of England. It has only 70 per cent. of its resource allocation working party target. Against that, we know that the district is to receive major capital growth of more than £35 million for the expanded Medway district general hospital. That is a programme of which we can and should be proud. No one is naive enough to believe that we can suddenly conjure up additional unlimited resources for a second district general hospital in the immediate future. But what is unacceptable to the thousands of people who have written to me, to the community health council and to the local elected council is that we should continue to run down the services in the eastern part of the district until new facilities are built.

What we need from the Minister is an assurance that he will resist any proposals—and I suspect that they will be coming to him—to close surgical facilities, maternity facilities or casualty facilities. They are not under threat at the moment. We want to be sure that the Minister will support us locally in resisting the closure of any such services. It is clear that it is my hon. Friend who will decide these matters because it is virtually certain that the local council and the community health council will 424 continue to resist the closures. They have a clear understanding of local hospital needs and are very much in touch with local feeling on these matters.

This is perhaps the most important point. Will my right hon. Friend the Minister raise with the region or Medway health district the possibility of bringing forward our planning for the new hospital? That is the key point. The hospital is part of our strategy. It must be an indictment of our system if we cannot get on with site acquisition and planning at the very least. We would warmly welcome a visit from my right hon. Friend. I promise him that it would be a friendly visit. A ministerial visit allows us to show how unusual the location of the Isle of Sheppey is, and how concerned local people are about the difficulties of communications to the mainland.

Recently, members of the community health council and the hospital watch committee demonstrated the difficulties facing people on Sheppey when travelling to the mainland, and just how impossible it will be if they are forced to travel even further for more of their hospital needs. For example, one of the propositions is that the day surgery should be transferred to Sittingbourne. which is a smaller hospital with fewer facilities than Sheppey. For that, one of the rules is that one has to be in hospital by 8 am. That is physically impossible by public transport from many parts of the Isle of Sheppey. Someone at Leysdown, at the eastern end of the island, would have to leave by 6.30 am, and still he would he late at Sittingbourne. It would be a difficult bus, train and then bus journey taking over two hours and costing nearly £5 for the return fare.

Travelling to the Medway hospital is worse. Again, the journey time would be well over two hours by bus, train and bus. The journey would be long and difficult. At one point there is just a four-minute transfer time from one train to another at Sittingbourne. That assumes that one is healthy enough to maintain a rigorous timetable and switch trains at quite a rate. But one would not he going to hospital if one was healthy. On a Sunday it would be literally impossible for residents to go by public transport to visit relatives in the hospital at Medway and get back again. The timings make it too difficult.

I do not believe that in trying to provide a caring Health Service and first-class medical facilities, which we are all striving to achieve, we are serving the community if we move the centres of excellence so far from the periphery that people cannot get there to receive humane and caring personal services, which, after all, is part of the process of cure. We all know the difficulties. In many ways, the solution is within our reach. It is to maintain our local facilities until such a time as the desirable goal of building a new local hospital can be attained.

For all those reasons, I have received 7,000 letters and submissions. I venture to suggest that few other hon. Members will have received 7,000 separate letters on a single issue, although that number of people might sign petitions. Opening most of those individual letters my self has been a sobering task. Many people have related personal anecdotes and stories about the importance of the hospital and the difficulties that they and their families would face. It is heart-rending to read what people say about the prospect of losing the large range of services at Sheppey.

That is why, once again, I have brought this proposition to my right hon. Friend the Minister. I ask him to try to cut through the planning and financial red tape and to make 425 it clear to the hospital authorities that it is unacceptable to continue to concentrate hospital facilities in the Medway area to the detriment of the people of Swale. We must maintain those local facilities to high standards even if it means a modest improvement of local facilities for the next decade, until such time as we can make the prospect of the Swale district general hospital come true. We do not expect miracles, but we expect sensible planning and compassion. We feel more and more that they are lacking from the long-term plans of the planning authorities.

Swale considers itself to be the poor relation in the poorest hospital district in the south-east. I warmly welcome the extra expenditure committed to Medway. It is wrong that people are misled into believing that there are wholesale cuts or that the changes are the result of cuts in expenditure. The reverse is true. Medway will have one of the finest, new hospitals in the south-east. It is unacceptable to my constituents that, parallel with the improved facilities, there should be a withdrawal of facilities from the hospitals of which they are so proud on the Isle of Sheppey and in other parts of Swale.

§ The Minister for Health (Mr. Barney Hayhoe)

I first congratulate my hon. Friend the Member for Faversham (Mr. Moate) on having once again secured an Adjournment debate in which to raise matters affecting hospital medical provision in his constituency. This time, my hon. Friend has concentrated his debate on the proposed district general hospital at Swale. He referred to the proposed closure of some surgical facilities. My hon. Friend must recognise that certain procedures are laid down in law which must be followed in the case of closure proposals to which objection has been made by the community health council, and I assume that objections will be made in this case. It would be wrong for me to comment on a matter which will come before Ministers for decision. I assure my hon. Friend that the proper procedures will be followed.

I know that my hon. Friend is voicing the concern of many of his constituents about developments in that part of the Medway health district to which he referred—the Isle of Sheppey. He did so eloquently in an Adjournment debate last March on the Sheppey maternity unit. As a result of what he said on that occasion, the proposals were modified. I hope that my hon. Friend will take that as a sign that careful consideration is given to all the points that he makes.

My hon. Friend is well known for the role he plays in representing his constituents' interests. The 7,000 letters to which he referred are a tribute to him. I suspect some hon. Members—I would not be foolish enought to say where they sit or who they are—do not have 7,000 constituents who believe that it is worth writing to their hon. Member. My hon. Friend clearly commands much respect among his constituents, who believe that if they write to him, it will affect what happens in the future.

I shall not add to what was said by my hon. Friend the Minister for Housing, Urban Affairs and Construction in response to the Adjournment debate last March about the Sheppey maternity unit. However, I should make it clear that the Government do not lay down in detail what should or should not be the pattern of service in different localities. Indeed, as soon as one thinks of the task that 426 would be involved and the burden that would rest on civil servants and Ministers, one would recognise that it would be impossible. Hospital provision, whether of a district general hospital or of a more specialist kind, must be planned flexibly in the light of resources available, of professional advice and of local circumstances and demand.

I know that my hon. Friend recognises that demands for health care are pretty well unlimited while most claims that are made on health care resources are desirable. He also recognises that resources are not unlimited and so priorities must be established nationally, regionally and locally. The demand and the need for a district general hospital in the Sittingbourne and Swale area is, I understand, fully recognised by both regional and district health authorities. The crucial issue is not whether such a hospital is needed but the timing of priorities and resources. My hon. Friend acknowledged that.

If Swale were the sole district general hospital development proposed for the Medway health authority, there would be nothing to debate. It would no doubt be more than halfway to completion. However, the development at Swale is one of two major schemes in preparation by the district health authority. Given that resources are finite, the authority's decision is that the phase III development at Medway—costing some £35 million at 1984 prices—should take priority. This decision rests firmly with the health authority, and was, I am advised, taken on three main grounds. The authority saw its first priority as providing a development which would substantially reduce the overall shortage of beds and services in the district. Development on a new site, at Sittingbourne or elsewhere, would require money to be spent providing back-up services, roads, stores, and so on, and thereby reducing the potential sum available for patient services. The greater part of the district's population—about two thirds—is concentrated in the Medway towns and understandably, the authority believes that that is where its present effort to develop services should be focused.

The phase III Medway development is expected to become operational in stages during the years 1988–89 to 1991–92. The early stages will result in the internal transfer of services, but the later stages will enable more work to be undertaken within the district with a corresponding reduction of work currently going out to other districts.

Once this is achieved, the Medway health authority, I hope by then more self-sufficient and better funded through its increased RAWP allocations, will be equipped to prepare for a second district general hospital development at Swale. As I have mentioned, the need and demand for such a development is well recognised. Inclusion of surgical beds, for instance at Swale, will make possible a rationalisation of acute services throughout the district and the phasing out of some of the older, smaller hospitals that are increasingly less able to provide a modern and comprehensive health service.

I know that the district health authority has the support of the local authority, the community health council, the regional health authority as well as that of my hon. Friend and his neighbouring colleagues who will be affected. Support for the Swale development is widespread—I know of no one who opposes it. Therefore, in principle, everything appears to be in its favour, the only problem being time and resources. Once the resources are 427 available, my hon. Friend can feel confident that the planned development will become a reality. However, I would be less than honest if I left any impression that I foresaw early action being taken. As my hon. Friend recognised, there is a long time scale. I appreciate my hon. Friend's concern that that timescale seems to be stretching so far ahead at the moment that people will not be able to think of there being a real plan but just a hope and dream for the future.

I shall pass on to the regional chairman what my hon. Friend has said, and in particular I shall pass on his desire to take the early steps, which might well be highly sensible when considering the time scale that must be followed for major developments of this kind.

I have also noted and been impressed by what my hon. Friend said about the need to deal with the existing services in the area so that they do not present real difficulties for the population who would be left with a declining service and only a long-term and distant hope for the improvements that all agree are necessary.

428 I understand the pressure and thrust of what my hon. Friend is saying. He is not demanding more money at the moment and he is not saying that another area should be denuded in order to help his own. I was grateful for his comments about the significant developments in the Medway district, and I also recognise his concern for the longer term on behalf of his constituents.

I suspect that my hon. Friend did not believe that I would have available in my hip pocket today a post-dated cheque or a promise in hard terms that the Swale district general hospital would be in the programme by a certain date. But once again my hon. Friend has performed a valuable service for his constituents by drawing the attention of the House to the problem, particularly by commenting on the transport difficulties that many of his constituents face. I shall try to ensure that all those matters are taken into consideration on any decision that Ministers have to make.