HC Deb 30 October 1986 vol 103 cc585-92

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

10.38 pm
Mr. Dick Douglas (Dunfermline, West)

I should like to point out a slight change in the motion before the House. The subject of the debate should be the future development of the west Fife district general hospital and not "Fife West" as on the Order Paper.

I am pleased to see in his place the Parliamentary Under-Secretary of State for Scotland, the hon. Member for Argyll and Bute (Mr. MacKay). He has been translated from responsibilities that he had for the Health Service in Scotland to another post and his place has been taken by Lord Glenarthur. I understand that the Parliamentary Under-Secretary is answering questions on health matters. My hon. Friend the Member for Dunfermline, East (Mr. Brown) and I met the hon. Gentleman to discuss this matter.

It is with some diffidence that I raise this matter in the House. It involves some detail and trying to achieve a balance of advantage between certain areas in Fife and other areas outside Fife. It concerns the inter-relationship of the Scottish Home and Health Department with a health board and the health board's area of responsibility. As a Member of Parliament, I have some diffidence about intervening in these activities. I hope, therefore, that I will not bore the House by going over some of the background as I try to set the scene as to what is agreed and where the areas of disagreement may be between the Scottish Home and Health Department and the health board in Fife.

I do not think that there would be any disagreement about the shortage of acute beds in Fife. My information is that—and I accept that these are broad brush figures — between 5,000 and 10,000 patients a year have to travel out of Fife for hospital attention. My argument is based on statistics furnished by the health board. There is a requirement, in terms of acute bed provision in Fife, for 938 beds. That is the total requirement for Fife.

I am not trying to play my area off against any other area, but in Dunfermline we have certain additional disadvantages in relation to the shortages of acute beds. The problems lie in the fact that there are three different hospitals which cater for specific services: Milesmark, Dunfermline and west Fife hospital and the Dunfermline maternity hospital. That leads to an unsatisfactory situation as there is a duplication of services and unsatisfactory and old facilities.

The health board naturally desired to rationalise the position and to concentrate activities on one hospital in Dunfermline. In 1983, the health board tried to resolve the position by making an earnest attempt to examine the overall position and, coincidentally, to determine the content and progress of the acute bed facilities in Dunfermline under the phase II development in the new west Fife district general hospital. I make no criticism of the Government's overall strategy. They have tried to reallocate the resources within hospital expenditure in Scotland and, instead of being one of the disadvantaged areas, Fife has begun—and I say that diffidently— to receive fairer treatment.

I have referred to 1983. After many years of unproductive discussion about the new acute hospital for Dunfermline, it became apparent to the board in 1983 that the effort should be made to reach a decision which would lead to approval being given by the Scottish Home and Health Department to the building of a new acute hospital in Dunfermline. That building project was of such a magnitude that it would have to be funded centrally by the Treasury. To obtain approval in principle from the SHHD, the board was obliged to carry out two procedures. As far as I understand it, that was unique. The board was the first to carry out these procedures, what is called an option appraisal exercise and the preparation of an approval in principle submission. These are technical terms and I do not understand the details except to say that the option appraisal exercise consumed a great deal of valuable time—about 18 months — of highly paid officials within the board and elsewhere.

Arising from the option appraisal scheme there were five options available to the board. One was to cater for the facilities outside the Fife area and another was to do so within the Fife area. Both options were dismissed for obvious reasons. The options were narrowed to two. Option C was based on an equal distribution of facilities and option D on the balance of population.

On 26 June 1984 the board decided to proceed with option C on the basis of advice from the building division that developing the Victoria hospital site was not feasible. I do not want to interfere with any of my hon. Friend's constituency, but that was the advice from the building division. Option D involved a third set of theatre suites. On balance it was decided to proceed with option C in Dunfermline.

One would have thought that everything was set and that the Fife board could proceed with option C, subject to other approvals being granted. However, in late autumn 1985 the board received a development plan for the Victoria hospital from the building division which had stated earlier that it would be inappropriate to develop the Victoria site further. The building division suggested that a fairly large new building might be built. Further investigations suggested that it might be possible to provide a larger development, contrary to what had been stated previously by the building division.

I do not know about the Minister, but I have seen a sketch plan which reveals a weird and wonderful development and which opened up further study. Advances in engineering and technology could make what was not possible in 1983–84 possible in 1985. Anyway, the hospital board found that it was impelled, if not compelled, to go through the exercise of evaluating whether it was technically possible to expand the Kirkcaldy site.

Initially the Scottish Home and Health Department raised a number of queries about the phase II development of the west Fife district general hospital, to which answers were given. Information was given to the SHHD about the feasibility of a larger development on the Victoria site at Kirkcaldy. In April 1986 the Department wrote to the board stating that as there had been recent indications from the building division that further development at Victoria hospital might be feasible, a more detailed study of the apparently abandoned option D— or something like it — was required and it requested a study to be carried out, having regard to capital cost and revenue consequences. This study has been embarked upon.

I may not have entirely accurate information—I do not wish to mislead the House—and 1 apologise to the Minister but I am told that, in broad ball park figures and capital costs, there is little to choose between option C and option D. We are talking about figures of between £28 million and £30 million either way. Although full studies have not been completed, there is little to choose, in revenue terms, between the options.

My information is that, on Friday 24 October, the Fife health board's senior officers met with officers of the building division of the Common Services Agency to discuss the studies in relation to the design and capital costs involved in option C at the Victoria site and the option D implications of the west Fife district general hospital site. This meeting was reported to the Fife health board on 28 October and there will be a further meeting to discuss the matter.

I apologise to the House for the time I have spent in setting out the background. What is at stake is the delay and the disadvantage to constituents — not only mine but constituents throughout Fife.

If Treasury money is involved or Treasury sanction is required, it is right that we should go through an evaluation exercise. I do not question that—indeed that would defeat my purpose. The evaluation exercise has been carried out but it has been reopened on the basis of what I consider to be a very flimsy overture by the building division and its architects.

No conclusion has been obtained on the basis of a capital evaluation and no conclusion has been obtained on the basis of a revenue evaluation. To put it crudely, we are back to political pressures and a balanced judgment of what could be done on a green field site in Dunfermline and what Can be done on a rather congested site in Kirkcaldy. These are value judgments. I believe that the best organisation to assess these judgments would be the Fife health board. I appeal to the Minister to make it clear that, at the end of the day, which I hope will be soon, we will not have any pressures exerted by the Scottish Home and Health Department on the health board, through various political channels, to accept something which the health board does not want.

The health board is strictly adhering to option C, which it initially embarked upon. Other factors interpose themselves. Due to the shortage of acute beds in Fife, many people in my constituency and that of my hon. Friend the Member for Dunfermline, East and other hon. Members have to travel either to Tayside or to the Lothians. We await an evaluation of the cost of option C from the Scottish Home and Health Department.

Recently we met Lord Glenarthur and he said that he hoped that this "delayed" survey on the cross-boundary flows would be done quickly. In a letter to my hon. Friend the Member for Dunfermline, East and myself on 22 October he said: On the matter of cross-boundary flow, I must emphasise that Fife Health Board's proposals for West Fife District General Hospital Phase II, together with the option appraisal were only submitted to the Scolttish Home and Health Department in January of this year. We do not necessarily accept that stricture.

The assumption on the part of the Fife health board was that, having assessed option C, the exercise of cross-boundary flow was one that it should not concern itself with. However, the letter went on: The work on cross-boundary flow could not, therefore, have commenced prior to that time, as it was not known what the Board's proposals were. We dispute that. The letter also states: Assuming the Health Board are able to resubmit their proposal to me before the end of this year, I would still hope to be in a position to make a decision early in 1987. We welcome that. However, I must emphasise that the major concern is delay.

I hope that the Minister will accept that what I have said is said with sincerity. Our concern is about the injection, late in the day, of another survey. The File health board was the first to go through an option appraisal scheme. I submit that to open the argument again, however persuasively it may have been put—initially I was not persuaded on the basis of an architect's flimsy drawing—involves delay. That has a cost that no one has been asked to evaluate. Delay involves suffering to people in Fife, especially people in my constituency, who expect to have their needs in terms of acute beds satisfied.

We are talking about getting something done that should have taken anything up to nine years. My estimation is that, because oi' the delay, it will be the year 2000 before the problem is resolved. I know that the Minister has difficulties and I understand the problems of intervening. However, I am asking for an assurance that he will give resources to the Fife health board to expedite this and that the board will be left to make the judgment at the end of the day as to what is best for the people of Fife and what the distribution of hospital services should be between one part of the board's area and another. I earnestly look forward to the Minister's reply.

10.57 pm
The Parliamentary Under-Secretary of State for Scotland (Mr. John MacKay)

The hon. Member for Dunfermline, West (Mr. Douglas) has illustrated his concern about the delays in building a new acute hospital in Dunfermline. I can understand that. As he mentioned in his speech, he and his hon. Friend the Member for Dunfermline, East (Mr. Brown), who I see is in the Chamber, came to see me while I was the Minister responsible for health and we discussed this matter. I know that they have been to see my noble Friend the Minister of State who has taken over those responsibilities at the Scottish Office and have expressed to him their concern about the delays.

I am afraid that, as I and my noble Friend have said, we cannot agree that the board ignored the new evidence which came to it affecting the choice of the site that it would develop when considering a new hospital investment in Fife amounting to many millions of pounds. I do not think that the board or the Scottish Home and Health Department could have ignored what they heard from the building division. They had to look at the implications of that advice and at the implications for the adjoining health boards of any proposals to build a new hospital in Fife.

I shall describe the acute hospital provision in Fife at present and why the Fife health board wishes to provide replacement and additional accommodation. I shall simply be underlining something that the hon. Gentleman and I agree upon, which is that new hospital accommodation is needed in Fife.

At present there are some 793 acute beds in Fife, the main concentration being at the Victoria hospital, Kirkcaldy, with 365 beds, and a scattering of eight small and medium-sized hospitals, some in less than ideal condition, making up the balance. The total number of 793 compares with anticipated needs in 1991 of 918 acute beds. The number of acute hospital beds in Fife is therefore significantly short of the number required. At present, the shortfall is in large measure compensated by treatment provided for Fife patients in Edinburgh by the Lothian health board.

Fife health board wishes substantially to reduce the cross-boundary flow. The board is also concerned that the proliferation of small units of existing accommodation in Dunfermline and the Kirkcaldy area needs to be rationalised. In 1983 the board embarked on an option appraisal. The hon. Gentleman used the word "unique". It was not unique—it was the first detailed option appraisal on that scale. Now it is a routine procedure. Option appraisal is an important procedure to determine where we should put major capital investments and how best we can make those investments for the benefit of the service into the future.

I do not want to repeat what the hon. Gentleman said because I want to try to put the main points in my speech. However, he mentioned the options. Option A involved closing a number of acute beds at Dunfermline and substantially increasing the number of patients treated in Lothian. That, for obvious reasons, was rejected.

Option B was essentially a "no change" option. Facilities at Dunfermline would be upgraded and the cross-boundary flow to Lothian slightly increased. Fife health board rightly decided to reject that option.

Option C involved a large new hospital at Dunfermline, with the existing acute hospitals there closing down, and a smaller extension to Victoria hospital, Kirkcaldy, replacing the beds at Cameron, Hunter and Randolph Wemyss. It was thought that that option would substantially reduce cross-boundary flow to Lothian.

Option D would provide rather less development at Dunfermline but correspondingly more at Kirkcaldy. The fifth option, option E, envisaged substantial development at Kirkcaldy and very little at Dunfermline, with cross-boundary flow to Lothian increasing slightly.

Options E and D were quickly ruled out because of what were thought at the time — April 1983 — to be insuperable difficulties on the Kirkcaldy site. In April 1984 option A was also dropped because it would have caused revenue problems for Fife and also, of course, because of the inconvenience to patients and relatives travelling to Edinburgh. Furthermore, it was thought that Lothian health board would have considerable difficulty in absorbing a large increase in acute patients. Option B was rejected as failing to meet the problem, leaving option C as the board's preferred solution.

In December 1985 the board presented a submission to the Department for approval in principle to build a second phase of west Fife district general hospital, providing 432 beds. That was followed in January 1986 by the board's option appraisal document. However, at that time it became apparent that further development at Victoria, Kirkcaldy, in addition to the 102 beds proposed by option C, might in fact be possible. That followed on advice provided by the building division of the Scottish Health Service Common Services Agency. It was clear that the board would have to look again at what facilities might be provided at Kirkcaldy, and that option D need not have been deleted purely on the ground that it was not feasible to build additional accommodation at Kirkcaldy.

Mr. Gordon Brown (Dunfermline, East)

rose—

Mr. MacKay

I shall give way to the hon. Gentleman, although it will probably mean that I shall not be able to cover all the points.

Mr. Brown

I want to comment on the precise point which has led to the further consideration of option D. It seems that it was pointed out that it might have been technically feasible to build on the site. Is the Minister aware that the board rejected option D not only because it doubted the technical feasibility but because it regarded the proposal, which would involve three theatre sites, as — to use the board's words — "totally impractical"? Therefore, whether or not the site was technically feasible for building was not the major or only issue in the board's decision when it rejected option D. Why, then, is the board being forced to go through a technical submission on option D when it is clear that it rejected that option as being totally impractical even if technically feasible?

Mr. MacKay

I was not present to hear the board's deliberations. It may not have been the only reason for rejecting option D, but if one is told that there are insuperable building difficulties, that must be a principal reason. One may not like what flows from that, but one does not pass that hurdle if advised that there are insuperable difficulties.

Both hon. Members told me that they would have preferred it if those insuperable difficulties and that position had remained. I understand that point, but we have reached the stage where it appears, from advice from the building division, that it would be possible to provide such facilities at Kirkcaldy. Both hon. Members have asked me why the new advice meant that the board's appraisal of the options had to be reconsidered. It is now clear that further development is feasible at that site, and the board and the department thought that it should be explored. The building division has produced a design solution for the Victoria site which is being considered by the board.

I have already stressed the importance of a proper appraisal of options when dealing with capital expenditure. If Fife health board had ignored the new evidence about building possibilities at Kirkcaldy, the basis of the decision-making process leading to the approval in principle submission for phase 2 of the west Fife district general hospital would have been substantially undermined and there could have been no confidence in the board's conclusion. The board was well aware of that. Hon. Members have not sought to introduce into the debate the conflicts between different areas in Fife, but that problem also existed and those who were keen on the Kirkcaldy solution became aware of the possibility of option D, which the board agreed to reconsider. It was not just a matter of the Scottish Home and Health Department delaying matters by telling the board that option D would require further investigation. The board itself first brought the revised development potential of the Victoria site to the attention of the Department.

The building division has produced a design solution for the site and comparative figures for the costs of the two options. I can confirm that the latest advice from the building division is that option D is unlikely to cost more in capital terms than option C. That is also contrary to what was originally believed. Indeed, when hon. Members visited me they put that view to me. At the time, I thought that that might be the likely outcome, but that has not been the case. Indeed, option D may be cheaper.

Similarly, preliminary information from the health board is that the revenue costs of one option are unlikely to differ significantly from those for the other option. The service implications of option D as opposed to option C are less easy to assess, and I understand that the board is working on them at the moment. Therefore, it does not expect to make a fresh submission to the Department on phase 2 of the hospital before December this year. Of course, there is no longer a possibility that the board can apply to the Department requesting that option D should be dropped on cost grounds. I informed the hon. Gentlemen of that possibility when I met them, but we know that it is no longer a possibility. That means that the board will have to make decisions about the merits of both schemes, if the financial aspects are equal.

I do not have time to deal with the cross-boundary flow. It is a factor, but it will not cause any delay —

The Question having been proposed after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at eight minutes past Eleven o'clock.