§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Portillo]
§ 8.4 pm
§ Mr. Alex Carlile (Montgomery)My good fortune in obtaining the Adjournment debate enables me to talk about a small but important town in mid-Wales, Machynlleth. It is not a declining town although it is small. It is in an area that, like other parts of mid-Wales, is seeing the growth of small industry. There is burgeoning tourism and many people are coming into the area to live and work because of the beauty that it offers as well as opportunities.
I am pleased to see that the Under-Secretary of State for Wales with responsibilitites for the Health Service in the Principality is in his place. I thank him for meeting me last week and having a discussion with me about the Machynlleth hospitals, which are the subject of the debate. I express my gratitude to him on behalf of my constituents for arranging for a petition, which I shall refer to later, to be received by one of his officials in the Welsh Office. I wish to express my gratitude also to that official for his courtesy in receiving the representations that were made to him. I commend that official's courtesy greatly. He listened with great care and made many notes. As the Minister knows, I should have been happier if he had been the person to meet the deputation that came with me to the Welsh Office, but there is no doubt that we were well received and are thankful for that.
In considering hospital provision in Machynlleth, perhaps we should know a little about the town. For centuries it has been an important centre to which people have come to market from a wide area. At one time it was the capital of Wales and the home of the Parliament of Owain Glyndwr. One might say
how are the mighty fallen!because only last Saturday I held one of my constituency surgeries on the site of Owain Glyndwr's Parliament. What I can say for certain it that the people of Machynlleth hold their democracy at least as valuable now as they did centuries ago with Owain Glyndwr when he held sway in the area.Machynlleth is a town in need of good hospital provision. It is a busy town with a growing industrial sector. It has a considerable craft industry and some remarkable shops that are perhaps a part of the original Laura Ashley boom. These shops attract people from throughout the area and from far afield. The town has a considerable part of the backbone of the economy of my constituency of Montgomery — a strong agriculture sector—and it has the important business of tourism. This means that in the summer months especially—we try to make the season in Machynlleth as long as possible now—there is a considerable influx of visitors with the result that the population grows considerably. A growing number of hotels, guest houses and camp sites fills up each year.
It is right to observe that whenever planning consent is granted for any new property in or around the town, it is in great demand. It is a town that has an increasing use for an increasing number of public buildings. Recently the remarkable Machynlleth tabernacle was restored, and it is now the tabernacle arts centre. The restoration took place 724 with private money and the new centre is showing signs of thriving. It brings many people into the town and it will do so increasingly.
The Plas is one of the most attractive and historic buildings in mid and west Wales. There are plans afoot for it, and for new tourist facilities and other public facilities alongside the town's excellent high school. There is the now celebrated Centre for Alternative Technology outside the town.
I say all that not to cause a diversion but to emphasise that Machynlleth is growing and blooming rather than shrinking and wilting.
In a few moments, I shall refer to the views of the people of Machynlleth and to a petition that was presented on their behalf. The people of Machynlleth are not greedy. They have never demanded more than their fair share of the public spending cake. However, I remind the Minister of a snippet of Welsh history that, no doubt, he will recall. The strong community feeling and the ability to identify community needs in that town can be traced as tar hack as the resistance of Caradoc to Agricola's onslaught of mid-Wales. There are independent witnesses of the independence of spirit of mid-Wales and west Wales. I am sure that the Minister, who went to school rather more recently than I did, will remember his Tacitus with enthusiasm. Tacitus described in his Agricola the stout spirit and resistance of the people of mid-Wales.
That may be a rather roundabout and pittoresque way of making a point, but it is an important one. The people of Machynlleth and district are sound judges of their interests. They feel those interests strongly. They state them firmly and they have an impeccable nose for unfairness. Their nose for unfairness, as they perceive it on the matter of the Machynlleth hospitals, was demonstrated most eloquently by the petition signed by nearly 11,000 people, which has already been presented to the Welsh Office.
I seek to make a case in support of the 11,000 signatures. It is not just in support of the voices of the ordinary people of the town and the district but also of the voices of many who are closely involved in the medical profession and in the National Health Service in the area, not least the general practitioners in Machynlleth whose views accord entirely with those of the petitioners. There have been times during the history of the dispute when the general practitioners may not have seemed wholeheartedly to support the case made by the petitioners; but it is quite clear that, when they were given the opportunity to stand back and take an objective view of the situation, they formed the view that the proposals of the Powys health authority, which are currently before the Welsh Office, were not in the best interests of the town and the area.
There are two hospitals in Machynlleth. They are approximately 80 yards or so apart on opposite sides of the main road which leads through the town and towards the coast — towards Aberystwyth in one direction and towards Aberdovey in the other. The newer of those hospitals is about 50 years old. It is called the Machynlleth and Corris district hospital. It was built as a result of public subscription. Some families gave massively towards the construction of the district hospital. What is perhaps more important is that, as I have been told, every family in the district gave something, including not a few widows' mites.
As I live in mid-Wales, I am delighted to say that we who live in mid-Wales — "Powys Paradwys Cymru" — 725 live somewhat longer than average. Thus, many people living in Machynlleth and other parts of mid-Wales remember well the excitement of the collection of the money and the satisfaction of the building of the hospital.
The other hospital, the Machynlleth chest hospital, started its life, perhaps a little less promisingly, as a workhouse about 125 years ago. More recently, it achieved an enviable reputation as the Machynlleth chest hospital.
It is a pleasure to see the Parliamentary Under-Secretary of State for Wales, the hon. Member for Conwy (Mr. Roberts), on the Government Front Bench. He will be well aware of the name and the reputation of Dr. G. O. Thomas, who did years of distinguished work in the Machynlleth chest hospital. Dr. Thomas and others did pioneering work in the chest hospital on the treatment of farmer's lung. They made great strides and became famed worldwide for their work on that dreadful disease. Sadly, there has been an increase in the incidence of farmer's lung in the past few years. It is one of the diseases which the Machynlleth chest hospital still treats.
The chest hospital is a place not only for the treatment of farmers lung. It has become a popular and highly respected hospital for the treatment of all sorts of chest-related ailments. Some of my own friends have had excellent treatment there. I recall a celebrated resident of Montgomeryshire, Mr. R. O. Hughes of Castle Caereinion, who sadly died recently, but was kept alive for many years by the excellent treatment that he periodically received at the chest hospital in Machynlleth. He was a patient who regularly travelled about 35 miles for treatment there. That is an example of the breadth of the hospital's catchment area.
The chest hospital and the district hospital have a wonderful reputation for their nursing care. I have visited them both on many occasions and have seen for myself the tradition of care that is carried on excellently by the present staff and Mrs. Lloyd the matron—if I may be permitted to use the old-fashioned word that is still well-understood in Wales.
The two hospitals are physically close. They work efficiently together. They efficiently share the same catering and the same administration. They have a joint league of friends which has provided a fully-furnished day room in each hospital. It is worth noting that the league of friends has in its possession a sum of money, the size of which is staggering when one considers the size of Machynlleth. I am given to understand that the amount of money which could be provided by the league of friends is in excess of £100,000. They would like to apply that sum of money to schemes of which they approve.
The catchment area, as I have already intimated, is much wider than Machynlleth itself. Indeed, it is much more than simply the whole of west Montgomeryshire or, for that matter, the whole of Montgomeryshire. It includes the old counties of Ceredigion and Meirionnydd. It is difficult to make precise estimates of its catchment area. One submission made to me suggested that it might be as large as 100,000 people. Perhaps so. Perhaps one should err on the lower side and say that the catchment area consists of 50,000 or 60,000 people. It is still substantial and, in my view, greater than has been suggested by the Powys health authority, whose proposals are currently before the Minister.
726 It is a town where acute medical services are required on a reasonable scale for the whole of the district. We know of many patients who live, for example, in Dolgellau, the county town of the old county of Meirionydd, who, for some quite routine medical treatment, have to travel for long distances over country roads to the town of Wrexham. It is very much to be hoped that we shall not see more people being forced to travel that kind of distance for medical treatment, or to visit their relatives in hospital.
As the Member of Parliament for Montgomery, of course I welcome the decision by the Powys health authority to spend money on the hospitals in Machynlleth to upgrade the provision of medical facilities there. Money is needed, particularly for the chest hospital, some parts of which are in less than excellent condition. However, local people believe—and I share their belief—that there are a number of misconceptions and errors in the plans that are under consideration.
The first of those misconceptions and errors relates to the proposed new geriatric unit, combined with a unit for the elderly mentally infirm—a geriatric-EMI unit, as it has come to be known. Of course I welcome the decision. and so do my constituents, to build a new geriatric-EMI unit and associated day facilities, but having reflected upon the matter and looked at it in great detail we are all of the view that it is quite wrong that those facilities should be placed in the grounds of the chest hospital, rather than on that side of the road where the district hospital is situated.
The site of the chest hospital is entirely unsuited to the provision of those facilities. It is a congested site. On that site there are the comings and goings of the ambulance station. The mortuary's proximity is a problem that causes great concern. And it causes offence in Machynlleth that it is proposed that the geriatric-EMI unit, where some patients will live for years, should have a clear view of the cemetery. In my constituency in mid-Wales, matters of birth and death are viewed very seriously indeed—perhaps in a less cavalier fashion than in some of the modernistic urban areas of England. For elderly people to have to watch corteges proceed on their stately way could hardly drive home an unwelcome point more tellingly.
I believe that those of the elderly who have to spend their last months or years in a geriatric unit are entitled to a better view than that; and that the people of Machynlleth are right in drawing this important detail to the Minister's attention. No amount of landscaping will achieve in any reasonable time the screening that would be required to remove that defect in the proposals.
If all that I were saying was that the site is unsuitable, the Powys health authority would be able to reply—I know that the Minister is constrained tonight because he will have to decide this matter in due course — "But what is your alternative?" The alternative is a good one, and it is readily available.
Whereas the chest hospital is on the more built up side of the town, the district hospital is on the less built r,p side. It is on the same side of the town as the Cartref Dyfi home for the elderly. It is also on the same side of the town, conveniently, as the car park, and on the side of town with some most attractive views.
Next to the district hospital there is a site that already belongs to the health authority. It is a flat site that is large enough for the geriatric-EMI unit. That site could be built upon without any difficulty whatsoever. What is more, it 727 is a site that is free of obstruction and free of charge to the builders. On one side it has a view of the road. The elderly in the geriatric unit would be able to see the world go by. On the other side it has a view of the mountain. The elderly would he able to see the world in which they had lived their earlier lives. One cannot imagine a better site for the geriatric-EMI unit than that which is supported and proposed by my constituents in Machynlleth—the site next to the district hospital.
If the geriatric-EMI unit were put on the opposite side of the road from the chest hospital, people might ask what would happen to the associated occupational therapy and physiotherapy facilities. That is not a valid objection, either. In the proposed plans of the Powys health authority, the geriatric-EMI unit would have integral gymnasium-type mobility facilities and also occupational therapy facilities of its own. I suggest, therefore, that there would be no extra cost, to speak of, in putting the geriatric-EMI unit on the district hospital site and that if there were any extra cost it would be small and would be amply justified by the overall improvement in the facilities and by the fact that the unit would be in a far more attractive position.
The second of the misconceptions and errors in the plans to which I wish to draw special attention relates to the size of the geriatric-EMI unit. The Powys health authority's proposal is that there should be 14 geriatric beds, four EMI beds and two respite care beds. Those are inadequate numbers to meet the future local need. I have already said that we have a substantial elderly population, because longevity is remarkable in Montgomeryshire. Indeed, 21 per cent. of the population of the catchment area of these hospitals is over 65 years old, a very high figure. Local estimates, including those of the general practitioners who know the state of health of the young and the middle aged within the catchment area, make it clear that a greater number of beds will be needed in the future. Detailed submissions have been made to the Welsh Office on this matter. I suggest that what would be appropriate would be 20 geriatric beds, six EMI beds and two respite care beds.
The third of the misconceptions and errors is the proposal that the general practitioner and maternity beds should be moved out of the district hospital altogether to the existing site of the Machynlleth chest hospital. The effect of that would be that the district hospital would be closed to in-patients. It would probably be closed for ever; indeed, it would almost certainly he closed for ever. There have been suggestions that it would be retained for Health Service facilities, but it is a matter of considerable dubiety as to exactly what those facilities would be and how long they would last.
During the discussions on the fate of the district hospital there have been all sorts of suggestions. At one time the health authority suggested that Powys county council should take over the district hospital for some sort of use—perhaps as a day centre—but Powys county council had not even been asked, and does not have the money to take it over. We must face the fact that if the general practitioner and maternity beds are moved out of the district hospital that will probably be the beginning of the end of that hospital.
At present there are 14 general practitioner beds and two maternity beds in the district hospital. It is proposed that on the chest hospital site there should be a reduction to 12 general practitioner beds and two maternity beds. 728 One may get the impression from the proposal to close the district hospital that in some way it is an unpleasant place, that it does not meet the needs of the patients and that it falls below an acceptable standard of care. I say to those who feel that. "Go and see for yourself, as I have. See whether there are any complaints from patients or their relations." They will find that there are none.
Many patients use the general practitioner beds in the district hospital during the year. Some are there for relatively minor complaints, others go there for a rest and recuperation, and a third group go there, sadly, for care at the ebbing of their lives when acute medical assistance no longer avails them. Of course, some modernisation would be welcome in that hospital. What hospital other than the brand new would not welcome some form of modernisation? It is a quiet, efficient, homely and attractive hospital. It is wholly unnecessary to replace it entirely. A moderate modernisation would make the Machynlleth district hospital into a general practitioner unit which could be the pride of Powys and of the Powys health authority.
The numbers proposed —a reduction to 12 general practitioner beds—are inadequate. From time to time I have checked randomly through local residents who visit the hospital on a regular basis. On several occasions this winter the district hospital's general practitioner beds have been full. Furthermore, the maternity suite operates satisfactorily. Mothers like being there and there is no need for any substantial change.
On the matter of the provision of acute medical services in Machynlleth, I draw attention to the fourth of the misconceptions and errors in the plan. It is proposed that there should be a reduction from 35 beds with an operating theatre to 15 consultant beds and minor operating facilities. There has been a gross underestimate of the needs for acute and consultant beds, having regard to a number of factors. First, as I have already said, the catchment area has been underestimated. Secondly, there has been such a delay in the completion of the second stage at Bronllys hospital in Aberystwyth that, to quote one consultant physician in the area:
Machynlleth has been a valuable pressure valve in soaking up patients from Aberystwyth.A point worth mentioning in passing, although I do not wish to exaggerate it too much or put a false perspective on it, is the proximity of the nuclear power stations in north Wales. With that in mind, it is as well that there should be adequate facilities for hospital beds in the area. There is already an operating theatre in the district hospital which serves both hospitals. The operating theatre needs upgrading, but I am informed that the league of friends would be especially interested in examining the possibilities, perhaps with a view to helping towards the upgrading of the operating theatre to more modern standards. Recently, when I checked, the acute beds were full. They were full on two occasions when inquiries were made recently of the occupancy of them.
I shall mention briefly the consultation process that has taken place and led to the recommendations and proposals of the Powys health authority. It has not, unfortunately, been a happy process. I do not regard it as appropriate here to make special criticism of the Powys health authority, but I observe, for I was there, that the public meeting that was reluctantly and eventually agreed to by the health authority on 9 June of last year was a wretched occasion. The presentation of the proposals was done with 729 great skill and professionalism by those representing Powys health authority, but most people at that meeting felt that the many strong feelings expressed by local residents and representatives of the local community—myself and many others—met a response that was less sympathetic than was appropriate. As a result, many representations on these matters have had to be made privately and, in some cases, fairly desperately.
The local community does not believe that it has had a fair opportunity to make out its case fully until recent weeks. The local community welcomes the fact that in the end the decision will be taken by Ministers in the Welsh Office and hopes that it can be confident that all the representations that it has made and that I have had the opportunity to make tonight will be taken into account. We all look forward to a decision that will be acceptable to the community, consistent with good medicine, and will lead to the early start of building work to improve hospital facilities in Machynlleth.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Mark Robinson)I congratulate the hon. and learned Member for Montgomery (Mr. Carlile) on his good fortune in securing tonight's Adjournment debate. I congratulate him not just on his success in doing so but on the fact that the business of the House has allowed him to state his case about hospital provision in Machynlleth in rather more detail than would normally have been allowed. If he had had the opportunity in a normal debate to speak at this length, I should not now be replying to him.
I thank him, as I am sure the House does, for the interesting history that he gave us of Machynlleth and the developments that have taken place in the town from the days of Owain Glyndwr, and indeed before that of those of Caradoc and right up to the present day.
However, on checking Dods — perhaps this is my youthful appearance—I discovered that I had received my schooling just a short time in advance of the hon. and learned Gentleman. Therefore, his memory of Tacitus is perhaps even clearer than my own.
In recent months the hon. and learned Gentleman and I have been in correspondence on the subject of Powys health authority's proposals for future hospital provision for Machynlleth. I am grateful for his kind words about the manner in which his constituents, who presented a petition, were received. I have attempted to explain the procedures under which the district health authority can bring about changes of use through the established procedures and the process of public consultation that is required. I welcome the chance to expand on that tonight, bearing in mind the fact that it is not appropriate for me to make any substantive comments, which the hon. and learned Gentleman has already recognised, on the proposals at this stage as they have now been submitted to my right hon. Friend the Secretary of State and that the one-month period for public representations has begun and will conclude on 28 February.
I fully realise the importance of this matter to the hon. and learned Gentleman's constituents and I urge them to submit any further representations that they wish to make 730 as soon as possible. I also assure him that the petition presented to the Welsh Office will be taken into account as part of that exercise.
It would perhaps be useful if I began by sketching out the background to the proposals in terms of the health authority's strategic plan of January 1985 and the current provision at Machynlleth. The strategic plan details the direction to be taken over the 10 years to 1994 in the operation and development of health services in Powys. Changes are proposed in all services, especially in the priority areas of caring for the elderly, the elderly mentally infirm, the mentally ill and the mentally handicapped with a change of emphasis from hospital care to continuing care in the community.
The health authority has stated that its philosophy will be to care for people as far as possible within the community and that, in order to achieve that objective, particular attention will be paid to providing community-based consultant services in geriatrics and mental handicap. The authority intends that the development of community hospitals within the district should assist the realisation of those objectives.
The proposals for provision of services take into account the fact that public transport within the county is sparse. The authority is therefore adopting the principle of developing community hospitals which can bring medical services close to small concentrations of people throughout Powys. In relation to the care of the elderly, the strategy retains the target of 10 beds per 1,000 population over the age of 65, but accepts the need to encourage the elderly to remain in their homes and aims to work jointly with the social services department, local housing authorities, other statutory bodies and voluntary groups to provide increased special housing and develop local day centres for the elderly.
Current hospital services in Machynlleth are provided at two long-established sites. The Machynlleth and Corris district hospital is situated in a 50-year-old purpose-built premises about half a mile from the centre of the town on the road towards Welshpool and Newtown. It was built as a cottage hospital in 1935, funded by voluntary contributions from the people of Machynlleth and surrounding areas. The Machynlleth chest hospital occupies an older building, the former workhouse, and is opposite the district hospital. The Poor Law institute made the workhouse available to the Red Cross during the 1914–18 war. The Welsh national memorial hospital trust leased the building in 1921 and eventually bought the workhouse for use as a chest hospital in 1929. In total, the two hospitals have 51 beds run by 54 medical and nursing staff. I also pay tribute to the league of friends and its support for the two hospitals.
The existing bed provision of Machynlleth chest hospital is 35 beds. In making its proposals, the Powys health authority considers that the categories of patients have changed over the years. The chest hospital apparently now caters mainly for elderly patients with or without a chest ailment, and the authority's view is that only one third of the 450 discharges per annum can truly be considered chest cases. In 1985, the average daily number of occupied beds at the hospital was 22.3 out of an average number available of 33.8. I apologise for the technicality of those figures.
The Machynlleth and district hospital provides 16 GP beds, two of which are maternity beds. In 1985 the average daily number of occupied beds was about nine out of an 731 average number available of 16. Both hospitals cater for patients from the adjoining areas of Meirionnydd and Ceredigion, as well as from Powys. For that reason, Gwynedd and East Dyfed health authorities are involved in the consultation process.
With regard to the current proposals under consideration, I understand that Powys health authority began to give detailed consideration to the future hospital needs of the Machynlleth area in 1985. That was prompted by the announcement by the consultant in chest diseases of his impending retirement, the need to consider how best to provide geriatric facilities with appropriate consultant cover, and the requirement to make the best possible use of medical services in general.
The health authority published its proposals for the future of hospital provision in the Machynlleth area in April 1986. It undertook consultation with members of the public, community health councils, other representative bodies and the neighbouring health authorities of Gwynedd and East Dyfed, but. having failed to reach local agreement on the proposals, the authority has, as I have already said. referred them to my right hon. Friend for decision.
Although I cannot comment on them, it may be helpful if I tell the House the nature of the proposals submitted by the authority. First, it is intended to provide a new 20-bed geriatric and elderly mentally ill unit and associated day hospital facilities on the Machynlleth chest hospital site. It is also intended that the facilities at present accommodated at the district hospital be transferred to the chest hospital to provide 12 GP beds, two maternity beds, a delivery suite and minor operating facilities, that 15 consultant beds be provided on the chest hospital site, that an appropriate level of both consultant and junior medical staff be appointed to manage the service and that the out-patient services currently provided by Dr. J. J. Griffiths at Tywyn, Dolgellau and Bronglais hospitals be discontinued.
The health authority has said in its public consultation document on these proposals that, although it seeks to transfer the acute services from the district hospital to the chest hospital in updated and modernised accommodation, it is intended that the district hospital will be retained for the provision of medical services. The acute psychiatric day hospital that is to be developed in the area can be accommodated in the district hospital along with county council social services provision.
With the expansion of community services in all areas of Powys, the health authority considers that there is a need for day hospital facilities not only for the elderly, but for the mentally handicapped, mentally ill and the physically disabled. In its consultation paper the health authority says that it envisages over the next five to 10 years that the district hospital would be fully utilised as a day hospital, thereby ensuring that provision is made available for the increasing needs that are inherent in any programme of expansion of community services.
The health authority has outlined in the proposals published for consultation its wish to develop a full range of services, with provision more appropriate to the needs of each discipline, to current day standards and beyond. The authority's decision to site the geriatric — elderly mentally ill unit at the chest hospital is based on its view that, over a 15-year period, a full development at Machynlleth should be on a single site. The authority 732 considers the district hospital site too small and lacking the patient accommodation areas and range of facilities that are available on the chest hospital site.
The authority points out that the new remedial therapy department and out-patient department were built on the chest hospital site for that reason and because it had been expected that the geriatric unit, when built, could be phased into this development with an enhancement of the paramedical departments to provide a day hospital facility.
It may be helpful if I outline the details of the procedures which must he followed before a change in health care provision can be implemented. Responsibility for the detailed planning of Health Service provision and for local consultation on the plans produced rests of course in the first instance with district health authorities. In formulating plans, authorities are required to have in mind the need to make the most efficient use of their available resources which is consistent with the changing needs of patients. Ultimate ownership of all health authority buildings is normally vested in my right hon. Friend and, as proposals for permanent closure or change of use can and do have a significant effect on the local and, as in this case, wider community, special arrangements have been designed to ensure that the public and all local interests are fully consulted and that, in cases of controversy, my right hon. Friend should decide on the proposals in full knowledge of the contending considerations.
Guidance is given to health authorities in Health Service planning paper five, entitled "Procedure for Consultation on the Closure and Change of Use of Health Buildings". The procedure can be summarised as follows: the health authority should first prepare a consultation document giving the reasons for the proposals, which should include the implications for patients, such as travelling and transport, the options which have been considered and the arguments put forward in favour of them. There should be an evaluation of the possibilities of using any redundant facilities for other purposes, and manpower implications must be considered. The relationship between the closure or change of use and other developments in the district's plans should be drawn out.
A three-month period of consultation is the next stage, with comments being invited from community health councils, local authorities, joint staff consultative committees, any other recognised staff organisation not represented on the committees, family practitioner committees, local advisory committees and any other body or person which the health authority considers should be consulted.
The health authority should then reconsider the proposed closure or change of use in the light of the comments received. Should an agreed decision be reached which accords with the guidelines from the Welsh Office, the health authority may proceed with the closure or change of use. If the result is either irresolvable disagreement, as in this case, or a locally agreed conclusion which differs substantially from the original proposals, the authority is required to refer the matter with its recommendations and an outline of the alternative arrangements to my right hol. Friend.
Following referral, in order that members of the public who oppose the proposals may have adequate opportunity to make their views known before a final decision is taken, 733 a period of one month must be allowed and publicly announced in which individuals or organisations may appeal and make representations against the proposals that have been put forward.
The way in which Powys health authority has implemented this guidance is as follows. Comments on the proposals were invited in April 1986, and therefore the closing date for comments to be made on them would usually have been the end of June. It became clear, however, from early on in the discussions that these proposals would generate a great deal of comment. Powys health authority therefore decided, exceptionally, that in this case the usual timetable would be extended to allow a full discussion of the proposals with neighbouring community health councils and health authorities.
Powys health authority's proposals on the future hospital provision in the Machynlleth area, together with copies of all representations received, and incorporating amendments made by the authority in the light of comments, were presented to my right hon. Friend under cover of a letter dated 17 December 1986. The next stage was then for the health authority to issue a press notice announcing that fact and giving one month from the date of the notice for any objections to its proposals to be sent to my right hon. Friend for consideration before the final decision is given.
Once my right hon. Friend has reached a conclusion on the health authority's proposals, a letter giving his decision and the reasons for it will be sent to the health authority. Copies of the letter will be sent to other people or bodies who have expressed an interest in the matter, including the hon. and learned Gentleman, and these decisions will also be publicised by means of a press notice. I can also assure the hon. and learned Gentleman that the points that he has made tonight will be carefully considered before any final decision is taken.