§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Maude.]
2.33 pm§ Mr. Roger Moate (Faversham)I am glad to have this opportunity to raise the plans for the Swale district general hospital and I am most grateful to my hon. Friend the Minister for being here to reply.
Perhaps I may also draw attention to the presence of my hon. Friend the Member for Gillingham (Mr. Couchman) who, while silent, has been a staunch supporter of plans to expand and improve our hospital facilities in the Medway health district.
Medway is, and has been for many years, an underresourced district. Year after year Medway Members have been hammering away at Ministers — as have many others — to try to get an increase in the resources available to the people of the Medway towns, an area that includes a large part of my constituency.
Less than a year ago I raised in the House the need for a Swale district general hospital. I make no apology for raising the subject again so soon. Developments since then have been such that it is of great importance that my hon. Friend the Minister, the Secretary of State and the regional health authorities should be giving renewed, urgent and sympathetic attention to the initiation and planning of a new general hospital for Swale. This is the sixth occasion in five years that I have raised in the House the question of local hospital facilities.
There are two fundamental aspects. The first is that the whole of our health district—which embraces much of Swale—is seriously underfunded, and is likely to remain so for many years. Even when we get the new major development at Medway hospital—which is one of the largest hospital projects in the south-east, costing some £40 million, but which will probably cost more at current prices—we shall still be below our resource allocation working party target. Despite the efforts of many Members of Parliament and others over the years, even with the current plans, Medway will still be an underresourced district in the, theoretically, over-provided south-east Thames region. We are a deprived district in a theoretically over-provided area, and our area often suffers from the constant pull of resources between it and the London teaching hospitals.
The second aspect is that in the Medway health district, Swale has been the poor relation—the poor relation of the poor relation, which is a frustrating position for my constituents. We have old and fragmented hospital services. There is a further complication. The borough of Swale is divided, for hospital purposes, between Medway and Canterbury. We have seen a growth in the improvement of major district general hospitals at each end of the area—Medway at one end, Canterbury at the other—while in the middle, in a large widespread rural area, we have seen the contraction of our local hospital services.
I put it to my hon. Friend that it is unacceptable that we should continue to run down our hospital services throughout our rural, semi-rural and urban areas, thus causing considerable hardship to the local population. The only compensation that we have been offered is the prospect of a second general district hospital in Medway, which will be located in Swale at some time in the future.
564 Sadly, the 10-year plan for Medway made no provision, even for site acquisition, for a Swale district general hospital. It is just a pipe dream to most people.
The challenge that we face is how to translate that pipe dream into reality. We cannot wave a magic wand and produce hospitals overnight, but we can and should be laying the foundations for a new hospital to serve future generations. We know what the lead time is for such projects. Unless we start this project soon, it will be for the 21st century, not the 20th century. We want a firm plan that can be launched before the expiry of the current 10-year strategy. That will involve serious planning and site acquisition now, and it may mean locating some services on that site at an earlier date than is currently envisaged.
The concept of Swale hospital is fundamental to planning in Medway. As far as I know, there is no dispute in the health authority about the need for this second district general hospital and, as far as I am aware, there is no disagreement on that subject with the region. It is a question of when resources can be allocated I shall give a helpful quotation from an earlier debate when the then Minister for Health said:
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."—[Official Report, 9 May 1986; Vol. 97; c. 426.]That was a welcome statement.What has happened to make me bring the matter back to the Floor of the House? The health authority was expecting to maintain a high level of hospital services in Sheppey and in Sittingbourne. Its plan involved the retention of our splendid maternity unit at Sheppey and the retention of some surgery at Sittingbourne. However, because of a decision by the Royal College of Obstetricians and Gynaecologists to withdraw recognition from Sheppey and from Canada house for medical training, the health authority has been forced to propose the early closure of the Sheppey maternity unit and to present a plan involving the withdrawal of surgery from Sittingbourne. Suddenly, the pace of withdrawal of services from Swale has quickened and my hon. Friend the Minister will understand why the alarm of local people has intensified. The need for more urgency to be attached to a plan for a Swale district general hospital has also increased.
The response to the problems has been heartwarming in some respects. My hon. Friend the Member for Gillingham knows that the Medway health authority has given even greater emphasis to the importance of replacing our scattered, fragmented and reducing services in Swale with a new district general hospital. I cannot quote the regional authority, but I have a feeling that it has increased sympathy for our case and a greater understanding of the need for urgency. The support of my hon. Friend the Minister and of the regional authority could make all the difference between success and failure.
Another important initiative has been taken by Swale borough council which, in an imaginative move, has commissioned a firm of management consultants, Peat, Marwick, Mitchell and Co., to prepare a report on the case for a new district general hospital. The report will be 565 presented to the borough council fairly soon and will be passed to the district health authority, in the hope that it can be incorporated in a plan for submission to the region.
I wish to put on record my appreciation of the initiative taken by the borough council in commissioning such a report and my appreciation of the way in which the project has been accepted by the district health authority, which co-operated fully in the preparation of the report and shows signs of receiving it with great sympathy. Hon. Members were brought in to the early stages of consultation during the preparation of the report and all the signs are that it will get across the message that there is an established need for the hospital and that it makes economic sense.
We are right to be encouraged by what we have heard, but the important aspect is what happens to the report when it is received by the district health authority and passed to the region. The report should be the trigger for action. There is no point in our establishing the need for a new hospital unless we get a positive response from the region and the Government. I want to hear from my hon. Friend the Minister, not that he will open the purse today—things do not work that way—but that if he receives a submission from the regional health authority he will help the project on its way. I very much hope that he will receive such a submission.
There is another aspect to this. I am not just asking for something for Swale. I am asking that Government and region use this proposition as the means at long last of giving Medway 100 per cent. of its RAWP target. That is the way we call do it. If it is seen in this light, the Government can fully justify the diversion of resources into our part of north Kent.
If it helps us to attain 100 per cent. of RAWP my hon. Friend the Minister will see that there is scope for building a second district general hospital in Medway. At one stroke, albeit quite a large stroke, we shall have dealt with a degree of deprivation in health care in north Kent that has been a longstanding cause of unhappiness in that area. It can be demonstrated that there is a shortfall in the provision of hospital services that there is an imbalance in the location of hospital provision and that much of the building stock in north Kent needs replacement. All of those propositions stand out clearly and are beyond contradiction.
It can be established that there is a clear need for a new district hospital of 300 plus beds at a cost which could be borne within that 100 per cent. RAWP target. The borough of Swale which includes the towns of Faversham, Sittingbourne and Sheppey must look forward to the building of this new hospital. It is imperative that we start the ball rolling and do not wait until the turn of the century.
Before I conclude, I must say that I understand that my hon. Friend the Minister may soon have before him, if the consultative and appeal procedure takes its full course, the question of the transfer and the closure of the maternity facilities and the transfer of surgery from Sittingbourne at an earlier date than otherwise was planned. I fully accept that he cannot make a judgment, or even comment upon that now, but I must stress that, when he receives that proposition, he should understand that it is a serious blow to the people of Sheppey, who have seen a continuing reduction in local hospital services.
Just before the debate I was talking to one of the great campaigners in my area, Mr. George Lowe, who had 566 engraved on his heart the words of the 1962 White Paper on the pattern of hospitals which he asked me to look up. The words in it are so applicable to my area that I wish to put them on the record. Command Paper 1604 of January 1962 states:
There will sometimes be justification on geographical grounds for providing maternity units at peripheral towns where the population to be served is sufficient to support a viable unit. Thus the retention of a local maternity unit of 15 to 25 beds serving a population of 35–50,000 might be regarded as justified if the nearest district general hospital was 15 to 20 miles away.That quotation is so applicable to the Isle of Sheppey that it should be borne in mind when Ministers consider the whole question of the provision of hospital facilities in my area. At this stage we are paving the way for a proposition that may soon come to my hon. Friend the Minister. When it comes—I hope that it will come soon—I ask my hon. Friend the Minister to give it every support possible within the resources available to him.
§ The Minister for Health (Mr. Tony Newton)I begin more than conventionally by congratulating my hon. Friend the Member for Faversham (Mr. Moate) on securing this Adjournment debate. I find it difficult to believe that there are many, if any, cases where one Member of Parliament has raised in this way no fewer than six times in five years the issues of health care, and in this case especially hospital care, in his constituency. That is a formidable record of bringing those important matters to the attention of the House at large and to the responsible Ministers in particular, and I have no doubt that it has also had at least some of its intended effect on the other authorities responsible, which will certainly have read and digested what my hon. Friend has said on a number of occasions.
It is also typical of the concern of my hon. Friend the Member for Faversham with the health interests of his constituents that my hon. Friend the Member for Gillingham (Mr. Couchman) is here this afternoon too. His capacity in being here is twofold, in that, as the House will know, he is my parliamentary private secretary; we therefore keep closely in touch about these matters. I had not in any way failed to register his interest, but it was borne in on me in another way in this case only very recently by the fact that I visited the Medway general hospital site in his constituency to plant a tree to mark the start of the development only a few weeks ago. I am conscious of all that my hon. Friend has done to promote the interests of the hospital service in his part of the area since he became a Member of the House. I am glad to pay tribute to both my hon. Friends for their efforts.
My hon. Friend the Member for Faversham spoke eloquently in the Adjournment debate last May about future health care provision for Swale and raised points then, as he did today, that rightly are close to his constituents' hearts. Important developments within the Medway health authority were discussed. At that time, I was not the responsible Minister, but I feel a little like the chairman of a company in being able to report a year's progress. I think that real and significant progress is being made in the provision of health care in the Medway health district. I have already mentioned one aspect of that.
My hon. Friend talked about the process of resource allocation, which is known so inelegantly as RAWP. My hon. Friend will be aware that within the last couple of 567 months we have made additional funds available to the South East Thames regional health authority by a device known in the trade as the RAWP bridging fund to ease some of the transitional problems of achieving the fairer distribution of resources among the districts in the region. I cannot say in terms that any immediate specific additional money for Medway will arise from that bridging fund, but it is important to understand that it eases the problems in the region by continuing the redistribution of funds in the interests of Medway, an under-funded district. I hope that it is clear to my hon. Friend that that is part and parcel of our commitment to ensure that the money and the policies are available to enable the continued movement towards improving health services in the Medway district.
My hon. Friend referred—again in the inelegant jargon of the world which I now inhabit—to the bipolar strategy to provide a district general hospital at Medway in the west of the district and another in the borough of Swale in the east. I shall not repeat for the third time the exact words used by my hon. Friend the former Minister in the debate on 9 May, but I recognise the unanimity of support among local interests of various kinds for the Swale general hospital.
One pole of the bipolar strategy is the health authority's plans for a district general hospital at Medway. Those plans are now being realised, if not yet in terms of brick, glass and concrete, at least in terms of firm foundations. The access roads to the new Medway hospital, which were under construction at the time of my hon. Friend's last debate on the subject, have since been completed and the next stage of the development has begun. I had the pleasure on 9 December of planting a tree to mark the start on site of that stage. Before that tree is past its young growth—I hope that at least the tree survives the inclement weather—by the summer of 1989, the doors will be opened for the care of out-patients, the mentally ill and elderly people.
I understand that extensive foundation work is already well under way, despite the bad weather, and that the steel girders for the entrance block are already in place. A further phase of this major £35 million development is scheduled for completion in 1991 and will provide new obstetric and acute blocks, operating theatres and other supporting departments.
It is important to emphasise especially to my hon. Friend the hon. Member for Faversham that the services to be provided at Medway district general hospital will not only benefit the people of the Medway towns. The people of Swale currently travel to Medway for much of their acute care. Although I recognise that my hon. Friend regards that as less than ideal, it means that the new facilities at Medway will improve the services available to the people in Swale.
My hon. Friend recognised the points made by my predecessor in last May's debate about the difficulty for the health authority, and indeed any authority, of making rapid progress on all fronts at once. The district health authority judged it right to focus first on Medway, where two thirds of the district's population live and where much of the essential hospital infrastructure already exists. But it is clear that neither they nor anyone else has forgotten the people of Swale. When the development at Medway is 568 completed in the early 1990s, there will be a swing to Swale as the health authority turns the focus of its development plans to that part of the district.
As my hon. Friend rightly said, future developments require careful planning well in advance, and I understand that a possible site for a new hospital in Swale has been identified by the district health authority and Swale borough council. However, some essential steps—again, this was fairly recognised by my hon. Friend—must be taken before committing funds to land acquisition. Any decision to commit resources to a capital development must be based on a clear statement of need, a clear definition of service and development objectives and an explicit appraisal of options. The regional health authority can purchase land for development only after an option appraisal study has been completed and it is intended to build on the site within the strategic planning period.
I am aware, as my hon. Friend emphasised during his speech, that Swale borough council has been actively involved in the matter and has commissioned a report on the need for improved hospital provision in Swale. I, too, pay tribute to the close interest which the authority has taken in these matters, which is a good illustration of the co-operation that we wish to see between local authorities and health authorities in such matters. I commend the council's efforts.
The district health authority, which is committed in its strategic plan to improved hospital provisions in Swale, hopes to use the report, when it is available, in its development of an option appraisal study. That will be sent to the South East Thames regional health authority, I hope by the end of the year. I know that the regional health authority looks forward to receiving the report.
It was clear from what he said that my hon. Friend is anxious that the regional health authority should fully recognise the urgency that is perceived in Swale about this matter, and I undertake to ensure that everything that has been said today, not least the important remarks of my hon. Friend, is drawn firmly to the attention of the regional health authority. My hon. Friend will agree that these steps of appraisal, which can sometimes sound bureaucratic, are an essential part of ensuring that if we commit substantial sums of public money we do so in a properly measured and responsible way.
My hon. Friend asked whether I could guarantee the sympathy of myself and of the regional health authority. For the moment, I shall concentrate on speaking for myself. I very much hope that the regional health authority will study carefully what my hon. Friend has said and the commitment to this project of all concerned in Swale; but in the end it must make its own judgment. I undertake to consider as positively as I can any proposals from the regional health authority, although inescapably I have my responsibilities to examine carefully and thoroughly any proposals for the large-scale expenditure of public money.
My hon. Friend mentioned the measures that have been proposed by Medway health authority for the provision of health care services in Swale during the next five years. I am grateful to my hon. Friend for recognising that the background to those proposals, or a significant part of them, is not some desire by the district or regional health authority or the Department to modify the services, but the withdrawal of recognition by the royal colleges. I also appreciate my hon. Friend's concern that the quality of services in Swale should not be diminished in the years before it is possible to build a new hospital.
569 I can assure him that the proposals will not be rushed through. The Medway authority is consulting widely on the proposals, having issued a consultation document in January. The closing date for comments is 17 April. My hon. Friend will be aware that if the local community health council wishes to object to those proposals, it will need to submit alternatives, but it is likely that, in due course, proposals will come to me for decision. Therefore, my hon. Friend will appreciate that there is little comment that I can properly make at this stage.
570 I hope that my hon. Friend recognises that, if those proposals do come to my Department, we will consider them carefully and thoroughly. Our considerations will he greatly aided by the views that he has clearly presented today on behalf of his constituents.
§ Question put and agreed to.
§ Adjourned accordingly at Three o'clock.