§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Portillo.]11.40 pm
§ Mr. Robert Litherland (Manchester, Central)
I welcome the opportunity provided by this Adjournment debate to raise the future of Ancoats hospital in my constituency.
On Monday 11 August 1828 Ancoats hospital opened its doors and established itself as a medical centre. On Sunday 1 February 1987 at 9 am the doors closed on the casualty unit, thus ending a magnificent period of medical history in that part of Manchester. Simultaneously, a number of local residents made the spontaneous gesture of occupying the waiting room and declaring a sit-in in an effort to save a hospital that was dear to their hearts and recognised as part of their heritage.
When one reads the history of Ancoats hospital, one finds that it was set up in 1828 for the purpose of providing a medical dispensary. The reason for that was that the poor had been subjected to the expense of their time and financial loss by having to travel considerable distances to the Manchester infirmary. That loss almost equalled the value of the medicine that was dispensed. Therefore, by establishing a medical dispensary in Ancoats that severe inconvenience for a deprived population would be removed.
Now, in 1987, the area is still suffering from acute deprivation and the people occupying Ancoats hospital are fighting for the same cause. They are fighting for the provision of a casualty unit for people who can ill-afford to travel long distances to receive medical treatment.
Those people have an affinity with Ancoats hospital. They are well aware of its magnificent reputation and are willing to foresake their normal everyday living activities just to sit-in and sleep in cramped conditions. Their purpose is to save a hospital of which they are proud. Those actions and their voices should be taken into consideration. They have a right to be consulted. Regrettably, consultation is not the strong point of the district health authority, and the local community and other interested bodies, including the trade unions and local elected representatives, were not consulted. Closure was a fait accompli.
It has always been recognised and accepted policy that adequate alternative arrangements would be made before the closure at Ancoats took place. My hon. Friend the Member for Manchester, Blackley (Mr. Eastham) would readily inform the Minister that that is far from the case and the casualty provision at North Manchester general hospital is, to say the least, in an appalling condition and totally inadequate.
The chairman of the district health authority has written to inform me of the intolerable burden now being imposed on the Manchester Royal infirmary and emphasises that this hospital cannot cope with the extra workload since the closure of the Ancoats casualty unit. The closure has inevitably increased the workload of the Manchester Royal infirmary, which has now become the only remaining city-centre accident and emergency department.
In 1986 the Manchester Royal infirmary treated 43,286 new patients and 7,071 follow-up patients—a total of 269 50,357 patients. In the same year Ancoats accident and emergency department treated 25,656 new patients and 11,611 follow-up patients — a total of 37,267. It is estimated that the additional resources needed by the Manchester Royal infirmary will cost about £189,000 if that hospital is to meet the extra commitments. Additional funding will be essential for new nursing, medical and clerical staff, security, consumables, wardrobes and extra beds for the in-patient facilities.
Sir John Page, the chairman of the regional health centre, informed me by telephone that he was urging the Royal College of Surgeons not to withdraw its licence from Ancoats, and that he was also consulting Professor Moore, the chairman of North Manchester district health authority, in an effort to delay the closure until alternative and adequate arrangements had been made. Regrettably the closure went ahead.
It is the easiest thing in the world to run down an activity by just starving it of resources. This is what happened at Ancoats hospital. Closure took place in spite of the fact that the building of a nucleus hospital on the site of the North Manchester general hospital, intended to provide a new accident and emergency department, will not commence for four or five years.
Closure went ahead in spite of a number of ambiguities in Professor Sherrard's report to the hospital recognition committee, which advocated the withdrawal of recognition. The report, seen from a different perspective, could have suggested that the upgrading of Ancoats hospital was essential. In any case, we submit that the Royal College of Surgeons took a hasty decision. Have they gone into it in depth and taken into consideration the view of the ambulance emergency service, which is in full support of the action of local residents?
In the past the ambulance emergency service relied upon Ancoats hospital, which had a stabilising unit and staff on hand specifically for such cases as heart failure. Regrettably, the ambulance service will now have to travel far longer distances and patients will have to be attended to while they are actually in the vehicles. It will he a struggle for ambulance crews to care for patients because they do not have trained staff and because they have depended on the existence of Ancoats emergency hospital to provide this back-up service.
Another stipulation that was laid down by the representative from the Royal College of Surgeons for approval of the casualty unit was the amount of time considered necessary for the arrival of an ambulance in response to a 999 call. This was given as 15 minutes. The ambulance service points out that it is now down to eight ambulances right across the city operating from 6 p.m. to 8 a.m., including weekends. The ambulance service states categorically that, with its limited number of vehicles, it could never guarantee arrival to a call within the time specified by the RCS.
I have received many letters of support for this aim. Mr. Dafforne, who was general superintendent and secretary of Ancoats hospital for 21 years and who feels strongly about the closure, has written:The Royal College of Surgeons requires a hospital to give a good general basis of experience to help the young doctors to qualify for the RCS exams if they so wish. Ancoats Hospital has provided that for decades and has thus been recognised in the past by the RCS.270Two or three years ago the so-called planners and bureaucrats removed General Medicine and General Surgery from Ancoats. So for the first time since 1872 Ancoats ceased to be a general hospital.Likewise, East Man chester has lost its general hospital and had to depend on Crumpsall Hospital for all hospital services except orthopaedics and a little ENT unit.Dafforne said that north Manchester general — Crumpsall hospital—serves North Manchester 'well, but never has it and never will it serve East Manchester.In a foreword to a booklet to mark the 150th anniversary of the hospital, the reve[...]ed Sir Harry Platt, professor of orthopaedics surgery, president of the Royal College of Surgeons and honorary surgeon of Ancoats hospital, said:I count myself one of those on whom, in his formative years, Ancoats conferred many blessings. So, with others, I salute our hospital in this year now one hundred and fifty years old; but young in spirit and in endeavour, and with a great future before it.Another contributor to the foreword said:Finally, I hope and pray that Ancoats Hospital will maintain its spirit of "care" and long remain to serve the people of Manchester.Sir Harry died recently, but I should have loved to know his thoughts on the closure. That pride continues with the latest generation. Young and old, people from all walks of life, are imploring the Minister not to hide behind the autonomy of the Royal College of Surgeons—the cover behind which the management has taken refuge—but to take action to re-open Ancoats casualty unit so that it can offer a vital service to an area of great deprivation and to the industrial and commercial sectors of Manchester. We trust that the Government will not do a Pontius Pilate on this matter and say that they have no responsibility over the Royal College of Surgeons. The Government have a responsibility for proper health care. There is tremendous unity of will to keep the hospital open. Thousands of voices are echoing to Harry Platt's wish that Ancoats should have a great future before it. The people will look carefully at the Government's proposals. They will look carefully at the Government's reaction to this debate and to their plea. Aricoats still means a lot to many people. I ask the Minister to use her office to get the bodies involved together to com;ider re-opening Ancoats hospital
§ Mr. Deputy Speaker (Sir Paul Dean)
Order. Does the hon. Member have the agreement of the hon. Member for Manchester, Central (Mr. Litherland) and of the Minister to intervene?
§ Mr. Eastham
I pay tribute to my hon. Friend the Member for Manchester, Central (Mr. Litherland) for his vigilance and attention to the difficult problem with which he has been dealing over the past few weeks. The dedicated staff of Ancoats, have shown, with my hon. Friend, their determination to fight this battle with the Department and the regional health authority. My hon. Friend has received little consideration from the regional health authority in the representations that he has made. We are extremely disappointed and our only option is to turn to the Minister in the hope that there will be some form of reconciliation and reconsideration.
271 The closure of Ancoats hospital will not improve the casualty services for the central or northern part of Manchester, which I have the honour to represent. The Minister will be aware from the brief that casualties will be transferred to the Crumpsall hospital in north Manchester, in my constituency. Crumpsall hospital is over 110 years old. It is obsolete and has many problems.
The closure of Ancoats hospital will compound those problems. It will also cause probl ems to casualties because of transfer difficulties. Time is of the essence when people are in desperate need of medica1 attention. When one considers the peak periods of traffic and the normal congestions, the resultant delays to some of the emergencies may be extremely imp ortant. There may be a price to pay—fatalities.
If the regional health authority decided to go ahead to close Ancoats, one would have thought that proper prior arrangements would be made. However, no such arrangements have been made. All that has been said is that Manchester Royal infirmary and Crumpsall will take the extra casualties.
In my correspondence with the regional health authority I have already pointed out the. problems at Crumpsall. It has said that it intends to all ocate an extra £250,000 to improve the inadequate casualty provision at Crumpsall. It would have been logical if, first and foremost, the authority had made arrangements concerning the building needs and then made t he decision to transfer casualty services. Unfortunately, the authority has allocated the money far too late and one wonders what will be obtained for that £250,000.
§ Mr. Eastham
The Minister will have plenty of time; we are dealing with only one hospital.
I hope that the Minister will not say that the Government have allocated £17 million f br the first phase of the rebuilding programme. We already know that. But it will be two or three years before Crumpsall will be in an adequate state. We are worried about the present position. Provisions are inadequate at the MRI and at Crumpsall and thus all kinds of stresses and strains are being placed on the services in Manchester.
I hope that the Minister will not say that the Government are improving the National Health Service in Manchester and the north-west — that is not true. Everyone in the city will condemn such a statement from the Minister. I hope that he will reconsider this matter with a view to saying that a mistake may have been made and a new instruction will be given to the regional health authority.
§ The Parliamentary Under-Secretary for Health and Social Security (Mrs. Edwina Currie)
I congratulate the hon. Member for Manchester, Central (Mr. Litherland) on his success in the ballot that gives us a brief opportunity to discuss what is happening at Ancoats and what the district and regional health authorities are proposing.
I join the hon. Gentleman in his tribute to Sir Harry Platt, who died recently. He was probably one of the most 272 distinguished people in medicine and surgery that the country has ever produced. He was held in great affection and will be sadly missed.
I appreciate also the comments of the hon. Member for Manchester, Blackley (Mr. Eastham). I am sure that the issues that he has raised will be taken into account by the district health authority and the regional health authority in the formal consultation, which is yet to begin, on the proposals that are now before them.
Ancoats hospital was opened in 1828 and has seen various changes during its lifetime. The accident and emergency department was opened in 1971 and, as has been rightly said, in 1985 there were about 27,000 new attendances there and nearly 40,000 attendances in all. However, A and E is not the only work done at the hospital. The bulk of the work done there is trauma and orthopaedic, with over 100 beds, and it is highly valued. It is linked with the rheumatology work.
The problem that faces the district and regional health authorities is to determine how Ancoats is to continue serving the community of the hon. Member for Manchester, Central. It is a small site, and it is bounded on three sides by factories and the Rochdale canal. There are major roads—Old Mill street and Pollard street—at the back and the front of the hospital, and that rather limits what one might like to do in a modern hospital on any rebuilding. Secondly, although a housing estate is across the road, the area is zoned by Manchester city council as an industrial and commercial improvement area. Therefore, one might expect that the population shift that has rather denuded some of the area will not be halted and may well continue.
Most important, the hospital lacks the back-up facilities that a modern accident and emergency facility requires. There is no intensive care unit, no coronary care unit and no blood bank. There are no general surgery beds or general medical beds. All such patients requiring hospitalisation require transfer to other hospitals if they come in through the A and E department at Ancoats. They have required such transfer for some time.
There are other A and E departments in the north Manchester district, especially at North Manchester general hospital and Booth Hall children's hospital, both of which have been quite busy. Booth Hall typically deals with about 22,000 or 23,000 attenders and the North Manchester general hospital has been dealing with over 40,000. The facility at Ancoats has been one within the area but not the major one.
Ancoats cannot admit emergency cases to medical or surgical beds and the ambulance service tells us that it cannot guarantee that roads will be clear and that swift transfer will be possible. This obviously might involve some risk to patients. I take the points that the hon. Member for Manchester, Central has made about the ambulance service, and I have no doubt that any permanent closure proposals will take that into account.
In 1969, as the hon. Member for Manchester, Central probably knows, the DHSS issued a hospital building note. That was done under a Labour Government. The note gave guidance to health authorities on the planning of accident and emergency services, and there are two particular things that are of interest. It reads:An accident and emergency department should be part of a hospital which also provides supporting inpatient beds. The department is primarily concerned with patients who are victims of accidents, including head injuries and burns, 273 locomoter injuries, thoracic, abdominal and vascular injuries, sudden illness and poisoning … Many accident and emergency departments also deal at present with large numbers of casual attenders suffering from minor illnesses or injuries, though care of these should come increasingly within the province of the work of the general practitioner.That was the guidance that was being issued nearly 20 years ago by a Labour Government. It still seems sensible, and it was an issue before the Ancoats A and E department opened in 1971.
Subsequent reorganisation, which the hon. Member for Manchester, Central rightly described, ended up with the swapping around of beds from the orthopaedic department at the North Manchester general hospital, with the general medicine and general surgical beds going to that hospital instead. As a result, the Royal College of Surgeons, over a period of about 18 months, has been protesting and stating that the surgical facilities are no longer up to the training standards that it would expect.
The hon. Member for Manchester, Central talked about the report of Professor Sherrard including ambiguities and being hasty. I think that the Royal College of Surgeons and I would reject those criticisms. It was hardly hasty as the discussions have been going on over about 18 months. As for ambiguities, I can do no more than quote exactly from the report that Professor Sherrard sent to the Royal College hospital recognition committee, which met on 30 September 1986. He started by describing the A and E department position as "somewhat anomalous". He said that it is "well furnished and equipped" and that itis clearly a happy department and the junior staff do acquire knowledge and experience largely by virtue of seeing many patients, together with some minimal tuition but the teaching is not adequate. It may well be improved when the new consultant comes into post"—of course, we now have that—but the situation as the whole of the department is a very unsatisfactory one. At the weekends the SHOs are virtually on their own, and if they receive General Medical or Surgical patients in dire straits, there is no one but them to look after them or keep them alive, or even to decide about their transfer. I was told that ambulances could take as long as 2 hours to come for such a patient. The A & E SHOs themselves were very unhappy about the situation and it is probably only a matter of time before a serious problem occurs that might have medico-legal consequences. There is no feedback mechanism by which the Casualty Officers know whether the diagnosis and management they have made was Correct in respect of non-Orthopaedic cases. There is no observation Ward … A possible rotation between the A & E Department at Ancoats and North Manchester General Hospital would improve things, but would still not make the Ancoats section acceptable or satisfactory.He concluded his report as follows:Recognition should be withdrawn forthwith from the A & F. posts when the holders who are about to commence in August 1986 have completed their term of appointment. The A & E service should cease by the closure of the department for that purpose and the patient load transferred, either to Manchester Royal Infirmary or to the North Manchester General Hospital. North Manchester General Hospital will need to have an immediate temporary expansion and SHOs at Ancoats could transfer to that hospital — which would be an improvement, both as regards training and economy.
§ Mr. Litherland
I also have the document from which the hon. Lady has been reading. Has she seen the letter which highlights the ambiguities in that report? If not, shall I send her a copy?
§ Mrs. Currie
I would be delighted to receive anything that the hon. Gentleman wants to send me. I merely say that what I have read is about as unambiguous as anything could be.
As on 25 November 1986 the Royal College of Surgeons withdrew recognition for the training of junior medical staff from 1 February 1987, the district health authority had very little choice, except as an emergency and on the temporary procedures, but to close the A and E department from 1 February 1987. Procedurally the closure is temporary while consultation takes place. I understand that the district health authority hopes to approve a document about the form of consultation at its meeting tomorrow.
I have to say to the hon. Gentleman that in these circumstances no junior doctor in those specialties can work in that A and E section. The only way it can be staffed with medical staff is by consultants and by general practitioners. Both of those possibilities, I understand, are covered in the consultation document of which I have had foresight.
It follows, therefore, that the old A and E department is not an option. No responsible authority and no doctor would or can ignore the Royal College of Surgeons. It is not a question of absolving myself from the responsibility. The Royal College of Surgeons sets the standards for us and we have to take note of them. We should be looking to the future and trying to ensure that the legitimate needs, requirements and requests of the hon. Gentleman's constituents are met, both for accident and emergency provision and for everything else.
My hon. Friend the Minister of State was apprised of the position when he was in the neighbourhood on 10 February. He met the leader of the protest group, Mrs. Anne Dobson. He is taking a close interest in what is going to happen.
The hon. Member for Blackley asked me not to say that we have a lot more money going into the neighbourhood. He knows that that is true. He knows that spending in North Manchester has grown from £47 million to £54 million last year. I believe he knows that £50,000 extra has recently been allocated for waiting list money in that neighbourhood, which will help a large number of patients, and £450,000 extra from the RAW P bridging fund to enable that district, and many other districts in that region, to catch up better than they have been able to do.
Last week my hon. Friend the Minister of State announced the approval in principle of a £17.5 million phase 1 redevelopment at North Manchester general hospital, and part of that redevelopment will be the new accident and emergency department. The extension will be opened in September, and in its consultation document the DHA proposes that that development should be its top priority. We hope that the result will be a vastly improved accident and emergency service for the north Manchester district that should take into account many of the worries of the hon. Gentlemen who have spoken in the debate.
§ Question put and agreed to.
§ Adjourned accordingly at ten minutes past Twelve o'clock.