Hospital Complex (Downpatrick) (Hansard, 24 February 1988)

§ Mr. Eddie McGrady (South Down)

I am pleased and grateful to have this opportunity to speak about the crisis that faces the Downpatrick hospital complex in my constituency. I am also glad to see that the Minister responsible has returned to full health—the theme of the debate is good health.

When I applied for the debate, it was to ask for the provision of sufficient capital to rebuild what is known as the Downe hospital at Downpatrick—a building which is 104 years old and was built for another purpose entirely. We have since had an announcement from the Eastern health and social services board, which is responsible for the Downe unit of management, that it has been notified of a budget which is totally deficient for its purpose of supplying an adequate hospital and medical service to the entire board area. The board has said that it will face a deficit in 1988–89 of £7.6 million, not taking into account the fact that, in the next fiscal year, it must meet a wage and salary increase. The consequence of that shortfall is that the board is frantically—perhaps indecently—trying to close hospitals and wards to meet its unrealistic budget.

This is an old debate. It is 20 years old. I have had this argument with the Eastern board for that time. We are still without any capital programme to provide what it was recognised was needed as long ago as 1965. Notwithstanding that, we are now faced with the closure of a maternity hospital and the decimation of acute surgical wards. The hospital problem in Downpatrick has changed in the past couple of weeks, from seeking capital expenditure, to stemming the rot of closures and cuts.

I have the privilege to speak on my own behalf and on behalf of the entire community of Downe, of whatever political persuasion. I have received the unanimous support of the medical and paramedical members of the community.

Some 23 years ago, in the debates in Stormont and the then Department of Health, it was recognised that the Downe hospital needed to be replaced. Funds were earmarked for the enterprise. Unfortunately, we had only talk, and the money was redeployed to the Masserene hospital in Antrim.

A couple of years ago it was with a sense of déjà vu that, when I was seeking £6 million or £7 million of investment in that aging structure, we were told that no capital was available. Yet, out of the blue, £33 million suddenly became available for a hospital. Will hon. Members believe that again it was a hospital in the Antrim area? I do not begrudge money being well and usefully spent in the Antrim area, but our long-term approved need was not met in any way by the health board or by the Department.

In considering the problem, it is important to note the background against which I speak. Down is a rural area of 646 sq km, with a scattered population of 82 persons per sq km. It has no railway system, a poor bus service, and a road system that is still in the 18th century. Geographical features have a considerable impact on the delivery of health and community care services. None the less, the people of Down expect reasonable access to medical and surgical services.

418 That expectation was recognised by the Royal Commission on the National Health Service, which, in its 1979 report, stated: A fundamental principle of the national service must be an equality of provision, so far as this can be achieved without an unacceptable sacrifice of standards. It went on to state: If inflexibility is to be avoided health authorities should implement national policy in the context of their particular geographical and demographic constraints. That is the basis on which I urge the Minister to reconsider the Down district.

All rural areas have a service centre to which the rural community looks. At the moment that service area is the town of Downpatrick. I ask that a good hospital service be provided in that town. The alternative is totally inconceivable. It would mean that 40 per cent. of the entire area of the Eastern health board would be devoid of any real hospital and medical services.

In addition, there is an influx of inhabitants during three months of the year. Hon. Members may, or may not, know that the county of Down is the most beautiful and most tourist-oriented county in Ireland. It is not surprising—indeed, the Department of the Environment accepts this—that 1.2 million persons visit the area during a 12-week period. This means that, on a day-to-day basis, there are 11,500 extra people. On top of that, there are 900,000 overnight stays within that 12-week period, which means that another 9,800 people are resident in the area during the summer months. That is a total population surge of about 21,000.

Tourists and short-term stay people require medical services, just as the rest of the community do. In addition, injuries and accidents related to sailing, climbing, horse riding and other vigorous tourist pursuits put a greater demand on services than that which is normally expected in such a rural community. Again, the Royal Commission's report states: Hospitals must be accessible to the population they serve. Another aspect of the background of Down relates to socio-economic factors. It is a poor, deprived area, which, in parts, has 21 per cent. unemployment. Other hon. Members may quote similar pockets of unemployment. There are other socio-economic factors.

The 1981 census of the Down district, as distinct from other local government areas in the Eastern health board district, produced certain facts. The census showed that the district had the highest average number of persons per household; the highest number of persons per room; the lowest percentage of households connected to the public water supply; the lowest percentage connected to public sewers; and the highest birth rate. I will add that, thankfully, it has the lowest perinatal mortality rate, due entirely to the presence of the maternity hospital. The district has a higher proportion of the population in the higher dependency bracket—the under-14s and those over 65 years of age. I am proud to boast that it also has the highest natural increase in population of all the districts.

In addition to those socio-economic factors, 32 per cent. of householders have no car. Of those in employment, 25 per cent. must commute outside the district. That adds another considerable dimension to the number of households without a motor car during the working day. Because of the lack of transport and the lack 419 of a transport system, people cannot avail themselves of the hospital service unless that service is within a reasonable and convenient distance.

All those factors show a great need for an available and local service in the local hospitals, but what is being planned for the areas? There are plans for the closure of the maternity hospital and the destruction of our acute and surgical wards. Our maternity hospital was opened during 1981–82. Since then it has achieved a bed occupancy of 78.4 per cent., which is the third highest of the maternity units in the Eastern board area. However, the hospital has been singled out for closure simply because it has not reached that magical figure demanded by the authorities of 1,000 throughput births a year. Anyone would think that we were talking about cattle instead of human beings.

The total number of births in the district in 1986–87 was 1,073. Unfortunately, 355 were misdirected — in my opinion — to other maternity units. That statistician's delight, that bureaucratic blunder of 1,000 births, must not stand in the way of making adequate provision for the mothers-to-be, who very often will have to travel considerable distances from mountainous areas, but I doubt whether that will have occurred to the authorities.

I have no doubt that infant mortality will increase again to its previous levels. Infant mortality in the Down district was reduced to 5.34 deaths per 1,000 births, against a Northern Ireland average of 13.4 and a United Kingdom average of 11.4. That, if no other, is a justifiable reason for the maintenance and continuation of our maternity hospital.

What savings will be made? If those patients are placed elsewhere, they will need the same treatment and care, but with additional transport costs, additional stress and psychological factors that will probably extend the stay in hospital and so increase costs. There is no monetary sense in the matter at all. A monetary budget that takes no cognisance of the needs and welfare of the patient is flawed in the medical sense.

The other factor is the proposal to cut our surgical beds by almost 50 per cent. In practice that means that upwards of 1,000 people in the Down area who have received acute medical services in the past will have to go elsewhere, with the same costs for transport, the same stress, the lack of visitation and the psychological deprivation and new surroundings that I said would occur if the maternity unit were to close. The real effect will be to end the viability of the hospital as an acute hospital service.

I have not mentioned the fact that there is a large psychiatric hospital in the area, which, in turn, is dependent upon the maternity and surgical hospitals. Who, or what, is going to service the mentally ill and the seriously mentally retarded in that psychiatric hospital? The services are already being run down. Our ambulance service was transferred in 1986. Ear, nose and throat services and optical specialties were transferred in 1987. The financial administration organisation is to be transferred in 1988.

We are suffering from the past and continuing policy of the board and the Department — a desire for centralisation. Presently, centralisation is the god of medical administration. It is interesting to note that this week an eminent surgeon at the Royal Victoria hospital, who is one of the chief proponents of centralisation, in relation to Downe district hospital, said: 420 This issue in this case is again not between peripheralisation and centralisation, but the extreme difficulties that would be involved for patients if Downe hospital were closed. I am a layman, but it is clear that the medical opinion of Downe is unanimous and firm. The following observations have been made: 1. We feel it is extremely unwise to make major policy decisions about the provision of services based solely on financial considerations.

2. The arguments about the pros and cons of retaining a maternity unit in Downpatrick have been rehearsed many times already, but the medical advice has been clear throughout, namely that the maternity services should be retained in Downpatrick because of its geographical isolation.

3. Closure of the maternity hospital would remove obstetrics and gynaecology from the GP rotational training programme of the unit. This programme is vital to the junior staffing of medical, surgical, geriatric and gynaecology departments. It is also said that a 50 per cent. reduction in the number of acute surgical beds would mean that the unit would be unable to function effectively and therefore would be subject to future closure. It is also believed that the provision of existing facilities represents the minimum viable size of the unit.

I have expressed my grave concern about the effect of the proposals for the Down district. I ask the Minister to intervene directly to exercise his authority to prevent the gross deprivation of medical, maternity and, ultimately, psychiatric care. I ask the Minister and his Department not to stand aloof from the decision-making process of the Eastern health board. The Minister must not hide behind the departmental argument that it is for the board to decide. He must exercise his right to oversee the medical services for the Down district. The Minister and the Department must ensure that. Downe receives equality of provision that is of an acceptable standard.

I am sure that the Minister is already in receipt of two reports from independent sources — one from PA Consultants and the other from Coopers and Lybrand. One deals with the need for the services and the other the costing of a modest, modern hospital for Downpatrick. I ask the Minister to consider urgently the points that I have made and that I know would receive the support of hon. Members if they were applied to their particular areas.

I ask the Minister to intervene to stop the closures and, at a reasonable date in the future, to lay aside a modest sum for the replacement of a 104-year-old building.

§ The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Richard Needham)

I thank the hon. Member for South Down (Mr. McGrady) for commenting upon my health. My general practitioner was on holiday and therefore I have not made any use of the NHS, but I am glad to say that, at least for my benefit, I have fully recovered.

I understand the hon. Gentleman's concern, and he has expressed it in his usual forthright and eloquent way. He has raised two separate issues: the question of Downe hospital and the maternity unit.

As to the immediate threat, the hon. Gentleman will be aware that the Eastern board has issued a consultative document and it contains a wide range of possible options. As the hon. Member for South Down has said, this is not the first time that the matter has been discussed. The board will not take any decisions on the issue until there has been an opportunity for discussion. I appreciate that the time 421 scale is fairly short. The end of the original time scale will not bring an end to the debate about what options the board is to adopt. The debate will have to continue.

Since the options are to be adopted by the board, I cannot go in any substantive way into the points that the hon. Gentleman has raised on the board's arguments or his own. As the hon. Gentleman is aware, it is the role of the board to make a determination and to judge the arguments. I cannot overrule that. I have listened very carefully to the hon. Gentleman because if the board comes forward with proposals the Department will have to consider them carefully.

The hon. Gentleman raised some points which gave me cause for concern. I do not think that the hon. Gentleman can compare the proposals for Antrim with those of Down. The proposals must be considered on their merits. If the merits of the case are such that Down should have a rebuilt hospital, that will be considered, as the case for a new hospital at Antrim was considered. Nor do I find it particularly persuasive for the hon. Gentleman to argue that, because there is a large influx of tourists into a most beautiful part of Northern Ireland, facilities should be built which would be used for only two or three months of the year. As he rightly pointed out, we must build facilities to serve the population.

I understand the force of the hon. Gentleman's criticism, but the board has to live within its budget for the next year. The budget that we have had to place upon the board, the 5.2 per cent. increase, means that it will need to make savings of 2 to 3 per cent., which, as the hon. Gentleman said, is approximately £7 million. That means that the board will have to make difficult decisions. Clearly some of those decisions will not be popular.

We have to consider a point of principle in maintaining the acute services for Downpatrick. I appreciate the force of the arguments that the hon. Gentleman put so eloquently about the numbers involved in the population of the eastern area and the distance that people would have to travel were there to be a significant change in the acute care, but I hope that the hon. Gentleman will accept that there are problems in keeping a high-quality hospital open to small, dispersed and mainly rural communities.

It is not a question only of capital funds being made available for a new hospital. Even if we were to make the capital investment — I appreciate that the hon. Gentleman strongly believes that that capital investment should be made available—that is not the only problem. We are talking not only about buildings, but about the scarcity of staff, equipment and skills. It is not possible simply to buy those skills.

An acute hospital with modern facilities must be large enough to sustain adequate levels of junior medical staff. 422 Otherwise consultants must put up with a heavy on-call commitment, and that cannot be satisfactory to maintain a service. An acute hospital of that sort must be viable in terms of capital costs, staff—the Downpatrick hospital has good, immensely dedicated consultants who work extremely hard—and the future. One must consider its capacity to attract, keep and train junior medical staff and to give them a range of specialties. Clearly, regional centres of excellence are bound to be more attractive. I am not saying that the argument for an acute hospital at Downpatrick is not necessarily strong, but it must be seen in the round and remembered that this is not only a question of money.

The hon. Gentleman suggested that the figure 1,000 had been grabbed from the sky; it has not. To have a successful and efficient maternity unit there must be a certain level of throughput. There must be sufficient clients for good paediatric cover, proper facilities and intensive care, and to allow staff to exercise and develop their skills. If there is a reason for doubt about the future of the Downpatrick maternity unit, it is that only 60 per cent. of mums in South Down use it. The hon. Gentleman said that mothers were misdirected, but I am not clear who misdirected them, whether their GPs, consultant gynaecologists or themselves. The unit has a capacity for 300 more babies a year than are born there. Many mums are voting with their feet for whatever reason. If the hon. Gentleman and community leaders want to keep that unit open, it is crucial that those who would naturally use it do so. It is questionable whether hospitals such as Downpatrick acute hospital and the maternity unit are viable if they are not properly utilised.

This debate has raged for many years. The Eastern board, in its area strategic plan, stated clearly that services would be maintained during the current planning period to 1992. I understand the hon. Gentleman's concern to reconcile that commitment with the problems of making the 2 or 3 per cent. savings to meet its 1988–89 budget. I can assure him that before any final decisions are made I shall want to explore this closely with the board chairman. If the board finally adopts a firm proposal which in any way affects Downpatrick, I shall make absolutely certain that it makes financial sense for the services involved.

I hope that the hon. Gentleman will accept that the Department will study closely any proposals from the board. This is not merely a question of funding; it concerns how the services are run on behalf of both the clients and staff so that the staff can give the quality of service that the people of Downpatrick deserve.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Twelve o'clock.