§ Motion made, and Question proposed, That this House do now adjourn. —[Mr. Lennox-Boyd.]12.52 am
§ Mr. Kevin Barron (Rother Valley)
I am pleased that I have been granted this Adjournment debate tonight to bring to the attention of the House the closure of Firbeck hospital in my constituency. Firbeck hall was bought by the Miners Welfare Commission in December 1945 after being used during the second world war by the Sheffield hospitals board. It was converted into a rehabilitation centre with accommodation for 50 patients, and the first cases were received in April 1947. By 1950 the capacity had been increased to 95 beds through the building of a new wing comprising a gymnasium, hydrotherapy pool, treatment rooms and workshops.
The centre was transferred to the Ministry of Health in 1952 and it was agreed that it would have its own management committee within the NHS, but by virtue of the National Health Service Reorganisation Act 1973 the committee was abolished and the centre came under the control of the Rotherham area health authority in 1974. It has kept a Firbeck hospital committee, with members from neighbouring health authorities, British Coal, Rotherham community health council and coal mining trade unions. It has changed its views to treat many patients from all walks of life, including amputees, who are referred to it from the artificial limb and appliance centre at Sheffield. Those patients have been allocated beds where concentrated courses of treatment and care take place.
On 12 November 1987 the Rotherham health authority agreed to circulate a formal consultation document and an option appraisal on the rehabilitation services in Rotherham. According to that document, the authority believes that the closure of Firbeck hospital is justified. I disagree with that decision. The option appraisal identified three possible choices: to upgrade Firbeck hospital; to provide rehabilitation services at Badsley Moor lane hospital; and to provide such services at the district general hospital at Rotherham. The authority decided to favour the second option, and then sent the matter out for consultation. The consultation document mentions the number of miners who have been treated during the past decade and the changes in attendance, which have meant thatthe number of patients treated has increased over recent years, particularly in the day and sessional out-patients categories.The document says that more patients could use the hospital, including those who are not receiving treatment because of their inability or unwillingness to make the long journey to Firbeck. That caused me to smile, because I have with me the minutes of a meeting held in August 1945 of the local trade union associations and the Miners Welfare Commission, when it was decided to purchase Firbeck. Mr. A. Nicholl, the community surgeon to the commission, stated that a centre should not be more than 25 or 30 miles from patients' homes. I assure the House that private and public travel facilities have improved a great deal since 1945, when the historic decision to buy the hospital was made.
The penultimate paragraph of the consultation document states: 425Having considered the option appraisal, and recognising the need to provide services effectively and in the most efficient manner, the Authority believes closure of Firbeck Hospital is justified because the service can be provided more effectively elsewhere to a wider range of patients. Significant revenue savings can be achieved which will be available for other service developments.Let me deal with those two assertions: first, that money will be saved. That is the case on revenue costs, but not on capital costs. Indeed, the other two options would have a much higher capital cost. The actual difference when capital costs are taken into account is small when compared with the area health authority budget. We must offset that small cost against the treatment and care the hospital can provide now and in the future.
The hospital has helped many thousands of miners to get back into work after serious injury. My father and brother have had in-patient treatment at the hospital following industrial accidents. The health problems of mineworkers are different from those of the general population, and the requirement for orthopaedic-related services is much greater. About 45 per cent. of disabilities in the mining industry are in the trauma of musculoskeletal categories.
In a report written in 1983, Mr. E. B. Macdonald, then the National Coal Board's principal medical officer for Yorkshire, who is an honorary consultant in rehabilitation and rheumatology, said:Medicine in the United Kingdom is primarily orientated towards acute treatment rather than prevention and rehabilitation. Rehabilitation has always been recognised as the 'Cinderella' among the medical specialties. Furthermore, treatment services have evolved such that they tend to be centralised around large district general hospitals which are designed to provide most facilities necessary for the majority in the community … Prolonged unnecessary absence from work takes its toll psychologically. It is well recognised in sociological studies that after as little as three months off work a man or woman can lose their drive and volition to work. This in itself makes the rehabilitation process more difficult because of these and other psychological effects. These patients do not respond well to short sessions of treatment in hospital outpatient departments in between which they lapse back into the apathy of the sit-at-home, visit the-club routine. These patients tend to make very good progress at Firbeck … I believe that it is important for men and women working in heavy industry to get prompt and effective treatment for their disability, not only for their own benefit but for the good of the community as their unnecessary absence from work has enormous economic effects.Mr. Macdonald believed that Firbeck should be fully integrated into the National Health Service as part of the continuing rehabilitation process. That is evidence from a leading expert who is recognised in south Yorkshire and in most other areas.
The hospital was previously under scrutiny in 1983–84, in the Trent regional review. Rotherham community health council visited the hospital in August 1984, and I can summarise its report as follows:'Small is beautiful' and small organisations can cater more for a specific person. Firbeck develops competition between patients. Patients may lose their identity and become `lost' in a large unit … The setting at Firbeck is ideal and inspires patients to communicate with nature. Firbeck should be developed to a greater extent … Firbeck provides a very valuable service to the local heavy industries and encourages patients to get themselves fit for work … As opposed to a District General Hospital environment Firbeck has the time and facilities to concentrate on cybernetics and the human involvement.426 The neighbouring Bassetlaw community health council also visited the hospital in October 1984, and concluded in its report:There is no hesitation whatsoever in recommending that Firbeck Rehabilitation Centre be continued and indeed expanded as members are convinced, after having the opportunity of talking to both patients and staff, that the care and facilities provided at Firbeck could not be equalled on a DGS site.When visiting Firbeck, I spoke to a person who had lost both his lower limbs in an industrial accident. There was certainly no doubt in my mind that the treatment and care that he was receiving was going a long way towards rehabilitating him to the realities that a young man with such traumatic injuries must face. I recall that he was the same age as me, and he also had a young family. The extended course that he was undergoing as an amputee was doing much to adjust him to the psychological state induced by what had happened to him. The appraisal points out that some patients are removed from stressful home environments after difficult times following injury and benefit from the excellent environment at Firbeck.
Even Rotherham health authority has in the past recognised the unique facilities at Firbeck for both treatment and care. The environment of the hospital is aptly described in its own words in a leaflet that it issued a few years ago. It said:the grounds lend themselves to a variety of therapeutic and pleasure uses. There are footpaths laid out through the woodlands to demand varying degrees of effort from the patients, a bowling green, putting green and cricket/sports field, and numerous areas suitable for ad hoc recreational activities such as volley ball, netball etc. While maintaining the emphasis on recovery by means of purposeful exercise and activity, relaxation and social affairs are also there to be enjoyed. A games room is provided for both therapeutic and leisure activities. Snooker tables are available and there is also a covered skittle alley.In 1952 the conveyance from the Miners Welfare Commission to the Ministry of Health contained the following clause:The Minister hereby undertakes with the Commission to use and maintain the property hereby conveyed as a Rehabilitation Centre primarily for the use of injured workers in or about coal mines and to use the same for no other purpose until such time as after consultation with the Commission he is satisfied that not less adequate alternative facilities are available to such workers".Rotherham health authority has failed to maintain the hospital. In its own appraisal, it admits to receiving a report in May 1983 suggesting that building fabric and engineering services were in need of refurbishing and replacement. We can only assume that it has done nothing since then. The appraisal also states, in paragraph 7.1.3 on page 22, in relation to the authority's preferred option:this provision would meet the clause in the deeds regarding adequacy of alternative provision.I strongly dispute that. The care given at Firbeck, especially to amputees, and its beautiful environment, can never be matched in either of the two alternative options.
I travel on the motorway regularly when going between the House and my Yorkshire constituency. I happened to listen to a phone-in programme presented by Nick Ross in December last year, in which the Minister took part. I wonder whether the hon. Lady remembers a call that she received from a Mr. Paramoor from Exeter, who spoke of the hospital and ward closures that were then taking place. In answer to his question the hon. Lady spoke of a small 427 cottage hospital in South Molton, north Devon, where I understand her relatives came from. She said that closure had been talked of, and:then they realised it's nice for people to have not treatment hut care.She went on to describe that care as very valuable and very nice.
The very same phrases could be applied to the many thousands of people who have been in Firbeck hospital over the years; and, indeed, to the patients who are there now, receiving the same treatment and care, rather than simply being brought into a major hospital—perhaps a district general — and being given one or two days a week of out-patient physiotherapy. Firbeck can provide services which can be found nowhere else in the health authority area. They certainly cannot be provided under the options drawn up by the area health authority. I urge the Minister to support me in asking Rotherham health authority to change its mind and keep open and improve—for the benefit of all in the area—the rehabilitation service and the excellent standard of work in the amputee unit at Firbeck.
§ 1.5 am
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)
I congratulate the hon. Member for Rother Valley (Mr. Barron) on his success in the ballot. It gives me my opportunity to answer my 41st Adjournment debate since coming to this post. I always feel that it is a privilege to have the opportunity to respond to the interests and concerns of hon. Members' constituents in this way, and I shall endeavour to do so again tonight.
The subject that the hon. Gentleman has chosen is of interest to his constituents and the National Union of Mineworkers, which is his sponsor in the House, given Firbeck hospital's origins as a miners' rehabilitation centre. It still provides a service for miners, as do many hospitals in mining areas, including mine. It numbers pit men and ex-pit men among its past and present patients.
It would probably be helpful if I were to explain the procedure concerning variations in services. If there is a substantial variation in health services — it may be something other than closure, such as a change of use—health authorities must consult widely on their plans and consider all the comments. The local community health council must be consulted, and it should submit counter proposals if it disagrees. Any such counter proposals must be carefully considered by the district health authority. The hon. Gentleman will note that I said "must" and not "should".
If the district health authority rejects the counter proposals and reaffirms its original plans, the matter must be referred to the regional health authority. In the case of Firbeck, it would be Trent region. If the regional health authority supports the district's decision and the community health council still objects, the proposal must be referred to Ministers for a final decision. Effectively, therefore, whether a closure comes to Ministers depends on the community health council's view, but we prefer decisions to be taken locally wherever possible.
I can assure the hon. Gentleman that, before reaching a decision, Ministers are scrupulous to take into account and give weight to all of the comments. It is therefore 428 important that we do not commit ourselves in advance but hear all the arguments. I am glad to have this opportunity to hear at least some of them.
I can outline the facts as they have been represented to me, especially by the district health authority. I understand that Firbeck hospital is situated some nine miles south of Rotherham near the health authority boundary. It is in a very attractive area and surrounded by pleasant parkland. It was transferred to the NHS nearly 35 years ago. Progressively fewer miners have used the hospital, partly because the number of people employed in mining has reduced substantially during that time, partly because the accident rates in mining are lower—which I am sure everyone here will welcome — and partly because the provision of modern hospitals with improved rehabilitation facilities elsewhere mean; that more miners can be treated as out-patients near their homes. That also must be generally welcome as it is part of an improvement in service.
In 1974, 265 miners received residential treatment. In the first six months of last year, only 58 did. The hospital now also provides residential rehabilitation and outpatient and day services for other groups—mainly men, but also some women. Their numbers have increased steadily and they now heavily outnumber the miners. In 1982, there were 321 residential and 99 day patients. Since then, patterns of treatment have changed again and, by September 1987 there had been 294 resident and 211 day patients. The shift has gone far more towards day patients.
I understand that a number of problems have prompted the Rotherham district health authority to review the rehabilitation services provided in the district, including that provided at Firbeck but not just the Firbeck service. For example, many of those who use Firbeck come, I understand, from the southern and central parts of the district. It is said that many patients do not receive appropriate rehabilitation treatment because of their inability or unwillingness to make the long journey to Firbeck.
While I take on board entirely what the hon Gentleman says about improved transport services since 1945, it is a fact that people's expectations of what constitutes a short or a long journey have also shifted since that time, when perhaps people were more prepared to make longer journeys for scarcer services than they are sometimes now. I am told that this problem particularly affects women because public transport to Firbeck is not easily accessible and, of course, many of the women we are talking about are older ladies who may not have the use of a car. Travel to Firbeck can take a considerable time.
At present only limited provision exists in the district for rehabilitation treatment of people with disabling diseases, such as rheumatic conditions, strokes and back injury. The service appears to have developed substantially in response to accidents, arid that is welcome, but increasingly the people that we need to care for in this kind of service are those of whom age and infirmity have simply taken their toll. It is felt, I understand, that the maximum benefit to these patients can be obtained by beginning intensive treatment as soon as possible after the onset of illness. The need to be resident at Firbeck hospital or to travel considerable distances for out-patient treatment there causes difficulty.
Apart from that, a condition survey has revealed the need for considerable renovation at Firbeck, despite the expenditure of considerable sums, referred to by the hon. 429 Gentleman, in the recent past. It has been estimated that the cost could be £750,000. On completion, revenue costs would remain at over £400,000 a year, and even then it would not be possible to use the whole of the building.
A district health authority appraisal has been carried out of the best way to provide services in future—and it is a question of ensuring that these services are provided in the future. I am sure that the hon. Gentleman would not dream of misleading any of his constituents by implying that these services would simply vanish. At a meeting in October 1987 the Rotherham DHA decided against upgrading Firbeck in favour of developing the rehabilitation service at Badsley Moor lane hospital. It was the authority's view that Badsley Moor lane hospital was better situated, since it is in Rotherham itself, and could, with some capital investment, provide a more comprehensive rehabilitation service for the whole of Rotherham—and it would end up costing only £200,000 a year.
§ Mr. Barron
I am sure that the hon. Lady has no intention of misleading the House on the matter of costs. I said that the actual revenue costs would be higher; but of the three options discussed, the capital costs are certainly higher on the other two than for the refurbishing of Firbeck hospital. What I said was that, if one looked at the revenue costs and the £200,000 a year difference, it is not a lot in terms of the overall budget of the Rotherham area health authority. The real question must be whether £200,000 out of some £30 million is a lot to take into account when one thinks of this long treatment that can be given to amputees. I know that the health authority in any of its appraisals—which, I assure the hon. Lady, I have read in great detail—has not convinced anybody that there is any long-term treatment for amputees. This is not just for the Rotherham area, of course, but for the whole region.
§ Mrs. Currie
Happily, I reassure the hon. Gentleman and his constituents that nobody is planning to do away with a long-term service to amputees. If they require a medical service, they will get it. The question, as I understand it, is whether they should get it at Firbeck or somewhere else, and whether they can at the same time see some improvement of the service not only to amputees but to people suffering from other forms of disease. I merely offer him the figures that I have been given. I note his view that £200,000 a year difference in running costs is not much—
§ Mr. Barron
They would be s aving on capital expenditure.
§ Mrs. Currie
Perhaps the hon. Gentleman would allow me to continue, as I have not quite finished.
I was interested also to hear what the hon. Gentleman said about bowls and skittles and the facilities at Firbeck. That is really quite remarkable. I do not think that many hospitals in this country spend National Health Service money on excellent services like that. In my area they are provided either by the miners' welfare or by other organisations. I merely offer that as a thought to the House. The district health authority is now consulting those concerned locally and has invited comments and, if necessary, counter proposals by 29 February. So it rests with the people concerned locally to contact the health authority with their views.
430 I should stress that the argument is about how to provide care most efficiently and appropriately and with the least stress and trouble to the people concerned, particularly in travelling. It is not about the standard of care provided. The staff at Firbeck are to be praised for their dedication and their effort towards patients.
Obviously I cannot anticipate what the district health authority will decide, but I understand that the hon. Gentleman has already discussed the issue with the health authority on 8 January. I will ensure that his comments tonight are brought to the authority's attention and that they are borne in mind.
I described the procedure earlier, but there is at least one slight variation in the case of Firbeck. As the hon. Gentleman says, the conveyance under which the property was handed over to the Health Service some 35 years ago states:The Minister hereby undertakes with the Miners Welfare Commission to use and maintain the property hereby conveyed as a Rehabilitation Centre … and to use the same for no other purpose until such time as after consultations with the commission he is satisfied that not less adequate alternative facilities are available to such workers.We will obviously look at this point carefully before allowing any change in the service.
I understand also that the National Union of Mineworkers may ask for the building back if a decision is taken to close it. If I have to, I will take legal advice on that. I offer the hon. Gentleman this thought. If the property were to be disposed of through the district health authority, the proceeds would go straight into the National Health Service, not to the Treasury nor anywhere else. We would expect a sum of at least £250,000, which would, I understand, stay in Rotherham health authority. I am sure that most of the hon. Gentleman's constituents would agree that that is a wise procedure and would result in improvements for the public good. I am sure he will agree that the health services in Rotherham could use it. I have no information on what the National Union of Mineworkers might do either with the building or with the money if it was sold by the union.
§ Mr. Barron
The Minister brings up the question of the National Union of Mineworkers claiming the hospital back. It was the money of coal owners and coal miners that bought the hospital. I have had discussions with the NUM. I have never heard any of the officials say that the union wants it back. We want the facility to carry on being used.
§ Mrs. Currie
I am most grateful to the hon. Gentleman for giving us that information. All the money that we can release from the sale of assets that are no longer required we need in the Health Service, particularly in areas like Rotherham. His assurance will be welcome to his constituents. However, we are nowhere near taking legal advice or other decisions on it.
It is important to remember that the Health Service needs to change and to keep up with new demands. We need to develop and improve services within the resources available. We need to realise resources in a way that has been going on to quite an extent in Yorkshire and in Trent regions. We need to meet changing health care needs. Sometimes we need to recognise the different physical distribution of local people from the time when the hospitals were built.
Most changes are agreed locally and most changes result from the improved services which are provided more 431 appropriately and more economically from a different location. It would not he acceptable to the House, in my judgment, to continue to provide inferior health services from old and outdated buildings when better ones could be provided in better or more modern facilities. That is the basis upon which much of the change has been agreed locally.
The Government attach the highest priority to improving and modernising the estate. Since 1979 at least 176 schemes costing more than £1 million have been completed in the Health Service, providing over 20,000 new beds. There have also been many smaller facilities completed. There have been closures, but the service in 432 terms of patients treated has increased enormously and Is being provided broadly speaking from more modern and better located hospitals and other facilities.
The process will continue. About £1 billion will be spent this year on capital projects. Throughout England some 470 schemes, each costing over £1 million, with a total value of over £3 billion, are at various stages of planning, design and construction. In Rotherham, as elsewhere, we hope to see the benefits of that massive record building programme. We hope—we are assured—that, whatever decisions are taken about Firbeck, they will be taken entirely in the interests of the patients concerned.
Question put and agreed to.
Adjourned accordingly at twenty minutes past One o'clock.