Acute Beds (Fife) (Hansard, 21 March 1988)

§ Mr. Dick Douglas (Dunfermline, West)
It is an sign of how important my colleagues and I believe this issue to be that all Fife Members of Parliament are present, including my hon. Friend the Member for Cumbernauld and Kilsyth (Mr. Hogg), the Opposition Front Bench spokesman on health. We certainly outnumber the Scottish Conservative Members present.
The issue of acute bed provision in Fife, and the way in which the Under-Secretary of State for Scotland has behaved towards the people of Fife and the members of the Fife health hoard, illustrates the Government's scant regard for the opinions of people outside the House which differ from their own. It is a matter of common knowledge. I wish to quote from a letter to the Minister dated 4 March, from a large group practice in Dunfermline. Perhaps the Minister will give us some indication tonight of how he will reply to the letter, which stated: For twenty years and more, the integration of hospital medical services serving West Fife has been debated and in the meantime our patients have had to put up with a service, which, because of its lack of inter-specialty co-ordination, has left a lot to be desired. The health board's current attempt—I use that word advisedly—to solve the problem goes back to at least 1983, when the board embarked upon a course of action that should have led to a relatively speedy decision by the Scottish Home and Health Department as to the best direction to be followed in Fife.
To obtain an approval in principle to its scheme or schemes the health board was obliged to conduct what has become known as an option appraisal exercise or study. It was the first such study to be undertaken in Scotland and was carried out by the health economics research unit of the university of Aberdeen. It was completed in May 1984.
I shall briefly enlighten the House on the concept of option appraisal. The first report of the Select Committee on Scottish Affairs 1986–87 on hospital provision states in paragraph 24: The Board is required to undertake an Option Appraisal …examining the alternative ways of meeting the identified need in order to find the best solution. The present so-called Minister for Health in Scotland was a member of that Committee and indeed was a signatory to that report. The Government reply to the Select Committee on 13 May, states in paragraph 11: The systematic approach of option appraisal should reduce, rather than increase, the time taken in the planning stage. There can be no argument that, in the case of the Fife health board, the need was not clearly defined and that the option appraisal exercise was not completed in a highly professional manner.
I shall not detain the House by going over all the health options that were put before the health board at that time. Realistically, those options came down to two that have become known as option C and option D. In shorthand terms, option C was based on the "equal" distribution of facilities and option D was based on what one might loosely call the "balance" of population in Fife. Suffice to say that, in June 1984, the Fife health board decided to proceed with option C.
174 I shall not weary the House with all the details of the meetings that have taken place between colleagues, myself and the various Tory so-called Ministers of Health. The House should be aware that the issue that we are discussing in the early hours of Tuesday morning was debated on 30 October 1986. In a letter to colleagues and myself on 3 December 1986, Lord Glenarthur, then Minister of State, Scottish Office, with responsibility for health, said: I can confirm that it now very much up to the Board to decide whether they wish to proceed with Option C or Option D. They are not obliged to follow any recommendation made by the Buildings Division, and I assure you that neither I nor the Scottish Home and Health Department are seeking to influence the Board one way or other." Given that the board thought that the Minister was a man of his word it is not surprising that it confirmed its decision for option C in February 1987 and again in October 1987. In view of what has transpired since the hon. Member for Stirling (Mr. Forsyth) became Minister one would have thought that he has been faced with a politically hostile Fife health board. I estimate that in 1979, out of 19 members of the Fife health board, 10 were Labour party members, or sympathetic to the aims of the Labour party. In 1988, only four of the 21 members can be considered to be either Labour party members or to have broad sympathy with the aims of the Labour party, despite the fact that there is not one Tory Member in the whole of Fife. That is really manipulating. I claim that the Minister and his predecessors tried to manipulate the membership of the Fife health board along their own political lines. So much for playing by the rules of the game. It is to the credit of the board members that they have maintained and sustained their views.
I now want to consider the crucial period during which the Minister has had the approval in principle scheme before him. I have been told that the Scottish Home and Health Department had placed the approval in principle on the Minister's desk in early December 1987 and that the Minister was to give his decision in January 1988.
The Minister wrote to Fife health board on 24 February 1988 stating: I have considered carefully the Board's submission and have decided Option D is preferable to Option C. The House should know that at no time was the Fife health board or its officials aware that the Minister had misgivings. At no time was a hint given that the Fife health board's preferred option was to be cast aside.
When he was wearing his education hat this morning, the Minister had the temerity to quote from a teacher who wrote in the Glasgow Herala. I want to quote again from the group practice to which I have already referred and from which the Minister has received a letter. That letter puts the point to the Minister. In fact, if he would pay attention, he may understand. The letter is dated 4 March —[Interruption.] The Minister has not received the letter. Still, I will quote from it. It states: It seems to us that it would have saved a lot of time and money, if you"— that refers to the Minister, not you, Mr. Deputy Speaker— had simply considered the different options yourself without asking for the Health Board's recommendations, which you appear to have totally disregarded. The purpose of this letter is purely to record our disquiet and disgust at a decision which we believe is totally wrong. It would be naive of us to think that any opinions of ours would even be considered by a representative of a Government which has a reputation, growing by the minute, of paying no heed to local and informed ideas and carrying out its policies by diktat. 175 The Minister may snigger at that, but that is the view of politically active people. I have a copy of the letter and I am willing to give it to him. It is from the Netherton surgery in Dunfermline and is signed by everyone in the practice — Dr. Yellerly, Dr. Alexander, Dr. Orris, Dr. Alexander and Dr. White. To the best of my knowledge, they are not members of the Labour party. However, that is an expression of local opinion.
Regardless of the merits of the decision, the concern lies in the method of approach adopted by the Government. What is the effect of Government by diktat on the people of Fife? First there will be more delays and suffering. It will take another three or four months to prepare a new submission. Even if things go smoothly, phase 2 in Dunfermline will not be completed until at best 1994.
Secondly, I do not wish to pronounce judgment on Kirkcaldy, but given that little or nothing can be done there until Dunfermline phase 2 is completed, we shall be into the 21st century before anything is achieved. I am willing to give way to the Minister if he disagrees with that.
The Fife health board stated: In view of the delay, the Board will have to commit capital resources to maintaining the existing facilities in Kirkcaldy. Already it has been identified that major work will have to be carried out in upgrading operating theatres and replacing the boiler-plant. Attention is now being given to these matters. The re-location of existing beds throughout Fife in view of changing medical practice and technology is also an ongoing exercise. The board is saying that Dunfermline phase 2 will take nearly six years—until 1994—and the Minister is on record as saying that he will not consider approval in principle for Kirkcaldy until Dunfermline is completed. I am willing to listen to differences of view on this.
Thirdly, we are not even agreed on the number of beds we are talking about. The Fife health board says: In his letter of 23 February, the Minister used for the first time a total of 855 existing acute beds and this figure was reached by including the 62 acute mixed beds in Adamson Hospital, Cupar, and St. Andrew's Memorial Hospital. The Minister said that the additional 59 acute beds in Dunfermline when added to the existing 855 beds will bring the total number of beds in Fife very close to the planning target of 918. From the time the acute bed option appraisal was started in 1982 the number of existing acute beds in Fife was calculated as 793 by both the Board and the Department. This number is reached by adding up all the acute beds in D. & W.F., Milesmark, Victoria, Cameron, and Randolph Wemyss Hospitals. The number did not include the 62 acute mixed beds in Adamson Hospital, Cupar, and St. Andrew's Memorial Hospital. Let us have some clarification of this, if possible. One of the Minister's opinions is that it would be difficult for a health board to anticipate carrying on two capital projects of this nature simultaneously. A few of my colleagues went the other week to Faslane and Coulport. Those two schemes amount to roughly £500 million. So when the Goverment want something done, it can be done. The necessary sources can be deployed. However, I warn my colleagues that, given the Minister's known views, if there is no change in the Government of Scotland there will be little hope of a solution to the problem of acute beds in Fife within the private sector. The Minister is looking for a delay that will force people in Fife to adopt the private sector option.
Having listened to the Minister today, first in his guise as a Minister with responsibility for education and then for health, I might be forgiven for using the term "Pooh Bah" 176 to describe him. He is a Lord High Everything. He does not quantify his approach. He gave an interview to the Dunfermline press in which not a single financial figure was mentioned. Behind that lies penny-pinching by the Treasury and the Government. If the Government wanted to alleviate the suffering for lack of acute beds in Fife that has gone on for a long time, the money could be supplied.
Pooh Bah is a wrong description. My knowledge of Gilbert and Sullivan leads me to suggest—I apologise to those who are not so knowledgeable—that the Minister is really King Gama from "Princess Ida". [Interruption.] You will not laugh when you hear it, brother. Taking a little liberty with the lyric, he might be summed up thus: He has an irritating chuckle, He has a celebrated sneer, He has a most annoying snigger, He has a despicable leer. To everybody's prejudice he knows a thing or two. If you want your poll tax estimated in half a minute, then he can, And although he feigns to make himself the economic man, To everybody else he is such a disagreeable man. That is the person we in Scotland have to suffer as the so-called Minister for Health and the so-called Minister of Education.

§ The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth)
I am grateful to the hon. Member for Dunfermline, West (Mr. Douglas) for raising this matter for debate—if not, perhaps, for the way in which he chose to do it. In the time that he has left me—having taken so much time to indulge in personal abuse—I shall try to answer some of the points that he has made.
The hon. Member seems somewhat aggrieved about what he sees as a decision to force the Fife health board to accept an option that it does not want. I should have thought that the hon. Gentleman would be glad that I had made a decision. Indeed, when he came to see me, he urged me to take a decision quickly. We did. We have made a decision which will bring considerable improvements to hospital facilities in Dunfermline.
The problem of acute hospital bed provision in Fife has been discussed for almost a decade, as the hon. Gentleman said. It is high time that the debate ended and we got the hospitals built. That can only be of benefit to the people of Fife as a whole, and especially to the hon. Gentleman's constituents.
Throughout the period of discussion, Fife health board has attempted to meet the needs of all the people in Fife, but its task has not been helped by the polarisation of views between east and west Fife, and the heat generated by that debate. I am delighted to see the hon. Member for Dunfermline, East (Mr. Brown) present. That debate has led some people to lose a sense of proportion about what is proposed. I was recently asked by the local paper why I was perpetuating a cottage-hospital level of acute-bed provision for Dunfermline". I am not aware of any cottage hospital in Scotland with 572 beds, but that will be the size of the hospital that will be completed under option D. It will compare favourably with other district general hospitals now being planned and built elsewhere.
There has also been talk about downgrading Dunfermline, but option D brings a new expansion of acute beds. We should be quite clear: we are proposing the 177 replacement of the acute and maternity beds in three aging hospitals, with a net increase of 59 beds in brand-new facilities.
The hon. Member should not look a gift horse in the mouth. He has said that my decision will further delay the development of new acute beds in Fife. That need not be so. The board has accepted my decision and is making every effort to expedite a new approval in principle submission for the reduced scale of provision at Dunfermline. I would expect the work to be completed within three months, and it is possible that the hospital, being smaller, will be open sooner than under option C. Further delays will, however, occur if the wrangling, which the lion. Gentleman seems intent on continuing, about opinions and options in Fife, continues indefinitely.
The hon. Member asked why I chose option D. It may be helpful to recall the background to the option appraisal exercise carried out in 1983, which considered in detail the five strategic options. Option A involved closing most of the acute beds in Dunfermline, with a substantial increase in patients treated in Edinburgh. Because of the inconvenience that that would bring to patients, the hoard rejected that option. Option B involved upgrading the existing hospitals in Dunfermline, but the board concluded that they were unsuitable for upgrading. Option E concentrated on all acute beds in the east of Fife at Kirkcaldy. That was considered unacceptable because of the inconvenience for residents in west Fife.

§ Mr. Douglas
Oh, come on, we know all that.

§ Mr. Forsyth
The hon. Gentleman may know all that, but his constituents may not. He asked me to justify the decisions taken by the SCottish Office, and I am attempting to do so.
The real choice lay between options C and D. Both options involved building a new hospital at Dunfermline and an extension to he Victoria hospital, Kirkcaldy and only the size of the two resultant hospitals varied beween options C and D. Option C provided an equal distribution of beds in west and East Fife so that when complete, the two hospitals at Dunfermline and Kirkcaldy would be the same size. To achieve that, two specialties—urology and ophthalmology — would transfer from Kirkcaldy to Dunfermline. Option D proposed to limit the increase in beds at Dunfermline, and to have proportionately more beds at Kirkcaldy to reflect the balance of population between east and west Fife.
The choice was by no means clear-cut; indeed, the health board had great difficulty in reaching its choice of option C. A substantial proportion of board members favoured option D, as did the board's own officers, two local health councils, a community council and the North-East Fife district council.

§ Mr. Douglas
Will the Minister give way?

§ Mr. Forsyth
I will not give way to the hon. Gentleman after the way that he has behaved during the debate.
In deciding on option D, I took a view of what was best for patients throughout Fife, taking account of the location of population and the need for patients to travel. Costs and the demands on the Scottish hospital building programme were other factors that I had to take into account. I firmly believe that option D gives fairer access to health care for all of Fife's residents.
178 The hon. Gentleman suggested that my noble Friend had been engaged in some sort of breach of faith, and that the letter sent to him gave undertakings that have now been broken.

§ Mr. Douglas
I will stand many things in this House, but I will not allow the Minister to assert that I said something that I did not say. I said that Lord Glenarthur had said certain things in good faith, and I quoted him in good faith. I ask the Minister to withdraw his remarks.

§ Mr. Forsyth
No doubt Hansard will make it clear that the hon. Gentleman said that he thought that the undertaking given by my noble Friend in his letter had not been fulfilled by the Scottish Office. That is not correct. The hoard was told that the preferred choice of options was a matter for it, on the basis that the costs and benefits of the two options were broadly similar. It was never possible to give any assurance that the resultant submissions would necessarily be endorsed. That would be to offer the hoard a blank cheque.
When I had the submission before me, with the full details of both options, it was clear that there were advantages in both cost and patient care from option D. The choice was not so evenly balanced as was first thought, and I could not, in all conscience, go along with the board's preference when it did not give the best deal for the majority of Fife patients and, moreover, had higher costs. We are, after all, talking about a multi-million pound investment that will serve the people of Fife for many years to come. The Government have a proper and legitimate interest in ensuring that the right decision is made, and I reject any suggestion that there has been a breach of faith.
The hon. Gentleman has suggested that the motivation for our decision has been cost and not concern about patient care——

§ Mr. Douglas
The Minister has admitted that.

§ Mr. Forsyth
No, I have not admitted anything of the sort—

§ Mr. Douglas
Hansard will show it.

§ Mr. Forsyth
I have not said anything of the sort. I have made it clear that a major factor in my decision was patient care. It seems to me beyond argument that the size of a hospital should match its catchment population, otherwise more people will have to travel further. That view is based on an analysis of the population spread in Fife carried out by the board's officers as part of the option appraisal. They concluded that a substantial proportion of the west Fife population is located to the east of Dunfermline in the Cowdenbeath and Lochgelly areas. For them, the distance and the public transport services to Dunfermline and Kirkcaldy are not dissimilar.

§ Mr. Gordon Brown (Dunfermline, East)
Will the Minister give way?

§ Mr. Forsyth
No.
A substantial proportion of the east Fife population is located to the north and east of Kirkcaldy — that is Glenrothes, Levenmouth, East Neuk and Cupar. For them, the distances to Dunfermline are much greater than to Kirkcaldy and the public transfer less convenient. Option D offers a better match between the size of the two hospitals and their catchment populations.

§ Mr. Henry McLeish (Fife, Central)
Will the Minister give way?

§ Mr. Forsyth
No.
It is equally beyond argument that we must get the best value from scarce resources and, happily, in this case the option that offered the best deal for patients was also the best in cash terms. Option D is marginally cheaper in absolute terms, and also made more even, and therefore more manageable, demands on central capital. Equally important, it is less demanding in revenue in the early years, so giving the board opportunity to continue its work for the mentally handicapped and elderly.
The hon. Member for Dunfermline, West has said that he is concerned that the requirement for Dunfermline to proceed first will cause long delays to the works at Kirkcaldy. That need not be so. The board has recognised, since before my time, that it makes sense to complete the 180 building at Dunfermline before starting work at Kirkcaldy. That point has been made by the hon. Member for Fife, Central (Mr. McLeish) in a local newspaper——

§ Dr. Lewis Moonie (Kirkcaldy)
No, for Kirkcaldy.

§ Mr. Forsyth
I apologise to the hon. Gentleman: I meant the hon. Member for Kirkcaldy (Dr. Moonie).
The board has recognised since before my time that it makes sense to complete the building at Dunfermline before starting work at Kirkcaldy.

§ Mr. McLeish
Will the Minister give way?

§ Mr. Forsyth
No, I have little time.
If the board proceeds——
The motion having been made after Ten o'clock on Monday evening, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at thirteen minutes to One o'clock.