HC Deb 23 March 1989 vol 149 cc1275-81

Question again proposed, That this House do now adjourn.

11.29 am
Mr. Ieuan Wyn Jones (Ynys Môn)

Before the statement I was asking who would be paying the price for the health authority's inability to develop a coherent strategy in financial and planning terms. I am convinced that in this case the patients in Gwynedd will pay the price: what a heavy price it is. Is it right that the patient pays a penalty when he or she has committed no wrong? Why should we be punishing innocent victims?

As the Minister will know, the people of Llandudno lose a children's ward, and Groesynyd hospital will close. The Druid hospital closes, with the proviso that a new ward is to be built on the Cefni site at Llangefni. The Madog hospital is to close. Caernarfon cottage hospital may have had a temporary reprieve but still faces the axe. St. David's hospital is to close and services are to be transferred to ysbyty Gwynedd.

Let me assure the Minister that neither I nor my colleagues are saying that every hospital should be kept open for all time. Hospitals need to close when the buildings are old, difficult to maintain and heat and when they become costly. However, they should not be closed at the expense of decent. comprehensive community provision.

I was astonished at some of the statements in the Secretary of State's letter of 3 March to the authority approving the plans. It said: The Secretary of State accepts that implementation of your Authority's proposals will in fact mean some reduction of services, including loss of beds, notwithstanding that overall implementation will maintain services and indeed improve some. To be charitable, the Secretary of State is saying that there will be virtually no change, but, at worse, there will be a significant reduction in the provision for many people. I have no hesitation in saying that the old will suffer as a result of the plans.

On the position in Llangefni, if the health authority had introduced plans for a fully resourced, fully funded community hospital, I would not have objected, and neither would the staff and patients, to the closure of Druid.

What should be done? One does not criticise others lightly and I accept that I have been highly critical of the health authority today. I have done so only after careful consideration of the matter and in the knowledge that my views are likely to be reported. However, there are occasions when one feels that there is a duty to speak out and I do so today on behalf of my constituency and the people of Gwynedd. In my view, the authority has failed in its statutory duty to provide a comprehensive health service for Gwynedd. I call upon the Secretary of State to set up an inquiry into the affairs of the authority, as he has powers to do under the National Health Service Act 1977. If he finds that the authority is in breach of its statutory duty, he should issue a direction to ensure that it complies with that duty.

In the meantime, I call upon the members of the health authority who voted for the rationalisation plan to consider their position and ask themselves whether they can, in all conscience, remain members of an authority that has failed the people of Gwynedd.

11.33 am
Mr. Dafydd Wigley (Caernarfon)

I congratulate my hon. Friend the Member for Ynys Môn (Mr. Jones) on securing this debate. It is a timely debate in view of the major threat to the vital hospital facilities in Gwynedd. Two hospitals in my constituency are under threat. The first, the ysbyty Madog in Porthmadog, has regrettably had its closure confirmed by the Welsh Office and the second is the Caernarfon cottage hospital, which is subject to further consultation on the dental facility, but which we fear will be subject to the same rubber-stamping exercise thereafter, as has happened to the four hospital facilities that are being closed.

I need not stress to the Minister the outrage that is felt in Gwynedd about the proposals. He should know that from his constituency. The outrage was manifested in Llandudno on Monday this week when 400 people unanimously passed a vote of no confidence. He should remember the experience of his predecessor but one, now Lord Thomas of Hendon, who, because of the strong local feelings on the issue of leasehold reform, lost his seat. The Minister should take note of that lesson.

My hon. Friend the Member for Ynys Môn has put the general arguments about the failure of performance by Gwynedd health authority over a number of years. I touched on those arguments in our debate on 14 June 1988 and they were not answered by the Under-Secretary of State. They are even more persuasive now. The guts of the argument is this question: why on earth should the ordinary people of Gwynedd who depend on these hospitals be chastised and lose their services because of the health authority's ineffectiveness—an ineffectiveness which the Welsh Office has acknowledged?

Our impression is that, because the Welsh Office was not able to get from the health authority the performance that it wanted, it sent in consultants. So as not to be criticised by the Welsh Office, the health authority slavishly adhered to the consultants' report, without differentiating between or looking to the merits of individual proposals. We suspect that the health authority has called the Welsh Office's bluff. The Welsh Office is afraid not to rubber-stamp the closures in order to ensure that the health authority does not blame any future predicaments on the Welsh Office. This yo-yo game is not good enough. There is a need for greater statesmanship and vision and a need to ensure that any rationalisation is part of a coherent, long-term strategic and investment plan that ensures that there are services worthy of the 21st century.

In Porthmadog we should be moving towards a new community hospital to serve the ysbyty and north Meirionnydd area. That proposal has been put forward on numerous occasions by the health authority but is not part of any strategic plan. The closure is taking place in a vacuum. It is ridiculous that a town of the size of Porthmadog should face the prospect of having no hospital.

The number of objections to the proposed closure is so large that the Secretary of State has failed to take proper note of them. In annexes E and F of the decision the Secretary of State said that no objection had been received from any of the community health councils in Gwynedd. That was said as a justification of the closure decision.

On 13 March, a letter from the secretary of the Arfon-Dwyfor community health council to the Welsh Office said: The members of my Council at their recent meeting were astounded at the statement in Annex E and F that 'no objection had been received from any community health council'. A letter was sent to the Gwynedd Health Authority on 7th March, 1988, setting out this Council's detailed objections to the proposals affecting the 3 hospitals in the Arfon-Dwyfor area, namely, St. David's Hospital, Bangor; Cottage Hospital, Caernarfon; and Madog Memorial Hospital, Porthmadog. On the same date, a copy of the letter was sent to your Department". The Welsh Office is playing with words. On 20 March, the Welsh Office said in a parliamentary answer to me that it was firmly aware of the objection of the community health council dated 7 March but, because it was it was dated March and not April, it had referred to the fact that no objection had been received from any community health council. The Minister cannot get away with that. It is not good enough. Why does the Welsh Office not just admit that it made a mistake?

The Minister of State, Welsh Office (Mr. Wyn Roberts)

indicated assent.

Mr. Wigley

That would be much more honourable. I see that the Minister nods. If he is going to admit that a mistake was made, that is fair enough. However, if a mistake has been made, the whole issue should be reconsidered. The Minister should go back to the drawing board because the decision on Porthmadog was reached after an 8:7 vote at the Gwynedd health authority meeting. It was a knife-edge vote. Given the enormous number of objections, the Minister should think again.

The Porthmadog hospital was set up as a trust, as a memorial to those people from the Porthmadog area who lost their lives in the first world war. Does the Secretary of State have the right to close the hospital and reduce the service in the area? Does he have the right to sell off the building? Surely it should revert to the trustees as a war memorial building. This matter may well be taken up in a legal case by people from the Porthmadog area, who feel strongly about it. If the closure goes ahead, the Welsh Office should be warned that there will be an enormous campaign to have a new, much-needed community hospital for the area.

I should like to refer to the cottage hospital in Caernarfon. There is still a glimmer of hope because the Welsh Office has asked for further consultation to be undertaken on the dental side. The Minister knows that I and my family have a strong personal commitment to this hospital. My goodness, that hospital is not going to close if there is anything that I can do to stop it. I say that in all seriousness.

Many objections have been put forward by people in the Caernarfon area and it seems that, again, evidence has been lost. I have a full list of the names and addresses of the people whom the Welsh Office recognises as having submitted objections. It was sent to the area health authority and it has come into my possession. It does not include the names of numerous people who, I know, have sent objections. I have a letter from Selwyn Griffith, clerk of the Llanddeiniolen community health council dated 15 March, confirming that objections were sent formally opposing the closure proposals. Yet his name does not appear on the Welsh Office list or the area health authority list. That is only one example. I could quote dozens of examples of people who have written in and have had their letters acknowledged, but who have not received a copy of the consultation document or any other acknowledgement of their objection. This serious matter needs to be looked into because it appears that consultation procedures have not been carried out as they should have been.

Circumstances at the cottage hospital have changed dramatically over the past 15 months, since the closure proposals were put forward. Utilisation at the hospital in 1988 was 80 per cent. of a 14-bed facility, compared to only 67 per cent. of the 10-bed facility in the original proposal. That is a massive difference in utilisation. The staffing level is now down from 21.5 full-time equivalents in 1987—the figure given in the consultation document —to 17.5 full-time equivalents. Those two factors taken together mean that the cost at the Caernarfon cottage hospital for patients is equivalent to 10 per patient per day cheaper than in ysbyty Gwynedd, one of the alternatives being put forward. It would be ridiculous for the health authority and the Welsh Office to go ahead with the closure when circumstances have changed so dramatically since the proposals were drawn up.

There has also been an increase in the demand for geriatric provision at ysbyty Gwynedd and the specialists there have used the cottage hospital increasingly for people to recuperate in the community. Further consideration is to be given to dental provision. I ask the Minister for assurances that there will be a further public meeting in Caernarfon to consider the new proposals that he has asked the health authority to bring forward. Will he also clarify whether objections should be sent to the health authority or the Welsh Office, as the Welsh Office does not appear to take much notice of objections sent to the health authority? Will he also confirm that the whole proposal to close the cottage hospital at Caernarfon will be looked at again, rather than just the dental aspect? One aspect affects the others and logically the whole matter must be considered afresh, in its entirety. Finally, can the Minister confirm that, as circumstances have changed since 1987, those changes will be considered by the Welsh Office before a decision is taken? I support the plea made by my hon. Friend the Member for Ynys Môn. Members of the health authority should consider their position and the Welsh Office should consider seriously the future of the health authority itself as a result of this sad saga.

11.43 am
The Minister of State, Welsh Office (Mr. Wyn Roberts)

This debate is being held in the light of the decision letter issued by my right hon. Friend the Secretary of State on the hospital rationalisation proposals of Gwynedd health authority and I fully understand the concerns expressed by the hon. Member for Ynys Môn (Mr. Jones) and for Caernarfon (Mr. Wigley). Their constituents are affected, and so are mine because I too am a Gwynedd Member.

I believe that my right hon. Friend's decisions on the Gwynedd health authority's proposals were right in the context in which they were taken and that they lay the foundations for a potentially better health service in Gwynedd. Of course, my right hon. Friend and I appreciate that the process of transition to a new pattern of services is not easy, but the long tradition of service by those hospitals scheduled for closure should not blind us to the strenuous efforts of the health authority to provide a full and effective service elsewhere. The proposals that have been approved by my right hon. Friend include a number of features which will improve the service available to Gwynedd as a whole, such as the reprovision of psychiatric facilities in purpose-built accommodation at ysbyty Gwynedd and the integration of maternity services on the district general hospital site. They also include proposals of local benefit such as the centralisation of care for the elderly in refurbished premises at Llangefni in the constituency of the hon. Member for Ynys Môn. The approved proposals provide an opportunity for the health authority to build for the future, and the Welsh Office will be watching with interest to see whether the lessons that have been learned can be applied elsewhere.

The hon. Member for Ynys Môn has spoken at some length about his assessment of the management of Gwynedd health authority. It may help, therefore, if I dwell for a moment on the relationship between the health authority and my right hon. Friend the Secretary of State.

My right hon. Friend is of course ultimately responsible for the National Health Service in Wales, but the day-to-day running of hospital services is delegated to the district health authorities. Health authorities are responsible for providing effective and efficient services to people in their districts from within the revenue resources allocated to them. They are also responsible for planning the future pattern of services, using the most appropriate combination of buildings and equipment, within the capital funding provided to them and on the basis of capital allocation assumptions for future years published for planning purposes by the Department. Authorities' shares of both capital and revenue resources are determined each year using formulae agreed by the joint NHS/Welsh Office resource allocation working group. Health authorities are under a statutory duty to keep their finances within balance.

The hospital rationalisation plans to which my right hon. Friend has given his approval form part of a package drawn up by the health authority to bring its finances into balance. The health authority first drew the attention of the Welsh Office to its financial problems at the beginning of 1987. After discussion with the authority's chairman and senior officers it was decided to bring in management consultants, at the Welsh Office's expense, to investigate the authority's financial position. The consultants concluded that the authority's problems had their roots in 1984–85, with a developing trend of overspending on budgets in following years. The authority had managed to contain its overspending by taking advantage of non-recurrent savings—including slippage on capital schemes—and in 1986–87 by substantially increasing its creditor balances. But by 1987–88, the position had become untenable.

The consultants attributed the authority's position to the cumulative underfunding of pay awards, an increase in activity levels, particularly in high-cost specialties at ysbyty Gwynedd, the failure to make recurrent savings to finance the 0.5 per cent. transfer of funds to priority groups and the effects of incremental drift on pay.

The consultants also concluded that insufficient management action had been taken to control activity and spending levels. Later in their report they were critical of the authority's systems of planning, budgeting and financial control. It is vital that, as part of its programme to restore financial balance, the authority takes vigorous action to improve its arrangements for planning, budgeting and financial control, and I am pleased that action has been set in hand to achieve that.

The authority remained within its cash limit in 1987–88 mainly as a result of advances from the Welsh Office and the effect of emergency measures adopted by the authority when its financial crisis first became apparent. A similar combination of advances, together with the effects of the emergency measures, has contained the position in 1988–89.

The problems are the more serious when set against the background of an authority that has been shown—by both the capital and revenue formulae used to assess the relative funding position of Welsh heath authorities—to be one of the best resourced in Wales. The growth in recurrent revenue resources which will have been made available to the authority in the period 1978–79 to 1989–90 is some £21.5 million, or more than 51 per cent. after adjusting for actual and expected inflation. That is the second highest rate of growth of any authority in Wales, and it compares favourably with the Welsh average of 44 per cent.

In the light of these figures, I cannot say that I am satisfied with the level of financial management which has been shown by the authority in the past. However, I am encouraged by the steps that the authority is now taking to improve its performance in that respect.

There have been several references to the consultation procedures which led to my right hon. Friend's decision letter. It may be helpful if I outline the details of the procedures under which Gwynedd health authority consulted upon its hospital rationalisation proposals. Before I do so, one or two points have been raised by the hon. Member for Caernarfon about objections by two community health councils. I openly admit that there has been an error, for which officials have already apologised to the community health councils in question, in that the letter of 3 March conveying my right hon. Friend's decision did not record the fact that objections were submitted to him by Aberconwy and Meirionnydd community health councils following the health auth-ority's meeting on 25 April. Although the decision letter in the case of Meirionnydd CHC was inaccurate in not correctly attributing the objection by Meirionnydd CHC, the council's two objections were discussed in paragraphs 19 to 21 and 34 of annex F of the decision letter.

In view of the council's statutory duty with regard to representing the interests in the Health Service of the public in Gwynedd, my right hon. Friend has looked again at its objections, but he is satisfied that his original view of them is correct and that the authority's proposal to close the Madog memorial hospital is still to be supported.

The bulk of the objections submitted by Aberconwy CHC was a copy of its representations to Gwynedd health authority during local consultation. They were considered by my right hon. Friend before the issue of the decision letter. A letter is being sent today to all those who received the original decision letter notifying them of the additional consideration that has been given in each case.

I am aware also that the hon. Member for Caernarfon has written to my right hon. Friend raising several points about the additional consultation to be carried out on the proposals for the cottage hospital at Caernarfon. My right hon. Friend will send a separate detailed reply to him. I should like to confirm that my right hon. Friend will be prepared to take into account all objections received about the cottage hospital as part of his additional consultation, whether or not they relate specifically to the dental service.

I have already referred to the responsibility of district health authorities in Wales for the detailed planning of health service provision. Responsibility for local consultation on the plans produced also rests in the first instance with district health authorities. In formulating plans, authorities are required to have in mind the need to make the most efficient use of their available resources which is consistent with the changing needs of patients. Ultimate ownership of all health authority buildings is normally vested in my right hon. Friend. In view of the fact that proposals for permanent closure or change of use can have a significant effect on the community, special arrangements have been designed to ensure that the public and all local interests are fully consulted. The procedures provide a right of appeal to my right hon. Friend, who decides on the proposals in the full knowledge of the contending considerations. Guidance is contained in the procedures for consultation on the closure and change of use of health buildings set out in planning paper No. 5. I stress that the role of my right hon. Friend is essentially to consider whether to approve the health authority's proposals, in the light of objections made to him. Under the consultation procedures, it is not the role of the Welsh Office or my right hon. Friend to draw up proposals of their own.

Mr. Ieuan Wyn Jones

He has a duty.

Mr. Wyn Roberts

The hon. Gentleman says that my right hon. Friend has a duty, but his duty is exactly as I have spelled it out. Of course he has a responsibility for the National Health Service in Wales, but when these sort of proposals are put before him his role is to decide whether to approve them. It is not up to him to make his own proposals.