§ Mr. Tom Clarke (Monklands, West)
I am pleased to have this opportunity immediately before the recess for a debate on the important matter of the Greater Glasgow health board and in particular on the financial constraints and the morale of patients and staff. That is a great worry for most people who are aware of what is happening in Greater Glasgow and in a sizeable part of my constituency.
I welcome the presence of the Minister. I think that he will confirm that the board has been underfunded this year by about £13 million and that it has been instructed to make further cuts of between £20 million and £40 million over the next two years. It is not surprising that rumours abound. In The Scotsman of 10 May there was an article headed:One-third of Glasgow's senior hospital doctors asked to quit.I do not know whether that is true, but I know that the constraints are causing enormous problems. I hope that the Minister will seize this opportunity to enlighten us on Scottish Office thinking.
Much of what is happening affects Strathkelvin in Monklands, West. A few days ago in the House, my hon. Friend for Glasgow, Springburn (Mr. Martin) expressed his worries about the long-term future of Stobhill. We are concerned about the immediate impact of decisions on the maternity and other units. Much of my speech will be devoted to the great problems of Stoneyetts hospital in Moodiesburn in the heart of my constituency which the board is determined to close.
What have such closures to do with community care? It is a serious decision and will have profound effects on the mortality rate, an issue which has not been given due consideration by the board. Few of my constituents understand why the board is so determined to close Stoneyetts after the minimum of consultation.
We are looking at the land and land values and some of us have reached an inescapable conclusion. I asked an independent valuer to assess the value of the land, and he said that it was worth between £6 million and £7.5 million. It may be worth even more if the board decides to sell the land to individual developers because it is a beautiful location and has the Campsies as a backdrop. I can find no other logical explanation for the stubborn way in which the board is proceeding with the proposals in spite of the damage that they are bound to cause to health care in my constituency.
Stoneyetts is the cheapest hospital to run in terms of mental health in Greater Glasgow or indeed in the whole of Scotland. The Scottish average weekly cost of a patient is £340 but in Stoneyetts the cost is £235. As the Minister may know, the hospital has 180 patients, whose ages range from 40 to 98, and they all suffer from mental or degenerative illness. I must pose the question that those patients, their friends and families, the staff of the hospital and the community ask. Where are those patients to be sent? We are told that some will go to Woodilee and some to Ruchill in Glasgow and some to Gartnavel on the other side of Glasgow. We have no means of knowing where the rest will go.
The board says that many of the patients have not come from the Moodiesburn area. That is true, but only 46 out 1311 of 180 come from the Ruchill and Gartnavel areas to which, we are told, many of them will be transferred. In any case, many of those people, after long years in that hospital, regard it as their home, their community.
I cannot understand why Ruchill is being considered as an appropriate location. As the board knows, I was there the other week, and I can see that there are security problems even with the new units. I can also see that the environment will cause difficulties if we want real community care. I take grave exception to the account of my visit that was apparently given to the board by a nursing officer when it was considering closure. I make it plain that, although I was impressed by the units, and take the view that they could serve very well purposes other than use in the mental illness sector, at no time did I express the view that that was a reasonable alternative to Stoneyetts or anywhere else. Nobody had the right to give the board that impression.
Over the years, the Greater Glasgow health board has had a strong view about Ruchill. For example, in a report, it said:The hospital, as becomes its name, is set on a hill. It is one of its defects in modern conditions … It is a serious disadvantage for elderly visitors.It said that in 1975. Here we are in 1991 and the board is taking the view that Ruchill is a reasonable place for such patients to be sent. It is not, and we are entitled to a better explanation than we have so far received.
The new units at Gartnavel are set a mile and a half from the main hospital entrance and four miles from local amenities. Staff are very important, although I get the impression that the board is dismissing their views on any of these matters. They would have great difficulties in travelling from Moodiesburn and, in fairness, I should say that the board has conceded that single point. As with Ruchill, links between units for patients and the community will be virtually non-existent. If we are genuinely concerned about supporting patients, particularly with psychogeriatric and elderly patients in the mentally ill sector, the fact that buses do not run to Ruchill on Sundays from the Moodiesburn area is extremely important and should not be lightly dismissed.
I have often visited Stoneyetts, particularly in recent weeks. I know that many patients who know Ruchill and Gartnavel do not like the prospect of moving there. It may be acceptable for those who live in the area, and I do not contest the fact that there are modern facilities in the hospital. However, it is not all right to move people there from Lanarkshire and other distant parts and expect them to feel happy.
I am greatly worried about the consultation exercise that the board claims it undertook. I thought that it was a sham. I tried to make my contribution to getting the views of the communities when I arranged a well publicised public meeting in my constituency, in Moodiesburn. I invited the Minister, and I was sorry that he was not able to come. I invited the chairman of the Greater Glasgow health board, but he was not able to come either. Nevertheless, it was the biggest meeting that had ever been held in my constituency, and was widely representative of the churches, the community council, patients, families of patients and people in the community who are simply concerned about the future of the hospital.
In a secret ballot, those attending reached a unanimous view. Although I gave this information in writing to the 1312 board the following day, it is not recorded anywhere in its minutes. There was unanimous opposition to the closure of Stoneyetts and Birdston hospital in my constituency.
Despite the evidence that was given, the board dismissed the important issue of mortality rates after disruption. It said that the evidence on the matter was dubious or non-existent. That is an astonishing comment from a board that knows the story of Woodilee, which is next door to Stoneyetts. There was an evacuation in March 1987, and prior to that, 14 patients died every month. In 1987, 22 patients died in March and 27 in April. There is no doubt that there is evidence that disruption increases mortality rates. It has been found by several studies, including the Wandsworth district health authority's report of 1982, that the benefits of relocation cannot be offered without some increase in risk. A similar conclusion was reached by T. L. Coffman in 1981 in Gerontologist.
We have heard a great deal in recent days about citizens charters. I should like to know why the board did not take it upon itself to consult the most important group of people, the patients. Many of these people can vote in elections, but they were not consulted about their own future. Even the board had to record that there were 42 unsolicited letters from patients opposing the closure. These are people who are entitled to speak about their quality of life. Had advocacy existed—I understand that it is mentioned in passing in the citizens charter, and it was much in evidence in the Disabled Persons Act 1986—a great deal more would have been said.
The board has said that Stoneyetts is eccentrically located. It is not. As a result of new transport links, because of the Stepps and Cardowan railway station, because of improved local bus services, and above all because of the Stepps bypass, it is clear that there will be improvements.
I emphasise the importance of the community facilities that exist at Stoneyetts. I walked around them on Sunday afternoon. It was a beautiful day. Some of the patients were taking part in a barbecue. They were happy and relaxed in a beautiful setting. Given the alternative arrangements that might be made I do not know anywhere else in Greater Glasgow where that could be done. People were walking at leisure in the grounds beside the hospital. None of that is available in Ruchill or elsewhere. People in the Stoneyetts community and in the wider community—Stoneyetts is recognised as being part of our locality—see real friendship. In the mining community, the Auchewleogh miners club welcomes the patients and offers them facilities. The same is true of the Knights of St. Columbo club. There is peace and tranquility which is fitting for this sort of community care. Unfortunately, it is not always to be found elsewhere.
I know that the Minister will recall that, sadly—none of this reflects on him—even in his constituency there were some difficulties when it was suggested that people with learning difficulties might live in a particular place. I know that such placings raise difficult issues. I emphasise that the Stoneyetts patients are extremely welcome in the community and that the community would be saddened if things changed.
Willie Copeland, who is involved in nursing, said:They are not allowing us to be progressive. We do not want to stay in the 50s and 60s. The health board is starving us of funds.1313 There is support for community care. Ricky MacManus, also someone working in nursing, said:Stoneyetts is basically well located. It is therapeutically inviting.Jim Anderson, who is also involved in nursing, said: "This is their community." The fact is that community care is being taken from us.
The board argues that the hospital is in such a state that it must respond in the way that they have outlined. I am sure that the Minister will have the honesty to confirm that time after time I have drawn his attention, and that of the board, to the conditions that exist in Stoneyetts. I have asked for investment for refurbishment. During a previous debate on Woodilee and Stoneyetts, I said:I hope that the Minister will be convinced, and in due course will persuade the board, that there is still a need for both hospitals, a need to invest in those hospitals and a need to improve capital and revenue expenditure."—[Official Report, 29 January 1988; Vol. 145, c. 676.]I am not too keen to listen to lectures on the rundown of the hospital. That was clearly a deliberate decision by the health board, so the responsibility lies with the health board. It is certainly not an excuse for closing the hospital, especially in the light of the overwhelming arguments for its retention.
I want to refer to the involvement of Strathclyde regional council. Is there any joint planning? Even the evidence offered by Professor Edwards was taken to be the view of the council, which had not discussed the matter. My regional councillor, Charles Grey, is opposed to the proposals, and he believes that there should be joint planning.
In view of the importance of these matters to my constituents, I ask the Minister to invite the Secretary of State to meet a delegation led by myself, and including people who work in the hospital and people from the wider community, so that he can listen to the views of those who know what they are talking about. Although the Minister could not attend the meeting that I held, I ask him to visit the hospital. I am sure that he would find it interesting. Before the Secretary of State makes a final decision—and the matter rests with him—in the interests of democracy the very least that we should expect is that he meets the delegation.
I want to refer to the health board's strategies for the mentally ill and mentally handicapped in Greater Glasgow. The present strategy was decided in 1987, and it was envisaged that it would be completed by 1993–94. Why is there to be a complete revision of the strategy in 1991? If the reason is not financial, what is it? If it is financial, we must be told the facts. We do not pretend that there are not constraints on the board, because there clearly are. I think that sometimes the board is too apologetic in representing views which are, presumably, those of the Government. It would be helpful if patients and the wider community in Greater Glasgow were told about the real problems with finance. They could then assess how fair the Government were being.
What is now happening has nothing to do with improved patient care, as I and many others envisage it. The Government say that they believe in voluntarism and that they depend upon the voluntary organisations in Scotland, but they seldom listen to their views. The Care in the Community group, the Scottish Society for the 1314 Mentally Handicapped, and many other organisations have to deal with the problems of the rundown in hospital provision, and in particular the closure of hospital beds.
My hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) said recently:The board has described these changes as readjustments, whereas they are wholesale and sweeping reforms.A study of the proposals shows us why we should not be surprised by my hon. Friend's conclusions. Currently, there are 2,886 beds for the mentally ill, but the board says that it needs only 1,300. That is a reduction of about 1,600 beds in Greater Glasgow—more than half the beds in use. Again, we must ask, and ask assertively, where those patients will go. On the assumption that other patients might have been admitted in the coming months and years, what will happen to them? The Greater Glasgow health board has been extremely vague on that, as on other issues, but today the Minister has a splendid opportunity to tell us a great deal more than we have already heard.
The changes are massive in their application and implementation and, as a result, we are entitled to ask what consultation has taken place. Strathclyde regional council, again with an immense social work concern, met the Greater Glasgow health board after the decision on the strategies was taken. What about the National Health Service (Amendment) Act 1986? Was not there something there about joint planning? Why, five years later, have the Government declined to introduce an important section of that Act, agreed without a Division in either House, which deals with the kind of joint planning which is absolutely essential if we are to deal with those important matters and to put patient care first?
We are told by the Greater Glasgow health board that hospitals or units within hospitals are to close or to be rundown. In Woodilee, again in my constituency next door to Stoneyetts, we are told that there is to be a reduction in beds from 576 to 180. In Gartloch, there is to be a reduction from 414 to 150. We shall see the complete closure of mental health units at the Southern General and Stobhill. In the mentally handicapped sector, there will be closures in Waverley Park, David Elder infirmary and the upper half of Lennox Castle, among other proposals. Those are pretty drastic reductions, certainly for the patients and their families.
In the absence of reasonable assessments for individual patients and in the absence of preparations to deal with the needs of patients before they leave hospital so that we know precisely where they are going, we must ask where the board thinks that they will go. There is nothing specific in the details that the board has given about arrangements for those patients or about the consultations with local authorities, the voluntary organisations, the advocates where they exist, or the patients themselves.
Such an exercise is gravely damaging to the whole concept of community care. The Minister will know that I must be one of the strongest supporters of community care. I want to see genuine care in the community. I would, of course, much prefer the Victorian hospitals to be part of our history, although there will always be a need for hospitals. Yes, I want to see people living in the community, properly supported by home help services, occupational therapy, meals on wheels and so on, and with that feeling of independence which is so important. Therefore, I know that the Minister will accept that my commitment to genuine community care is real and is 1315 something that I want to see. But I do not believe that what the Greater Glasgow health board is now doing represents that type of community care.
The Greater Glasgow health board says that there are three alternatives to existing arrangements when the beds have gone and the hospitals have closed. We are told that one is community care, as it sees it.
We are told that there are partnership agreements, such as that with Birdston hospital in Milton of Campsie in my constituency. We are entitled to know more about such agreements, because for the most part they have been untried, and our limited experience of them does not fill many of us with great confidence in terms of the provision of the best in patient care. Agreements between the board and the private sector seem to be reducing the role of Greater Glasgow health board, which does not seem unhappy at the prospect of changing its role from an enabler to a provider. I would like to hear the Minister's defence of that policy change, because it is not one endorsed by the majority of the people of Scotland—and never has been.
The fear is that, although people will be given an opportunity to provide, initially with low profit margins, fees will then mysteriously increase. I can predict a scenario in which the board will be held to ransom because it will be so difficult to make alternative arrangements. What is a local authority supposed to do once it finds that its role will be reduced from that of an enabler to a provider, in terms of dealing with the elderly?
With the move towards privatisation, competitive tendering and commercialism, with profit-making as the main incentive, local authorities will be asked to deal with the most difficult elderly patients. I cannot imagine that private entrepreneurs will go rushing in to care for people who are doubly incontinent or who suffer from other difficult conditions. I do not have much confidence in the board's proposals, and we should hear much more from the Minister today on that aspect.
My hon. Friend the Member for Strathkelvin and Bearsden wrote to the chairman of Greater Glasgow health board on 24 July in respect of the board's three alternatives to current policy. He dealt with the third alternative by quoting from the board's own document, "Mental Health Strategy 4/":A rationalisation of short-stay beds by realigning catchment populations (to among other things take account of available capacity at the new Parkhead hospital) and gaining consistent performance in the use of the retained beds.My hon. Friend rightly asked the board's chairman:What does this mean in ordinary language?I put the same question to the Minister now. People are entitled to the answer, because such decisions are extremely important to patients and the health service in Greater Glasgow. It is not enough for the Minister and his colleagues simply to impose conditions on the people of Greater Glasgow in the absence of consultation, and in the knowledge that in any reasonable consultation or secret ballot, the people of Greater Glasgow would not accept the board's proposals in a million years.
I ask the Minister to be more candid today than hitherto. He should display more candour than the health board and the Secretary of State, and this debate provides him with a splendid opportunity. My constituents are entitled to candour from the Minister, given that, for example, heart disease is a third higher among them than the national average. If we are told that is a reflection of 1316 the quality of life in my constituency, it seems unlikely that the health board's proposals will add to that quality of life. I do not believe that our history of unemployment, closures and the rest is helpful to that quality of life. Constituents, from every age group and in every part of my constituency, have suffered a great deal in the past 12 years. They have suffered closure after closure—a once proud mining and steel community does not have a job left in those industries and many other jobs have gone too. If, on top of that, it is now proposed that the national health service as we recognise it should be dismantled, I assure the Minister of State that, although I look forward to his reply, he can expect a long hot summer on health issues in Greater Glasgow because some of us will attack again and again, as we believe in preserving the very best of the national health service in our constituencies.
§ The Minister of State, Scottish Office (Mr. Michael Forsyth)
I am surprised at the hon. Member for Monklands, West (Mr. Clarke) and at some of his less than favourable comments about the Greater Glasgow health board. I can only assume that he has not yet had an opportunity to read the health board's annual report and has not seen the lists of major developments and innovations in health care for which that board is responsible. I shall mention only a few: the newly refurbished accident and emergency department at the Glasgow Royal infirmary, costing just over £1.5 million; the 180-bed development for elderly patients at Rutherglen; the refurbishment at Drumchapel costing £1.1 million; the installation of a new total body scanner at Yorkhill; the investment at the Western infirmary on the first of two linear accelerators at a cost of £1.8 million; and the announcement of a new heart transplant centre at the Glasgow Royal infirmary. There are many other examples of Greater Glasgow health board working for patients.
The health board is to be congratulated, not least for its innovative and progressive attitude towards identifying new ways to provide a better quality of health care, and its ideas—some of them quite new to the health service—such as the provision of a patients' hotel on the Western infirmary campus, which is an exciting concept and will release acute beds and provide a better environment for convalescent patients and those who do not require constant nursing or medical care.
For the hon. Member for Monklands, West to describe the best-funded health board in Scotland as underfunded takes one's breath away. He knows very well that resources are being transferred from the Greater Glasgow health board to other boards but that is because people have moved out of Glasgow into Ayrshire and the surrounding communities and the Government have built new hospitals, such as those in Paisley and Ayr, so that services are where the people are. Only a socialist would argue that services should be provided to meet the convenience of the NHS, which may be resistant to change, rather than to meet the needs of patients for whom the service is provided in the first place.
It is certainly true that Greater Glasgow health board is rationalising services and that that will affect a number of hospitals. I am clear, and I know that the hospital board is clear, that such changes are designed to consolidate and 1317 improve services provided to the community. The board's acute services strategy involves substantial investment—about £13 million—spread over several years.
The hon. Member referred to the fact that Greater Glasgow health board is studying the future organisation of its maternity units. The five units vary in quality and, given their age and the condition of some of them, a review was essential. Extensive consultations were held and they led the board to conclude that the change is needed sooner rather than later. The board has taken account of the needs of modern obstetric practice and of the standards that expectant mothers desire when they visit a maternity unit. I hope that it will soon be possible to announce a decision on the board's proposals.
The hon. Gentleman will have received a copy of the board's consultation document on proposals for the future organisation of community care in its area. The board makes some interesting points and suggestions. I am especially encouraged by the emphasis placed on health promotion. I know that the board is keen to have reaction and constructive comments, and I hope that the hon. Gentleman will play his part in that consultation process.
The health board does not have a blinkered approach to health provision. It puts patients first. I welcome its initiative in taking advantage of spare capacity in the private sector. The hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), the Opposition spokesman, attacked the health board because it chose to make a contract with a private hospital to ensure that more than 100 patients were given cardiac surgery who would otherwise have been put on the waiting list. It is an example of dogma being put before patient care when the Labour party attacks health boards which are doing everything within their resources to ensure that waiting lists are reduced.
As the hon. Gentleman said, the board's involvement with the private sector also extends to its arrangements for care of the elderly. Again its approach puts patients first. The board has decided on plans for four partnership developments with the private sector for provision of continuing care of the frail elderly and the elderly mentally ill. Two of the plans have already been identified at Rutherglen and Darnley, and patients will transfer towards the year end. As a result, elderly patients will be accommodated in state-of-the-art accommodation, and resources which are taken up in the acute sector at present will be released for further patient care. I regret to say that the board's progressive approach has met with condemnation by Opposition Members.
Further benefits to patients arise from the investment in patient care of all savings effected under the board's rigorous competitive tendering exercise—for which, again, the board has been criticised by Opposition Members. But that competitive tendering exercise has released some £11.5 million this year. Greater Glasgow health board has achieved savings which are about 40 per cent. of the total saved in Scotland as a result of that process.
The hon. Member for Monklands, West mentioned that the health board is conducting a review of mental handicap strategy. The board consulted on its strategy in 1987 and published a document in June 1988. It is that strategy which is under review. I look forward to seeing the board's further proposals in due course. There are many 1318 strands to the board's review of mental handicap and mental illness strategies, some of which will require separate and careful consideration.
The board has already consulted on the proposals that it has prepared for the closure of Stoneyetts hospital, which provides psychogeriatric care. Following its consultative exercise, the health board announced proposals on 16 July for the closure of the hospital. The board proposes that the psychogeriatric service be transferred to the two new purpose-built units at Ruchill hospital and Gartnavel Royal hospital. If approved, the proposal will represent a £4.5 million investment in the area by the board.
The new accommodation proposed for Ruchill and Gartnavel Royal will match the level of provision at Stoneyetts. There will be no reduction in the number of psychogeriatric beds as a result of the proposal. As I said earlier, the closure is subject to ministerial approval and as yet no formal submission has been made to me.
I have been made aware of the campaign in support of Stoneyetts hospital. The health board has taken account of all views lodged with it during the consultation exercise on the proposal affecting the hospital. Of course, comments were made in support of the board's view that Stoneyetts should close which the hon. Gentleman did not mention, most notably by the local health council and the board's professional advisory committees. The views of the hon. Gentleman were also taken into account, as was the 8,000-signature petition lodged in support of retention.
The board has emphasised that it is its principal intention to establish the individual needs and wishes of the patients and, wherever possible, those will be taken into account when decisions are made on placements. I am sure that, if the decision is taken to transfer Stoneyetts patients, the board will honour its commitment to deal with the transfer of patients with sensitivity, care and consideration. All staff at Stoneyetts will be offered alternative employment with the board. It is hoped that the majority will transfer with the patients to the new units at Gartnavel and Ruchill. I assure the hon. Gentleman that, once I receive the board's formal application, I shall consider it very carefully.
The hon. Member for Monklands, West disappoints me and doubtless disappoints the relatives of the patients at Stoneyetts hospital. I am aware, for example, that the board, having quite properly sought the views of relatives, was encouraged that 70 per cent. of those who responded were fully in favour of the move to Gartnavel and Ruchill.
Clearly, the hon. Gentleman is not speaking on behalf of the local health council, the professional advisory committees, the patients or their relatives. It is absurd that he is arguing that elderly people should be placed in old-fashioned, sub-standard accommodation, rather than encouraging the board in its efforts to provide modern, purpose-built, easily accessible facilities which will give patients the benefit of more pleasant surroundings and a better quality of life.
The hon. Gentleman's argument in favour of Stoneyetts hospital was that it was the cheapest hospital to run. The Government are interested not in cheapness but in quality of care and value for money.
I have heard and read the hon. Gentleman's empty allegations that the board's proposals are financially motivated. He would do well to accept that the board is reacting to patients' needs and to the fact that Stoneyetts accommodation is now proving sub-standard compared 1319 with what can and should be provided for those patients. If approved, this proposal will represent a commitment of some £4.5 million—hardly the action of a board starved of resources, more an investment in patient care.
Greater Glasgow health board recognises the need to look beyond its geographical boundary where appropriate for specialist treatment of patients from Glasgow. We have seen that in their commitments to brain injury rehabilitation at Wishaw.
Greater Glasgow health board, as with all 15 health boards in Scotland, is for the first time setting targets for waiting time within which patients will be expected to obtain treatment. This initiative is designed to cut hospital waiting times and follows up proposals in the Government's citizens charter programme. The Initiative will make a comprehensive improvement in waiting times. I am sure that patients will welcome that move. They have every right to know how long they can expect to wait for treatment. The Government intend to give them that right, no matter where in Scotland they live.
Waiting times at present are affected in no small part by the fact that, since 1979, the number of referrals has increased by over 21 per cent.; the number of in-patients treated has increased by over 22 per cent. and day cases by a staggering 147 per cent. Indeed, for Greater Glasgow health board, the increase in day cases is an incredible 205 per cent. Waiting lists have fallen by 14 per cent. over the same period, and we continue to look for improvements.
The Citizens Charter will have a direct bearing on the patients served by the Greater Glasgow health board. Patients and relatives will know exactly what they can expect of the national health service and what the board must do to meet those expectations. Patients will know exactly what they are entitled to and the service standards to be met. Patients charters will be in all hospitals and other units, and Greater Glasgow health board has led the United Kingdom in taking that idea forward. Targets are being set on waiting times for admission for treatments. The Greater Glasgow health board, like all other health boards, will have to give guarantees on maximum waiting times.
In the teeth of opposition, Greater Glasgow health board has proved to be innovative. I regret to say that Opposition Members, including the hon. Member for Monklands, West, sometimes appear to be spokesmen for COHSE and NUPE rather than representatives of patients' interests. The proposals in respect of Stoneyetts are an example of a board innovatively tackling difficult problems and providing a quality of care which previous Labour Governments could only dream of.