§ Mr. David Young (Bolton, South-East)The subject of this debate is the closure of a long-stay, continuing care ward for elderly patients in my constituency. The closure was carried out without any statutory consultation procedure. The issues involved far transcend the closure of one ward; they go to the root of the whole policy of the district health authority on long-stay, continuing care in the three constituencies of Bolton.
The Minister may not be aware that, following a debate in 1981 that I initiated to get the Bolton hospital centralised on one site, money is only now coming forward to build the remainder of what is to be the new Bolton general hospital, updated into a facility ready to deal with the care of the people of Bolton.
Bolton district health authority does not seem to have thought through a policy for beds for the long-stay elderly in need of continuing care. The proposal was that one block in Bolton general hospital, H block, was to be used for continuing elderly care until the elderly patients can be transferred off the main site which was to be used for acute patients.
There was a broad-brush approach to consultation in Bolton concerned with the Mereworth exercise. It was intended that patients should then be transferred to another hospital off site. It was to be Hulton hospital. It is an old hospital and lacks modern facilities. It lacks privacy, space in bathrooms and space in dayrooms to give the dignity that elderly people require and quality of life they should have. The district health authority had promised that H block on the Bolton general hospital site—I should tell the House that the different sites are some miles apart—should be maintained until the older hospital some miles away was updated.
We need a clear policy statement from the health authority about how it intends to care for elderly patients. Although it has talked generally about improving the facility at Hulton Lane hospital, to date, that facility has not been upgraded. Now we find that some of H block will be closed despite the promise to maintain it until the other facility was upgraded and ready.
I am not arguing against the proposed new use of the vacant wards, but one should not rob Peter to pay Paul. If the district health authority has a sincere policy for long-term, continuing care for the elderly, it is vital that the facilities for them are updated in line with those in the newer hospital.
One problem is that the district health authority has never appeared to determine how many long-term continuing care beds are required at the hospital. A notional figure of 120 has been bandied about, which appeared in a discussion paper by an eminent consultant. It has never been incorporated into the district health authority's policy. An additional concern is that the health authority has taken no note of the fact that by 2001 the number of people over 85 in Bolton will have increased by 47 per cent.
From April 1993 the local government authority will be responsible for community care. Long-stay continuing care beds in hospitals will be affected by the provisions made by the local authority. People will be aware that those authorities are concerned about whether they can provide the facilities in the first place. Working parties 1287 have only just been set up between the district health authority and the local council to consider the number of beds required. It is high-handed to close wards before those discussions have taken place.
What adds to the local community health council's concern is that on 6 February 1992 health officials in Bolton assured open meetings of the community health council that H block would remain in operation until new developments were completed at the general hospital. They also said that money would be spent on the development of the Hutton Lane hospital. On 5 March, just one month later, it was confirmed, by telephone, to the community health council that H1 ward would close by the end of March. That was done without consultation and the staff were redeployed into other disciplines. A belated consultation exercise is now taking place, but that will do nothing to restore the morale of the staff who have seen a specialist team broken up overnight and dispersed into other specialties.
We used to allege that such arrogant bureaucracy occurred only in eastern European states. Offering consultation once a ward has been closed, the staff redeployed and the patients reallocated is like offering a man who has been hanged a fair trial by those who hanged him.
Consultation must take place when proposals are made about the elderly because they are among the most vulnerable in the community. For physical or mental reasons, many of them cannot put up a fight on their own behalf, and many of their relatives cannot do so because they are elderly.
Guidance is given in the Community Health Council (Amendment) Regulations 1990 about the need for a consumer-orientated strategy among authorities, and it says:
The principle of making the NHS more responsive to the needs of the consumer is central to the reforms announced in 'Working for Patients'.It goes on:True consumer involvement is more than just a consultation exercise to 'rubber stamp' a decision that a DHA has, in effect, already taken. It involves DHAs in taking the initiative in forging links with their local communities in advance, before there are controversial plans in the offing; this will be best achieved by developing a shared understanding"—among other things, there being consultation on substantial developments or variations in services. I support that Bolton district health authority argues that the change was not substantial, and, no doubt because it is a grey area, it will try to avoid the responsibility of acting in the way suggested. But if we are to build up confidence in the NHS, we must go further than simply following what might be described as the legal regulations. A body—such as the district health authority in this case—that has acted with such arrogance does much to destroy the faith in the NHS of the people of Bolton.I would not have pressed for today's debate but for the fact that we are due to recess for the summer, and some important questions must be answered. As there is no allocation in this year's estimates for the upgrading of Hulton Lane hospital, we must be told what the upgrading will involve and how much will be spent. Blair hospital in Bolton, another continuing care facility for the elderly has been closed and about £500,000 is expected from its sale. Will any of that money be used for upgrading Hulton Lane 1288 hospital? As a result of the premature closure of H1 ward, £280,000 was saved by the authority. Will any of that be used for the upgrading?
Precisely what proposals does the district health authority have? All the goodwill and sympathy in the world will not provide one bathroom in Hulton Lane hospital. Answers to such questions are vital because it has only recently been announced that Bolton hospitals will be going for trust status, and trusts vary from one part of the country to another. The key point is that they are commercial enterprises. Their aim is to be profitable, and once an enterprise changes to a commercial basis, its facilities move along those lines. Even if that does not happen immediately, as the years pass pressure for that activity grows.
Beds for the elderly in need of continual care are a financial liability. It becomes increasingly necessary to ask, now that applications are being made for trust status, what will be the position of long-stay elderly people in Bolton? Those key questions transcend the closure of just one ward. We must ask whether the closure of Blair hospital and H1 are the beginning of a movement, which began without statutory consultation, to remove continuing elderly care from the people of Bolton. If not, what are the district health authority's detailed proposals for the facilities that they will provide? What will they be and how will they be financed? What assurances do we have that, if the NHS trust is approved, it will carry over commitments and obligations made by the district health authority to the people of Bolton? What machinery exists to ensure that those commitments, if made, will be honoured?
It is important to know how the directors of the trust will be appointed and paid and where they will come from. Will their remuneration and position depend on making the hospital profitable or looking after the health of everyone in Bolton, whether young children or long-stay elderly patients?
Those questions must be asked because they go to the fundamental conception of the health service provided in Bolton. Will the remuneration of directors depend on the profitability of the hospital or the hospital's service to the people of Bolton? It is important that, in a free and democratic society, we have adequate consultation so that people's views can be taken into account. The citizens of Bolton should have as much say in the future of their hospitals as any official or board of directors.
Ultimately, the most vulnerable people are the elderly, many of whom had no chance to contribute to private insurance schemes. Most of them contributed during all their working lives to the national health service. They expected—not unjustly—that at the hour of their greatest need the state would provide the facilities to look after them when they could not look after themselves and have no relations who could look after them. Those ideas are, unfortunately, changing, but that is all the more reason for requiring discussion and consultation and explanations before arbitrarily deciding to close a ward or hospital facility. Above all, we depend on the dedication of our nursing staff and doctors.
It is worrying that many consultants and nurses say that they should not talk to Members of Parliament because their jobs could be in jeopardy. My district health authority never refuses to give me information—provided I phrase the question correctly and, in effect, know the answer before I ask it. There must be much more consultation. I am arguing not along political lines but for 1289 the best future of the people of Bolton. To that extent, my speech may be highly political, but all hon. Members owe their constituents the best and most caring health service possible, and that requires open consultation with the community and its elected representatives.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo)I am glad to have the opportunity to respond to the hon. Member for Bolton, South-East (Mr. Young) and to congratulate him on bringing before the House the proposal to change the use of ward H1 from continuing care for the elderly to gynaecology services at Bolton general hospital. I know that the hon. Gentleman is interested in securing the welfare of all his constituents and is concerned about the frail elderly. I agree that they are among the most vulnerable members of society. I am also aware that the hon. Gentleman has had a personal involvement with Bolton general hospital in recent months.
I have listened to him with interest and recognise that he has much local knowledge. He shares with the chairman of Bolton health authority, Tom Taylor, a concern that Bolton gets the best available care from the national health service. The health authority is striving to improve the health care of all Bolton residents.
The proposal at issue is part of a process completely to reshape hospital services in Bolton. At the heart of the process is a massive investment by the Government in the local acute hospital that will take it into the next century in the best possible shape.
The broad strategy in Bolton is based on spending £45 million on a regeneration of Bolton general hospital and on concentrating long-stay continuing care for the elderly at Hulton hospital, which is also in Bolton. The genesis of the proposals goes back to November 1988 when the North Western regional health authority asked every district health authority in the region to carry out a strategic planning exercise covering the following 10 years. That exercise was known as Mereworth and Bolton's document was accepted by the regional health authority. As a consequence, the major development at Bolton general hospital costing some £45 million was approved.
For elderly services, the strategy had two aims: first, to provide some 120 beds for continuing care; and, secondly, to locate these in a single hospital. That would benefit elderly patients because they would not be competing for acute services on the same site, and the services could be managed more effectively. There seems to be a broad consensus in support of that overall strategy, which includes the local community health council. Hulton hospital has been chosen to accommodate these elderly patients. It is against that background of broad agreement that we are debating the important step of implementing the strategy.
As I have explained, the health authority aims for 120 continuing care beds. There are presently 146 such beds—72 at Bolton general hospital and 74 at Hulton hospital. Figures from the health authority's consultation document suggest that, for some time, many of these beds have been empty, suggesting, of course, that there are more beds than patients who need them. The proposal to 1290 change the use of H1 ward would reduce the number of continuing care beds at Bolton general hospital by 24, leaving a total of 48 beds on that site.
With the 74 beds available at Hutton hospital, the overall total of continuing care beds within Bolton health authority would be 122, which is broadly in line with the long-term target. I understand that continuing care patients already at Bolton general would not be moved but that new admissions would be made to Hulton hospital. I understand that plans are now in hand to upgrade the facilities for continuing care patients at Hulton.
I hope that that makes the background clear. I assure the hon. Gentleman that money has been allocated both this year and next year for upgrading at Hulton. As he said, there is to be a meeting tomorrow at which the longer term allocations are likely to be discussed.
The hon. Member made some remarks about the consultation on the changes. The process of consultation is fundamental to the Government's health strategy, and extensive consultation has taken place elsewhere on the establishment of national health service trusts and also when larger district health authorities are created to improve the ways in which the health needs of patients are assessed and met. Similarly, the guidance issued by the Department of Health makes it clear that the consultation must be a real process. Adequate time must be provided and there must be a wide opportunity for local interests and users to express their views.
Consultation is therefore an integral part of the management process. Many people could speak with knowledge about the situation in Bolton. As the hon. Member has demonstrated today, the House is also one of the arenas in which local issues can be aired. The process of making the health service more responsive to the needs of its consumers is central to the Government's reforms.
Setting up national health service trusts to run hospital services allows health authorities to concentrate on obtaining the best possible services for the residents of their area. I recommend that the hon. Gentleman encourages local people to support the health authority's expression of interest in becoming a fourth wave NHS trust. The trusts remain within the NHS; they are not commercial operations, although they must be efficient and businesslike, in the interests of the patients whom they serve.
There is a well-established process for scrutinising applications for trust status, and the health authority retains a statutory duty to provide for all the health needs of the population. The departmental guidance is clear. Consumers and community health councils, which act as consumers' representatives, must be consulted about any controversial plans. I share the hon. Member's concern that consultation on the change of use of ward H1 took place after the patients were transferred. That is outside the spirit of the consultation process. I shall write to the chairman of the health authority stressing how imperative it is that every effort is made to secure local agreement for the changes.
There has been an element of misinterpretation. A good deal of discussion took place following the publication of the broad strategy document in 1989, and following that discussion there was a consensus among interested parties that the proposed strategy was right for Bolton residents. The health authority took that to mean that component changes within the overall strategy would not be subject to 1291 formal consultation procedures. That, I believe, was a mistake—but it has been corrected and a consultation document was issued in April.
Since then the community health council seems to have acknowledged that the proposal to close the beds is consistent with the strategy. The consultation paper was issued to 49 individuals and representative bodies, and I understand that nine responses have been received.
I sympathise with the sense of unfairness when a change of use takes place before the outcome of consultations is known. That is unsatisfactory. However, the process has now been completed. On the whole, decisions on levels of service should be made locally. Occupancy levels for long-stay beds for the elderly are apparently low, and it is not in the best interests of patients that such a situation should continue. I am sure that the hon. Gentleman will acknowledge that the health authority has a record of careful planning.
As I have said, the community health council is not pressing for the ward to be reopened, but its acquiescence to the proposal is contingent on the introduction of a clear plan for upgrading Hulton hospital. I understand that the health authority has such a plan, which will be considered tomorrow.
If, after tomorrow, the CHC presents an objection to the change of use, that must be referred to the regional health authority. If the regional health authority supports the district, the matter will come to the Secretary of State for consideration.
Mr. John MeAllion (Dundee, East)On a point of order, Mr. Deputy Speaker. We are now almost in the final minute of the Session, and the Government continue to treat Scotland and Scottish Members of Parliament with contempt, refusing to make a statement to the House on the privatisation of Scottish water.
1292 As representatives of Scottish constituencies, we appeal to you, Mr. Deputy Speaker, to use the office of the Chair to protect the interests of our electors by insisting that a Minister comes to the Chamber and makes an announcement to Scottish Members about what the Government intend to do about Scottish water. Otherwise we, as ordinary Members of the House, will be forced to do whatever we can to ensure that the House does not adjourn until the Government have made a clear statement of their intentions on the privatisation of Scottish water.
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)Order. The occupant of the Chair is in no position to insist that a Minister comes to the House. As I have already explained to the House——
§ Mr. Deputy SpeakerI have already explained the position to the hon. Member for Glasgow, Hillhead (Mr. Galloway). I have received no information to the effect that any Minister intends to make any such statement, and I think that it is unlikely to happen now. Mr. Yeo.
§ Mr. Dennis Canavan (Falkirk, West)Further to that point of order, Mr. Deputy Speaker. Is it not possible, even at this eleventh hour, for you to send for a Minister to come and make a statement, bearing in mind the contempt which the Government obviously have for Parliament and for the people of Scotland? The Government did not even receive a mandate from the people of Scotland, especially not for the proposal to privatise Scotland's water——
§ It being Three o'clock, MR. DEPUTY SPEAKER adjourned the House, without Question put, pursuant to the Resolutions [3 July and 9 July], till Monday 19 October.