Standish Hospital, Stroud (Hansard, 15 June 1993)

§ Mr. Roger Knapman (Stroud)

I am grateful for the opportunity to initiate the debate. I apologise to you, Madam Deputy Speaker, for keeping you up half an hour longer than might otherwise be the case and hope you will forgive me. In all probability, if I had not done so somebody else would have done so.

I am also grateful to my hon. Friend the Minister for attending the debate. I am sure that, as Parliamentary Under-Secretary of State for Health, he is a veteran of such occasions. Finally, I thank my hon. Friend the Member for Norwich, North (Mr. Thompson), the Parliamentary Private Secretary to the Minister of State. If he does not mind my referring to him as a conduit. he is a very efficient conduit in a Department where it is important that there should be close liaison between Ministers and Back Benchers, and I thank him for his efforts.

May I now voice some concern about the proposals to close Standish hospital which is situated in my constituency between Stroud and the city of Gloucester and replace it with a new extension to the Gloucestershire Royal hospital.

1 will, of course, leave my hon. Friend plenty of time to respond. I know that he is always grateful for such thoughtfulness. To ensure that, I shall first make four main points so that we can concentrate on the four or five other points which may be fractionally more contentious.

First, I acknowledge that most of the medical consultants support the proposals. Anybody who has read the response to the consultation document will have the utmost regard to the comments by doctors Prior, Durkin and Uff and others which must be of concern to us all.

I also recognise that, for obvious reasons, acute provision units should, wherever possible, be on one site. I know of one particular circumstance in Gloucestershire when an elderly man was taken to Standish, suffered a heart attack and subsequently had to be taken on to Gloucestershire Royal hospital. There have been other such cases.

Thirdly, I understand that the choice between the existing Standish hospital and a new hospital is not, as some people suggested, cost cutting. If we are not to make use of the £10 million or so for capital improvements, someone else in another area will no doubt be very glad to do so.

Fourthly, we all recognise that Standish is not a community or a cottage hospital but is an acute services unit serving a large part of the county. When I visit the hospital, not least at Christmas, I meet a number of the patients there and they are just as likely to come from the constituency of my hon. Friend the Member for Gloucester (Mr. French) or from the Forest of Dean, represented so ably by my hon. Friend the Member for Gloucestershire, West (Mr. Marland). There are patients from large areas of the county including my constituency.

As we are all in agreement up to this point, I hope that my hon. Friend the Minister will forgive me if, despite my introductory remarks, I come to the considerable level of public concern about the proposals for Standish hospital. The crux of the matter is that the general public like 842 Standish hospital. They like it for its setting, its staff, its friendliness and its efficiency. If they have a hospital that they like and with which, in the main, they are satisfied, they want to be sure that the proposals will lead to further improvements.

Many local people and their relatives have been treated at the hospital over decades, perhaps more than one generation in some families. Most are satisfied and regard the hospital with considerable affection. The very active league of friends attests to that. I or anybody else could deposit an elderly relative at the hospital and drive away knowing that the patient would receive prompt and excellent treatment in a well-equipped and efficient unit.

Following conversations with my hon. Friend the Under-Secretary, I am grateful to him for the considerable interest that he has shown, particularly in view of his many and heavy responsibilities. He will substantially know the arguments advanced by the district health authority and the response by the community health council which has to represent the public interest and has done so well.

Having painted in the background to the matter, I wish to ask my hon. Friend a few questions which, if he cannot or will not answer tonight, I hope he will respond to later. First, I have already mentioned that the local population likes Standish. Many people can identify with a smallish unit in a rural setting, but few really like the large tower block hospitals in city centres which sometimes have parking problems.

In those circumstances, having heard the views in the consultation document of the professionals and consultants, does my hon. Friend agree that the views of the general public should also be taken into account? Does my hon. Friend agree that Standish is set in a particularly attractive rural location on an eminence overlooking the Severn valley with extensive grounds and, as one would expect from what was originally a TB hospital, a pure air? All that amounts to a considerable help to patients for their rapid recovery and recuperation.

How can one measure those benefits? Will my hon. Friend attempt to do so? That is the major point which convinced some 20,000 of my constituents, and perhaps a few beyond the boundary, under the guidance of the Save our Standish campaign, to sign a petition. I cannot say that I counted the 20,000 names, but I can confirm that that petition had no chance of fitting in the bag behind the Speaker's Chair. When we unrolled it, it broke several times and I am grateful to the House of Commons staff who deal with petitions for their forbearance for half an hour or more.

Although consultants back the proposals, not all GPs do. A local GP wrote to me as follows: I have been a general practitioner in Stroud for thirty-five years, during which time a great number of my patients have made use of the facilities at Standish Hospital, mostly as in patients, but, sometimes, by using the physiotherapy or hydrotherapy departments as out-patients … my strong impression is that Standish is highly valued because of its convenience for patients and visitors alike, its beautiful and morale boosting surroundings, the quality of its treatment, and the consistent kindness of all its staff, medical, nursing and ancillary. There have been very few complaints, if any. For local GPs, Standish has provided a much valued alternative for emergency admissions, of patients with acute respiratory disorders in particular, when other hospitals (Gloucester Royal and Stroud General) are reluctant to admit because of pressure on beds. We have been told that major surgery should not continue at Standish, because the lack of intensive care facilities makes it hazardous. It is difficult to comprehend why this should become a consideration now, 843 after forty years of successful orthopaedic surgery. In summary, my strong impression is that Standish Hospital is highly valued by patients, their relatives, and general practitioners locally, and that its services would be greatly missed if it was closed. I am not suggesting that all GPs think like that, but a number of GPs—and a huge section of the general public —have written in similar terms. I hope my hon. Friend will confirm that their views will be taken into account.

Will my hon. Friend give careful consideration to the community health council's report, particularly the recommendations in paragraph 3.2, under the heading "Capital Savings"? The CHC concludes: More consideration should be given to the Health Authority's forecast of £9.5m to transfer services, when the cost to retain services at Standish would be only £4.8 million. The potential saving, on interest and capital charges, could be usefully employed in the provision of services with a higher priority. What consideration has been given to that point? If some £4.8 million would indeed provide a first-class hospital on the existing site at Standish, would that be a suitable alternative to the present proposals? I hope that my hon. Friend will consider that carefully before any final decision is made.

I have already paid tribute to the professionalism and dedication of the hospital's staff. Will a substantial proportion of those staff—who, over the past few years, have been welded into a very successful team—be prepared to travel to the Gloucestershire Royal and work in the new unit? Can my hon. Friend confirm that all the facilities currently at Standish will be provided at the Gloucestershire Royal extension? If not, what aspects of provision will not be available? Has full agreement been reached with the consultants with regard to those facilities?

That is quite a list of questions, and I promised my hon. Friend plenty of time to reply to them. I assure him that these matters are considered to be very serious in Gloucestershire: indeed, on occasion they are considered matters of life and death. I am sure that my hon. Friend will provide for a thorough and exhaustive inquiry. I shall support him fully, because I know that he will decide the issue on medical rather than political grounds.

§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I congratulate my hon. Friend the Member for Stroud (Mr. Knapman) on having secured this debate on the proposed transfer of services from Standish hospital to the Gloucestershire Royal hospital. My hon. Friend presented his case with his typical skill and demonstrated his care for his constituents' interests.

I shall set out briefly the current position on the proposal to transfer services. As my hon. Friend knows, a major review of services at Standish hospital was undertaken in 1987 by the former Gloucester health authority, in conjunction with clinicians, professionals and representatives from the Cheltenham district health authority. At that time, there were also recommendations from the Royal College of Physicians. The review recommended the reprovision of acute services at Gloucestershire Royal hospital and the subsequent closure of Standish.

844 My hon. Friend will know about the approval of that recommendation by the health authority and the objection of the community health council. It was passed to the regional health authority and is now in the hands of my right hon. Friend the Secretary of State for a decision. I assure my hon. Friend that my right hon. Friend will take full account of all the comments that she receives on the proposal before making a decision.

I am aware that Standish is a small and friendly hospital, located in an attractive setting. I am also aware —my hon. Friend mentioned this—of the activities of the league of friends which raises funds for the hospital, together with 60 or more local volunteers who provide the trolley shop and other assistance at the hospital. For all those reasons, I am sure that no health authority will take a decision lightly about a much-loved hospital.

I understand that the overriding reasons for the proposal are based on medical recommendations, some of which were mentioned by my hon. Friend. Standish has, as has been said, 120 acute beds, including orthopaedics, chest medicine and rheumatology. It has no intensive care facilities. In the event of an emergency, the patient must endure a difficult and possibly dangerous transfer to the intensive therapy unit at Gloucestershire Royal. Also, Standish is too small to have its own specialists in all the various branches of acute medicine. That requires the transfer of acutely ill patients at times to the Gloucestershire Royal. I understand that, on average, one patient a day is transferred for other services.

Another key medical reason for reproviding the current services on a site with intensive care facilities is that a much wider range of patients than is at present allowed could benefit from major joint replacements. Those patients would be those who need pre-operative intensive care stabilisation of chronic conditions followed by postoperative intensive care monitoring. The point about intensive care is particularly apt in the case of an elderly and aging population who may require a higher level of high-tech back up.

Another medical reason is that there are no medical consultants based at Standish. Therefore, they are required to visit regularly once, twice or more each week. That results in a loss of considerable and valuable time in travelling between the two sites, which is unsatisfactory.

The royal college has withdrawn and will continue to withdraw recognition for training in anaesthesia from any district hospital that allows unsupervised trainees to anaesthetise patients. In that context, "unsupervised" means any time that a consultant or senior registrar is not present in the hospital. Standish is provided with a consultant in anaesthesia for nine of its current allocation of 14 substantive sessions. When a consultant is away on leave, the replacement must be one of senior registrar or equivalent status. That is not always possible from the small department at Gloucestershire Royal hospital, where there is only one senior registrar and where a registrar with the fellowship diploma is a rarity.

An additional problem that the limited pool of medical staff at Standish makes adequate 24-hour cover difficult without requiring junior doctors to work in excess of the 63-hour maximum week. Transferring services to the Gloucestershire Royal hospital would allow the new standards for junior doctors to be met as well as providing on-site support from senior medical staff.

There can be no disagreement about the fact that Standish hospital is set in idyllic surroundings. I take my 845 hon. Friend's point about the effect that such surroundings may have on patients, although it is, of course, impossible to measure the therapeutic effect. I must add that the question of hospital design, quite apart from architecture, is a matter of considerable concern to me and, I hope, will continue to be so to the health service. However, having said that, it must be admitted that Standish hospital is, I think, five miles from Stroud and 10 miles from Gloucester. That has some ramifications for accessibility, especially for a general hospital which attracts customers —patients —from a very wide area.

On the question of buildings and capital investment, the 1987 review, to which I have already referred, highlighted the poor condition of many of the buildings at Standish hospital, some of which date back to the early part of the previous century. One ward was in such a poor condition that it had to be replaced. The condition of the remaining estate is such that large sums of money would have to be spent to maintain the building if services remained there for very much longer.

I very much appreciate what my hon. Friend said about the level of public concern. Standish hospital is clearly much loved, and there is considerable local feeling about it. If I were given the choice, I should want to be treated in a small hospital in attractive, rural surroundings. However, that is an ideal, and one which unfortunately cannot always be met in the real world.

My hon. Friend mentioned clinicians. There is widespread agreement among consultants about the proposals, although many local general practitioners, who would like to continue to send their patients to Standish hospital, may have a different view.

It is not merely a question of spending a certain sum of money on Standish hospital. To keep some acute services 846 on a relatively isolated site is not desirable or cost effective, and that is all that could be achieved as a result of minor reprovision at Standish. Services at Standish would, in the longer term, need the full support of a district general hospital. As I said, there are a number of difficulties in providing the 24-hour medical cover at Standish. It would be impractical and probably prohibitively expensive for the local health service as a whole to base staff at Standish to provide such a level of cover. I have already touched on the argument about untrained anaesthetists, and the impossibility of allowing them to be in sole charge of anaesthetised patients.

My hon. Friend also asked whether all the facilities now available at Standish could be provided at the Gloucestershire Royal. The answer to that question is definitely yes. I am assured that all patient services could be provided at that site, and at a higher technical and clinical standard.

As I have said, I appreciate the opportunity to make those points, especially as the matter is now before the Secretary of State for a decision. My right hon. Friend has yet to decide the future of the hospital, but I thought that it would be helpful to explain the thinking behind the district and regional health authorities' decision to put the proposals forward. I am fully aware of the strength of feeling about the hospital on the part of my hon. Friend and of local residents, and I reiterate that the Secretary of State will pay close attention to the views of all those involved, including the community health council and all other interested parties, before reaching any decision.