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§ Mr. Michael J. Martin (Glasgow, Springburn)I am grateful for the opportunity to talk about an important matter that affects my constituency. I thank the Minister for coming to reply on behalf of the Parliamentary Under-Secretary of State, the Baroness Cumberlege; I also thank a consultant at the Stobhill hospital, Dr. Matthew Dunnigan, who helped me with my research, and Dr. Frank Dunn, who is a specialist at the hospital.
Last Sunday, an impressive gathering took place in the grounds of the hospital, which is in my constituency. Six thousand people assembled at 1 pm. They had one thing in common: they were all protesting at the possible closure of Stobhill. These were not the kind of protesters who normally become involved in rallies and demonstrations; they were simply men and women who live in my community and the neighbouring constituencies, and who use the hospital.
As I made my way to the demonstration, I was impressed by the number of friends and neighbours, including pensioners, who were heading for the hospital grounds. By any standards, it was a most impressive turnout. Those people spoke with one voice: they all said that they did not want the hospital to close. It was a massive gathering. At exactly 2 pm, they all linked hands and surrounded the hospital to show that they were not happy with what was proposed by the bureaucrats in the Scottish Office and Greater Glasgow health board. My thanks must go to Sam and Jeannette Watson for their excellent work in organising the demonstration.
I do not want Stobhill hospital to close. Everyone in the north end of Glasgow, and the surrounding areas, has a high regard for it; and I have a close link with it. My son Paul was born there, my daughter Mary was treated there not long ago, my wife—also called Mary—was treated there, and 10 years ago I received treatment. I can testify to the hospital's dedication: it is first class.
According to the Government, who have plucked an arbitrary figure out of the air, 1,000 beds must go in the Greater Glasgow area. The health board, however, seems determined to carry out the Government's wishes. As the Minister will know, every member of the board is hand-picked by the Government. Solid medical evidence from people who are highly regarded in the profession suggests that the loss of 1,000 beds will severely damage the health of local people.
Dr. Matthew Dunnigan, whom I mentioned earlier, presented a paper to the health board. As he explains, it is proposed to close Stobhill and amalgamate its service with that of the Royal Infirmary. Even if the Government were to do that tomorrow, the hospital would be needed for five to 10 years. I hope that the Minister will comment on that.
There is talk in Government and health board circles of building a mega-hospital—an amalgamation of Stobhill and the Royal Infirmary. That would mean a reduced service for those who currently use the Royal Infirmary, which—in terms of discharges—is the second largest hospital in Scotland. Stobhill is the fifth largest. Those in the north end of Glasgow would be particularly affected by the resulting disruption. Moreover, although the amalgamation could not take place overnight, Stobhill would be expected to maintain its high standards despite the sentence hanging over it.
1046 Dr. Dunnigan states:
A combination of rising demand, current saturation of hospital bed capacity at peak demand and the absence of forward planning to provide compensating capacity in the community make it unlikely that there can be any significant reduction in Glasgow's bed capacity within 5 years and possibly within 10 years. However, Greater Glasgow Health Board … is under pressure from the Management Executive to announce plans to reduce bed capacity and to close two hospitals before funds are allocated for hospital redevelopment and rebuilding in the city.It seems likely that GGHB will announce a strategy for acute beds within the next few months, possibly in June 1993. No hard information on a final decision is yet available but it seems probable that GGBH will opt for option (c) of their discussion document 'Review of Acute Services and Maternity Services to the Year 2001'. This will result in an announcement of the closure of Stobhill General Hospital and the amalgamation of the Victoria Infirmary and Southern General Hospitals on a single site. Hospital services will be concentrated on three sites in the Western/Gartnavel complex, the Royal Infirmary and in a combined hospital on the south side of the City.As discussed in detail elsewhere, this scenario will not be in the best interests of Glasgow's hospital services and will run contrary to national trends in planning hospital services in the next century. The immediate result of a decision to close Stobhill General Hospital when circumstances permit will be to place a sentence of death over the Hospital. The Hospital is currently operating at full capacity and there is no prospect of Stobhill's present capacity being taken up … The combination of announcement to close the Hospital in the face of a continuing need for its services over this time scale will produce a potentially destabilising series of developments for the Hospital and its efficient functioning in relation to its catchment area.Once the closure announcement is made public, all staff will immediately, in their best interests, seek to obtain employment elsewhere as and when the opportunity arises.Employment will be easily obtained in shortage specialties such as Anaesthetics, Psychiatry and Geriatrics, and by highly trained senior technicians in laboratory specialties whose services are easily transferable. Hospital secretaries are in short supply and will also find it relatively easy to find alternative employment. Once the closure of the hospital is announced, suitable replacements will prove difficult to find, other than by locum appointments and poorly trained staff who cannot obtain employment elsewhere. Loss of staff and shortage medical and surgical specialties (already evident in the loss of a Senior Radiologist and an Anaesthetist) and natural wastage due to retirement, sickness and normal job turnover will make it progressively more difficult to find replacement staff in all categories. It would take only the loss of several key personnel in shortage specialties and laboratories to produce a situation in which the Hospital cannot offer an adequate or safe standard of care to its catchment area of 200,000. This potentially disastrous scenario is already the subject of widespread speculation in the Hospital.The Hospital's difficulties in finding staff replacements will be compounded by the advent of self-governing hospital Trusts. Before the advent of Trusts it would have been possible to offer long-term security and redeployment in the Board's Hospitals or within the National Health Service in Scotland. Since there will be few or no directly managed hospitals within a relatively short space of time this prospect may be removed with the coming of self-governing Trusts who will have their own priorities and will be unwilling to guarantee employment for staff outwith their own hospitals. Thus, the coming of trusts will increase insecurity in Stobhill Hospital's medical, nursing and ancillary staff and accelerate their desire to find secure employment outside the hospital as soon as possible.GGHB must ponder carefully the consequences of announcing the eventual closure of Stobhill Hospital while dependent on its efficient functioning for the next 5–10 years. The Hospital serves one fifth of the population of Glasgow and currently discharges 68 per cent. as many inpatients and 60 per cent. as many outpatients as the Royal Infirmary. The 1047 Royal Infirmary is totally unprepared to cope with this demand in the foreseeable future if Stobhill's capacity to manage is compromised by an exodus of key staff.A similar situation may be created by the announced amalgamation of the Victoria Infirmary and Southern General Hospital since rationalisation may be required at all grades of medical, nursing and administrative staff in the combined hospital. The prospects of staff losses with a failure to recruit suitable applicants will make the prospects for the effective staffing and management of all three Glasgow hospitals in the short and medium term highly uncertain.Dr. Dunnigan makes four points in summary:Demand for acute hospital beds in Greater Glasgow Health Board continues to rise each year. On present evidence, based on trends analysis for acute medical and surgical specialties, the claim that 30 per cent. fewer acute beds will be required by the end of the century is difficult to sustain.At present, there is no evidence of significant under-use of acute hospital beds in Glasgow hospitals. On the contrary, bed capacity in most acute specialties is fully occupied at times of peak demand. With pressure on beds, difficulty in accommodating patients at such times is leading to patient inconvenience and distress and impeding their efficient management.District General Hospitals of moderate size such as Stobhill General Hospital (about 500 beds) provide optimum geographical and functional relationships with primary care and community services in catchment areas which do not exceed 200–250,000 and should not be closed. Stobhill hospital is currently working at full capacity with winter bed occupancy rates approaching 100 per cent.For a city of Greater Glasgow's size, tertiary (supra-area specialty) referral services and the University's clinical academic unit should be concentrated on a single site to reduce the present dispersion of the scarce resources on several sites in the city and create the potential for a 'centre of excellence' in post-graduate teaching and research.Dr. Robbie Robertson, the representative of Springburn health centre, supports Dr. Dunnigan's view. Dr. Robertson and his staff, including clerical and auxiliary staff and GPs, marched from Springburn health centre last Sunday to join the campaign at Stobhill. Dr. Robertson states that his centre alone has 30,000 patients, many of whom live in highly deprived areas, and there is an aging population in his catchment area. He has nothing but praise for the service that is given by Stobhill hospital to the health centre and GPs operating in the area. He says that laboratory specimens are lifted twice daily and that, if they reveal abnormal results, consultants will, if necessary, offer advice on the same day. There is a special coronary care hot line between the centre and the hospital, which has saved many lives.I mentioned the aging population. Geriatricians in Stobhill have a feel for the community. Consultants and GPs have an excellent relationship. Adjoining the grounds at Stobhill hospital is Hunters Hill hospice, an excellent hospice, with which the Minister will be familiar, that is run by the Marie Curie organisation. I have visited it several times, and it must offer the finest care in Scotland for cancer patients. It depends heavily on assistance that is given by Stobhill hospital. If it were to lose Stobhill, it certainly would experience many difficulties.
The hospital, as the Minister knows, has 600 general beds and 174 long-stay geriatric patients. It serves 200,000 people in the north of Glasgow in my constituency and in that of my hon. Friend the Member for Glasgow, Maryhill (Mrs. Fyfe). It also serves the constituencies of my hon. Friends the Members for Strathkelvin and Bearsden (Mr. Galbraith) and for Cumbernauld and Kilsyth (Mr. Hogg). It reaches out to widespread rural areas. It is also used to teach medical students from Glasgow university.
1048 There are pockets of severe poverty in my constituency. As the Minister knows, poverty leads to a higher incidence of heart disease, chronic chest complaints and, unfortunately, drug abuse, which can cause terrible side effects that only a hospital can seek to repair.
I wonder about the Government's argument that there are too many beds, especially when one expert at Stobhill states:
On many occasions this last winter elderly patients with medical conditions have been transferred to surgical wards or even by taxi to other hospitals to make way for the winter peak of admissions. Consultant medical staff and hospital management have walked the wards together. They looked for patients who were in hospital but should be at home. They found almost none. On this audit, Stobhill needs the beds it has to meet the needs of a particularly needy population.The Tomlinson report on London stated that hospitals should be located where people live, not in the city centre but out in the community. In that case, why are there proposals for mega hospitals in Glasgow when the population has moved out of the centre and has been doing so since the 1950s? The Minister will know that his own constituency has expanded immensely, especially the districts of Newton Mearns and Giffnock, due to the arrival of people who formerly lived on the south side and in the centre of Glasgow but have moved out to the areas that he represents.In the old days hospitals were in the centre of cities because that was where the population lived. However, we are keeping hospitals there although the population has moved out. There is no economic argument for that, although economics is the case usually put forward by the Government. Every Minister, including the Under-Secretary, speaks about costs, but it is cheaper to keep and care for patients at Stobhill than at the Royal Infirmary or the Western Infirmary. The population of Bishopbriggs is expanding and the population in my constituency is increasing due to a great deal of redevelopment.
There is a similarity between our previous housing problems and the problems that we are now experiencing in the health service. When Springburn had terrible redevelopment problems, it was known as planning blight. Shopkeepers would not invest in their shops because they did not know what would happen in the future. Young people moved out because the factor would not carry out property repairs as he did not know whether there was to be redevelopment. The young people moved to Cumbernauld, Kilsyth and East Kilbride. There was a general blight over the area because people were uncertain about its future.
That blight is now coming to Stobhill because people there are uncertain. As Dr. Dunnigan said, if bright and talented people are uncertain about their present place of employment and are offered a more secure job in a hospital that is not the subject of such speculation, they will move on. The Minister knows that that can lead to difficulties.
I cannot see the case for closing a hospital that is highly efficient and sits in the most beautiful grounds overlooking the Campsie hills. It provides a very pleasant environment for people in need of care and attention and in which to work. I mean no disrespect to the Royal Infirmary but, as the Minister knows, the buildings are old with little room for expansion. Any expansion would be expensive because of the historical nature of some of the buildings. However, there is plenty of room for expansion at Stobhill. I hope 1049 that the Minister will give me, the community and the dedicated staff of Stobhill some hope for the future because the speculation has led to a sad state of affairs.
I also hope that the Minister will bear in mind the fact that medical evidence suggests that the loss of 1,000 beds in Glasgow would be damaging. There is also concern that the people making the decisions about the future of Stobhill are the political appointees of a Government who, admittedly, went to the people on the basis of cuts in public expenditure. Nevertheless, there is some distrust of people who have been appointed by the Government and who have the same political leanings. Perhaps it would be better if Greater Glasgow, like London, were the subject of an independent public inquiry into hospital and medical needs. Everyone in the community is worried about the hospital.
My neighbour, Sophie Anderson, aged eight, was so impressed by the demonstration on Sunday that she sent me a poem for the debate. It is called "Stobhill Hospital" and reads:
- "Today we stand around Stobhill
- To try to stop it closing,
- We want to let the people know exactly
- What they're losing.
- I think it would be a terrible shame
- Because lots of people use it.
- We want the Health Board our plea to hear
- Keep it open, don't close it!"
§ The Parliamentary Under-Secretary of State for Scotland (Mr. Allan Stewart)I congratulate the hon. Member for Springburn (Mr. Martin) on securing the Adjournment debate and on speaking with his customary knowledge and eloquence on a matter that is undoubtedly of great importance to his constituents. As Hansard will attest, he has asked about the future of Stobhill more than once during Scottish Question Time. I shall try to answer his questions but I hope that he will understand that I am not in a position today to make any announcements about its future.
There is no formal proposal from the health board to Ministers about the future of Stobhill or any hospital in Glasgow. The board is conducting a review of its future requirements for acute beds and their distribution throughout the city. That process is well advanced but it will be a while before the board is able to put firm proposals to Ministers and some time thereafter before final decisions can be taken.
However, I repeat my pledge to the hon. Gentleman that before any final decisions are taken my right hon. Friends the Secretary of State and the Minister of State will be happy to discuss the issues fully with him and other hon. Members involved.
Let me describe some of the background. The final decision on closures or major changes in the pattern of health services is a matter for Ministers, and I must re-emphasise that no decisions have been taken about Stobhill or any other hospital in Glasgow.
The hon. Gentleman referred to investment and the use of public resources. It is perhaps worth emphasising that over the past 10 years or so the hospital capital building 1050 programme for acute services has been directed at building district general hospitals outside the main centres of population.
The past 10 to 15 years have seen major hospitals in, for example, Dumfries, Inverness and Melrose—the list is quite long. The Princess Royal will be opening the new Queen Market hospital in Dunfermline at the end of next month and new hospitals are under construction in Oban and Campbeltown. I must resist boring the hon. Gentleman by continuing, there simply is not time to list all the new developments.
Since taking office, the Government have spent more than £512 million on 91 major national health service capital investment projects in Scotland; 21 of those projects, totalling £86 million, were in Glasgow.
As I have said before, that programme of creating new district hospitals outside the main centres of population is coming to an end. We now need to turn our attention to the main centres of population, where the acute hospitals are generally old and in an unsatisfactory condition. Our first priority for the remainder of the decade is to create modern and efficient acute hospitals in our main centres of population to produce a pattern of acute care which best meets the needs of our population.
The hon. Gentleman and I agree that it is vital that we get the process right. I shall now respond to his more detailed points by setting out the factors that we need to take into account and explaining why we believe that the number of acute hospital in-patient beds will fall.
There are four main factors which will influence the number of acute hospital beds that we shall need in future: first, the number of patients who need to be treated as hospital in-patients; secondly, how long they stay in hospital as in-patients; thirdly, the efficiency with which acute hospitals use the beds available to them; and fourthly, how medicine and surgery will be delivered in future. Those factors were at the heart of the hon. Gentleman's argument and I shall deal with them in turn.
Since the mid-1970s, the number of patients treated by the acute services has increased from around 615,000 to nearly 870,000—the hon. Gentleman referred to the figure for Stobhill. That represents an average annual growth of 2.3 per cent. and that figure has not changed very much over the years.
Increasingly, not all patients will be treated as hospital in-patients. Within the overall figures that I have quoted, there has been a marked shift towards treating patients as day cases. In 1975–76, only 8.3 per cent. of patients were treated as day cases. By 1990–91 that proportion had increased to nearly 18 per cent., and it will not stop there, as recent studies by the Audit Commission and the Scottish Office Audit Unit have predicted. They found that the use of day surgery is well below its estimated potential and concluded that up to 30,000 additional cases a year are possible for the 20 procedures covered by the study. That represents a 90 per cent. increase on current levels.
We expect health boards and hospitals to expand considerably the use made of day case treatment and that it might be possible to increase the number of cases by at least 75,000 over the next few years. I believe that that trend will be generally welcomed.
The shift away from hospital in-patient treatment or treatment by general practitioner is not about saving money; it is in the best interests of patients. It means that the medical or surgical treatment that the patient receives is less drastic. That reflects medical advances.
§ Mr. Malcolm Chisholm (Edinburgh, Leith)The Minister is making a lot of the increasing number of day cases. How does he know that the trend will continue? Has he carried out surveys about whether patients want such treatment and has he studied issues such as the higher rate of post-operative infection in day-case patients and the increased numbers that have to be re-admitted? If he is supporting the trend towards day cases, is he putting more money into care in the community?
§ Mr. StewartAs I have told the House, the basis of my case is the recent studies by the Audit Commission and the Scottish Office Audit Unit. In answer to the hon. Gentleman's second question, we have indeed substantially increased resources for care in the community. The shift to local authorities has been accompanied by considerable increases for care in the community.
I now turn to length of stay. For some of the reasons that I have just mentioned, the average length of stay for those patients who have to be hospital in-patients has also declined dramatically. In the mid-1970s the mean length of stay for all acute specialties was 10.7 days. By 1990–91, that had fallen to 6.7 days and it continues to fall.
In our planning we have assumed that length of stay will continue to fall, but at a slower rate than in the past. We have assumed an annual rate of 2 per cent.—a cautious assumption compared with the recent rate of more than 4 per cent. I accept that the figures that I am quoting are averages and will vary in different parts of the country. The hon. Member for Springburn was quite right to mention that there are problems of deprivation in some areas of Glasgow and that may well mean that planning has to assume a slightly longer length of stay than in other areas. However, that has been taken into account in our planning.
I now turn to occupancy rates. Acute hospital beds have an occupancy rate of just over 70 per cent. With the move to hospital trusts and the associated increase in efficiency, it is reasonable to assume that that figure will rise to about 80 per cent. Again, that is an overall average.
§ Mrs. Alice Mahon (Halifax)Will the Minister give way?
§ Mr. StewartI want to answer the points raised by the hon. Member for Springburn, but I shall give way.
§ Mrs. MahonThe Minister said that there could be a dramatic increase in occupancy. Have the Government made any estimate of the number of staff that would be needed to cope with that increase?
§ Mr. StewartFirst, may I warmly welcome the hon. Lady's intervention in a Scottish debate. Of course, the House will generally appreciate the fact that this is a United Kingdom Parliament, and we are all delighted that the hon. Lady, who represents an English constituency, has taken the opportunity to avail herself of her right, as a Member of the United Kingdom Parliament, to intervene in a Scottish debate. I warmly welcome the assertion from the Opposition Benches that this is a United Kingdom Parliament.
§ Mrs. MahonI am half Scottish, actually.
§ Mr. StewartIndeed, but the point is that the hon. Lady is here in the House as a Member of the Parliament of the 1052 United Kingdom. I pay tribute to her for asserting her right, as an English Member, to intervene in a Scottish debate.
Secondly, in answer to the hon. Lady's detailed question, what I was saying did not have staffing implications. I was emphasising the fact that at the moment acute hospital beds have an occupancy rate of just over 70 per cent., and that, irrespective of staff numbers, we believe that increased efficiency could increase that figure to 80 per cent.
When we consider medical advances, we sometimes assume that medicine and surgery will be delivered in the future in pretty much the same way as they are delivered now. That assumption seems increasingly questionable. Because of the advent of, for example, keyhole surgery, and the work of leading authorities such as Professor Alfred Cuscherri of Dundee university, patients recover much faster. The implication of that is that lengths of stay in hospital will fall quite sharply.
What do all those factors, taken together, mean for I he planning of acute hospitals? Our best guess is that the need for acute in-patient beds across the whole of Scotland will fall by 3,000 to 5,000 by the end of the decade. I can reassure the hon. Member for Springburn that those figures have been discussed with many people in the medical profession. Of course, what I have said does not mean that fewer patients will be treated. We have assumed that the number of patients treated in the hon. Gentleman's constituency and elsewhere will continue to grow by between 1 per cent. and 2 per cent. a year.
§ Mr. Michael J. MartinDoes the Minister still maintain that 1,000 beds must be lost in the Greater Glasgow catchment area?
§ Mr. StewartThe figure of 1,000 or so was arrived at through various planning models. It has been discussed and generally agreed with many clinicians through the internal consultation process, and it is in line with the overall Scottish figure to which I have referred.
In the two minutes or so remaining to me, I emphasise that the whole exercise is not about saving money—[Laughter.] The hon. Member for Halifax (Mrs. Mahon) laughs, as part of her continued and welcome intervention in Scottish debates. But the exercise is not about reducing the scale of the national health service in the sense of treating fewer patients; it is about getting the size of the hospital sector right so that resources are not wasted on providing in-patient beds when they could be better used —for example, by providing day surgery facilities, by supporting the development of primary care, by providing high-technology operating theatres to allow minimal access surgery, or by doing a dozen other things that will provide a better service to patients than providing hospital beds that are simply not needed.
The cost of achieving those better services will be high. We are talking about investment in new and improved hospitals in Glasgow, which will cost between £200 million and £400 million. The easy option would be to leave everything unchanged. That would save the Government money. It would not only be cheaper, it would avoid a lot of fuss and bother, but I emphasise to the hon. Member for Springburn that that would not be the way forward.
§ Mrs. MahonOn a point of order, Mr. Deputy Speaker. Clearly a major reshuffle of the high offices of state is taking place at this moment. I understand that the former Home Secretary is to become Chancellor—
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)Order. That is in no way a matter for the Chair.
§ Mrs. MahonI just wondered, Mr. Deputy Speaker—
§ Mr. Deputy SpeakerOrder. That is not a matter for the Chair.