HL Deb 08 December 1964 vol 262 cc9-12

2.55 p.m.

VISCOUNT BRENTFORD

My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

[The Question was as follows:

To ask Her Majesty's Government whether they will define their policy with regard to the smaller general hospitals and whether they agree that these hospitals do fulfil a very genuine need in the best traditions of the medical and nursing professions.]

THE PARLIAMENTARY UNDERSECRETARY OF STATE FOR COMMONWEALTH RELATIONS AND FOR THE COLONIES (LORD TAYLOR)

My Lords, Her Majesty's Government's policy is to improve all our hospital services. Many smaller general hospitals fulfil a genuine need, in the best traditions of the medical and nursing professions. As more district general hospitals are developed, each with more facilities for diagnosis and treatment than can be provided in smaller hospitals, some smaller hospitals will have to be closed; others will be retained, but their use will be changed. None will be closed without the personal decision of my right honourable friend the Minister of Health or the Secretary of State for Scotland.

VISCOUNT BRENTFORD

My Lords, while thanking the noble Lord for his reply, may I ask him to invite his right honourable friend, when considering these matters, to take into account the fact that so many patients and their friends and relatives are greatly convenienced by being able to attend their local hospital, which is virtually around the corner, as against having to go some five miles or so to attend a general hospital? Also, will the noble Lord take into account the fact that the friendly, private and very sympathetic atmosphere of these smaller general hospitals is vastly more conducive to recovery than the atmosphere which is frequently found in the major and larger hospitals?

LORD TAYLOR

My Lords, I think that both the noble Lord's points are good ones. In the case of the proximity to the hospital, the problem is that we are short of diagnostic facilities and of experts to work these facilities. In these circumstances it really is more economical to use them in one place rather than to have them scattered in several places, if that is the choice, and it is a reluctant choice. With regard to the noble Lord's second point, the very pleasant and good atmosphere in many smaller hospitals—what the Americans call "T.L.C.", tender, loving care—is something very important. Our problem is to preserve and develop this in the district hospitals as well as keeping it in the smaller hospitals which are retained.

VISCOUNT BRENTFORD

While again thanking the noble Lord for that reply, may I ask him also to bear in mind that when the smaller general hospital finds itself unable to cope with some particular case or complaint, customarily and invariably it sends the patient on to the larger general hospital where the diagnostic ability is available.

LORD TAYLOR

My Lords, that is indeed true for the less acute conditions. But in acute emergencies tragedies sometimes happen through patients going to a smaller hospital which cannot cope with all emergencies.

BARONESS SUMMERSKILL

My Lords, may I ask my noble friend this? In view of the fact that there are many people like the noble Lord who are particularly attached to these smaller hospitals, could not his Department give more publicity to the fact that, with the increasing specialisation in medicine today, it is not in the interests of the patient to encourage these smaller hospitals?

LORD TAYLOR

My Lords, this is really a difficult problem because one has so much to balance the value, which is a real value, of the smaller hospital as a social unit as against the known medical efficiency of the larger unit. We anticipate that these smaller hospitals will continue to play a rôle as geriatric units, and possibly as maternity and minor illness units, in remote localities. However, I would agree with my noble friend that it is important to teach the public that good medicine needs proper facilities and these are not necessarily always provided in the smaller places.

LORD AMULREE

My Lords, can the noble Lord tell me, in view of what he said, why an old person should not get proper and good facilities? If you are going to turn these hospitals into geriatric departments, does this not mean that these old people are going to receive second-class medical care?

LORD TAYLOR

Certainly not. The answer is simply that most old people, as the noble Lord well knows, suffer from lingering complaints where speed is not of vital importance, except occasionally. By and large, old people can properly and very well be looked after in small units, provided that there is good geriatric supervision. One knows there are many excellent small units doing this work, and I am sure the noble Lord knows them, too.

LORD BRECON

My Lords, may I ask the noble Lord who will have the final say about the closing of small hospitals in Wales? It was the Minister of Health in England, and, I presume, also in Wales and Scotland, as the noble Lord said earlier.

LORD TAYLOR

I am afraid that I shall have to consult with my noble friend to answer that.

BARONESS WOOTTON OF ABINGER

My Lords, does not the Minister think that a rather false antithesis is being made in suggesting that tender loving care can be obtained in a small hospital but not in a large one. Is not the real solution of this problem to develop a different atmosphere in the large hospital and is it not perfectly possible, provided that we are determined to do it?

LORD TAYLOR

I entirely agree with my noble friend Lady Wootton of Abinger. I am sorry that I did not make myself clear. It is more difficult in a large institution to develop this atmosphere, but even more important.

LORD NEWTON

My Lords, may I compliment the noble Lord on the answers he has given to these very difficult and sensitive questions? Is he aware that I am very glad to know that, so far as the small hospitals are concerned, it would appear that Her Majesty's Government do not propose to change the general policy of the previous Government?