§ 5.57 p.m.
§ EARL FERRERS rose to ask Her Majesty's Government whether they will advise the South West Metropolitan Regional Hospital Board to reconsider their decision to withdraw the grant for contractual beds from St. Teresa's Maternity Hospital at Wimbledon. The noble Lord said: My Lords, I bring this Question to the attention of your Lordships because the decision to withdraw this grant has caused widespread concern to all the people who have had anything to do with this hospital, whether they are patients, or ex-patients, doctors or nurses, or whether they merely reside in the locality. Indeed, the interest in this decision goes far wider even than the locality. It has stirred the interest of people who do not live in the locality; it has stirred the interest of the newspapers and television. It has resulted in a spirited lobbying by mothers and their children of their Members of Parliament. And some 5,000 people are expected to meet in Trafalgar Square and to march upon Downing Street next Sunday with a petition to the Prime Minister begging him to keep the hospital open. Such concern is not generated lightly.
§ I should like to give your Lordships the background to this case. The hospital is run by Roman Catholic nuns of 767 the Order of St. Anne. I hasten to add that their patients are not restricted to Roman Catholics, but are of any and of no persuasion. It was started in 1938 as a hospital for cancer patients, and in 1948, when the National Health Service took over, the cancer patients were moved to another hospital and St. Teresa's became a maternity hospital. At that date it catered for 22 patients. In 1951 an extension was opened by Sir William Gilliatt, bringing the number of beds to 40. In 1956 another extension was opened by Lord Evans, and in 1959 a third extension was opened by Lady Dorothy Macmillan. Last year a fourth extension was opened, enabling the hospital now to cater for 70 patients. Of these 70 patients, between 40 and 50 are National Health Service patients and the remainder, about twenty, are private or semi-private patients.
§ In addition to carrying out its duties as a maternity hospital, St. Teresa's is a teaching hospital. In 1955 the hospital started to train two students a fortnight in midwifery, and this still continues. In 1962, obstetric courses, which last for three months, were started for 16 nurses from St. George's Hospital, and this forms part of the training for their S.R.N. In 1966, 20 hand-picked students were sent from St. George's Hospital to St. Teresa's for an experimental course in obstetrics, as part of a scheme to see whether it were possible for the S.R.N. course to be condensed from three to two years. These girls were hand-picked; so, presumably, was the hospital. In 1966 the Central Midwives Board approved St. Teresa's as a training centre for Part II midwifery, allowing those who passed to become fully-qualified midwives, practising midwifery in any part of the world.
§ I mention these details at some length to stress that this is not a small, pokey, little substandard hospital, but a maternity hospital of outstanding ability and qualifications, built specifically as a maternity hospital and recognised as a teaching hospital. It is this which the South West Metropolitan Regional Hospital Board have decided in their wisdom to close down; or, to put it more accurately, from which they intend to withdraw their grant of some £70,000 a year so that it probably will close down. Why is this to be done?—for one simple reason, that the State is building a new maternity wing at Queen 768 Mary's Hospital, Roehampton, and it is therefore considered that the beds at St. Teresa's will be superfluous. But is this so? The Minister says, "Yes". But this is not the view of people in the locality. This is not the view of the local authorities, such as the Wandsworth Borough Council and the Merton Borough Council; and indeed it is not the view of the Merton and District Trade Council who are highly concerned at the closure of St. Teresa's.
§ The Minister said in another place, that the building of this wing will form part of a district general hospital, and that it is in the interests of the safety of mothers and babies. The standard of nursing at St. Teresa's is so high that since 1948, when it started. 19,000 mothers have been delivered of their babies in this hospital, and not one mother has died. In 1948 the national average of deaths among mothers having babies was 3 per 1,000, which has now dropped to 1 per 1,000. But in St. Teresa's there have been no deaths out of 19,000. Therefore, it would hardly seem to be in the interests of mothers and babies that this hospital should be closed.
§ Is St. Teresa's to be eliminated from the Health Service in the interests of economy? The answer is, No. The cost per bed per day in St. Teresa's, given by the Minister, is £4 12s. 11d.—and, if I may say so, a figure of unusual, uncanny precision. The estimated cost at Roehampton—and noble Lords will know that Government estimates are invariably on the low side—is not £4 12s. 11d. but £6: an increase of 30 per cent. over the cost of St. Teresa's.
§ Noble Lords may be interested to know that the State has not had to pay one penny towards the capital cost of St. Teresa's, either of the building or its contents. This has to be found by the Order. But it does pay to the Order the sum of £291 per month for the use of the building and its contents; what one can loosely describe as rent. Your Lordships know that within half a mile of where we are sitting there are three-bed-roomed flats which command a rent of £2,000 a year. The Health Service is paying not £2,000 a year but £3,500, not for a three-bed-roomed flat but for a 70—bedded hospital, fully equipped with all modern devices, fully equipped with labour wards and theatres; and within this same figure is the service of 20 nuns. 769 Indeed, these ladies work for 12 hours a day. Their responsibility is with them even on their time off. They work seven days a week, and they have two weeks holiday a year, with an occasional weekend in the winter if the strain gets too much for them. So if we are talking of economics and money, I think your Lordships will agree that this is dirt cheap at the price.
§ Your Lordships may also be interested to know that a matron of the equivalent standard of the matron at St. Teresa's, were she paid on the Whitley scale in a State hospital, would receive the sum of £1,460 a year. A qualified midwifery tutor would receive the sum of £1,200 a year. The matron of St. Teresa's has both these responsibilities and receives nothing. A qualified nursing sister would receive up to £1,200 a year but the nuns, also qualified, receive nothing. Who benefits?—the State.
§ But there is one inestimable benefit which St. Teresa's has. If I were asked what was the greatest shortcoming of the National Health Service, I should unhesitatingly say the lack of personal relationship between, on the one hand, the doctors and nurses, and, on the other hand, the patients; the fact that the patient so often feels that he is being treated as a case and not as an individual. But it is just this quality of personal relationship in which St. Teresa's excels, whether the patient is a married mother or an unmarried mother. I stress this, because 10 per cent. of the patients at St. Teresa's are unmarried mothers, and your Lordships know only too well that this type of patient needs a very personal and specific form of help.
§ The love of the nuns, the devotion to their work and to their patients, the atmosphere of happiness and selflessness are there to be sensed by anyone who cares to visit this hospital. This is at the moment being given to the Health Service. Of course, the trouble is that these qualities, like so many other valuable ones, cannot be measured by statistics. But it is because they cannot be measured by statistics that their value should never be underestimated, because they can never be taught. They should, indeed, be prized and guarded and not be allowed, like some small candle, to be snuffed out with a puff.770
§ People love this hospital. They love what it is and they love what it does, both medically and in terms of humanity. Forty-seven thousand people—and that is a great many—have signed a petition asking the Government to keep this hospital open. But no, the Board says that it must be closed. Why?—because it does not fit in with some planner's plans. But there must be a point on the graph where the curve depicting the advantage to be gained from a plan is crossed by the curve depicting the advantage gained from skill, devotion, tenderness and practical common sense.
§ Who are the people who have decided to cut right across the grain of public feeling and the grain of economics? They are the members of the South West Metropolitan Regional Hospital Board. They are not elected by anyone. They are appointed by the Minister for a term of office, and they are directly responsible to him. One would have thought that, after taking such a decision which has aroused such feeling, the Chairman of the Board would at least have taken the opportunity of going down to see St. Teresa's, to see what it is that he is closing which has caused such an uproar. But this has not happened.
§ I am glad to see the noble Viscount, Lord Addison, in his place this afternoon; and I realise, of course, that, by the Addison Rules—which, by some unfortunate quirk of providence, were adumbrated by his father and were then generally accepted by your Lordships' House—he may feel it, if not impossible at any rate difficult to participate in the debate this afternoon. But I hope the noble Viscount will not feel that I am hitting him whilst his hands are tied behind his back if I say that I am astounded that he should have taken this decision, have watched the public outcry grow and have stuck firmly to his decision and yet never have visited the hospital or ever shown any willingness or intention to do so.
§ One might have thought that the senior medical officer to the Board, Dr. Taylor, would have considered a visit to the hospital appropriate. But no; he also has not made a visit to the hospital. Indeed, he has never visited the hospital since his appointment as senior medical officer.771
§ LORD BESWICK
My Lords, will the noble Earl allow me to interrupt him before he pursues this line of argument even further? Would he be good enough to say that my noble friend Lord Addison invited members of the Hospital Committee and other members of St. Teresa's to visit him at his office and discuss these matters?
Of course the noble Viscount has; but my complaint is that he has taken a decision not even having seen the building or the hospital to which his decision, which has had this devastating result, refers. I say with the greatest respect to the noble Lord, Lord Beswick, that that does not answer the point at all. The noble Viscount, Lord Addison, as chairman, has not visited the hospital; nor has his senior medical officer; nor, indeed, has any other of the 25 members of the Board. I can only say that I consider that such action, which has had such far-reaching consequences and which was taken without ever a visit having been made by anyone, is nothing short of a public scandal.
Yet my Lords, it is this decision, taken by a Board who have shown that their interests in this hospital are confined to the boardroom table arid to the statistics which are placed upon it, which the Minister is seeking to back up. One might have thought, again, that the Minister of Health would have considered, with such a feeling growing, that at least a visit to the hospital would prove both prudent and fruitful. Indeed, he has been invited to visit the hospital on two occasions, both in his official capacity as Minister of Health and in his private capacity—not to be lobbied or to be pestered, but just to see what it is that is being closed. But both those invitations the Minister has refused.
My Lords, if this decision to withdraw the grant from St. Teresa's, whose object is to work for the poor and for the unmarried mother, is to be maintained and the grant removed, the Health Service will be losing a unique hospital—unique in the very qualities which the Health Service is lacking. There is no Party issue here, and I have no doubt that the Minister and the Board have acted with the best of motives. But mistakes can be made; wrong decisions can 772 be taken by the best of men acting with the best of intentions and the highest of motives. But decisions are not irrevocable if there is the intention and the desire to see that, in the end, the right decision is made. A mistake has been made over St. Teresa's and a wrong decision has been taken, but it is not irrevocable if there is the real intent and determination to see that, in the end, the right course of action is taken.
St. Teresa's is an outstanding hospital. Its medical record is outstanding, its cost to the State is outstanding, its service to the National Health Service is outstanding, the devotion of its nurses is outstanding and the love of and by the people whom it serves is outstanding. Its only crime is that it does not tit in with some planner's plan. I hope that the noble Lord, Lord Beswick, will give a helpful reply this evening; but even if he cannot be as helpful or as conciliatory as I should wish, I beg him to go back to his right honourable friend and say, "Minister, think again".
§ 6.15 p.m.
§ LORD SILKIN
My Lords, I am sure the House is grateful to the noble Earl, Lord Ferrers, for having raised this matter. It is one which admittedly is causing concern, at any rate in that part of the area for which the South-West Metropolitan Hospital Board is responsible; and I agree with the noble Earl that a large number of ex-patients and prospective patients are very agitated about what is happening. I think it is right that a matter which is causing so much concern in a particular area should be raised in this House, and the noble Earl has raised it in a fair way, although I think he has done less than justice to some of the reasons which prompted the Hospital Board in coming to its conclusion.
Let me say at once that there is no dispute whatever about the very valuable work which the hospital has done and is doing at the present time. No one is suggesting that the work has not been done with skill, with ability, with devotion, and even with dedication. I would not dispute for one single moment the tribute which the noble Earl has paid to those who are concerned with the running of the hospital.
773 What then is the reason for proposing to terminate the contract? It is certainly not on some vague planning ground, as the noble Earl said. Nor does it come as a surprise to the hospital itself. They have known about this for a number of years. For possibly as long as five years they have been aware that this was coming. Therefore it did not come to them as a bombshell. Had they been so minded, they had ample opportunity to make other arrangements for the use of this hospital in ways which would have been equally valuable to the community.
§ LORD WINDLESHAM
My Lords, will the noble Lord excuse me for interrupting him? I wonder whether he could substantiate that statement. I had understood, subject to his correction, that the five Members of Parliament from the area concerned who visited the chairman of the Board asked about these warnings and were unable to obtain any satisfactory confirmation that early warning, at any rate as far ahead as the noble Lord has just mentioned, was ever given. Does the noble Lord have more evidence than I have on it?
§ LORD SILKIN
Yes, I think so. I think there is some correspondence going back to 1965 from the hospital itself to the Board. That is over three and a half years; but they have known for five years of the plans that were being propounded by the Hospital Board for this area. At least, I presume they have, because the plans have been public knowledge all that time.
Did I hear the noble Lord say from 1965 to the middle of 1967? That is not five years. It is not even three and a half years.
§ LORD SILKIN
What I am saying is that the hospital have known since the plans for the area were propounded. But certainly they have known since 1965, because there is correspondence on the subject dating back to that time. But whether the period is two, three or five years is not the vital point. The point is that the hospital have not been taken by surprise. This has not been a bombshell to them, and they have had ample time to consider what to do. In any event, this contract is not coming to an end until the end of this year, so they will have had ample time, had they so desired, 774 to make other plans for the use of their hospital.
My Lords, the noble Lord will agree that, as the contract is coming to an end at the end of the year, those mothers-to-be who would be expecting to occupy places in this hospital have now to make alternative arrangements. Therefore, in effect, the change is coming into effect now.
§ LORD SILKIN
My Lords, the noble Lord can do arithmetic as well as I can; but the number of women who are to-day making preparations for the use of this hospital by the end of the year must be very limited indeed. Certainly alternative arrangements will be available for them. There will be no difficulty: no woman will be left without proper attention and treatment.
My Lords, the question then is: What is in the best interests of the community itself, taken as a whole? I would not dispute the fact that one must throw into the balance—and it is a balance—such questions as the personal relationship between the staff and the patients. I agree that those are excellent, and that it may well be that those personal relationships will be closer and more to the comfort of the patient than they would in a general hospital. But, when all that has been said, the fact is that some five years ago a plan was drawn up for the purpose of providing accommodation for obstetric treatment in this area. I think no one will dispute that it is right that the Board should have looked ahead. There were figures projected as to what would be the ultimate requirements of the area, and on the basis of those forecasts new accommodation was provided and will become available from the beginning of the year.
This accommodation consists, first, of some 50 beds at Queen Mary's Hospital, Roehampton. This will, of course, be first-class accommodation. It will have available X-ray and laboratory facilities; it will have the services of a professor of obstetrics and will be closely associated with Westminster Hospital. It will have facilities for student nurses from Westminster Hospital, and generally it will be in a position to provide the highest service of this kind for expectant mothers. In addition, there will be accommodation for ten more beds in the Queen Charlotte's Hospital at Richmond this year. Here 775 again it will be in association with a teaching hospital; and everyone knows that Queen Charlotte's Hospital has the highest reputation of any hospital in this field. Moreover, a further 12 beds will be provided at Kingston, making 72 in all.
My Lords, the fact is that at the present time the total number of beds is not being fully used. It was expected that beds would be occupied to the extent of about 70 per cent.; but in fact this is not happening. Whether there has been a decline in the birth rate or whether there is some other reason, the beds are not being occupied to the full. And with the coming into operation of these new beds that I have mentioned there is no doubt that the beds at St. Teresa's for obstetric purposes will become redundant. In face of all this, as I see it, the Hospital Board had no alternative but to terminate the agreement and to ask the hospital whether they could not use their accommodation in some other way in the public interest. The hospital had no difficulty in making a change from cancer treatment to obstetrics when the Health Service came into operation. Good luck to them! I think it very praiseworthy that they adapted themselves to the requirement of the time. The present time necessitates further adaptation. I hope they will not feel that there is any indignity or any kind of discrimination against them. They are asked once more to adapt themselves to changing circumstances.
I would ask the noble Earl, Lord Ferrers, what he would do in the circumstances. Here are these beds becoming available. Here are the needs. What would he do?
My Lords, I would answer by asking the noble Lord another question. Does he think it prudent expenditure of public money to build maternity wings for hospitals which will result in maternity hospitals now in use becoming redundant?
§ LORD SILKIN
The noble Earl answers my question by asking me another. I would answer by repeating mine. But I will answer him. The fact remains that here are these beds. Provision was made for them some years ago when, on the best information available, it was believed they would be required to meet the needs of a rising population. Here 776 they are. They exist. The noble Lord can perhaps say that in 1960 (or whenever these beds were planned) some mistake was made; but they were planned in good faith. Here they are. The question is—it can be a rhetorical one—what is the Board to do in these circumstances, when they already have available 72 beds, which they are going to have some difficulty in filling, and when there are another 40 beds in St. Teresa's. I would submit that they did the only possible thing—and the noble Lord does not challenge their good faith in the matter; he merely says they made a mistake—in giving as long notice as possible of the termination of this agreement.
My Lords, may I ask the noble Lord whether he is advocating that the hospitalisation in this country should be so completely regionalised that it is quite impossible for a patient to go across a boundary? Surely there is no superfluity of maternity beds generally over the Metropolitan area.
§ LORD SILKIN
My Lords, the South-West Metropolitan Board already covers a very large area. It does not comprise merely the Borough of Wandsworth or another London borough. It is a wide area. There must be a limit, and I think this limit is already being reached in the South-West Metropolitan area.
§ LORD WINDLESHAM
My Lords, I am sorry to interrupt but this is a point of some importance. The noble Lord has made considerable play with the statement that there is, or will be, a superfluity, of beds in this area. This is not accepted by the local health authorities. I have here two resolutions, one from the Health Committee of the Merton Borough Council, the other from the Health Committee of the Wandsworth Borough Council. They are resolutions to the Minister of Health on the closure of St. Teresa's; so this is up-to-date information. That from Merton says that:… the Council considers that there is already a local shortage of beds for maternity cases in the Borough.Merton says there is a shortage. So does Wandsworth. Neither supports the statement that has just been made.
§ LORD SILKIN
I do not know whether they have directed their minds to the statement that I am making. I am taking the region as a whole. It is a very big 777 region and, as was said by the noble Lord, Lord Hawke, you must not compartmentalise these cases into Merton and Wandsworth. It may be that in fact there is not enough accommodation within the Borough of Merton, it may be even that there is not enough accommodation within the Borough of Wandsworth, but my case is that there is more than enough accommodation within the area of the South-West Metropolitan Regional Hospital Board, and that is a very different thing from what the noble Lord was saying.
So I hope that some kind of accommodation can be arrived at. I hope that my noble friend will pay a visit to the St. Teresa's Maternity Hospital and discuss the possibility of making use of the accommodation there in a way which would meet a need. There are other departments and other uses which could be made of this hospital so that a real shortage could be met. If some adjustment of this kind could be made, I can assure the noble Earl—at least, I hope I can—that every effort will be made to meet the wishes of the hospital and see that it is allowed to continue the excellent work which it has done in the past.
§ LORD SOMERS
My Lords, before the noble Lord, Lord Silkin, sits down, can he describe—I do not think he made it clear—what he considers the new hospital wing will provide that St. Teresa's Hospital does not provide, and whether he thinks it will be done better?
§ LORD SILKIN
Yes, my Lords, I think it can be done better in the public interest—that is to say (I thought I did explain), that facilities for X-ray examination and laboratory facilities will be provided. There will be available the services of specialists—certainly at Queen Mary's Hospital they will be on the spot—and there will be students and student nurses, in considerable numbers. Generally, I think that the services that will be provided will be better. But that is not part of the case which is being made. It is not suggested, even, that the reason for the change is that better facilities will be provided. The reason is that there are these facilities which have become available; and what is the Hospital Board to do about it? There certainly is not a demand for 72 beds which are available, or will be available by the end of the year, plus the 40 at 778 St. Teresa's Hospital. There is certainly not a demand for 112 beds. What is the Hospital Board to do? I think that in the public interest and in the interests of economy the only thing the Board can do is to ask St. Teresa's Maternity Hospital to consider making use of its accommodation in some other way to fulfil some other need.
§ 6.33 p.m.
§ LORD WINDLESHAM
My Lords, if I may say so without disrespect, I think the noble Lord, Lord Silkin, has made the best of a very thin case.
§ LORD WINDLESHAM
The best—I was being polite and generous. I do not want to follow the noble Lord, Lord Silkin, and the noble Earl, Lord Ferrers, on the detailed points which they have made, because I believe there are some important issues here of general policy. Before coming on to these, however, I will touch on two things said by the noble Lord, Lord Silkin. The first was the alternative use to which the 40 maternity beds could be put. I think the noble Lord finds himself in the same difficulty as the noble Viscount, Lord Addison, and Mr. Kenneth Robinson, and others who have not visited the hospital. They do not appreciate the grave difficulties in switching these over to geriatric purposes. This is a compromise solution which has been made by the Regional Hospital Board.
As the noble Earl explained, St. Teresa's is a hospital which, since 1948, has been expanded from 22 beds to 70 beds entirely for maternity purposes. In effect, the additions made since 1948 have constituted a custom-built maternity hospital. On the ground floor, where the old people would have to go, there are a lot of small rooms. Some of these have large glass windows reaching down to the ground, or to a balcony. That, as I think my noble friend, Earl Ferrers, would agree, is one of the attractive features about the hospital. It is situated on the side of a hill, and the mothers can sit on a balcony in the sunshine, or walk up and down. That is one thing which would be unsuitable for old people; they could not be put in rooms where the windows are low, or down to the floor, and a hill outside. It would be too dangerous. Then the hospital is composed of many small 779 rooms, instead of the large wards and communal recreation rooms necessary for old people. In addition, the hospital is specially equipped for maternity work and not for the care of old people. The nuns have acquired a special skill in maternity work over the last twenty years. So there is much more to this than suggesting that all that is required is a little flexibility of mind.
The second point mentioned by the noble Lord, Lord Silkin, if he will forgive me for returning to it—indeed it was the central part of his argument—was that there will not be a need for maternity beds at St. Teresa's when the new wing at Queen Mary's Hospital, Roehampton, is opened. I read out statements from the Wandsworth and Merton Borough Councils, formal statements, on the record, which do not support that argument. These statements are important because it is these areas which are, in the main, the catchment area for St. Teresa's. Both these statements were quoted in the House of Commons Adjournment Debate as reported in Hansard for April 12. Also the St. Helier Group hospital consultants sent out a letter to general practitioners saying they might not be able to take in all the mothers they had done until now, in particular young mothers between the ages of 18 and 25. The adequacy of maternity provision in the area may be an arguable point, but it should not be taken by noble Lords as a fact that there are enough maternity beds in the area without St. Teresa's.
As I said, my Lords, this decision by the South-West Metropolitan Regional Hospital Board raises two issues of principle which are of far-reaching importance. The first is the relationship between public and private provision in hospital care, and the second is the lack of any effective machinery for public participation in policy decisions in the Hospital Service. I think that noble Lords on both sides of the House would agree that in social policy, generally the trend is towards mixed institutions—that is, institutions which are partly supported by fees and partly by public funds. This applies to education in respect of the direct grant schools, and the present approach towards the public schools is, in fact, based on the same idea of mixed 780 institutions. It applies also to housing development by local authorities. The Minister of Housing and Local Government is always urging—correctly, in my view—for provision to be made for houses for letting at economic rents to be included in new housing estates, so that there may be a move away from segregation by class and income. If this is true of education and housing, why should it not be true of hospitals?
In this connection noble Lords opposite, including the noble Lord, Lord Silkin, probably remember that when the Health Service was set up Mr. Aneurin Bevan—perhaps to the surprise of some people—came out strongly in favour of retaining private wings in State hospitals in order to prevent, in his words, "a rash of private nursing homes." He was worried that if there were a lot of private institutions, doctors and nursing staffs might be drawn towards private nursing homes and away from the big general hospitals. I suggest that St. Teresa's is an excellent example of what one might call a direct grant hospital. In addition to its fee-paying patients, who are in a minority and always have been, it provides an excellent service for 40 to 50 National Health Service mothers.
As the noble Earl has said, it is one of the aims of the nuns to provide for poor and unmarried mothers. About 10 per cent. of the National Health Service mothers cared for at the hospital have been unmarried. It is a hospital which is remarkable both for its efficiency—and that is demonstrated by the fact that no mother has been lost in 19,000 confinements over 20 years—and perhaps as important, for its atmosphere of humanity and cheerfulness. The hospital has been extended from 22 beds in 1948 to 70 beds to-day. The cost of three extensions has been met entirely by voluntary subscription. The nuns are unpaid and have little time off. So in my view the Regional Hospital Board are getting a bargain at £70,000 a year. Through this subvention from public funds, an institution has been established where there is a very good mix between fee-paying patients and patients provided for publicly.
The second issue of policy raised by this decision, perhaps for the first time in the history of the Health Service, is the question of responsiveness. Some 781 months ago the decision was taken to discontinue the grant. There may have been warnings put out before, but the time came when the decision was taken. We may assume it was taken at official level on the facts as they were then known. I suppose the decision was later confirmed by the Board. The noble Lord who is to reply can tell me if I am mistaken, but I imagine that was the procedure.
Since then a completely new factor has come into existence—the extraordinary demonstration of public support by the users of the hospital. It is no good saying that the closure of hospitals always provokes an outcry. The five Members of Parliament for the area, from both major Parties, have testified that in their experience they have never seen a public protest like this against an administrative decision. Even the Minister of Health and the Regional Hospital Board are no longer attempting, I notice, to brush this off as a bit of trouble which would all die down by Easter. The opposition has not died down, and it will not die down, because the Board's decision is an unjust one which will deprive the National Health Service mothers of a hospital which many of them have come to love. That cannot be said of many hospitals, but undoubtedly it is true of this one. It is a great mistake to dismiss the opinions of the mothers as emotion. Their feelings cannot be put on one side by the administrators in the Regional Hospital Board, and now by the Government, who are stuck with having to support what the officials decided. These mothers are the users of the maternity services. The hospitals exist for them, and not for the administrators to administer, tidily and neatly.
How are these dissatisfied users to express themselves?—and everyone who opens a newspaper knows that they are dissatisfied on a wide scale. They can express their views in two ways—first, by public demonstration, and then by recourse to Parliament. There is a petition which has been signed by between 45,000 and 50,000 people. There has been a mass lobby in the House of Commons of Parliament from the area concerned. There have been large scale protest meetings, and another is due in Trafalgar Square this Sunday, after which a petition will be presented to the Prime Minister in Downing Street. It is rather unusual 782 for a small hospital with only 70 beds to be able to organise a protest on this scale. The noble Lord, Lord Soper, who knows about organising protests, will be aware that a protest on such a scale about so small a subject is rather exceptional.
There is the alternative of recourse to Parliament, and here the mothers have obtained the unanimous support of all five Members from the area. There have been Parliamentary Questions and an Adjournment Debate. The five M.P.s also went as a delegation to make representations to the Regional Hospital Board. But it has all been to no avail. Nothing has happened. After all the Parliamentary exercises have been gone through, the situation is exactly the same as before.
What are the mothers to do? Here is an administrative decision which is palpably against the wishes of the people whom it is intended to benefit. Where a railway station is closed there is a procedure for public inquiry, and an appeal procedure if the people whose interests are being affected do not agree with what is decided by the public authority. If there is a development scheme, or a compulsory purchase order on one's house, there is a procedure whereby the views of the people concerned can be taken into account. Even in the ill-starred Iron and Steel Act there is provision for a consumer's council, so that consumers can make representations and, if necessary, appeal against decisions. Not so in the Hospital Service. There is no way for the users to make their views known on matters of policy. This is a serious shortcoming, which so far as I know, has not previously come to the surface.
What happens now? If there is another stonewalling answer by the noble Lord who is to reply for the Government to-day, all the opinions of the users of the hospital, of the local population, of the Members of Parliament, of the local authorities—who have gone on record with the resolutions I read out—and much newspaper and broadcast comment, is going to have no effect at all. We must credit the Minister of Health and the Regional Hospital Board with sincerity and a desire to do what they honestly believe to be the best thing for the people in the area. But they are now caught in an impossible situation. A decision was originally taken 783 at official level. We can assume that it was endorsed formally by the Regional Hospital Board. Now the Chairman, the noble Viscount, Lord Addison, and the Minister of Health are stuck with this decision. They cannot afford to go back on it. Ironically, there has been too much public protest. If they now go back on the decision they let down their staff. No one can suppose that the noble Viscount is not deeply disturbed by this whole episode, and this goes for the Minister of Health as well.
The public response to the decision could not have been foreseen, but the system is such that now nothing can be done to change it. Yet if we are to have democratic and representative institutions in this country, and not sweep aside the views of the people whom a social service is intended to benefit, this dilemma has to be resolved in some way. It cannot be left to endless argument and marching up and down in Trafalgar Square. I appreciate the reasons why the noble Viscount, Lord Addison, cannot take part in this debate, but the noble Lord, Lord Beswick, will no doubt put the point of view of the Regional Hospital Board in his reply. The noble Viscount must have given this question a great deal of thought. It is one that has preoccupied me. As a local resident myself, living a few hundred yards away from the hospital, I am well aware of the reputation of St. Teresa's. And from the opportunity I have had of visiting the hospital and meeting the staff, I can confirm everything that has been said in its favour by my noble friend Lord Ferrers.
There is now only one solution. I believe a wrong decision has been taken, on inadequate information, and without taking into account the opinions of the users of the service. To be frank, in these circumstances the only way out is for the Chairman of the Regional Hospital Board to resign. This might be thought too drastic and unfair a proposal. It is unlikely that the Chairman was personally concerned with the original decision at all. But if the Board are to be regarded as directly responsible for a policy decision—and the Parliamentary Secretary made it quite clear in two replies in the Adjournment Debate in another place that he sees this as primarily a matter 784 for the Board—then it seems to me that this is the only solution to the problem.
I do not seek to make this suggestion as a personal criticism of the noble Viscount, Lord Addison. But the structure of the Hospital Service is such that there is no other way for the users to get at the Board. They do not have any representatives on the Board, and, therefore, they cannot ask their representatives to put forward arguments on their behalf. Nor can their representatives themselves resign. Hospital users can make representations through their Members of Parliament; and they have done so. But none of this, as I have said, has had any effect.
In conclusion, I would say that this decision, and this hospital, might seem to be relatively small and unimportant. But when real issues of principle arise, administrative decisions can become symbols of something much more important. Crichel Down was not in itself a very important matter, but it did come to stand for what people generally regarded as a just, fair and reasonable solution. If Governments and Boards disregard deep rooted opinions of this sort, then they do so at their peril.
§ 6.53 p.m.
§ BARONESS BROOKE OF YSTRADFELLTE
My Lords, those of us who care about people must welcome the opportunity that has been given to us to-day to discuss the future of St. Teresa's Maternity Hospital at Wimbledon. We have every reason to be grateful to the noble Earl, Lord Ferrers, for putting down this Question. I am glad to be able to support him, and in doing so I should like to make it clear that I am not speaking as a Roman Catholic. Since the inception of the National Health Service, St. Teresa's Hospital has been used by the South West Metropolitan ' Regional Hospital Board for maternity cases. As we have already heard—and I make no apology for repeating this figure—some 19,000 mothers have been safely delivered of babies there. At a time when the Regional Board had insufficient beds to meet the needs of its maternity cases, St. Teresa's Hospital willingly and efficiently adapted itself to help to bridge the gap. In another place, the Parliamentary Secretary referred to the temporary nature of contractual arrangements with hospitals independent 785 of the National Health Service. I must say, my Lords, that I find an unbroken contract of twenty years duration a pretty strange sort of temporary nature.
During the debate in another place on April 12 reference was made to the comparative cost of a bed in St. Teresa's and the estimated cost of a bed in the new maternity wing at Queen Mary's Hospital, Roehampton, when it opens next January. The cost at St. Teresa's, as has already been said, was quoted at £4 12s. 11d. a day, as against the estimated cost at Queen Mary's of £6 a day. My Lords, most of us have had experience in our own lives of the inaccuracy of forecasting estimates for potential services, and when the time has come for the actual bill to be rendered the cost is almost invariably higher than we have been led to expect. Indeed, in another place, the Parliamentary Secretary to the Ministry of Health said himself that "estimates tend to go awry". I shall watch the estimated figure with much interest when Queen Mary's maternity beds are in full use.
It appears from that debate on April 12 that the Minister of Health bases his costing of maternity cases upon the length of stay in hospital, rather than upon the cost per bed per day. A comparison was made between the length of stay in Regional Board hospitals, which was, on an average, 9.4 days in 1965, and in St. Teresa's hospital, where it was 12.2 days in 1965 or 11.15 days in 1966.
My Lords, in common with the noble Earl, I have visited St. Teresa's hospital, and when I was there I put this particular question to the Mother General and to Sister Barbara, the matron, who were good enough to meet me and take me round. I understand that the figure given for the average length of stay in St. Teresa's includes the extra length of time that some of the mothers have to stay when they come in before their confinement because of complications in their pregnancies. For instance, in the case of a pregnant mother suffering from toxæmia, it sometimes happens that she may have as much as 14 extra days in hospital before her baby is born; and this will be shown in the final average figure for length of stay. Could the Minister who is going to reply tell us whether the figures for the average length of stay in a Regional Board hospital are based upon 786 the same contingencies and calculated in exactly the same way? If they are, the length of stay of many of the mothers using Regional Board hospitals must be considerably lower than the 9.4 days referred to by the Parliamentary Secretary to the Ministry of Health on April 12; and that, surely, is not a desirable feature.
What I find difficult to understand in the whole of the unhappy developments in this particular case of contractual beds is why no members of the South West Metropolitan Regional Hospital Board have ever been to visit St. Teresa's Hospital. During my time—some twelve years as a member of another Regional Hospital Board—any similar situation such as has arisen between the South West Board and the hospital, where the Board has had contractual beds, and those members of the general public who are deeply involved, would have been personally investigated on the spot by a member or members of the Board in order to get a true picture of all the background facts. But in the case of St. Teresa's Hospital, so far as I am aware, no member of the Board has ever been to the hospital. Officers have been in touch, but even their contact seems to have been somewhat superficial.
It would seem as if the decision to end the contract for maternity beds had been based, as has been suggested by noble Lords this evening, upon paper considerations, with no thought of the people involved—the nuns, the mothers and fathers, or, indeed, the babies. At a time when the Regional Hospital Board had not been in a position to provide sufficient maternity beds in their own hospitals St. Teresa's had provided a very convenient solution. But as soon as the Board gets round to building the new maternity wing at Roehampton, St. Teresa's is written off—though the Board, again to suit their own needs and convenience, are prepared to offer St. Teresa's another temporary contract for three years for 30 geriatric beds or beds for young chronic sick. No thought seems to have been given to the consequent scrapping of the labour wards, the nurseries and the milk kitchen, which would not be needed by geriatric cases. That problem was to be left with St. Teresa's.
My Lords, there seems to have been no regard for the very real and personal feelings of the women who had counted on 787 having their babies in a hospital they knew well and in which, because of its justifiably proud record of safe deliveries, they had every confidence. To have visited St. Teresa's Hospital is an experience I shall not easily forget. I have spent many years closely involved in hospital work. Seldom have I been more deeply impressed than I was by the happy, competent, quiet serenity I experienced when I was taken last week round the hospital by some of the nuns who devote their lives and their trained skill so un-self-consciously to the mothers and the babies in their care.
It may be argued that the hospital staff is not entirely drawn from the sisters of the Community. That is true enough. But the posts of responsibility and leadership are held by nuns who, because of the nature of their dedicated calling, create such an atmosphere of quiet, happy calm that those lay nurses training under them, or working with them, cannot fail to respond. This is by every count a good and happy and a productive place.
I hope, my Lords, that the South West Metropolitan Regional Hospital Board, encouraged by the Minister of Health, inspired perhaps a little by some of the thoughts that have found wing in this Chamber to-day, will think again; and that, as a result of their thinking, St. Teresa's will be allowed to continue to bless mothers and babies for many years to come, as I would suggest the Mother General and two of the sisters have blessed this Chamber this afternoon by coming to listen to this debate.
§ 7.2 p.m.
§ LORD SOPER
My Lords, I take it that it is now my turn to speak, and I speak with a certain diffidence, which your Lordships will understand. I should be very unhappy if anything I said were to be interpreted in a denominational sense. I am a Methodist, and I have been involved for many years in the kind of work to which we are turning our thinking. Let us get two things clearly out of the way. No one thinks more highly than I do, and knows perhaps out of experience more confidently than I do, of the magnificent work that places such as St. Teresa's Hospital have done and continue to do. This is not in debate. The loving care and sense of vocation are only too obvious to all who have 788 any contact with this kind of hospital run by the kind of people with whom we are concerned to-day.
In the second place, there is no question whatever in my mind that enlightened Government must seek indefinitely a marriage between local authorities and central Government and vocational bodies, who have in the past become the bellwethers of enlightened social practice, and who have in many respects worked for their own redundancy. That, I think, is particularly applicable to-day in the emergence of the Welfare State.
Before I venture a little more widely, I should like to deal with a number of the enthusiastic and highly inaccurate statements which have been made. I was much impressed by the enthusiasm of the noble Earl, Lord Ferrers, but I must point out that in many respects he created a good deal of heat but not very much light. Moreover, he was severely at fault in a number of misstatements he made—not least, the statement that this hospital was being closed down. Let us clear up that point straight away, because there is no suggestion that this hospital should be closed down. In fact, the evidence—and I can give specific dates and figures—indicates how clearly a contractual undertaking was arrived at some years ago; and even then it was known that modifications, in view of other practices and other procedures, would be required.
On October 18, 1963, St. Teresa's indicated that they were aware that a maternity unit would be opened at Queen Mary's, Roehampton; and on October 21 the Board replied that this would not be in the next eighteen months to two years, but that it might well be that modifications would be necessary in about one and a half years to two years' time. This does not entirely remove the problem, but it casts a much more radical light upon it, and the inference which has to be drawn is an inference which, I think, belongs to the very nature of this kind of work. Furthermore, it is the kind of work which I think the noble Earl, Lord Ferrers, must not castigate, when it is taken over by public authorities, with this old and weary cliché that personal relationships are lost in public institutions. This simply is not true. I have a pretty long experience of public hospitals, and I am continuously 789 encouraged—and sometimes, I confess, surprised—at the amount of care and personal attention which is given to people, whoever they are, and the almost universal gratitude which patients express (and this also is gratifying) for the attention they have received.
I hope that this stale assumption that public authorities do not provide personal attention, and that only private and vocational authorities do, is not going to be argued out in your Lordships' Chamber again to-day; because this is an old subject, and it is not true.
My Lords, may I interrupt the noble Lord? As he has attributed those sentiments to me, I think it would be fair to make it perfectly plain that what I said was that in my opinion this was the greatest shortcoming of the Health Service. I did not say that this personal attention did not exist.
§ LORD SOPER
I would repudiate that as well. I understand this point; I know how often it is repeated and how familiar it is, but I want to say how clearly and categorically I repudiate it.
I am indebted to the noble Lord, Lord Windlesham, for his comments about my own acquaintance with public outcries and "raising steam" in public matters under consideration. This is perfectly true. But I am not sufficiently naïve to believe that this cannot be contrived, and I am not sufficiently naive to believe that this is a matter which should be taken as an indication of public outcry in itself. I can imagine what would happen, for instance, if the local authorities in Lincolnshire decided to close Epworth Rectory. The local inhabitants of Epworth are a very small community, but they would have the entire Methodist Church behind them in their public outcry. St. Teresa's is a small hospital, as the noble Lord, Lord Windlesham, said; and no Roman Catholic must take offence if I remind your Lordships that they have at this moment the whole apparatus and instrumentality of the Roman Catholic Church, highly organised, to do this very thing. All honour to them, if they believe in it! But let us not make the mistake 790 of thinking that this is a spontaneous outcry on the part of the local community. It has its repercussions, and I am sure it has its relationship to the most highly organised and most integrated Christian community I have ever known.
I am sure that this question raises a matter of principle, or, rather, two matters of principle; and I would briefly advert to them. I am sure that a very great deal of voluntary effort in this field should be working towards its own redundancy. This would certainly not be true in any community which did not seek a Welfare State. But I am sure that in a Welfare State there are opportunities for the whole community to take responsibilities which in other ages have been the accepted vocational responsibilities of only a few. And I see nothing wrong in recognising the inevitable process whereby such (if I may say so) ordinary, almost everyday, occurrences as belong to the business of a maternity hospital can and should be taken over, not entirely but in large measure, by local authorities who can provide certain amenities.
This is a matter upon which I think a little more accuracy is required, because it is true that in this particular instance there are to be provided an additional ten maternity beds over the allotment in St. Teresa's, as well as the availability of the full resources of a general hospital, X-rays and laboratory facilities, while a "flying squad" service to the community is also being planned. It would be, I think, gratuitous to assume that, with all the love and care, there is not a considerable argument to be made that in maternity care the enlightened community can probably be better than even a vocationally inspired religious community.
Having said that, I would immediately pass to the other thing which I think is a companion truth. I firmly believe that there are certain services which need to be rendered by devotionally-minded people who have two qualities which are probably not to be found in the public sector. One is a particular sense of devotion; and no one would want to say that this is not displayed in an exemplary manner by the Roman Catholic sisters. The second, and equally important, is a reference back to some kind of reservoir of fellowship in many cases, and I am thinking particularly of the hostel in which I have the care of girls who are pregnant 791 and unmarried, of unmarried mothers and their babies, and those who are ill and old and are very lonely. I think here there will be a continuing—indeed a permanent—need for the sort of tasks which have been so splendidly undertaken by St. Teresa's and like hospitals in the past.
I earnestly invite the responsible people in St. Teresa's to do again what they have done already, which is to follow out the advice of John Wesley to his helpers. He said: "Go to those who need you, and especially to those who need you most". At the time when this contractual arrangement was entered into the greatest need was for some hospital beds for maternity cases. To-day I am convinced that this need is secondary to a need of an entirely different kind of particularised and devotional work. It ought to be put on the record, although I think in fact it was referred to by the noble Baroness who has just spoken, that far from the Regional Hospital Board's saying, "The only thing you can now do is to go back to geriatric work", what the Board has proposed is that this hospital should turn over to the kind of chronic sick nursing among young people which I believe is one of the most difficult and complex and heart-rending opportunities which we have for public service, and for which I share with my Roman Catholic friends a sense of great conviction and devotion.
Therefore, far from hoping that out of this debate it will be assumed that the public sector has no further need for St. Teresa's, I earnestly invite your Lordships to consider whether or not the right course is for St. Teresa's to seek to do a job which, on the evidence, seems to me to be approaching redundancy in this particular area. It may be of interest to point out that in the Inner London area there are at the moment 719 beds available and only 556 of them are occupied. It should be considered whether St. Teresa's should not turn from this work which is now becoming, not unnecessary, but equally well done by the public authorities, and concentrate once again on those pioneering efforts, as it has done in the past and by which it has known its greatest glory and has fulfilled its deepest mission. I hope this will be done in the future.
§ 7.13 p.m.
§ THE EARL OF IDDESLEIGH
My Lords, until the last speech I had not regarded this as being in any sense a 792 denominational issue. I am quite unaware of this supposed effort by my Church to make trouble over this incident. I should have thought that if that had been the case someone, in the expectation of this debate, would have sent me some documentation on the subject. I have received no documentation at all. No-one in authority in my Church has suggested that I should take any interest in the question. I put down my name to speak only this morning, after a visit I paid to Wimbledon on Saturday and Sunday, and I am speaking not as a Roman Catholic but as a man who has a great love for, and some understanding of, the Borough of Wimbledon. Before the war Lady Iddesleigh's parents had a cottage at Wimbledon and I spent many happy weeks there as an engaged man and a young married man, and I got to know it very well. My battalion was at Wimbledon in 1940 and I spent many, not quite so happy, hours in Wimbledon in that year. Now my younger son lives at Wimbledon.
I do not believe that the Regional Hospital Board would have come to this decision if they had understood the character of Wimbledon. It is a very closely knit community. A Wimbledon housewife said to me yesterday, "Living here is not like living in a suburb; it is like living in a county town. We are proud of our community; we are proud of our Wimbledon institutions. We fill our theatre very well and we are proud of our maternity hospital, where our babies are born in our Borough". This closely knit feeling which is notably strong in Wimbledon is the cause of this agitation, and I repudiate the suggestion that it is an agitation provoked by Roman Catholics. It is a genuine, common feeling.
The arguments in favour of retaining the services of the community, and retaining them in maternity work, have already been given by other speakers. I will add only this: if we deprive this community of the maternity work we shall be wasting about ten maternity trainings. The members of this community are pioneers. Fifty years ago it was not considered suitable for nuns to do maternity work at all. They avoided it then; but progress goes on in religious Orders as in other places, and when there was a need for more midwifery, in this country the Sisters 793 undertook maternity training. Whatever other work they do in geriatrics and the work of which the noble Lord, Lord Soper, has spoken, that training of those nuns will be completely wasted. That is an appallingly uneconomic thing to do and I blame the Regional Hospital Board that when they came to level up the maternity services available they did not reckon on the possibility of keeping this excellent hospital going by continuing the contract. This would have suited Wimbledon, it would have suited a great many mothers who are fond of the place, and it would have avoided a great expenditure of public money on other places. I follow the noble Earl, Lord Ferrers, in begging Her Majesty's Government to think again about this matter.
§ 7.19 p.m.
My Lords, it is with great diffidence that I rise to say a few words to-night on my noble friend's Question. In fact I feel rather like Daniel in the lions' den, and I am afraid my noble friends, the lions, will not be quite so kind to me as those lions were to Daniel. There can be no doubt, my Lords, that if one's heart were to rule one's head we should all be backing St. Teresa's here to-night. Wonderful work is being done by the nuns there. I know only too well, my daughter being in St. Mary's Convent at Roehampton what wonderful work they do for the mentally handicapped, and how grateful I am to them. Unfortunately, those of us who have a major or minor responsibility in the Health Service have to ensure that the best use is made of the all too little money available for the care of the public. I feel I should state that my hospital group is in the South West Metropolitan Regional Board, and hence under the chairmanship of the noble Viscount, Lord Addison, but that in no way has influenced my words to-night.
After very careful thought I have come to the following conclusion. I have for many years been connected with charity organisations, and I am convinced that the main function of a charity organisation should be to pioneer new projects and to fill in the gaps in services not covered by the health scheme. We shall be hearing from the noble Lord, Lord Beswick, factors which have influenced the Board in their decision, but I understand 794 that in general the maternity services in the area are now fully covered, with all the up-to-date techniques which medical science has devised. I also understand that there is urgent need for the care of old people and the chronic sick which the Board have been unable to cover fully. I would therefore say humbly to St. Teresa's, "Well done thou good and faithful servant. Turn now to new horizons where your loving kindness is so badly required".
§ 7.22 p.m.
§ BARONESS HYLTON-FOSTER
My Lords, like the noble Viscount, Lord Addison, I must confess that I also have not visited this hospital, but I have been stung into speaking this evening because I am a great admirer of voluntary effort, and I feel that until this matter was brought into the open, and in particular this evening, no real appreciation or thanks has been shown to St. Teresa's for the splendid work they have done and are doing. I should like to make clear that this dispute is entirely with the Regional Board and not with Westminster Hospital; the name of Westminster Hospital has been mentioned because it is the hospital which is taking over Queen Mary's when the new general district hospital is built. All of us in the Palace of Westminster know that if you are taken ill it is to Westminster Hospital that you are taken, and many of us have reason to be grateful to that hospital for the excellent treatment that all their patients receive. I should like no confusion about that.
When St. Teresa's was taken over by the National Health Service in 1948, as we have been reminded it was caring for cancer patients. At the request of the Ministry it then converted itself, at its own expense, into a maternity unit, having at that time, I think it was, 22 beds, and during the four conversions those beds have now risen to 70. All that has been at the expense of the hospital. The National Hospital Plan, which was presented to Parliament in another place, I think in 1962, while extensions to St. Teresa's were still going on, included Queen Mary's as a district general hospital. The then Minister asked the Board of Governors of Westminster Hospital to plan a maternity unit. So the Regional Board must have known about this. Surely a member of the Board could have gone personally to St. Teresa's 795 some time between 1962 and the present day to explain the position to them, and not just convey notes, or whatever method was used. Even in 1966 St. Teresa's were, vaguely, at any rate, under the impression that they were still going to be used, until they were suddenly told their contractual arrangement would stop in 1967. I agree with the noble Lord opposite that the job of the voluntary organisation is to pioneer objects and hand them over, but you cannot suddenly hand over wards that have been converted; you need a little time and also money to do that.
Whatever the reasons why the Regional Hospital Board showed no personal interest in this hospital at all, I put it to your Lordships that there were the most appallingly bad public relations between the Regional Board and the hospital, and also with the local people. It has been pointed out that Wimbledon is a little community on its own. Surely somebody on the Regional Board could have taken the trouble to go and see for themselves what really was happening in this hospital, and if this decision had to be taken, give them some helpful advice as to how their very splendid wards could be used.
Perhaps I might add a personal note here. I am myself a nurse. I have nursed both in maternity units and in geriatric wards, and I know that very different conditions are needed in both. In St. Teresa's you have a trained staff for a specific purpose, whereas for geriatric wards you need a rather different staff, and the talents of these ladies would really be rather wasted. I must emphasise again that the exceptional service that this hospital gives is not only in nursing but also in human relations. Although one noble Lord rather suggested that human relations do not matter very much, I think they matter enormously. Also, of course, there is this exceptional question of cost per bed. The very low cost, nobody will deny, is because very much of the service is given free. Free service is a very rare thing in these days, and I personally think it should be praised and taken into account, and not just fobbed off by saying, "You have done a splendid job; now turn your splendid maternity unit into a geriatric ward". And again the hospital pays; there is no suggestion that anybody else pays.
796 As there is a difference of opinion as to the number of maternity beds needed in the district, and bearing in mind the extra cost to the State of the new beds—quite apart from the cost in money and time to the relatives of patients who will then have to travel to other hospitals, to Kingston and Richmond, to visit their friends—would it not be wiser to keep all the available beds until the effect of the new Queen Mary's unit is seen? I should like the Minister to tell me whether it is the policy of the Regional Boards to be regionally bound, or whether there can be interchange if there is a shortage of beds in a particular region.
Finally, I was talking to a local resident of Wimbledon on the telephone—I discovered he was a local resident by chance—and I asked him whether he had any comments to make on this question of St. Teresa's. His only comment was, "It is a crying shame". I join with the noble Earl in hoping that Her Majesty's Government will persuade the Regional Board to think again.
§ 7.30 p.m.
BARONESS STRANGE OF KNOKIN
My Lords, I am very pleased indeed to take part to-day in this debate on a subject that is close to my heart—I refer to the maternity services, and in particular to St. Teresa's Hospital in Wimbledon. I am most grateful, too, to the noble Earl, Lord Ferrers, for this chance to be able to give him my unqualified support. I have lived most of my life in the country, and there I have learned what their hospitals mean to mothers when they have had their babies and need so much help, comfort and understanding. This is perhaps more evident in the country than in the towns, because, as well as other things, the mother often has a long journey to undertake.
St. Teresa's has been equipped especially as a maternity hospital. It is only a short time ago, in fact only last year, that the last improvement was made. The nuns there are dedicated people, catering principally and particularly for the poor and the unmarried mother. As there is not so much pressure on their beds as there is in other kinds of hospitals, the patients are allowed to stay there longer than they can in other and bigger hospitals. This is a good thing, because, when the mother and baby go 797 home (and this is especially true of National Health patients), the mother starts to work. Often it is heavy work, and so she does not get the rest and the quiet that are necessary to her. Also she is on her own. She may have other children to look after, as well as the small baby. For that reason she does not get back her strength so soon as she might. Surely this is an argument for the small hospital like St. Teresa's.
Though I think that a geriatric hospital is a good idea, the more so because I have a feeling that I may need to get a bed there myself soon, I consider that the young should not be deprived of a service which has been especially equipped for them. A maternity hospital is a thing apart. In it, it has some of the greatest joys in the world, and also the most demanding responsibilities. St. Teresa's is a teaching hospital, of which there are all too few in Great Britain. The skill and the high standard of devotion of these nuns has made them respected and loved by thousands of mothers who have had their babies there. I beg that Her Majesty's Government shall ask the South West Metropolitan Regional Hospital Board to reconsider their decision to withdraw the grant from this splendid hospital. If they do so, they will earn the grateful thanks of many thousands of people.
§ 7.34 p.m.
§ LORD SOMERS
My Lords, before the noble Lord, Lord Beswick, replies, and although I had not intended to join in this debate, may I just say that no doubt he has heard from more than one speaker that about 19,000 cases have been dealt with in this hospital without the loss of a single mother. I wonder whether he could quote one other National Health hospital which has a similar record? If he cannot, is it not a strong indication that the Minister of Health is throwing away this remarkable talent in favour of a hospital which bows the knee, not to the true God, but to the more fashionable god to-day—at any rate among those in the Government—of bureaucracy?
§ 7.35 p.m.
§ LORD BESWICK
My Lords, we have had a useful, a reasoned and an informed debate. I am only sorry that my noble friend Lord Addison has not 798 himself been able to take part in the discussion, especially as he came under what I thought was a somewhat unfortunate personal attack. The noble Earl, Lord Ferrers, made a persuasive speech. He spoke with great feeling, and he made a contribution to a campaign which must rank as one of the most remarkable of recent years. Undoubtedly—and, like others who have spoken, I live in that part of London and therefore I know—St. Teresa's campaign has attracted great attention and support, especially in South-West London. However, that is not to say that its case is incontrovertible, or that there is not another side to it.
It is my experience (hat it is seldom that human beings can be persuaded to protest so strongly and persistently unless there is some good basic reason. The reason in this case, as so many noble Lords have already said, is the deep and understandable gratitude and affection for a hospital in which so many lives have been brought happily and safely into this world. The noble Earl, Lord Ferrers, emphasised this, and nobody has challenged it. The Minister certainly has not challenged it; the Regional Board have not challenged it, and I personally would never challenge it, because my wife and I have a special reason to be grateful to that hospital, as my son was born there. If I may be allowed to make this one personal reference, it so happened that at the time she was confined there I was dismissed from my post as a Parliamentary Private Secretary in the Labour Government of that time.
§ LORD BESWICK
My Lords, if I may say so to my noble friend, it was for supporting the Ireland Bill at that time. The nursing sisters there, with great care and sympathy, for which we shall always be grateful, because they thought, mistakenly, that I had lost my livelihood, went to immense trouble to see that the newspapers were kept from my wife. But though I understand the reason underlying this campaign, there are other factors which, in my view, justify the policy which I propose to explain.
I thought that the noble Earl made overmuch of the point that my noble 799 friend Lord Addison had not personally visited the hospital. I think it unfortunate that this observation was made, or that so much was made of it. Anyone who knows my noble friend—and here we all do—knows the voluntary and unpaid time which he devotes to his duties as chairman of the Regional Board, and would really hesitate before speaking as did the noble Earl, Lord Ferrers, in that way. In any case, my noble friend would not have learned a single new fact about this situation. The facts were all known, and my noble friend would be the last to challenge the assertion that has been made over and over again, that St. Teresa's is a fine hospital.
What we are really concerned with here is not so much the past, but how for the future we can ensure for South-West London the best possible maternity service with the large, but strictly limited, share of national resources which are at the disposal of the Regional Board. Let me deal with the charge made by some of the politicians in the area, and implied by the noble Earl, Lord Ferrers this afternoon, and certainly made by one other noble Lord, that the developments affecting St. Teresa's are being pursued for ideological or political doctrinaire reasons. This charge is false and is known by those who make it to be false.
My Lords, may I interrupt the noble Lord? I specifically said that there was no Party issue whatever here, and such remarks as he has made certainly do not refer to me.
§ LORD BESWICK
My Lords, the noble Earl is quite right. What I said was that it was implied in what the noble Earl said, but it has been said in terms by others in this controversy.
§ LORD BESWICK
The noble Earl went to great lengths in saying what was being done, in referring to the bureaucracy implicit in the way in which the Minister was acting. He implied that it was a decision of the present Government, and by people of a different political Party from his own.
I must interrupt the noble Lord. This is absolutely a misrepresentation of what I said. I said 800 that this decision had been taken and that in my judgment it was a wrong one; but I said specifically that there was no Party issue in this whatsoever.
§ LORD BESWICK
My Lords, I am very glad the noble Earl now makes it absolutely clear, but the fact still remains that it has been said in the course of this controversy—the noble Earl will agree with this—that the decision has been taken for ideological and doctrinaire reasons. I am quoting here from speeches that have been made.
§ LORD BESWICK
We will read tomorrow what I said and what the noble Lord said. The fact I want to stress is that the initial decision to enter into a contractual arrangement for the use of beds at St. Teresa's—this was a temporary arrangement—was made during the time of, and by, a Labour Government. The policy which has led inevitably to the ending of this contract was decided by a Conservative Government. Both decisions were justified on medical and administrative grounds. In neither case was there a hint of doctrinaire thinking.
The principle governing the policy, decided at the time of the Conservative Administration, meant that the Hospital Service should be based on a network of district general hospitals, of which a maternity unit would normally be part. The advantage of this policy is that the full supporting services to be found in a district general hospital will be available to all maternity patients. In South West London, Queen Mary's Hospital, Roehampton, which, as my noble friend Lord Silkin has explained, is part of the Westminster Teaching Hospital Group, will be the district general hospital to serve the surrounding community. A splendid modern maternity unit is under construction there and is expected to be admitting patients from January next year. My noble friend Lord Silkin went into some detail about this new hospital, and I do not propose to add more on that subject.
801 The noble Lord, Lord Windlesham, queried a statement made by my noble friend Lord Silkin, that St. Teresa's had known of this development of Queen Mary's as far back as 1965. In fact I have seen correspondence referring to this development as far back as October, 1963, and it is surely reasonable to assume that this development was, or should have been, taken into account in the forward planning of St. Teresa's.
§ LORD WINDLESHAM
My Lords, will the noble Lord excuse me? I asked the noble Lord, Lord Silkin, for evidence that the decision had been notified to the hospital five years ago. In his answer he shrunk the period to about 1964.
§ LORD BESWICK
The facts, as I understand them, are these: that there must have been a discussion about the new development in 1963, because I have seen correspondence in which this new hospital accommodation at Queen Mary's, Roehampton, is mentioned. A further warning was given verbally, I understand, in 1964 that the new accommodation coming forward would make it impossible for the contractual arrangements with St. Teresa's to be continued.
I would emphasise, in view of the point made about the position of my noble friend Lord Addison, that these early warnings were given at the time of my noble friend's predecessor. The original decision, or, rather, the planning which made the decision inevitable, was taken by the Board in 1964, before he assumed his present responsibilities as Chairman. Again, if the noble Lord wishes to make a personal point of this and press for the resignation of my noble friend Lord Addison, I can assure him that such is the feeling of the Board itself that if the question of his resignation arose the whole Board would automatically, I am certain, resign with him, because the decision was a decision of the Board as a whole.
§ LORD WINDLESHAM
My Lords, would the noble Lord allow me to intervene? What I was arguing was not a personal criticism of the noble Lord, Lord Addison, in any way. What I pointed out at some length was that, because of the structure of the Hospital Service, there is no way for users to make their views known and no possibility of an 802 appeal. May I put it in the form of a question to the noble Lord? Assuming that there was a proven case of maladministration in the Hospital Service, what, in his view, would be the correct remedy?
§ LORD BESWICK
I know that the noble Lord, Lord Windlesham, did raise the broader issue, and I hope that he will excuse my not going into that matter this evening. There is not time, and I do not think that it would help this particular case. I have some sympathy with what he said. I personally think that there is a case for a more democratic structure of the Regional Boards but it seems to me that this has no bearing on the situation here.
I was taking up the point made by the noble Earl, Lord Ferrers, who did call for the resignation of my noble friend Lord Addison.
My Lords, the noble Lord must get his facts right. I did not call for the resignation of the noble Viscount, Lord Addison. I said that he had never visited the hospital. I never called for his resignation.
§ LORD BESWICK
My Lords, I speak in the hearing of the House, and I am sure that when the noble Earl reads Hansard to-morrow he will find that he said something very different from what he now thinks.
§ LORD WINDLESHAM
My Lords, perhaps I can help the noble Lord. It was I, not my noble friend Lord Ferrers, who called for the resignation of the noble Viscount, Lord Addison.
§ LORD BESWICK
Then I apologise to both noble Lords. That is quite right. I am very sorry, but certainly this question of resignation arose, and I thought that it was raised by the noble Earl.
May I now deal with one or two of the detailed points raised? The question of comparative costs was mentioned. Part of the campaign's argument is that it will be more expensive for the Regional Board to provide at the new hospital the service hitherto available at St. Teresa's. The actual figures have been published, and I do not propose to go into them in detail. Briefly, they seem to show that the cost per day at St. Teresa's is somewhat lower, but since the Regional Board paid St. Teresa's on the basis of so much per 803 patient per day, and as patients there tended to be retained for slightly longer that the regional or national average, the cost per patient to the Board is somewhat higher. But I do not think that the difference between the two would lead to a decision one way or the other.
There are two other relevant matters in this question of costings. First, the St. Teresa's figures have recently increased significantly, and in the last year or so they have spent this additional sum of money on the equipment of the hospital, and I should be surprised if the figures do not show a further increase in the future. The second, and more important, point is that the Health Service figures, which are slightly higher on a per-day basis, include an element for the specialist facilities not provided by the private hospital; for example, the maternity flying squads for emergency calls. They are available for all the people in the area and they have to be paid for, and the costs of those services are caught up in the average costs on the National Health Service hospital.
I am sorry that the question of comparative safety has been brought into the argument again. I agree that St. Teresa's has a very fine safety record; but so have other hospitals. If this part of the argument is pursued, as the noble Lord, Lord Somers, appeared to wish to pursue it, then one must point out that the really difficult and complicated cases are more likely to be admitted into a maternity unit, at which all the specialist facilities of a general hospital are available.
§ BARONESS BROOKE OF YSTRADFELLTE
My Lords, would the Minister agree, while he is talking on that point, that the vast majority of maternity cases are perfectly straightforward, natural deliveries? So is it not essential that we should not send to the really expensively produced units those cases which can be perfectly well delivered in such a hospital as St. Teresa's?
§ LORD BESWICK
My Lords, I was dealing with the question of the comparative safety record, and all I am saying is that if you get on to the figures on which some have tended to dwell—whether it is a matter of one death or two deaths or three deaths over a period of years—that can be accounted for by the fact that really difficult and complicated 804 cases would not go to the small private maternity hospital but to a unit which is attached to a general hospital, at which the specialist facilities are available. That is the only point I was trying to make here.
One other point has been made very strongly, both in the campaign generally and again to-night, concerning the adequacy of maternity bed accommodation in this part of the metropolitan region. I must say that this was the one point on which I personally had doubts when I went into this problem. I am only too well aware of the housing development in the Wandsworth, Roehampton and Kingston Vale areas. I know, too, that there have been complaints about difficulty in gaining admission to a particular hospital at a particular time. But I think the position here must be understood. No one claims that at the present time there is, should be, or could be, 100 per cent. availability of beds for confinements. The Maternity Services Committee, under the chairmanship of the noble Earl, Lord Cranbrook, reported in 1959 that the objective should be to provide hospital accommodation for 70 per cent. of all confinements on the basis of a normal stay of 10 days. In the Boroughs of Merton and Wandsworth respectively, 85.9 per cent, and 85.4 per cent. of mothers were delivered in hospital last year. So, clearly, the Regional Board are more than fulfilling requirements in this respect.
§ BARONESS BROOKE OF YSTRADFELLTE
My Lords, may I ask just one question? Since 1959, when the Report of the noble Earl, Lord Cranbrook, was produced, a very much larger proportion of mothers—and also potential aunts and grandmothers—are going out to work. Therefore, there are fewer home helps, and real home helps, available, which means that there needs to be a higher proportion of maternity cases in hospital.
§ LORD BESWICK
My Lords, I think the noble Baroness is quite right, and the 70 per cent. was a national average. There must be a variation as between one part of the country and another, and in London the factors to which she calls attention apply much more than in other parts of the country. Nevertheless, the fact remains that the average suggested in the Report was 70 per cent., and I am saying that in Merton and Wandsworth 85.9 per cent. and 85.4 per cent. of the mothers 805 were delivered of their babies in hospital last year. So I do not really think it can be claimed that there is a shortage of beds in this area.
A particular reference was made at one point to the fact that there had been a statement that at St. Helier it was not possible to take mothers at a given time. But my information is that the position in the St. Helier group was not that there was a shortage of beds, but that there was a shortage of staff, and not all the beds were being used. That position is being improved, and I think there will be less cause for concern in the future, so far as St. Helier is concerned. Nevertheless, even though there were difficulties at that hospital at one time, overall in the South West Region there is no question about the adequacy of beds.
I have brought out the fact that some 20,000 additional people have moved into the area in recent years, and that this must mean a substantial additional requirement. But, again, if one goes into this without emotion and with a slide rule, and if one assumes a birth rate of 16.6 per 1.000, the extra requirement there indicated is 11.6 beds. As has been said, there will be this extra number at Queen Mary's—50 instead of the 40 at St. Teresa's; there will be 10 more at Queen Charlotte's and another 12 at Kingston Hospital later this year. To demand that the Regional Hospital Board, after making provision in its budget—a limited budget—for these extra beds, should, in addition, continue to contract for the use of beds elsewhere is simply to ask them to spend money unnecessarily, which they urgently need for other hospital services.
I have tried to explain the policy first declared by a Conservative Minister of Health (I accept what the noble Lord said, but there has been this feeling in the rest of the campaign, and I think it is fair that I should make the point), which provides for maternity services as part of a district general hospital. I have sought to show that the South West Regional Board are carefully and efficiently applying that policy. Nevertheless, I know that no-one will derive any sense of satisfaction if a side result of the application of this policy is the closure, or the curtailment, of the devoted service which the staff of St. Teresa's render to the local community. It ought not to mean that. 806 Previously, it is true, the hospital cared for the chronic sick. They have since accepted, and presumably will still accept, private fee-paying maternity patients. So the question of closing down the hospital does not, and should not, arise from the decision about which we are talking.
My noble friend Lord Addison, the Chairman of the South West Regional Board—and a more fair-minded and generous-hearted person cannot be found—is prepared to discuss with the hospital the use of some of St. Teresa's beds for other essential hospital services. I hope that it will be possible to listen to the appeal which was made by my noble friend Lord Soper. What he said was absolutely right: there are other needs, possibly greater needs, which have to be met in the area. The noble Lord, Lord Grenfell—and, as always, he spoke movingly on a matter concerning hospitals—called attention to the fact that greater avenues of service were now opening; and this is, of course, so. I beg those who have played a part in this campaign to realise that there is still in that area urgent hospital service to be performed.
My Lords, harsh words have been used in this campaign—not in this House, but outside. There have been some who, in my view, have sought to exploit the deep-seated and understandable affection which many of the electorate in the constituencies around there have for St. Teresa's. But I am addressing my appeal this evening to those who actually serve in the hospital and who wish only to continue to serve the community. I put it to them that I believe it would be useful if they accepted the invitation of my noble friend and got round a table with him to see if some alternative use could be made, on a properly planned and longish-term basis, of the beds which will become available at St. Teresa's. That, I am sure, is the best way one can tackle what is, we all agree, a very difficult and moving problem.