HL Deb 15 March 1971 vol 316 cc280-306

4.44 p.m.

LORD AMULREE rose to ask Her Majesty's Government what plans they have for the development and future of Queen Charlotte's Maternity Hospital. The noble Lord said: My Lords, I have put down this Unstarred Question to Her Majesty's Government for the sole reason that at the present time certain rumours exist about what plans the Department of Health and Social Security have for Queen Charlotte's Maternity Hospital. Also, there have been statements in the Press which show that something is being talked about, and I hope the noble Lord will be able to tell us a little more than we know at the present time about what his Department are planning.

According to my information, the suggestion that Queen Charlotte's may be closed arises because there could be an excess of maternity beds in West London, particularly when they get their extra 95 beds at the postgraduate hospital at Hammersmith and 95 beds at the new Charing Cross Hospital which is being built at Fulham. Since Queen Charlotte's, as your Lordships may know, has 130 beds, this would make the number of beds in that part of London rather greater than the average, because Queen Charlotte's Hospital is in the Borough of Hammersmith, where it is estimated that in 1981 there will be 2,961 births. Kensington and Chelsea reckon that they are going to have 3,813 births, and Westminster 3,205. These boroughs each have 150 maternity beds, which will mean that Hammersmith, supposing the number of births to be 2,961, would certainly have far too many; because the total number of discharges from Queen Charlotte's in the year 1969 was 4,492.

I am sorry to inflict all these rather dull figures on the House but I have not a great many more. The bulk of the discharges naturally came from the neighbouring boroughs of Hammersmith and Ealing, but a proportion of people came from the rest of the G.L.C. area and quite a number—some 200-odd—came from the rest of the country. I should like to say just a few words on that.

Prospective mothers wish to go to Queen Charlotte's for three reasons. The first is because it is their local maternity hospital, and therefore they wish to go there for convenience. Secondly, they know that it has a great international reputation, and if they are feeling rather frightened and nervous about the birth of their child they would rather be there than in some other place which they did not know. The third reason is that a doctor in the Provinces—an obstetrician or a general practitioner—may feel that his patient may be likely to have trouble in her confinement, and he may wish to send her to Queen Charlotte's because he knows that she will get particularly expert treatment there. The patients will get expert treatment, both diagnostic and therapeutic, and also have available to them one of the best laboratory services in the metropolis. Incidentally, my Lords, Queen Charlotte's happens to be the oldest lying-in hospital in the country; and, what is more important, it has comparatively new buildings. The building it occupies now in Goldhawk Road was opened just before the war, in 1939, which means that it is a great deal different from some other hospitals in the country which were opened some considerable time earlier.

It can be argued that there is in the diagnostic and therapeutic research field at Queen Charlottes' expert skill which is quite excellent, or even unique, and that if the department there is broken up and its members transferred to other hospitals, there is no reason to suppose they will not be able to continue in the same way and get as good results as in the past. I do not think so. One of the curious things about medicine, and medical research and diagnostic facilities, is that they seem to have some kind of mystique attached to the place where they come from—whether it is the feeling of tradition in the past, whether a feeling of esprit de corps or something of that sort. As a result, it is very difficult, if you have a good functioning department, to break it up and transfer the various members of it to other places end think they will be able to carry on in exactly the same good way as they have done hitherto.

Secondly, I think that, within limits, patients should go where they wish and to a hospital in which they have confidence. That, I think, has been a principle of the National Health Service from the start. It was one of the things Mr. Aneurin Bevan said: that the patient should have free choice of doctor. That means not only the general practitioner; it must mean also the surgeon, or the obstetrician. It must mean any medical people the patient wants to see. That is why I do not think it is really possible to divide London up into catchment areas which are too rigidly bounded. I agree that there is something to be said for a certain variety, trying to see that the services are scattered reasonably and equally over the county or the G.L.C. area. But if you begin to draw little boundaries, even though they are fairly soft ones, it seems to me that you are going against the principles of the National Health Service and will lose a great deal, because you are then making merely for administrative tidiness. One of the phrases which made those of us who have worked in a Government Department (and I worked in a Government Department for ten years) shudder was that something "administratively difficult", or would lead to "administrative neatness or tidiness". All it meant was that nobody was prepared to do something that was going to cause a little trouble. That is why I do not like this "tidy" arrangement for the pregnant women of London.

I would not say for a moment that there are not very great obvious advantages in having the particular, special hospitals next door to or embodied in the general hospitals. It makes cross-consultation far simpler; and exploratory services and all that sort of thing become easier. For that reason, supposing one were going to start a service from scratch, one would probably not build a maternity hospital that was not part of a general hospital at the present time. But, my Lords, there seems to be no reason at all why, if you have a first-class hospital that is doing excellent work, you should deliberately set out to destroy and suppress it. London is surely a big enough and important enough city to carry both the integrated and special departments in the general hospitals and the medical schools, as well as the highly concentrated ones which serve as a basis for post-graduate teaching. And Queen Charlotte's has certainly done a great deal of good work in that way, because I believe that to-day there are some 3,000 or 4,000 people working in the world in obstetrics who have been trained post-graduately at Queen Charlotte's. Some of your Lordships may have seen a letter in The Times in which obstetricians in Australia expressed their horror at the chance that Queen Charlotte's might be suppressed.

If that is to be done, supposing the rumours and the tales I have heard have some basis in truth, what is going to be the future of other hospitals which have a speciality? What is going to happen to the Hospital for Sick Children in Great Ormond Street; the National Hospital for Nervous Diseases, in Queen's Square; the Royal Marsden Hospital, the paraplegic hospital at Stoke Mandeville? Are they all to be broken up and bits of them joined on to existing hospitals purely for administrative tidiness? My Lords, I very much hope that the Minister, when he replies, will tell me that that is not the case.

There are just two more short points that I would like to make. One of the advantages of Queen Charlotte's is that it is very easy to reach. It has good communications with a great deal of London, so it is simple for patients to get there; and that must surely be a factor to be taken into consideration when dealing with hospitals and patients. I know that the Todd Report (and I am pleased to see that the noble Lord, Lord Platt who was a member of the Todd Commission on Medical Education is going to speak) was not entirely in favour of keeping these particular special hospitals, but I am not sure that I entirely agree with everything the Todd Committee said; and the fact that they do not approve of that does not upset me a great deal. All I want to say to your Lordships at the present time is that I think the noble Lord, Lord Aberdare, will understand the Question I have down, and I trust that he will be able to give me a comforting reply.

4.58 p.m.

LORD PLATT

My Lords, first of all may I say that I agree with almost everything which the noble Lord, Lord Amulree, has said in asking this important Question about Queen Charlotte's Hospital. I strongly share his views on administrative tidiness, but I am not at all sure that it is simply that which has been influencing the Department in this case. However, I have no intention of giving any pronouncement on the special case of Queen Charlotte's Hospital. Obstetric medicine was never my branch of medicine, neither do I know the geographical and population details which must be a factor in considering the siting of any hospital. I say "a factor" advisedly because, as the noble Lord has already said, a hospital which has more than a local reputation and a staff which has a national if not international reputation must be allowed to draw its clientele not only from the neighbourhood but from the whole of London, the whole country and to a less extent the whole of the world, so anything I have to say is only on matters of general principles.

There are, I think, certain principles in relation to these specialist hospitals to which the noble Lord, Lord Amulree, has referred. They were mostly built in the 19th century. He has mentioned the National Hospital for Nervous Diseases in Queen Square, the Hospital for Sick Children in Great Ormond Street and, I would add, the Moorfields Eye Hospital—

LORD BOOTHBY

Hear, hear!

LORD PLATT

—and Queen Charlotte's. At that time progress was greatly favoured by a concentration of special skills in hospitals equipped to develop those skills and built for the treatment of special groups of patients. All these were, of course, voluntary hospitals in those days. Moreover, I suspect that in some cases it was easier to attract money for a special object rather than for the general, unspecified treatment of all and sundry.

To-day, my Lords, the emphasis has changed. We have to realise that in modern medicine advance is chiefly through the application of advances in basic sciences. For instance the next great advance in the treatment of the eyes could come, not from Moorfields Hospital, but from biochemists, physicists, immunologists and even engineers; and it is unlikely that the comparatively small special hospital could attract a sufficient number of scientists of the highest reputation who would apply themselves to their special interests. It is therefore in the interests of the specialities that sooner or later, gradually and on an evolutionary basis, we should work towards this. They should be linked as closely as possible to, and, as Lord Amulree has said, eventually become part of, a more general hospital area catering for general medicine and surgery and fully equipped with the necessary scientific departments.

These principles were already becoming clear long before the Royal Commission on Medical Education met; and there was, of course, the Joint Committee on the Future of the Postgraduate Institutes in London under the chairmanship of Sir George Pickering which had already pronounced on the subject. What we actually said in the Royal Commission which is of particular relevance to the present discussion was this: We have no intention of laying down a precise scheme of association for the special hospitals and institutes. I should like noble Lords to remember those words. Royal Commissions, in laying down certain principles towards which they think we ought to be working, are in danger of being told in retrospect that they said that such and such a thing had to be done. The report goes on: Provided that a reasonable balance is maintained among the general teaching groups in the allocation of the special facilities, we think that specific associations should be determined in the light of natural affinities"— I am not quite sure what those are— accommodation requirements, and rebuilding opportunities. As examples of associations that might be suitable, but without prejudice to other proposals that might be put forward in the light of a fuller examination of needs and possibilities, we suggest the following.… There follows a long series of paragraphs dealing with various special cases. The eventual amalgamation of Queen Charlotte's in the postgraduate group at Hammersmith is one of the suggestions made.

Whether the time has now come for a change of this kind to be made, and whether this would threaten the individual reputation of Queen Charlotte's (the noble Lord, Lord Amulree, raised a very important point there) or deprive patients of the facilities which they have come to expect from hospitals with such a reputation I do not presume to say. All I do say, and the Royal Commission said it, is that when the building or regrouping of hospitals seems to be advisable, do not let it be haphazard. Do not let us leave out of consideration matters of reputation, and even matters of sentiment; but also let us try to see it as part of the general evolutionary plan for teaching and the investigation and treatment of special diseases for which these hospitals have catered so well in the past.

5.5 p.m.

LADY RUTHVEN OF FREELAND

My Lords, like the two noble Lords who have spoken, I also would ask what is to be the future of Queen Charlotte's Maternity Hospital. I understand that the Department of Health have not really got a plan but that it has been considered that 350 maternity beds are necessary for the West of London, and that all these beds should be put into the various teaching hospitals in the West of London: Charing Cross Hospital; Hammersmith Hospital; St. Mary's, Paddington; and the Middlesex Hospital. My Lords, Queen Charlotte's Hospital has been in existence for more than 200 years, as I think was said by the noble Lord, Lord Amulree. Patients come to the hospital from all over this country and from abroad. Each year 3,500 women choose to have their babies in Queen Charlotte's Hospital.

Is a woman no longer to be allowed to choose the hospital at which her baby shall be born? I think this is something very extraordinary. It was laid down in the original National Health Service Act that a patient was allowed to have a choice of hospital, specialist and so on; and I thought that principle was to be carried on. If a woman about to have a baby—perhaps the most important event of her life—is not to be able to choose the place where the baby shall be born, it represents, I think, a falling back in the Health Service—

THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)

My Lords, if I may interrupt the noble Lady, may I say that there is certainly no intention whatever of interfering with the right of a woman to have her baby wherever she wants?

LADY RUTHVEN OF FREELAND

My Lords, I thank the noble Lord for his intervention. But, of course, if a woman wished to go to Queen Charlotte's Hospital which has a national reputation—as I have said, women come there from all over the country—she would not be able to do so because there would be no Queen Charlotte's Hospital. She would have to go to a different hospital of which she had no knowledge.

There is another point, my Lords. Queen Charlotte's is world-famous for its training in midwifery. I have visited hospitals all over the world, and one of the things one is always told at a maternity hospital, whether by a black African nurse, an Indian or a Pakistani, or whatever the nationality may be, is: "I did my midwifery at Queen Charlotte's". It is always said with pride. Where is that training to be given in future? Is that also to be given in teaching hospitals? Is each teaching hospital to have a midwifery training unit? If that is so, it seems to me a waste of personnel.

There is also the sister hospital to Queen Charlotte's, the Chelsea Hospital for Women. This hospital, too, has a wide reputation. I wonder whether the Chelsea Hospital is to be closed down as well, or is to be merged with a teaching hospital. I hope that the Minister will be able to reassure us that real consideration is to be given to whether Queen Charlotte's and its sister hospital should be closed. Having read the Todd Report, I understand why closure was suggested; and I also understood the remarks of the noble Lords, Lord Amulree and Lord Platt, that it is very much tidier to have all maternity beds in certain places. It may be easier for the specialist, but it is not so tidy for a woman who has decided that she wishes to have her baby at Queen Charlotte's Hospital, whether she lives near to the hospital or a long way from it, because she knows that there she will have good attention, and because many of her friends went there to have their babies.

My Lords, I think that a hospital stands on its reputation—by which I mean the sympathy and understanding of the medical and nursing staff and the atmosphere in the hospital. That is what appeals to a prospective mother who wishes to go to the hospital of her choice. It will be a sad day for the Health Service if anything is done to destroy the confidence which the prospective mother has at present and which results in her wishing to go to Queen Charlotte's Hospital, in preference to another hospital even though it be just as efficient and perhaps nearer to her home.

My Lords, I am a great believer in allowing people to choose for themselves on many things, and especially on matters concerning health. I always thought that one of the views of the Party we placed in power was to allow people to choose for themselves rather than have their future decided by the Government. Surely the choice of where a woman is to have her baby is something that should be left to her.

5.21 p.m.

LORD BROCK

My Lords, we owe thanks to the noble Lord, Lord Amulree, for raising this important question. We must first of all make sure that we know clearly and for certain what it is we are talking about. I will present my own impression, and if it is not correct I am sure the Minister will put me right in due course. It has already been stated that Queen Charlotte's Hospital was founded in 1752. It has therefore existed for well over 200 years, during which time it has attained a pre-eminent place in obstetrics, not only in Great Britain but in the world. At one time it was planned to build, with its sister hospital, the Chelsea Hospital for Women, a new combined hospital that would have immense importance and prestige as a great post-graduate teaching and training hospital for obstetrics and gynaecology. That possibility has become a dream and apparently is now dead.

The Post-Graduate Institute of Obstetrics and Gynaecology is formed by the Chelsea Hospital, Queen Charlotte's Hospital and the relevant department at the Hammersmith Hospital. It is now planned—I use the word carefully and exactly—to destroy Queen Charlotte's Hospital, and inevitably to disrupt the Institute. The planning on which this is based is administrative convenience. It is computed that in ten years' time the three boroughs of Hammersmith, Kensington and Chelsea, and Westminster will need only 350 beds, which will be set out as has been described: St. Mary's Hospital and Middlesex Hospital, two undergraduate teaching hospitals, will have 142; Charing Cross Hospital, another undergraduate teaching hospital, 90; and Hammersmith, 118. Queen Charlotte's is not included in the distribution.

By the chance of geographical location, Queen Charlotte's is just within the area of the three boroughs, but 60 per cent. of its patients come from outside the three boroughs towards the West, from Ealing, Hounslow and Richmond. It has already been emphasised that many of their patients come from all parts of Great Britain.

LORD BOOTHBY

And the world.

LORD BROCK

A recent communication from the Vice-Chancellor of the London University to the University Grants Committee indicates that for postgraduate teaching a further 125 maternity beds and 100 gynæcological beds will be needed outside the three boroughs. Of these, some will be at the new Charing Cross Hospital and some at Hammersmith, and a new unit will be formed at the West Middlesex Hospital, a non-teaching hospital. If Queen Charlotte's no longer exists, the West Middlesex Hospital will house a large and important unit; and it is stated that the Bernhard Baron Laboratories, now at Queen Charlotte's, could move to the new unit at West Middlesex Hospital.

This reveals the advanced state of planning that has gone on, and so far without consultation with the authorities of Queen Charlotte's Hospital. They are only aware of what is in store for them; they have not been invited to the feast. They are rather like Lewis Carroll's oysters. Unless I have been misinformed about this matter, or have got it wrong, in which case I stand to be corrected, this would appear to me to be not only discourteous and unco-operative, but authoritarian. The simile to the oysters in Alice in Wonderland becomes increasingly clear: indeed, the similarity becomes sinister, because it means that the intention is to destroy, to eat up, Queen Charlotte's Hospital.

One's first reaction to the news that it is proposed to eliminate Queen Charlotte's Hospital is one of disbelief that anyone could be so obtuse as to suggest it. Then one realises that it is a serious suggestion and has to be taken seriously, even though it would appear to be so unreasonable. It is, however, a serious threat and demands serious counter-attack. We first have to ask how it is that this threat arises. It seems to have originated from the Todd Report on Medical Education, one of rte recommendations of which was that the great post-graduate hospitals of London serve no useful purpose and that they should be replaced by departments in the London undergraduate hospitals.

I feel it is unconvincing that great scientific advances are likely to come from this process of forcing affiliation to an undergraduate hospital or to district hospital which is not even a teaching hospital.

This concept of the unworthiness of the great post-graduate special hospitals, such as Queen Charlotte's, supports the argument that greater administrative tidiness can be achieved if the special work that they do can be replaced by reorganisation of the other hospital services within their particular area: that an area needs, say, 200 beds for maternity cases, and these can be more conveniently, more economically and more tidily provided within an adjacent hospital or hospitals which are either already built or will be built. It may well be that the hospital or hospitals selected for the purpose are old ones, perhaps built originally as Poor Law hospitals, now upgraded to more modern standards but having no tradition, distinction or special appeal. In this way the lowest form of doctrinaire development or organisation is satisfied.

We had an example of this when St. Teresa's Maternity Hospital was severed from the National Health Service affiliation and was deprived of practical support, an action that would have led to its closure had it not received alternative support. The closure of St. Teresa's to achieve greater administrative economy and efficiency could be supported, even though it led to the threat of destruction of a worthy institution, but it is not possible to compare the worth of Queen Charlotte's with that of St. Teresa's. St. Teresa's Hospital holds a considerable place as a local hospital which has engendered much local affection and trust because of its great local achievements, but in the case of Queen Charlotte's Hospital we are not dealing with a small local institution whose functions can be taken over by a redistribution of beds in other hospitals. We have a centre of excellence which has a national and international reputation founded on its achievements of the last two centuries. Its obstetric staff is highly skilled and experienced and is able to advance still further standards of obstetrics, not only within its walls but elsewhere.

Post-graduate students come from all over Britain and from many other countries to attend and profit from its work and practice. This achievement would all go if the hospital were replaced by an equivalent number of obstetric beds in one or more other hospitals. The body might be there, but the soul would have gone. The same applies to the nursing standards of training and teaching. Many nurses come here to train and learn from Queen Charlotte's methods, and, as the noble Lady, Lady Ruthven of Freeland, has already mentioned, they disperse to train and teach many others in many districts and countries. The post-graduate students who flock here from all parts of the word and act as catalysts in distributing the knowledge, skill and experience they are able to gain here would not be attracted by a similar block of beds, however administratively convenient, in an adjacent innominate hospital.

So far as the proposed new large unit at the West Middlesex Hospital is concerned, it will be much further from Hammersmith Hospital than Queen Charlotte's is, and will be that much more inconvenient for the post-graduate students who attend the practice and teaching of the two hospitals. The standard of excellence achieved by our great post-graduate hospitals is irreplaceable, and it can soon be destroyed at the hands of reorganisation based on a soulless administrative convenience.

LORD PLATT

My Lords, may I intervene for a moment to say that considerations of administrative convenience were not the guiding principle on the Royal Commission on Medical Education: it was considering education—post-graduate and undergraduate education.

LORD BROCK

I am indicating that the recommendation of the Royal Commission in regard to education and the suppression of the post-graduate hospitals which would result from it has been taken as, I will not say an excuse, but a stimulus for the administrative convenience to be accordingly adjusted.

The noble Lord, Lord Amulree, mentioned a letter in The Times of Tuesday, March 9, about the closure of Queen Charlotte's Hospital from Sir Lance Townsend, Professor of Obstetrics at Melbourne University, in which he writes: Firstly, and as important as any of the other duties which the hospital carries out is the creation of a community of leading obstetricians and gynaecologists who can stimulate each other by day to day contact and so continue and even improve the standards already set in this the greatest obstetric hospital in Great Britain. On an earlier occasion I pointed out in your Lordships' House that there is no evidence that any member of the Post-Graduate Commission on Medical Education had first-hand knowledge of the London post-graduate hospitals and institutes, nor that any study in depth of their work and achievements was made. The Commission did not seem aware of any difference between teaching basic education to undergraduates and training post-graduates in a specialised and technical discipline. The two are entirely different.

And yet this incomplete knowledge and experience of the members of the Commission on Medical Education, and their unawareness of the great part played by the London special post-graduate hospitals such as Queen Charlotte's, has inspired and directed thought towards the administrative readjustments and alterations that are going to lead, unless stopped, to the destruction of Queen Charlotte's Hospital. In its place, a great post-graduate unit will be split up between various undergraduate teaching hospitals and a large unit will be formed at a non-teaching hospital, the West Middlesex. In this way a great postgraduate teaching centre will be deliberately obliterated.

My Lords, when one has such a successful, such an important organisation it seems folly to destroy it and replace it by something else, untried and having no pretensions to the degrees of excellence which are undoubtedly possessed by Queen Charlotte's. And what of its sister hospital, the Chelsea Hospital for Women, which has already been referred to? Is this to go the same way? The Romans had a maxim—divide and conquer—and this seems to be the method of destruction that threatens these two great hospitals that make such important contributions. If they are not completely destroyed they will become so much smaller, so much weaker, that from first-class institutions they will drift into second-rate mediocrity. This is the threat they face. It is all too familiar in the international scene to-day when a small country or Slate with great traditions, achievements and worth is raped. This is an important matter, and I greatly fear that the Minister's reply will be polite, of course, but will be essentially equivocal in that it will state that the matter is still under consideration by his Department and that he will be influenced by the views of the University.

I hope that sufficient disquiet will have been expressed in your Lordships' House to-day to ensure that we shall not have passively to accept the unilateral decision already formulated if not actually made, but that a complete re-appraisal of the situation will be made in the light of today's debate and after close discussion and co-operation with the boards 'of governors of Queen Charlotte's Hospital and the Chelsea Hospital for Women, both of which bodies have been so far precluded from giving their opinions and thoughts in this matter that affects them so closely and also affects much else in the organisation of post-graduate training and teaching in London.

5.24 p.m.

LORD STAMP

My Lords, in intervening very briefly in this discussion, I must confess that I do so with somewhat mixed feelings. I have been most impressed by the arguments put forward against the closing of Queen Charlotte's Hospital by the Association of Friends of Queen Charlotte's and Chelsea Hospitals, and also in leading articles and letters in the national Press to which reference has already been made. I know that many senior obstetricians and gynaecologists, both in this country and abroad, who have been associated with the hospital deplore the idea. Yet I wonder whether they ate right, as some of them have maintained, as in the letter to which reference was made, in asserting that obstetrics and gynaecology at the highest level should be divorced from the activities of a general teaching hospital As the noble Lord, Lord Amulree, has said, I personally can see great advantages in the interchange of medical knowledge, expertise, teaching and research facilities from their incorporation in a general hospital, provided that this were of the same high standing.

The tragedy is when this involves a break with a great tradition, as must be the case it the present proposals are implemented. These have come as a great shock, not only to doctors who have trained at Queen Charlotte's but also to the very many patients who have benefited from the incomparable skill, warmth and understanding of its medical and nursing staff. The question arises, in this day and age: is tradition enough? If a decision is arrived at that Queen Charlotte's outstanding services to obstetrics and gynaecology are to be transferred to another location, the important thing to ensure is that this should be done as speedily and with as little inconvenience as possible, both to the staff of Queen Charlotte's itself and that of the hospital, or hospitals, with which it is to be incorporated. The last thing one would want would be to see a protracted and unavailing last ditch stand.

It has, I believe, been suggested that Queen Charlotte's might join up with Hammersmith Hospital, with which I have been associated for very many years. While I am sure that this hospital and the Associated Royal Post-Graduate Medical School would not wish to take sides in the matter, if a decision were ratified along these lines they would do everything in their power to ease the transition and to help develop still further Queen Charlotte's tradition in its new setting. The one proviso, though, that I cannot underline too strongly would be that the change of plans must in no circumstances interfere with the timing of the building plans for Hammersmith. Like many other medical schools and hospitals in the country during the last decade, it has experienced the deepest sense of frustration at having its developmental plans, on which an enormous amount of time, energy and money have been spent, turned down on the score of expense, with instructions to do it all over again. Only those who have gone through this experience can know what it means in terms of lowering of morale. Everyone is counting the days until the new urgently needed buildings go up, and any further delay would be too much.

The other point I should like to make has already been made by other noble Lords; namely, to express concern lest too great an emphasis should be placed on district responsibilities of the great undergraduate and post-graduate general and specialist teaching hospitals, as they exist at present or as they may exist if the Todd Report is implemented. Important as these responsibilities may be, these schools, particularly those in London, have a responsibility—as has already been emphasised—far beyond that of providing an efficient health service in their locality. They have to teach doctors from overseas as well as from this country, and they are the centres of specialised research. For this reason they cannot be restricted to drawing their patients from the locality in which they are situated. There must be considerable latitude in this respect, whatever the tidy-minded administrators may think. I must confess that this is one of the greatest dangers I envisage in the present trend of thinking, so far as the development of the Health Service is concerned. It would indeed be a great tragedy if, in trying to improve administration of the Health Service, the teaching and research on which it depends were to suffer.

5.29 p.m.

LORD BOOTHBY

My Lords, I have not had the good fortune to be a patient in Queen Charlotte's Hospital, but I have many relations who have been, and I rise for a minute or two to express my anxiety about the suggestion, which I hope is not true, that Queen Charlotte's is to be destroyed. I know something of its reputation, not only in this country but throughout the world, as one of the finest post-graduate hospitals in the world, and its tradition in research which is almost without parallel. And tradition does count for something. We now have a Tory Government in power. They must pay some regard to tradition and to the pride which all who work at Queen Charlotte's take in their work and in that tradition. And they must have regard to the fact that, wherever one travels—in Hong Kong, Australia, or anywhere else—people ask, "What is Queen Charlotte's doing now?" It is a tremendous tradition, and I beg the noble Lord, Lord Aberdare, not to get up and say, when he does get up, "We are going to abolish this Hospital for the sake of administrative convenience." I do not think he is going to say that. I am hoping very much that he is going to say he is not going to abolish it.

My Lords, I had to rise to make these few remarks, but I am a little embarrassed because it so happens that I had quite a good speech to make, quite a long speech, but point by point was taken by previous speakers, particularly by the noble Lord, Lord Amulree, and the noble Lady, Lady Ruthven of Freeland. Finally I came to the position where I had to put my notes away because every single point I had intended to make had, without exception, been made. That is an experience I have never hitherto had in a long Parliamentary career. However, I beg the noble Lord to give a little encouragement to this great Hospital, and not to destroy something which has taken over 200 years to build up and which is the admiration of the whole civilised world to-day.

5.32 p.m.

BARONESS SUMMERSKILL

My Lords, I must apologise to the House for not being in my place at the appropriate time, but I think this near medical committee will forgive me when I tell them that the reason why I was not here was that the time for me to speak here came a little early and I was at the Ministry of Agriculture discussing brucellosis, with, I hope, fruitful results. I have to admit that this is the first time in my life that I have had to take Whitehall at the double. I am sorry that I have not heard all the speeches, but, having discussed this matter with many people, including doctors, I recognise full well how the House will be divided. Nobody in this House could charge me with not having the work—the wonderful work—of Queen Charlotte's Hospital at heart. It has made a contribution to obstetrics almost second to none in the world. The noble Lord, Lord Boothby, referred to 200 years. He admits, of course, if I may put it baldly, that he has never been pregnant. But obstetrics 200 years ago was quite different from obstetrics to-day in so far as the approach of the expectant mother was different.

Many years ago few women would go into maternity hospitals because of public opinion about such hospitals—and, incidentally, it was their husbands' wish that they should remain at home for a confinement. Those who were persuaded to go into hospital were generally suffering from a condition which their doctor anticipated might require specialist help when the time for confinement came; the general practitioner often felt that he himself was not fully qualified to give such attention. That is the background of so many hospitals which to-day take maternity cases. During this century, particularly, things have changed considerably. Women are only too happy to go into hospital, not only because they know they will get the best obstetrical treatment but because many realise, and their families realise, that the mother in the home deserves a rest at this time. All these factors combine.

There was a campaign in the 'thirties when we took as our slogan that it was more dangerous to be a mother than a miner, because the maternal mortality rate was so high, the infant mortality rate was so high, and particularly the neo-infant mortality rate was so high—the death rate among babies shortly after confinement. The propaganda was so effective that women recognised that they could get the best possible treatment in hospitals. Queen Charlotte's Hospital, which was the queen of our obstetric hospitals, had a tremendous reputation and was recognised by women all over London and all over the country as being extremely good. But women knew that in their own areas hospitals were built which were staffed by excellent obstetricians and nurses and were, so far as ordinary confinements were concerned, equal to Queen Charlotte's Hospital. Now we must recognise this change in approach. We must not be simply mesmerised by the words "Queen Charlotte's", rather as one might be mesmerised by the words "Rolls-Royce".

Queen Charlotte's Hospital has done a magnificent job. Now all these years have passed. The population of London has increased. There are special concentrations in different parts of London which only those who have carefully examined the problem know about; and it has been decided that the maternity cases should be redistributed. We have heard a great deal about tradition. I was a student at Charing Cross Hospital. Think how many of the students and staff of Charing Cross Hospital felt when they were told that Charing Cross Hospital was going to be moved to Fulham. The area I am speaking about I know well, because I was for 18 years Member of Parliament for West Fulham. The new site of Charing Cross Hospital was within my constituency. With my association with Charing Cross Hospital and with Fulham I examined the arguments for and against that great move and I recognised that, with the change in the attitude towards obstetrics and the change in the allocation of hospitals, it was quite right to move Charing Cross Hospital to Fulham.

The other hospitals we have heard about I know very well—St. Stephen's in East Fulham, the Chelsea Hospital for Women, the Hammersmith Hospital. They are all excellent places. Do not let us think that because a man or a woman qualified in one London Hospital he or she is far superior to members of staff who qualified in another. The standing of medical education in London is second to none in the world. The men and women who staff these hospitals where more beds will be available—and no doctor at Queen Charlotte's would deny it—are equal in professional standing to those at Queen Charlotte's Hospital. What we feel, quite understandably, is that this magnificent institution must modernise itself in so far as it must recognise that this change has to take place.

When the National Health Service was set up it was decided to have Regional Hospital Boards. Why was that? It was a very wise decision because, as those of us here who are in the Hospital Service know, in certain parts of the country people were absolutely denied specialist help. For instance, if someone in North Wales suffered from a condition which required the services of an orthopædic surgeon one found that there was not one along the coast and so one had to go to Liverpool. In so many of our small provincial towns, if someone had to have a serious operation there were medical people who felt, "I cannot tackle this. You must go to London." This was bad for the patient and bad for organisation, and it was not in the interests of the doctors who, after all, preferred to have a well-equipped team in the area. So the Regional Hospital Boards were set up in order that in each region there would be a group of people who could view the medical, surgical and obstetrical needs of the region as a whole.

I have given this matter considerable thought, and I am guided by principle—not solely by emotion but also by principle. I am guided by the Royal Commission on Medical Education, which recommended for London and the rest of the country that teaching hospitals should merge with the Regional Hospital Boards to provide single authorities based on the university hospital. Surely, this is the common-sense approach. All of us, I hope, are agreed on one point; namely, that the most important individual in this discussion is the patient—not the surgeon, the obstetrician, the physician, the nurse or any of the rest of the staff. The person whose welfare we must have in mind is the patient. Therefore I say the only person who can see the needs of the whole area must be the Regional Hospital Board. My Lords, I hope you will not say "Charlotte's, right or wrong", but recognise that times have changed. The Regional Hospital Boards are very well organised. They are composed of people of integrity, people of conscience who have the welfare of the whole area at heart. Therefore I would ask the Minister, in deciding this difficult issue, simply to be guided by the decision of the Regional Hospital Board.

5.41 p.m.

LORD ABERDARE

My Lords, may I say to the noble Lord, Lord Amulree, how very much I welcome the opportunity given to me by his Question to put before your Lordships the factors affecting the decisions which are facing us about the future of Queen Charlotte's Maternity Hospital, and may I thank him for introducing the Question in a very well balanced speech.

I should also like to assure your Lordships at the outset of the great importance which I attach, in common I am sure with the majority of people, and certainly in common with all your Lordships who have spoken this evening, to the first-class reputation and the long tradition of this well-known and deservedly well-loved hospital. I would give that assurance right away to the noble Lord, Lord Boothby. The question which is exercising my mind and that of my right honourable friend the Secretary of State for Health and Social Services is how best to secure a worthy future for the hospital within the framework of developing health services and the changing social environment.

May I say at this point how appalled I was to hear so many of your Lordships speaking of "administrative convenience", and how very far this is from the thoughts of anybody I have ever come across who has discussed this question, though not of some of your Lordships who have spoken to-day. I have studied a great many papers on this subject during the short time that I have been at the Ministry, and the words "administrative convenience" have never entered into any of them, nor have they been in the minds of those who have discussed the question. There are far more difficult and deserving problems to face than anything of that sort.

There are two relevant senses in which the provision of maternity services, whether in hospital or elsewhere, must occupy a unique position. One is that in contrast with the generality of clinical conditions which require skilled professional advice and treatment, pregnancy is a normal condition and not a disease. Unlike, for instance, tuberculosis and poliomyelitis, the incidence and severity of which have been dramatically reduced by medical advances, the incidence of child bearing is relatively predictable. The other, a corollary of this, is that given the appropriate basic information about local populations, the upper limit of need for maternity services can be fairly closely defined. In my view, it is too early to estimate with confidence the long-term effects on the birth rate of changes which have taken place in the law relating to abortion or of the development of family planning services and contraceptive techniques. The most one can say is that because of these the birth rate seems unlikely to increase.

Assessment of the need for hospital maternity services is made by the appropriate hospital authorities on the basis of advice issued from time to time by my Department; it takes account of such factors as the estimated size of population and birth rate, the length of pre-natal and post-natal stay in hospital, and the needs and wishes of the local community. A sub-committee of the Standing Maternity and Midwifery Advisory Committee under the chairmanship of Sir John Peel recently reported on domiciliary midwives and maternity bed needs, and recommended that sufficient facilities be provided for 100 per cent. hospital delivery. That report is still being considered, and I cannot yet say whether this recommendation will be accepted. But in view of the trend toward shorter stay in hospital, in many areas it may not be necessary to make a great increase in beds in order to achieve this 100 per cent. hospital confinement. And, of course, some women wish to have their babies at home, and their wishes must be respected.

When one looks at the condition in London, one is immediately forced to take account of the forecast, particularly of the Greater London Council, that its population is falling, more especially in Inner London, and to realise that, in looking forward to what is likely to be the case at the end of the current decade, it is probable that this downward trend will continue. So far as Inner West London is concerned—that is, the London boroughs of Hammersmith, Kensington and Chelsea and Westminster—there are already too many maternity beds for the existing population and on service grounds alone we see a need to reduce the total of these beds by half, from 600 to 300 by 1981. This number would still provide enough beds for 100 per cent. hospital confinement on the formula recommended in the Peel Report.

Looking more widely at the area from which Queen Charlotte's currently draws most of its patients, the changing need follows a similar though less dramatic pattern. At the same time, in maternity as in other medical and surgical specialities, the quality of local hospital provision is constantly improving, and the disinclination of the general public to travel farther than they need for hospital and specialist services, already discernible in hospitals in Inner London, may be expected to grow rather than to diminish. This point was very well made, if I may say so, by the noble Baroness, Lady Summerskill, and is surely the answer to my noble friend Lady Ruthven of Freeland, that people should have a free choice of where to have their babies. Many of them want to have their babies near their homes outside London. The old attractions of coming into the specialist hospitals are far less vivid now.

In planning hospital services in West London, there is the additional consideration that most of the hospitals are teaching hospitals. Questions of reconciling the needs of the communities they serve and of the clinical teaching in these hospitals have therefore been the subject of further discussion, not only with the Regional Hospital Boards, which are the statutory planning authorities for hospital services, but with the University Grants Committee and the University of London. The three Inner West London boroughs between them contain no fewer than four undergraduate teaching hospitals and two post-graduate teaching hospitals providing maternity services, together with one non-teaching hospital group. Although the three boroughs lie in an area administered by two Regional Hospital Boards, it has been sensible to consider them as a whole. The conclusion we have reached is that even allowing for the continuing attraction to patients and their family doctors of the special skills of the teaching hospitals, the projected need cannot be seen as greater than a total of 350 maternity beds. Even this may prove to be an over-estimate.

The appreciation by the University of London of the requirements for clinical teaching in obstetrics has taken due account of the service constraints which I have described, and is based, I understand, upon two main considerations. One is: That in future the Institute of Obstetrics and Gynaecology should be sited in association with a general hospital which will provide the necessary collateral, clinical, investigative and research facilities, including the relevant basic medical sciences. The other is: That in allocating the scarce clinical facilities for the teaching of obstetrics within the three boroughs, priority should be given to the needs of the General Medical Schools. In other words, the undergraduate teaching hospitals should have maternity beds, if necessary at the expense of postgraduate teaching hospitals. As a result of this appreciation it is now proposed by the university authorities that the Institute of Obstetrics and Gynaecology should be rebuilt at the Hammersmith Hospital.

The more closely one looks at the combination of these factors, my Lords, the more one is drawn to the realisation that since Queen Charlotte's would in any case cease to be a postgraduate teaching hospital when the postgraduate Institute with which it is associated is transferred elsewhere, its own future development as a centre of excellence, both in clinical practice and research, might well lie in closer association with undergraduate teaching. As your Lordships may know, and as the noble Lord, Lord Amulree, mentioned, Charing Cross Hospital is being completely rebuilt on the site of what used to be the Fulham Hospital, and the disposition of maternity beds between this and the other hospitals in West London is the subject of discussions which are still going on between my Department and the various hospital authorities; I think I should lay stress on the fact that a decision about the best means of securing the future of the teaching function at Queen Charlotte's Hospital has not yet been taken and that is one of the reasons why this short debate is useful.

Given the total of 350 maternity beds as the long-term need for this area; the need to give priority for these beds to undergraduate hospitals; the need to keep a large maternity unit for the Institute of Obstetrics and Gynaecology at Hammersmith and the need to secure a properly balanced distribution of the 350 beds over the three boroughs, one is left with the choice between building a new maternity unit in the new Charing Cross Hospital and using the existing maternity beds at Queen Charlotte's Hospital for the medical training in obstetrics of Charing Cross undergraduates for the immediate future. In either case we feel compelled to respect the principle that obstetric teaching facilities for undergraduates should be provided so far as possible at the main teaching hospital, as well as the view that maternity services should be provided in general hospitals and supported by the full range of other hospital services rather than in isolation. Pædiatrics is an obvious and important example. On the face of it, it may seem wasteful to build new maternity beds in Fulham, when there are relatively modern beds a short distance away from Queen Charlotte's, and we must take this factor into account as well as the alternative uses to which these beds might be put. We must also decide how much weight to give to the consideration, of which I have been reminded this evening, that Queen Charlotte's is readily accessible by public transport for patients and visitors, and to its well-merited international reputation. There are a great many pros and cons. I will not weary your Lordships with all of them, but these are the choices between which, I am satisfied, a decision must be made.

May I say to the noble Lord, Lord Brock, who spoke, I thought, rather intemperately and not altogether accurately, that I personally have twice met the Governors of Queen Charlotte's Hospital and I have every intention of meeting them again. So it is not correct to say there have been no consultations. I really could not recognise my Department in some of the strictures with which he belaboured us. The question is much more complicated and goes much deeper, I think, than the noble Lord made out. May I say to the noble Lord, Lord Stamp, how interested I was in his well balanced views, and the possibilities he put forward of some association between Queen Charlotte's and Hammersmith Hospital. In the end, I would repeat that no decision has yet been made. But this is one of the valuable reasons for this debate.

May I finally say some words about the other London postgraduate hospitals? This matter was referred to by the noble Lord, Lord Amulree; and I listened with great interest to what the noble Lord. Lord Platt, had to say with his usual wisdom on this subject. Unlike undergraduate teaching hospitals which provide, or are being developed to provide, a total hospital service for their local communities, jointly with their teaching responsibilities, the postgraduate hospitals exist primarily to provide clinical facilities for highly specialised aspects of medicine and for the post-graduate medical and research needs of their associated Institutes and serve only a limited local function. Your Lordships will recall that when the noble Lord, Lord Todd, presented the Report he recommended that post-graduate Institutes of the University of London should be linked with undergraduate medical schools, and that while their identity and reputation as centres of excellence in their special fields should be preserved, they should become an integral part of the medical school for all academic, financial and administrative purposes. The Todd recommendations and their implications have been studied by the University and the University Grants Committee and by my Department, and I understand that some time later this year, these two bodies hope to make a statement about the future of post-graduate medical education corresponding with that which was issued in relation to undergraduate medical education in August 1969.

LORD BOOTHBY

My Lords, would the noble Lord forgive me? Could he say whether there is any threat to Moorfields, which is a parallel case?

LORD ABERDARE

My Lords, I should not like to commit myself on one particular hospital, but I have visited Moorfields twice and I have just as great a respect for Moorfields as I have for Queen Charlotte's. Certainly its future will be given the most careful consideration. I understand the noble Lord must have been in Moorfields, though not in Queen Charlotte's.

LORD BOOTHBY

True.

LORD ABERDARE

When the University issue their plans for the post- graduate Institutes I anticipate that my Department will issue a matching statement on the hospital side, and that will include the future plans for Moorfields. The Institutes and their associated hospitals are highly individual organisations, and the academic clinical requirements and their service implications vary greatly between the different specialties. I can, however, assure your Lordships that it would be inappropriate to regard the resolution of the problems of maternity services as they affect Queen Charlotte's as establishing any precedent whatsoever for the post-graduate Institutes and their associated hospitals generally, any more than do the already agreed joint redevelopment of the National Heart and Chest Hospitals with their two Institutes on the Fulham Road site or the rebuilding of the Eastman Dental Hospital and the Institute of Dental Surgery as part of the St. Mary's Hospital complex. All these problems will arise and we shall be discussing them on a future occasion. But may I say, with gratitude to the noble Lord, Lord Amulree, that I have very mach welcomed this opportunity to outline the problems which exist in respect of Queen Charlotte's and to assure him that we are conscious of the world-wide reputation of the hospital and are only considering what we can do in the best interests, not only of Queen Charlotte's itself but also of the future provision of maternity beds in London.

BARONESS SEROTA

My Lords, before the noble Lord finishes, as I understood it he has given the House the assurance that no decision about the future of Queen Charlotte's has been taken. What I am not clear about is whether his right honourable friend is holding that decision until we have a general statement following the Todd recommendations on the post-graduate hospitals and institutions, or whether the decision will be made and announced before that.

LORD ABERDARE

My Lords, I hope that the decision will be announced before that. A good many people are anxious to know what the position is, and I hope that it will come first.