THE ELIZABETH GARRETT ANDERSON HOSPITAL

HL Deb 26 April 1978 vol 390 cc1921-66

9.4 p.m.

Lord SANDYS rose to ask Her Majesty's Government which groups, professional bodies and associations they are consulting before reaching future policy decisions in regard to the Elizabeth Garrett Anderson Hospital. The noble Lord said: My Lords, at this late hour it may seem, perhaps, inappropriate to start on an entirely new debate; but with your Lordships' customary vigour and rapidity of mind we are going to transfer our thoughts from the problems of Southern Africa to the problems of one very particular hospital in London. In rising to ask this Unstarred Question on a day when the business of this House has been long and of great weight, I feel that it is perhaps unfortunate that we are sitting at this hour. Nevertheless, this matter is of great importance and, as many of your Lordships who remain are anxious to speak, I feel that you have given currency to the same view.

The Unstarred Question invites the Government to tell us what consultations have taken place with a particular group of bodies and associations; but I would prefer to open this short debate on the background of the pattern of events which has taken place in regard to the Elizabeth Garrett Anderson Hospital. I think that this will be helpful both for record purposes and also for some of your Lordships who, like me, have perhaps not acquired until comparatively recently a working knowledge of the chain of unhappy events that have taken place within the last seven or eight years.

In 1972, the Elizabeth Garrett Anderson Hospital had a particularly unfortunate event. It was that the pre-convalescent facilities in the Rosa Morrison Home of Recovery—a home where there were a number of beds that permitted early recovery and a good patient turnover—were removed from the hospital. Hence, while patient turnover had been hitherto very much better, the costs were diluted. From 1972, patients were unable to enjoy that particular facility. Later that year, the rundown process continued and the National Health Service began a policy of non-replacement of consultants with permanent appointments and only locums were appointed to the particular task.

In 1974, a further serious blow occurred because the General Nursing Council complained of a number of minor matters and said that the Elizabeth Garrett Anderson Hospital was no longer needed in regard to nursing training in the area. I would emphasise here that the General Nursing Council did not withdraw its support of the whole remit of the hospital ——far from it! But it said that it was possible to get similar training elsewhere. In November 1974, the threat of closure became imminent. It was stated by the Department that the hospital was too expensive to run and, immediately, the Department became inundated with a very large number of inquiries. Our information is that over 25,000 signatures in protest were sent to the Prime Minister. That is one measure of the degree of public support which the Elizabeth Garrett Anderson Hospital has.

The noble Lord, Lord Platt, asked a Starred Question in your Lordships' House on 21st January, 1975. I should like, if I may, to remind your Lordships of what the noble Lord, Lord WellsPectell, said in reply on that day in column 9 of the Official Report. He said this: no decision has been reached on the future of the Elizabeth Garrett Anderson Hospital or of its maternity home in Hampstead. Because this hospital was founded with certain special objects, no decision on its future … can be made by the health authorities without the agreement of the Secretary of State for Social Services ".

Only a month later, on 19th February of the same year, the noble Lord, Lord Aberdare, asked an Unstarred Question in somewhat similar terms to those of my Question this evening. At that time the noble Lord stressed that this was a matter of great urgency and he urged upon the Government the need for an early decision.

Here we are now, more than three years later, looking at the situation; and here I would pause in my remarks to say what very great stress the hospital staff have been under during these last three or four years. I believe it has been an intolerable experience for a staff loyal to their hospital and to the needs of the local population in that area, and indeed to a wider one, to have been placed in this position, not knowing perhaps from month to month or from year to year whether the axe would fall or whether it would not, and still most loyally continuing to support the hospital and all that it stood for in very trying circumstances. Many speakers who are to follow me in this debate will be able to identify the points at which the staff have been put under this particular burden, especially as regards journeys to the Whittington Hospital—a facility which they have used at a distance of some six miles from the Elizabeth Garrett Anderson Hospital.

The year 1975 continued and on 5th November of that year the noble Lord, Lord Aberdare, pursued his earlier Unstarred Question with a Starred Question. He asked whether a final decision had been made, and to that Question the Government replied that they had not yet completed the study. The noble Lord, Lord Aberdare, at that time said that the matter was very urgent and that the problem had been going on for at least a year.

The situation at last received the attention of the Secretary of State for Social Services at that time, Mrs. Barbara Castle. She announced in February 1976 a proposal to close the present site of the Elizabeth Garrett Anderson Hospital and to graft it on to one of the following hospitals in the area: the Royal Northern Hospital, the Whittington Hospital, or possibly the University College Hospital.

A very unfortunate event took place in February 1976, which caused the most serious dislocation to the activities of the hospital. That was when the lift was closed. The lift, which operates on all floors of the hospital, is particularly important to the management and running of surgical operations because the connection between the operating theatre and the rest of the hospital is made by means of the lift. The reason the lift was taken out of service was a fault in its installation some 12 years earlier, in 1964. It does not cast any aspersions upon the structure of the building, and I am particularly grateful to the noble Lord, Lord Bowden, who will tell your Lordships, so I understand, later this evening a little more about the structure of the hospital and its present condition.

I believe that there has been what amounts to a tacit silence—perhaps "conspiracy "would not be too strong a way of phrasing it—within the Department of Health and Social Security to see that the Elizabeth Garrett Anderson Hospital is phased out. A step in this direction, as I have suggested to your Lordships, was the removal of the pre-convalescent home, that is the Rosa Morrison Home of Recovery, the rendering of the lift inoperable and hence the cutting down of the numbers of surgical beds able to be kept in service. But the hospital continued in service, as there is a very large out-patient requirement. This is a particularly significant fact in the management of the hospital. At the present moment, there may be only 43 beds in service-I do not doubt that the figure is substantially accurate—due to this problem within the hospital. But the out-patient department functions as successfully as hitherto.

This sorry tale continued with a further Starred Question in February 1976, another in March 1976 by my noble friend Lady Brooke of Ystradfellte, and a further one on 25th May 1976 by the noble Lord, Lord Platt. I do not think that in recent years any hospital in the United Kingdom has been the subject of so much interest to your Lordships, or of so much continuous inquiry to the Department from outside. This is one of the matters of interest, but it goes very much deeper. This Unstarred Question refers to consultation, and that is something which has been woefully lacking throughout this long and sorry story. In particular, one should consider what ought to have happened when the Govern- ment published their consultation document.

In one of his replies, the noble Lord, Lord Wells-Pestell, referred to the role of the Community Health Council, and the South Camden Community Health Council has taken an active part in opposing the closure of the hospital. But there are responsibilities placed upon both the Secretary of State and the Area and Regional Health Authorities, and when a closure is intended wide consulta- tion should take place. I hope that the Government will be able to inform us further upon this point, because it does not appear that a number of inquiries have been set in hand.

To begin with the bodies which have supported the hospital in the past, one must first consider the family, the succes- sors, of Dr. Elizabeth Garrett Anderson, and I should like to ask the Government whether inquiries have been set in hand there. My noble friend Lord Stradbroke has written to me on this subject but I shall not pursue it now, except to ask whether the family have been consulted. Also, have the Government consulted the National Council of Women or the Federation of Women's Institutes, both of which bodies have expressed interest? I have here a resolution from the National Union of Conservative and Unionist Associations' Women's National Advisory Committee, which states: The Conservative Women's National Advisory Committee wish to express their support for the continuance of the Elizabeth Garrett Anderson Hospital, and the valuable service it affords and urges the Secretary of State to take the necessary steps to provide for its future ".

That is not the limit of the bodies which should have been consulted. I wonder whether the Government have published their intentions in medical and other journals, and whether there were notices in the national Press. Certainly we who have been following what has happened have not seen anythinglike that. Other bodies which are particularly con- cerned are the Regional Consultants' Committee, composed of those medical practitioners within the region who support the continuation of the hospital. In addition, there are an enormous number of donors and others interested in the continuance of the hospital. I mentioned earlier no less than 25,000 people who signed a petition to the Prime Minister. We do not expect the Government to contact each of those 25,000 personally, but through the mediums of publication which are open to any Government it should be possible to publicise what they have in mind.

On what does the Government's case rest, and of what should they have informed these various bodies? As we understand it, there are three pillars, starting with the view of the right honourable Barbara Castle and repeated by her successor in office, the right honourable David Ennals, who said that he believed that the future of the hospital would be within the ambit of a district general hospital. The second pillar was very accurately described by the North-East Thames Regional Hospital Authority, which said that they are, very doubtful whether there is today a sufficient need for a hospital for women entirely staffed by women to justify the high level of expenditure necessary to maintain the services of the EGA ". We reject totally this point of view. Indeed, all of the arguments which I have been attempting to put before your Lordships entirely contradict that view. How can the Regional Hospital Authority say that it is very doubtful today whether there is a sufficient need, and what are the criteria for a sufficiency of need?

May I turn to the question of the Area Health Authority. That authority has stated in blunt terms in its document that already it has no need for the EGA in order to fulfil the hospital needs of the population. I believe that argument to be entirely untrue, for this reason. If it were the case that all of the present beds in the hospital were empty, and if there were no visitors to that very busy outpatient department, I think one could say that the Area Health Authority had a case; but if the needs of the population mean that there is a full waiting room all the time, that all of the beds which are in service are full and that the hospital could provide a further 100 beds because there is the capacity to develop up to nearly 200 beds, the Area Health Authority's case falls to the ground.

I believe, further, that the Government's claim that the relocation of the EGA would save a sum of £500,000 could easily be demolished. It has been suggested that this saving would take place if the hospital were relocated at the Whittington Hospital. After examining this proposition with great care, the health authorities have come to the conclusion that relocation would be unsatisfactory, for a number of reasons which it is unnecessary for me to go into now. However, I believe that the EGA Action Committee can demonstrate that for a sum of £60,000 the vital link, namely, the lift, can be repaired, and that for £120,000 the fire regulations can be fulfilled and the lift put into service. There is quite a substantial difference between that figure of £120,000 and the Government's figure of £500,000.

The Government claim that the hospital is too expensive to run. They claim that, because of the number of beds available, this is a very small, unsatisfactory and unviable unit. However, may I remind your Lordships of one fact which is borne out in an article in today's Daily Telegraph—and a very interesting one it is, too. It deals with the role of the small hospital in medicine. Two hospitals in particular are cited. The first is the Brompton Hospital, where streptomycin for the treatment of tuberculosis was originally set in motion in 1947. These experiments have had a worldwide implication. It is a small hospital, not particularly well found. The second hospital is St. Mark's Hospital in London's City Road. This hospital is also particularly significant, because at that hospital the colonoscope has been tried out quite recently and the tests and trials have proved to be satisfactory. Once again that is a small hospital which is similar in size to both the Brompton Hospital and the EGA.

How is it that these enormous new hospitals which are too expensive to run at full stretch—and I should like to mention two of them; namely, Charing Cross and the new hospital at Leicester which is a 1,000 bed hospital—can be said by the Government to be the most deserving hospitals to receive the resources which are made available to them by the Resource Allocation Working Party? Tonight is not the appropriate time to discuss the sharing of resources for health in England and Wales—the report of RAWP—but we shall do so on another occasion. I believe that in considering the future of the Elizabeth Garrett Anderson Hospital these arguments must be brought to bear. I have taken over long in my remarks, but I know that your Lordships are keenly enthusiastic to follow this argument.

9.25 p.m.

Lord AMULREE

My Lords, I should like to support what the noble Lord, Lord Sandys, has just said and to add my few words in favour of maintaining the Elizabeth Garrett Anderson Hospital, which I know very well. I have been called in there for consultation about patients in the past and, indeed, I was there a day or two ago. It has the making of an extremely pleasant and attractive hospital where patients would be taken care of most efficiently. The site is quite a large one, being one acre in extent and there are a good many of what might be called temporary buildings there which could be extended if the Government make up their minds that the hospital should be preserved.

One or two rather unfortunate things have occurred there, which were referred to by the noble Lord, Lord Sandys. One concerned the Rosa Morrison Home, which was given to the hospital in, I think, 1912. Of course that passed to the Minister with the coming into force of the National Health Service Act in 1948 but the Home was closed in 1972. The number of patients who could be admitted to the main hospital was therefore cut down quite considerably, because the Home had been somewhere where people who had been treated surgically could go to continue their recovery. It was closed in 1972 and, so far as I know, it remained closed for five years and is now occupied by mentally handicapped adults. They are perfectly proper people to be there but that was not the original intention for the use of the building.

There appear to be two main difficulties confronting the hospital now. One has been referred to by the noble Lord, Lord Sandys—namely the failure of the lift. It means that the two top floors of the hospital where the main wards were situated and where the theatre is, cannot now be used. I do not think it is because the lift or the lift shaft is faulty. I am not a technical engineer but I think it has something to do with the suspension of the lift. In the meantime, quite a considerable amount of money has been spent on scaffolding, hoists and other equipment to bring necessary articles up to the top floor. I believe the sum involved amounts to £27,000. Not being a technical engineer, I am not quite sure what it would cost to put the lift in order but probably it would not take long to recoup the money spent on repairing the lift from the saving made on the present expenditure on scaffolding, hoists and so on.

The second thing which occurred was that the General Nursing Council decided in 1974 that the place was no longer suitable for the training of nurses, partly because there were other places where they could be trained, the University College Hospital and others round about, and partly because the nurses training there would not get training with male patients at all. That situation has been in existence for quite a long time, but the training was done perfectly well; there was an arrangement made with the general hospital at Greenwich, which, I think I am right in saying, takes entirely male patients; so the nurses training with the women at the EGA got their training with men at the Greenwich hospital. That arrangement could have been carried out quite satisfactorily for a long time. I cannot see why it cannot be carried on now.

There was an alternative suggestion made to the EGA, which was to have beds at the Whittington Hospital, which is a long way away and is not really suitable for a rather specialised hospital like the EGA. It was one of the old Poor Law infirmaries, and it is a place which, although quite satisfactory in a way, is not what one would really choose as an alternative to a well-run and efficient hospital. I saw a statement in The Times yesterday in which the Regional Health Authority said that it was not really worthwhile continuing with the EGA because it could take only 43 patients, but that was solely because the lift had not been repaired and so the wards on the top floors were not available for patients.

What is the future, then, of this hospital? I am sure that the cause for which it was founded, so that women could be treated by women, whether that is a proper thing or not, is something for which people do wish. It is very well situated between the London termini. It is quite reasonably accessible by public transport. I should have thought that money would be quite well spent in making the Elizabeth Garrett Anderson Hospital work properly again. One is told that the site is an extremely valuable one and could be sold for a very large sum of money; but I was told by the people at the hospital, when I visited it one day last week, that the site value does not seem to he very much more than £200,000. I was rather surprised at that in that part of London. I should very much like to support what the noble Lord, Lord Sandys, has said, and to encourage the Government to see that the Elizabeth Garrett Anderson Hospital, whose structure, I gather, is perfectly sound, is put back into working order for the people for whom it was intended.

9.35 p.m.

Lord BOWDEN

My Lords, this subject of debate has very often been before this House and it has been much before the Department itself. The last time I saw the Secretary of State he said, "If ever the time comes for an autopsy to be performed upon me, the initials EGA ' will be found upon my heart". I have no doubt that he is aware of the problems. He said something else which I felt was very interesting. He said, "When first I heard of the idea of a hospital dedicated entirely to the proposition that women may need to be treated by women, I was extremely sceptical of it. I felt that in these days it was hardly appropriate. However, I looked into the matter and I am firmly convinced that there is a case".

Millions of women—certainly many thousands of women—find themselves almost unable to accept treatment from men. Some of the women are Asians, whose religion prohibits such treatment. But many more are Englishwomen, some of whom are forbidden by their husbands, believe it or not, to admit to treatment except by women. The case for a hospital decicated to this is evident. The Secretary of State, like his predecessors, has conceded that such a facility is essential and must he maintained somewhere in the Health Service.

The number of women's organisations which have petitioned that the facilities be provided and continued is very great. I cannot enumerate them all. However, they include, for example, the National Council of Women, the Women's Institutes, the Headmistresses' Association, the Inner Wheel, the Mothers' Union, the Catholic Mothers of Scotland and the Communist Women of Camden Town. That is a good representative cross-section of society. It cannot he held to be politically biased in one direction. There is no doubt that there is an enormous need for this peculiar service, which is available only north of the Thames in this one hospital, so that women may come to it from all parts of England.

It seems to me that its basic problem is due to the fact that it is not regarded as an institution of national importance and has somehow been mixed up with the ordinary provision of beds in Camden Town itself. Successive Secretaries of State and Ministers of State have gone on record as saying that somehow the provision of facilities for the treatment of women by women must be preserved somewhere. The question that we have to discuss is, where?

As the noble Lord said, there was a report in The Times yesterday from a reader who dismissed the case for maintaining the hospital in the same phrases and for the same reasons as have been adduced many times in the past, all of which are totally invalid. The first reason that we have heard is that the site is valuable and the building decrepit. Neither of those statements is true. We had the site surveyed and assessed by the appropriate people. The building has been surveyed in very great detail—I suspect in more detail than any other hospital in London—and has been found to be a perfectly splendid example of late Victorian architecture: solid, well built, with walls two-and-a-half feet thick, which will keep out the heat and the cold and allow the building to outlast the pyramids. In fact, it is my view that if the building was cleaned up and if some of the odds and ends that have been stuck on were removed, it should be classified as a building of special architectural merit and preserved, because it would be one of the finest buildings in the whole of the Euston Road. So much for the building and the site.

It is also true that at the moment it cannot be properly used for reasons to which other noble Lords have referred; namely, the failure of the lift. It is true that the cost of repairing the lift need not exceed £60,000 or £70,000. The cost of putting the hospital back into proper use, and providing perhaps 100 beds, would be one-third of the cost of moving it to the Whittington Hospital, supposing that had not been found to be totally impossible because of the administrative reasons which would flow were it done.

May I go briefly through the case which we have heard so often. It was said that the hospital is on a valuable site. Not so. The building is decrepit. Not so. It was also said in a recent report in The Times that the hospital was the most expensive in London. That is quite untrue and it is due to the extraordinary way in which the accounts have been cast.

A point which has already been made is the serious effect of the loss of the Rosa Morrison Hospital. However, I must explain that it was that hospital, rather curiously combined with an insane system of accounting, which gave the impression that the hospital was expensive. The patients in it stayed for only a few days before being moved out. If, on the one hand, we assess the cost in terms of beds per annum on the basis that each bed is occupied by a critical case for only a couple of days, the expense is great. If, on the other hand, we include the total cost of curing a patient as our criterion, the hospital has always been cheap. It is cheap today.

It costs, on average, £28 per patient in the EGA and £36 in the Whittington Hospital, which has been claimed to be cheaper. In fact, it is more expensive. The EGA has always had a record for treating its patients and discharging them very quickly which has made it much more efficient in the use of its beds than any other hospital in the district.

I have not time to deal with the matter in detail, hut a very complicated study has been made of the time it takes to cure patients in different hospitals and the EGA has always been one of the speediest. In the days when it had the marvellous facility of the convalescent home, it discharged patients after a very short time indeed. In terms of the cost per patient cured, it was, as it still is, one of the very cheapest in the country. Therefore, the ground that it is expensive is equally invalid.

I turn to the reason why we believe that it should be kept on its present site. Proposals were made to move it to the Whittington Hospital. It seemed strikingly inappropriate to choose that hospital because that was the one that pioneered the use of male midwives. It seems hardly likely that a hospital dedicated to the treatment of women by women could be fitted into another which had pioneered the use of male midwives. However, for all sorts of other administrative reasons it proved utterly impossible to devise any mechanism whatsoever by which the EGA could preserve its identity were it transferred to become part of another organisation. The idea of moving to the Whittington Hospital proved to be impractical and I suggest that it should be quietly forgotten.

That leads me to say that I do not believe that to move the EGA to any other site would prove possible either. If it is to survive, it must be where it is. It stands on a site which is ideally suited to its purpose. It can be easily reached from the main London termini and that was why the site was chosen. It is near not only to Euston, King's Cross and St. Pancras, but to the main tube stations and main bus routes, which make it easily accessible to women who come to it from far and wide. Therefore, the site is ideal from that point of view. The building could be repaired relatively cheaply. It could be brought into use for the purpose for which it was built 100 years ago, and the service which it would provide is one which was known even then to be necessary and which is necessary today.

Therefore, the case for moving it has, in my view, vanished. All the arguments which were adduced have been shown to be invalid. We have had tremendously complicated analyses of the detailed costs of the hospital and I shall not trouble your Lordships with the results. I can only say that there are many major matters of dispute between the analyses of the accounts which have been made by our own people—some of whom are extraordinarily experienced accountants—and some of the accountants from the Region. I should like to mention the fact that we found that the Region was charging, for example, porters, at the rate of about £7,000 a year each, which is about three times as much as the poor chaps actually earn and that that appeared as an addition on the balance sheet. We found that consultants who were actually working for about six or seven hours at the EGA were put down as working 20 hours at the EGA. The costs are inflated; they are almost certainly wrong. As I have said, this hospital is still cheaper than most others in the district.

It is a cheap hospital. It has potential and could be developed so that it becomes as good as it ever was. The number of beds could be increased to 100 or more. It is a splendid place. The most important thing is the tremendous demand for its services and the extraordinary dedication of the staff. When I went there some time ago I went into the picket room. This is a cubbyhole in which the pickets sit. They have looked after and cared for the hospital night and day for about two years, in case attempts are made forcibly to close it.

When I was there, a delegation arrived from Germany to learn how to picket English-style; I thought that that was a remarkable example of invisible exports to the Common Market. Furthermore, during the recent firemen's strike the firemen pickets sat there too, so the picket room became a little social club for those seeking to preserve the hospital, those trying to keep the fire station from working and the Germans trying to find out how to do everything. It was most extraordinary.

I have commented many times on the fact that the morale of the staff is wonderful. That is true from consultants down to kitchen maids. When the Secretary of State was there about three weeks ago I think that he was profoundly impressed by the eloquence of the girls who spoke in the hospital's defence. I wrote to the Secretary of State quoting Napoleon Bonaparte: In peace as in war, morale is to material as two is to one". The hospital has earned the affection of women the world over. I have met doctors in New York who have said, "Whatever you say about the National Health Service, it has kept the Elizabeth Garrett Anderson Hospital going and I can forgive it anything for that". It is known affectionately in Africa. I was in Ghana the other day. It seems to be known to every woman one ever meets in London. They all know it and think it is very good, and they all view with horror the prospect that one of our great national assets may be destroyed.

The last time I saw Mr. Ennals, I told him that the hospital must not be allowed to die the death of a thousand cuts. In other words, it is impossible to expect it to survive in its present state, with about a third of its facilities available to it and no real hope for the future. It must be given the minimum support it needs to get it going again. I think that it would be possible to raise the money by public subscription, and thus repair it and get it going. Once that has been done, it must be guaranteed support as a national institution instead of a purely local hospital. The teaching hospitals are taken out of the ordinary system of costing. The EGA is an extraordinary anomaly; there is nothing like it in the country. To most administrators the fact that it is an anomaly is sufficient reason for wishing to destroy it. It is far too precious; it must be preserved.

9.49 p.m.

Lord PLATT

My Lords, after the splendid speeches that we have had so far I am left with very little to say. I shall simply pick on a few points, perhaps raise one or two new arguments and emphasise others. The need for the hospital has been clearly spelled out. That seems to be agreed by everyone, except the Regional Health Authority, which I suppose is part of the reorganisation of the Health Service. Perhaps the noble Lord, Lord Wells-Pestell, could tell us by what extraordinary expertise and skill the Regional Hospital Authority which I think has met only once on this matter—knows more about it than all those of us who have studied it for years and who really do know something about it. I should like it to be spelled out why they think their opinion overrides that of practically all others.

I was going to point out that the former Secretary of State, Barbara Castle, felt that the hospital should be closed at that time but nevertheless wanted it to keep its identity in some way, and of course its name, which is important to it. For this reason the Whittington experiment was tried. We need not go into that any further because Whittington does not want the EGA and the EGA does not want Whittington, and the Area Health Authority has agreed that this is an unacceptable solution.

Among the points that have been raised is one that a large number of its patients—a percentage has been quoted, but I am not sure what it is—do not come from the district in which the hospital exists. Of course, this is true of, I suppose, all our most famous hospitals, and it was Nye Bevan who was quite certain that the Health Service hospitals should be allowed to take patients who did not come just from the district in which the hospital was situated. This was a great relief to the medical profession at the time who thought that the original basis of the new Health Service, as it then was, might mean that, say, Guy's Hospital could serve only the South-East part of London and so on.

If you take any of our most famous hospitals, especially the specialist ones—the Neurological Hospital at Queen's Square, the Brompton which has been mentioned, Moorfields Eye Hospital, and of course the Royal Post-Graduate School of Chemistry—all have a clientele from the whole country, not just from Hammersmith or wherever they exist. This is part of their job, and goes to the building of their reputation, to make them known, in many cases all over the world. So that, far from it being an argument against the Elizabeth Garrett Anderson Hospital, it seems to me to be a very powerful argument in favour of it, though I can understand the Area Health Authority saying, "Yes, we agree with you "—I think they do— "but nevertheless we do not see why we should he paying for it out of a budget which has already been cut down".

This is a point which one must listen to, and it brings back to the Department and the Secretary of State himself, sitting over the Regional Health Authority, the need to support this hospital out of central funds, or as the noble Lord, Lord Bowden, has said, initially perhaps by voluntary effort, because most of us feel that a large amount of money would be forthcoming. Of course, even if the initial cost were covered by voluntary effort, it would have to be guaranteed in future. The cost of the renovations now —and nobody knows more about this than the noble Lord, Lord Bowden, and we have heard him on the subject—as far as I can see, is about three times what it would have been five years ago.

As to the site value, that, too, seems to he exploded; but if hospitals are going to be judged on site value, the sooner we sell the Westminster Hospital the better for the country. Nurse training and certain ways of overcoming that problem have been mentioned, but there is absolutely no reason why a nurse should not serve a certain hospital—it might be a geriatric hospital, a paediatric hospital, it might be the EGA—for a period of three months, or six months, of their training, although their base might he in some other teaching hospital.

I hope that this evening—and I mean this evening—we shall hear that at last a real attempt is to be made to rescue this hospital. For goodness sake! do not start looking for another site somewhere else—this is a perfectly good site; as we have heard, it is very well situated—because we shall only have another Whittington all over again. Everybody can get to London, but they cannot all get to Bedford or Letchworth, or somewhere like that if the hospital is put far afield. That would simply mean that the whole of this sorry story would begin again. I hope that is not what we are going to hear tonight.

I feel that throughout the two most important considerations have tended to be neglected. The first is the patients, although I would say they have come in for an honourable mention tonight. The second is the reputation of British medicine. It is the special hospitals of this kind—although by no means entirely—which have a big part to play in the worldwide reputation of British medicine. So my final word is to remind Her Majesty's Government. as I have done on numerous occasions in this House, that finally they cannot run a successful Health Service without the willing consent of the doctors.

9.57 p.m.

Lord HUNT of FAWLEY

My Lords, I do not want to repeat what I said in this House on 19th February 1975 about the Elizabeth Garrett Anderson Hospital. At that time the idea was being debated as to whether or not it would be feasible to close it and move the staff and equipment to the Whittington Hospital as an identifiable unit which could continue the good work of the care of women by women, and which would perpetuate the name of our first woman doctor, Elizabeth Garrett Anderson. That idea came to nothing: although nearly everyone agreed that there was a need, albeit a relatively small one (but not perhaps as small as certain people think), for some women to be treated entirely by women should they wish for this. We are now back where we were originally. The burning question before us now is: Should the Elizabeth Garrett Anderson Hospital be closed and used for other purposes, perhaps for offices, or should it be modernised and remodelled, or enlarged and rebuilt on its present site?

My noble friend Lord Sandys asks Her Majesty's Government this evening some most pertinent questions: which groups, professional bodies and associations they arc consulting before reaching future policy decisions in regard to the Elizabeth Garrett Anderson Hospital? The first of those people to be asked must, I feel sure, be the patients who use it now, who have used it in the past, or who may want to do so in the future. Second are the consultants and the Hospital Action Committee (composed of all grades of staff, social workers, voluntary workers and local groups). Then there are the sisters and nurses, ancillary medical staff, hospital administrators, and the general practitioners who send their patients to this hospital for diagnosis and treatment.

Many others are involved, too: the Camden-Islington Area Health Authority, other local authorities, the Area Medical Advisory Committee, the local Community Health Council, and some trade unions. Among other important bodies which should also be consulted are the major women's organisations, as has been mentioned: the Medical Women's Federation, the National Council of Women, the Federation of Women's Institutes, the League of Jewish Women and, importantly, the Association of Asian Women, all of whom are involved in some way.

Then, certainly are the larger local district general hospitals with which the Elizabeth Garrett Anderson Hospital might possibly be associated or affiliated, as it has been called, for very special investigations and treatment. Last of all, because of the hospital's clinical and teaching commitments, we must not forget the British Medical Association, the General Medical Council, the Royal Medical Colleges and Faculties, the Royal College of Nursing, the British Postgraduate Medical Federation of the University of London and the Council for Postgraduate Medical Education, though I understand that a few of these professional bodies have expressed a wish not to be drawn into this debate.

Some of the organisations I have mentioned feel very strongly indeed about the future of this hospital, more especially the consultant staff of the hospital and the trade unions. A report from the National Union of Public Employees said that NUPE members at the Elizabeth Garrett Anderson Hospital had voted unanimously that they would resist to the very end any removal of patients or equipment. The Association of Scientific, Technical and Managerial Staff also wishes to be associated with the out cry against the hospital's closure: and so does COHSE, the Confederation of Health Service Employees, though we must bear in mind that these unions tend to oppose any closures anywhere for fear of increasing unemployment.

There are, as many of us must know, a number of important and formidable arguments against the continuation of the Elizabeth Garrett Anderson Hospital on its present site. Only two days ago, the Camden-Islington Regional Health Authority, in a report to the Department of Health and Social Services, recommended its closure as rapidly as possible. But there are also many cogent reasons and arguments in its favour.

When this hospital was founded more than 100 years ago, supported by private subscriptions, it was most important as a pioneering Victorian concept at a time when the very few women doctors had great difficulty in obtaining consultant hospital posts. The foundation of this hospital was an entirely reasonable and understandable emotional reaction to give women doctors consultant appointments. to allow women patients who wished it to he treated only by women, and to offer some part-time consultative jobs to those women doctors who were married and bringing up families. We must ask ourselves: Are these factors important now? I believe they still are. Nowadays, it is true, there are many more women doctors—about 50 per cent. of medical students are women—so, on the face of it, it should not be hard for a woman doctor to become a consultant, or for a woman patient to find herself a woman general practitioner or hospital specialist. But there are not yet enough consultant appointments for women to hold, and there will not be enough for a considerable time. I am told on good authority that only 9 per cent. of consultant posts in England are now held by women; that there are only 10 women general consultant surgeons (two of whom are on the staff of the Elizabeth Garrett Anderson Hospital); and that only 25 per cent. of all senior registrars are women.

Where, then, do all the young women doctors go? Many of them, of course, get married and have children and drop out of medical work, perhaps only temporarily. More than half of them enter general practice or take up community medicine or public health, family planning, child welfare, child guidance or health education of various kinds.

We must ask ourselves: Does the Elizabeth Garrett Anderson Hospital fulfil a district need now, or does it fulfil an important national need? The answers to both these questions are, "No", according to many people including the Regional Allocation Working Party. Although the figures are approximate, 80 per cent. of this hospital's patients come from London postal districts, but only about 27 per cent. are from the Camden-Islington area. About 18 per cent. are from South-East England outside London, and about 2 per cent. come to the hospital from abroad.

Women who wish it can now be treated by women in many large hospitals elsewhere in England, but these do not always have enough women consultants, resident and domestic staff to do this completely. We all have our likes and dislikes as to who is to look after us. Some women have very deep religious and personal convictions about not being cared for by men, and not only for gynaecological conditions and obstetrics. The nervous and shy adolescent girl worried about her bosoms, or her boy friend, may want sympathetic and intimate advice from a woman rather than from a man. There must also be considered elderly unmarried women, nuns, Moslem women in general from many countries, and some orthodox Jewish women. In most hospitals arrangements are now made for them to be looked after by women if they wish, but with the best will in the world this cannot always be guaranteed with all consultants and resident staff with night duty rota systems, combined with staff shortages, sickness, holidays and so on.

In the North of England there is no hospital where women can he cared for entirely by women, from which it might be argued that no such hospital is really needed anywhere. The answer to this is that we do not know how much such hospitals in the North would be used did they exist. The Elizabeth Garrett Anderson Hospital has nearly always been fairly full. Four years ago I suggested in your Lordships' House that there was a need for a country-wide assessment of how many women really do prefer to be looked after entirely by women doctors, in order to try to determine patients' needs in this field. I should like to ask the noble Lord, Lord Wells-Pestell, whether any such survey was carried out.

The site of the Elizabeth Garrett Anderson Hospital is not perfect, but I agree with the noble Lords, Lord Bowden and Lord Platt, that it might he very difficult indeed to find a better site. It was deliberately chosen, originally, not far from three main railway termini, for the convenience of patients coming from the Home Counties and the Midlands. Set back from the Euston Road, it is said to be rather noisy, but this, I am assured, is not a great problem. When double glazing was suggested this was turned down by nursing staff and patients. As has been mentioned, the site could not now he sold for a very large sum—probably for not more than about £300,000. Camden, I am told, does not want it for building purposes.

The hospital is at present shabby and in a poor state of repair, because very little has been done to preserve, decorate, or improve it during the past few years. As we have heard, of the two main lifts, one is unusable, and the other needs frequent repairs. But the shell of the building (with 18 inch walls, good brickwork and pointing) and the roof (except in one place where the lift shaft goes through it) are structurally sound. Modernisation of the present building could be carried out at not too high a cost—I believe that about half a million pounds has been suggested—but the number of beds would then be rather small, only 80 to 100. Rebuilding of the hospital to give it about 200 beds would be ideal, and this, I am told, could be done for about £11 million to £2 million, at 1976-77 rates—so it may be more than that now. Some people tell us, although this is strongly denied by others, that it would be impossible to build a 200-bedded hospital on this site, even though it was considerably higher than the present building.

Another question that is asked is: Is the Elizabeth Garrett Anderson Hospital viable? Yes, I am assured most emphatically that it is professionally viable. It is busy, it sees more than 2,000 new out—patients a year, many of whom become in-patients; and it has more than 22,000 out-patient attendances a year now, in spite of the publicity given to its possible closure. Some people say that the Elizabeth Garrett Anderson Hospital is now redundant because it is in an overbedded area. But whose fault is that? Many of the Elizabeth Garrett Anderson beds were there first!

The Elizabeth Garrett Anderson Hospital does not aim to be a complete multi-specialist unit or a miniature district general hospital, but it does provide a supra-regional and supra-national healthcare service for women from about eighteen special departments in its building. It has a highly qualified specialist staff, and adequate (though not extremely sophisticated or very expensive) equipment. A hospital such as this, much smaller than a large district general hospital, is often attractive to doctors, patients, nurses and medical students, with its friendly, personal atmosphere. Humanitarian, emotional, and traditional factors cannot be entirely ignored in solving a problem of this kind.

The Elizabeth Garrett Anderson Hospital has always offered a useful range of services within its capacity. It has been helpful in pre-registration training—and there are not now enough jobs in London for this—and in the post-graduate continuing education of women in part-time and full-time training posts. For expensive diagnostic and treatment equipment and services, such as for high-powered intensive care, difficult or complicated obstetrics, organ transplants, neuro-surgery, open-heart surgery, artificial kidney machines, EMI body scanners, cobalt therapy and so on, a small general hospital like this could easily be attached to, or affiliated with, one or more larger nearby district general hospitals, such as University College Hospital, the Royal Free or the Whittington.

Other small hospitals are linked in different ways with their larger neighbours, and are helped by them. We appreciate, however, that many of the big hospitals have been asked to reduce the number of their beds, and no one would expect them, in order to look after women from the Elizabeth Garrett Anderson, to introduce sex differentiation or restrict the work of their wards which are common to men and women, or of their male staff or students, in order to enable ill women patients from another hospital needing very expert treatment to be looked after entirely by women in that special environment.

During the war, in the RAF, I learned that very few patients were ever too ill to be moved over hundreds, or even thousands, of miles to a place where they could be better treated, so long as the move was done carefully and well. A move of only a few hundred yards from the Elizabeth Garrett Anderson Hospital to University College Hospital, or of two or five miles to the Royal Free or the Whittington, should be completed quite safely by almost any very ill patient.

We should not be daunted by the cost of a modest, phased rebuilding programme for, say, half a million pounds now, and a further £11 million revenue or more for maintenance. Much, if not all, the money for rebuilding could, I am sure, be raised by a well-planned appeal run, after consultation with the Secretary of State for the Social Services, according to Sections 90 to 92 of the National Health Service Act 1977. Such an appeal would, I believe, have countrywide support, and it is not only women and women's organisations who would contribute. If the Elizabeth Garrett Anderson Hospital were closed, its patients would have to be looked after somewhere else by the National Health Service, which might be willing to contribute some revenue towards the maintenance of a modernised or a new building. The result of such an appeal would be a good indication of how much popular support there was for the treatment of women by women, though the trade unions would, I am sure, prefer the National Health Service to supply all the money, without involving a private-enterprise appeal.

In conclusion, may I, at this period of our country's history which is dedicated to the advancements of women's rights, make a special plea to the Government through its Department of Health and Social Security and the Secretary of State for Social Services to allow the Elizabeth Garrett Anderson Hospital to be modernised and up-graded on its present site, and that the Department should look carefully and sympathetically at the possibilities of permitting a public appeal to be launched not only in this country but in the Moslem States (who, I feel sure, would be very generous) and elsewhere.

The problem of the future of this hospital, which is now part of our national heritage, has been hanging over us for many years. It must be faced squarely and solved quite soon. A favourable decision—to give this hospital a further lease of life—could safely be made now. But I agree with the noble Lord, Lord Sandys, that any decision remotely unfavourable must be very carefully debated during the next few months with the help of all those people and organisations whom he and others have mentioned. To close this unique hospital with its great traditions, a hospital which many people believe still has a useful and necessary part to play in our National Health Service, would be against much public opinion, against the wishes of a considerable part of the medical profession and against those of several trade unions.

It is refreshing nowadays to find the doctors on a hospital's staff and four trade unions, whose members work there, all wanting the same thing. To keep this hospital would, I and many others believe, be a reasonable and popular gesture which would be right historically, be good for the morale and confidence of many members of the medical and nursing professions and of many women patients. It would prove that the Department of Health and Social Security, whichever Government are in power, has an imaginative, sympathetic and humanitarian approach to the medical problems and needs of women in Britain.

10.18 p.m.

Baroness VICKERS

My Lords, it is a great pleasure to have the opportunity to join in this debate. I should like to thank my noble friend Lord Sandys for opening it and giving us such an interesting description. I think that the noble Lord, Lord Hunt of Fawley, really proved the point. He said that these people were coming from all over Britain, and from overseas also; so that this hospital is not just serving a local area. If it is needed so badly that, surely, has proved the point that we should try to keep the hospital open.

I was interested in the speech of the noble Lord, Lord Bowden. He reminded us that the Secretary of State, Mr. Ennals, has stated that if he dies of a coronary, the initials on his heart would be those of the hospital "EGA". I think it would be useful for him to decide that he is going to live happily. Therefore, if he can, through his Minister, the noble Lord, give us an assurance that he is going to keep this hospital open, he will get the whole thing off his conscience and not have this trouble in the future. He also remarked in a Press conference that he was impressed by the dedication of the staff, the concept of hospital treatment for women, and he added—and this is important— "For a long time I did not understand, but now I appreciate their views". I hope that he also appreciates the views of all the various organisations, like COSI, NALGO, NUPE and a few others, including the BMA.

There is a very interesting book called The Administrative Reorganisation of Women's Health Needs and Hospital Planning in London, written for the Elizabeth Garrett Anderson Hospital by Linda Clark and John Mason. This will be advantageous reading for anybody deciding what is going to happen to this hospital. The hospital, I should like to remind your Lordships, has a Royal Charter which was granted by King George V and the foundation stone of the building—which, the noble Lord, Lord Bowden, rightly reminded us, is a nice building—was laid by Her Majesty Queen Alexandra.

It has been remarked by one or two noble Lords that women have always had a great struggle to become doctors. I understand that 97 per cent. of the consultants in general surgery and 96 per cent. in general medicine are men. Even in obstetrics and gynaecology only 12 per cent. of the total are women. It may be remembered that Miss Garrett herself had a great deal of difficulty in getting training. She tried in England and in Scotland, and eventually had to go to Paris to take her examinations and become a fully fledged doctor.

It is also interesting to note, I think, that very often when women have become doctors their families carry on in the profession. In her case, her daughter, Dr. Louisa Garrett Anderson, was joint organiser of the Women's Hospital Corps in the First World War and chief surgeon in a military hospital at Endell Street. I mention this because it is often said: "Women get trained and then they get married". I may say that one of my cousins, who is a doctor in Ireland, has two daughters who are both now doctors. They very often carry on a family tradition when given a chance. One also has to remember that up to six years ago there was a quota system for women training at medical schools. I believe the proportion was one in five. I should also like to mention another interesting book which proves the case; it is The Fight for a Health Service that Provides for Women's Needs, by Candy Unwin. It gives an excellent description of what is needed and I think proves the need for this hospital.

Mention has been made of Moslem and Jewish women. I know what has been said is true, because I am sure the noble Lord, Lord Amulree, will remember that when we were rescuing prisoners of war and internees there were nuns on board our ship and he was not even allowed to see them: they had to stick their foot out when they had a bad ankle and I had to tell him about their complaints. That is some proof of what occurs.

If I may cite what women can do, there was the Women's National Cancer Control Campaign which was started by Mrs. Joyce Butler, MP, and that marvellous woman Dame Josephine Barnes. I do not want in any way to be rude to men doctors, of whom there are still two left in the Chamber, but I think this campaign would have not got along very well without women doctors and, in particular, the type of hospital we are talking about. In Plymouth, I myself started two clinics with part-time women doctors. It took a long time to get women to come to them. One interesting point was that I got another clinic installed in the Royal Naval Hospital, and women would go there because they felt they could see a woman doctor and also that people would not know why they were going: they would think they were going to visit husbands or fiancés.

Unlike men, women make demands on health care not only when they are really ill—this point has not so far been mentioned—but because they need care during pregnancy, through difficulties of menstruation and during the menopause. At such times I think they really appreciate seeing another woman. As mentioned by my noble friend Lord Sandys, 23.000 signatures were sent to 10 Downing Street, also the shop stewards marched in July 1976 and there were pickets by ex-patients and many other supporting groups. I think this is the first hospital to have what is known as a "work-in", which gained great support from many people.

Mention has been made of the amount of money that has to be spent. This seems to vary considerably. However, I understand that without making the building any taller it will be possible to modernise the kitchens in a way that would not cost too much, because now that we have pre-prepared food we do not need large kitchens. That will make available quite a lot of room for extra beds. There are special facilities in this hospital. There is the infertility clinic, and clinics for family planning and matrimonial problems, together with a gynaecological and cancer clinic, in addition to the normal hospital facilities. Therefore I suggest that, for these other reasons, this hospital is giving good service.

I should like to end by quoting from a booklet called The Reorganised National Health Service 1977, published by the Office of Health Economics. In the final analysis, it is to be remembered that the object of ultimate importance is not the Health Service as such, but the health of the community it seeks to serve. The responsibility for achieving such ends is not exclusively the Health Services'. It is shared by the entire community". I think that what the entire community wants to do is to save this hospital, and I hope that the Minister will be able to give us a satisfactory reply.

10.25 p.m.

Lord BROCKWAY

My Lords, I first became devoted to the Elizabeth Garrett Anderson Hospital as a hospital for women, staffed by women, 71 years ago when I came to London as a young journalist. At that time there was the beginning of an upsurge of the movement for women's equality and I became involved in it. I used to go to meet my first girl friend at the gates of Holloway Prison when she was released as a suffragette. It was probably my becoming involved in the women's movement at that time which led me to have an almost religious fervour for Elizabeth Garrett Anderson as the first woman doctor that our country has known. Nevertheless, I want to acknowledge this fact. I did not intend to take part in the debate this evening. I have been fairly fully engaged in this Chamber since 2.30 this afternoon. But last night a councillor from Camden came to me and made such urgent representations that I did not feel I could avoid saying a few words.

Councillor Joan Hymans is, in the first place, devoted to the people of Camden itself and to their service; but, equally, she has been involved on behalf of the Commonwealth immigrants in that borough. She is a very active member of the Camden Community Relations Council. Knowing that I have some interest in this subject, she asked me whether I would emphasise this side of the issue that we are discussing tonight. She stated, first, that the experience of the Community Relations Council is that there are very many Moslem women who will not be treated medically by men. Indeed, some of their husbands will not even allow another man to touch them. I shall comment a little later upon that prejudice. But it is, undoubtedly, the case that there are very many women of the Moslem faith who need hospital treatment but have this deep objection to medical treatment by a man. Figures have been given in this debate as to the minority of women doctors and women consultants, and the experience on the Camden Community Relations Council has been that many of these women have to wait long periods before there is a woman doctor available to them.

I was surprised to find that the evidence of the Camden Community Relations Council referred not only to Moslem women but to Bengali women from both West Bengal, which is still in India, and Bangladesh which has become an independent country. The Camden Community Relations Council employs a woman officer who is specially concerned with the health of Bengali women. Her reports to the council state that Bengali women, even if they are not Moslems—perhaps their attitude is connected with the culture of that area—also refuse repeatedly to be treated by men The figures show that only 27 per cent. of the Elizabeth Garrett Anderson Hospital patients come from the Camden and Islington area and that the great majority —over 70 per cent.—come from all over the country. I believe that these figures indicate that there is a special need for one hospital at least of this character to serve, in particular, Commonwealth immigrant women from all over the country.

I do not think I need to say more than that. I hope very much, however, that in reaching a decision on this issue the noble Lord the Minister will take into account, together with the other arguments which have been put forward this evening, the need among the Commonwealth immigrant community for a women's hospital.

Baroness WARD of NORTH TYNESIDE

My Lords, at this time of night I am sure that everybody who has taken part in the debate will be anxious to hear what the noble Lord the Minister who is to reply has to say about all the facts that have been put before him. I have great pleasure in supporting the case that my noble friend Lord Sandys has made for keeping this hospital in good form and making provision for the patients who are so devoted to it.

My first point has not been made so far this evening. May I put to the Minister the point that, although, naturally, there has been quite a lot of comment about the EGA hospital in this part of England, the suggestion has frequently been made throughout the country that the National Health Service is on the point of collapse.

I like to say that I live on the right side of the Border; I come from Tyneside and am very devoted to it. I happen also to be a Vice-President of the Royal College of Nursing.

If a full report appears on the comments which have been made in our debate tonight, in particular on those with which my noble friend opened the debate, unless the Minister is able to give a satisfactory answer one might begin to wonder whether there is something wrong with the National Health Service and whether it may be on the point of collapse. That is really very sad indeed for the people in the country who, after some years, have learned to appreciate the National Health Service, who have received very good treatment from it and who have been well looked after. We have made great progress in curing all sorts of diseases and finding new methods of dealing with some of the worst diseases that people can get. Therefore I should hate the facts that have been given tonight to be known, unless we can get a really satisfactory answer from the Minister.

My noble friend Lord Hunt of Fawley said he did not know quite what women in the North thought, but as I have lived up there and belong up there and was in another place for 38 years representing them, I know very well what they think. They are always very helpful when I want to make any points in a debate, whether it is on this subject or on industry or anything else.

The question of money has been raised in regard to the Elizabeth Garrett Anderson Hospital and I should like to point out to the Minister—although I think perhaps he will know—that we had a very famous hospital called the Sanderson Home for Crippled Children, which was given by some well known people in the North of England. It was heavily endowed and did a great deal of good work for crippled children. When the National Health Service acquired the Sanderson Home, they took the endowment money, and I can only assume that it went into the general funds of the National Health Service. At any rate, we did not get any support from it in the North of England. So I do not think we are asking too much when we suggest to the noble Lord that some of the money which has been taken from private hospitals which were endowed by private people, presumably like the particular hospital we are discussing tonight, might be returned to us by the National Health Service.

I should like to make one other point about the North of England. It has been found fairly recently that the use of swimming baths is important in the treatment of certain complaints from which people suffer Not so many months ago, the people in the small place where I live just outside Newcastle-upon-Tyne were asked to collect money for a swimming pool to be attached to the Sanderson Home. The people from my part of the world went to it and we collected £75,000 and built a marvellous swimming pool. At that moment the Government decided to close the Sanderson Home, take the money, and take the crippled children who were still there and put them on the fifth floor of our new hospital, the Freeman Hospital, with no balcony, no garden and no chance of getting to the swimming pool. Now, when only a very small amount of money appears to be needed to put the Elizabeth Garrett Anderson Hospital fully into operation again, there seems to be some suggestion that there is no money available. That is a most unfortunate thing.

Although I have not taken part in the debates on this hospital I felt that as a Vice-President of the Royal College of Nursing I might express some of the things that I feel about it. I hope the Minister will not say either that the National Health Service is about to collapse or that there is no money available, because I would then ask whether he would let us have back, to use for this hospital, the money that was taken at the time the Service acquired the Sanderson Home.

I will not keep the House long, There is always the temptation to put all the points of view one has, and I always have a great many points of view; I am rather a talkative person really, and sometimes it is difficult not to talk when an opportunity like this occurs. I want to say to the Minister that I have great admiration for him; I think anyone who has come into contact with him would agree he is most helpful, most kind, and willing to consider points of view put forward. Sometimes I look at what I call the constitutional position of Ministers. I cannot believe that the noble Lord, Lord Wells-Pestell, can have listened to all these very important comments without feeling that the case has been made for dealing with this hospital in a satisfactory way.

Of course, it must be an awful bore being a member of the Cabinet if the Cabinet does not agree with the point of view with which the Minister wants it to agree. I have a sort of feeling—I may be wrong—that the noble Lord would really be delighted to get up and say "yes "to the point of view we have all expressed about this hospital. At any rate, I am hoping that he will. If he does not feel he can do that, I think we might send a very strong deputation to the Secretary of State, and it would not be too difficult for the deputation to set out again all the very forceful arguments that have been put. I feel that the noble Lord is so good at listening to our points of view that in his heart he is longing to say "yes". But, of course, I do not know what goes on in the Cabinet. I sometimes think that on matters relating to the Health Service the Cabinet and the Ministers concerned do not know anything about the problems which hospitals like this have to face; nor do they know what a tragedy it would be if it did not stay there for very many years to come.

The point has been made that people come from all over the country to go to the Elizabeth Garrett Anderson Hospital, but as I am sure the Minister knows perfectly well, there are long waiting lists all over the country; thousands of people are on waiting lists. If they can find room in this hospital, knowing its reputation, of course they come down to it. Now and again people like myself write rather nasty articles about Departments of State. I hope the country will know exactly what points are being put forward.

My noble friend who opened the debate quite rightly made it appear that some extraordinary things go on in the Department dealing with the Health Service, and I think it would not please the Department if all the facts my noble friend gave were properly reported for the public to see. Then they may say: "Oh, my goodness, we had better get this hospital closed down, and that will be the end of it". But it will not be the end of it, because, as I said in my opening remarks, there is a feeling among the general public as a whole that the Health Service is collapsing due to shortage of money for one thing and another.

The noble Lord will be glad to hear that I am the last speaker before he gets up. I ask him to please bear in mind, much as I like and admire him and think that he is very helpful and kind, that this is an awful business. Women have a rather peculiar approach. I will do things for Ministers whom I like that I will not do for Ministers whom I do not like. But as I like the noble Lord I should love to think that he will say: "Yes, a wonderful case has been made by all the experts, and I am only too delighted to give them my pledge, on behalf of my Government, that such action will be taken". I shall now look forward to a nice, helpful reply from the noble Lord who will answer the debate.

Lord SWINFEN

My Lords, I rise on one small point. I wondered, on the question of the lifts, what the cost per bed would be for repairing the lifts and putting them back into service, so that the beds that are no longer in use could be brought back into service, in comparison with the average cost of new beds supplied to the National Health Service. I wonder whether this would not be a much cheaper method of producing additional beds, and so reducing waiting lists in other hospitals.

10.48 p.m.

Lord WELLS-PESTELL

My Lords, I think that I should begin by thanking the noble Lord, Lord Sandys, for introducing this debate—if only because it gave the noble Baroness, Lady Ward, an opportunity of saying many nice words about me. I am indebted to her. I think that, by the end of my contribution, even if I cannot satisfy her noble friends that there is a strong case for the Government doing what they wish to do in this matter, I shall at least perhaps satisfy her.

I was a little upset. I took exception to something that the noble Lord, Lord Sandys, said, when he implied—in fact, he did not imply it, he said it—that he felt that there was some kind of conspiracy going on in the DHSS to find ways and means of closing the Elizabeth Garrett Anderson Hospital. What sort of people does the noble Lord think we are in the Department of Health and Social Security? What kind of integrity does he think the Ministers who are running the DHSS have if he can make a statement implying that there must be some kind of conspiracy? I take exception to that.

Lord SANDYS

My Lords, I—

Lord WELLS-PESTELL

No. Just a moment. I take exception to that. I want to ask the noble Lord—we are very good friends—to withdraw that implication, for it was unworthy of him.

Lord SANDYS

My Lords, after what the noble Lord has said I would naturally he willing to withdraw the word "conspiracy". However, I think that there was a pattern of events, as I attempted to display to your Lordships, that showed the progressive running down of the hospital. It was a conclusion which led me, in company with my noble friends, to feel that perhaps something less than support for the whole management of the Elizabeth Garrett Anderson Hospital was being displayed by the Department.

Lord WELLS-PESTELL

My Lords, I am much obliged to the noble Lord, Lord Sandy's, for withdrawing the implication that there had been a conspiracy, so let us leave that particular matter there. The only other point that I want to make at the outset is that the noble Lord complained of the length of time which he said it has taken my Department to come to some sort of conclusion on this matter. He would have been the first to condemn the Government if they had made a very hasty decision. Is it not true to say that the length of time which my right honourable friend and his predecessor have taken to arrive at a decision—a final decision has yet to be made-is a very clear indication that a good deal of thought and a good deal of heart-searching have gone into this particular matter? As I have said, I shall come to the charge of lack of consultation-which, again, I think the noble Lord made-when I deal with the procedures which must precede any attempt at closure.

I am well aware of the widespread loyalty and affection in which the Elizabeth Garrett Anderson Hospital is held and I welcome this opportunity to set out the present position on the consideration of the hospital's future. I know that almost everybody, both inside and outside your Lordships' House, looks with sympathy at a hospital purposely conceived for the treatment of women by women. Let me assure your Lordships right at the outset that both I and my right honourable friend the Secretary of State fully accept the principle that a woman should, whenever possible, be able to consult a woman doctor. We believe that, at hospitals with women doctors, female patients who want on conscientious, religious or other serious grounds to see a woman doctor, should be allowed to do so provided this can be done without disrupting work or imposing too great a burden on the individual doctors.

In the past, the small number of female doctors has tended to restrict the availability of such a service, but I am glad to say that, since the proportion of female medical students is, as the noble Lord. Lord Hunt of Fawley said, now approaching 50 per cent., it should become increasingly possible for such requests to be met in the future. The chief characteristic of the EGA has always been that it was a hospital where medical care could be guaranteed to be given by women to women and, let us face it, my right honourable friend and his predecessor have gone to some considerable trouble to preserve that facility.

I hope that your Lordships will bear with me when I say that I believe that the current position cannot be satisfactorily understood without a fairly full résumé of the background to date. I am not unmindful of the time, but this is a serious matter and, although I shall not keep your Lordships unnecessarily long, I believe that, because of the importance of the matter, I must go into it fairly fully.

At its inception in 1974, the Camden and Islington Area Health Authority inherited from the North West Metropolitan Regional Hospital Board an uncertain and fairly long-standing situation regarding the future of the EGA on its Euston Road site. The EGA had long been considered expensive in terms of unit and departmental costs in relation to similar 100-bed hospitals and, in March 1975, the Area Health Authority opened formal consultations on the hospital's long-term future.

The Area Health Authority quite rightly sought the opinions of many different bodies, including the medical staff of the hospital itself, the South Camden Community Health Council, the staff associations, the unions involved, local Members of Parliament, the District Management Team and the London Borough of Camden, among many others. I have a whole list of people who were consulted, which I shall not go into because it would take me some considerable time to read.

After studying the results of this extensive consultation, the Area Health Authority informed the Department of Health and Social Security that: if the policy of maintaining a general hospital service in which women are treated by women is continued, the Authority—or some other Authority —should introduce into the strategic planning a requirement that a suitable unit wherein the treatment of women by women doctors can be carried out should be included in its plans for a new District General Hospital or the redevelopment of a District General Hospital". That was the recommendation by the Area Health Authority. In February 1976, therefore, having visited the hospital, my right honourable friend the then Secretary of State for Social Services, announced her decision in the following terms: I am aware of the line traditions of the hospital and of the loyalty it has aroused as a result of its services to women and am anxious to preserve the concept of treatment of women by women for which it stands. Unfortunately, this is a small, uneconomic building in an expensive location and the continued use of the hospital on its present site, together with its associate maternity home, would entail considerable capital expenditure, together with annual running costs of over £1 million. I have decided therefore that the best solution is to transfer the facilities provided by the hospital and the maternity home to a District General Hospital within the same Area "— and this is the important part— in an identifiable form which preserves the original concept of the hospital". That decision was endorsed by my right honourable friend in October 1976 when he said in another place: I am convinced that if this special service for women to be attended by doctors of their own sex is to survive, it can only be from within a District General Hospital. I am sure that it would be wrong to encourage the Health Authorities to spend our precious resources to restore and continue this small and ageing budding which can never be developed to fulfil the proper functions of a modern acute hospital". We must face the fact, whether we like it or not, that the EGA is a small, ageing hospital in need of substantial capital investment of upwards of £500,000 and costing, as I said a moment or two ago, £I million a year to operate. All the available evidence suggests that, whatever capital monies are invested in the hospital, it would not be possible to create the conditions under which patients could be assured of the resources which modern hospitals enjoy. Doctors must know this —they must know it. Nor would it be possible to provide modern working conditions for the staff. The most that could he provided would be an upgrading of an existing fabric, possibly with the introduction of a few maternity beds and some improvement in bed accommodation, but this would generally be at the expense of reducing the total number of beds, which would lead to even higher costs per patient. Hospitals have changed today. They arc very different places from when the EGA was built. There are far better facilities and we want to provide those facilities.

As a result of these decisions, the Area Health Authority established a planning group to investigate how it could best re-locate the EGA to satisfy the conditions outlined by my right honourable friends. After receiving advice on sites from a project team fully representative of staff and management interests, the planning group recommended that the EGA facilities should be sited at the Whittington Hospital, which is in the process of being redeveloped as the District General Hospital for Islington. After further preparatory work, the Area Health Authority issued a formal consultation document in October 1977 and requested comments on its proposal to create a facility for the treatment of women by women identifiable under the name of the Elizabeth Garrett Anderson within the Whittington Hospital.

Given the co-operation and the goodwill of all the staff of the Elizabeth Garrett Anderson Hospital, those facilities can still be provided. What does that mean? It means that, in the Whittington Hospital, we can provide four wards, wards 12, 13, 14 and 15, which will provide ordinary medical facilities, surgical facilities, obstetrics and gynaecology—a total of something like 88 beds.

Lord BOWDEN

My Lords, is the noble Lord aware of the fact that this proposition was put to the people in the Whittington Hospital, who said that it was totally impractical? It has been rejected by everyone who has considered it and no amount of goodwill will get over the fact that it cannot be done unless capital is made available.

Lord WELLS-PESTELL

My Lords, I am saying that those facilities are available at the Whittington Hospital. The reason why they are not acceptable by the staff at the EGA is, I believe, because nothing can persuade them, however good the facilities, to leave the EGA. I think we have to face the fact that these facilities —better than those which they have at the moment—can be provided, and that, what is more, if they were willing to show some goodwill and co-operation, it would be possible to take the staff, lock, stock and barrel, to the Whittington Hospital where all the facilities that have been provided in the past at the EGA could be provided in a much more modern hospital.

Lord BOWDEN

My Lords, the Whittington will not have them there.

Lord WELLS-PESTELL

My Lords, I am not going to give way. I am not going to continue being interrupted. As the noble Baroness said, I have listened without interruption myself, although I wanted to interrupt on a number of occasions and, however unpalatable things are, I must say to certain noble Lords that I am afraid they will have to be prepared to accept what I am saying. I should like to mention at this point that the consultation procedures now followed in the National Health Service when a Health Authority proposes to close a hospital, to change its use or to re-provide its facilities elsewhere, as in the special case at present under discussion, are deliberately designed to balance two essential requirements—the need to redeploy resources with maximum speed and effectiveness and the need to undertake adequate local consultation. I hope noble Lords will agree that both sides of this equation are necessary if the National Health Service is to develop and to respond to changing needs and demands in a rational and democratic manner.

While I am talking about the whole question of consultation, those noble Lords who are interested in this will know that my right honourable friend has seen a large number of deputations consisting of quite a number of Members of Parliament. He has visited the hospital and, in addition, he has seen a number of individuals, including my noble friend Lord Bowden, on this very matter, and nobody can say that there has not been adequate and proper consultation. He has seen a very wide section of the community.

In general, responsibility for determining the pattern of change in the use and location of health facilities rests with the Area Health Authority concerned, and it is the Authority's duty to consult very widely on its proposals. This policy was very clearly adhered to in the case of the proposal to transfer the EGA to the Whittington. The groups and professional bodies who were consulted, many of whom had also been consulted on the hospital's future in 1975, included Community Health Councils, the Area Medical Advisory Committee and the Area Nursing and Midwifery Committee, local Members of Parliament, the Joint Staff Consultative Committee, Family Practitioner Committees, the London Boroughs of Camden, Islington and Haringey, and many others. In addition, both my right honourable friend and my honourable friend the Minister of State for Health have received a number of deputations and many letters from groups and individuals about the EGA's future.

I think we can say that we have a very comprehensive knowledge of what people are thinking and of what people have felt and are feeling at the present moment. I do not, therefore, believe that either the Area Health Authority or my right honourable friend can be accused of a failure to take account of the wide range of views expressed to them. I am personally aware of the individual efforts which a large number of people have made, and I congratulate one woman doctor, who had perhaps better be nameless, on her persistence in writing to a number of noble Lords, including myself.

I mentioned earlier the Area Health Authority's consultative document on the proposal to transfer the EGA facility to Whittington. Having received some 30 replies, the Authority considered them at its meeting in February. It concluded that it was in fact unable to carry out my right honourable friend's request that the EGA facility be transferred to a district general hospital in the area because of the almost universal opposition to using the Whittington Hospital and the rejection by the EGA staff of a move to the Royal Northern Hospital, the only possible alternative location in the area.

The Authority also expressed the view that the EGA was not needed to meet the Authority's service commitments. The teaching hospitals in the area are increasingly committed to providing a service for the local population and the two specialties of most concern to the EGA—gynaecology and obstetrics—have both shown a declining demand for beds in recent years. If I may further expand this point briefly, the AHA is regarded as considerably overprovided for so far as acute beds are concerned, even after its very important teaching commitments have been met. Moreover, by all accepted criteria, the area is better provided for in comparison with other parts of the country and, indeed, is far better provided for than other areas in the Region.

I have to say to your Lordships, however unpalatable it may seem, that the Government are committed to a fairer distribution of National Health Service resources not only between Regions but also within them, and the implications of that policy arc that Inner London—historically well-endowed with hospitals, with facilities and with money—must expect a lower rate of growth in the next few years. We have to see that some of the under-provided areas get a larger slice of the financial cake and better facilities than they have enjoyed for some considerable time. Hence the Area Health Authority that we are discussing is faced with the need to reduce the demands on its budget if the redevelopment of its district general hospitals is to take place.

The latter is by no means the sole reason why the AHA has concluded that it could not give high priority to financing any capital works on the EGA buildings on Euston Road. That site is heavily constricted, which means that the hospital could not in our view and in their view be economically developed there. Moreover, the AHA feels that, if upgraded, the Euston Road hospital will have too few beds to form an acceptable multi-specialty unit, and the inclusion of obstetrics would make the situation worse. The AHA takes the view that the very extensive upgrading and rebuilding which would be necessary to make the Euston Road hospital viable as a modern unit would inevitably mean a loss of ward space and a reduction in the number of beds to 80 or less.

Quite apart from the conversion costs, a hospital of this size is increasingly regarded as undesirable, since the complete range of services necessary for acute medicine cannot adequately be provided with so few beds. The ever-growing complexity of medical care and the recognition of the interdependence of the various branches of medicine in the treatment of individual patients have dictated an emerging pattern of hospital services where single-specialty hospitals or small multi-specialty ones, like the EGA, are being replaced by a district general hospital complex operating from a single building or integrated group of buildings.

It is for all these reasons—the size of the site, the need to conserve resources and the fact that the hospital is surplus to service requirements—that the AHA has decided that it cannot give priority to the refurbishing the Elizabeth Garrett Anderson on Euston Road. The Area Health Authority cannot be expected to fund out of its revenue allocation a hospital which it regards as surplus to its service requirements.

Might I say briefly that I recognise that the analysis of the running costs of the EGA has been a source of contention between the AHA and the EGA Action Committee? Both the Regional and Area Health Authorities have considered the comments made by the EGA staff, who I understand were advised by the firm of Mott, Hay and Anderson. The health authorities have expressed misgivings about the methodology adopted in the Mott, Hay and Anderson report, particularly the assumption that the present average length of stay at the Whittington would automatically apply to the EGA in-patients when they were transferred, since the case mix at the Whittington, which includes long-stay patients, is quite different from that of the EGA.

Lord BOWDEN

My Lords, would the Minister permit me to submit to him privately afterwards the statistical survey on which that was based?

Lord WELLS-PESTELL

My Lords, also the assumption that the addition of a comparatively small number of beds will add pro rata to all the costs of the Whittington. However, may I therefore repeat my right honourable friend's assurance that he intends to satisfy himself that this question has been satisfactorily dealt with before he approves any proposals by the health authorities?

The Area Health Authority's report was then referred to the North-East Thames Regional Health Authority and, in anticipation of that Authority referring the matter to him for final decision, my right honourable friend visited the EGA in February to see for himself the physical condition of the buildings and to meet the staff and patients and hear their views at first hand. I understand that he found his visit both helpful and informative. I think that this illustrates the determination of my right honourable friend to ensure that the final decision is taken in full knowledge of the relevant information, and having heard the views of those most concerned about the EGA's future.

At this stage I want to try to answer some of the points that have been raised. Various noble Lords referred to selling the hospital. and the value of the site. So far as I understand the situation, this does not come into the matter. My understanding is that when the National Health Service has no further use for a building, it must offer that building to another Government Department. If no other Government Department requires it. I believe that the next stage is that the building has to be offered to a local authority. It may be that this site would be taken up by a local authority, perhaps for housing purposes; I do not know. I am saying that we just cannot sell it. So there is no thought in our minds that here is a very valuable site from which we can make an enormous sum of money.

The noble Baroness, Lady Vickers, referred to patients coming to the hospital from all over England, and my noble friend Lord Brockway gave a figure of 70 per cent. in this regard. It is nothing of the sort. The hospital does not fulfil a national role. Thirty-four per cent. of the Elizabeth Garrett Anderson Hospital patients come from outside the North-East Thames Regional Health Authority in which the hospital is situated. All the rest, with the exception of 2 per cent., come from the four Thames regions. So about 98 per cent. of the patients who use the Elizabeth Garrett Anderson Hospital come from the various Regional Health Authorities in London and the Home Counties. Only 2 per cent. come from outside that area. So we ought not to say that this is a national hospital in the sense that 70 per cent. of the patients come from all over England; this just is not so.

The noble Lord, Lord Hunt of Fawley, asked me whether a survey had been carried out to determine nationally whether women would prefer to be treated in an EGA-type facility. So far as I know, no national survey has been carried out along those lines.

The noble Baroness, Lady Ward of North Tyneside, raised the question of endowments. Under the 1946 National Health Service Act any trust funds endowed to a particular hospital were made the responsibility of the appropriate management body for that hospital, with an obligation that the money should be used so far as possible to secure the objects of the endowment. The National Health Service did not take this money: it remained with the hospitals—

Baroness WARD of NORTH TYNESIDE

My Lords, if the noble Lord will allow me to intervene, I should like to point out that the National Health Service closed down the hospital to which I referred, and so the money could not be used. I can assure the noble Lord that I have had quite a row about this. I asked whether the National Health Service had taken the money, and it certainly had. We have a very good Area Health Authority up there, and I am on very good terms with it. The Authority would not tell me things that were not correct. The money could not be used. It was not given to build the swimming pool, I can assure your Lordships. It was taken away.

Lord WELLS-PESTELL

My Lords, it is quite clearly set down in the Act that if a situation like that arises—

Baroness WARD of NORTH TYNESIDE

Perhaps sometimes you do not keep the law.

Lord WELLS-PESTELL

We will not go into that. All monies that are left over in the event of a hospital closing must be used for purpo:;es similar to those laid down in the charity. and I can only say that to the best of my knowledge and belief this is so, because the conditions laid down in the charity are controlled by the Charity Commissioners, whose responsibility it is to see that monies are used for the kind of thing envisaged in the charity.

My Lords, I must stop now, but the Area Health Authority's report was considered by the North-East Thames Regional Health Authority at its meeting on Monday of this week, the 24th April. I understand that the Authority decided, in view of the unsuccessful efforts to provide alternative accommodation for the Elizabeth Garrett Anderson Hospital in a district general hospital, to recommend to my right honourable friend that the Elizabeth Garrett Anderson Hospital on Euston Road be closed. The Regional Health Authority has now submitted its conclusions to my right honourable friend, and I know that he is going to give this matter urgent consideration. It is his intention to announce his decision as soon as possible in order to end the prolonged uncertainty over the future of the hospital. He knows that this debate is taking place here tonight, and I know that he will want to take full account of the points which have been made in today's debate in reaching a final decision. But I can assure your Lordships that a decision will be made before very much longer.