§ 3.21 p.m.
§ Baroness EMMET of AMBERLEYMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government how many hospitals it has been their policy to have closed, how many operating theatres have as a result been put out of action and by how much the waiting period for surgical cases has thereby increased.
§ Lord WELLS-PESTELLMy Lords, it is a part of the management responsibility of area health authorities, not that of the Government nor of my right honourable friend the Secretary of State, to review the use of their resources and to ensure that they are wisely deployed. This process necessarily involves change—for example, the building of new hospitals, improvements to others, and, in some cases, the closure of those which are inefficient, only partly used, or of least benefit to patients.
Closures of hospital units are often the natural consequence of new hospital developments. In 1976 and 1977, there were 173 closure decisions, the great majority of which were agreed locally by the community health councils. Information on the number of operating theatres affected is, I regret to say, not available centrally. Closures should not generally have any significant impact upon the waiting period for surgical cases, which I readily admit—and I did so last Tuesday—is much longer than we would want to see.
§ Baroness EMMET of AMBERLEYMy Lords, I thank the Minister for his reply, but may I suggest that this is a very serious position. In my part of the country, we have 1,332 waiting list cases. This is very largely due to the fact that, although we had two hospitals, we now have only one, and the consultant surgeon there has an 18 months' waiting list, even for urgent cases. The loss of the hospital which was closed has deprived us of an operating theatre and it has been turned into an administrative body. The number of administrative staff has gone 611 up from 70,000 in 1971 to 101,000 in 1976, and although I do not have the latest figures I understand that they are higher still. Would not the Minister agree that we ought to be increasing operating facilities and the number of consultant surgeons rather than the numbers of administrative staff?
§ Lord WELLS-PESTELLMy Lords, the supplementary question which the noble Baroness has asked requires a very detailed reply. At this stage I do not wish to try to deal with specific hospital situations. However, 70 per cent. of all hospital closures relate to units of fewer than 50 beds. It is these hospitals which are not productive from a health point of view. They are often under-used and cost a great deal of money to service. Hospitals are not closed unless area health authorities are convinced that an adequate service can be provided for that area by another hospital. Where there were two hospitals and one has been closed, it does not follow that a less efficient service is being rendered to the people in that area.
Earl FERRERSMy Lords, can the noble Lord explain one thing which I find puzzling today and which I found puzzling the other day? How can the Minister say that, if one closes a hospital and removes the facilities, it nevertheless has no effect on waiting lists?
§ Lord WELLS-PESTELLMy Lords, if you close a hospital, you do so because it is too small, because it is uneconomic, or because it is offering only a limited medical service. By transferring whatever facilities there are to another hospital giving a much wider coverage, you can offer a better service, and that often speeds up the waiting list.
§ Lord BALFOUR of INCHRYEMy Lords, would the Minister not agree that it is deplorable that the overall shortage of operating theatres should have been intensified by the action taken at the Dulwich Hospital? Patients are being deprived of operating facilities because of industrial action that is being taken by an irresponsible few.
§ Lord WELLS-PESTELLMy Lords, we had better not go into that matter. If 612 the noble Lord wants to go into matters of that kind, I should like to remind the House that in 1975, when the consultants were on strike and working to rule, the waiting lists were increased by 70,000.
§ The Earl of ONSLOWMy Lords, can the noble Lord say why we had better not go into something? Is not that gross impertinence to Parliament? Parliament has the right to inquire into anything.
§ Lord WELLS-PESTELLMy Lords, I said that we had better not go into it because I have a more than adequate answer.
§ The Earl of ONSLOWMy Lords, then perhaps the noble Lord might like to give it as opposed to hectoring people on this side of the House.
§ Lord SANDYSMy Lords, if I may turn to the subject of beds, is the noble Lord able to give us the net figure of beds closed in those 173 hospitals?
§ Lord WELLS-PESTELLMy Lords, in the last two financial years we have provided about 11,000 beds in recently built or converted buildings. During that period I think I am right in saying that there has been a reduction overall of something like 13,000 beds. I do not know whether that answers the noble Lord's question.
Baroness VICKERSMy Lords, may I ask the noble Lord what is the position with regard to the Elizabeth Garrett Anderson Hospital?
§ Lord WELLS-PESTELLMy Lords, apart from the fact that this is wide of the Question, I said at the beginning that I do not think that I ought to try to discuss the situation of particular hospitals.
§ Lord DAVIES of LEEKMy Lords, we appreciate the care which my noble friend has taken in giving us these answers, but could he say what criteria are contained in the formula before a hospital is closed? Secondly, is my noble friend aware that the incubus of administration has a frustrating effect upon surgeons and consultants and that often this in itself can cause delays? Finally, is it not therefore time that Parliament should look at this administrative incubus and decide whether the 613 number of administrators should be lessened and that the number of surgeons and consultants who do the real job should be increased?
§ Lord WELLS-PESTELLMy Lords, with regard to my noble friend's last point, may I remind him that it was the re-organisation introduced by the Party opposite that seriously increased the number of administrators in the National Health Service. I have already given noble Lords a number of reasons why hospitals are closed and I do not propose to go over that ground again. I am afraid that I have forgotten my noble friend's other point. However, where hospitals have been closed, it is because it is possible to offer a more effective service in another hospital in the area.
Earl FERRERSMy Lords, to return to the question of waiting lists, is it not a fact that, if you close a hospital because, as the noble Lord says, the facilities are not good enough and transfer people to another hospital where the facilities are greater, you add to the waiting list of that other hospital, which is already, presumably, a long one?
§ Lord WELLS-PESTELLMy Lords, as I have said, by closing one hospital, one can very often add to the efficiency of another. There is the question of staff; there is the question of medical personnel; there is also the question of operating theatres which are not going to be used but which could be used in another setting.
§ Lord SANDYSMy Lords, while recognising that this may be so in certain cases, is it not true, from the figures the noble Lord has given, that there is a net loss of 2,000 beds?
§ Lord WELLS-PESTELLMy Lords, that is true, but I would remind your Lordships that a good many of these result from the closure of hospitals and hospital wards where there have been patients undergoing psychiatric treatment. It has been part of the policy of this Government to try to get as many people as possible out of institutional psychiatric hospitals and return them to the community. If I may say so, we have been very successful in doing this. In those 614 cases, it has not been necessary to use a great number of beds, and in that sense there has been a reduction.
§ Lord SEGALMy Lords, would my noble friend not agree that an efficient modern hospital can maximise the use of the beds available and of the operating theatre facilities?
§ Lord WELLS-PESTELLMy Lords, that is the chief reason for a policy that we have at the moment of building what we call "nucleus" hospitals, which will give a great deal more flexibility at the present and in the future.