HOSPITAL SERVICES IN OMAGH

HL Deb 16 January 1980 vol 404 cc250-70

9.36 p.m.

The Duke of ABERCORN rose to ask Her Majesty's Government whether they will make a statement on the future of hospital services in the Omagh district. The noble Duke said: My Lords, in asking the Government to make a statement on the future of hospital services in the Omagh area, it is most reassuring to know that one has the entire support of the local community, since there is deep concern for the future health services in this area as a result of a recently published working party report for the Western Area of Northern Ireland. This concern is not based on sentiment or indeed on civic pride but on the future welfare of the patients, for in any remote rural area of high unemployment, health facilities are rightly regarded as of paramount importance and top priority. These factors are even more crucial and pertinent in the case of the Omagh area, since this catchment area is not only the most westerly part of the United Kingdom, where the population is subjected to a much lower standard of living than in most comparable parts of Great Britain, but it is also exposed to all the pressures and tensions of civil violence.

Therefore the current Omagh hospital services provided by a dedicted, hardworking and highly skilled medical and nursing staff represent an added dimension of importance. It is right and totally proper that the entire community should express its grave concern and anxiety that its one and most important plank of comparable service with other parts of the United Kingdom—its health services—should now be plunged into doubt and uncertainty. To sever this one focal point of psychological and actual stability, the Tyrone County Hospital by downgrading its services as recommended in a recent report to the Western Health and Social Services Board, is rightly regarded as something which would result not only in a reduction of a current standard of patient care and in loss of employment but also in inconvenience and stress to patients, visitors and relations.

At this stage I should inform the House of the main recommendations of the working party for the future of the two Omagh hospitals. It has been recommended that the Tyrone County Hospital, which has been the main acute hospital for County Tyrone for over 100 years, should be downgraded to a community hospital and that, once established as such, the largely geriatric Omagh General Hospital should be closed. As a result, all patients requiring admission for skilled attention, including of course those who are chronically or seriously sick, would be subjected to a tortuous and bumpy journey by ambulance to an expanded Erne Hospital which would provide all necessary acute hospital facilities. Omagh is separated from Enniskillen by a 28-mile drive on a substandard and totally inadequate road. The working party recognised the current hazardous conditions of this road, and I quote from their detailed report as follows: The Board of the Department of Health and Social Services should enter into discussion with the appropriate road authority with a view to upgrading the main road between Omagh and Enniskillen as a matter of priority". This recommendation (Chapter 6) of the working party is an essential prerequisite of their strategic plan. However, the cost of upgrading the road to single carriageway without hard shoulders would be in excess of £10 million at current costs. Therefore the probability of this happening is minimal, in view of the Government's current public expenditure policy. Surely implementation of the working party proposals and the improbability of the Omagh-Enniskillen road being upgraded would increase danger to life in emergency cases.

I am assured that there is already in existence close co-operation among consultants at the Tyrone County Hospital and the Erne Hospital, which must result in providing additional medical benefits to the community. However, this welcome functional integration in no way necessitates structural centralisation. It must be accepted that the recommendation to merge the acute services of the Tyrone County Hospital and the Erne Hospital would simply be merging two small, acute hospitals into a larger hospital at very considerable cost and distress to the Omagh district community.

The Western Health Board, and indeed the Government, must decide whether the proposed hospital, serving as it would a population of approximately 120,000 people, would in fact permit sub-specialisation to any significant extent. In other words, a very considerable capital expenditure could he incurred without a significantly improved service for patients. Here I should like to quote a recent statement on centralisation by the Health Minister, Dr. Vaughan, who is reported to be an advocate for the retention of small hospitals: At the end of the day you haven't improved the service for patients at all—just moved them around". A retired and distinguished Erne hospital surgeon underlined this prospect in a recent letter to the local paper, The Impartial Reporter. He said: The report shows that the present overall total of beds in both hospitals is 441, whereas the proposed complement of the single acute Erne hospital would be 268. These figures are not necessarily comparable due to probable redistribution, but general surgical bed totals fall from 138 to 85; general medical from 117 to 73; and obstetrical from 62 to 51. I find these figures difficult to credit and assume that only a hyper-rapid turnover of cases could cope with this reduction of beds. The result, I imagine, will be a constant stream of ambulances between Enniskillen and Omagh carrying only post-operative cases and others for convalesence. Can this be fair to surgeon or patient? ".

I can assure this House, and indeed the people of Fermanagh, that I want to see an improved Erne Hospital working in collaboration with an improved Tyrone County Hospital to provide an extensive, but not remote, service to the community. The desire of the patient to have hospital treatment provided locally and within easy access of his home is not disputed by the working party. However, the report maintains that this service is no longer possible. In particular, a member of the working party is quoted as having said at a public meeting: The main problem at Omagh is to sell jobs which are not attractive to the medical profession ".

Unfortunately, the report failed to mention the strong medical opinion that patients can be better taken care of and respond and recover more swiftly in their own environment. In fact, regular visits from family and friends are regarded as an essential ingredient in the recovery process. Of course, highly specialised treatment can he provided only centrally. However, in the case of Tyrone County Hospital, out of every 100 patients referred to this hospital 95 can be dealt with there perfectly adequately.

Again, we are assured that the argument for down-grading the county hospital is based on consultant staff shortage, and not on financial consideration. It is most doubtful that the recommendations, if agreed upon, can be implemented for at least 10 years, since money has already been allocated for all capital expenditure for that duration. It is common knowledge that there are more medical graduates now in the pipeline than ever before. In fact, I believe there is even talk of future medical unemployment, since opportunities for emigration have been mainly closed due to the attitude of the Canadian, Australian and American Governments. Therefore, can anyone realistically imagine or envisage a continuing shortage of consultants and doctors in the future? Again, there is a national nursing recruitment problem, but this is certainly not applicable, my Lords, to Tyrone County Hospital, since our district's tradition of nursing recruitment cannot be equalled in the Western Area of Northern Ireland. Is it therefore wise to downgrade a good hospital, situated right in the middle of its catchment area and with a plentiful supply of excellent, keen, young nurses?

No one can deny that there have been problems in maintaining acute hospital services in the Western Board Area, mainly as a result of consultant medical staff shortages. However, these staffing problems have not been unique to Tyrone County Hospital since many hospitals have experienced similar difficulties over the past decade. I welcome this report for highlighting this problem, for it should encourage a radical rethink of the current senior staff level of requirements, particularly since there are now so many doctors in training, which should surely not only ease the shortage problem but also ease the pressures on consultants' I workload. If the number of consultants in these small hospitals were increased from 2 to 3 in the major specialities, surely the dual objectives and purpose of reducing the"on-call"commitment and the opportunities for consultants to develop more effectively their special interest would in fact be achieved. I am assured that this is not a new concept since it is widely applied in most areas of the United Kingdom. Furthermore, if these opportunities were offered at the Tyrone County Hospital then the centralisation argument—the main argument put forward by the working party—would become irrelevant, if not redundant.

It is most unfortunate that there is only a passing reference to the Tyrone and Fermanagh Psychiatric Hospital, which provides facilities for 900 patients with a nursing staff of 150, since the needs of a large psychiatric hospital for the services of an actute general hospital are totally relevant and recognised as such by the Royal Commission Report which states: It is evident now that both mental hospitals and District General Hospitals are essential to a well-balanced psychiatric clinic". Yet the implementation of this report will result in a fragmentation of this service since the report totally fails to highlight the problem of moving psychiatric patients to Londonderry or the Erne Hospital for in-patient and out-patient care and the major implication for the ambulance service. I am informed that if the Tyrone County Hospital was to be down-graded, then increase in ambulance costs per annum would be £200,000 and in five years this cost would increase to half a million pounds per annum.

If the report is implemented, would the Tyrone and Fermanagh Hospital also be moved to Enniskillen? If so, is there an estimate available for the cost likely to be incurred? If not, what alternative arrangements for the patients' care will be provided in Omagh? Surely, there should have been more emphasis in the report on the profound effects of converting the Tyrone County Hospital to a community hospital on the excellent health centre in Omagh; for all the Omagh general practitioners are alarmed and concerned at losing consultant facilities for their patients. In conclusion, for the reasons already expressed, the Omagh community is appalled and alarmed at the thought of their acute hospital becoming a community hospital—in particular as the Royal Commision has come out strongly against the concept of community hospitals. I quote: There is still dispute about the best use of many small hospitals. It is clear that the community hospital approach is not acceptable—and we would deplore too rigid an approach". The Omagh community are rightly apprehensive that a bureaucratic, rigid approach will be applied to this complex but, above all else, human problem, which must be approached with an attitude of flexibility which is totally mindful of local opinion and requirements.

9.54 p.m.

Lord DUNLEATH

My Lords, I shall speak only briefly; first, because the hour is late, and, secondly, because I am virtually uninfected by any knowledge about this problem. But if your Lordships permit, I should like to broaden the discussion a little because I think that many of the points the noble Duke has made are relevant not only to other parts of Northern Ireland but to other parts of the United Kingdom as well. I take many of the points that the noble Duke has made, but, having consulted my medical friends, I think that he would probably agree with me that it seems that we are moving further into the position whereby there will have to be two sorts of hospital: first, the ordinary hospital where you go if you have a broken wrist or an ingrowing toenail or something like that, and, secondly, the major hospital which has to be equipped with highly sophisticated and extremely expensive equipment. It also has to have a team of technicians who are able to operate that equipment. The results of the treatment that has been developed in recent years by that equipment is such that it is obviously necessary, but it cannot be put into every hospital.

At the same time, the noble Duke is quite right in drawing attention to considerations of accessibility and remoteness—and to that I would add movement of population as well; and the geographical considerations have to be thought about. Indeed, one of my medical friends said that the vast increases in population in the North Down area would justify a new hospital there; and perhaps indeed it would, with hindsight, have been better to have spent some of the money that has been spent in expanding the city hospital in Belfast, where the population is declining, on a new hospital in North Down. All these considerations have to be taken into account.

I have been reading, are labouring to read, the consultative paper on the structure and management of health and personal social services in Northern Ireland. I would not presume to make any strong recommendations to the noble Lord about this because, quite honestly, I do not understand it; I have never sat on any of the boards. However, I am told that perhaps the areas are too big, whereas some of the districts could be amalgamated; and also that there might be an argument in favour of having advisory committees.

One thing I can speak about from personal experience is geriatrics. From time to time my constituents—and, unlike many noble Lords, I have constituents—ask me to try to get geriatrics placed into suitable care. It is a terrible job to try to do that. The advice that I have received is that we are now beginning to feel the effects of antibiotics and the highly sophisticated technical equipment to which I referred earlier. It used to be that if one contracted pneumonia—not only in one's seventies but in one's fifties—it was a fair chance that that would be fatal. That is no longer the case.

The percentage of elderly people in Northern Ireland who may or may not be geriatric but are at risk of being in need of treatment now, according to a recent report, is 13 per cent. As far as I can gather there is every reason to believe that that percentage will increase. Not just in Northern Ireland but nationwide the problem of placing geriatrics is going to become greater and greater. I am told that it is in the interests of the patients and of the staff that they should not be separated into different geriatric hospitals but that there should be geriatric wards in the general hospitals, otherwise staff who are going to be able to give the acute treatment that is desirable cannot be attracted. If geriatrics are on their own staff cannot be attracted and therefore the patients do not get the correct treatment.

Finally, may I make a quick reference to private medicine. I know that the noble Lord, Lord Melchett—who was subjected to some unjustified criticism for his rationalisation proposals of the hospital service in Northern Ireland—possibly does not agree with private medical treatment. My own view is that even if you consider it to be a waste of money to have private treatment, at least anyone has freedom of choice. If they want private treatment and are prepared to spend the money, they should be entitled to it.

In this instance, in Northern Ireland an independent clinic has been started. It has been alleged by the trade unions—and perhaps the noble Lord, Lord Blease, will want to comment on this when he speaks—that this will place a burden on the National Health Service. I have not a bad word to say for the National Health Service—they have stood me in good stead in my time—but I honestly think that rather than placing a burden on the National Health Service, the provision of additional beds will take pressure off them and make National Health Service beds available for those who cannot afford private treatment and who desperately need those beds. I would therefore urge Her Majesty's Government not to accept any doctrinaire attitudes towards this matter, but rather to say, when private enterprise is prepared to take an initiative and provide private medical treatment, that it should be encouraged rather than discouraged.

10.1 p.m.

Earl ERNE

My Lords, I shall also be brief. The hour is indeed late. I am deeply grateful to my noble friend and kinsman the Duke of Abercorn for initiating this debate and I should like to congratulate him on his excellent speech.

Unlike so many others in the Western area, I share his concern over the future of the Health Service in Omagh. My personal interest is in the neighbouring district of Fermanagh, and especially in the Erne Hospital, which is similar in many respects to the Tyrone County Hospital. It is much the same size and serves virtually the same number of people. It is held in equally high esteem by the local community. These two hospitals cover the scattered rural areas of West Ulster. However, great difficulties are experienced by both patients and visitors in reaching them owing to the very nature of their geographical situation, inadequate roads and poor public transport.

The Western Health and Social Services Board is at present studying a report which recommends rationalising these two hospitals by building up one acute unit to overcome the recurring staffing problems, which seem to have become worse in recent years. This board will have the unenviable task of deciding whether in fact this is justified or whether the alternative view should be accepted—that is, the increasing flow of doctors from our medical schools will enable small hospitals to remain viable in the future.

We in Fermanagh are most anxious for an early decision on this matter, not only to relieve the concern expressed by my noble friend the Duke of Abercorn but also because the present uncertainty is holding up a scheme of the Erne Hospital, which is causing considerable concern to me and my committee: that is, the replacement of Ward 7, which is long overdue.

This is where I agree with the noble Lord, Lord Dunleath, as it concerns geriatrics. Ward 7 is a geriatric ward, situated in a temporary building where the staff are doing a magnificent job under the most appalling and difficult conditions.

I do not wish to influence the board in any way in its deliberations, and while I wholeheartedly support what could be described as a"cry of mercy"by the Duke of Abercorn, on behalf of the hospital services in Omagh, I feel it my duty to emphasise the isolated position of Fermanagh, which is indeed the most western county in the United Kingdom, and to remind the board of the very considerable distances that exist between some of the outlying villages, such as Rosslea, Beleek and Derrylin, from the Erne Hospital in Enniskillen. It is for this reason that I feel it is of paramount importance that the full range of acute services are maintained in the Erne Hospital for the people of County Fermanagh, for which it was originally designed.

10.6 p.m.

Viscount BROOKEBOROUGH

My Lords, by leave of the House, I should first like to apologise for not having put my name down to speak. I went to the Whips' Office and discussed the number of speakers, but forgot to tell them that I was going to put my name down. Therefore, I apologise and I am grateful to the House for allowing me to speak.

I should like to start by welcoming this Question of my noble friend the Duke of Abercorn. I also welcome very much his noble kinsman, my noble friend Lord Erne. I was a little afraid when I saw that the two were speaking, one for Omagh and one for Fermanagh, that this new team which we have from the North of Ireland would end up fighting each other. But having heard the speeches, I am glad that they are both saying basically the same thing. I shall be saying the same thing and endeavouring not to repeat myself, because of this late and un-Christian hour.

This debate is taking place in this House now because we do not have a devolved Government to discuss these matters, which are not of great importance to the United Kingdom as a whole, but to us and to those in our area they are of great importance. So I am grateful to your Lordships' House for bearing with us even at this hour in discussing what to us, and to the people around us, is a very important matter. I live on the border between Fermanagh and Tyrone and I have benefited from Tyrone Hospital and from the Erne Hospital, so perhaps I can hold the balance. But I am afraid that I am not that kind of person, because I always find that I come down on one side or another.

In this case, I say to the Government: whatever the outcome of the question about Tyrone, Fermanagh must remain an acute hospital. I shall go on to say that I believe that Omagh should also be an acute hospital. But, whatever the outcome, the case for Fermanagh remaining an acute hospital is absolutely overwhelming. I say that, first, because of its geographical position. We have one-third of the total land frontier of the United Kingdom and we are a very remote area divided by a very large lough. We have a very modern building, designed specifically for the purpose of serving the population of County Fermanagh. It is tailor-made for that purpose. The morale of its staff is absolutely excellent. Any solution which deprived Fermanagh of an acute hospital would be a real hardship to the people of Fermanagh, to the patients and to the visitors who make the recovery of the patients that much quicker. What we want is speed of turnround in the beds, with patients recovering quickly and getting out of hospital.

Because of the late hour I want only to say how much I endorse what my noble friend the Duke of Abercorn said in his speech, which people should read very carefully, about the problems of recruitment and treatment. The problem that has arisen is almost entirely due to recruitment and the retention of specialist staff in these smaller hospitals, and it is a very difficult one.

Immediately after the war, we in both Fermanagh and Tyrone benefited from the fact that the fishing was extremely good. We therefore got people who came out of the Forces and who were dedicated fishermen as well as being dedicated medical staff. For years we have had the most marvellous specialist staff, because those people were interested in a way of life as well as in serving their calling. But a great issue has been raised by this report. The capital cost for enlarging the Erne Hospital is £5.8 million and it will cost £10 million to make the road viable. The view of the report is that it would be unthinkable for the Erne Hospital to be enlarged unless the road was improved; so we are speaking about £16 million which is not available and which cannot be made available for some time.

It has been recognised, in the case of agriculture, that there are certain areas of this country—and Northern Ireland is one of them—where there should be a remoteness grant. When one takes into account the interest on the amount of money we are speaking about, is there not a case for what I would describe as a "remoteness salary" in order to sweeten the life of the specialists and induce them to stay in County Fermanagh for a longer period, thus enabling both hospitals to be acute hospitals?

The argument which the noble Lord, Lord Dunleath, raised—but which at this late hour we cannot go into—is how specialist should an acute hospital be and how great should the specialist services in the great central hospitals be? That is a matter of judgment and I do not want to go into it. However, despite the most marvellous equipment at hospitals in Londonderry and Craigavan for the people of Fermanagh and Tyrone—I know that I am speaking with certainty about this—when it comes to their wanting real specialist services they think of Belfast. This has been emphasised more and more because of what are called "The Troubles". Belfast now has a specialisation that is unrivalled in the medical world anywhere in the Free World, and this has to be recognised.

I believe that the whole strategy of our hospital development must be looked at again. This fact must be taken into consideration, for it will be difficult to get it out of the minds of the population. One will be unable to re-educate the population under a very long period.

Therefore, I say two things. The level of acute hospitals must be maintained in Fermanagh and Tyrone, and if necessary we must innovate. We must not say, "Because we can't keep specialist staff, that's that. We must therefore spend £10 million on the road and £5.8 million on the building." We have got to find a method of paying sufficient specialist staff to enable us to have acute hospitals in those particular places. Secondly, we must look at the question of the tremendous specialisation in Belfast to which inevitably people are going to be drawn. Once more I should like to thank the House for its courtesy in allowing me to speak and to thank the noble Duke for raising this subject.

10.13 p.m.

Lord BLEASE

My Lords, I should like to compliment the noble Duke, the Duke of Abercorn, on the reasoned and very comprehensive way in which he presented the various issues concerning the future of the health services in the Omagh district. The noble Duke has rightly and fairly drawn the attention of this House to the great wave of public concern and anxiety about the Western Health and Social Services Board's working party proposals to downgrade the Tyrone County Hospital and to close the Omagh General Hospital.

During the past few months these issues have given rise to some of the largest public demonstrations and meetings ever held in the Omagh area. In August, an estimated 6,000 took part in a protest march, and on 27th November there was a capacity crowd of 350 in the Omagh town hall at a meeting arranged by the Omagh Trades Council. There is total opposition to this part of the working party's report on A Strategic Plan for the Hospital Services. In the current Northern Ireland scene, this total opposition is unique. All the elected members of the Omagh District Council, representing six political parties—Left, Right and centre—signed a document on 13th December last expressing determination to oppose the recommendations in so far as these relate to the Omagh district. This opposition is based on a careful study of the working party report, in addition to the outcome of a specially commissioned independent report prepared by a group comprised of elected representatives and the representatives of trade unions, community and consumer interests, as well as medical and relevant professional specialists.

It is claimed that the recommendations of the Western Health Board's working party report, if implemented, will have very serious consequences for the people of that area and the noble Duke has already mentioned a few of those particular consequences. I may be repeating what he has said but I will be brief. The consequences include a significant reduction in the standards of patient medical care; serious avoidable inconvenience and distress to patients, relatives and visitors; a vital loss to the area of persons with important professional and specialist skills and their overall contribution to the life of the community; a critical loss of jobs in an area of chronic high unemployment and a considerable untoward effect on the community morale and the industrial potential of the Omagh district by the downgrading and the closure of valuable and vital public services.

However, it is my own opinion that the issues are much deeper than matters concerning the number of available hospital beds and the status of a particular hospital within the health and social services board management hierarchy. I will resist the very tempting bait offered by the noble Lord, Lord Dunleath, to go further on other matters but I should like to say that under the Labour Administration there was in Northern Ireland a progressive hospital programme based on a foundation of community care and an environmental approach to hospital and social services.

The good health of a community depends on much more than hospital beds and highly sophisticated medical technology, important as those are. There is a need for a development and expansion of local health centres. There is a need for improvements in preventive medicine and in health care through the provision of health visitors, social workers, home helps and other suitably trained ancillary health and social service personnel. Any curtailment of these services and the health provisions adds burdens to hospitals of whatever kind and specialisation. The need in Omagh is for more and better health and social services, not for curtailment, cuts or closures. Therefore concerning the report and the issues involved I hope that the further consultation promised on 13th December by the Minister of State, Mr. Michael Alison, will take place before decisions are made.

I support the noble Duke's approach to the question concerning the Omagh services and of course I shall await with interest the Minister's reply.

10.13 p.m.

Lord ELTON

My Lords, I should like to thank my noble friend the Duke of Abercorn for raising in this House tonight the question of the future of hospital services in the Omagh district. These services are at present provided from the Tyrone County Hospital and the Omagh General Hospital, both of which are located in the town of Omagh. I welcome the opportunity to explain on behalf of the Minister responsible the Government's position in this matter and to clear up any misconceptions which may have arisen. These matters are, as my noble friend Lord Brookeborough rightly said, of very great local importance and this is recognised by Her Majesty's Government, who are not entirely taken up with matters of great estate for the whole of the United Kingdom.

First of all, I should like to say as firmly and clearly as possible that no decisions have been taken by the Western Health and Social Services Board or by my honourable friend the Member for Barkston Ash, who is the Minister responsible, on the future role of Tyrone County Hospital or on the closure of the Omagh General Hospital. The noble Duke referred at several points in his speech to a working party report which has also attracted considerable attention from other speakers, notably the noble Lord, Lord Blease. This working party investigated the future of the health services in the Western Area. While I am grateful to noble Lords for their penetrating critique of that report, I should like to make it quite clear that the recommendations of this working party carry the authority neither of the Western Board nor of the Government.

I think it would be helpful to inform noble Lords of the administrative structure of the health and social services in Northern Ireland and of the origins of the working party referred to by my noble friend. The Western Health and Social Services Board, in common with the other three boards which together serve the province, is the body charged with the delivery and planning not only of health but also of personal social services in its area. It is answerable directly to the Department of Health and Social Services of the Government of Northern Ireland. There is no intervening regional tier as there is in England.

As part of its planning responsibilities, the Western Board established in 1976 a working party charged with making recommendations to the board on the best future pattern of hospital services for its area. Noble Lords should note that the working party was not a departmental working party and it did not report to my honourable friend's department. The noble Duke has recognised the medical staffing problems which have beset not only the Tyrone County Hospital in Omagh but other hospitals in the area from time to time. Concern at these continuing problems was one of the reasons for the establishment of the working party. The working party spent almost three years examining in detail the present hospital service in the Western Area, and I think it is worth noting that it did not go about its work behind closed doors, but consulted widely at all stages.

The working party made its report to the Western Board in June 1979, and the board has since undertaken wide-ranging consultations with interested organisations and individuals. It has in fact made a very considerable and time-consuming effort to reach as many people as possible. I am sure the board would like to complete its consultations as soon as possible and thus remove speculation on the future of individual hospitals; and this will I think be particularly of interest to the noble Earl, Lord Erne, who pointed out with specialist knowledge the difficulties in which uncertainty as to the future places planning bodies when it comes to the administration of hospitals. I am told that none the less the board has given an undertaking to Omagh District Council that it will not reach recommendations until that council has completed a report specially commissioned by it to counter the working party's report. This, I think, underlines the importance the Western Board attaches to the need to give every opportunity to local bodies to comment. This is entirely in line with the Government's view that local communities should be involved as far as possible in determining the future of their own local hospitals.

I should add that the report itself, and a popular summary thereof, are freely available to the public, and indeed to noble Lords, from the Western Area Health and Social Services Board. Obviously noble Lords who have spoken in this debate will have copies, but I believe that some may read this debate and interest will be lit in their breasts also. I am sure that in the circumstances which I have explained noble Lords will understand that it would be quite wrong for me to comment on the findings or recommendations of the working party's report, including those recommendations concerning hospital services in the Omagh district, until the Western Board has completed its consultations and made recommendations to my honourable friend. However, I want to emphasise that my honourable friend will not take any final decisions on the board's recommendations until he has also consulted local interests on his own behalf. Indeed, he stated this publicly himself when he visited Omagh and met members of the district council and senior hospital staff on 13th December last.

I do feel, however, that I can comment on some of the more general points raised by noble Lords during the course of this debate, and that I can do so without prejudging the decisions which have yet to be made. Firstly, I should like to underline my noble friend's comment on the close co-operation between the medical staff of the Erne Hospital in Enniskillen and the Tyrone County Hospital in Omagh, and to stress the need for such co-operation. Indeed, there has been a meeting between the two medical staffs within the last ten days. I also endorse entirely what he has said about the dedication of medical staff at these hospitals over the years; they have continued to provide a service, sometimes at the cost of great personal sacrifice and in the face of chronic staff shortage. It is therefore essential that these scarce skills are pooled to ensure the maintenance of stable services. Indeed, I note that the working party urged this as an essential item until such time as its recommendations could he implemented.

Even if the report's recommendations are accepted, I can say that there will not be any appreciable change in the role of Tyrone County Hospital for some years to come since Northern Ireland's Capital Development Programme for Health and Social Services, as has been rightly pointed out, is fully committed for at least the next three or four years, and the development of the Erne Hospital at Enniskillen, suggested in the report, would have to be considered in relation to other priorities throughout the whole Province. For that reason also it is essential that the medical staff of the two hospitals should continue to work closely together.

I can also say that the Government and the Western Board will continue to give the fullest support to the staff of these hospitals in their efforts to maintain services to the public. At Tyrone County Hospital, for example, money in the region of half a million pounds has been spent since 1972 on improving facilities, and schemes currently in the pipeline for the hospital will cost at least a further £200,000. This bears witness to the Government's awareness of the need to maintain Tyrone County Hospital in the shorter and medium term, regardless of any decisions on its long-term role.

My noble friend also raised in his speech the role of the Tyrone and Fermanagh Hospital which is a large psychiatric hospital located outside Omagh. The future of that hospital was not dealt with by the working party report, but I can state quite clearly now on behalf of my honourable friend that there never was a question of moving it elsewhere. Its future in its present location is not in question although, of course, as my noble friend pointed out, the fact that an acute hospital is next to it, or is not next to it, is a matter which will concern him and those examining the report when it is finally considered by my honourable friend.

Whether the Erne Hospital will be expanded as proposed in the working party's report remains to be decided by the Western Board, and ultimately by the Minister responsible. However, I should like to make it absolutely clear that, regardless of these decisions, the Erne Hospital, like the Tyrone County Hospital, will continue to provide acute services for the people of Enniskillen district for some years to come.

The noble Lord, Lord Dunleath, widened the debate beyond the limits set by the Question; indeed, he loosed a hare and invited the noble Lord, Lord Blease, to hunt it, which the noble Lord, Lord Blease, prudently and most welcomely refused to do. So I shall also not be hallooed away on to a fresh scent. He also suggested that it would have been wiser perhaps to spend money on a new hospital in North Down than elsewhere. I am not certain whether he is aware of this, but a team from the Eastern Board is now reviewing hospital services in the Eastern area and I do not doubt that they will be taking into account the population pressure to which the noble Lord referred.

A number of noble Lords rightly referred to the staffing problem, and the noble Viscount, Lord Brookeborough, in particular pinpointed that as central to the problem and wondered whether a remoteness allowance might, to use his words, sweeten life for those grades of staff who are in short supply. Attractive though the idea may seem, I regret to tell him that that scheme has been tried elsewhere in the United Kingdom without success, and for that reason it has not been tried in the Province.

The noble Lord, Lord Blease, spoke with concentrated feeling of the concentrated public feeling existing in the Omagh district. Having correctly voiced his understanding and sympathy with that, he then went on to point out that one cannot look at one area of provision in isolation, and it is how one deploys the whole of one's resources that determines how one is free to deploy them in a particular area. He ended with a plea that my honourable friend in another place would honour his commitment to enter into full consultations before arriving at a conclusion. I have already assured him that that commitment will be honoured, and I repeat that undertaking now on behalf of my honourable friend.

Finally, I should like to assure the noble Duke and other noble Lords that the detailed points which have been made during this debate will be brought to the attention of the Western Board, and I am confident that the board will take them fully into account when arriving at its recommendations. They will also be carefully considered by my honourable friend before he comes to a final decision. He will take account of the board's recommendation, but, as I have already said, he will undertake further consultation on his own behalf with local interests before taking final decisions.

As noble Lords know, it is this Government's view that small hospitals should continue to play an important role in providing services to local communities wherever sensible and practicable. The noble Duke and the people of Omagh can be assured that the continuing problem of maintaining high-quality hospital services not only for the Omagh district but, indeed, for the Western Area as a whole, is being approached by the board, and in due course will be approached by the Minister responsible, in the most sympathetic and flexible way possible.