HL Deb 15 December 1983 vol 446 cc346-9
Lord Auckland

My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government how many hospital closures have taken place during the past ten years: how many new hospitals have been built during that period: and whether they will bear in mind the special needs which the cottage hospitals meet, especially in country areas.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)

My Lords, from 1st January 1974 to 30th September 1983, 413 hospitals were approved for closure. From 1st April 1974 to 31st March 1983, 141 major hospital building schemes were completed. Decisions about the organisation of services should reflect local needs and are primarily for health authorities following local consultation. This includes the role of small local hospitals.

Lord Auckland

My Lords, I thank my noble friend the Minister for that Answer, but the matter still gives rise to a great deal of concern. It is generally accepted that there has to be closure of old hospitals from time to time, but has his attention been drawn to an article in the Guardian on 14th December? It concerned Welwyn Garden City, which has a new general hospital, and the Westminster Children's Hospital, where bone marrow transplants are carried out. Can my noble friend confirm or deny that consultations took place with those hospitals before closure was contemplated? On the question of cottage hospitals, is my noble friend aware that in rural areas, especially with transport problems growing worse, it is becoming increasingly essential to keep cottage hospitals open where possible?

Lord Glenarthur

My Lords, my noble friend has asked a general Question about closures, and I do not think that it would be proper for me to be drawn on detailed issues. I am aware of the article to which he refers. The document referred to in the article is nothing more than a simple working document, illustrating the relationship between National Health Service resources and provision in certain parts of the North-West Thames area. Before any strategic proposals can he implemented, they must be the subject of full public consultation. Where proposals for changes in the use of hospitals are opposed locally, the final decision will rest with my right honourable friend the Secretary of State for Social Services.

We acknowledge the valuable part that is played by small, local cottage hospitals. There are many advantages to local communities in having a small hospital which they can identify and which treats cases that do not require the full range of investigation and treatment which is available in a district general hospital.

Lord Hatch of Lusby

My Lords, may I ask the noble Lord to be a little more forthcoming about the second part of the Question, which concerns cottage hospitals? Is he aware that in rural areas many cottage hospitals have been closed, or have had their services curtailed? I should like to give him one example. In the area of Skegness—which caters for about a quarter of a million people in the holiday period—in the evening, people needing attention now have to go to Boston, which is 25 miles away. Is it not sensible for the Government to grant extra facilities to cottage hospitals in rural areas where frequently the need is immediate?

Lord Glenarthur

My Lords, I hope that I said just now in answer to my noble friend Lord Auckland that the Government acknowledge the value of these hospitals. I am not aware of the point concerning Skegness. Of course health authorities are bound also to look at the cost of the service provided.

Lord Wallace of Coslany

My Lords, is the noble Lord aware that, as a result of financial pressure on district health authorities, inevitably the smaller hospital is the victim of projected or actual closure? The tendency today is for the larger hospital to survive at the expense of the smaller one. Furthermore, can he tell the House how many more projected closures are in the pipeline so far as the new policy of the Government is concerned? Perhaps he could break down the 413 closures since 1974 and tell us how many there have been since 1979.

Lord Glenarthur

My Lords, so far as the last part of the noble Lord's supplementary question is concerned, I am afraid I cannot give him that answer without working it out, which would take me more than a minute or two, and I have not got the latest figures available. So far as the district health authorities are concerned and their responsibility towards local hospitals, it is, of course, health authorities themselves which have got to determine how services should be organised to get the best value from the available resources for all the communities they serve. It is up to them to work out, in consultation with all others concerned, the pattern of services which best suits local needs.

Lord Renton

My Lords, is my noble friend aware that the Government's policy of getting mentally handicapped children out of hospitals and into the community is warmly applauded? Is he aware that there are a number of mental hospitals which are well known to be unsatisfactory? And can he say whether any mental hospitals of that kind are included among the figures he has given of hospitals closed down?

Lord Glenarthur

My Lords, not without notice, I am afraid; but certainly there are plans to close some mental hospitals because, as my noble friend will be aware, they are consumers of a considerable amount of revenue. That revenue, as he so rightly says, will be much better spent on care in the community.

Lord Kilmarnock

My Lords, the Government have introduced these cuts in the middle of the financial year. Some authorities, as I am sure he is aware, have underspent owing to their uncertainty of Government intention. Would the noble Lord agree that the best way to solve this problem would be to allow them to carry the money forward to the next financial year without penalty? Would not the solution be to raise the carry-over limit from 1 to 3 per cent. and allow it to be put to capital account so that this money is not spent on hasty financial window dressing?

Lord Glenarthur

My Lords, with respect, I think that question goes rather wide of the narrow Question on the Order Paper.

Baroness Masham of Ilton

My Lords, does the Minister agree with me that the small cottage hospital generally deals with low technology medicine and is usually for the elderly and the infirm? Would he agree that it is much easier to close a small hospital than a large one? But are the expenses of the ambulance services taken into consideration, because with rural transport being cut back the elderly and the infirm have difficulty in getting to hospital if it is not near their home unless they go in an ambulance?

Lord Glenarthur

My Lords, I am sure that the health authorities concerned will take the point about ambulances into account before they reach any decision on the closure of hospitals. But it is, of course, as I said earlier, a matter for the district to decide how they should best use the resources which they have at their disposal.

Lord Molloy

My Lords, would the noble Minister not agree that one cannot just shift the blame on to RHAs? What RHAs have to do is carry out the policy of the Government of the day. Several clauses have been implemented without any discussion whatsoever with the staff, nurses, doctors, midwives and so on—

Noble Lords


Lord Molloy

I am coming to the question—be patient. Would the noble Minister not agree that it might be a good idea for everyone—the RHAs themselves and their staff—if the staff were brought into discussions before the decision is made? If it goes the wrong way they then have to join the unemployed. Members of our National Health Service are now being added to the total of the unemployed. Surely, that cannot be a good thing.

Lord Glenarthur

My Lords, I do not agree with what the noble Lord says. The fact remains that there are representatives of the professions as members of regions, and they of course express their views at regional meetings. No doubt these are all taken into account when the district raises the possibility of closing a hospital.

Baroness Gardner of Parkes

My Lords, is the Minister aware that there are some districts—for example, one in north Westminster—where the meetings of the health authority have reached such a degree of consultation that the members of the district authority are almost suffering intimidation from the hundreds of people who attend who are all staff employees? This is really an attempt to intimidate those members in the decision making.

Lord Glenarthur

My Lords, I am not particularly aware of the point at the place which my noble friend mentions, but I entirely deplore that sort of attitude if it prevails.