§ 8.7 p.m.
§ Baroness Macleod of Borve rose to ask Her Majesty's Government whether they will make a statement on the future of the South London Hospital for Women.1501
§ The noble Baroness said: My Lords, I rise at this very, very late hour to ask Her Majesty's Government if they will make a statement on the future of the South London Hospital for Women. But, before I do so, I hope that your Lordships will allow me to thank in advance—because I am not allowed to do so at the end—all noble Lords who are taking part in this debate and also other noble Lords who would have liked to do so but who unfortunately are not able to be here this evening. I should also like to thank all those outside the Chamber who have given me and all noble Lords who are taking part, such a great deal of support and help as regards this debate, and to welcome the noble Lord, Lord Lawrence, who will be making his maiden speech. We certainly look forward to hearing him.
§ For the last three hours I have spent my time tearing up most of what I wanted to say because I knew that it would take me too long to say it. But, in my view, this hospital is not only unique, but essential. It is 70 years old. It occupies an excellent building, which cannot be said of all the new buildings. It is called the "South London" hospital which means, to most people, a geographical area, but it by no means covers only that particular area of London. It covers the whole of London and many patients come from all parts of the country. Along with the Elizabeth Garrett Anderson Hospital, it is unique in that, completely and throughout, the whole of the hospital is staffed by women for women. It is unique also because of the number of disciplines and the number of out-patients with which it deals.
§ I feel it worth stating the disciplines here because then your Lordships will have some picture of the amount of work done in this hospital. Medicine includes cardiology, rheumatology, gastro-enterology, diabetes and endocrinology; surgery includes a breast clinic; obstetrics includes a GP delivery unit; gynaecology includes cytology, colposcopy and infertility. There are special clinics for dermatology and psychiatry; there is a dental clinic, a clinic for radiotherapy and ophthalmology; there is a dietician, and a chiropody clinic; there is family planning, including psycho-sexual counselling, a day-care abortion unit, and a clinic for venereal disease. I think that that is enough to show your Lordships that it is a vitally important hospital.
§ However, from all the people to whom I have spoken about the South London Hospital for Women what comes out loud and clear is TLC—tender, loving care—which is given by those members of the hospital to their patients. That come out very clearly indeed.
§ This hospital is essential because I and many other people in your Lordships' Chamber believe in freedom of choice. We believe that we should be able to be treated and to be counselled by a woman. No one can tell me that if one goes to a general hospital, even if one is lucky enough to be seen by a woman consultant at the beginningg of one's treatment, one will go on being treated by a woman. Therefore, I think that freedom of choice is essential.
§ It is also essential for the ethnic minority who live in that part of London and, indeed, in many other parts of London, because, as all noble Lords will know, part of the religion of some of the ethnic minorities is that they have to be treated by a woman.1502
What are the reasons for the possible closure? It seems to me to be entirely financial, but even that does not hold water, because the cost of a bed at the South London Hospital is 57 per cent, the cost of a bed at St. George's, Tooting, where the patients will go if the present scheme is allowed to go ahead. I agree with my honourable friend Mr. Shelton, who said in an adjournment debate in another place on 19th July, at column 353 of the Official Report:
of course one appreciates the ambitions of those who wish St. George's to be a showpiece and one of Europe's finest hospitals. No doubt there are some who regard the South London as standing in the way of that ambition. However, I think that hon. Members will agree that ambition must not overrule logic, commonsense and financial prudence".
§ Those of us who have anything to do with vast hospitals know how expensive they are, how soulless they can be, and how quickly they can become unreal white elephants. My noble friend Lord Porritt, a previous president of the Royal College of Surgeons, has allowed me to quote him as saying that he likes small hospitals, and is in favour of hospitals for women. However, he was not able to join us this evening.
§ At the moment the position is that on 30th June the district Health authority decided on closure next April. The voting was 10 in favour, seven against, and one abstention. That decision was ratified by the regional health authority. But it is interesting to note that the four medical members of the district health authority of Wandsworth work at St. George's, and that by no means all members of the authority have even been to the South London Hospital.
§ However, the important point is that the Community Health Council, which is the statutory representative of the public, is completely opposed to closure, and it has been backed by many members of the district health authority. Recently I had the privilege of going to the South London Hospital and, on behalf of the staff, the League of Hospital Friends and the GLC, all of whom are optimistic for their hospital, I handed over a laser—a vitally important piece of equipment—which cost those people £25,000.
§ There is a very great deal of feeling in the country, and, of course, especially in London, about the possible closure of this hospital. Last week a meeting was held in the Grand Committee room downstairs at which the noble Countess, Lady Mar, was present with me. The Mothers' Union was represented and spoke, the Women's Institute was represented and spoke, the Catholic Women were represented and the Leagues of Hospital Friends were represented. It was a very full enthusiastic gathering. It was, of course, also attended by the medical staff, and all the staff of the hospital were represented at that meeting. I have since received a letter from the chairman of the Women's Institute in which she says that all of her 360,000 women members of the institute are behind her in asking the Government not to close this hospital. The Prime Minister has also received some 55,829 signatures.
§ I said that I would be brief, and I shall be. In conclusion, through my noble friend Lord Glenarthur, I would ask the Minister to make whatever financial provision is necessary. I would also ask him not to allow this great hospital to close. Once closed, it can never regain its special, unique and essential position. 1503 I know that he will listen to all sides, but the dedicated staff at all levels hope that he will realise how vital their work is in the field of medicine in this country.
§ 8.18 p.m.
§ Baroness Denington
My Lords, I am sure that all of us in this Chamber and, if they were able to, many thousands of women outside this Chamber, would love to congratulate the noble Baroness, Lady Macleod, and thank her deeply for raising this very special and particular issue just before the summer recess. For it is absolutely essential—and I hope that the Government will listen with great sympathy—that this hospital shall not close. It is that for which we are pleading.
The noble Baroness, Lady Macleod, has made it clear why the hospital is under threat. I agree with her that it looks as though it is a financial matter, because the Wandsworth Health Authority wants to build this magnificent wing at St. George's. It will cost a lot of money to build and I understand that it will cost a lot of money to run. I think that in the other place Mr. Shelton mentioned that it would cost £13 million per annum at 1982 prices to run. So that health authority is looking round at its holdings to see what it can do in order to have that fine project, and what it can do in its pool of accommodation to save a little money. I cannot think how it could do it, but it has; its eyes alighted on this small hospital for women along Clapham Common, which would apparently save it £5 million a year. For some, £5 million is indeed £5 million; but that is all it is.
I think the noble Baroness, Lady Macleod, did not mention that the West Lambeth Authority has pointed out that if the South London Hospital is closed then its area will be short of 80 beds. When this issue was referred to the Wandsworth Health Authority they apparently said, according to Mr. Shelton, that it was no concern of theirs. I find that a most irresponsible and regrettable attitude for any health authority to take.
The noble Baroness, Lady Macleod, mentioned the unit costs of South London compared with St. George's. That is something that should be noted carefully. I agree with the noble Baroness, Lady Macleod, that small is beautiful. Have we not begun to learn that lesson yet in this country? Have we not seen that we now want smaller schools? The housing estates, great blocks of flats and so on, are not what people respond to. They are not economical; they are not what the nation requires. Small is beautiful.
I use the word "small", but I would make it clear that we are not talking about a cottage hospital, a tiny hospital. This hospital, as the noble Baroness, Lady Macleod, made plain, is wonderfully well-equipped. It gives wide services over a wide field. It has four fine operating theatres. It is an excellent, well-equipped hospital which stands on its own. The desire of the Wandsworth Health Authority to build this other wing should have no effect on the South London Hospital for Women at all.
It is a special hospital. It treats only women. It is entirely staffed by women, and it should be kept as a completely separate unit. It has been under threat 1504 before, but any threat to close it should be forgotten for ever as long as it lasts. It should be allowed to stand on its own for the special thing that it is, keeping its own identity, with no question of amalgamating it with anything else at all.
I, too, do not want to speak too long because the hour is late. The main point is that it is a hospital exclusively for women, staffed by women. It is rare and valuable, and I must say I agree with the noble Baroness, Lady Macleod, that it is a greatly appreciated institution. It has enormous local support. I live within half-a-mile of it, so I know. I have also experienced it as a patient, and so I again know from the inside how excellent it is. It is wonderfully well served by public transport. It has a Tube station across the road with a pedestrian crossing to bring people across to it. It is well served by buses, and the building is an excellent and attractive building.
I do not ever count myself as a feminist. I do not join women-only committtees, or anything of that sort at all. I agree that they do a good job of work, but they are not for me. However, there is an essential and strong case for keeping a women-only hospital. Let us be frank: women are physically different from men. We have body rhythms that are different from men. These body rhythms affect women physically, psychologically and emotionally. The best of men doctors do their utmost, I am certain, to understand women's problems, but their understanding must be an intellectual understanding. A woman doctor is a woman, and she understands a woman's problems as only a woman can. In medical matters this is vitally important.
A woman doctor has an innate and intuitive understanding. I am sure your Lordships would all agree that there are things that a woman would tell a woman doctor which, however skilful and sympathetic a man might be, he would never get out of her; things that would reveal hidden problems that were affecting her physically, mentally, and emotionally. Therefore, to have women doctors available for women in a hospital where you know you are going to have a woman doctor is important.
It is not the same to go to another hospital, however good, and to be told, "Well, you can have a woman to see you, but it cannot be guaranteed that you will never come up against a man doing something for you, or seeing you in such a hospital." It is not possible to guarantee that; and it has to be guaranteed for some women, such as the ethnic minorities, which have already been mentioned. This is important. It is important to a woman not to have to go to another hospital and to have to say, with some diffidence, "I would like to be seen by a woman". She does not want to have to do that. She wants a hospital where she knows that she is going to have a woman. Why should she not have such a thing? Are we asking for something extraordinary for women—one little hospital? Not Elizabeth Garrett Anderson, but just this one other hospital. Surely it is not too much to ask; surely it is a proper thing to be granted.
I mentioned that I went to the hospital as a patient. I remember going home afterwards and saying to my husband, "I was most impressed". I know those were the words I used. As a patient I was most impressed by 1505 the reception; by the examination; by the down-to-earth questions that were asked me; by my treatment; by everything in that hospital. I have also been to other hospitals. I go to St. Thomas's, which is a fine hospital; but this little hospital was different, and it was absolutely excellent. I shall not continue any further, but we must plead with the Government to let us. as women, keep our little hospital because it is so first-class.
§ 8.28 p.m.
§ Lord Kilmarnock
My Lords, the whole House will be grateful to the noble Baroness for putting down this Question. It is well known that we on this Bench and our Liberal colleagues support the principles of the National Health Service in an unqualified manner. We committed ourselves in our manifesto to allow for the growth required by changing age patterns in the population, as well as to provide £500 million for experiments and innovative practices in medicine. At the same time, we are acutely conscious of the cost factor, and would certainly want to seek productivity improvements wherever possible without loss of service.
In this particular case, that of the South London Hospital for Women, we of course understand the genuine concern expressed by the noble Baroness, and so movingly by the noble Baroness, Lady Denington, who has just sat down, over the future of this hospital, with its great tradition and fine record of service. Certainly, also, the "small is beautiful" argument is attractive. That, again, was eloquently put by the noble Baroness, Lady Denington.
It was in fact argued by Mr. William Shelton in another place in the adjournment debate mentioned by the noble Baroness. Lady Macleod, on 19th July, at col. 354, that hospitals with between 100 and 300 beds are usually cheaper to run than those with over that number. Perhaps the noble Lord, Lord Glenarthur, when he comes to reply could comment on that. The real problem surely is that there are too many acute beds rather widely dispersed in and around London as a result of the shrinkage of the population of Greater London by some 10 per cent. over the past decade.
So it seems inevitable that some sort of rationalisation should take place. In this connection I understand that a heavy investment has taken place in the Elizabeth Garrett Anderson Hospital. When the noble Lord winds up the debate, will he tell us whether it is the intention of the Government to reopen the Elizabeth Garrett Anderson Hospital for in-patients if the South London Hospital is closed?
Mr. Patten, the Minister, said in another place:I do not comment in any detail tonight on a possible marriage between the South London Hospital for Women and the Elizabeth Garrett Anderson. That idea is new to me".—(Official Report. Commons; 19/7/83, col. 356.]That seems strange if such expenditure is being made at the Elizabeth Garrett Anderson Hospital, but it may simply mean that the Minister is new to the job. Perhaps the noble Lord, Lord Glenarthur, is better informed than his colleague and can tell us the position there.
As has been mentioned, there has also been a substantial investment in the St. George's Hospital which, according to my information, has 560 beds, 1506 which puts it in a bigger league. But it could hardly operate with a lower figure if it is to remain a teaching hospital.
But the crux of the matter is the all-important question of the right of access to women doctors for women who so desire it. It has been the great achievement of the South London Hospital to make this a reality since the early days of its foundation, back in 1912. But, at the same time, the Minister argued in another place that the situation has changed since those days. Equality of opportunity for women doctors is protected by legislation and currently nearly half of all students entering medical schools are women. Thus, he argued, it is much more likely that a woman who wishes to be treated by a woman doctor will have that opportunity.
This is obviously the case, but even with a high or higher percentage of women doctors spread throughout the system it must remain something of a lottery, particularly at hospitals and in emergencies. This constitutes a problem, particularly for Muslims and other religious and ethnic minorities, who are inhibited by custom or prohibited by religion from being examined or treated by male doctors. There is the rather alarming prospect of some women or girls refusing to go to a hospital for cervical smears or the other necessary aspects of preventive medicine, if they could not be seen by a woman doctor. It is my firm view that it is incumbent on the Government, before they permit this closure to go ahead—the Minister reiterated on 19th July that no decision had yet been taken—to tell the House how they propose to cater for these legitimate needs and preferences if they permit this closure to go ahead.
Health policy often seems to be conducted in a piecemeal fashion. What is clearly required is a coherent view of how this real problem can be solved, or is best solved, within the wider pattern of the provision for South London. There is a further point which has not yet been mentioned this evening. I gather that the Wandsworth Community Health Council. which is a statutory body, has come up with alternative proposals. We should like to hear the Government's reaction to these.
While we sympathise very much with the noble Baroness's Question—I am asked to say the same on behalf of my Liberal colleagues—our attitude on this issue will depend on the Government's answer to this debate. I look forward to hearing the statement called for in the noble Baroness's Question.
§ 8.35 p.m.
§ Lord Lawrence
My Lords, it is a great honour that I am allowed to speak in your Lordships' House and I crave your Lordships' indulgence in this my maiden speech. Also may I thank the noble Baroness for asking this Question on the South London Hospital for Women. It might strike your Lordships as presumptious and that it is peculiar for me to choose to make a maiden speech on a subject that is primarily of interest to women; and that it is a presumption on my part to speak on behalf of women; but in view of the composition of this House I hope that your Lordships will bear with me.
1507 It strikes me that the crux of this matter is whether gender is a factor that creates its own special needs; that is, whether men and women differ in their medical and psychological needs and therefore require special services within the National Health Service. Also, some women perceive it to be the case that their needs are different and they think this is the situation, be they adolescents, Asians or shy old-age pensioners. In addition, in a single sex hospital catering to a single sex, they have control over procedures and policies. If they are one unit within a major hospital group, that unit has to follow different procedures and be integrated into a major hospital. This integration process could be in conflict with a single sex policy.
This might seem to be an issue of closing one hospital, but surely this is an issue of choice. If this Government during the 1980s are going to support freedom of choice they cannot justify the closing of this hospital.
§ 8.37 p.m.
§ Baroness Gaitskell
My Lords, I should first like to make two congratulations; the first is to the noble Baroness, Lady Macleod of Borve, on having the courage to raise this very important Question today, and the other is to the noble Lord, Lord Lawrence, who has made his maiden speech.
It is often well known that women like women doctors to look after them, much as some people do not believe that. There are often small medical problems to deal with which only women can understand. Certain small adjustments may have to be made. Women understand these but men do not; it is difficult for men to understand these things.
When a women has problems often the only alternative is for her to go to a specialist to be treated. This is not much fun because it is not the National Health Service she goes to, but to a specialist. That means she pays about £15 for three minutes for a very slight adjustment to be made. That is very unfair. One's own national health doctor has no time at all, as I have discovered myself, to deal with certain problems. There has to be a hospital for women to go to which they can trust, which they understand, which is good and is important. Women cannot pay £15 for three minutes, as I have said.
It is shocking that a good hospital should at this time be shut down. There is no excuse for that. It is not that we are overwhelmed with doctors; we are not. We do not have all the facilities we would like to have, so it is a particular disgrace to find that a good hospital may be shut down, especially as it is solely for women.
I have very little else to say, having congratulated the maiden speaker and the noble Baroness, Lady Macleod. The fact is that women like women doctors—much as some people try to deny this. Women like to be dealt with by women doctors. It seems to me heartbreaking that this hospital should be shut down, and personally I am very much against it. I hope that the Government—or whoever has to think about these things—will think again and not do this. It is an attack on women; it is treating women badly if we shut down this hospital. And we are not in a position 1508 to treat women badly. It is not a good thing; it should not be done. I hope either that this hospital will be maintained or that something very, very good will be put in its place.
§ 8.41 p.m.
§ The Countess of Mar
My Lords, I am sure your Lordships will not mind if I, too, congratule the noble Lord, Lord Lawrence, on his maiden speech. I feel very guilty because I put him up to it. I did not think that he would make a speech on women's hospitals; and I feel that he has done very well indeed. I do not know whether he or I was the more nervous. The noble Baronesses, Lady Denington and Lady Gaitskell, very adequately made the points that I had intended to make about the need for some women to be seen by women, so I shall not repeat them.
The Wandsworth District Health Authority has given only financial reasons for its proposal to close the hospital in April 1984. By saving the £5 million it costs to run this small efficient, up-to-date hospital, the authority will meet the £3 million deficit in its current revenue expenditure. In addition, the authority expects to improve facilities for priority care groups, provide out-patient ante-natal facilities in the vicinity of the existing hospital and put some of the savings towards its long-term planning strategy—in other words, the funding of Phase 2A of the improvement to St. George's Hospital, Tooting. I am led to believe that the extension to St. George's Hospital is going to cost several million pounds to build and will cost in the region of £14 million a year to run. Even with my pocket calculator and my shoes and stockings off, I cannot work out how the Wandsworth District Health Authority thinks it can balance its books now, let alone in five years' time if it provides all these facilities.
My Lords, I do not want to speak for too long but I have several questions that I should like to ask the Minister. Is he satisfied that the financial proposals tabled by the Wandsworth District Health Authority are soundly-based and feasible and, if so, in the event of the closure of the South London Hospital for Women, can he guarantee that the women in its catchment area will receive the same very high quality of treatment that they receive now? This must include the ability to be seen by female consultants and other staff throughout the period of their need for treatment as in-patients or out-patients.
Will the ante-natal clinic include facilities for X-rays, blood and urine analysis, scans and other diagnostic equipment; or will they be expected to travel to and to wait at either St. George's or St. James' for these facilities? Is the authority able to make up the loss of 100 ante-natal and post-natal beds in either local hospital at April 1984? Are out-patient services at the two remaining hospitals sufficient to be able to cater for an additional 45,000-plus visits a year, including nearly 8,000 venereal disease cases, without detriment to the current two-week maximum between the time a patient asks for an appointment and the time she is seen?
Can the Minister say whether consideration has been given to the proposal by the Wandsworth Community Health Council for a marriage with the Elizabeth Garrett Anderson Hospital with supra- 1509 regional funding? I am most grateful to the noble Baroness, Lady Macleod of Borve, for raising this Unstarred Question.
§ 8.45 p.m.
§ Baroness Ewart-Biggs
My Lords, my purpose in speaking certainly is not to make a long speech. Already the points have been very well covered by the noble Baroness, Lady Macleod, herself with support from the other speakers. But it is such an important issue that I would wish to identify myself with the debate and also to underline some of the points that have already been made. It has clearly been put forward that the case for closing this important hospital is really financial and that the Wandsworth Regional Hospital Health Authority has stated that the savings that come out of this closure will go into developing the big new hospital at St. George's and that this will provide services for priority groups in the future.
This evening, I think that it is our preoccupation to try to identify some of the reasons for keeping the hospital open. This is why I should like to underline some of the points that have been made already. I think the point that this hospital is a unique one is of great importance. It is, indeed, Britain's only surviving women's general hospital where patients are treated entirely by female doctors. Thus two needs are met. First, with only 11 per cent. of hospital consultants being women, there must be a case for positive discrimination to allow more female doctors the opportunity to become consultants and to gain clinical experience. On the second count, there will always be women patients wishing to be treated by women doctors. I know that this point has been made very often and already this evening; but I think that this is not only so for the women of ethnic minorities: there is also a very strong case for women of all kinds to he looked after by female doctors.
Perhaps this is a little difficult for men to understand. My noble friend Lady Denington has said this. After all, many of the ailments from which women suffer and which provide reasons for wishing for medical attention come from their physical makeup. Thus, one can conclude that these sensitivities and anxieties are better shared and attended to by women doctors. I really cannot see that it is too much to ask. I sometimes feel that, if the male and female roles in life were, through some sublime intervention, to be suddenly reversed, there would be numerous hospitals where men were being attended to by numerous male doctors; and there would be no question of any of those hospitals being closed. I am not saying this from a purely feminist point of view but because I think it is probably the case.
Finally, I should like to mention one or two of the supportive, practical reasons (some which have been given already) for keeping the hospital open. First, it is important that it is so accessible. It is provided with adequate public transport, which is a very important factor as 75 per cent. of its patients come from social classes unlikely to be in a position to afford private transport. How will those patients get to St. George's? The waiting list is short, and the future of its essential family planning clinic and cervical cytology and Well 1510 Women clinics have not been ensured in any way. It is a small and happy hospital as has been stressed.
However, there is also doubt as to whether the savings from the closure will go into development of new medical services. This doubt, I think, can be justified by the fact that no money for new development has been released despite the closure of five hospitals in Wandsworth over the last seven years. Finally, the consultant anaesthetist at the hospital has been reported as saying that transferring patients to St. George's would mean fewer obstetric and gynaecological beds, which would lead to women being sent home earlier after having their babies. And these are women coming from homes where conditions should not allow them to come home early.
Lastly, I think it is an important factor that there has been a public outcry about this and a petition signed by an infinite number of people. It is proof that there is very strong feeling in the community about it. It surely all adds up really to wondering why we should get rid of something which is both working efficiently and responding to a real need in order to replace it with something which is unproved and unknown. We in this country have always prided ourselves on having a respect for the sensitivities of minorities. Surely, the South London Hospital for Women has been a means of respecting that virtue. It has not only watched over the sensitivities of women coming from the ethnic minorities but it has also helped the group which, although it is in the majority, is sometimes treated as a minority—and that group consists of women generally. So I, too, should very much like to urge the Minister to look at this again and see whether this hospital can be saved.
§ 8.50 p.m.
§ Baroness Hornsby-Smith
My Lords, first may I add to the congratulations that have been given to my noble friend Lady Macleod, not least for being fortunate enough to get this debate but also for the zeal and effort she has put into the campaign to keep this hospital open. May I also congratulate the noble Lord, Lord Lawrence, on his maiden speech, which was, I am sure, a delight to all the Whips—so commendably short, as we are always told a maiden speech should be, and so succinct. I hope that we shall hear him on other occasions. I also have to apologise to my noble friend because it is just possible that time will run out on me as I have to catch a train tonight to the West Country. I assure him that I intend no discourtesy to him, to the noble Lord, Lord Wallace of Coslany, or to other Members of your Lordships' House if I have to leave before the end of the debate. I can also assure your Lordships that I shall read Hansard avidly tomorrow night when I get back.
I must confess that with six years' experience of the Ministry of Health behind me I have some sympathy with my noble friend because I know from experience that you can build at vast expense a beautiful modern hospital with double the accommodation of its predecessor, but if you try to close even a 30-bed cottage hospital you are going to have a petition, a picketing and a demo, no matter what. So I have great sympathy with him; but I believe that in this instance there are certain features about the South London which stand on their own. There is its record and the 1511 use that is made of its capacity. I believe and hope that the Minister will give this matter very special consideration.
I do not think I can claim to be anything like a militant feminist, because I must confess that throughout my life I have always been attended by male doctors. I have never been attended by a woman doctor in my life. But, however much we may deplore it, the complete dominance of many Arab and Asian males, and some Africans, in dealing with the womenfolk in their families is very real indeed. We may deplore it; and I am on record in this House as opposing arranged marriages for girls who never see the man they are to marry until he arrives in this country. I have also opposed female circumcision; but my concern this time is not with men but the fact that women needing medical treatment may be denied it because of religious and male prejudices, which are often shared by the females themselves as a result of their rigid upbringing. It is going to take time, it is going to take new generations of women born, bred and educated in this country, to eradicate that prejudice. In the meantime, we must take steps to ensure that women do not suffer.
The South London area includes a considerable proportion of Commonwealth immigrants. This hospital—not too large and not over-administered—is very fully occupied practically to its capacity, and it is very greatly in demand because, as other speakers have outlined, there is a sense of unity and of loving care on the part of the staff. It is ideally situated, as has been pointed out already, from the point of view of patients and visiting families.
Twice at a great London teaching hospital, while myself a patient, I have seen a poor sick woman, shrouded from head to foot and flanked by two men, held back from her treatment until the husband had assured himself that there were no men in sight in the treatment rooms. I am convinced that, had there been, those two men would have whipped the poor woman off and taken her home without her treatment. I believe this male attitude is quite intolerable, but our concern must be the sick and, in many cases, the very subservient woman.
Strangely enough, my concern is less in respect of pregnant women, because many men will swallow their prejudice in order to get top gynaecological treatment for a wife in the prime hope that she will present him with a son. It is rather in the realm of real illness, as distinct from the natural progression of pregnancy. It is there that the prejudice against examination by a male doctor may bear more heavily on these unfortunate women. A cervical smear test may be involved or a check for breast cancer, a check for diabetes or an abdominal disorder. All these may go unchecked until it becomes desperately acute where there is a rigid prejudice prevailing against the general hospital, with its predominance of male doctors, and these women are not allowed to be seen unclothed by a male doctor. It is a question of time, patience and education; yet if we are to ensure that these unfortunate women. now citizens of our own country, get the medical treatment they require, I believe that the South London Hospital for Women remains a very real need.
§ 8.57 p.m.
§ Baroness Lockwood
My Lords, may I, too, thank the noble Baroness. Lady Macleod, for her initiation of this debate and for all the work she has been doing in support of the South London Hospital for Women. I hope that the Minister will be able to respond favourably to the many points that have already been put in the debate. As many speakers have said, the South London Hospital is now unique in this country in that it is the only hospital solely for women where the medical staff, too, are women only. It is the only hospital of its kind which is providing such a wide range of services in such an excellent way, as the noble Baroness, Lady Macleod, and others have said.
I do not want to dwell on some of the excellent services this hospital provides. I want to look at it from another aspect, because it has been said that in the 1980s it sounds like an anachronism to want to maintain a single-sex hospital, a hospital for women only. Some may be surprised that, as a former chairman of the Equal Opportunities Commission concerned with equal opportunities for both men and women, I should he standing up in this debate supporting the continuation of this hospital.
Let me assure your Lordships there is no contradiction here. When the Sex Discrimination Act was going through Parliament it was quite clear that hospitals such as the Elizabeth Garrett Anderson Hospital (now no longer functioning in the way it used to function) and the South London Hospital should be protected. Lest that should be doubted in any way, I have checked the Home Office notes on clauses which were published at the time the Sex Discrimination Bill was before Parliament. These notes state quite clearly that the intention was that Clause 7 of the Sex Discrimination Bill—genuine occupational qualification—would apply to single-sex institutions such as single-sex hospitals.
Therefore, although it has never been contested in the courts, it is likely that medical staff in a women's hospital could be women only and that this would be upheld in the courts. Similarly, the provision of a service for a single sex in a single sex hospital would also he lawful under Section 35 of the Act. Therefore it is highly likely, as I believe the Equal Opportunities Commission have advised, that the continuation of this women's hospital is well within the provisions of the Sex Discrimination Act. I regret that Dr. Enid Vincent, the Wandsworth Health Authority's medical officer, is reported to have said that the hospital is an anachronism. I have more sympathy with the hospital spokeswoman who is reported to have said: "A lot of women can't talk to a male doctor—and quite honestly a lot of male doctors cannot talk to women patients on, for example, problems like severe premenstrual tension".
Whatever may be our attitude in this House in talking to doctors of either sex in a confidential and professional way, we must acknowledge that there are some women who find this very difficult indeed. Sometimes women in ethnic groups, as the noble Baroness said, cannot talk to a male doctor because of their religion. There are also indigenous British women who find it difficult to discuss sensitive issues with a male doctor. As a result, many of these women tend to neglect symptoms which need immediate 1513 attention if worse symptoms are to be prevented from occurring.
There are many more women, particularly younger women, who are becoming very much aware of health problems related to a woman's physical make-up: problems relating to menstruation, childbirth and the menopause. They feel that these problems should be given more attention by the medical profession and that they should be discussed more openly. These women come from a very wide cross-section of the community. They are the kind of women to whom the noble Baroness referred who attended the meeting in a room in another place. They feel that they should be better able to understand the functioning of their own bodies and that this could better be achieved by discussion with a professional person of their own sex.
Therefore, for three reasons I support the continuation of this hospital as a hospital for women only. First, I believe it is essential that women should be able to have a woman doctor if they feel that they need one. Secondly, if this is to be a real choice, we need many more women consultants and hospital doctors. Although we are approaching near parity between men and women in the medical schools, still something like 20 per cent. only of all hospital doctors are women. And only 11 per cent. of consultants are women. One of the features of the Elizabeth Garrett Anderson hospital and the South London Hospital has been the support and encouragement given to women in a still male-dominated profession. This House should go on record as supporting women in this very important career. Thirdly, I support the continuation of this hospital because it is most important that more attention within our medical services should be devoted to the health problems of women arising from and connected with women's biological functions.
Forty per cent. of the population are women over 15 years old. All of them at some time will be affected by one or more of the health issues associated with this biological function. This is far too substantial a proportion of the population to ignore, or play down the peculiar health hazards associated with it. In the past, we played down these problems and pretended that some aspects of health did not exist. The South London Hospital, in a small but nevertheless very significant way, has been a counterbalance to this neglect. I believe that we in this House should support it in its efforts to continue to serve women.
I hope that the Minister will be able to respond favourably to the comments which have been made and to the work which has been done by the noble Baroness, Lady Macleod of Borve.
§ 9.7 p.m.
§ Baroness Jeger
My Lords, I apologise for not having put down my name to speak at the proper time. However, I wish to associate myself with the expression of thanks to the noble Baroness, Lady Macleod of Borve, who has raised this question tonight.
I shall speak only briefly. At this time of cuts and problems in the National Health Service, the policy seems to be to cut down first on women's health care. I have spoken many times about the Elizabeth Garrett Anderson Hospital. I do not intend to make any party point tonight. Indeed. I have had to fight Ministers in 1514 my own party about the Elizabeth Garrett Anderson Hospital. But there seem to be people in the Ministry or in the Government who believe that when there have to be cuts the services provided for women should be cut first. That is absolutely wrong.
It is very easy to say that in these modern times you can see a woman doctor when you go to hospital. That is true, but can you see a woman consultant? As my noble friend Lady Lockwood has pointed out, the number of women consultants is very much smaller than the number of male consultants. The worry for many women is that if they go into hospital they may see a woman doctor, but that if they need more sophisticated treatment they will not see a woman. We are still living in a situation where women consultants are very few in number when compared with men consultants.
I do not wish to make a long speech about this particular hospital, but where a hospital is doing a good job, why close it down? I should like to feel we were closing hospitals which were not doing any good, but here we are talking about National Health Service hospitals. If the National Health Service means anything it means that the public are paying for that service. If the public want that service, then they should have it. There should not be some committee or Minister coming along and saying, "You cannot have it". I hope very much that we shall tonight pass on the message, as we did with the Elizabeth Garrett Anderson Hospital, that this hospital, too, is meeting a need, that people want it, that the people pay for it—the public pay for it—and there is no reason why the Government should agree to its being shut down. I hope very much that the Minister will be able to tell us tonight that the hospital is going to continue.
§ 9.9 p.m.
Lord Wallace of Coslany
My Lords, we have certainly had a very good debate, and first I should like to congratualte the noble Lord, Lord Lawrence, on his maiden speech. We look forward to further contributions from the noble Lord. One thing of which I am sure is that the noble Lord feels better now than before he made his maiden speech. That is a feeling of relief that one can understand; I having made three, all told.
The noble Lord, Lord Glenarthur, faces a formidable task. We have heard many noble Baronesses putting the women's point of view, aided by a couple of noble Lords. Even with all the goodwill evident at the start of the recess, I am afraid that I am unable to help the noble Lord, Lord Glenarthur. I strongly support the plea made by the noble Baroness, Lady Macleod of Borve. The South London Hospital for Women renders a unique service to women and should be allowed to continue. It is most accessible in a heavily populated area—an area I know quite well. This is a very important factor, particularly in respect of gynaecological cases and in regard to older women. A further factor that cannot be ignored—and one that has been referred to—is that this hospital is situated in an area having a large ethnic population. Noble Baronesses have already stressed the desire of many ethnic women to be dealt with by a woman doctor as part of their conventions: it is not something with 1515 which I always agree, but it is a fact of life which must be faced.
I want to take a slightly different line from most of the speakers tonight because, unfortunately, this excellent hospital is only one of a number facing closure at the present time. A number have already been closed. The situation, already serious, is bound to get worse due to the imposition of further financial cuts by the Secretary of State on South-East England health authorities. The new cuts will wipe out all but £15 million of the £98 million gross money already allocated last April. I have had something to do with this in the past, and the policy of directing money away from the South-East to other health authorities is developing into an impossible situation, leading to a severe reduction of health service facilities in London and South-East England.
The diverting of facilities to larger hospitals—some of them new—as suggested in the case of the South London Hospital for Women, will not improve the situation but will only make matters worse. Such hospitals are already working under great difficulties with lengthening waiting lists. Much of this is due to financial restrictions. To me, it does not seem to make financial sense to close a structurally sound hospital and expand St. George's Hospital mainly to compensate.
New hospital buildings are costly and take considerable time to plan and build. One point of which I am sure is that the phasing of the building of hospitals with rising costs is a most expensive procedure to adopt. I have had some experience of this in the past and the noble Baroness, Lady Hornsby-Smith (who has now left her place) will also appreciate the point I am making. These remarks are relevant to this debate because neither the regional health authority nor the district health authority will have reached the regrettable conclusion to close the South London Hospital for Women had it not been for the acute financial position forced on them by the DHSS.
Personally, I feel a great deal of relief that I am not now involved in hospital administration and so have not to endure the agonising decisions that have to be taken by regional and district health authorities.
The decision to save this excellent hospital, to put it quite bluntly, is squarely in the hands of Her Majesty's Government. The situation facing the South London Hospital for Women is of their creation, and I sincerely trust that they will favourably consider the appeal made by the noble Baroness, Lady Macleod of Borve, and many other Members of your Lordships' House. Not one voice has been raised contary to the appeal made to keep this hospital going. I accept, of course, that women have a right to be treated by women doctors. There is a need in certain circumstances for others, apart from ethnic minority reasons. to be so treated. That right must be protected, and certainly this hospital must not close.
§ 9.15 p.m.
§ Lord Glenarthur
My Lords, my noble friend Lady Macleod has spoken with her usual eloquence about a matter which concerns her greatly; I am grateful to her for her remarks, and for the remarks of all those other 1516 Members of your Lordships' House who have spoken so eloquently and in such a moving manner this evening. I am also aware that my right honourable friend the Prime Minister and a number of your Lordships and Members of another place, too, have received representations about the future of the South London Hospital for Women. I am delighted, therefore, to have this opportunity to explain the current position and to clarify a number of the issues which have been raised.
But before I do so, my Lords, perhaps I may congratulate the noble Lord, Lord Lawrence, on his excellent maiden speech. This is in fact a maiden opportunity for me to congratulate a maiden speaker from the Dispatch Box, and I am delighted to do so on this occasion. The noble Lord's remarks were thoughtful, stimulating and also short. I know that I speak for all of us when I say that we look forward to hearing him many times in the future.
As my noble friend Lady Macleod will know, the South London Hospital for Women, which is managed by the Wandsworth Health Authority, was founded in 1912 with two main aims. These were to enable women patients who so preferred to be treated by women and also to train women doctors as hospital specialists at a time when it was often difficult for women doctors to gain appropriate graduate experience and postgraduate training. There have been many changes in attitudes towards women in medicine since those days and it is now possible for any qualified woman doctor to have the opportunity of following the postgraduate medical training of her choice. This equality of opportunity for women is protected by legislation. In 1911, the year before the South London Hospital opened, fewer than 2 per cent. of doctors in England and Wales were women. Currently, nearly half of all students entering medical schools are women. Therefore, it is now much more likely that a woman will be treated by a woman doctor. I also fully appreciate that some women prefer—for religious, cultural or other reasons—to be seen by women doctors. Indeed, it is the policy of most health authorities, including Wandsworth, to arrange for women who so wish to be seen by women doctors unless exceptional circumstances make this impossible. I hope that that to some extent covers the point that was made by the noble Countess, Lady Mar.
My Ministerial colleagues at the Department of Health and Social Security and I have received many representations against the closure of the hospital on the grounds that it provides a national service. There is statistical information, however, to suggest that the hospital provides an essentially local service. In 1982, for example, over 80 per cent. of patients at the South London Hospital came from the immediate neighbourhood (Wandsworth and West Lambeth). Fewer than 3 per cent. of the patients who travelled to the hospital came from the GLC area north of the river Thames, and fewer than 2 per cent. of the patients came from outside the GLC area. I hope my noble friend Lady Macleod will forgive me for having spent a minute or two outlining the origins and purpose of the hospital, but I feel that this is important in view of the current proposals about its future.
I should like to take the opportunity now to say that the Government have demonstrated their commit- 1517 ment to the redevelopment of the Elizabeth Garrett Anderson Hospital on its present site by agreeing to fund the building costs from central reserves. These costs will amount to a total of £3 million over the years 1980–84. It was suggested by the noble Lord, Lord Kilmarnock, amongst others, that some form of marriage between the Elizabeth Garrett Anderson Hospital and the South London Hospital might be possible. I cannot say that that is possible. Services at the Elizabeth Garrett Anderson Hospital are an integral part of health facilities in the Bloomsbury district. Even if the South London Hospital does close there are no plans to open in-patient medical, or surgical beds at the Elizabeth Garrett Anderson. However, it will provide in-patient gynaecology facilities, out-patient services and an early diagnostic unit. Another measure of the Government's concern about care for women is their decision to provide extra funds to enable the Royal Marsden to continue providing at their early diagnostic unit a routine breast cancer screening service for women.
Returning to the South London Hospital, the former Merton, Sutton and Wandsworth Health Authority envisaged the closure of the hospital in the late 1980s before the opening of Phase IIA of St. George's Hospital, Tooting. However, a number of factors have influenced the new Wandsworth Health Authority to bring forward both the consultation programme and the date of the proposed closure of this hospital. These include the need to ensure that the necessary revenue will be available for the next phase of St. George's Hospital before contracts are let next year. All health authorities have been asked to ensure that the extra revenue requirements of a scheme which will call for additional resources can be met before inviting tenders and letting contracts. This is essential if we are to avoid having new and much needed hospital developments which then have beds which can only be partially opened because of lack of funds.
Two main factors have led the Wandsworth Health Authority to bring forward the proposed closure from the late 1980s to 1984. First, the authority is properly taking steps to remain within its statutory cash limit. The Wandsworth District is historically overfunded in terms of national resources and, as part of national and regional redistribution policies, Wandsworth has faced a reduction in its revenue allocation in the current year and has had to take a hard look at all its services to find ways of improving efficiency and making savings. Secondly, the Wandsworth Health Authority is concerned to find ways of improving services for priority care groups within the district, particularly the mentally ill, and has therefore proposed the earlier closure of the South London Hospital partly in order to release resources in the interim for these services. Wandsworth estimate that closure of the hospital would save £5 million annually. In the short term, this would enable the authority to reprovide the services currently provided at the South London, at St. George's and St. James' Hospitals.
The Wandsworth Health Authority is satisfied that the additional workload could be met at St. George's and St. James' Hospitals if the South London Hospital were closed. It estimates that about £1 million per annum would be required to meet the costs of transferring services to St. George's and St. James' Hospitals.
1518 The figure of £13 million, which was referred to, relates to the additional running cost of the next phase—Phase IIA—at St. George's Hospital when this opens in the late 1980s. The health authority plans to meet these additional resource costs by closure of the South London Hospital, closing the old Knightsbridge wing of St. George's Hospital and transferring services for the elderly from St. John's Hospital to St. James' and Bolingbroke Hospitals. The additional cost of providing services now at the South London Hospital in other hospitals in Wandsworth—that is, by using underused existing facilities—is as I said, estimated at about £ 1 million a year.
A number of your Lordships have drawn attention to the financial constraints facing the Wandsworth Health Authority and have compared the unit costs of St. George's and the South London Hospital. I should like to assure your Lordships that we shall look very carefully at this before reaching a decision. We shall certainly have due regard to what my noble friend lady Macleod of Borve referred to as logic, common sense and financial prudence. The savings would also allow the authority to improve services for the mentally ill at Springfield Hospital and to meet the authority's reduction in revenue allocations.
Any health authority proposing substantial changes in the pattern of local services or the closure of existing facilities is first required to undertake very full consultation with all interested parties and, in cases where the local community health council is not in agreement with the changes proposed, the matter is referred to my right honourable friend the Secretary of State for Social Services for a final decision.
As my noble friend Lady Macleod and other of your Lordships will know, in March 1983 the Wandsworth Health Authority issued two separate consultation documents on the closure of the South London Hospital. They invited comments from community health councils, local Members of Parliament and other interested parties by 1st June 1983. The first document proposed the hospital's closure in 1988–89 as part of the rationalisation of services in the district consequent upon the opening of Phase II at St. George's and to release resources for that development. The second document proposed the hospital's earlier closure in April 1984 to release resources in the interim to help develop services for priority groups, particularly the mentally ill.
The Wandsworth Community Health Council opposed the closure of the South London Hospital in both sets of proposals, although it did not object to the other changes which were proposed following the completion of the next phase of St. George's. At a meeting on 30th June the Wandsworth Health Authority considered the responses received, and in particular the views of the community health council. The authority decided however that the community health council's alternative proposals for achieving comparable savings within the district did not constitute viable options within resource constraints and the timescale envisaged. The Wandsworth Health Authority therefore decided to recommend to the regional health authority that both the long-term and short-term proposals should be supported.
I understand that the South-West Thames Regional Health Authority gave this very thorough consid- 1519 eration at its meeting on 13th July and was satisfied that Wandsworth's proposals were consistent with service and resource allocation policies, that the proposals to improve services for the priority care groups were necessary and had high priority, and that the proposals for redistributing services in other hospitals in the district by making use of underused facilities should allow existing levels of service to be maintained. The regional health authority agreed that the proposals contained in the two consultation documents should be supported, and this will therefore be referred to my right honourable friend the Secretary of State for a final decision.
I think that I have explained the consultation procedure at considerable length, but I want to stress to your Lordships the very full local consideration which has already been given to the proposed closure of this hospital before being referred to Ministers. We shall now need to look very carefully at the district's proposals, the community health council's alternative proposals and the views of all those who have written to us about the South London Hospital before a final decision is taken. I know—and it is quite clear from the contributions that have been made this evening—that the South London Hospital is held in very high regard and that the staff working there are very dedicated and committed to the hospital. I understand the hospital also has a very active League of Friends which, together with the hospital staff, worked very hard recently to raise funds to purchase a laser (which was referred to by my noble friend Lady Macleod) for use at the hospital and to pay for regular maintenance over a number of years.
Finally, I recognise that many sincere views are held on this matter and they have been expressed very clearly. But I should like to stress—and I cannot do so any more strongly than I am going to do now—that no decision has vet been taken to close the South London Hospital. The decision will be further considered by Ministers in due course; it has not yet been decided by them. I should like once more to thank my noble friend for raising this extremely important issue and assure her and the House that her comments, and those of others who have spoken here today, will be taken fully into account before a final decision is made about this hospital.