HL Deb 04 April 1984 vol 450 cc706-9

2.47 p.m.

Lord Kilmarnock

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

The Question was as follows: To ask Her Majesty's Government whether they will intervene to arrest the closure of up to 31 GP hospitals currently under threat and whether they will institute a serious inquiry into the real savings, if any, which are likely to result from this drastic reduction in beds available to general practitioners.

Lord Glenarthur

My Lords, the Government value the important contribution made by GP hospitals to the National Health Service. Their place in the pattern of district services is primarily a matter for health authorities to decide in consultation with others concerned at local level. Many hospitals closure proposals are resolved locally, but in every case where the community health council opposes a closure a ministerial decision is required before closure can take place. Every case referred to Ministers is considered on its merits, and closure is approved only if we are satisfied that, on the balance of the arguments, patient services would benefit either directly or by the release of resources for developments in other parts of the service.

Lord Kilmarnock

My Lords, I thank the noble Lord for that reply. Is he aware that there is a very genuine wave of popular concern about the closures that are in the offing? I understand that the number is now 37, rather than 31, as stated in my Question. Have the Government read Occasional Paper 23 of the Royal College of General Practitioners, in which it is stated: The importance to a general practitioner and to the efficiency of his service to the community of an association with a hospital is difficult to exaggerate"? Finally, have the Government seen the report on community hospital planning by the West Midlands Health Authority Physician, Dr. John Beasley, which is based on a study of seven GP hospitals and which recommends an extention of the system?

Lord Glenarthur

My Lords, I am sure that my department will have studied all the documents to which the noble Lord has referred.

Lord Ennals

My Lords, is the Minister aware that there is an increasing number of GP hospitals that are now being proposed for closure? Does he know of any case in which this is being done because the standards of clinical care for patients in the hospital have sunk below the normal level? Will he not agree that these small hospitals provide an invaluable service, not only to their patients but also in linking the community services with the hospitals? If 31 hospitals are at stake, what about the other 320 that exist up and down the country? Cannot the noble Lord take a more positive view about this, rather than simply saying that it is a matter for other people?

Lord Glenarthur

My Lords, as the noble Lord, with his experience, will know quite well, the Government certainly do take a positive view about hospitals. The fact is that hospitals might have to be closed for a number of different reasons; for example, for repairs, because of staffing shortages, to remove a risk of infection, or for reasons of reallocation of resources. I do not think the noble Lord will find that the 31 hospitals, or the 37 to which the noble Lord, Lord Kilmarnock, referred, will necessarily all meet the fate that noble Lords opposite seem to think they might meet.

Lord Wallace of Coslany

My Lords, is the Minister aware that the Question refers to GP hospitals? I appreciate from what the Minister has said that the Secretary of State's consent should be obtained before closure. Is he further aware, however, that it is not only a question of GP hospitals but of GP beds? Many district health authorities, forced to make economies, are cutting out GP beds and, in some cases, closing complete wards devoted to GP beds. This is where the Minister does not have to give consent.

Lord Glenarthur

My Lords, the noble Lord refers essentially to what might be temporary closures for a variety of different reasons, to which I think I gave some answer in my reply to the noble Lord, Lord Ennals.

Baroness Masham of Ilton

My Lords, will the Minister agree that, now that there are hardly any convalescent homes left, the GP hospital serves to free the acute beds that sometimes get blocked, so enabling patients, after the acute stage, to go back to their home areas and be looked after by their GP? Is this not a very important advantage?

Lord Glenarthur

My Lords, I am well aware of the importance of the hospitals or homes to which the noble Baroness refers, and to the importance of GP hospitals generally. The essential factor is that the need for GP hospitals, or anything of that sort, depends very much on local conditions, and it should be local health authorities that make decisions about them.

Lord Wallace of Coslany

My Lords, I want to come back at the Minister. The noble Lord, when I referred to GP beds, said that this was a temporary measure. This is not necessarily so. My opinion is—

Noble Lords

Question!

Lord Wallace of Coslany

My Lords, is the noble Lord aware that the "temporary" issue of these beds will be resolved and got rid of only when this Government are disposed of?

Lord Glenarthur

My Lords, for several years now there has been an annual net reduction in the number of hospital beds. However, changes in the practice of medicine mean that we are now treating more patients in a fewer number of beds.

Lord Winstanley

My Lords, will the noble Lord give some thought to the reverse of the Question of my noble friend Lord Kilmomock and consider the possibility of a serious inquiry into the real savings that would result from a re-opening of GP hospitals that have already been closed? Does he not agree that those hospitals achieved excellent results in the limited cases with which they dealt—results that compared very favourably with those in general hospitals? Is he aware that real benefits could arise from the re-opening of some of the GP hospitals already closed?

Lord Glenarthur

My Lords, again, much will depend on local health authorities, and it is really a matter for them.

Lord Cledwyn of Penrhos

My Lords, the noble Lord said that the closure or otherwise of these important hospitals is a matter for the area health authorities. If area health authorities are in financial difficulties about keeping these cottage or GP hospitals open, will the noble Lord's right honourable friend take steps to help the area health authorities to keep them open? Is he aware that these GP hospitals are absolutely essential, especially in scattered rural communities and small towns which are some distance away from the larger hospitals, and that they provide an absolutely first-rate local service?

Lord Glenarthur

My Lords, as I have said, I fully endorse the remarks of the noble Lord, Lord Cledwyn, about the valuable service that these hospitals undertake. But the fact is that the Government attach importance to controlling public expenditure, and health authorities have a statutory duty to remain within their allocations. That is why it is a matter for the health authorities to decide, in the local circumstances prevailing, how services should best be provided.

Lord Rea

My Lords, will the noble Lord not agree, as several noble Lords have indicated, that where personal care is concerned the Schumacher principle of small but beautiful often applies? More seriously, is he aware of recent disquiet that the laid-down procedure for consultation prior to closure is not always adhered to? Is he able to state that both the informal and the formal stages of this procedure will be strictly followed in the case of any closures that are proposed in the future?

Lord Glenarthur

My Lords, I shall certainly send to the noble Lord a copy of the consultation procedures that lead, or could lead, to the closure of any small hospital.

Baroness Masham of Ilton

My Lords, is it not the Secretary of State who takes the final decision on closure, even if a district health authority wants a GP hospital closed?

Lord Glenarthur

My Lords, I shall send a copy of what I am sending to the noble Lord, Lord Rea, to the noble Baroness.

Lord Kilmarnock

My Lords, although the Minister says that this is a local matter, does he not agree that in 1980 his department issued a paper favouring this kind of hospital? Will he confirm that there has been no reversal of his department's general policy on the matter?

Lord Glenarthur

My Lords, there has been no reversal of the policy to which the noble Lord refers.