St. Thomas' Hospital: Future (Hansard, 13 June 1984)

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

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)
My Lords, West Lambeth Health Authority has recently published a consultative document on strategic options for its district for the next 10 years. Various options are proposed for the services at St. Thomas' and other hospitals in the district, but none of these options puts St. Thomas' at risk. It is now for the public in West Lambeth to consider the options and respond to them.

§ Lord Molloy
My Lords, is the noble Lord the Minister aware that there is grave consternation about all these proposals? Not one of them is acceptable to all levels of staff at St. Thomas' and other hospitals allied to it. It has been maintained all the way through that one of the proposals is for a reduction of about 55 per cent. in the number of beds, which will mean a saving of £8 million a year. It is this kind of proposal which is causing distress to one of London's great teaching hospitals and its allied hospitals in London.

§ Lord Glenarthur
My Lords, I do not accept that St. Thomas' is at risk in the way the noble Lord suggests under any of the options proposed in the district health authority's consultative paper. The options range from a very small reduction in the number of beds—that is, minus 23 at St. Thomas'—to a large increase in the number of beds—that is, plus 163, if South Western and Tooting Bec hospitals were to close.

§ Lord Vaizey
My Lords, is the Minister aware that, although nationally there has been an increase in the resources devoted to the health service, because of the operation of RAWP there has been a quite disproportionate run down in Greater London? Is the Minister further aware that among the teaching staffs of the great London teaching hospitals as well as among other members of staff there is widespread worry that centres of excellence will be run down? It is urgent that the Minister should make some kind of statement that this question will be looked at in a broader perspective.

§ Lord Glenarthur
My Lords, these matters are looked at in a broad perspective, but the fact is that they are also matters which affect people who live locally, and that is why it is appropriate that they should discuss them locally first, before they come before Ministers.

§ Lord Ennals
My Lords, does the Minister accept that if St. Thomas' is largely to remain unaffected, it would mean the likelihood of the closure of 1,000 psychiatric beds at Tooting Bec, which is one of the options, and 200 geriatric beds at the South Western in Brixton, which would inevitably place a very heavy burden upon the local authority, Lambeth, which is high on the list for rate-capping? Does the noble Lord not appreciate the appalling consequences for the community if these options are carried through?

§ Lord Glenarthur
My Lords, they are not serious in the way the noble Lord suggests. The closure of both the South Western and Tooting Bec hospitals is only one of four options in the document to which this all relates. The other options would involve closure of one or other of these two hospitals, or moderate reductions at all three hospitals in the district. It would not be right for me to comment in detail on the options because they are still being discussed publicly. The noble Lord, Lord Ennals, mentioned in particular the mentally ill, and the intention is, quite rightly, to improve local services for mentally ill people. The services for them will not necessarily be made worse just by closing hospitals, but will be improved by returning these people to the community.

§ Baroness Lane-Fox
My Lords, does my noble friend the Minister agree that, whether or not it is so designed, the implication of this Question is liable to damage the morale of staff who are carrying out such wonderful work?

§ Lord Glenarthur
Yes, my Lords, I fully accept that, and I am grateful to my noble friend.

§ Lord Ennals
My Lords, is it not already the case that morale at St. Thomas' and in the whole district, which is now under threat, is extremely low? If any part of the options is to be carried through will this not also affect the families of those who need care in the community?

§ Lord Glenarthur
My Lords, we all have to live within our means, and it is for the West Lambeth Health Authority to consider how best to live within its cash limit and to identify areas of waste and priorities for development.

§ Baroness Gardner of Parkes
My Lords, will my noble friend confirm that the Resource Allocation Working Party, which was transferring funds out of London, was introduced by a Labour Government because of the departure from London of the central London resident population? Will he also confirm that the teaching hospitals are now having great difficulty in finding normal teaching material, and that students have to go to peripheral hospitals to encounter ordinary cases?

§ Lord Glenarthur
My Lords, I am sure that much of what my noble friend says is quite true. RAWP has a history and has sometimes over-provided. It is difficult to forecast exactly how populations will shift. Nevertheless, we have to base plans on something, and it has been done through RAWP.

§ Lord Brockway
My Lords, is the Minister aware how famous are our leading teaching hospitals in London throughout the world? Is he aware that in America, West Germany, and India I have heard praise, particularly of St. Thomas' and of its consultants? With thousands of pounds now being spent on equipment in order to make St. Thomas' the equal of any hospital in the world, would it not be disastrous if there were any rumours that it was to be closed?

§ Lord Glenarthur
My Lords, as I thought I had earlier made clear, there is no risk to St. Thomas' in the way the noble Lord suggests.

§ Lord Annan
My Lords, would the noble Lord agree that if over 10 years £15 million is to be taken out of St. Thomas' hospital, that will reduce the hospital to something between 400 and 500 beds? As 1,000 beds are necessary to teach 100 medical students, this will mean a complete rethink about the future of the medical school at St. Thomas'. Has the noble Lord information from other right honourable friends in the Government connected with the Department of Education and Science that this is, or is not, in line with the plans of London University for the rationalisation of medical teaching?

§ Lord Glenarthur
My Lords, the figures I gave in answer to an earlier supplementary do not go quite so far as the noble Lord, Lord Annan, suggests. The four options vary between a reduction at the least of 23 beds to an increase of 163. Therefore, what the noble Lord says I do not think is necessarily correct.

§ Lord Molloy
My Lords, is the noble Minister aware that he is quite right when he says that St. Thomas' is not going to he subject to immediate execution, but that there are the beginnings, and they are evident, of the slow, tortuous death of one of London's—nay, one of Britain's—greatest hospitals? Will he recall that it is only 12 months ago that the threat then that St. Thomas' had to endure for a number of months was that its cancer research establishment was going to be drastically reduced, but that because of public outcry that was averted? Is he further aware that all endeavours will be undertaken both in this House and outside to prevent St. Thomas' suffering a slow death and vanishing, because its history is magnificent and we believe that its future could be just as magnificent?

§ Lord Glenarthur
My Lords, I really must say that I find the noble Lord's remarks so exaggerated that I do not think that they will help the issue at all. The fact remains that this is out for consultation. It is a matter for local concern to establish the needs, and the concern and interest expressed will be based on the options I have described.

§ Lord Annan
My Lords, can the noble Lord answer my question about medical education? I am asking whether the noble Lord is aware of the views of the Department of Education and Science. It is of great importance that the right hand in Government should know what the left hand is doing. Which is right and which is left, I would not care to say. May I put a further question to the noble Lord? It is in the plans for the rationalisation of medical services in London to move the Institute of Dermatology from Lisle Street to St. Thomas'. This is naturally a move which will cost some money. Can the noble Lord give an assurance that that plan will not be delayed even in view of the cuts which are obviously going to have to be necessary in that district?

§ Lord Glenarthur
My Lords, I cannot give the noble Lord an answer about the dermatology unit but I shall find out and let him know. The main point is that spending on the health service is now at a record level and we intend to increase it still further, but we are also committed, as the noble Lord is aware, to achieving a greater equality of access to health care throughout the country. It is therefore essential that London's health authorities plan for changes in the pattern of services in line with their reduced populations. This was the point brought out by my noble friend Lady Gardner.

§ Lord Molloy
My Lords, would the noble Lord agree that the cash limit cuts which are going to he exercised by the West Lambeth authority are going to be the largest ever? Would he now please turn his attention to the latter part of my Question, which asks how many other great London hospitals are so threatened?

§ Lord Glenarthur
My Lords. I do not think that it would serve any useful purpose for me to stand at the Dispatch Box and go through each of the London health districts describing what their plans are. I would remind the noble Lord opposite that there were 272 hospital closures under the last Labour Government, which compares with only 184 during the present Administration and a large increase in capital expenditure.