§ 2.45 p.m.
§ Lord EnnalsMy 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 whether they will make a statement on the future of St. Thomas' Hospital, the South-Western Hospital and the psychiatric unit at Tooting Bec, all of which are the responsibility of the West Lambeth Health Authority.
§ Baroness TrumpingtonMy Lords, it is for West Lambeth Health Authority to devise a strategy for the future of these hospitals within resource assumptions set by South-East Thames Regional Health Authority.
§ Lord EnnalsMy Lords, will the Minister therefore confirm that the future of St. Thomas' Hospital is in the balance because of financial restraints? Does that situation not cause her great concern? Also, bearing in mind the recent decision by the Minister of Health to close the cardiac surgery unit at Westminster Hospital, the plans to withdraw 63 beds at Guy's, and now the uncertainty about the future of St. Thomas' Hospital, is not the promise that the National Health Service is safe in the hands of the Government beginning to look just a little bit tattered?
§ Baroness TrumpingtonMy Lords, I totally reject the noble Lord's final remark. With regard to St. Thomas' Hospital maintaining its role as a major international medical centre, the answer is that, yes, it will. The strategy of the West Lambeth Health Authority is likely to involve rationalisation of local services and their concentration on St. Thomas' Hospital.
§ Lord AnnanMy Lords, is not the noble Baroness a little surprised by the Question put to her, because 987 does not the situation at hospitals depend to some extent on the implementation of the findings of the Resources Allocation Working Party—RAWP—and was it not at a time when the noble Lord, Lord Ennals, was Secretary of State for Health that the proposals of that working party were adopted? Part at least of the shortfall in resources for certain hospitals in that neighbourhood come from the perfectly understandable conclusion of the previous Government that resources should be moved out of London to the regions.
§ Baroness TrumpingtonMy Lords, I have several answers that I could give the noble Lord, Lord Annan. The point is that West Lambeth Health Authority, like every other district health authority in the country, has a statutory obligation to stay within its cash limit. We believe that the current problems in that particular authority are a matter for managerial action by South-East Thames Regional Health Authority. West Lambeth Health Authority's members agreed last Friday to produce a satisfactory short-term programme for 1985–86. That is a very encouraging piece of information.
§ Lord Jenkins of PutneyMy Lords, is the noble Baroness not aware that there is considerable concern among staff at St. Thomas' Hospital about the future of that famous hospital? May we take it that her Answer is of a reassuring nature and that it is possible to say now that the future of that great hospital need not cause the medical staff there the concern they are currently feeling?
§ Baroness TrumpingtonMy Lords, I thought that I had already replied to that question when I said that St. Thomas' will continue to be a major national hospital.
§ Lord Cledwyn of PenrhosMy Lords, is the noble Baroness not aware that there is a good deal of concern felt about many centres of excellence? Westminster Hospital is one such case, and there are many others. While we all agree that those hospitals must be administered regionally, as they are, they also have a national importance. Many of them are accessible and available to people living beyond the boundaries of the regions concerned. Is there not a case therefore for the Government to produce a paper—a White Paper, possibly—giving a national strategy in relation to those important centres of excellence—not all hospitals—and will she discuss that suggestion with her right honourable friend?
§ Baroness TrumpingtonMy Lords, I feel sure that the noble Lord, Lord Cledwyn, will agree that the subject of other hospitals is a little wide of today's Question, but I will certainly see that his suggestion is passed on to my right honourable friend.
§ Baroness Lane-FoxMy Lords, is my noble friend the Minister aware that those of us who are heavily committed to the £1 million appeal for moving the Phipps respiratory unit from the South-Western Hospital to St. Thomas' Hospital are deeply worried, because if this Question holds any water we are bound to feel that we are working on a false prospectus?
§ Baroness TrumpingtonMy Lords, the regional health authority has agreed to provide some capital for the move of the Phipps unit to St. Thomas' Hospital. Provided the district health authority produces a proper strategic plan and the patients' association is able to meet its fund-raising target, there is reason to be optimistic about the proposed move.
Lord RichardsonMy Lords, is the noble Baroness the Minister aware that on 30th October last year, at a meeting in the other place between her right honourable friend the Minister of Health and representatives from those concerned in the region of St. Thomas' Hospital and the district, the Minister said there was no likelihood of any of the three teaching hospitals in that area being closed? He went on to say that the worst thing that could happen would be that those hospitals should be destroyed by attrition. Is the Minister aware that the staff of St. Thomas' Hospital—of which I am an exmember—will be reassured by what she said, but only up to a point? St. Thomas' Hospital is facing an acute incompatibility. It is being required by the region, on the one hand, to take over—
Lord RichardsonMy Lords, is the Minister aware that St. Thomas' Hospital is being asked to take over many commitments while at the same time having its budget reduced to the extent of approximately £1 million a year? Finally—
Lord RichardsonMy Lords, finally, is the Minister of the opinion that the noble Lord, Lord Cledwyn, put an extremely important question when he asked whether these hospitals should be treated nationally rather than as local problems?
§ Baroness TrumpingtonMy Lords, it really is not for me to answer this question of whether or not the big hospitals should be treated nationally. As I said to the noble Lord, Lord Cledwyn, I shall certainly pass on the remarks made on that score.
One of the reasons that this Question has been asked today is the worry about St. Thomas' Hospital, much more than about the other two hospitals which come into that area. The South-East Thames Regional Health Authority's policy is to move resources in line with population movement in recent years. Districts like Medway have been relatively deprived of local health services for many years and need additional revenue for improvements. West Lambeth has been overprovided for—with acute beds in particular—and the pattern of services must change there to meet today's needs. On the other hand, St. Thomas' Hospital, as I have already said, is safe.
§ Lord KilmarnockMy Lords, is it not the case that some special arrangements were agreed for the teaching hospitals within the RAWP formula, and is it not important that these should be honoured?
§ Baroness TrumpingtonMy Lords, I am sorry, but I could not hear the noble Lord.
§ Lord KilmarnockMy Lords, I beg the noble Baroness's pardon. I simply asked whether it is not the case that some special arrangements were made for the teaching hospitals within the RAWP formula, and whether it is not of the greatest importance that these should be honoured.
§ Baroness TrumpingtonMy Lords, these will be honoured.
§ Lord EnnalsMy Lords, will the noble Baroness take very fair note of the point made by her noble friend Lady Lane-Fox and understand that I am concerned with the three hospitals, not just with St. Thomas' Hospital? Will she also accept that the RAWP formula (which was introduced when I was Secretary of State), with the provisions made by the noble Lord, Lord Kilmarnock, has happily also been totally accepted by the present Government? Does the noble Baroness not agree that there is no difference between the previous Government and the present Government except that at present it is very difficult to apply the RAWP formula when, in real terms, the rate of growth is so small?
§ Baroness TrumpingtonMy Lords, I agree with the noble Lord, Lord Ennals. West Lambeth Health Authority, like other London districts, is still over-provided with acute beds to meet the need of its declining population, while its priority services need considerable improvements. Large amounts of revenue can be released by rationalising acute services and hospital sites within the district health authority.
§ Lord AnnanMy Lords, may I ask the noble Baroness one further question? The findings of the Resources Allocation Working Party were based on mortality rates—that is, the resources for hospitals were judged on the number of cadavers wheeled from the wards to the mortuary, or the number of deaths recorded in that area. Does the noble Baroness not agree that it would be a much more significant statistic if the morbidity rates were taken?—that is, we should take the number of patients who enter a ward in a hospital in a morbid condition and are discharged having been cured or, at any rate, with their morbidity alleviated. That would surely be a more significant statistic on which to base the resources allocated to a hospital than is the number of deaths recorded in the hospital.
§ Lord EnnalsBoth, my Lords.
§ Baroness TrumpingtonMy Lords, the noble Lord's question is a general one of great interest.
§ Baroness Masham of IltonMy Lords, may I ask a very quick question arising from what the noble Baroness said? What about the thousands and millions of tourists pouring into central London and the additional load which arises on the casualty departments of both St. Thomas' and Westminster hospitals?
§ Baroness TrumpingtonMy Lords, that question is a little wide of the original Question, but I thank the noble Baroness for asking it.