HL Deb 30 July 1985 vol 467 cc248-57

9.16 p.m.

Lord Underhill rose to ask Her Majesty's Government what is their view on the possible closure of the Forest Hospital, Buckhurst Hill, Essex.

The noble Lord said: My Lords, in asking this Question to seek the views of the Government on the threatened closure of the Forest Hospital, may I make it quite clear that, although I am speaking from the Dispatch Box, I do so in a personal capacity. In case there may be any feeling that I am raising this issue from a sentimental viewpoint—because the Forest Hospital, Buckhurst Hill, was where I spent the first part of my recent, rather lengthy, illness—that is not the case. As far back as October I was involved in a minor way in the campaign against the closure of this hospital. I have written to every member of the district health authority. I have also written to the Secretary of State. I must say that I received a most courteous reply from the Under-Secretary of State in which he set out some of the background and the consultative procedure.

The position in this area—which is just over the border into Essex—is that the Lugano Hospital at Buckhurst Hill closed last year, and the Harts Hospital at Woodford Green closed last year. The Health Minister has recently confirmed the closure of another hospital, the Jubilee Hospital at Woodford Green; and there is now a fourth hospital in the area, the Forest Hospital, Buckhurst Hill, also threatened with closure. Perhaps I should say that the Forest Hospital comes within the area of the West Essex Health Authority but is managed extra-territorially by the Waltham Forest District Authority.

Two consultation meetings were held. I had the privilege of attending one. It was jammed to the doors with local people who were up in arms in protest against the closure of this hospital. I am certain that it would have done your Lordships good to have heard many of the expressions of their declarations of faith in the National Health Service, of which the Forest Hospital is a very fine part.

What is this hospital? The District Health Authority distributed a document to all those who attended this very large consultative meeting. Therefore, I am quoting from the document dated 15th November, 1984, issued by the health authority. Forest Hospital is a small, pleasant, well-run General Medical Practitioner Hospital which provides a valued service to the local community. Although it is possible to re-provide the majority of services efficiently by concentrating them on a smaller number of sites, it is recognised that this is not the same type of local service as currently provided by Forest Hospital.

It continues: The Authority's appreciation of the efforts of Forest Hospital League of Friends is on record. Forest Hospital was built with money raised on a voluntary basis and the present League of Friends have continued this tradition and raised many thousands of pounds to improve facilities for patients in the hospital.

In fact, the building was given by a local family but, as the document says, a substantial sum of money has over the years been raised locally to improve the hospital's facilities. The same official document states: The Authority is faced with … cuts in the amount of money received".

There has to be a cut of £2 million in the budget over the next three years and the North-East Thames Regional Health Authority is seeking a reduction of some 200 in the number of local acute beds.

The area cannot be said to be over-provided because there is a waiting list in the Waltham Forest district as a whole of some 4,000 people, and I am given to understand that some 1,000 have been on the waiting list for more than one year. Sixty per cent. of the in-patients in Forest Hospital reside in this part of Essex. If in future they have to go to other hospitals, there will be considerable travelling time involved—and travelling is not all that easy—and expense for persons visiting in-patients.

The criteria used for closure are that the services can be more efficiently undertaken elsewhere and that the majority of services can be provided on a more cost-effective basis elsewhere. It is suggested that the district general hospital—a large complex at Whipps Cross in Leyton—could take in many of the patients from this area. It is said that this would provide greater efficiency in the use of beds, and also that there could be an earlier discharge of patients. This will add to the present waiting lists, because only last weekend our local newspaper reported that there are more patients than ever before being treated at Whipps Cross on a reduced budget.

Only last August, Whipps Cross—the general hospital for the district—closed for an entire fortnight for all non-urgent admissions and some 900 operations had to be postponed.

Forest Hospital has 12 operating theatre sessions every fortnight. No resident medical cover is needed, because the local general practitioners operate on a call system looking after their own patients. My own doctor called in to see me every day while I was an in-patient at Forest Hospital. I understand that in any rearrangment there may be no proposals for GP beds.

Forest Hosptial has an efficient physiotherapy department. This will have to be transferred elsewhere, with the inconvenience of travelling and the time and cost involved. The radiology department handled no fewer than 85,000 cases in 1983, which is the last year for which I have records. Three-quarters of those cases were referred to the department by local general practitioners. It is highly efficient and it has a good appointments system. As distinct from many appointments systems, it is one that works, as 1 know from my own experience, having gone to the radiology department on quite a number of occasions in the past few years. That will need to be transferred and paid for elsewhere, and once again there will be travelling time and cost involved.

It is suggested by the authority that some services, will be absorbed into present work-loads".

I do not know which services could be absorbed into the present work-loads elsewhere without difficulty and what consultation has taken place with the staff in the other hospitals. There is a day centre which provides for about 20 people daily who need this sort of companionship and also gives a few hours relief to the relatives who look after these individuals in their homes. At present there are arrangements at Forest Hospital for long-term elderly patients. That will end with the closure of Forest Hospital. I understand that a meeting of the district health authority on 24th July—just a few days ago—decided to close at once the operating theatres and one ward and also considered the question of the general closure of the hospital in a short while under what is called the "temporary banner". I must emphasise that the final decision of the Secretary of State is yet awaited.

At this stage perhaps I should mention that the Epping Forest District Council, which has a substantial majority of political opinion opposed to my own, has done an excellent job in campaigning against the closure of this hospital. The district council is fundamentally opposed to the closure and it assisted in the presentation of a petition against closure signed by a substantial number of residents. The district council has said that the decisions of the district health authority which have just been taken, usurp the power of the regional health authority and that of the Minister of Health and reneges on assurances previously given".

I must ask the Minister if she will kindly see that this matter is investigated urgently and give an assurance that, if what the district council says is correct, the authority will be told to stop the closure proposals temporarily.

I was in the hospital when some of the staff returned from attending the meeting of the district health authority which took the final decision on closure for reference upwards to the regional authority and to the Secretary of State. There was an atmosphere of utter gloom and despondency among all the staff and among the patients who were in the hospital at the time that I was. During my stay at the hospital I saw a happy staff and excellent relations between the ancillaries and the nursing staffs. May I say, in passing, that while lying in bed I noticed that the ancillaries did not require a commercial contract to tell them exactly how to carry out the cleaning of a ward. They knew what had to be done and they did the job thoroughly.

The phrase "a much loved hospital' is often overused and overdone, but I can assure the noble Baroness the Minister that this is a much loved local hospital. Only in the middle of June the League of Friends still arranged, despite this threatened closure, their annual fete in the hospital grounds. It was attended magnificently—whether it was a last protest fling by the persons who attended or whether it was because of their devotion to the hospital, I do not know. The Forest Hospital costs £750,000 a year to run. I understand that the arrangements for the reprovision of some services will still cost some £300,000.

In conclusion, may I urge the Minister, in the interests of effective health care, to resist this closure of a fourth hospital in two years in this district and withhold his approval? Should the Minister, regrettably, feel that he has to give his approval to the closure, which I trust he will not, I hope there will be the utmost consultation with the unions for both the nursing and the other staffs concerned; that representatives of the local general practitioners, who know exactly what the hospital services give now, will be put on any body which will supervise the transfer of services; and that attention will be paid by the Minister to the extra territorial position in which Loughton, Chigwell, Buckhurst Hill, and the rest, find themselves. The hospital is actually situated in the West Essex district authority area but is administered by the Waltham Forest district authority area.

Finally, there have been press statements—perhaps based just on rumours—that private hospital interests are interested in taking over the Forest Hospital property. Only this week the local newspaper referred to the fact that the one private hospital in Buckhurst Hill has been purchased by a Califoraian-based health authority. It would be bad enough if any private medical interest took over Forest Hospital; it would be even worse if that Californian-based organisation was involved. It would be the crowning insult to all the local people if this much loved hospital was in some way or another transferred to private medical interests. I hope that that is one guarantee the noble Baroness can give me.

9.31 p.m.

Lord Murray of Epping Forest

My Lords, I am grateful to your Lordships for allowing me to trespass upon your goodwill at this late hour to indicate my support for my noble friend Lord Underhill and to declare my common interest with him as a resident of the area and as one who has benefited from the services and the tender loving care, as my noble friend has described it, of Forest Hospital in my own time.

I share the concern of many people in the locality. In the past ten years the League of Friends, to which my noble friend has referred, has raised and spent nearly £100,000 on supporting the hospital. That is nearly £2,500 for each bed in the hospital. That is no mean achievement, and it is an indication that the league is not merely concerned with words but is in a very practical way concerned with deeds.

Your Lordships may ask what is special about this hospital. There are many such hospitals, and many of them are under threat of closure. Some are going through the consultative procedure. My noble friend has raised this matter partly because the threat to Forest Hospital is typical of a tendency—in this case, the mega-hospital tendency—and partly because of the special considerations which my noble friend has laid before the House tonight. In particular, I should like to emphasise the circumstances of the consultative procedure itself.

We have seen many Green Papers and White Papers published in the past—notably the DHSS consultative paper of 1980 which emphasised the value and importance of the small hospital—on the hospital which caters for patients who do not deserve or require the panoply of extensive investigation or treatment. It is right, as my noble friend has emphasised, that the role of small hospitals should in general and in particular be reviewed from time to time. It is right—and I make no objection—that the role and function of Forest Hospital should be reviewed. However, I believe we would all agree that in the scheme of things there should be a place in the community for small hospitals. Small is not always beautiful, although in the setting of this particular hospital it is beautiful. In the case of this hospital, small is certainly very reassuring, as I know from my own experience.

The onus should be on those who want to close small hospitals to show that such is necessary and inevitable. That is manifestly not being done in the consultative procedure being followed at the present time. My noble friend has informed the House of the arguments made that services can be more effectively provided elsewhere. He has demonstrated the inadequacy of those arguments.

I emphasise the point that the arguments of the Waltham Forest District Health Authority in its document are vitiated by the fact that that health authority will not have to provide the alternative services to which it refers. The alternative services will have to be provided by other district health authorities, since 80 per cent. of the patients in the Forest Hospital come from health authorities other than Waltham Forest. The Forest Hospital, in this sense, is in no man's land, and we are looking for the Minister to venture forth to rescue it from the position of peril in which it is at the present time.

I believe that the Waltham Forest District Health Authority is the reluctant executioner, wielding the axe which has been thrust into its hands by the Regional Health Authority and by the Government themselves. This is neither the time nor the occasion on which to pursue the general question of the Government's attitude towards the health service. I believe that the Government have their overall priorities dreadfully wrong. However, tonight I am more concerned with the fact, or the danger as I see it, that in this case there is a serious problem of getting priorities wrong locally because of the curious situation that the authority which is seeking to close the hospital is not the authority which has to provide the alternative services to the community.

My noble friend referred to one of the most valuable of these services: the way in which the needs of local old people, the sick and the geriatrics, are catered for. Also, I place an emphasis on those who care for the elderly and the sick. It is common ground between us that there will be a big increase in the number of old people, particularly those over 75, before the end of this century. The emphasis, in my view properly, is being laid on the home care of old people. We all know the strain that that puts on the carers and on their families.

In my own case my wife's mother lived with us for a number of years. She was crippled by arthritis and in a wheelchair. She was totally deaf, but was able to spend a day each week at the Forest Hospital. My noble friend referred to a day centre. It is not so much a day centre as a day hospital unit. It is an integral part of the hospital. That one day a week was a godsend and a life-saver to my wife and to our family. Equally, my wife's mother was able to spend the occasional fortnight as a restful holiday in Forest Hospital, to which she was always happy to go. That was also a godsend to her and to us. She was happy because of the family atmosphere and the tender and loving care which she received, and which I doubt she would have received in a hospital like Whipps.

My noble friend questions whether the reprovision will be carried out adequately at other hospitals, and I believe he has touched on a central weakness in the consultative document. He emphasises that the other small hospitals—Connaught, Lugano, Harts and Jubilee; all small hospitals and all manifestly able to provide services of this sort—have all been closed down or are in the process of closing. Therefore, I commend to your Lordships what my noble friend says.

I do not regard the consultative document as a serious basis for discussion. No options are discussed, and there is no discussion of alternatives. The only concern of the health authority is, hugger-mugger, to inter the Forest Hospital. Therefore, I hope that the noble Baroness and her department will accept that they have a serious obligation to look not merely at the issue of closure but at the nature of the consultative process, and to bear in mind that this is a document prepared by an authority which will not have to deal with the consequences of its decisions if it manages to achieve its objective of closing the hospital.

I am not for a moment suggesting that the Minister should intervene willy-nilly in a properly set up consultative procedure. That would be wrong. But this is an exceptional situation and I suggest that it would be possible and proper for the Minister to indicate to the regional health authority the points on which she will wish to be satisfied by the end of the consultative process. In particular, I suggest that the Minister should indicate that in this situation it would be proper for there to be joint consultation between the different health authorities—Waltham Forest, which provides the hospital, West Essex and Redbridge, which provide most of the patients to the hospital—and that she would expect the consultative process to examine alternatives to closure: joint funding by health authorities, the possibility of the maintenance and development of the geriatric provision, and perhaps even the use of the hospital in the way of a hospice.

I also put to the noble Baroness the suggestion made by the Epping Forest District Council—whose members, as my noble friend has said, are by no means of our political persuasion—that, if necessary, the Secretary of State should be prepared to provide the funds needed to maintain the hospital in operation. This comes not from some intellectual Socialist donjon; it comes from a Conservative council which has examined the situation and has expressed its deep concern. I put to the noble Baroness that a situation which sees my noble friend Lord Underhill and myself marching shoulder to shoulder with our local Member of Parliament, Sir John Biggs-Davison, is a measure of the concern felt, and rightly felt, by a wide range of people in the locality, and we look to her to ensure that people in this place are put first.

9.42 p.m.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)

My Lords, I have listened with great respect to the words of the noble Lord, Lord Underhill—and may I say how good it is to see him in the pink? I also listened with great interest to the noble Lord, Lord Murray of Epping Forest; and now, on behalf of the Government, I shall try to do my best to explain the position both locally and nationally.

If a health authority wishes to close or significantly change the use of an NHS building, it has to consult local interests, including the relevant community health council or councils. If the community health council objects to a proposal, and the district health authority nevertheless thinks it is right to proceed, then the matter is referred to the regional health authority. If the regional health authority also agrees to the proposal (it may not of course) then the final decision is referred to the Secretary of State. The Secretary of State, or health Ministers acting on his behalf, have to weigh up the case for and against any proposal. This often involves meeting deputations of local people, including representatives of the community health council to hear their objections at first hand, before coming to a decision. I have been asked how his procedure operates in the case of Forest Hospital, which, although managed by Waltham Forest, is located in West Essex. The position is that the managing authority undertook the consultation. It consulted West Essex Health Authority and Waltham Forest, West Essex and Redbridge community health councils. The usual position in these cases is that objection from the community health council in whose area the hospital is located means that the final decision is referred to the regional health authority and the Secretary of State. In the case of Forest Hospital, like other hospitals in Waltham Forest, Ministers made it clear that any objections from any community health council with a substantial interest in the service provided would be sufficient. I understand that all three community health councils have in fact objected.

Many, if not most, changes are decided locally without controversy. Where there is controversy, it is appropriate that the matter should be referred for final decision to the regional health authority and thence to Ministers. That is right and fair. It does mean, however—and I am sure your Lordships will appreciate this—that the Secretary of State's role is to act in a quasi-judicial manner. Because of that, it has always been the practice that Ministers both in this House and in another place do not comment on the substance of proposals which are the subject of local consultation and which may therefore be referred to them. This is in case it is thought by either party that any comments have prejudiced either the outcome of local consultation or any decision that has to be taken by the regional health authority or Ministers.

I hope therefore that your Lordships will understand that it would not be appropriate for me to comment in detail on the specific points made by noble Lords on the proposal to close Forest Hospital and reprovide its service elsewhere. The community health council has objected to the proposed closure and the matter will be referred to North-East Thames RHA at its September meeting. If it agrees, it will then come to the Secretary of State.

Noble Lords who have spoken sought clarification on the decision taken last Thursday temporarily to end surgical work and out-patient sessions at the hospital at the end of August. They asked what is going on and how this is possible in advance of referral to the regional health authority and Secretary of State. Let me set out the procedures involved in such a decision.

Health authorities are allowed temporarily to close or to change the use of buildings wihout consultation, or, as in this case, before the full procedure has been completed, if they believe the interests of the service demand it. This can include the need to keep within spending limits. I understand that Waltham Forest believes that it is in danger of overspending at the end of the financial year. It considers that the best way of avoiding that is to bring forward proposals already in the pipeline and which it believes to be in line with its overall strategy. I understand that, although the closure of Forest is opposed by the CHC in its entirety, there is particular concern about the beds used by GPs for their elderly patients, about GP access to X-ray facilities, and whether the arrangements the authority has made for providing or reproviding the services are adequate. I can assure in particular the noble Lord, Lord Murray, that these services will not be closing at the end of August. Temporary closures while decisions are still to be taken on permanent proposals are clearly not ideal. I can assure noble Lords that they do not in any way prejudice the outcome of Ministers' decisions on permanent closure.

The noble Lord, Lord Underhill, said that if Forest Hospital closes it will be the fourth in succession. He said that it was the result of cuts. That is not strictly right. Hospitals close for the same reasons that new hospitals are built or that other hospitals are extended or rebuilt—for the very good reason that it is important to keep pace with change; change either to the relative health needs of different people or to the way services are best provided. The changes in Waltham Forest cannot be viewed as a succession of individual hospital closures. They are part of an overall strategy designed to meet changing needs locally, regionally and in the country as a whole.

Spending on the National Health Service over the country as a whole has increased significantly in recent years, as everybody knows. However, one of the main problems that face the NHS is that resources are still very unevenly and unfairly distributed. They still match historical patterns rather than present needs. It is the four Thames regions which have historically enjoyed the greater share of resources. These regions also have more acute beds for the needs of their present population and modern medicine. We have therefore given the less well funded regions, and those with higher population growth, larger allocations of increased spending than the Thames regions.

Even within these regions, the pattern of spending does not match up-to-date needs. This is why we have endorsed North-East Thames Region's strategy of giving priority in its own resource distribution to the development of "priority" services and to the more even distribution of resources between different parts of London and Essex. The recently opened new district general hospital at Colchester is a prime example of the results of this. The region has funded the development through savings in districts whose facilities are in excess of needs or whose services can be provided in more economical ways.

It is right that resources should be switched from better provided to under-provided areas. This does not mean any levelling down in the quality of service. The overall quality of service can be maintained in the better provided areas through finding better, more efficient, ways of providing services. This is, we believe, possible in North-East Thames. It means, of course, that some districts, such as Waltham Forest, face some fairly considerable changes in their allocations. Health resources must be used to best effect.

Waltham Forest has been rationalising its acute services into fewer sites, and into fewer, more effectively used beds. This is not only desirable in terms of making best use of resources; it also reflects the way medicine itself has developed over recent decades. It has become increasingly necessary to concentrate the bulk of acute service on to fewer sites. This allows all patients easy access to the full range of specialised services and support facilities which, because of their high cost in terms of equipment and skilled manpower, can necessarily only be available in one or two places in each district. It is a waste of resources to duplicate such facilities over too many sites especially if this can only be achieved at a cost to other services either in this district or elsewhere in the region or nationally. That would not be warranted. Most important of all, better access to specialised services improves the care that can be given to patients and this often outweighs the loss of convenience which occurs when a small local hospital closes.

This is borne out by the achievements of the health authority so far. In 1982, there were 3,051 available beds compared with 2,667 in 1984, and throughput, that is the number of deaths and discharges per available bed, increased from 11.8 in 1982 to 14.6 in 1984, in other words, an overall increase of 23.7 per cent. The health authority has therefore increased by 8 per cent. the number of patients treated in 1984 over 1982 and in fewer beds. I shall have to write to the noble Lord, Lord Underhill, with regard to the points that he made about waiting lists.

Finally, the noble Lord, Lord Underhill, expressed concern about the possibility of Forest Hospital being used in the future for private medicine. I am not aware of this. The health authority is unaware of any approach from a private source, and the health authority cannot in any case consider disposal of the site until a decision from the Secretary of State has been taken.

To sum up, the points I have made are not to be taken as meaning that the matter is decided in the case of Forest Hospital. This is the overall context in which the proposal to close Forest will be judged if it comes to Ministers. If it closes, there will clearly be a loss to local people in terms of convenience. How does that balance out with advantages to others in using the resources presently devoted to Forest in new ways? Much loved hospitals do have to close for what are usually very good service reasons.

For whatever reason a hospital may close, one should not forget the staff, many of whom may have worked at the hospital for a long time. They face a change to their lives. The need for change in no way reflects on the years of service they have given patients. Neither would I want to omit paying tribute to the generosity of the League of Friends of Forest. Alternative services will be considered very carefully by Ministers when considering any proposals concerning Forest.

In their speeches today noble Lords have raised points that are very relevant to the debate about Forest. I can assure them and those associated with Forest that those points will be considered very carefully. I hope that your Lordships will agree to leave the matter until it comes, if it must come, before Ministers.

House adjourned at five minutes before ten o'clock.