NHS: Capital Programme (Hansard, 1 July 1988)

§ The Earl of Arran
My Lords, the National Health Service is undergoing its largest ever sustained capital programme. In England there are currently 213 schemes in planning, 157 under design and 133 under construction each costing over £1 million. In all, the programme currently comprises 503 schemes at a total value of over £3.8 billion, and total capital investment in the National Health Service in all four home counties is at present running at over £1.3 billion a year.

Earl Alexander of Tunis
My Lords, I thank the Minister for that Answer. I should declare an interest in that I am a director of the international hospital group. Is the Minister aware that at present we are in advanced negotiations with one of the area health authorities to undertake a joint venture programme to design and build a major national health hospital within three years instead of 10 years, which is the usual timescale for such developments?

§ The Earl of Arran
My Lords, any hospital which opens ahead of schedule is nothing but good news for those living in the community.

§ Viscount Hanworth
My Lords, will the noble Earl agree when the new programme has arrived and been built, that there will still be a strong case for the old village-type hospital because it is near, it cuts down the travelling time and provides a facility for those who are getting on in years; geriatrics and so forth? Although they may be more expensive to run, surely would it not be a mistake to close down such hospitals purely on the grounds of small economy?

§ The Earl of Arran
My Lords, I appreciate the point made by the noble Viscount. However, it is for regional health authorities to decide upon the appropriate mix of facilities in their area.

§ Lord Broxbourne
My Lords, while the Minister will deserve and no doubt receive the congratulations of the House on his statement, can he say whether the special needs of mental health and mental handicap have been taken into account, because whatever the progress with community care there will always be a substantial residual need for hospital accommodation?

§ The Earl of Arran
My Lords, indeed they are taken into account. Of the 316 health building schemes which have been completed since 1979, 54 included facilities for the mentally ill or mentally handicapped.

§ Lord Prys-Davies
My Lords, I am not quite sure that I understood the thrust of the noble Earl's supplementary question. However, will the Minister confirm that it is a feature of the capital programme that beds will also be closed? Can he tell the House how many acute beds will be opened and how many acute beds will be closed under the programme? Secondly, can the Minister ensure that the district health authorities concerned are guaranteed sufficient revenue to bring the capital projects into full operation?

§ The Earl of Arran
My Lords, bed numbers reduced by 35,000 in the period 1974–79 and by a further 36,000 to date. Of those beds 41,000 were mental health beds which were closed as a result of the "care in the community" policy. The remaining closures result from the replacement of obsolete, usually 19th century, hospital stock by new hospitals capable of greater efficiency. This is demonstrated by the increase in activity since 1979. For example, inpatient treatments have increased by 19 per cent.; out-patient treatments have increased by 11 per cent.; day-care treatments have increased by 87 per cent. Those are the telling facts.

§ Lord Orr-Ewing
My Lords, can my noble friend say how the figure for investment of £1.3 billion a year, which is very satisfactory. compares with the investment rate in the 1970s? In relation to the comment made by the noble Viscount, Lord Hanworth, can he confirm that the cottage hospitals have a considerable contribution to make, because they are not only more convenient for patients but for voluntary workers? If one has a hospital in one's midst voluntary workers can serve it more conveniently than by having to get to huge hospitals in the centre of cities.

§ The Earl of Arran
My Lords, I take on board the point made by my noble friend about cottage hospitals. I can confirm that 316 schemes costing over £1 million have been completed since 1979 compared with 120 completions from 1974–79.

§ Lord Molloy
My Lords, the Minister may have mentioned this but, in case I have not heard correctly, will he say whether in the programme serious consideration will be given to the accommodation for staff?

§ The Earl of Arran
My Lords, that is of prime consideration. I hope I have stressed that it is a matter for each individual health authority to decide what is appropriate for that authority.

Earl Alexander of Tunis
My Lords, is my noble friend aware that the main thrust of my Question was to emphasise the important part that private enterprise plays in the National Health Service?

§ The Earl of Arran
My Lords, yes, I am aware of that.

§ Lord Prys-Davies
My Lords, will the Minister confirm that the cost of the capital programme he has outlined to the House will be paid out of general taxation, and that the cost is such that the role of private medicine can never be anything more than marginal?

§ The Earl of Arran
My Lords, I believe that the first question relates more to the Treasury and its particular policy on that matter.