§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Thomas Cox.]
§ 7.1 p.m.
§ Mr. John Cartwright (Woolwich, East)
Even at 7 o'clock on a Friday evening, I welcome the opportunity of drawing public attention to the difficulties that have been caused to thousands of my constituents in Area 3 of Thamesmead over the continued delay in providing temporary health centre facilities. The delay has been caused by a quite extraordinary degree of muddle and confusion between the public bodies involved.
Thamesmead was conceived as a city of the twenty-first century, a new town for 60,000 Londoners, built within London's boundaries on riverside land largely released by the Woolwich Arsenal. It was to be a model of planning, not just of homes but including factories, schools, recreation facilities and all the services that people need. As so often happens in these cases, the reality has fallen far short of the dream, and nowhere more so than in the provision of health services. The original plan called for a superlative health centre serving the whole of Thamesmead, but staged development of what were extremely isolated areas made it essential that area health centres were built.
The need for such a centre in Area 3 was discussed by representatives of the London borough of Greenwich, which was responsible for health centre provision, and the Greater London Council back in 1971 when a site was earmarked. It was intended that the project should be included in the 1974–75 capital programme. If the approval of the Department of Health and Social Security was not forthcoming, agreement was reached between the two authorities that the GLC would provide the necessary finance.
However, despite repeated approaches to the Department, including a personal letter to the then Secretary of State for Social Services signed by all the local authority leaders involved, approval of the scheme had not been received by the time that the Greenwich and Bexley Area Health Authority took over responsibility in April 1974.
2087 Perhaps not surprisingly in view of the chaos of National Health Service reorganisation, little more was publicly heard of the project until November 1975 when the area health authority produced a report indicating thatNegotiations with the Greater London Council are intended to provide a temporary building in Area III to serve a population of approximately 7,000 which will be reached by about 1980–81.Once again the project disappeared from view until March 1976 when the area health authority received a report which stated:Greenwich Borough Council Architect is acting on an agency basis and working drawings are in the process of preparation. It is hoped to take over the site of approximately one-third of an acre, located in Stage IIIB, in May 1976, the terms and conditions of which have yet to be received from the Greater London Council for consideration. It is hoped however that the building will be ready for occupation by the end of the year.Throughout that period the council has been pressing for action on the temporary centre and it has been assured that the area health authority welcomes its support in the struggle to find proper health facilities at Thamesmead.
By July 1976 the CHC had become extremely worried by the continued absence of any signs of progress. Its minutes said:The District Administrator explained that the building of the temporary health centre was in the hands of the RHA. Every pressure had been put on them by the District and Area. There was no hope of it being up and finished until February or March. The situation had been made worse through the GLC moving residents in more quickly than they had informed the health authorities they would do.The CHC therefore decided to make urgent approaches to both the RHA and the GLC. On 25th August 1976 the general administrator of the South-East Thames RHA replied to the CHC as follows:Responsibility for this scheme rests with the Greenwich and Bexley Area Health Authority and the Region's involvement apart from the design of the engineering services, which is being carried out by our works officers, is only on a monitoring basis. The latest programme, which is at present being updated, shows a completion of the Centre in June 1977.So the district said that it was the responsibility of the region, the region said that it was the responsibility of the area, and the completion date slipped again 2088 from March to June 1977. Small wonder in view of all this that the CHC minutes saidMembers made sounds of despair".In the meantime the GLC categorically denied that it was moving people into Area 3 at a faster rate than had been planned. Completion in June 1977 was bad enough, but worse was to come. At a meeting in November the CHC was advised that the regional health authority had referred part of the plan for a temporary centre to the Department for costing when the Department had queried the cost of the whole project. The entire scheme had now been referred back to the regional authority. It was suggested that the main problem was the cost of reinforcing the centre to make it vandal-proof. The main result was that the work would not start until May 1977 and the building would not be completed until May 1978.
When I put a Question on the matter to the Secretary of State asking why there had been still further delay, a Written Answer from him stated:I am informed by the Greenwich and Bexley Area Health Authority, which is now responsible for health centre provision, that the original plans for this project were unacceptably expensive. However, it is being redesigned, and it is intended that building should start in May 1977, with completion in May 1978."—[Official Report, 2nd December 1976; Vol. 921, c. 256.]I suggest that the clear implication of that answer is that the Department was not responsible for any delay, but when I asked the area health authority why it had been foolish enough to design a building which was unacceptably expensive it presented a different picture. The area administrator told me in a letter dated 14th DecemberThe original brief for the building included the usual cost limits imposed by Department of Health guidance, but did not take account of rules issued in 1971 on the reduced costs to be allowed if a building were to be temporary, i.e. to have a life of less than 25 years. These rules were issued to former Regional Hospital Boards and to the Boards of Governors but not to local health authorities (which were then responsible for health centre provision), and it was only belatedly that we were informed that these rules were considered now to apply to health centres".In other words, the area administrator is claiming that the Department changed the rules when the scheme was part-way through. In fact he told me that as far 2089 as the area health authority was concerned the project was on target until July 1975 when the DHSS procedures were imposed to require the regional health authority to undertake monitoring of the project.
This effectively meant beginning all over again and consulting additional people, so slowing down the whole programme. I am sure that my hon. Friend will understand that the sounds of despair that I mentioned earlier are now becoming much more widespread. If the results were not so tragic this bureaucratic buck-passing would be funny. No doubt it would provide the basis of an excellent script for the programme "The Men from the Ministry".
Meanwhile, back at Thamesmead two doctors, two health visitors and two students, a social worker, a community psychiatric nurse and two medical students are all attempting to serve almost 4,000 people from a converted flat. That means that nine staff members are trying to work in five small rooms in which they have to cope with four surgeries a day. Although 1,000 people per month are being seen by the doctors in this building, and a further 400 a month by other professionals, there is just one toilet for the use of patients and staff. There are no changing facilities for patients.
Files and medical supplies have to be stored in the bath, and it is not unusual for the bathroom to be used for meetings, and for patients to have to wait in a corridor so narrow that two pregnant women could not pass. The population of the area will have reached 4,000 by the end of the year and will be up to 5,000 by the end of 1977 when, on present information, the temporary centre will still not be ready.
The staff at the centre have over the past few weeks repeatedly pressed the GLC to provide larger accommodation to fill the gap before the temporary centre is ready, although why they should have had to do this themselves when it is clearly an area health authority responsibility to negotiate with the GLC I do not understand. Some of the offers of alternative accommodation by the Council have been ludicrous. They have involved trying to run a health centre from two separate flats, or expecting patients to climb up to 60 steps to reach the centre.
2090 The GLC has now offered three adjoining maisonettes to house the health care team but these are some way from the centre of Area 3 and cannot be occupied until the Post Office provides telephones, which is expected to be in February 1977. In the meantime, the GLC has suitable maisonettes available in the centre of Area 3 which have been unlet for almost a year. They would provide ideal accommodation, but I understand that the GLC intends to offer that accommodation to the potential tenants of shops that have also been empty for some time. I recognise the problem faced by the GLC, which is not of its own making. No housing authority likes to see housing units used for other purposes, but the GLC's sense of priorities of putting the possible needs of future shopkeepers above the immediate needs of the Health Service must be open to question.
The latest news is that the GLC has come up with an offer of a building which is being used as a staff canteen by building workers at Area 3. This might be converted into a temporary health centre. It is on the site originally earmarked for the temporary centre but it was withdrawn because the GLC wants to see a petrol station there by 1978. I understand that the site will be available until 1984 and that the area health authority is examining its suitability for conversion as a matter of urgency. I welcome that step and I hope that some thing will come of it.
I am surprised that two public authorities such as the GLC and the AHA could not have got together to discuss the availability of this building earlier in the game before considerable time and public money had been spent on designing a temporary health centre elsewhere. It is yet another example of the communication problems which have dogged this project from the start.
I apologise to my hon. Friend for going into such detail. I could have provided much more information but I hope that I have said enough to explain the sense of anger and frustration which is felt, first, by the health care team and, secondly, by my constituents about the bureaucratic bumbling which has plagued the project. No one can claim to have been taken unawares by the development of Thamesmead. It was planned long 2091 in advance and the housing has been so delayed that other services have often arrived first. The schools in Area 3, for example, were ready long before the bulk of their pupils arrived.
Why should an essential service like health be the one that lags behind? Is it, as some suspect, that there are jealousies about the amount of Health Service resources being devoted to Thamesmead rather than to other parts of the area? If that is so, I hope that my hon. Friend will take steps to counter it. Thamesmead is effectively a new town with all the problems of a new town. Its citizens suddenly find themselves in a totally new and strange environment, cut off for the next few years at least from neighbouring areas and with many problems to face.
The high proportion of families with young children is another reason why demand for health facilities in the early days of the development is above the national average. No one is asking for favours for Thamesmead but it is entitled to expect, if not the original dreams of twenty-first century provision, at least services which are acceptable by twentieth century standards.
Having examined the whole sorry story I ask my hon. Friend to do two things. First, will he set out clearly the responsibilities of the AHA and the RHA and his Department for the mistakes and delays that have occurred so that we can at least see an end to the buck passing that has gone on for too long? Second—and most important—will he take a personal interest in the issue and bang together whatever heads need banging to ensure that my constituents and potential constituents in Thamesmead will be able to see a doctor without having to queue in a corridor or be examined in a bathroom?
§ 7.14 p.m.
§ The Under-Secretary of State for Social Services (Mr. Eric Deakins)
I welcome the opportunity which this debate affords to give a fuller explanation of the circumstances regarding health centre provision at Thamesmead than was possible in replies to my hon. Friend's recent Questions.
The problem raised by my hon. Friend concerns the provision of primary care and I want to make clear from the outset that 2092 my right hon. Friend, the Secretary of State fully agrees that this is a matter of key importance, particularly in a new and expanding town.
In March of this year, we issued a consultative document on "Priorities for Health and Personal Social Services in England". As is said in the introduction, that document:restates the role of primary care in helping to relieve pressure on hospital and residential services by caring for more people in the community. The family practitioner services will continue to expand at an average of 3.7 per cent.; the health centre programme will be maintained and it is proposed that the growth of vital supporting services such as health visitors and home nursing should be given high priority. An expansion of 6 per cent. a year in both these services is visualised.The consultative document later reaffirms that:Health Centres make an important contribution to the development of primary care teamwork.The Government are fully aware of the need to give proper priority to primary care services. We are also convinced that the team approach, which develops as a result of the close working relationship between staff—of all disciplines—in a health centre is valuable. It helps to produce a more integrated service and, therefore, a better one for the patient. The consultative document adds that:priority should be given to establishing Health Centres in areas where inadequate accommodation is hampering the development of primary care teams ".These are views which particularly apply in a new community such as Thamesmead. The provision of new homes, mainly for families from other parts of London, started only in 1967 and the fact that there are already 14,000 people living there is an indication of the progress being made towards the target of rehousing a population of about 50,000. Both the pace at which the community is developing and the fact that services have to start from scratch mean that particular consideration has to be given to such facilities as education, health and welfare.
The part of Thamesmead which concerns us today is usually referred to as Area 3 where the first houses were let in October 1974 and which, after growing to accommodate 1,900 people by the end of 1975, now has more than 4,000 residents.
2093 It has always been planned that a main health centre should be provided for Thamesmead, but the responsible authorities realised that pending the final development of that centre they would have to make provision for some temporary facilities. A site for these was chosen within Area 3, as this will form part of the catchment area for the temporary facilities. I have used the phrase "temporary facilities", but the continuing rapid expansion of Thamesmead over a number of years must mean that such facilities will remain in use for as long as 10 years.
The paradox of so-called "temporary facilities" having to last for such a long period is an aspect of planning the services for a totally new and growing community. It must mean that special care has to be taken over the planning and design of such facilities and this, in turn, means that they cannot be provided as quickly as one would normally expect for a building described as temporary.
The area authority felt, quite rightly, that the population moving into Area 3 must, in the interim, be provided with services from premises convenient to their homes, and if acquired a maisonette made available at Nassau Path by the Greater London Council.
These interim premises had a floor area of only 79 square metres and it is obvious that they could be regarded only as a stop-gap. The number of patients on the list of the two doctors practising at Nassau Path has grown from 736 in October 1975 to almost 2,300 at present. This has meant, as my right hon. Friend emphasised, that the pressure on the space provided in the premises has also grown. Although it is difficult to be precise in measuring such matters, available figures suggest that the Nassau Path premises began to slip below normal standards for the number of patients from about July 1976.
I should like to pay tribute to the efforts of the staff who have worked in overcrowded conditions. The problem of assessing the overcrowding is especially confused because Nassau Path also accommodates two medical students from Guy's Hospital, as part of the general arrangement that students at the hospital will receive part of their training in 2094 Thamesmead. This arrangement is, of course, very valuable, but one can see how it could aggravate accommodation problems in the health centre premises.
The original plan was that the Nassau Path premises would, in 1977, be replaced by the Area 3 Centre but as my hon. Friend has said, the provisions of that centre has been delayed.
This delay is indeed unfortunate. The area and regional health authorities fully appreciate the anxiety which it has caused. In view of the importance which the Government attach to primary care services and health centre provision, I am greatly concerned that it should have happened. However, I feel that a number of points must be made in explanation.
First, the fact that for the reason I have already given the Area 3 centre was to have a longer life than one would normally expect from a truly "temporary" building meant that much greater care had to be taken over its design and construction.
Secondly, health authorities assumed responsibility for the planning and provision of health centres only in April 1974. This had previously been the responsibility of local authorities. The changeover meant that the health service authorities had to take on an important new activity and absorb the expertise which would enable them to adjust to the relevant DHSS guidance and handle the problems which are bound to arise. Health centres must, as I have said, be convenient to the population they serve and overall planning of health centre provision in Thames-mead has been made even more complex by the fact that the development of Thamesmead's housing is centred around several focal points and shifts in the GLC's relative priorities for each focal point often mean a consequent adjustment of health centre plans. Whilst this factor has not directly affected the services for Area 3 it has certainly complicated overall planning.
Thirdly, this change of responsibility was only one aspect of the re-organisation of the health service. Not only were there profound changes in the constitution and duties of the health authorities but the new authorities had to build up their management structures and establish relationships between the various tiers in the new service. Furthermore they had to set 2095 up effective arrangements for liaising with local authorities, who were still providing social services.
All of this was bound to mean a difficult process of adjustment, and in that process the Greenwich and Bexley Area Health Authority is, in conjunction with the South-East Thames Regional Health Authority, and in common with all health authorities in the country, at present carrying out a review of its services and resources.
As my hon. Friend is naturally aware, the area health authority has, in connection with this review, just published a "Consultative Document on Health Resources in the Area". This has, I understand, been distributed to all staff groups and to a wide range of other persons and organisations for consultation and comment.
At a later stage some of the proposals may—in the absence of local agreement—have to come to my right hon. Friend the Secretary of State for Social Services for decision. I am sure that, in this light, my hon. Friend will appreciate why it would not therefore be proper for me to comment on particular proposals at this stage. I shall confine myself to saying that the review was necessary and that the work involved in carrying it out has led to increased pressure on authorities and their officers. This is particularly so at area level in Greenwich and Bexley where the review has had to face very difficult issues and has been conducted well in advance of reviews in most other parts of the country.
All the work involved—and it has been an ongoing process since October 1975—must be borne in mind when we consider the handling of health centre plans in Thamesmead.
This does not, of course, offer a complete or final explanation of why the health centre has had to be delayed. It is certainly unfortunate that the authorities did not appreciate at an earlier stage that the proposed design for Area 3 could not —because it was not a permanent building—take full advantage of the cost allowances set out in my Department's guidance for the design of health centres.
The fact remains, however, that when matched in the correct way against the cost allowances, the cost of the design for the centre so exceeded the allowances that 2096 the authorities had to decide that they could not proceed with their plans. I am sure that this was the correct decision at that stage, although clearly one could have wished that the facts had been fully appreciated sooner and the decision taken at a time when alternative arrangements could have been made before the pressures at Nassau Path became so acute.
I can assure my hon. Friend that the appropriate lessons will be drawn from this experience and that the health authorities are now pursuing vigorously several possible alternative arrangements.
In the first place they are recasting their plans for the Area 3 centre. A new design—and I am assured that the costs of this will be acceptable—should be finished this month. Tenders will be invited in January 1977, received in March 1977 and, when these have been scrutinised, work on site could start by May 1977. Latest estimates are that it could be completed by December 1977 and the centre occupied early in 1978.
Simultaneously the area authority is investigating the possibility of acquiring a temporary building in Area 3. This would be available in July 1977 and, although the investigations are still at a very early stage, the present indications are that it may provide a very acceptable solution. Certainly, it is well worth looking into and the authority hopes that its examination of this possibility will be completed before it has to decide on tenders for the site.
The authority is also discussing urgently with the Greater London Council the use of larger premises in the interim period. These would replace the present interim provision at Nassau Path, but will be about three times as large and should ease the present accommodation difficulties.
I understand that the discussions have covered premises at Chadwick Court and at Postgate Court, although the area authority would, like the staff at Nassau Path, prefer those at Chadwick Court. The Area Administrator is to join a meeting with the Chairman of the GLC Thamesmead Committee next Monday and will press this view. I understand that my hon. Friend has also been invited to that meeting. In any event, the other houses offered are no more than 500 yards away and their use, if necessary, would 2097 I hope have little effect on the service to patients, which after all is the paramount consideration, as I am sure that my hon. Friend will agree. I can assure the staff that they and other bodies such as the community health councils, which have displayed such a lively interest in this matter, will be consulted over future plans.
I repeat, the delay that has occurred here is regretted. Much more should have been done at an earlier stage. I am assured that everything feasible is now being done to ensure that acceptable health centre premises are provided for my hon. Friend's constituents as quickly as possible.
§ Mr. Cartwright
I am grateful to my hon. Friends for his detailed explanation and for the news about the meeting on Monday. I am grateful, too, for the invitation to that meeting which has not yet reached me in any other way.
I am sure that my hon. Friend accepts that the work done by the area health authority does not necessarily excuse the delays—
§ Mr. Deputy Speaker (Mr. Oscar Murton)
Is the hon. Gentleman speaking for a second time? He needs leave to do so.
§ Mr. Cartwright
With the leave of the House, Mr. Deputy Speaker. May I put to my hon. Friend that the work on the consultative document does not necessarily excuse the delay on the design work for the temporary health centre? 2098 Secondly, will my hon. Friend tell me whether, when the area health authority takes advantage of the temporary building, all the design and other work that has gone into the temporary centre will represent abortive expenditure?
§ Mr. Cartwright
If the area health authority takes advantage of the existing canteen building, will all the effort and money spent on the design of the temporary health centre be abortive?
§ Mr. Deakins
I do not want to backtrack over the points I made. I certainly was not making excuses for the delay in the design and the work that had been going on merely because of the change-over in responsibility for health services from the local authority to the area health authority. I was trying to indicate that it was a factor that had to be taken into account. That factor also has to be taken into account in other parts of the country.
On my hon. Friend's second point, rather than answer it off the cuff, I would prefer to drop him a line when I have further information on that detailed point. In the meantime, I am sorry that he has not yet received an invitation to the meeting on Monday. I am confidently assured that he will get one, and that he is invited.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Seven o'clock.