HC Deb 21 December 1976 vol 923 cc634-44

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Stoddart.]

11.33 p.m.

Miss Joan Lestor (Eton and Slough)

When an issue such as the closure of a well-established and well-used hospital in one's constituency is proposed, it is right that the hon. Member for the area should voice the feelings of a large number of people in her constituency. I think that my hon. Friend the Minister is aware that I have sent to his Department a petition signed by over 30,000 people of Slough opposing the closure of Upton Hospital as a maternity unit and the transfer of facilities to hospitals outside the immediate area.

It is also important for an hon. Member faced with a proposal such as this to distinguish what might be regarded as sentimentality or emotion from the facts of the situation, and to make up her mind whether the proposal is likely to be in the best interests of Slough in particular and of the area health authority in general and whether it is likely to create more problems than it will solve. I am bound to say that the feelings that have arisen, the march that took place to draw attention to the problems that will arise if the hospital is closed and the spontaneous reaction from trade unions—one union has already sent comments to the Department of Health and Social Security and the area health authority—signify that the proposal has sparked off the feelings of Slough people to a great degree.

One of the proposals we are considering is the change of use of the hospital, which I shall not go into in detail because my complaint is not about what is likely to be put in its place but is about the transfer of maternity services. I think that the Minister is aware that the proposal is that the general gynaecological, maternity and pediatric services should be provided in two centres in the north and south of the area of the East Berkshire authority in which Slough is situated and that the regional health authority should be asked to build as soon as possible a unit of 75 maternity and 20 special care beds at the Wexham Park Hospital, that being a relatively new and expensive hospital in another part of the area slightly outside my constituency but nevertheless used by many people in my constituency.

The proposal is that, until the extra beds at Wexham Park have been provided, maternity facilities should be centralised at the Canadian Red Cross Memorial Hospital and at Heatherwood Hospital. I should like to make two points about that. First, there is no indication when the extra beds at Wexham Park Hospital are likely to be provided; and even if they were to be provided tomorrow morning, which in the present situation is hardly likely, I am bound to draw the Minister's attention to the fact that ever since Wexham Park Hospital was built—welcome as it was for the excellent facilities it has provided, although sometimes they have been under-used because of lack of staff—there have been continued complaints, all justified, about the difficulty of getting to the hospital because of the poor transport facilities in the area.

Therefore, even if the extra beds were to be provided quickly, there would still be a transport problem. However, as it is plain that they will not be provided quickly and that the facilities are to be transferred to other hospitals outside Slough, we are faced with the question of how the problems of pregnant women, women who have pre-natal difficulties, for looking after children will be solved.

Slough has a young community. The area has seen enormous changes over the years, because since the 1930s and even before then large numbers of people, many of them young, have come to Slough to find work, to make their homes and bring up their families. The birth rate in Slough is higher than it is in most of the surrounding areas which the hospitals have to serve.

The Minister may have been informed that the transport facilities to the two hospitals where the maternity facilities are to be located are very good. Comment has been made to the Minister in writing that there is a fast road from Slough into the two areas in question. That is true—if one has a car. It is often assumed that large numbers of women and husbands have cars and that they will visit and attend clinics by car. That is not true. Many of them will have to use public transport, and Slough, like many other areas, is badly served by public transport. As I have said, we have had this problem for a long time, and it will continue if maternity facilities are located outside our immediate area.

Another matter which characterises Slough and distinguishes it from the other areas in the East Berkshire health area is that, with a young and changing community, because people move into it, it has the type of problems which arise with a changing community.

The Upton Hospital has built up a relationship involving social workers and a variety of supportive agencies. That relationship will be destroyed if the maternity unit is moved out of the Slough area. For example, industry in the area has been most co-operative with Upton Hospital social workers and others by putting fathers on shift work so that they may care for children during the day. Other help is offered during the nights when fathers are at work.

Many factors have tended to make life difficult in Slough in terms of community life because of changes of population and the widening of the area over many years. The Upton Hospital has given a feeling of community to the people who have used its services for many years. The people in the area have become so involved and identified with the hospital, as the Minister will know from the petition he has received and from other representations that have been made to him, that they have often joined in various ways to raise money to buy some of the equipment for the Upton Hospital so that it may be available for people in the area. There is a genuine feeling that, if the hospital's maternity services are taken away, something valuable will be destroyed.

The practicalities of the matter presents enormous problems to people and agencies working in the maternity services. There is the question not only of transport but of the extra costs involved for those who will have to travel considerable distances, often by public transport, to make visits, to take children to hospital and other activities.

The staff in the Upton Hospital have been able to persuade young mothers with problems to come into the hospital earlier than might otherwise be the case, and certainly a reasonable time before their babies are born, so that they may be protected and their babies may be given every chance. Certainly the social workers and doctors are properly concerned over the fact that this service may be destroyed.

I do not think that Upton Hospital would be suitable for geriatric services, as has been suggested in some quarters. The hospital is situated in a noisy part of the town and does not have the facilities that one would wish to provide in respect of the elderly in the community.

In asking the Minister to examine closely the proposals to close Upton Hospital, I have the full support of doctors, social workers, trade unionists, fathers, mothers and mothers-to-be. They wish to see Upton Hospital kept open because of its value to the community and for the contribution which it makes to the area. I believe that it would cost more to provide money for transport and other facilities and to extend other supportive arrangements outside the present area than would be involved in keeping the maternity facilities at Upton Park as they now exist. We must see to it that those important and valuable facilities are not destroyed.

11.45 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

I am most grateful to my hon. Friend the Member for Eton and Slough (Miss Lestor) for giving me this opportunity to speak about the future of the Upton Hospital, which I know is causing a great deal of concern to the people of Slough, as evidenced by my hon. Friend's speech and the enormous petition which she has supplied, signed by her constituents.

At the outset, however, perhaps I should make it quite clear that the Berkshire Area Health Authority is proposing, and at this stage I must emphasise that it still is only a proposal, to change the use of the hospital and not to close it. This proposal is part of the rationalisation and development propoals for the East Berkshire health district as a whole which the area health authority has set out in a consultative document on which it has invited comments from various interested organisations, including the East Berkshire Community Health Council, whose duty it is to represent the views of the general public on the health services in the district to the area health authority. I am sure that my hon. Friend will appreciate the desire of health authorities to rationalise their services to make the best possible use of their resources, while at the same time providing an efficient health service, especially in these times of economic restraint.

However, before describing the proposals contained in the consultative document, including the proposals for the Upton Hospital itself, I should like to say a few words about the procedures for the closure or change of use of National Health Service buildings which my Department has laid down and which must be completed before the use of the Upton Hospital could be changed. Following the reorganisation of the National Health Service in 1974 and the introduction of new planning procedures in the National Health Service, the procedures for closure and change of use of health buildings were reviewed. The aim of the new procedures is to enable resources to be redeployed with the maximum speed and simplicity consistent with adequate local and, where relevant, national consultation. Especially at a time of economic constraint, it is essential that no unnecessary barriers should impede cost-effective use of resources.

In general, responsibility for determining the closure or change of use of health buildings rests with the appropriate area health authority, which in the case of the Upton Hospital is the Berkshire Area Health Authority, provided that the community health council is in agreement. Where there is general local agreement, it should be possible to effect a closure or change of use within a period of six months.

If, having discussed informally a particular closure or change of use with the interested organisations, an area health authority considered that such a measure would be beneficial, it would have to initiate formal consultations. In this event the procedures require the authority to prepare a consultative document covering such matters as the reasons for its proposal; an evaluation of the possibilities of using the facilities for other purposes, or the disposal of the site; implications for the staff; the relationship between the closure or change of use and other developments and plans; and the transport facilities for those patients who might be affected by the proposals. My hon. Friend has stressed this point tonight. The area health authority would invite comments on the proposals contained in the document, within a period of three months, from such bodies as the community health councils, local authorities, joint staff consultative committees and other staff organisations, family practitioner committees and local advisory committees, including the local medical committees. Hon. Members whose constituents were affected would also be informed of the proposals.

The area health authority would then seek the community health council's views on the comments it received and on its own observations on those comments. The authority would then review its original proposals in the light of the comments received and, unless there was strong local opposition, it could then implement its original proposals provided that the community health council agreed. The regional health authority and my Department would be informed of the decision.

However, if the community health council objects to the authority's proposals, it is required to submit to the authority a constructive and detailed counter-proposal, paying full regard to the factors, including restraints on resources, which led the authority to make its original proposal. The matter must then be referred to the regional health authority. If the regional health authority is unable to accept the views of the council and wishes to proceed with the closure or change of use, it falls to my right hon. Friend the Secretary of State to act as arbiter. Nothing I say today should therefore be construed as prejudging the issue, on which the consultative procedures I have described are still in progress.

The East Berkshire health district is one of the larger health districts and at present serves a population of approximately 340,000, which it is anticipated will increase to 375,000 by 1981 and to almost 400,000 by 1986. At present the district has about three acute hospital beds for every thousand of its population, which proportion is rather more than it considers necessary. The Oxford Regional Health Authority, of which the Berkshire Area Health Authority forms a part, has recommended that 2.1 acute beds per 1,000 population would suffice throughout the region as a whole, and the area health authority feels that this level of provision would be suitable for East Berkshire. If this were to be implemented, the resulting savings in running costs would make more resources available for improvements in other services, especially those provided for geriatric, mentally ill and mentally handicapped patients. In the consultative document "Priorities for Health and Personal Social Services in England", which was published earlier this year, my Department asked health authorities to give priority to these services.

In its consultative document the Berkshire Area Health Authority has proposed a number of measures which would enable it to effect the changes in the pattern of its services, the general philosophy of which I have just outlined. First, it proposes to reduce the number of units with general medical beds in the health district from five to four. This would mean that these services would be provided in future at the Wexham Park, King Edward VII, Heatherwood and Canadian Red Cross Hospitals. The number of units with general surgery beds would be reduced from five to the three at Wexham Park, King Edward VII and Heatherwood Hospitals. Obstetric and gynaecology beds would be provided in the short term only at the Canadian Red Cross Memorial and Heatherwood Hospitals. In the longer term, these facilities in the north of the district would be centred on either the Wexham Park Hospital on the outskirts of Slough or the King Edward VII Hospital at Windsor, and in the south of the district probably at a new hospital in Bracknell. Additional resources could also be made available by concentrating the smaller specialities, such as ENT and dentistry, on one or two sites, thus avoiding duplication.

These measures would enable the Maidenhead Hospital to be used as a community hospital until such time as funds became available to provide such a hospital on the St. Mark's, Maidenhead, site, which is considered more suitable for the purpose. Also, beds freed at the Canadian Red Cross Memorial Hospital could be used for the care of the young chronic sick. Facilities for the mentally ill would be improved by the provision of day hospital facilities in the southern part of the district, possibly at Heather-wood Hospital. Additional facilities for the care of geriatric patients and the elderly mentally infirm could be provided at Maidenhead, Canadian Red Cross Memorial and Old Windsor Hospitals. The East Berkshire District Management Team has also recommended that the area health authority should provide new facilities offering residential accommodation for the mentally handicapped at St. Mark's, which would enable the closure of Clarefield Court Hospital to be considered. Day places for the mentally handicapped would also need to be provided in Maidenhead and Slough.

The proposals envisage that most of these changes would probably be made in the next five or six years. However, also included in the area health authority's consultative document are proposals by the district management team for the further devolopment of the health services in East Berkshire after 1981. These include the provision of acute medical beds and rheumatology and rehabilitation facilities at Wexham Park or King Edward VII, and of rheumatology and rehabilitation services at the proposed new hospital at Bracknell. The district management team has also suggested that detailed plans be prepared for the provision of the community hospital facilities at the St. Mark's site, some time after 1981, including the provision of day hospital facilities for geriatric patients. The health authorities are acutely aware of the lack of adequate provision for patients suffering from acute mental illness and for those who are chronically mentally ill, and have suggested that plans be drawn up to improve further these services.

As I said earlier, these plans have been made public by the Berkshire Area Health Authority, and I understand that many organisations, including local trade unions, and individuals have submitted their comments on them to the authority, which is now starting to study them in detail.

Now that I have painted in some of the background, perhaps I might say something about the area health authority's proposals for the Upton Hospital itself—which is very much a matter of concern to my hon. Friend and her constituents—still bearing in mind that because of the possible appellate status of my right hon. Friend the Secretary of State for Social Services in this matter I can offer no comments on the merits or otherwise of those proposals.

The Upton Hospital at present comprises about 57 obstetric beds, four general practitioner maternity beds, 14 special care baby cots, about 24 gynaecology beds and 50 for geriatric patients. It is well located in Slough, and the Berkshire Area Health Authority considers that it has obvious potential for development as a community hospital, which would complement the district general hospital facilities which the authority proposes to provide at Wexham Park Hospital. Slough is one of four main centres in East Berkshire where the provision of a community hospital is highly desirable. The others are Bracknell, Maidenhead and Windsor.

While the services at Upton were being replanned, and until new facilities were built—probably at the planned district general hospital at Wexham Park—the area health authority proposed that the obstetric and gynaecology facilities for the people of Slough should be provided at the Canadian Red Cross Memorial Hospital at Taplow, which is five or six miles from Upton, and the Heatherwood Hospital, Ascot, which is 10 or so miles away.

There is no doubt that in the country as a whole surplus exists in the obstetric services, and it seems unlikely that there will be any rise in the birth rate within the next few years that might absorb this. In order, therefore, to reduce the wastage of resources that this represents and at the same time to further the policy that births should take place where the full range of facilities is available, it was proposed to concentrate services at district general hospitals where these can be provided. Far from leading to a lowering of standards this can be expected to offer better facilities for more mothers, particularly as it is intended that improvements aimed at further reducing maternal and perinatal morbidity and mortality should continue to be introduced at district general hospital units.

The district management team is concerned that there is undoubtedly an urgent need to provide more beds and other facilities in the district for geriatric patients. This need will become increasingly manifest in the next few years. Therefore, it has been suggested that the Upton Hospital should, at least in the short term, provide specialist geriatric services, day hospital facilities and a supporting rehabilitation department prior to its full development as a community hospital.

In conclusion, I should like to emphasise once again that the proposal to change the use of the Upton Hospital is still only a proposal, that the consultation procedures laid down by my Department are still far from completion, and that until they have been completed a firm decision about the future of the hospital cannot be made. Much of the consultation procedures will have to be covered in the local discussion of the area health authority's consultative document, but obviously further more detailed discussion would have to take place on such matters as the implications for the staff—a very important matter—and, as stressed several times by my hon. Friend, any transport problems for the patients affected by the change of use. These matters will have to be fully considered before any final decision about Upton can be taken. I am sure that these factors will be borne in mind by the area health authority and the local community health council in the further consideration they are bound to give this important issue.

Question put and agreed to.

Adjourned accordingly at three minutes to Twelve o'clock.