§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Graham.]
§ 12.5 a.m.
§ Mr. T. W. Urwin (Houghton-le-Spring)
I am grateful for this opportunity to raise a subject of considerable importance in my constituency. Happily, I am able to raise it earlier than would have been possible but for the perspicacity of my hon. Friend the Member for Newham, South (Mr. Spearing) who got the previous debate terminated so quickly.
The subject that I wish to discuss is the proposed closure of Seaham Hall Hospital in my constituency. For the benefit of the Minister who is to reply, it might be helpful if I gave a little of the history of this rather beautiful bilding.
It has historic links with the Millbanke family of local fame and was bought by the third Marquis of Londonderry in 1821. While in the ownership of Sir Ralph Millbanke, it became more famous because of the marriage of his daughter to the poet Lord Byron. The building occupies a spacious site set in romantic Byron's Walk on a promontory overlooking the sea.
The building was leased by the present owners to Durham County Council in 1927 for the purposes of establishing a sanatorium for tuberculosis sufferers and was an admirable choice for such a purpose. Latterly it has gained a considerable reputation for the excellence of the cardiothoracic service established there some years ago. This service occupied 49 of the 119 beds in the hospital. The service has recently been transferred to the new Freeman Road Hospital in Newcastle as part of the reorganisation of the regional hospital service.
That decision culminated in anxious and intensive speculation about the future of Seaham Hall Hospital. The decision to plan a complete closure was taken by the regional health authority early in 1977 and immediately provoked considerable local opposition to the closure proposal. Crowded public meetings were held and these led to the formation of a local action committee and a massive volume of support from virtually all public and voluntary bodies in the town of Seaham as well as private individuals.
626 Easington District Council and Durham County Council supported the campaign to save the hospital. A petition was organised by the action committee and presented to Sunderland health authority. Presumably the same petition will go to the area health authority in time for its meeting next week and will eventually arrive on the desk of my right hon. Friend the Secretary of State. It will contain at least 10,000 signatures supporting the retention of the hospital. Proposals from the Sunderland Area Health Authority giving specific reasons for the closure decision, supported by the Durham Area Health Authority, indicated that Seaham Hall would be closed after the transfer of the cardiothoracic surgical service to Newcastle and the transfer of the chest medicine service to Sunderland.
The Sunderland Area Health Authority went on to say that the principal reasons for wanting to close the hospital were the transfer of the cardiothoracic surgery service to the Freeman Road Hospital, Newcastle, which would render Seaham Hall an uneconomic unit, the need to make savings to finance other Health Service developments, and the desire to integrate general and chest services. As the authority pointed out, Seaham Hall is an adapted building and neither Sunderland Area Health Authority nor Durham Area Health Authority has any plans to re-use it for hospital services. The further development has now taken place where the 49 cardiothoracic beds have been transferred to the Freeman Road Hospital.
The proposals to transfer the cardiothoracic surgery and the chest unit from Seaham Hall were reluctantly accepted by the community health council, if only because those plans had been in being since 1975 and were really too far advanced for the council to make any impact on the decision. It is understandable that at that point the local campaign began to gain even greater impetus, if only because Seaham Hall has been an extremely valuable hospital, small though it is. A most glowing tribute was paid in an article in the local Sunderland Echo of 11th July 1977, in which it was stated:That leaves the hospital's other speciality —chest medicine, which Sunderland Area Health Authority wants to relocate.627 Relocation has since taken place. The article continued:The installation in the 17th century building of one of the best-equipped operating theatres in Britain was reported in 1965 as 'playing an increasingly important role in heart and chest surgery'.The first heart operation was performed in 1960. An intensive-care unit was developed during the next five years. One milestone in the Hall's enviable medical record was the successful 1964 hole-in-the-heart operation on a 13-year old boy. Open-heart surgery later became a Seaham speciality.Closed-circuit TV and a monitor room for physicians and technicians to watch theatre work kept the hospital in the forefront of developments. A new laboratory catered for pathology services.From that article the real value that is placed on the hospital by the local people will be acknowledged. They are quite properly claiming that it is unique in another respect, in that for many years it has been regarded affectionately as a happy hospital. It is a family hospital where, to my knowledge, there have never been any real staff problems.
The Sunderland Community Health Council, supported by the Durham Community Health Council, with the backing of the local action committee and acting strictly within the provisions of the statute, began the consultative procedures by presenting the closure document to a packed public meeting on 13th July 1977. There were 10 alternative proposals put forward for the continuing use of the hospital, some of which were selected by the joint community health councils. Those proposals were ultimately flatly rejected by the area health authority.
At a further meeting on 24th October 1977 the Sunderland Community Health Council decided formally to oppose the closure. It proceeded to submit a counter proposal comprising three specific alternative uses that had public backing. First, it was proposed that there be provision for the younger chronic sick. Secondly, it was proposed that it be used for geriatric patients. Thirdly, it was proposed that it be used for convalescent patients.
As for the first category of younger chronic sick, the suggestion was made that 25 to 30 beds could be retained and made available for the longer-stay younger chronic sick. From its researches, the community health council 628 was able to prove a quite substantial need in the Sunderland area for long-stay accommodation. It had established that in the middle of last year there were then known 30 or 40 patients who would have benefited from the provision of such accommodation.
The CHC went on to say that during the past four years people requiring long-stay care have been sent from the locality to places as far distant as Liverpool and Hertfordshire, many miles removed from Seaham Harbour, to Cheshire Homes in Consett and to Matfen in Northumberland. The CHC believes that this is the most important area of need in Seaham at present.
Additionally, the regional paraplegic unit at Hexham has experienced difficulty in returning patients to home areas, including Sunderland, while adaptations are carried out to their homes. The proposed unit would enable such patients to be within their own community and would facilitate visiting, and earlier rehabilitation might well follow. I understand that the ground floor area of the hospital is easily convertible for this particular use at what could be minimal expense.
The Department of Health and Social Security document "Priorities for Health and Personal Social Services", as my hon. Friend the Under-Secretary will recall, emphasised the need for provision for the younger disabled.
Secondly, the allocation of 30 beds for geriatric patients would clearly help the Sunderland area to move closer to the Department's guidelines on provision of beds for the elderly. There has been some difficulty in accurately assessing the number of old people in the area. The probable figure for Sunderland and that part of the Easington district which falls within the administrative area of the Sunderland AHA is about 53,000 people over the age of 65. I am told that that is a minimum estimate.
The Department's formula suggests 530 beds to service such a population of elderly people, whereas only 388 such beds are available in the Sunderland catchment area. It is estimated that there are 16,000 elderly people in the Seaham community alone. I understand that 400 of these people, on average, are hospitalised in Sunderland each year. In those 629 circumstances, there is clearly a heavy strain on apparently inadequate resources.
Increasing longevity, too, as my hon. Friend will appreciate compounds problems such as these. The example that I would cite is the large number of people who are over 75 years of age. This age group alone will increase by over 20 per cent. in the next 10 years. Clearly, this is another area of somewhat high priority.
In category three the CHC recommends that 10 convalescent beds should be made available at this hospital for patients requiring a rest following hospitalisation. The need is highlighted by problems surrounding Silloth Hall in Cumbria, which has been a receiving hospital for this kind of patient. Its future is uncertain. I am told that the hospital operates on a year-to-year basis. In the last full year of its operation, 290 patients were sent from the Sunderland area to Silloth Hall. Again, it is important to have people convalescing nearer home. Admissions to Silloth Hall are becoming increasingly difficult. My information is that in May 1977 there were 80 women on the waiting list. It is quite possible that some of those women are still waiting for places in the hospital.
It is the expressed opinion of social workers, general practitioners and consultants that the need is well above the current usage of convalescent beds in Sunderland of three to four patients per week. In those three categories the community health council proposal is for a maximum of 70 beds against the 119 that the hospital carries. The proposals have been rejected by the Sunderland Area Health Authority and have now been submitted to the regional health authority for final decision.
We must have some regard to costing. I understand that about £760,000 was required to run the hospital in the fiscal year which ended in March 1977. The withdrawal of cardiothoracic services would leave an estimated £400,000 budget for the continued use of Seaham Hall, on the projections by the community health council. On the basis of regional averages and available financial information, the community health council estimated that the three-point counter proposal would cost £290,000 a year.
630 It is reasonable to assume that that calculation does not take account of inflation since the figures were compiled, nor, I imagine, does it take account of the cost of the minor structural works that would be required to adapt the building for the proposed re-use, but this would be a non-recurring cost. It is equally reasonable to assume that the balance can be equated with estimated annual running costs.
Employment is an important factor here, even though the hospital is relatively small. It is even more important when we consider the very high unemployment rates in my constituency and in this part of it. A total of 202 staff were employed in the hospital when it worked at full capacity, and 60 per cent. were part-time workers. There is the possibility of some difficulty in redeploying those part-time workers in the Sunderland area. The 202 are the equivalent of a full-time complement of 160 staff.
The counter proposal from the community health council requires only 100 full-time staff. The retention of those 100 jobs at Seaham would be quite a stimulus to employment in Sunderland, as it would also require the recruitment of additional staff to man the new Sunderland General Hospital.
My constituents have given an emphatic "No" to the proposed closure. Here we have a fine building which has given wonderful service over a fairly long period. It is ideally sited for hospital purposes, despite being in a mining area There are three pits within virtually a stone's throw of the hospital. Closure must be a paradox in view of the high incidence of accidents and the dreaded industrial diseases to which all coal miners are highly vulnerable.
My hon. Friend the Minister will therefore appreciate that local feeling runs high, not least over the madness of Health Service reorganisation, carried out by the Conservative Government, which places Seaham Hall Hospital firmly in the area of the Durham Area Health Authority yet within the administrative jurisdiction of the Sunderland Area Health Authority. If my hon. Friend does not understand the geography, he will have difficulty in acquainting himself with those facts. That reorganisation also cuts across equally 631 controversial and ridiculous local government boundaries, also determined by the Conservative Government.
The regional hospital authority's decision is anxiously awaited not only by my constituents but by me. I appeal to my hon. Friend and my right hon. Friend the Secretary of State to examine carefully the case for retention, as proposed by the Sunderland Community Health Council. In the event of an adverse decision, I should hope to be able to persuade my right hon. Friend to receive a deputation from the locality. I should take great pleasure in leading it.
§ 12.25 a.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 Houghton-le-Spring (Mr. Urwin) for giving me the opportunity to speak about the future of Seaham Hall Hospital. I know this is causing a good deal of concern both to his constituents and to the people of Sea-ham and the surrounding area, and my hon. Friend enforced it in what he said. Indeed, my right hon. Friend the Secretary of State is already aware of this local feeling as he has received a number of representations from local groups including the Sunderland Community Health Council, about the proposed closure of this hospital.
The Sunderland Area Health Authority has only recently referred its proposal to close Seaham Hall Hospital to the Northern Regional Health Authority, and I understand that the RHA is to consider the matter at its next meeting on 24th January. I must emphasise, therefore, that nothing I say today should be construed as prejudging the issue in the case of Seaham Hall Hospital and, in this context, I think it might be helpful if I described the procedures for the closure or change of use of any National Health Service building.
Following the reorganisation of the NHS in 1974 and the introduction of new planning procedures, the procedures for the closure or change of use of health buildings were reviewed and my Department issued revised guidance in 1975. The aim of the new procedures is to enable scarce resources to be redeployed with the maximum speed and simplicity consistent with adequate local and, where 632 necessary, national consultation. The rightness of this approach seems especially relevant at a time of economic restraint, when it is absolutely essential that no unnecessary barriers should stand in the way of the 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 Seaham Hall Hospital is the Sunderland 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.
Having said that responsibility rests with the area health authority, I should like to say a little about the role of this statutory body. It is there to direct and lead the officers who serve the authority to create and improve services for the management of the local health service and, perhaps most importantly, to oversee the standard of services provided both in terms of quality and quantity. Lest some hon. Members feel that an area health authority must in consequence be out of touch with the day-to-day running of services in its area, district, and hospitals. I would add that, thanks to this Government's actions in bringing about within two years of taking office a greater degree of democracy in the National Health Service than we inherited under the National Health Service Reorganisation Act 1973, the people who sit on health authorities are very much attuned to the feelings and aspirations of their community.
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. The 633 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, 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.
Following this stage of consultation, the authority then reviews its original proposals in the light of the comments received, and 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. I must repeat, therefore, that nothing I say now should be construed as prejudging the issue, on which the consultative procedures I have described are still in progress.
Having outlined the consultative procedures generally, I should like to say a few words about the particular proposals contained in the Sunderland Area Health Authority's consultative document on the future of Seaham Hall Hospital. I should perhaps stress first of all that Sunderland Community Health Council does not object to the AHA's proposals for the transfer of beds from Seaham Hall, but only to the proposal that the building should no longer be used for health services purposes. Having heard from my hon. Friend about the history of the building, I well understand local feeling about it. I should also stress that it is the area health authority's belief that its plans, which essentially involve the rationalisation of under-used 634 beds, will enable the authority to provide a more economic and efficient pattern of health care to the population it serves.
In May last year Sunderland Area Health Authority issued its consultative document on the future of Seaham Hall Hospital which at that time provided part of the regional cardiothoracic service having 42 surgical beds, as well as 72 beds for chest medicine. The consultative document referred to two developments affecting the future of Seaham Hall which had been outlined in the regional strategic plan for the period 1976–86 published in March 1977. One development to which agreement had already been given in 1975 following consultation by Newcastle Area Health Authority (Teaching) was the transfer of the cardiothoracic service from Seaham Hall Hospital to the new regional cardiothoracic unit being built at Freeman Road District General Hospital, Newcastle. The second development was the building of Scheme I of Phase IV of the Sunderland District General Hospital to which I have already referred.
As a result of this development Sunderland AHA carried out a general review both of its existing hospital beds and future bed needs to see what service rationalisation might be achieved. One proposal was that the chest medicine beds at Seaham Hall Hospital could be absorbed into the existing pool of Ryhope General and Sunderland Royal Infirmary general medical beds which were and are currently under-used. The area health authority's view was that the implementation of these proposals would achieve both financial savings and the greater integration of the area's chest medicine and general medicine services.
As I have already said, agreement had already been given to the transfer of the cardiothoracic service from Seaham Hall to the new unit at Freeman Road Hospital and, as my hon. Friend is aware, the move took place last month. As the consultative document on the future of Seaham Hall explains, the area health authority's view is that the loss of the cardiothoracic service makes the hospital uneconomic. This is why the area health authority has proposed, first, that the chest medicine beds should be absorbed into the Ryhope General and Sunderland Royal Hospitals on completion of the 635 pulmonary function laboratory, the bronchoscopy room and ward upgrading scheme, which are all currently being built at Ryhope General; and, secondly, that the buildings at Seaham Hall should no longer be used for any other Health Service purpose.
These plans have been made public by Sunderland Area Health Authority and I understand that a number of local organisations have commented. In particular—and again I wish to stress this point—the Sunderland Community Health Council, acting jointly with Durham CHC, has not objected to the proposed transfer of beds. What it does object to is the proposal to relinquish the use of Seaham Hall for Health Service purposes and it has made the following counter proposals. First, that the 42 cardiothoracic beds be re-used for the provision of between 25 and 30 long-stay beds for younger disabled patients. Secondly, that the 77 chest medicine beds be re-used for about 30 geriatric beds and 10 convalescent beds. I have noted carefully what my hon. Friend said in support of these proposals.
I am told that the community health council's objections to the proposed closure of Seaham Hall and its counter proposals were carefully considered by the area health authority at its November and December meetings. As a result it was decided to reaffirm the principle of the authority's proposals and the matter has 636 therefore been referred to the Northern Regional Health Authority.
I understand that the RHA will discuss both the proposals and the community health council's objections and counter proposals at its meeting later this month and it would certainly not be proper for me to comment further at this stage. I certainly cannot say what the regional health authority's decision will be; nor, if the matter is referred to my right hon. Friend the Secretary of State, can I anticipate his decision. All I can do at this juncture is to assure my hon. Friend that the RHA and my hon. Friend the Secretary of State—if he is asked to adjudicate—will consider all the evidence with the greatest care.
Our aim is to ensure that consultation is a meaningful process, that each case is decided on its merits in the light of prevailing local circumstances, and that full account is taken of the views of the community health councils whose duty is to represent the interests of the general public. In this way we may anticipate that the National Health Service will respond objectively to changing needs and changing ideas and that the most efficient use will be made of available resources for the benefit of the population as a whole.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-six minutes to One o'clock.