§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Garel-Jones.]2.31 pm
§ Mr. Ken Hargreaves (Hyndburn)
I am grateful for the opportunity to raise on the Adjournment debate the question of the closure of the children's ward at Accrington Victoria hospital.
In my maiden speech last July I said that Hyndburn had many problems not of its own making — high unemployment, poor housing, and its hospital under attack. I am delighted that at this moment the Minister for Housing and Construction is formally opening our enterprise zone, which we hope will bring much-needed jobs to the area. Our housing needs have been recognised by a 16 per cent. increase in the housing investment programme announced last November, and the Minister will see the premises for himself on 19 April.
On two of our three major problems there has, therefore, been some progress, for which we are grateful, but on the third problem—the one about which there is the most vocal public opinion, Accrington Victoria hospital—we have taken a step backwards, and we need help.
When I said in July that the hospital was under attack, I did not expect the enemy to advance so quickly. We have had, after all, written guarantees from the Minister for Health, confirmed on 21 November by the Under-Secretary of State, that there would be no fundamental changes at Accrington Victoria without reference to Ministers. Guarantees were given that, while it was proposed to remove the 15 paediatric beds from the hospital to Queen's Park hospital, Blackburn, that would happen only when phase 1 at Queen's Park hospital was commissioned, and even then only after full local consultation had taken place. Imagine our surprise and dismay, therefore, when, only two months after the last letter was sent, the children's ward at Accrington Victoria was closed without any consultation with the community health council, the unions or the members of the district health authority. In comparison with that latest letter, setting out the assurances that the services at Victoria would remain, Neville Chamberlain's piece of paper seems positively meaningful.
Accrington Victoria hospital was opened in 1898 as a voluntary cottage hospital, and extended in 1919, 1928, 1932 and 1938, these developments being funded by public subscription. There are 135 beds. A twin operating theatre was built in 1973, and a two-roomed X-ray department was built and extended in 1975. The outpatients department was extended and upgraded in 1974 as part of a scheme to provide a GP maternity unit. It is obvious, therefore, that a great amount of money has been spent on the hospital; money provided direct by local people in what were difficult times, and, more latterly, money provided by the Government. All we ask is that money should not be wasted, and that we should be allowed to maintain the services that it was spent to provide.
It has, of course, been the intention of the district and regional health authorities, as set out in the strategic plan published in 1979—and repeated in the consultative document in 1982—to remove the 15 paediatric beds after the commissioning of phase 1 at Queen's park— 580 despite the fact that in between those two dates, in May 1980, the then Minister for Health, my hon. Friend the Member for Reading, East (Sir G. Vaughan), issued a consultation paper "The Future Pattern of Hospital Provision in England", in which he said that serious thought must be given to considerations such as the accessibility of hospitals to patients and visitors, to the sense of identity that many local communities have with their local hospital and to the expense and availability of public transport, especially for mothers with young children.
All those considerations apply to Accrington Victoria, but they have been ignored by the district health authority in the present decision to close the children's ward. Closing the ward would have been bad enough, but to close it, as has been done, without consultation is positively inept in view of the strength of feeling in Hyndburn about the hospital. That was first demonstrated when a meeting objecting to the strategic plan attracted more than 600 people, many others having to be turned away. More than 10,000 letters of objection were signed and sent to the Minister, as I am sure some unfortunate secretary will recall. Following a visit from the Minister, it was felt that the danger had passed—but the matter arose again suddenly in 1982, with the publication of the consultation document. A further public meeting attracted more than 500 people on an appalling night in October. Some Hyndburn people have even travelled more than 200 miles today to show their support.
I have explained to the Minister several times the strength of feeling, which is all the more remarkable because it comes from those who are usually quite reserved. Such public opinion cannot be ignored. I hope that the words of the Under-Secretary recently that public opinion can change medical opinion will apply in this case. More important, I hope that public opinion will have an effect on ministerial opinion.
In view of the demonstration of feeling that I have outlined, I should have thought that the district health authority would have been especially careful to ensure that the fullest consultation took place before any closure was implemented. The only possible justification for failing to consult would be if some emergency had arisen that meant taking immediate action.
At a public meeting called by the community health council on 14 February, again attended by more than 500 people, to enable the district management team and the consultants to explain their action, they at first refused to sit on the platform and to answer questions, but later, because of the serious criticism coming from the body of the hall, the chairman of the district health authority and the chairman of the district medical executive committee agreed to say a few words. When we learnt that the decision had been taken not hastily, but over a few months, that made the failure to consult even more serious.
Procedures are laid down by the DHSS for the closure of health buildings. They are set out in Health Service circular (IS) 207. Clause 2 states:Where sufficient local agreement exists it should be possible to move from a proposal to close to closure in a period of six months.No such agreement existed for the children's ward at Accrington. Yet, unless the temporary closure is ended or the proposed permanent closure eventually rejected by the Minister, the ward will have been closed not within six 581 months, but within six days of the surgeons' decision not to operate further on children at the hospital. That is wholly contrary to clause 2 and also to the wishes of the Secretary of State that, irrespective of statutory requirements, consultation should be undertaken on all closures wherever practicable.
Clearly, therefore, established procedures—presumably set up to avoid the position in which we now find ourselves, with all the ill feeling that it generates—have been flagrantly ignored. My constituents are entitled to ask, "Who runs the Health Service?"
I should make it absolutely clear once and for all that the reason for the ward's closure was given by the district health authority as beingthe lack of paediatric medical cover and the overriding regional and national policy following the Rochdale Inquiry in 1974, that paediatric surgery should be undertaken only in a hospital where all the facilities were available.The ward could, therefore, have been closed at any time since 1974 for the reasons now given. If it could have been closed at any time since 1974, why was it not closed? Are we to understand that if, as is claimed, children are now at risk, they have been at risk for 10 years and no one has done anything about it?
The chairman of the district health authority has refused to issue instructions that the ward be reopened. I have some sympathy for the position in which she finds herself. If she ignores the advice of the surgeons and orders the reopening of the ward, she will be held responsible if a child dies. However, my argument is that a child is more likely to die if the ward is not reopened than if it is.
Quite apart from the fact that the closure has meant ignoring regional and national policy on admitting children to adult wards, the unit administrator admitted that because of the decision to end paediatric surgery at Accrington Victoria, unless ward 8 at Blackburn infirmary is extended, it could become a bottleneck and restrict the amount of paediatric surgery undertaken. Thus, children needing an operation will not be able to have one. How is that safer for our children? How can it be safer for a child not to have an operation than to have one at Accrington? The closure of the ward has put a tremendous strain on children's facilities—medical and surgical—at Queen's Park and Blackburn royal infirmary. On 31 December 1983 we had a waiting list of 677 for ear, nose and throat surgery, 250 of which had been waiting for more than two years.
Closing a ward used by 574 children in 1982, and 377 children in 1983—when the ward was closed for two months for redecorating—will make the situation even worse. On Sunday 19 February a four-year-old boy from Oswaldtwistle was taken ill suddenly at home. He was semi-conscious, eyes staring and unable to speak. His father went to telephone for the doctor, but in the meantime his condition worsened and his mother ran to a neighbour's house and rang for an ambulance, which took him to Blackburn royal infirmary, where he underwent tests. Shortly before midnight he and another eight-year-old with the same symptons were taken to Queen's Park hospital. I understand from his father that two other children whom a nurse told him were not fit to be sent home were sent home in order to accommodate them—one in a cot and one in a bed.
The boy's father objected to his son being put into a cot because he feared that the boy might bang his head on the sides and make his condition worse. He was told that there 582 simply were not any beds available. On Tuesday 21 February the boy was sent to Preston for a brain scan, and then sent home. On being admitted he was unable to eat anything without being sick and that condition continued until Sunday 28 February. His local general practitioner saw him twice. On the Tuesday that he was discharged he was given a bottle of medicine at the hospital and it was emphasised to his parents that he was to take it every night, but that if he became sleepier than normal they should contact the hospital immediately. The responsibility of having to look after a child in that condition is too much to expect parents to accept. He should have been in hospital, in the care of people with medical training. I therefore urge the chairman of the district health authority to order the reopening of the children's ward. I honestly believe that there is more chance of a child dying if she does not do so than if she does.
The condition of the children's ward at Queen's Park hospital to which that young boy and other Hyndburn children now have to be admitted was the subject of an Adjournment debate on 6 July 1983, when the hon. Member for Blackburn (Mr. Straw) described the ward as appalling. That description has since been confirmed by Professor David Hull of Nottingham university's child health department who said, after recently visiting the ward:I travel all over the country and conditions on CH3 at Queen's Park hospital are the worst I have ever seen.In his view, no matter how able the members of the medical and nursing staff are, they cannot provide appropriate care there for sick children.
I pay tribute to the excellent job that the staff do in difficult circumstances. However, I share the view of the people of Hyndburn that it is utter stupidity that the children's ward at Accrington, which has recently been decorated and improved, is now padlocked while children are still having to use a ward in the condition that I have described. Despite its condition, that ward remains open, and it is hard to escape the conclusion that Accrington gets a rough deal from the Blackburn-based health officials and consultants.
The fear of my constituents is that this is unlikely to stop at the children's ward and, bearing in mind the strategic plan, can they be blamed for suspecting that the health authorities intend to keep chipping away at the facilities at Accrington Victoria, leaving Hyndburn people to make the far from easy and expensive journey to Queen's Park? From all parts of Hyndburn that journey involves taking two buses, and from many parts three. It costs at least £10 per week for a daily visit by one person, and which parent with a sick child would not want to visit the hospital every day?
The closure of the ward has been blamed on the surgeons' decision not to operate any longer at Accrington, but I feel that that was a decision which they were encouraged to take by the district management team, which is now hiding behind it. My constituents are right to feel that the closure is merely a further step to making Accrington Victoria a community hospital.
I feel that the decision cannot be justified on the ground of insufficient paediatric medical cover. We have in the Blackburn health district a total of 11 staff — three consultant paediatricians, one registrar, five SHOs and two vocational trainees. That staff covers a population of about 270,000, with four hospitals, including Accrington Victoria. The other three hospitals in Blackburn are all 583 within two miles of one another. It is now claimed that the 11 members of the staff are insufficient to cover the children's ward at Accrington Victoria, yet the same staff cover the GP maternity unit on the same site by way of a neonatal flying squad. Why cannot that squad cover the children's ward?
In Wigan, there is a staff of 10. There are three consultants, one senior registrar and six SHOs. They cover a population of 309,000, with three hospitals miles apart—Wigan royal infirmary, Leigh infirmary and Billinge hospital. They provide paediatric cover at Wrightington hospital. A smaller staff are looking after more people over a wider area.
Are the staff of the Blackburn health district being utilised to the best advantage? That is a question which the district management team was unable to answer during a meeting with Hyndburn borough council's Accrington Victoria hospital working group, when apparently it could not give an answer detailing where the staff were actually deployed. However, the district management team claims that it needs more staff. How does it know?
Will the next step be to claim that the Accrington Victoria is not suitable or safe for adult surgery? If so, despite all the assurances about consultation, both in the strategic plan and since, and despite the guarantee that the Accrington Victoria will stay as it is until 1995 at least, the bureaucrats will have achieved their objectives and the Accrington Victoria will become a community hospital.
First, at the meeting of the authority on 7 March, I urge the chairman of the district health authority to recommend the reopening of the ward. If a child dies as a result of the ward remaining closed, she and the authority will be responsible.
Secondly, I ask the Minister for a categorical assurance that if the authority refuses to end the temporary closure of the ward and begins the official procedures for permanent closure, the fact that the ward is already closed will not be taken into account when the proposal comes to him for a decision.
Thirdly, while supporting the request of Hyndburn borough council's Accrington Victoria hospital working group for an urgent meeting with the Minister for Health, I urge the Minister to give serious consideration to having such a meeting in Accrington so that he can see for himself the local situation and experience the strong local public feeling.
Fourthly, unless the district health authority can explain satisfactorily to the Minister why it ignored the consultation procedures and treated the Minister and the people of Hyndburn with such contempt, it should be removed from office. By its actions it has lost the confidence of the people of Hyndburn, whom it is meant to serve.
The children's ward at Accrington Victoria, which has given such excellent service in the past, has been closed by official utterances which fellow Gilbert and Sullivan addicts will know Sir Joseph Porter regarded as unanswerable. I do not believe that in this case they are.
§ The Under-Secretary of State for Health and Social Security (Mr. Tony Newton)
I apologise for the absence of my hon. Friend the other Under-Secretary who is unable to be here to answer the debate. We are pleased that my 584 hon. Friend the Member for Hyndburn (Mr. Hargreaves) has been able to bring to the attention of the House again today the issue of the closure of the children's ward at Victoria hospital in Accrington.
I have looked carefully at the papers and discussed the issue with my hon. Friend, and I am conscious of how energetic he has been in the cause of the hospital, not only since he entered the House recently, but in his former capacity as borough councillor in Hyndburn. I know how much his efforts are appreciated locally, not only by those who share his political views, but by the whole community.
Last October my hon. Friend led a deputation to meet my hon. Friend the Member for Oxford, West and Abingdon (Mr. Patten) to discuss the issue. The deputation pressed that in any development of the Health Service in Blackburn, Hyndburn and Ribble Valley health district, Accrington Victoria hospital had a major part to play.
There can be no doubt that my hon. Friend speaks for everyone in the borough on an issue that unites all parties. If there were any doubts about that they would have been dispelled today. Accrington is a proud town and justly proud of its hospital. Since its doors opened about 85 years ago Victoria hospital has given good service to generations of families. Of course, people want the hospital to continue to serve them. More than that, they want Accrington Victoria to be developed. They see the temporary closure of the children's ward—I emphasise that at this stage it is only temporary—as the thin end of a wedge. There is talk that developments at Queen's Park in Blackburn mean the downgrading of Victoria hospital.
I say clearly, but briefly, that this Government are not in the business of downgrading. We are upgrading in the Health Service, not least in the north-west. Next year we shall be spending an extra £850 million on the Health Service. That is cash growth in real terms of about 1 per cent. I represent one of the London Thames regions and I know that we are continuing to direct growth to relatively deprived regions like the north-western region whose growth money will be 1.3 per cent. The north-western region's capital allocation next year will be the second highest in England. It will be receiving over 11 per cent. of the money available.
Nevertheless, as the House will know, there is a great deal to be done. Not long ago, the House considered hospital services for children in Blackburn, Hyndburn and Ribble valley. This is the context in which the closure of the children's ward at Victoria hospital has to be seen. The House has heard of conditions at the main paediatric medical facility for the district, at Queen's Park hospital in Blackburn, where improvements were well overdue. Surgical beds are provided at the Royal infirmary at Blackburn and at Victoria hospital.
The arrangements do not seem to provide the best that the Health Service can offer to the children of Accrington and in the rest of the district. Children have particular needs and respond differently—more profoundly—to infection and injury than do adults. They need more extensive back-up services. Their needs, when hospitalisation is necessary, are wider,
Of course, hospitals also need to meet the social and educational needs of their child patients. For many years, professional advice has been that these can be best met in centralised units. At the very least, there should be 585 resident paediatricians and—in a surgical unit—an on-call anaesthetist. This has been the policy of the Government and their predecessors.
What has been done? Shortly after the debate last summer, my right hon. and learned Friend the Minister for Health met the North-Western regional health authority for the annual accountability review. Children's health services were discussed; and for this year's review, the regional chairman is to produce a report on deficiencies, such as those existing in Hyndburn and Blackburn, with the RHA's programme for improvements.
The House will recall—my hon. Friend reminded us today—that when this matter was last debated the hon. Member for Blackburn (Mr. Straw) pressed for an early start to the redevelopment of children's facilities for the district at Queen's Park hospital, to which my hon. Friend referred. I hope that it will be generally welcome, despite the anxieties in Hyndburn, that Ministers were able to give approval in principle to that scheme last November and that plans are going ahead for a start on the site this year, if possible in April.
The first phase of that redevelopment will provide 46 paediatric beds to replace the existing wooden-hutted accommodation at Queen's Park. I know that everyone in the area recognises that completion of this phase would have raised the question of closure of the 15 children's beds at Accrington Victoria hospital. I say, "raised the question" because proceeding with phase 1—I want to emphasise this—does not prejudge the issue and there would have to be local consultation before the beds could be finally closed. I shall come back to that in a moment.
Meanwhile, I must add that phase 1 is not the thin end of any wedge for Victoria hospital. Aside from the possibility of closing its children's beds, there is not expected to be any other impact on Accrington Victoria. I go further. On present approved plans and in the present state of medical knowledge, Victoria hospital will continue in all other respects.
What has brought forward the possibility of closing the children's beds is the fact that surgeons met in January to discuss emergency admissions of children to Victoria hospital. They concluded that the lack of adequate medical and nursing cover at the hospital made it no longer reasonable for them to treat children there. The children's ward was being used mainly for orthopaedic and general surgery. ENT surgery and paediatric medicine had ceased some time previously because of the facilities at the hospital. The 15 beds had had an occupancy of about 30 per cent. for some time. Children are now going to Blackburn royal infirmary for their surgery. There were 12 children on the waiting list for Victoria hospital, and the district has undertaken to ensure that they do not lose their places by the change.
§ Mr. Hargreaves
Will my hon. Friend accept that, although it is a 15-bedded ward, it holds not 15 beds but only 10 and that therefore the percentage is different?
§ Mr. Newton
I understand that, but it was intended as a 15-bed facility and that has to be taken into account.
586 I come to the major issue raised by my hon. Friend. The level of facilities at Victoria hospital had existed for some time and had not apparently changed. I can fully understand my hon. Friend's disquiet at the suddenness of the surgeons' decisions, but they have continually to make professional judgments about the adequacy of the facilities available.
I appreciate the concern locally, and I must make one matter clear. I refer to what my hon. Friend the Member for Oxford, West and Abingdon confirmed to my hon. Friend when he brought a deputation last year, that there would be full local consultation before the paediatric beds were withdrawn and that no fundamental changes would be made at Accrington Victoria hospital without reference to Ministers.
These pledges necessarily referred to possible proposals by the district health authority. They could nor cover action of the kind taken by the surgeons in deciding that they could not admit children to these beds. Neither Ministers nor health authorities can override the judgment of clinicians on a matter of this kind. The district health authority could, of course, have kept the ward open, but it could not have compelled the surgeons to admit patients to it, so that in practice the health authority had little alternative but to acquiesce in the short term, especially when one recognises the heavy responsibility on the authority if, in the light of the view of the surgeons, some tragedy occurred subsequently.
Despite this unhappy development, the undertakings of my hon. Friend the Member for Oxford, West and Abingdon stand. The closure is temporary. It cannot become permanent without a proposal to that effect from the health authority, which must be the subject of full local consultation. If the community health council objects, the matter must come to Ministers for decision.
The practical issue now, therefore, is whether the health authority considers it right to make such a proposal or whether it wishes to propose appropriate changes at Accrington Victoria which would enable clinicians to resume use of the facilities. I understand that consultation is due to begin this month. As I have said, if permanent closure is proposed but opposed by the community health council, the final decision will come to Ministers. That being so, the House will appreciate that it would not be appropriate for me to express any view at this stage.
I hope that my hon. Friend the Member for Hyndburn will encourage his colleagues in Accrington to approach the consultation process in a constructive spirit, so that the ground can be prepared for the Victoria hospital to do what we all want, which is to serve its borough and district for the next century. It is clear from the way that my hon. Friend spoke and the knowledge and thoughtfulness that he has shown that he will wish to play a part in that consultative process. I assure him that, if and when Ministers come to consider a specific proposal to which objection is made, they will consider it with the care that his advocacy deserves.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Three o'clock.