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Scotland (Hospital Building Programme)

Volume 784: debated on Friday 23 May 1969

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11.5 a.m.

I sought this opportunity to raise the question of the Scottish hospital building programme because the building of new hospitals or improving older ones seldom hits the headlines. We all agree that there is a great need for a steadily improving hospital service and for the modernisation not only of hospital buildings but medical and nursing techniques and so on.

It is clearly becoming more and more costly to provide the kind of service that our people rightly demand. It is interesting to see what has happened since the beginning of the National Health Service back in 1948. Between July 1948 and December, 1967, the amount of hospital building in Scotland totalled £65·61 million-worth. Over a third of that, at any rate in value, was completed in the three years 1965, 1966 and 1967. By the end of 1967 work to the value of about £47½ million was in progress. That is the enormous acceleration of hospital building that has taken place in recent years. It compares very favourably with the figure of £32 million-worth of building in progress at the end of 1964.

I shall not go into all the projects that are under way or nearing completion, but since the beginning of 1968 two very big projects have been started—the rebuilding of the Royal Hospital for Sick Children in Glasgow and the Gartnavel District General Hospital, also in Glasgow.

We can all play the numbers game, whether with house-building, murder rates, unemployment statistics or anything else. If one makes one's selection of statistics sufficiently carefully, one can prove whatever prejudices one holds at the time. But the Government's case in this, as in so many other matters, is so good that there is no need to be selective in that obnoxious and futile way. For example, in the 1950s hospital capital expenditure in Scotland was increased from about £2 million in 1952–53 to less than £3½ million in 1959–60. Even in 1962, after about 11 years in office, the then Government planned an expenditure of £70 million spread over 10 years—an annual average of £7 million. In 1964—significantly, on the eve of an election—the carrot was increased in size to £105 million over ten years, an annual average of £10·5 million.

The present Government, in their 1966 review, planned a programme of £60 million over five years—a £12 million annual average—and this has been more than maintained in real terms, not purely in money terms. In 1962–65 the total expenditure was £19·5 million and between 1965 and 1968 it was £35·5 million—an 80 per cent. increase in money terms and over 50 per cent. in real terms.

I have mentioned one or two of the major schemes under way, but in addition the regional hospital boards and the hospital management committees have been getting on with their regional and local programmes of relatively minor capital works. In that context, I should say in fairness how much we appreciate the fact that much has been done to improve the standards of accommodation in the West Fife hospitals and that the South-East Regional Hospital Board has just completed a new mental deficiency hospital at Lynebank near Dunfermline at a cost of £2¼ million. I was at the official opening a week or two ago.

We are proud of the honour bestowed upon us in that the area was chosen for the site of the first entirely new hospital for the mentally deficient or mentally ill for 30 years. The facilities are quite remarkable. There are a children's ward and school, facilities for industrial training and occupational therapy, a nurses' training school, a patients' shop and tea room, an X-ray and diagnostic department and an out-patients department. This is a remarkable achievement by any standards. I see that the hon. Member for Moray and Nairn (Mr. Gordon Campbell) is smiling and I think I know why. This project was initiated by the Conservative Government, but the money was provided by the Labour Government. There is no party point in it.

When one thinks of the kind of mental hospital that still exists and which my right hon. Friend the Secretary of State for Social Services has talked about—that horrible institution somewhere else in the country—and when one thinks of the grim, gloomy spectres of Victorian asylums, one cannot but be grateful for the revolution which has taken place not only in medical care and treatment of the mentally sick and disabled but as important, if not more so, the great change in the community's attitude to these problems.

It is interesting to note that when the hospital was originally announced and when it was building, I did not receive a single complaint from anyone in the locality objecting to the location of a mental hospital in the area. One of the pleasing aspects of the Lynebank project is the strong evidence that the local community are co-operating with the hospital authorities in order to take the hospital within the community and help the patients in every way possible.

Other schemes have been completed in Fife since 1965. There has been the second extension at the Victoria Hospital in Kirkcaldy at a cost of £2,336,000. This will be the first full district hospital in Scotland. It provides full medical and surgical services for the whole of East Fife, except for certain specialists services which are provided in Edinburgh.

Incidentally, I have previously raised the question of the difficulty of Fife patients who have to go to Edinburgh for the regular use of kidney machines. I hope that this facility will be provided somewhere in Fife, either in a unit in the Victoria or by the provision of home units for patients, since considerable expense and inconvenience are caused when patients have to travel to Edinburgh regularly for their treatment.

I return now to the list of some of the achievements. At Milesmark Hospital, Dunfermline, there were provided in 1967 a 60-bed unit, X-ray diagnostic facilities and an out-patients department and physiotherapy facilities at a cost of more than £250,000. This was in addition to other facilities, like a new boiler house, which cost nearly an extra £200,000.

In West Fife Hospital, again in Dunfermline, there was the provision in 1966 of new twin-operating theatres, a new record office and other accommodation costing about £88,000. At the Cameron Hospital, Windygates, in 1967, a 60-bed medium-stay geriatric unit plus an attached rehabilitation unit costing over £200,000 was provided.

So one could go on. There are many relatively minor but still costly projects. At Stratheden Hospital in Cofar, improvements carried out in 1966 and subsequently have cost £158,000. At the Victoria Hospital, Kirkcaldy, a central laundry for the whole of Fife hospitals was provided last year at a cost of over £300,000, together with residential accommodation for married medical staff costing £67,000 and residential accommodation for nurses costing £109,000. Finally, there was the provision at Fath Park Maternity Hospital. Kirkcaldy, of a general practitioner unit costing over £300,000.

This is a record about which no one need be apologetic, and I hope that when the Opposition talk about cutting public expenditure, as they frequently do, in vague general terms, they will make it abundantly clear that they do not have the hospital building programme in mind. We have a right to know what they have in mind and they should either spell it out or shut up.

In the light of all these achievements and many more which I have not time to mention, it might seem churlish to ask for more, especially for my own area of West Fife. But then I am a churlish kind of character. It is my privilege to be difficult to satisfy in this and other regards. I recognise not only that the National Health Service has to compete for financial and physical resources with other desirable objectives such as housing, education and roads, but also that even within the total allocated to the National Health Service there are conflicting and competing claims as between one part of the country and another and between one speciality and another—for example, whether one should provide more geriatric units or more maternity beds.

All this involves extremely difficult and complex political decisions by politicians of a geographical, economic and medical nature. In the south-east region of Scotland, we in West Fife recognise that there are competing claims on the resources available. For example, we know that there is a good case for a new district general hospital in the Borders. It may well be that that case is stronger than the case for the provision of a similar hospital in West Fife. That is not for me to decide but for the regional hospital board. One of my purposes today is to put the case for a new West Fife district general hospital.

I understand that the regional hospital board, in putting in its building plans for 1971–76 to the Scottish Home and Health Department, will be including as a priority the provision of a new district general hospital for West Fife. I need not labour the point. I simply recall the letter dated 9th February, 1966, which was sent to the Secretary of State for Scotland by my hon. Friend the Member for Dunfermline Burghs (Mr. Adam Hunter) and myself. The Secretary of State sent us a reply, dated 14th March. 1966, justifying the allocation of resources as between regional boards, and pointing out that the South East Regional Hospital Board did not propose to him at that time that a general hospital in West Fife should take precedence over the projects which were included in the programme up to 1970–71.

Since then there have been improvements, some of them quite substantial, in the West Fife hospitals, but the fact remains that the Dunfermline and West Fife Hospital, which is the main surgical hospital, is outmoded and out-of-date. The medical and nursing staff are first class; no patient need be worried on that account. The dedication of the staff in the West Fife Hospital, and in others, is beyond praise. The principal concern is that the present arrangement, whereby surgical beds are concentrated at the Dunfermline and West Fife Hospital and the medical beds at Milesmark, leads to duplication of certain ancillary services, with associated staffing difficulties. It also affects adversely the liaison between medical and surgical elements of the service. Furthermore, the provision of beds for general surgery, geriatrics and orthopaedic surgery, though better than it was, is still inadequate in the view of the hospital management committee. It is unsatisfactory to have the second line beds at Milesmark where there are no operating facilities. It means that the beds at Milesmark are little more than accommodation for convalescents.

I know what a difficult task the regional hospital boards must always have in determining priorities between conflicting demands on the resources available to them. In general, the regional hospital boards do a valuable job, and nothing that I say is in criticism, implied or otherwise, of the job they perform.

The National Health Service as a whole needs far greater injections of resources than it now gets. That is true of other services. One could put up an equal, or perhaps more powerful, claim for housing, roads and so on. Nevertheless, there is no room for complacency or smug self-satisfaction about the imaginative programme of house building in Scotland.

In preparing for this debate, I read some of the speeches that were made in 1946 and 1947 during the passage through the House of the National Health Service Act. They make astonishing reading; one does not know whether to be angry or to burst with laughter when reading some of them. For instance, on Second Reading, Sir Thomas Moore condemned the service as
"… this lifeless control by the State …"—[OFFICIAL REPORT, 10th December 1946; Vol. 431, c. 1078.]
Even more extravagant language was used on Third Reading on 21st April, 1947, when Lieut.-Colonel Walter Elliot, whom most of us remember, referred to the National Health Service Act as Fascism, and Lady Grant, now Lady Tweedsmuir, said that there were defects in the Bill:
"… which destroy much that is good of the past, limit the possibilities for the future, and give us instead, a rigidity of administration which is quite unsuited to the living human art of caring for the sick."—[OFFICIAL REPORT, 21st April, 1947: Vol. 436, c. 739.]
She is no longer with us, being otherwise engaged outside. Mr. Niall Macpherson, who is now being punished for what he said by serving in the House of Lords, said:
"But this will not be a health service; it will be a vast bureaucracy of red tape."—[OFFICIAL REPORT, 21st April, 1947; Vol. 436, c. 759.]
He forecast that it would bring chaos into the health services of Scotland.

Finally, Commander Galbraith spoke of it being a Measure which was highly repugnant to the people of Scotland.

Nobody dreams now of disbanding the National Health Service. We realise that it is here to stay and that we have to improve it, which means the injection of more and more capital and resources of all kinds.

I would, if I may, like to raise one or two general points arising from the section of the 1967 Annual Report, Cmnd. 3608, which deals with hospital planning. My first point concerns the research and development project at Falkirk to discover the optimum design for a hospital ward. That project was a pioneering effort for the whole of the United Kingdom and it deserves far more publicity than that which is given to the more squalid aspects of life and society in this country today. It involved the co-operation of medical, nursing, architectural and engineering staff, as well as patients. I hope that the Under-Secretary of State will be able to tell us more about it and how the results will be translated into practice in future hospital design.

There is reference in that section of the Report to progress made in standardisation of certain hospital departments, for example, the possibility of a standard design for hospital wards, which I have already mentioned, and standardised operating theatres. The more progress we can make in those areas the better value we shall obtain for money spent, and the more money we spend the more essential it is to ensure that it is spent wisely. Will the Under-Secretary of State give us some idea of the progress which is being made in that direction?

What has been the progress during the last year or so in the use of industrialised building and the standardisation of building components? Examples are given in paragraph 255 of that Report of the reduction in prices produced by the use of these methods. What progress has been made in the use of industrialised building methods for the provision of residential accommodation for junior medical staff in the hospitals? I know that in many areas this is a sore point. What progress has been made in linking up with hospital boards in England and Wales to build such accommodation by industrialised methods? Hospitals are one of the most expensive capital assets in the country, and it is vital that we should get value for money.

May I end by referring to what I regard as an extremely important point? The principle that prevention is better than cure makes it obvious that serious consideration should be given to whether it is worth while concentrating more investment in preventive measures rather than in building highly expensive curative institutions, which is what hospitals are.

In that respect it is good to notice a steady acceleration in the provision of health centres. Aneurin Bevan, when he was introducing the Health Service, made it abundantly clear time and again that the health centre where provision for services to the community a comprehensive provision with all the ophthalmic, dental, medical and minor surgery means were concentrated in one building, with means of doctors and teams of nurses, dentists and opticians working there, is the ideal corner-stone. Nye Bevan always used to say that this was the corner-stone of a real health service and that the service would never be what it ought to be until we got a nationwide distribution of such centres.

It is well known that at the outset of the National Health Service there was considerable opposition to this principle by the medical profession, which is an extremely personal profession. They were extremely suspicious of being either State or local authority servants. I believe there is much evidence that that opposition is breaking down. This probably is one of the reasons why there has been a substantial extension and growth in the number of health centres.

There were only three in Scotland before 1964. Since 1964, according to the latest figures I have, five more have been completed and one is building or completed at Livingston. I hope that my hon. Friend the Under-Secretary will give the most up-to-date figures. Plans have been approved for another 10—I am speaking of last year—and 50 other proposals were being considered. This probably is where the emphasis will be placed increasingly, on the provision of health institutions rather than haspital building.

I hope that I have said enough to enable my hon. Friend to give an up-to-date picture of what is happening in the hospital building programme. I am grateful for the opportunity of having this debate.

11.32 a.m.

I am very glad that the hon. Member for Fife. West (Mr. William Hamilton) applied for this debate and was successful. I know he has a particular interest in hospitals and the Health Service in Scotland and has pursued this subject from time to time.

While I congratulate the hon. Member on raising this subject today, I do not propose to filibuster the rest of the time for this debate and prevent the Under-Secretary replying. Some might think that there was a certain temptation to do so in view of the hon. Member's treatment of the private Members' precious time won in a Ballot the other day by my hon. Friend the Member for South Angus (Mr. Bruce-Gardyne) when he also chose a Scottish subject.

I am specially interested in hospitals and hospital building, if only because I spent a year as a patient, at the end of the war, in one of the large teaching hospitals. I have continued my great interest, as a "customer" one might say, in hospitals and the hospital services. The hon. Member for Fife, West has spoken about the numbers game, the fact that it is possible to consider, over 20 years or more, selected statistics to show that one party or the other has done better during the time it was in office. I believe he knows I agree that there is little point in competing in the game of producing selective statistics. None the less, I noted that he indulged in it to some extent.

In reply I will simply say this. In early 1964 the present Home Secretary, who was then shadow Chancellor of the Exchequer, referred to the Conservative programme of hospital building and for roads and schools. He acknowledged that those programmes
"could not be exceeded by any party with any degree of responsibility".—[OFFICIAL RFPORT, 11th March 1964, Vol. 961, c. 477.]
I remind the hon. Member for Fife, West of that before passing from this subject of competition in selective statistics.

I wish to raise a point of great concern on which the hon. Member hardly touched. That is the way in which costs have escalated. Money itself is no longer a realistic measure of the quantity of building being carried out or completed, or of results in general, because the rise in costs of building hospitals have soared to such a degree in recent years. On 30th January, 1968, nearly a year and a half ago, the Secretary of State for Scotland made a very important announcement. It was on the postponement of 12 major hospital schemes within the five-year programme and postponement of three others beyond the current five-year programme. That was shortly after devaluation. The Prime Minister, in his famous broadcast to the nation, stated that the hospital building programme would be safeguarded and not reduced as part of the measures accompanying devaluation.

The Secretary of State for Scotland made perfectly clear that he had had these proposed cuts under consideration before devaluation and stated clearly that they were not connected with devaluation. I have to accept his word because at that time he ascribed the cuts to the enormous increases in the costs of building. He said that costs had risen to such an extent that he had to reduce the programme. This was disappointing to hon. Members in all parts of the House, and also to the Press and the public. The Press reported it very widely in Scotland at the time.

My reckoning is that the increasing costs were such that the amount required to carry out the same hospital building increased by about 50 per cent. over a period of five years. This is illustrated in particular by the Ninewells Hospital at Dundee. The estimated costs are recorded in the Civil Estimates and the increase between the Estimates for 1963 and those for 1968 was 50 per cent. The Under-Secretary may say that there are some additional points to be taken into account, but I point out that the Civil Estimates also show a comparison with other projects between the Estimates of 1967 and recent Estimates and the increase is in the same proportion. It is a very large increase. Although it is two years or less ago, the increase is in the same proportion of 50 per cent. over five years.

The difference in respect of Ninewells is at least half accounted for by additions to the programme and the inclusion of equipment which was not in the original figure which at Ninewells amounts to £2½ million. Increases in the other cases can be accounted for in the same way.

I wish that this could be made clear in the Civil Estimates. On 30th January, 1968, the Secretary of State announced that there had to be these 15 postponements of major hospital schemes and stated that it was because of soaring costs.

We then see the civil estimates, with schemes put forward and precise estimates put against them in different years. Whether some of it, as the hon. Gentleman suggests, is in all cases attributable to extra equipment, the effect is that the costs of identifiable schemes are increasing at the rate of about 50 per cent. over a period of five years. We shall be interested to hear the hon. Gentleman's explanation, because the purpose of the debate is to enable him to explain these matters at greater length.

The Secretary of State ascribed the postponements to rapidly increasing costs. Clearly the building industry is having to face very steep increases. On 18th April, only a month ago, the Minister of Public Building and Works, in reply to a Question, stated that the increased costs to the building industry in Scotland in a full year arising only from the increase in selective employment tax proposed in the Finance Bill would amount to about £5 million.

Order. The hon. Gentleman may refer to that matter, but he knows that he cannot propose on the Adjournment a reduction in or abolition of selective employment tax.

I made that reference to the Bill, Mr. Speaker, only in order to identify the increase. I do not propose to go into the question of changes. I merely wish to remind the Minister that there have been two increases in the tax and that these fall very severely on the Scottish building industry. The Minister of Public Building and Works has given an estimate of the latest increase in costs to the building industry in Scotland. I therefore hope that the Under-Secretary of State will be able to give us a forecast of the likely increase in the cost of hospital building arising from the increase in S.E.T. and other increases which can be foreseen, such as in transport costs. It is the prospect of the estimates increasing even further which is worrying me and, I am sure, the hon. Member for Fife, West.

The hon. Gentleman raised another matter of considerable importance to which I hope the Minister will reply, namely, the design of hospitals. While new hospitals are being built, it is important that the suggestions and ideas of medical and nursing staffs should be sought, collated and crystallised and then put into effect as well as the techniques and expertise of architects and others concerned with building. The life of a ward in a hospital is unlike the routine in most other buildings. With a bit of imagination and thought, hospitals can be so designed as to make life in them as efficient as possible and as comfortable as possible for the patients.

I turn to a point which particularly affects my area in the North of Scotland, and that is regionalisation and where hospitals are to be built. I am not entirely happy with some of the proposals about where regional hospitals should be sited. For example, it may mean that some of my constituents would have to travel 70 miles to hospital, which is not easy in severe winter conditions, for certain operations or treatment. I should like the Under-Secretary of State to tell us whether this matter is still under consideration or whether it has been frozen into definite proposals. The Government should take into consideration the difficulties of travelling long distances which arise in the North of Scotland.

The Minister has plenty of time to make a statement about the latest position. I hope that he will make use of it and will tell us as much as he can about the present hospital building programme and future prospects in Scotland.

11.45 a.m.

I very much welcome this opportunity of saying something about the hospital building programme in Scotland. I am glad that my hon. Friend the Member for Fife, West (Mr. William Hamilton), with his usual initiative, managed to obtain this debate and to make the very well informed speech that he made in introducing it. I hope to take up most of the points which he and the hon. Member for Moray and Nairn (Mr. Gordon Campbell) put to me.

I start by saying something about the present hospital building programme as a whole. I follow the very accurate account which my hon. Friend gave of the expansion in hospital building expenditure which has occurred over the last few years and will make some additions to it to bring it even further up to date. In the last two or three years there has been a very considerable expansion in the hospital building programme in Scotland. The hon. Member for Moray and Nairn said that we must not just compare expenditure because it costs more money these days to provide a hospital bed than it did a few years ago. However, even allowing for that, the progress has been remarkable.

May I give the figures in terms of hospital beds provided. Between 1948 and 1962, the building programme in Scotland produced an average of about 230 beds a year. In the next three years, from 1962 to 1965, the rate rose to about 570 beds a year. But in the four-year period from the beginning of 1965 to the end of 1968, 3,900 beds were produced and the rate rose to almost 1,000 beds a year. In fact, the 1968 figure was considerably greater than that. These figures are based on comparable terms and they show the tremendous increase which has taken place over the last two or three years.

I turn to the question of expenditure. In 1968–69, the amount spent on hospital capital works was approximately £14·5 million. The exactly comparable figure for five years ago—1963–1964, which was the last full year when hon. Members Opposite were in office—was only £6·25 million. Even after allowing for the effect of increased wages and prices, this represents a rate of growth in real terms of about 15 per cent. compound per year over the years that I have mentioned. Although I should like us to do even better, this figure demonstrates the priority which the Government are giving to the hospital building programme.

On the question of costs, the programme which was announced in the 1966 review of the Hospital Plan has been maintained in real terms. Therefore, increases in costs have been taken into account. The programme of £60 million as it was then over the five-year period at 1965 prices is considerably more than that at current prices. In other words, we have maintained in real terms the programme which we set out in 1966.

How does the hon. Gentleman tie that up with the postponements which were announced by the Secretary of State in early 1968?

I intended to deal with that point. First, I wish to say something about the figures as they appear in the estimates, particularly for Nine-wells, which the hon. Gentleman quoted. Ninewells is a major teaching hospital, the first to be built for a very long time, and it must not be taken as typical of hospital developments in Scotland.

Even there, a large part of the difference in cost arises because the original costs did not include, and were not meant to include, the equipment for the hospital. It is difficult to estimate well in advance what the equipment costs will be, because equipment more than anything else is changing rapidly as medical technology improves and the equipment costs come in later than the original estimate.

In the case of Ninewells, no less than £2½ million is accounted for by the equipment cost alone which was not in the original estimate. Much of the other expenditure is also accounted for by reasons other than changes in costs—for example, by the addition of a radiotherapy department. Many of the other increases which appear in the estimate also relate to additions to the original project. As it develops, it is seen that additional departments or facilities have to be added.

I do not consider it desirable that as a project continues we should always be faced with adding additional bits to it, but in some cases this is inevitable. This explains some of the additional costs. An even more important factor is the equipment factor which I have mentioned in the context of Ninewells. This also applies elsewhere.

I take the hon. Gentleman's point that the Civil Estimates do not bring this out clearly. I could not agree more. When I read the Civil Estimates, published a couple of months ago—I do not have them with me—I was horrified at the interpretation placed on some of the figures in at least one Scottish newspaper because it had been misled by the footnotes in the Civil Estimates. I am taking steps to see that in future years we make the footnotes in the Civil Estimates rather more intelligible than they are at present and in particular, if possible, to bring out the equipment factor, because so much of the apparent increase in cost is accounted for by the items of equipment which do not appear in the original estimates.

It is also true that in January, 1968, my right hon. Friend the Secretary of State announced that there were to be certain deferments in particular hospital projects. Some of those deferments arose because of increased costs and additions to projects which were already in the programme. Some of them also arose because of the larger programme that we are dealing with in Scotland and because of the additional expertise that the regional hospital boards have been able, therefore, to build up in the handling of their programme.

We are now building hospitals more quickly than in the past. The planning and design is going ahead more rapidly than it used to do. When the building of a hospital commences, we are now improving on building times. All this brings expenditure forward and, unfortunately, means that some projects have to be dislodged from the programme and put a little further back.

Another factor of special importance in the deferments announced just over a year ago was that the rebuilding of the Royal Hospital for Sick Children in Glasgow, which could not be anticipated but had to be put into the programme as a matter of urgency because of the literal collapse of the previous building. This was a very expensive project which resulted in the deferment of certain other projects beyond the period in which we originally intended to see them built.

Those were the basic reasons for the announcement that was made just over a year ago. I repeat, however, and I cannot emphasise too strongly, that there was no question then, and there is no question now, of any cut in the hospital building programme. That was the word used by the hon. Member for Moray and Nairn. It is a completely inaccurate description of what happened. The amount of money made available to the hospital building programme has been maintained in real terms and has, indeed been slightly increased.

When we were preparing the review of the Hospital Plan in 1966, tremendous questions of priority had to be determined. I was glad to hear my hon. Friend the Member for Fife, West make the point a number of times during his speech that in the hospital building programme we are constantly involved in determining priorities between demands which, if the resources were available, we would like to settle simultaneously. In an ideal world, we would all like to see all parts of the hospital building programme going ahead as rapidly as possible, whether we are talking about priorities in different specialties or in different geographical areas. We do not, however, have the resources to allow that to happen and, therefore, these difficult questions of priority are involved.

When we published the review in 1966, we laid great stress on the need to repair serious deficiencies in the provision of beds for the care of elderly people. Anyone who knows anything about the appalling problem of dealing, whether at hospital or at residential level, with the increasing number of old people would support the priority that we gave to the increase in geriatric provision, particularly in the South Eastern and the Western Regional Board areas, in the 1966 Review.

Since 1965, almost 1,100 beds have been provided in new or substantially converted buildings for geriatric patients. We are talking here of a total stock of about 8,000. Schemes in present in progress will provide another 85, with further schemes to start shortly, including the important Langside cottage scheme, in Glasgow, of 256 beds, which will help considerably in the Glasgow situation.

Another important sector of development is maternity provision. Taking Scotland as a whole, although there are still little patches where we would like to see improvements made, we now have, with the existing beds and the beds in prospect, improved maternity provision out of all recognition; so that in most parts of Scotland, in terms of total beds at least, it is now very satisfactory. There are now many areas where more than 90 per cent. of babies are born in materity hospitals. There are 516 maternity beds under construction and 400 of these will be completed by the end of this year.

The third priority which we gave was to mental and mental deficiency patients. Again, those of us who spend time looking at different hospitals in different parts of Scotland will be very much aware of the need to improve our provision of mental and mental deficiency beds. Since the review of the programme was announced, we have completed nearly 1,300 new beds for mental and mental deficiency patients and a further 276 should be ready this year. The bed numbers in these three categories are substantial achievements within the overall priorities that we laid down for the hospital programme.

In all these fields of geriatric provision, materity provision and mental and mental deficiency provision, we can look back on progress over the last year or two as being, while obviously not as great as we would like in an ideal situation, nevertheless very substantial indeed.

On the question of hospital beds, there are schemes at present in progress valued at about £55 million. That must easily be a record figure for hospital building in progress. It is greater than the figure mentioned by my hon. Friend for the end of 1967. These schemes will provide about another 2,750 beds, and schemes are being planned to start in the period to 1972 providing over 4,500 more beds, so that the impetus we have in the hospital programme is being maintained.

There are many major schemes in progress. I do not wish simply to provide a catalogue of them, but the hospital at Ninewells is a very important development. There is a new general hospital at Inverness, of which the first phase is well advanced in construction, and there is the new mental deficiency hospital there. There are under construction four large maternity units in the western region. My hon. Friend mentioned the new Gartnavel Hospital and the Royal Hospital for Sick Children. In Edinburgh, there are major developments at the Western General Hospital and new geriatric and eye units are being built.

The hon. Gentleman mentioned Gartnavel Hospital, which is one of those where there has been a tremendous escalation in costs, according to the official estimates, since 1967. If I put down Questions to the hon. Gentleman, would he be able to answer on the various projects mentioned in the Civil Estimates, where explanations are not given?

If Questions are put down on individual projects, I shall be very glad to show the difference between one year and another. The hon. Gentleman will see that the explanation I gave off the cuff is accurate.

I was about to mention a number of individual completions we have had in recent years, and I am particularly glad to refer to the Falkirk ward mentioned by my hon. Friend. To the best of our knowledge, it is a unique example, certainly in Europe, of a fully worked through research project in ward design. It has an importance well beyond the area it serves in Falkirk and district. The 260-bed ward floors in the block are to a design prepared after a systematic study in detail of the functional needs of wards by a special study team of the Scottish Home and Health Department, which took in the various disciplines involved in the running of a hospital. It has been looked at particularly from the point of view of the medical and nursing staff involved in the operation of the ward. The results of the study were published in a Planning Note on Ward Design and related publications. The ward was designed down to the last detail to embody the operational policies devised as a result of the study. Even more important, it was the intention from the very beginning that the ward should be evaluated in use thoroughly, consistently and coherently. Therefore, its use has been very carefully recorded and detailed studies have been made of the way in which the concepts on which the ward was built have operated in practice.

The results have recently been published in a Design In Use Report, and I shall be very happy to send a copy to my hon. Friend. He will see in the Report evaluations of the ward not only from the technical point of view, but from the point of view of the medical and nursing staff who have had to operate it. He will see that, for example, it has proved to be more economical in nursing use than we had planned at the beginning, and that the financial aspects, in terms of current building costs, are also very favourable.

The Falkirk design is being used, with certain modifications, as a basis for planning ward design for many of the new district hospitals which are beginning to be planned. I shall say something later about hospital planning as a whole, but I thought that I might mention the Falkirk Ward here because, although there has been a good deal of interest in it, the interest has not been adequate in view of the importance of what has happened in the design that we have now put into operation.

Many other projects have recently been completed, and I would particularly mention the new Lynebank Mental Deficiency Hospital in Dunfermline, about which my hon. Friend talked. It is an important development in our mental deficiency services. It has very good educational, training and occupational facilities for children and adults and, as a modern mental deficiency hospital should be, it is very much designed to prepare its patients to the fullest possible extent to return to community life.

I am very happy to have confirmation direct from my hon. Friend of my information that, far from there being any resentment in the local community at a hospital of this sort having been built. the local community has welcomed it. That augers well for the success of the hospital.

My hon. Friend also mentioned developments and hospital provision in West Fife. I was glad that he was generous enough to outline some of the projects, admittedly comparatively minor ones, which have been carried out at the Dunfermline Hospital in the past few years. It would be unfortunate if the impression got about, as it sometimes has, that Fife as an area has been neglected in terms of hospital development since the inauguration of the National Health Service. In the first 20 years of the Health Service, the capital expenditure per head of population in Fife has been £25 10s., whereas in Scotland as a whole it has been £17 8s. That is a very crude figure. I am not suggesting that it represents an adequate answer to my hon. Friend, and I accept that there is a pressing need in West Fife for a new district general hospital. There is no dispute about that, and I would in no way question his point about the inadequacy of the present hospital situation in that part of Scotland. I am glad to add my tribute to the staff who are working sometimes in inadequate conditions to provide a service in West Fife.

I agree with my hon. Friend that it is necessary to have a new district general hospital to replace the series of hospitals and the divided service available in West Fife. But my hon. Friend knows that this is very much a matter of priorities, and that the original determination of priorities here is a matter for the South-Eastern Regional Hospital Board. We recently asked all five regional hospital boards in Scotland to give us their projects in order of priority for the mid-1970s, which is the period to which we are now looking. We have yet to receive details from the South-Eastern Regional Hospital Board, but I know that it is considering the West Fife General Hospital among a number of other very pressing priorities that it has to consider in looking at the next stage of the hospital building programme. I am not able to say clearly on this point just at what part of the programme West Fife District General Hospital will find its place, but I do know that the regional hospital board is looking at this at the minute, and, as I have said to my hon. Friend, there is no question that we for our part accept that there is a need for a district general hospital in West Fife.

There are, however, in the South-Eastern region as a whole a very large number of important projects which have to be fitted into this exercise in priorities. There is, for example, the rebuilding of the Royal Infirmary in Edinburgh, which will eventually be a very costly project indeed. There are important developments at the Western General Hospital in Edinburgh, and the Royal Hospital for Sick Children in Edinburgh which will be built in the grounds of the Western General Hospital. There is need for a district general hospital in West Lothian to be built at the new town of Livingston. There is need for a district general hospital in the Borders. There is need for more geriatric accommodation, including geriatric accommodation in Edinburgh and Fife and there is need also for a regional plastic surgery and burns unit to be considered.

One has only to state very briefly the outline of the projects involved to demonstrate that there is a very considerable problem of priorities indeed in the South-Eastern Hospital Region, and that, of course, is one region out of five for which priorities have to be settled, but I repeat that a hospital in West Fife is certainly one of the projects which the South-East Regional Board has very much in mind in determining its programme for the next few years after the mid-1970s.

My hon. Friend also mentioned the question of health centres and perhaps I could just say something about them now, because as he said—

Before he leaves the question of hospitals, could my hon. Friend give us some information as to the new hospitals to be started in 1970? Will he recall, for example, that Airdrie Hospital, which serves Coatbridge and an area including the town of Cumbernauld, has been postponed twice, but a statement was made that it would be started in 1970? Could my hon. Friend give us some information about that?

I think my hon. Friend has a Question down about that today. Unfortunately I have not seen the Answer yet, but I think I can give him the assurance he has asked for. However, he will get the Answer a little later today about Airdrie. If I had known my hon. Friend would be here I would have made sure that I knew the answer, but, unfortunately, I do not, but I think he will be reassured when he gets it.

I was going on to mention the health centre programme because, as my hon. Friend the Member for Fife, West said, there has been a very considerable improvement in the acceleration in that programme over the last few years. It has taken a very long time indeed to get it generally accepted by the medical profession as well as by others that the health centre is the way in which general practice should be expanded and developed in Scotland. As my hon. Friend said, this is the way for getting the new service which will provide in one group not just general practice but also a range of local authority and a range of hospital services as well, providing both a better service to the patient and a more adequate and stimulating environment to the general practitioner to work in. It has, as I say, taken a long time to get this generally accepted, and I am glad to say that there is now a general acceptance of this in Scotland.

Before 1964 there were only three health centres in Scotland. That is, from 1948 until 1964 only three had been built. Since 1964 eight more have been opened, four of them by local health authorities under delegated powers. There are five more under construction at the present time. Plans have been approved for another 15, and there are proposals for about 60 more centres under consideration. I may say that of that figure eight of them are in Fife, one of them for Glenrothes, which will be of particular interest to my hon. Friend.

Again, one has only to state the bare facts about the health centre programme to see that there has been a considerable acceleration, an acceleration which will continue over the next few years.

In this programme, of course, and particularly in the hospital programme as a whole, it is important to get value for money, and I was very glad that my hon. Friend made a particular point of this, because, again, I think that there are quite important developments happening at the present time. I have already mentioned the Falkirk ward. That is not intended simply, even primarily, as an exercise in economy. It is an exercise in getting the best design, the best facilities, the most efficient use of space, and so on, from the point of view of nursing staff, as well as providing, as it does, enhanced amenity for patients. It has also very important economic considerations, and is an illustration of the way in which we are trying to develop our planning from the point of view of getting services which will both improve amenities for the patients, be more efficient from the medical point of view, and also at the same time be economic in building terms.

It is true that the advantages of standardisation and particularly hospital development would be increased if it proved possible to adopt a standardised system of building that would permit the use of common structural and other components in all such development. The work which is being done upon the functional layout of wards is being studied to ascertain whether it would be advantageous to adopt a client-based system of construction of new hospitals. Any system which may eventually be adopted would need to be related to the Compendium of Hospital Assemblies which continues to be revised as necessary, and work is going on on that at the present time.

Another development which I may mention relates to the need for residential accommodation in hospitals. We set up a small study group last summer to report on the possibility that the entire programme for building staff residential accommodation in hospitals over the next 10 years or so might be tackled as a whole rather than that we should treat each hospital scheme separately. The study group's report demonstrates that a programme approach of this sort is likely to be feasible, and also that there are available local authority house plans which could be fairly easily adapted to provide residential accommodation to meet the requirements of different grades of staff. So we are considering this important aspect of development with the regional hospital boards.

As for industrialised methods of construction generally in hospital building, we are looking at the minute at the possibility of using the CLASP system of construction, of which, of course, my hon. Friend will already be aware.

I may also mention the work which is being done at the Scottish Hospital Centre. I do not know whether my hon. Friend has ever visited it in Edinburgh, but it is very well worth visiting. It is now providing an information centre for ideas and developments in building and equipment and all the rest of it, and it is providing a focal point for exhibitions and so on, and it allows people in the hospital services as a whole to see what is going on in design, what is available, and to see it on the spot in a well laid out way which otherwise would not be possible. The Scottish Hospital Centre, for example, has recently published information on the layout and equipment of domestic service rooms.

We have been looking at the accommodation needs of new nurse training schools, in this case in consultation with the Scottish Education Department. We have been carrying out an interesting study, which is producing interesting results, about the extent to which we could relieve acute hospital beds by providing pre-discharge units to which patients could go at an appropriate point in their recovery from, say, a surgical operation to an atmosphere which would be both less expensive in nursing and medical terms, and also more congenial from the point of view of the patient who has gone from the acute stage of illness and wants to spend the rest of his time in hospital in a more relaxed atmosphere. That is the position in the acute surgical wards in general hospitals. Work is going on and it looks as if development of pre-discharge units will provide an economical way of relieving some of the burden of the acute hospitals.

I am most interested in what the hon. Gentleman is saying. I know that we are coming to the end our allotted time, so could he reply to my general inquiry about the state of regionalisation in Scotland?

I am just coming to that, but at the moment I am dealing with the question raised by my hon. Friend about giving value for money, hospital planning, and so on.

We are at present faced with tremendous demands on the hospital building programme. Unfortunately, we are not able to meet all these demands as quickly as we should like to meet them. We have therefore to determine priorities, which we are doing. We have also to see that we use as economically as possible the resources which we have.

My general point is that there is far more thought, study and consistency of approach being given to that problem than has even been the case at any time in the past. In fact, the tremendous increase in the hospital building programme over the last few years enabled us to carry out all the work to which I have referred. We now have a sufficiently large hospital programme, it is coherently organised and the regional hospitals boards are now staffed to do the planning which is required so as to enable us now to go on to the rather more sophisticated developments which have taken place over the last few years.

The hon. Member for Moray and Nairn mentioned regionalisation. I am not quite clear what he means by it. If he means the concept of the district general hospital, he knows that it is not economical to build district general hospitals except when there is an adequate population to use the hospital so that it can be built on the basis that, except for certain specialities or super specialties as they are sometimes called, the normal range of medical and surgical services can be provided in the district general hospital.

Unfortunately, it is not possible in the area represented by the hon. Member to provide the complete range of services. Therefore, patients will have to look to Aberdeen, as they do at the moment—and they will continue to have to look—for a number of the services which from their point of view it would, of course, be far more convenient for them to have in Elgin. The hon. Member would also know that there has been a considerable advance in hospital building in Elgin. I have seen some of it for myself in the last 12 months. But I could not hold out any promise that Elgin would ever be anything like self-sufficient in hospital services.

I was not inquiring so much about the particular as about the general. I agree with the hon. Gentleman in principle, but there is argument about what is an adequate population, particularly when long distances are involved. I asked whether these matters had been settled or whether the situation is still flexible and open to discussion with the medical authorities concerned.

The board of management at Elgin manages quite successfully to keep a number of matters flexible and open as between it and the regional hospital board. No absolutely rigid limits are laid down, but the general principle is as I have described it.

May I say in conclusion that I am grateful to my hon. Friend for raising this subject this morning, for the way in which he did so, and for the compliments which he paid to the Government for what they have done over the last few years. A tremendous amount of progress has been made. There is still need for a good deal more progress.

It is a tribute to the medical and nursing staff in our hospital services that the quality of the service provided for the patient is not always dependent just upon the adequacy of the buildings. In many cases it is considerably greater than the adequacy of the buildings would in fairness lead one to expect.

Many members of the medical and nursing staff are still working in difficult conditions and are still providing excellent service to patients. But as the hospital building programmes steps up, as it has done over the last few years and as it develops over the next few years and into the future, we hope that in Scotland we shall see more and more hospitals of the quality which we see, for example, in mental deficiency at Lynebank in Fife. With that increasing quality in building there also comes an increasing quality in the service provided for the patients. This is the end to which all our efforts in the hospital services are devoted.