It is depressing from my point of view that the Minister is not present. However, I am most grateful to you, Mr. Deputy Speaker, and to Mr. Speaker, for allowing me to raise a matter, about which I am most concerned, regarding the hospital situation in my constituency in the City of Chester.I raise this matter on a totally nonparty political basis. I do so out of a genuine concern at the present situation in the hospitals in my constituency. I shall endeavour to convey that concern to the Minister, who I am now glad to welcome. I appreciate the difficulties under which the Minister is working at the moment. I know that the cash which his Department is able to dispense is limited severely, and I have read reports of what the Minister of State said at the weekend in the course of a speech to hospital administrators when he identified how difficult it was for him to have extra cash to spend. However, I hope that when the Minister has heard what I have to say, he will put Chester and its hospitals at the top of his list of priorities or at least near the top. My reason for wanting to raise this matter on the Adjournment is born out of a genuine concern for all those involved in the medical profession and for the health of my constituents and others living near my constituency. First, as regards the patients, I do not want to alarm the Minister, because I have had no serious complaints, but, if the present situation is allowed to continue for much longer I know that I shall start getting letters from patients or potential patients who have to go into hospitals. Secondly, the area health authority is definitely worried by the situation. It has done a tremendous job under reorganisation, and I for one am filled with admiration for its work. Thirdly, there are the consultants, doctors and nurses. All of them want to give of their best to those who are sick and have to go to hospital. They want to provide the best possible service. They feel that, if nothing is done in the very near future in the hospital situation, the service which they provide is bound to suffer. The problem is twofold. First, the hospitals in the City of Chester simply do not have enough beds. We are a growing area in terms of population, and we provide hospital services not just for those in and around Chester but also for those in the Deeside area as well. The reason why we do not have sufficient beds is that Chester is part of a regional health authority area which includes Liverpool. Liverpool is over-bedded. The Department tends to look at the region as a whole and to say that we have enough beds. That is true in terms of Liverpool, but it is not in terms of Chester, and therefore we need a compensating factor because we lose by being a small area in a large region. The second and more important problem is that Chester's hospitals are antiquated. Money has not been spent on them as it should have been. They do not have the necessary equipment or the room to provide the right sort of service. All would be solved were the proposed district general hospital to be completed. Plans for the new district general hospital have been discussed for well over 10 years now. It was in 1962 that agreement was reached in principle that the new district general hospital should be built. A lot of man hours have been put into these plans, and they have in-architects' fees, surveyors' fees, all the volved a great deal of money in terms of civil servants, and so on. But it is not just a matter of money. There has been exceptionally hard work and devotion towards this new concept of a district general hospital, so much so that, were it never to be finished, there would be genuine disappointment amongst a great many people who really care about the health of my constituents and others who live near my constituency. The first phase, the maternity unit, is now completed and is working well. I have seen it for myself. I have no doubt that all those who go there are grateful for the services which are provided. The second phase, which concerns other aspects of medical life, has been put back continually. I must tell the Minister as he was not in his place when I started my speech, that I raise this matter in a nonparty political sense, because the second phase was put back by the Conservative Government. I accept the reasons for the decision and the difficulties in which the hon. Gentleman finds himself regarding the second phase. But the net effect of not building the second phase of the new district general hospital is that the first phase, the maternity unit, operates under difficulties in isolation, as it now is, because it is dependent upon the completion of the second phase for some of the services which it intends to provide. As long as the second phase is not built, the morale of the medical profession—doctors, consultants and nurses—will be very low. Some of those doctors and consultants went to Chester because they were assured by successive Governments, both Conservative and Labour, that the new district general hospital would be built. Therefore, not surprisingly, morale is low. Morale is also low amongst the administrators, because they have worked on the second phase for a long time and want to see what they have built in their minds completed. Perhaps the most important net effect is that the existing hospitals have to cope with a situation with which they are no longer equipped to deal, because successive Governments, through good housekeeping, have not spent money where normally they might have spent it as they realised that it would be a waste of taxpayers' money given that a new district general hospital was to be built to replace the old hospitals. Therefore, as the old hospitals are still battling on and providing services and as no money has been spent on them, something must now be done. The area health authority is just as concerned as I am. It is so concerned that it has prepared a list of priorities where money has to be spent on existing hospitals. The authority has prepared a list of schemes which are vital to keep the services operating. Even if the Minister were to announce tonight, which we all hope he will, that the Department is willing to go ahead tomorrow with the new district general hospital, that money would still have to be spent on the existing hospitals because it would be eight years or more before the new district general hospital could be completed. In case the Minister should think that I am talking from the textbook or that I am being fed with information, I hasten to assure him that I am not. I am a layman. I do not profess to understand everything about hospitals, but I have seen and considered the problems on several occasions. The schemes on which I think that money should be spent are matters about which I feel strongly having seen them for myself. The Minister will no doubt recall that the Chester Royal Infirmary building dates back to 1756. Therefore, the hon. Gentleman will understand that it is antiquated, to say the least, and difficult to convert. The first major scheme which needs to be dealt with in the Chester Royal Infirmary is the upgrading of the main operating suites. Not being a doctor, I do not pretend to understand what an operating suite should look like, but I have seen it and I am assured that in some respects at least it is no better than a field operating suite of the Second World War. The second major scheme in the Chester Royal Infirmary where money needs to be spent is in terms of the extension and adaptation of the X-ray department. I am told—indeed, I have seen for myself—that the toilet facilities and changing area facilities are such that patients are really quite incapable of having any privacy of any sort, despite the fact—and this is the sadness—that a certain amount of money has already been spent on these facilities. Those are the two schemes concerning Chester Royal Infirmary. The Minister probably knows that Chester City Hospital is an old workhouse. Here, again, I expect that it is difficult to convert, but, given the need to provide these services, something must be done. Here it is absolutely essential that two wards—Wards 19 and 21—should be upgraded. These were the old maternity wards, before the new maternity unit in the district general hospital was built. I have seen them. They really are not in a fit state for patients. Then there is the upgrading or, indeed, the replacement of the pathology laboratory. The Minister probably knows much more about pathology laboratories than I do. However, unless we have effective pathology laboratories in Chester the health and, indeed, the very survival of some of my constituents may be at stake. Finally, in relation to the really desperately necessary schemes which must materialise, I come to isolation facilities. We do not have them at present in Chester. Sick infants have to come from 30 or 40 miles away, perhaps from a farm in the middle of Cheshire where the disease which the infants may have is not diagnosed, and when they arrive at the Chester City Hospital or the Royal Infirmary they are diagnosed as isolation cases. They cannot stay there. They must move on to another hospital perhaps some 10 or more miles away. When that happens the Minister will know as well as I do that there is a real chance that a child may not live. I should like to repeat how much I appreciate the fact that the Minister is in great difficulties. I would not want him to feel that he must reply in any detail tonight. That would be asking much too much from him. However, I should like him to answer the following questions in principle. First, will he give the go-ahead for the new district general hospital? Secondly, if he will not, is he prepared to spend money on up-dating the old hospitals, given that that money would have been spent in the normal course of events had there been no plans for a new district general hospital? Thirdly, if he will spend money on the old hospitals, will he give an assurance that despite that money being spent, the commencing date of the building of the phase 2 of the new district general hospital will not be put back in any way at all? Finally, in case the Minister should think that I am exaggerating the case—it may be that I am, because I am a layman and it may be that I get rather "uptight" about the worries and concerns of my constituents; but I do not think that I do—I ask him on behalf of my constituents to come and see for himself. I am sure that were he to do so he would have no doubt that the money I am asking him to spend would be well spent.
I say at the outset that I certainly appreciate the concern that the hon, Member for the City of Chester (Mr. Morrison) has shown not only tonight but in the lengthy correspondence he has had with my Department and the long series of Questions he has put down on this matter. I can assure him that my Department and I are very much aware of the needs of the Chester area on the provision of hospitals.Nothing depresses me more than to listen to hon. Members outline the defects in individual hospitals or in hospital services. Nothing would please me more than to be able to say to the hon. Member "Here is the pot of gold—spend it as you wish to meet the needs in Chester now". But that is not possible in the economic situation in which we find ourselves. Tonight's debate certainly marks the latest move of the hon. Gentleman in his campaign for improving all the Chester hospitals—a campaign which the hon. Gentleman took up almost immediately he took his seat in the House in February 1974. He has frequently attended meetings of the hospital staff, and I know of the many occasions on which he has raised Questions with my right hon. Friend about problems which face his area. I can assure him, therefore, that we are aware of the need for improved hospital facilities in Chester, and this awareness is on the part not only of the Department but of the Mersey Regional Health Authority and the Cheshire Area Health Authority. The hon. Gentleman's main concern has been with the development of the second phase of the West Cheshire General Hospital. He referred to the 10 years' of planning in this matter so I shall say a few words on that aspect. The former Liverpool Regional Hospital Board commenced planning the new district general hospital—the West Cheshire—to serve the Chester area, in 1964. The first phase consisted of the maternity department which was opened in 1971. I was pleased that the hon. Gentleman emphasised how well this aspect of the development was now working. Plans for the second phase, to contain 413 "acute" beds, were submitted to the Department in 1969. I understand that protracted discussions took place then on the design and cost of the scheme. This was aimed at ensuring that the planning and design of the hospital would produce modern facilities which could he built swiftly and economically. These discussions may have appeared to some to have unnecessarily delayed the start of the scheme, there were a number of features in the design of which, based on experience gained elsewhere, the Department's professional officers were critical. In particular they were concerned that the whole phase to be built as a single contract was estimated to cost about £9 million, at prices ruling in 1973. From experience elsewhere single contracts of such a size have been found to be very vulnerable to delay and to cost variations and the hospital authorities, therefore, examined the possibility of splitting the design into smaller self-contained phases. It was when this planning had almost been completed that the new regional health authority had to reappraise its whole capital programme in the face of the stringent cuts in capital allocations to health authorities announced by the previous Government in November 1973. The Mersey Regional Health Authority took over from the former Liverpool and Manchester Regional Hospital Boards and the Cheshire County Council repsonsibilities for health services in Cheshire on 1st April 1974. The authority had even before this date been reconsidering the capital programmes it inherited from the former authorities in the light of what it could afford to continue with in the light of the reduced capital available to the region. It came to the conclusion that, in view of the general need for capital improvements in the region as a whole, it could not justify the concentration of the large proportion of its resources which the Chester project would pre-empt in a single health district. It therefore decided, with the greatest reluctance, that planning on the West Cheshire District General Hospital, and a similar project at Macclesfield should be suspended, but that in the meantime urgent consideration should be given to what interim schemes could be undertaken at Chester hospitals so as to relieve the greatest difficulties that were being met. This decision by the regional health authority must be considered against the background of the provision for health services in the Mersey region as a whole. The authority is responsible for the health needs of a population of over 2½ million in the Merseyside Metropolitan County and the County of Cheshire. The population of the Chester health district makes up less than one-tenth of this figure. The region includes two expanding new towns at Warrington and Runcorn, whose populations are expected to increase by about 70,000 and 100,000, respectively, over the next five to 10 years, in addition to a substantial programme of urban renewal taking place in Liverpool. All of these developments result in a move of population away from the areas well served by the old hospitals and open up a need for new facilities.
The point I was trying to make was exactly the point that the Minister is making—that the old hos- pitals in Liverpool are over-bedded and that the hospitals in the City of Chester are under-bedded as a result. The region is so large that Chester loses out on that basis. Chester has to serve a large and growing population. That is one of the reasons why it needs help, whereas an area such as Liverpool, with a diminishing population, does not need extra cash.
What I was seeking to do was to relate the Chester problem to the whole regional problem. I do not deny that Chester has a need, but I was trying to state it in the setting of the whole region.To meet the commitents arising from these new developments in the region as a whole, and the need urgently to improve hospital and other health facilities, the new authority inherited from its predecessors a substantial programme of capital work, including three new district general hospitals—one at Arrowe Park, in the Wirral, one at Runcorn, designed to meet the needs of the developing new town, and the third at Warrington, to replace an old and inadequate hospital and cater for the needs of the developing new town. I am stating this as part of the whole regional policy. I understand that the hon. Gentleman may not be so passionately interested in it, but it has some significance in the authority's decision on priorities in hospital services. The deficiencies in Chester's hospital services to which the hon. Member has referred result to a large extent from the fact that improvements to existing hospitals, which would have closed had the new general hospital been built, have in the past few years been kept to a minimum. This course was followed because of the pressure on limited resources and through a desire to avoid undertaking expensive upgrading schemes on facilities which would be redundant after the opening of the new hospital. However, once it became clear that the new hospital would not be built as programmed, no time was lost in pinpointing where services were inadequate and planning improvements. In the two hospitals which currently provide acute services for the Chester area, the Chester Royal Infirmary and the Chester City Hospital, upgrading schemes to a total completed cost of £400,000 are already under way or shortly to begin. They include the provision of an intensive nursing unit and an anaesthetic room at the Chester Royal Infirmary and a geriatric day hospital at the Chester City Hospital. Also, the Cheshire Area Health Authority has submitted to the regional health authority a list of five additional schemes at Chester hospitals to be considered for inclusion in the region's 1975–76 capital programme. This list includes the hon. Gentleman's specific requests. They comprise schemes to upgrade two wards in the pathology laboratory at Chester City Hospital and the upgrading of the main operating theatre suite and extensions to the X-ray department and accident and emergency unit at Chester Royal Hospital. These were the specific requests of the hon. Gentleman. It is too early to say whether sufficient funds will be available for all these schemes to be undertaken this year since in drawing up its programme the regional health authority has to consider the needs of the other areas in the region. The region is also unable to finalise its capital programme for the current and succeeding financial years pending receipt of a firm capital allocation from the Department. We are hoping that it will be possible to issue this shortly. I do not mean that as a mere form of words. The decision is imminent. I hope that we shall soon be able to announce which of these schemes, if not all of them, will be able to progress in the future. Although these schemes will not meet all the needs—including those created by closures of a number of outdated hospitals—which the new hospital would have met, they will go far towards eliminating the backlog of works which have been delayed in anticipation of the construction of the new hospital. The hon. Gentleman will recall that my right hon. Friend has said on a number of occasions, that as a Government we would seek to divert resources to those areas where health services are of a lower standard than is normally found in this country. It has not yet been possible to establish the criteria which are required to measure this type of relative deprivation or to say how the needs of Cheshire will relate to them. I can assure the hon. Member that the Department is at present directing considerable efforts to this end aimed at correcting the injustices he has mentioned. I remind the hon. Member that although we have naturally heard a lot about hospitals, they represent only one aspect of health care as it is provided today. Primary health services play a vital rôle in all areas of treatment, and in this respect Chester fares comparatively well as against the rest of the country. I shall not go into details. I am not suggesting that there are no problems in Chester, but, by and large, taking the work of general practitioners, and so on, and the waiting list—
The Question having been proposed after Ten o'clock on Tuesday evening and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at twenty-eight minutes past Twelve o'clock