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Hospital Facilities (West Midlands)

Volume 894: debated on Monday 23 June 1975

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11.53 p.m.

It has taken me 11 weeks to get this Adjournment debate. With any other subject I would probably have given up in despair long ago. It is absolutely vital, however, that the attention of the Minister should be drawn to the appalling plight of accident, eye and cancer patients in the West Midlands and to the utterly disgraceful conditions under which medical staff dealing with these patients have to work.

Many years ago plans were laid for the replacement of the Birmingham Accident Hospital and the Birmingham and Midland Eye Hospital on the Queen Elizabeth Hospital site and for the extension and improvement of the radiotherapy unit already there. There was to be a great medical centre at the Queen Elizabeth, incorporating eye, accident, geriatric, psychiatric and children's hospitals All were to be on one site. Completion date was to be 1975 or 1977 at the latest. That was in the 1950s.

Today that plan is in ruins. Governments of both political colours have imposed delays, but the present Government have finally wielded the axe. It is in the belief that they have done so without appreciating what this means to the people of my area that I have sought this debate.

The Birmingham Accident Hospital in Bath Row is 130 years old. It had an international reputation for such things as advances in burn treatment, wound infection and the prevention of thrombosis. But the fabric of the building is so old that it is literally crumbling. It sounds incredible, but accident victims who are rushed to the operating theatre run the risk of bits of ceiling falling into their open wounds.

One senior surgeon there, Mr. H. Proctor, says:
"The fabric of the building is worn and inadequate; the operating theatre ceiling has crumbled and fallen, providing not only a physical threat but also one of wound infection. The latter is also a risk from the many dust traps of such an old building, despite diligent efforts by our cleaners."
Another surgeon, Mr. Michael Porter, has spoken of the
"overcrowded and cramped conditions and a higgledy-piggledy electrical system".
The latter may not sound too serious, but a 51-year-old man died recently because an ancillary nurse pressed the wrong switch in the intensive care unit. The switches are scattered in a Heath Robinson way all over the wall, having grown in size and number at various times, with no overall plan for efficiency.

Even if the Government had not halted the plan to have a new accident hospital, the five or ten years needed to build it would be too long. But with no new hospital in sight at all, the situation for patients and staff is truly hopeless in every sense of the word. It is so bad that the hospital has said publicly that it can no longer guarantee the safety of its patients.

The Birmingham Eye Hospital was also once internationally renowned but it has been regarded as in urgent need of replacement for nearly 40 years. Young doctors, fresh from medical school, with the ink hardly dry on their degree certificates, went to the eye hospital because it was well known to be such a fine hospital and because it was shortly to be replaced by a new building. Today those same doctors face retirement with the grand plans for a new hospital as far away as when their careers began.

In 1964 the hospital closed for six months after six people had each lost the sight of an eye due to an infection. An independent report was commissioned which described the conditions in the casualty department as "deplorable". It said that they were 70 per cent. deficient by the standards set out as minimal by the Department of Health. It said that the situation in the main theatre was "almost unbelievable" and that it was unsafe to use. The report found that every requirement for a reservoir of the bacteria which caused blindness existed in the sterilising room. The hospital has no incinerator to burn infected rubbish, and the report noted this too.

That report was suppressed because its publication would cause concern to the patients. A new hospital was again promised and the old was opened again on that understanding and because it was desperately needed in the area. I beg the Minister to resurrect that report, which must be filed somewhere in his Department.

Today the situation has not changed. Improvements which could have been made have not been carried out because everyone thought that a new hospital was imminent. A senior eye surgeon in Birmingham, Mr. Roper-Hall, warns that many West Midlanders will go blind because of their faith in the NHS. He says, in effect, that the patients are too patient. His actual words are:
"They have a touching faith in the ability of the Eye Hospital. But many will lose their sight while waiting for years on the waiting list—sight which could be preserved if we could reach them to prevent complications setting in. Some who will become blind, inevitably, are children."
About 1,700 people are on the official waiting list, but because they know that the hospital can cope only with serious emergencies family doctors in Birmingham have almost stopped referring non-urgent cases to the list.

No one knows how many people are in need of treatment, but more than 400 have been waiting for well over a year, some of them up to three years, and their sight could well have gone beyond re- covery. Many people on the list have died while waiting.

On 29th April I asked the Secretary of State for Social Services
"what steps she intends taking to improve eye hospital care facilities in the West Midlands."
The answer I received reduced staff at the hospital to despair. It was that
"Thirty-two additional ophthalmic beds will be provided when phase I of Selly Oak Hospital, now under construction, is completed, and work is planned to start this year on new operating theatres at the Wolverhampton Eye Infirmary."—[Official Report, 29th April 1975; Vol. 890, c. 80.]
The eye hospital must, if it is to be as efficient as it has been in the past, continue as an integrated unit. Wolverhampton is too far away to serve the Birmingham area in the way that the planned hospital would have done.

All sorts of research has been going on in the incredibly difficult conditions at the eye hospital. The research includes such matters as ultrasonic techniques, the use of laser beams and electronic techniques. The research staff say that all of this will have to be abandoned if the hospital is fragmented as suggested.

I quote Mr. S. J. Crews, Director of Research at the Hospital:
"It would be a disaster to have to abandon research because of the Eye Hospital being split into five or six separate, scattered hospital departments."
He added that such a split would utterly destroy the morale of the research staff.

Finally, this horror story must deal with conditions at the radiotherapy department of the Queen Elizabeth Hospital. Mr. William Bond, director of the department, sent me a letter about conditions in his department. I visited it and I could hardly believe what I saw and heard. The Queen Elizabeth is one of Britain's finest hospitals and is famous throughout the land. I was prepared for some of the troubles which were outlined in Mr. Bond's letter, but I was appalled by what I saw.

The corridors have scaling walls and ceilings. May of them are absolutely filthy and some of them are overrun with rats—rats in one of the finest hospitals in Britain‡ Water drips through the roof whenever it rains on to a high voltage electrical circuit and this has to be dried out with a hand hair-drier. Skilled technicians have to dash in and out of the isotope department because radiation there is well above the acceptable level. I do not scruple to tell the House that conditions at this department are a national scandal. No maintenance has been done because of the plans to extend the department. Now, those plans have been scrapped.

Is my hon. Friend aware that similar situations prevail in parts of the hospital at Solihull which was designed to cater for a population of 200,000 and most important parts of which are housed in workhouse buildings dating from 1840? Here again, first-aid work has been suspended because there is a plan for the future, but the plan is postponed from year to year.

I have no doubt that the Minister will take on board the comments made by my hon. and learned Friend. If this debate could last longer, there is no question but that we could all fill it with similar pieces of information about our constituencies. It concerns me that in this regard the Minister has not been well informed.

Is my hon. Friend aware that I have recently had correspondence with the Minister which makes it clear that he does not understand the position on the site? Will she confirm that the facts are as she has stated and are not those which the Minister has intimated in correspondence? Is she further aware that consultant staff have already begun leaving these hospitals? I refer particularly to a distinguished consultant in the radiotherapy department. I support my hon. Friend's remarks about the length of the waiting list for the eye hospital and conditions at the accident hospital which have given great concern, especially in the absence of any definite plan for a new hospital at Bromsgrove and Redditch.

I confirm that all the facts which I give to the House are absolutely correct. I have gone to great lengths to be extremely careful in what I say, and I assure the House that I am not overstressing the case. It is true that the Minister has not been well informed, because according to another piece of correspondence he believes that phase 1 will ease the situation. I am not re- ferring to the hon. Member for Oldham, West (Mr. Meacher), whom I welcome to his new position on the Government Front Bench. He will know the Minister to whom I refer.

Far from phase 1 easing the situation, the difficulties will be increased, because there is no direct access to the building from the main hospital, and sick patients will need to make an ambulance journey to receive treatment, even when they are in-patients. There are no plans to continue using the present therapy unit—where the rats are. One machine has been condemned by the Department of Health and Social Security, and the other is in need of urgent overhaul, but the plans require it to be dismantled and stored until it is needed for phase 2. The phase 1 development merely replaces the present equipment, admittedly in better surroundings, but there will be no increase in the services offered to patients.

The Minister must understand that it proper treatment for cancer is to be given in the Birmingham area it is vital that the decision to stop building and equipping a radiotherapy unit must be overruled. I understand that radiotherapy will actually cure advanced cancer of the cervix, laryngeal cancer, Hodgkins disease, testicular cancer, cancer of the bladder, cancer of the tongue and mouth and cancer of the tonsils and skin. All these diseases can be cured. Radiotherapy will greatly relieve the suffering caused by many other types of cancer.

One X-ray machine for such treatment came over from America under lend-lease in 1942 for the treatment of gas gangrene, and it is still in daily use. The other was pieced together from bits of old and broken-down machines. I have a sheaf of immensely pathetic letters from cancer patients and relatives of cancer patients who tell me of times when, the ambulance having collected the patients from home and taken them to the Queen Elizabeth Hospital for treatment, they have to be sent home again untreated because the machine had broken down.

I congratulate my hon. Friend on raising these matters, and I support her by confirming the truth of the description she has given of the frustration which is felt in Birmingham and district about the situation affecting the eye hospital, the accident hospital and other important radiotherapy and health services to which she and my hon. Friends have referred. This frustration is intensified by vague news of further Government cuts.

Does my hon. Friend agree that it is desperately important that we should be told the precise financial position of the West Midlands Regional Health Authority at the earliest possible moment, because further intolerable Government delay is making even more difficult the position of the dedicated staff who are striving to do their best for Birmingham patients in extremely worrying circumstances?

Having seen the radiotherapy department at the Queen Elizabeth, I am amazed that the staff remain there. No tribute to them is too high. Goodness knows, they would be welcome in other areas, in other hospitals and, indeed, in other countries.

I have with me a pathetic petition from 294 people. It is headed
"Petition for a new megawatt voltage machine to help cure cancer".
The petition was obtained quickly and sent to me when it was known that this debate was coming up. The 274 people who signed it are desperately anxious either about relatives who suffer from the disease or about their own future. I hope that the Minister will later accept the petition.

Radiotherapy for at least half the people in the West Midlands is based on the Queen Elizabeth department. It has to deal with one-tenth of all cancer patients in the country with only a fraction of the equipment provided elsewhere. Each consultant at the Queen Elizabeth has to deal with 600 patients a year, whereas elsewhere the patient—consultant ratio is 300 to one. The consultants have to do that without adequate junior support, because whereas most of the country has a trainee ratio of 60 per cent, of the consultants, the West Midlands has a ratio of only 14 per cent.

For a population of 5·5 million the Department recommends 20 consultants. Birmingham is far under that figure and more and more consultants are needed. Indeed, the loss of skilled medical men in the area is gravely worrying to us all. As Mr. Bond says, in qualified staff and equipment, in trainees and sympathy, we are hopelessly deficient.

When will the Department recognise what a plight the Midlands are in? It is true, and must be noted by the Minister, that West Midlanders are more likely to die of cancer, treated or untreated, than any other group in the British Isles.

Of course I know that money is short, but there are dozens of other areas where it is being spent on less important matters. In the name of the people of my area, I ask the Minister to give top priority to investigating the situation. If he does that, I am confident that the heartless and hopeless delay of these vital plans will be stopped.

12.11 a.m.

I congratulate the hon. Member for Birmingham, Edgbaston (Mrs. Knight) on securing her Adjournment debate after the long delay to which she referred, and on her perseverance and the forceful and careful way in which she described the present very serious deficiencies in the medical services in the West Midlands.

I appreciate that the indignation which the hon. Lady has expressed, and rightly so, about the inadequate facilities is shared in many other parts of the West Midlands. I will comment on a number of the specific points she made but will first explain the background to the present situation in Birmingham and the process by which the deficiencies and inadequacies she has detailed will be put right.

Let me say straight away that I agree with a great deal of what the hon. Lady has said. There is no doubt that in Birmingham and in the West Midlands region as a whole—and, of course, I mean the West Midlands health region of 5 million people, not the West Midlands metropolitan county of 2·8 million people—there are too many old, unsatisfactory hospitals, and too many cases of inadequate primary care facilities. Indeed, this is true right across the country. There is no doubt that a great deal of money needs to be spent to remedy these deficiencies, and the Government intend to provide the necessary funds as quickly as the country's overall economic position allows.

I know that many people in Birmingham were deeply disappointed—perhaps that is too mild a word—that the major development of the Queen Elizabeth site was not included in the 1975–76 hospital building programme. The truth of the matter is that, after the 1973 cuts forced on the Government of the day and in the excessive economic difficulties thereafter, it was just not possible to include such a large scheme. The estimated total cost of the scheme last year was £20 million.

The Birmingham Area Health Authority (Teaching) has been quick to seize the implications of the present capital situation, however, and is considering alternative strategies for the provision of those elements of the Queen Elizabeth development that are most urgently needed, particularly expansion of the radiotherapy facilities and the reprovision of the eye hospital and accident hospital.

It may be possible to undertake some of these schemes very quickly without too much new expenditure—for example, by resiting some of the units which are now in very unsatisfactory accommodation which the hon. Lady was entirely right to emphasise—in existing, more satisfactory buildings. Others will undoubtedly need considerable capital expenditure, however, and this is where we face major problems.

In rightly drawing attention to the appalling condition of the Queen Elizabeth Hospital, the hon. Lady indicated that she had visited the radiotherapy department quite recently. The Department's medical officer responsible for the West Midlands also visited there the week before last, and I have seen his report. I hope that one of the major problems involving existing equipment breaking down will be remedied very shortly when the new linear accelerator and cobalt machine come into use in the new building. I fully realise, however, that this only replaces existing accommodation and does not provide the necessary increase in facilities. The West Midlands Regional Health Authority will obviously be considering the relative priority of this increased provision in relation to the other needs of the region.

I have seen reports in the Birmingham Press, and I have heard the hon. Lady tonight describe, the deplorable state of the existing building, particularly the problem of rat infestation. I do not want to be unduly critical of the health authorities, because they had reason to expect that the existing accommodation would quickly go out of use as the new scheme proceeded. I am bound to say, however, that I regard some of the problems reported—the leaking roof, paint flaking from the walls and particularly the problem of rat infestation—as being a failure of local management. Even if one expects to replace a building within a matter of months, there is no justification for not making a serious and effective assault on a problem such as rat infestation. I know that the regional health authority is considering urgently how the present problems can be remedied. We in the Department have offered the services of our adviser on domestic services, who has a special knowledge of means of dealing with rat infestations, if the regional or area authorities feel that they need our help.

I know that some concern has been expressed about the possible danger to people working in the radiotherapy department from some of the isotopes used. I am advised that in fact there is no danger provided very stringent safety precautions are observed. In such an old and unsatisfactory building, these precautions have necessarily to be more stringent than those that would be necessary in new accommodation, but provided they are observed I assure the hon. Lady that there should be no danger.

Could the Minister press his experts about this? I understand that the medical technicians have to rush in and out again because the area in which the isotopes are kept is too small. I am sure the Minister is right to say that safety precautions are followed, and the Department lays down stringent rules, but I understand that those rules are not met in the present siting of the department where the isotopes are situated.

I accept what the hon. Lady says. I was saying that the facilities are recognised to be cramped and that the procedures require to be tighter and more strenuous than otherwise would be necessary. I am advised that it is possible to carry them out. I assure the hen. Lady that I shall have that matter further investigated.

We have to face the fact that it will inevitably be many years before all the present deficiencies in the National Health Service, including those in the West Midlands and more particularly in Birmingham, will be put right. It is not only the global resources that must be borne in mind, but allocations within regions.

The hon. Lady asked about procedures for the health capital programme in future years. I should comment first about the global level of resources. Ever since December 1973, when the then Government found themselves forced to impose severe cuts on health service expenditure, successive Governments have had to plan on lower levels of future expenditure than they would have wished because of our general economic situation. I am afraid that, as my right hon. Friend the Secretary of State announced on Budget day, the outlook for the health capital programme for future years is by no means favourable.

1 can only say that as a Government we mean to spend more on the health services as soon as the economic situation allows. As to whether the West Midlands gets a fair allocation of the resources available for the country as a whole, it is very difficult indeed to devise a system of allocation which can be proved to be objectively fair. We are not satisfied that the present system of allocating capital to regions is satisfactory, but since taking office we have given urgent priority to restructuring the criteria for allocating resources, and we have set up a working party precisely for this purpose, to make them more responsive to the needs of different parts of the country, particularly areas of health deprivation.

With a view to this my Department is giving urgent study to ways of objectively measuring existing local variations in the distribution of resources. I would expect that it will be quite some time before we are able substantially to improve the present system, and obviously I cannot also predict whether, if a more objective means is found, it will necessarily prove that the West Midlands has had more or less than its fair share of resources over the last few years. But I have certainly noted the very powerful comments made tonight on that score.

As part of our proposed National Health Service planning system I should also add that we have already asked the 14 regional health authorities to begin the preparation of outline regional strategies for the next decade. This involves an appraisal of existing resources, an analysis of needs and the preparation of a strategy to meet these needs in the region over the years. This review will apply both to the obvious needs for new capital expenditure on new hospitals, and for what are in many ways the more important elements of the health serivces—good primary care facilities.

The aim is thus for a new systematic identification of deficiencies to be made up or new standards of provisions to be achieved, and the meeting of these deficiencies and the achievements of these new standards just as quickly as resources allow.

The importance of all of this for the present Birmingham situation, and indeed the situation in all other parts of the region, is that, beginning with the Green Paper and later through the National Health Service planning system, the regional health authority will be systematically reviewing needs and determining priorities for meeting them. In other words, the regional health authority will be able to consider the needs of, say, Dudley or Walsall, which are also grossly deprived, against the need to reprovide Birmingham Accident Hospital, and will prepare, as it were, a priority list of projects. Thus the very real need to expand the radiotherapy facilities in central Birmingham—

The Question having been proposed after Ten o'clock on Monday 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-three minutes past Twelve o'clock.