Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sainsbury.]
In all the years that I have served in this House, this is the most convenient time at which I have had an Adjournment debate. My previous Adjournment debates have taken place in the middle of the night and I have had to apologise to the Minister who replied for keeping him out of bedI have a sad story to tell about a hospital and a series of broken promises and delays. This is not the first Adjournment debate that I have had on the subject. I made the case for the south Trafford district hospital on 30 June 1980. My hon. Friend the Member for Ealing, Acton (Sir G. Young) was then the Minister responsible. He said that a decision on the new hospital would be reached with all possible speed One year later, almost to the day, just to keep the Ministry on its toes and to remind it of the happy occasion, I went to see my hon. Friend the Member for Reading, East (Sir G. Vaughan), who was then a Minister in the Department of Health and Social Security. He agreed to consider proposals for the new hospital which he was about to receive. In October 1981, the scheme was accepted by the Department and the regional health authority. Approval in principle was sent to the Department in July 1982 and a deadline of December 1982 was set for a response. In November, the Department replied that further work was required on the document and the regional health authority agreed to purchase the site. However, the Department and the Treasury could not agree without any firm scheme being included in the capital programme In April 1983, at the formal review of capital schemes, the regional health authority could not guarantee a place in the programme and its previous acceptance of a start in 1987–88 was not confirmed. In October 1983 we seemed to get some cheering news. We were told that the hospital had provisionally been put in the programme for the 1988 financial year and that the Treasury had approved the purchase of the site. Many of my constituents believed that at last the new hospital, which had been promised for so long, would come into being. There was an element of mystery at that stage because the regional health authority did not act as the regional team of officers appeared to have doubts about whether the new hospital would ever materialise. That was when outline regional strategy was being prepared by the regional health authority and alternative schemes, which would be less expensive in capital terms, were being considered. At the beginning of 1984, the regional officers began to suggest that the new hospital should be reappraised. That appraisal used only capital costs as the basis for considering alternative options and what became known as the Wythenshawe option was first put forward In September 1984 we were told that the appraisal showed that, on the criterion of capital costs, a development at Wythenshawe was cheaper than building a new hospital in south Trafford. The Trafford health authority felt that other considerations should be taken into account, such as accessibility, convenience for patients and many other non-financial criteria. It also thought that the capital costs of proceeding with the Wythenshawe development had been disguised to show the proposal in a more advantageous light. It is clear that Trafford health authority was not exactly jumping with joy In November 1984 the regional health authority agreed to reconsider the scheme and promised a full option appraisal by February 198.5. As a result, it was discovered that there was little cost difference between the two main options, the new hospital in south Trafford and the Wythenshawe option, when all the non-financial benefits, capital and revenue costs were fully taken into account. Despite this, the regional health authority accepted that the appraisal was marginally in favour of the Wythenshawe option, and decided that it should proceed I believe that the views of the population of south Trafford do not seem to have been taken much into account by the regional health authority. We have been waiting for years for a new district hospital that would provide, among other things, services for the elderly and for mental illness, services which are desperately needed in the south Trafford area Trafford community health council has over the years supported the plans for a new hospital. It has tackled successive Secretaries of State in seeking a decision on the new hospital because it knew that the new hospital was central to the strategy for the area. Despite all the exhortations to come to a speedy conclusion, little progress has been made As I have mentioned, the regional health authority decided on a full option appraisal. These options went to the community health council on 14 January with a request for comments by the end of January, in other words, in just over two weeks. I was told that a medical staff member who attended a recent public meeting in Sale, a man who is a consultant with the Sale and Brooklands hospital, announced publicly that consultants were asked for their opinions on 19 February, six days before the regional health authority took the decision. I feel that the regional health authority could well ask itself whether its record on consultation was satisfactory Prior to the meeting of the regional health authority, Trafford community health council presented a resolution asking it to defer a final decision until it had had an opportunity to discuss the situation with the chairman and members of the regional health authority. This request was rejected on the ground that further delay was considered inadvisable. Considering the delays that have stretched over the years, I should have thought that a request for a delay of a few weeks was not asking too much. A project that has dragged on for years could not be deferred for a short time in order to hear and assess the views of the residents of south Trafford Because of the concern of the local people, the community health council decided that it would hold a public meeting on 20 March. I am told that the meeting was well attended. It is unfortunate that nobody from the regional health authority was present to put the authority's point of view. If somebody attends and puts forward a point of view, even though many people in the audience may not necessarily agree with it, at least the point of view will be heard In fairness, I think that there may have been sortie misunderstanding. I am told that the chairman of the community health council and a deputation are to meet the chairman of the regional health authority on Friday 26 April to put their view and that of the local residents to him As a result of the public meeting, the community health council is anxious to have some answers to what it regards as vital questions. First, it wants to know whether the proposals will meet the needs of the people in south Trafford. The community health council has done a great deal of homework. I am told that inpatient activity under the revised intentions shows an increased work load of approximately 15 per cent. While the provision of additional ward accommodation is covered under capital proposals, it is not clear whether support facilities — catering, pathology, radiology, physiotherapy and so on —would be capable of coping with the additional work load without extra capital input. The proposals presume no extra capital requirement There is a further complication because of the situation that has developed in the south Manchester health authority which has, I think the American expression would be, an overspend situation. There is a great deal of publicity in our local newspapers about the cutting of services in the South Manchester health authoriy area. Two decisions—one local, the other regional—have coincided. The vital question is whether the capital intended for south Trafford will merely be absorbed There is also the question of acceptability to the people of south Trafford. This is tremendously important. They must be consulted on things which are of great importance to them, such as hospital provision. In all fairness, I do not think that the appraisal took account of acceptability to the general public because of
The people of my area certainly know the answer now. Public opinion, the community health council and the Trafford borough council have all come out strongly in favour of a new district hospital. The Wythenshawe option has very few friends in my constituency Do these proposals meet the needs of south Trafford? It seems that the proposals for mental illness provision have again been referred back to the joint working group. This is of enormous concern to the community health council, not only on the grounds of service provision but also because it could affect the basis of the financial considerations of the appraisal That brings me to the $64,000 question in respect of which I hope my hon. Friend the Under-Secretary can give some illumination. The people of my constituency desperately want to know whether the Wythenshawe option has been definitely decided. If that is the case, is there any appeal? There is a desperate need to know exactly what has happened over hospital provision in the south Trafford area Linked with this are the futures of certain small hospitals in the area, over which there are question marks, particularly the sale of Brooklands war memorial hospital. That hospital was built by public subscription and has a tremendous record of service to the people of the area. There are strong local feelings about it. In fact, I have received more letters on keeping the Brooklands war memorial hospital open than on any other hospital in the area. Many people have spoken with enormous sincerity about the tremendous care that their relatives received in that hospital. They feel that if it were to close, it would be an extremely black day for the area I hope that my hon. Friend the Minister will be able to say that no final decision has been reached and that the voices of the local people will be heard before a decision is finally made"the difficulties of obtaining any firm founded statement of views in the time available"
:I can begin by reassuring my hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery) that no final decision has been taken, certainly none which has been formally notified to myself and my right hon. and learned Friend the Minister for HealthMy hon. Friend and his constituents must of course have their say, and that must be listened to. Just as it is critically important that hospital closures are looked at properly and closure decisions taken only when they are of benefit to patients, so, too, with the approval of new hospital building programmes. Heaven knows they are expensive enough and take long enough to complete. Once begun, we are locked in for a considerable time. We in the centre are determined that decisions shall not be taken until the voice of everyone has been fully and reasonably heard and every conceivable option looked at Once a new integrated district authority hospital has been built, and once the first foundation stone is laid, the die is inexorably cast in terms of service development, not just for 10 or 20 years, but for probably half a century, so long is the lead time, so massive the capital investment and so substantial the impact on the pattern of patient services in the area. I fully recognise that this is a momentous decision for the people in my hon. Friend's area No one could have been more assiduous than my hon. Friend over the years in bringing the needs of south Trafford to the attention of successive Ministers of Health. I heard what my hon. Friend had to say about an Adjournement debate with the then Minister, my hon. Friend the Member for Ealing, Acton (Sir G. Young). He and I between us have dealt with an adequate number of Adjournment debates on this and similar issues over the last three or four years. I am only sorry that the decision which my hon. Friend the Member for Altrincham and Sale wanted on a previous occasion is still in the air It is very difficult for my right hon. and learned Friend and me in the Elephant and Castle, as the men in Whitehall, the faceless people who are not known in Trafford and who do not know Trafford, to take decisions about major capital building programmes in the region. Those decisions have to be taken locally, within a regional framework, by people who understand the local community, who know what makes the north-west tick and who understand the needs of the people. While we have a legitimate and proper interest—if we did not show that the Public Accounts Committee would be after us very quickly—we could not logically be expected to decide exactly where new hospitals are to go. If we took upon ourselves that unlikely role, I am sure that my hon. Friend the Member for Altrincham and Sale and others of my hon. Friends would want to know why on earth the men from Whitehall were making decisions when they did not understand local conditions There is a slight problem in that my hon. Friend rightly brings the issue to the high court of Parliament, where matters are finally decided, and to the Department of Health and Social Security, where the actual decisions are taken, but we cannot, except in a residual way, act as more than a benevolent long-stop until such a row breaks out that no local decision can be taken because the people in the region cannot agree. In the end, hospitals have to go somewhere. In the end, the location pleases some constituents because they have a hospital in their immediate area, and it does not please other constituents because they do not have a hospital in their area. There is no way in which we can put a large integrated district general hospital every five or 10 miles across the land. We could not afford to do so and, indeed, we do not need so many. Those are the difficulties in which we find ourselves when we listen to the proper appeal that is made on behalf of the constituents of my hon. Friend I told the House at the outset that no proposals by the North Western regional health authority had yet been submitted to Ministers for consideration. The matter is still in the formative stages locally, though Trafford district health authority has shown a clear preference among the options open to it for dealing with the health problems in the south of the district. My hon. Friend will be aware of that. However, that preference is subject to certain conditions which have been referred to the regional health authority for investigation The members of the regional health authority and the district health authority will be keenly interested in what my hon. Friend has said this evening. They will read what is reported in the local newspapers and, perhaps more importantly, in the pages of Hansard. As a demonstration of their determination to take a balanced view, Sir John Page, the admirable chairman of the regional health authority, whom we are pleased to see fully back to health after his recent illness, has offered to receive a local delegation. My right hon. and learned Friend the Minister for Health has also been approached by my hon. Friend the Member for Altrincham and Sale on the issue and I understand that he will hold a meeting with representatives of Trafford community health council in the near future to discuss the issue further It does not need me to tell the House, and particularly my hon. Friend, about the nature of Trafford. It is a well populated area with a major general hospital in the north of the district and with the southern part of the district cut off by the river Mersey, which makes communications between north and south difficult. The local community in the south are served by a number of small hospitals for minor acute and geriatric services, and by Wythenshawe hospital in south Manchester for major services. Therefore, the task facing the district health authority is to rationalise services in the south of the district and to make them more cohesive Changes in the NHS—rationalisation, and, from time to time, the closure of old buildings, some of them worn out and inappropriate for modern clinical uses—do not mean cuts. They simply mean that things are changing. Throughout the country the NHS is changing, with the biggest building programme that the service has seen since 1948, with more than £1 billion worth of major hospital schemes being designed, planned and built The Government are striving hard, with hard-earned taxpayers' money, to make up the damaging and slashing cuts on the NHS that occurred between 1976 and 1979, when the IMF sent in its men to bail out the British Government. Cuts made over three or four years in the NHS represent a huge chunk out of the building programme. We are just catching up. We are running hard to make up the lost ground of those disastrous years of the last Labour Administration That is the national picture. The picture in Trafford is also far from gloomy. The local newspapers, if they care to report this debate and anything that I say, might note that at present Trafford residents have more money spent per person on their health services than the people of any other district in the north-western region. The residents of Trafford find it easier to obtain inpatient hospital beds than do most others in the region, including many living in teaching hospital districts, and Trafford does not have a teaching hospital We are trying in the north-west to do what we can for the Trafford district, while moving historically deprived districts such as Blackpool and Bolton, both of which I have visited in the last year, closer to the level of quality and service that Trafford enjoys. This year we are spending an extra £8 million on the health service in the north-west. That is a cash growth of about 11 per cent., and the North-Western regional health authority's capital allocation is again this year the second highest in the country While, therefore, my hon. Friend is rightly pressing us for action and decisions, and while his constituents wish to have the hospital provision that he has represented to us, both wishes must be set against the considerable success story that can be told about the NHS in the Trafford district, just as it can be told of other districts—Watford, Abingdon, Oxford and any other randomly chosen constituencies to which one might refer A challenge faces the planners in Trafford and in the region. How can the excellent local health service which Trafford already enjoys be enhanced in a way that releases resources to improve the lot of deprived districts as well? They must ask themselves whether it is right to ignore the fact that patients seem to prefer to go to Wythenshawe hospital. I shall give way to my hon. Friend if he feels that I do not have that right. I do not know the area and I have reported the position as I am advised
It is not the reaction that I have been getting. Wythenshawe is not the easiest place to get to from south Trafford. It is easy if one has a car, but many people do not. Nor is there the best of bus services on that route. The Wythenshawe option has been extremely unpopular in the area
I stand corrected by my hon. Friend arid I am glad that he intervened to make that pointThere are two options. One is the Wythenshawe option, and the other is to build a new hospital in south Trafford. The Wythenshawe option involves further developing that hospital to provide district hospital services for south Trafford. Over the past 15 years, Wythenshawe hospital has been developed as one of the three teaching hospitals associated with the University of Manchester My hon. Friend said that the Wythenshawe option was meeting with considerable local opposition, and I hear and believe what he says. On the other hand, I have been advised that some local people regard this as not much more than a stop-gap measure, even if it should go ahead. It is preferred by the district health authority, subject to satisfactory arrangements being made for the mentally ill patients in south Trafford. It has said that, should the Wythenshawe option be adopted, management should be transferred from south Manchester, with its unfortunate cash problems, to the Trafford health authority, and the regional health authority has to consider all these points when it looks long and hard at these problems It is difficult for us to decide from the centre. My hon. Friend the Member for Altrincham and Sale can see that it is difficult for me and for my right hon. and learned Friend the Minister for Health, before we have concrete proposals before us, to attempt to adjudicate on problems which have to be sorted out locally. I emphasise that representations can still be made to Sir John Page, the chairman of the regional health authority, about the totality of services to the people of south Trafford. Those representations should still be being made, and I was pleased to hear from my hon. Friend that in only two days' time one further meeting is to take place between local representatives and the regional chairman This debate has been valuable because I have been able to learn more about the problems of the district. I listened carefully to the points that my hon. Friend made. I and my right hon. and learned Friend will be able to consider these options when they are put to us if they are put to us in the form in which my hon. Friend has suggested that they will be If my hon. Friend and his colleagues and constituents of all and no political parties, the community health council, the borough and everybody else feel that consultation has not been carried out as well as it should have been, I take that seriously. In running a modern health service, the people whom we are trying to satisfy are not politicians, Ministers, trade unionists or the people who work in the NHS, but the people who consume the products of the NHS—the patients. My hon. Friend's constituents are the consumers of the products that we are labouring hard to improve If my hon. Friend feels on reflection after tonight and the meeting on Friday that there has been something seriously wrong with the consultation process, I happily give him the undertaking that I shall discuss the reopening of the consultation process with the regional chairman so that everybody feels that their views have been taken into account We also need a decision soon. This has been the subject of meetings and Adjournment debates, with more meetings to come. We need a proper decision, taken against the background of full and proper consultation, as soon as possible. I shall be giving that message firmly to the regional health authority.Question put and agreed to.Adjourned accordingly at twenty-eight minutes past Ten o'clock.