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Singleton Hospital (Casualty Unit)

Volume 86: debated on Thursday 14 November 1985

The text on this page has been created from Hansard archive content, it may contain typographical errors.

Motion made, and Question proposed, That this House do now adjourn.— [Mr. Peter Lloyd.]

10 pm

I am not sure whether it is my reputation as a speaker or that of the Minister that has led to the rapid egress from the House. However, I am sure that we will have a more helpful and constructive discussion as a result of the more intimate atmosphere we are now enjoying.

The purpose of this debate is to focus attention on the unbelievable antics of a non-elected, non-repesentative, out-of-touch quango—the West Glamorgan health authority. It has put forward an absurd proposition to close the casualty unit at the hospital that is virtually in the centre of the city of Swansea, and to move it to the extreme outskirts.

There is massive opposition to that proposition. In addition to myself and the Labour party, the city council, the county council, the community health council, the Association for the Welfare of Children in Hospital, the West Glamorgan local medical committee—on behalf of the local medical community—the representatives of some of the schools in the area, of women's and pensioners' organisations and the public, through an absolute flood of petitions, have made it absolutely clear—I hope beyond any doubt in the Minister's mind—that that proposition is utterly unacceptable to the people of Swansea.

What we have before us is a saga of contempt, arrogance and unbelievable incompetence. If we look back to the so-called phase of consultation, it is evident that the health authority has tried to shelter behind consultation that took place 10 years ago on a set of proposals that are unrecognisable when placed alongside its current proposition. A decade ago it was considering a proposal under which, in addition to facilities at the Morriston hospital, there would be minor facilities at the Singleton hospital—which it now intends to close—and at Neath.

In addition, there would have been a scattering of casualty facilities throughout the city, based on general practitioners' surgeries and health centres. That latter proposition, which was included in the initial proposal, has long since disappeared. Yet that same health authority is, incredibly, trying to base its defence of its untenable posture on consultation that included that scattering of subsidiary and supplementary casualty facilities.

By 1978 its proposals had already changed considerably, and at that stage it produced a planning cycle paper. However, in April 1984, in a letter to me, it made it quite clear that the question was not whether there should or should not be any facilities available at Singleton hospital. It stated in its letter that the issue in dispute was the "precise scale" of the facility that was to remain at Singleton.

The Under-Secretary of State wrote to me in December 1984 and his letter reflected the Department's understanding nine years after the initial consultation. The hon. Gentleman explained that he was confirming that the health authority intended as part of its strategic plan to provide a casualty service and to continue with an emergency admissions unit at the Singleton hospital.

That was not a trivial or frivolous proposition. It was understood by the Department nine years after the initial consultation that that was part of the strategic plan. I emphasise "strategic" because that implies that the range of facilities of medical support that would exist in the two hospitals had been taken into account when he proposition was advanced that some facility would be retained at Singleton. Until the end of last year the Department, like many others, understood, as the health authority appeared to understand itself, that there would remain a facility at Singleton.

When the community health council, representing the consumer in West Glamorgan, pressed for consultation, it was given a meeting as recently as 28 February, at which it was promised that the health authority was still trying to provide a service at Singleton and that the council would be consulted again once the authority had firm proposals to put forward. It is important to note that there was to be consultation on proposals and not notification of a decision already taken. However, from that day until 21 May the council heard nothing.

On 21 May, in an astonishing volte face—this was unrelated to any proposition put to the public, the community health council or public representatives—the authority announced the proposition to close the unit at Singleton hospital. In a letter of the same date, the council stated:

"On the same day, the Authority released for mass distribution copies of a publicity leaflet which had been prepared prior to the meeting, advising the public of its decision. Promises of consultation with the community health council before decision was taken had not been kept."
It appears that there was contempt for the health council and for the other members of the authority. The leaflet had been prepared before the secret meeting that took place on 21 May at which the proposals of the chairman and chief executive were eventually endorses. The leaflets were circulated in anticipation that the decision would go the way that the leaders of the authority wanted.

When I and the community health council and others complained to the Welsh Office that it was unacceptable that after nine and a half years of consultation on one set of proposals the authority had announced a conclusion that was completely different, the Under-Secretary of State wrote me a letter similar to the one that he sent to the community health council. It contained the damning comment that
"Ministers have taken the view that the health authority has not conformed with the normal procedures for public consultation on this issue."
That is a serious comment by a Minister about a quango whose members are his own appointees. After nine years of discussion, proposals and alleged consultation. the Minister has to admit that the normal procedures had not been observed in relation to the authority's final proposition. He went on to say—and I was grateful to him for this—that for that reason he was imposing another consultation period.

If the Minister wants to approve what the authority is suggesting, I give warning that I regard one month as inadequate. If I had the normal three-month period in which to organise opposition to the stronger and more disastrous proposal, I could ensure that the protestations that he heard about the original proposal would have been dwarfed by the representations that he would have received on the closure proposition.

That was not the end of the quango's contempt for the public and even the Department. Before the Secretary of State gave his decision, the local union had to veto an attempt by the health authority to transfer porters from Singleton hospital casualty unit to Morriston. That was in anticipation of the closing of the Singleton unit, and despite the fact that at that stage the authority would have received no sign from the Minister and the Department of their intentions.

In the past 10 years, most of the population build-up in Swansea has been in the Singleton catchment area, and most accidents happen in the home. Therefore, it is reasonable to conclude that the population most at risk is in the catchment area of the unit that the authority proposes to close. As a holiday area, it receives an enormous increase in population over the holiday period and, inevitably, most of the beach accidents also arise in the Singleton catchment area.

Another interesting feature is the incidence of road accidents. Statistics which are available to me, and which I understand were available to the health authority in Swansea, show that in 1973, of 710 road accidents, 508 occurred in areas with quicker access to the Singleton unit than to the Morriston one. Because of the build-up of traffic, inevitably travel conditions in the city have worsened.

Despite all these factors, the local authority is proposing the closure of the central unit and the taking of all cases to the peripheral unit on the east of the city at Morriston. If that were to happen, according to the ambulance timings carried out by the health authority for incidents in the west of Swansea an extra 20 minutes would be needed in the time that ambulances take to get to the casualty unit, and that does not take into account the rush hour or the holiday season. Anybody who has tried to get away from the beach area when the holidaymakers are going home in the early evening will confirm that it is virutally impossible to move on the main road.

In any event, the ear, nose and throat patients and the outpatients will be in the absurd position that they will be taken out to Morriston only to be taken back to Singleton where the correct facilities exist.

It is indicative that from 1968–72 Singleton brought up its accident patient throughput so rapidly that, although it had not been intended that it should have a major facility, by 1972 it was taking 80 per cent. of the cases and the Morriston unit was closed down. I am not suggesting that Morriston should not have a unit—I am delighted that, under this proposal, it will get the unit. The decision seems nonsense as all experience even before the build-up in population and the intensification of the rate of road traffic accidents shows that the majority of people would automatically go to Singleton hospital. Therefore, the case is proven.

I hope that the Under-Secretary of State will here and now reject utterly the proposition to close the Singleton unit, and that he will set up an inquiry into the eccentric activities of this peculiar West Glamorgan quango. Its antics have been a source of some hilarity, not just in relation to Singleton hospital. Its carousel activities in relation to Mount Pleasant hospital are equally bewildering, as was its posture on fluoridation, when the Minister had to veto its attempt to overrule the local authorities and me. The whole of its recent history suggests that there should be an inquiry into the way in which it seems so isolated from the community it serves.

If as a result of this absolute fiasco, which could be disastrous, the chairman and chief executive of the authority do not have the good grace to resign, I hope that the Secretary of State will sack them.

10.17 pm

Although I share the concern of the right hon. Member for Swansea, West (Mr. Williams) about the way in which West Glamorgan health authority has handled this matter, I must make it clear that the transfer of major accident services to Morriston was approved by the previous Administration in 1977, and is not the issue now. If the right hon. Member has any complaints about that decision, I suggest that he directs them to the appropriate quarter of his own party. We are concerned only with the retention of a minor casualty unit, at Singleton.

For many years after the transfer of major accident services to Morriston was approved, the health authority was committed to the concept of continuing to provide a minor casualty unit at Singleton. In May of this year, the authority abandoned that commitment, and the matter soon landed on my right hon. Friend's desk. It falls to me to announce his decision, which I shall now do in the unavoidable absence of my hon. Friend the Member for Newport, West (Mr. Robinson), the Parliamentary Under-Secretary of State, who is suffering from a viral infection. I shall then outline the background and events leading to that decision.

My right hon. Friend is not satisfied that the West Glamorgan health authority has fully explored all the avenues and options for providing a minor casualty service at Singleton hospital, and he is, therefore, not prepared to confirm West Glamorgan health authority's decision. The director of the NHS in Wales has today written to the health authority advising it of that. The Health authority is required to draw up plans within three months, and to negotiate with local general practitioners with a view to introducing a minor casualty service at Singleton to be run by the general practitioners under the overall supervision of an appropriate consultant. In formulating those plans and drawing up an operational policy, the health authority must consult informally all the appropriate local bodies, including the community health council, which must be kept fully in the picture.

My Department will keep in close contact with the health authority to see what progress is being made, and if at the end of three months the authority has failed to produce positive plans to open the unit it will be required to undertake public consultation on the issue and to publicise full details of the action that it has taken and the response of the general practitioners.

I can assure the right hon. Member and the people of Swansea that should the matter come before my right hon. Friend again he will require a great deal of convincing that the service should not be provided in accordance with the wishes that so many of the population have voiced.

Let us consider the background. In December 1975, the newly formed West Glamorgan health authority published a consultative paper entitled "Planning a Comprehensive Health Service in West Glamorgan". Serious deficiencies in the accident department at Singleton were identified, and it was proposed that major accident services should be centralised at Morriston, where traumatic and orthopaedic services would be located. It stated that minor casualty services would be provided at Singleton and Neath. However, when this plan was approved by the previous Administration in April 1977, a note of caution was sounded and the authority was advised to consider further the casualty services to be provided at Singleton and Neath when the new accident and emergency unit at Morriston neared completion.

Notwithstanding this, year after year the authority's annual plans reiterated its commitment to the minor casualty service at Singleton. From 1978 to 1981, these plans contained a policy,

"that the Accident and Emergency services be organised on an Area basis, with the Major Traumatic Department sited at Morriston Hospital … but supported by the present Neath General Accident and Emergency services and a Casualty Unit at Singleton Hospital."
In 1982, that policy was,
"to identify the nature of the Casualty Services to be provided at Singleton Hospital after the completion of the Major Trauma Unit in Stage I of the Morriston Development."
In 1983, the authority published its draft strategic plan, which said that minor casualty services will continue at Clydach and Gorseinon, serviced by general practitioners, and that a similar provision at Singleton hospital will be considered. In the final plan which was submitted for the approval of my right hon. Friend the Secretary of State late last year, the authority said that it,

"would continue to pursue the possibility of providing a casualty service at Singleton."
In view of the authority's earlier commitment to the provision of the service, it appears that it was generally accepted that the authority was continuing its earlier policies. If my right hon. Friend had any doubts in the matter, his fears would have been allayed by a statement referring to Singleton in the chief administrator's letter of 15 August 1984, which accompanied the submission of the plan, to the effect that the strategy expresses the intention of providing a minor casualty service that would support the full accident and emergency service at Neath and Morriston hospital.

Thus, the publication of the so-called final decision in May this year, to which the right hon. Gentleman referred, came as a bolt from the blue, and the good people of Swansea were understandably taken aback. In my Department, it was fairly assumed that consultation would take place, and when the strategic plan was approved in July reference was made to the need for consultation. However, following West Glamorgan's announcement in May, my Department received much correspondence alleging that, without consultation, the authority had reneged on its previous commitment to provide the unit. When in July the director of the NHS in Wales wrote to the general manager asking what consultation had taken place, the authority replied that it had not gone to public consultation because such an exercise would be a sham in the authority's view and it was unable to provide the service. This, of course, conflicted with established procedures laid down by the Department.

In the meantime, the authority's information sheet had raised a hue and cry in Swansea, and received much coverage by the media. Even if proper public consultation had taken place, I doubt whether the issue would have received a wider airing. The authority took considerable steps to publicise its decision. Some 5,000 copies of the leaflet were distributed in the city to health centres, general practitioner and dentists' surgeries, libraries, community, sports and leisure centres, political parties, Members of Parliament, post offices, education establishments, and so on.

The right hon. Member for Swansea, West said in a recent letter to my right hon. Friend that in all his 21 years as a Member he had never come across a local proposal that had created such widespread anger and opposition. In view of all this and the fact that the authority was refusing to budge, there would have been little point in delaying the determination of the matter whilst it went through the full consultation process. The three-month public consultation exercise that Welsh health authorities are required to undertake goes beyond the statutory requirement contained in the Community Health Councils' Regulations 1985, which only require consultation with the community councils. The Department has extended consultation to involve other public bodies and their representatives and the general public. Detailed advice on our procedures is contained in service planning paper 5, of which there is a copy in the Library.

At the end of the day, if there is still local disagreement that cannot be resolved, the authority must refer the matter with recommendations and an outline of the alternative arrangements to my right hon. Friend for the final decision. A period of one month is then allowed, and publicly announced by the health authority for public representations to be made direct to my right hon. Friend. By forgoing formal consultation and by announcing the abandonment of the proposed casualty service at Singleton, West Glamorgan health authority would have precluded the submission of the proposals to my right hon. Friend, and the period of one month for the public to appeal to him. That was not acceptable to us, and for that reason the director of the NHS in Wales wrote to the general manager of West Glamorgan health authority on 12 September requiring him to put the authority's case formally to Ministers, and publicly to announce that it had done so while giving the public a further month to make their views known to my right hon. Friend.

That was done and the people of Swansea have not been reticent about making their feelings known. Indeed, we have been inundated, and I am satisfied that even in this case the time permitted for representations to be made was adequate for my right hon. Friend to judge the strength of local feeling.

My right hon. Friend considered the case put forward by the authority and the representations made. Of the 412 letters the Department received, only one was in support of the decision. Some of the letters included petitions and more than 7,000 names were collected.

Many of the objections we have received concern the greater length of time it will take people from certain areas of the city to reach Morriston instead of Singleton. However, accident and emergency services are best provided at Morriston where there is a wider range of back-up services available than at Singleton. These are to be enhanced in due course by the location of burns and plastic surgery services. This basic policy was, of course, fully endorsed by the previous Administration when they approved plans for Morriston, including the accident and emergency department.

In its submission the health authority has drawn comparisons with other cities and conurbations of similar size to Swansea that have only one accident and emergency department. It quoted Cardiff, Exeter, Wolverhampton, Newport, Wrexham, Oxford and Bristol. I suggest, however, that Swansea is unusual in that its major accident services are located on the outskirts of the city. I apprecitate that there could be difficulties for patients who are not severely injured in reaching Morriston under their own steam.

For the benefit of people who have only minor complaints, there is a strong case for providing a minor casualty unit at Singleton. The authority contends that to provide such a limited service at a major acute hospital is potentially dangerous because many conditions presented at the unit could not be treated because the particular specialties are at Morriston. However, any patient who cannot be treated properly at a minor casualty unit could, if necessary, be transported urgently by ambulance to Morriston.

The concept of a minor casualty unit serviced by general practitioners is well established. Such units are part of the accepted provision in a community hospital, and are also found in other small hospitals in areas that are some distance from major accident services. Indeed, West Glamorgan health authority itself has such units at Gorseinon and Clydach hospitals, and the latter is far closer to Morriston than is Singleton.

The health authority has said that funding the service is not a problem. I am glad that it takes that view, because my Department's funding of the running costs of the Morriston development was based on the premise that a minor casualty service was to be retained at Singleton.

The authority's submission shows that it has not given sufficient and detailed consideration to the feasibility of providing a service run by general practitioners. I note that the local medical committee, which represents general practitioners' interests to the health authority, has said that, although it supports the idea of a minor casualty unit, it should be staffed by consultants—

The Question having been proposed at Ten o'clock and the debate having continued for half an hour, MR. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.