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Health Services (Mid-Glamorgan)

Volume 201: debated on Tuesday 14 January 1992

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. Boswell.]

12.12 am

I express my appreciation for the opportunity to address the House on the important matter of the planning and development of health services in Mid-Glamorgan. Due to time constraints, I must confine my remarks to the Rhondda and Taff-Ely district, served by the East Glamorgan general hospital. That area is covered by my hon. Friends the Members for Pontypridd (Dr. Howells) and for Ogmore (Mr. Powell), and I know that they hope to catch your eye, Mr. Deputy Speaker, a little later in the debate. To enable them to participate, I shall have to be rather cryptic. I hope that the Under-Secretary of State will be able to provide fuller answers in writing if he cannot get in at the end of the debate.

I am very concerned about the level of health service provided for my constituents. In voicing my concerns, I make it abundantly clear at the beginning that there is no criticism from any of us of staff in all sectors of the health service in Mid-Glamorgan. All the staff labour mightily, often in difficult circumstances, to provide health care for my constituents. All my complaints and criticisms arise from points that have been brought to my attention by people who work in the health service.

The catchment area of the district general hospital and of the Rhondda valley is, by any socio-economic indicator, a poor region of Wales and of the United Kingdom. That is not the fault of the people who live there. It is part of our inheritance, as is our radicalism and our peculiar and particular valley culture.

The area is one of high morbidity, demanding an equally high standard of medical input if that morbidity is to be effectively treated. Even after allowing for differences in the age and sex structure of the population, Mid-Glamorgan has a standardised mortality rate 13 per cent. above that for England and Wales as a whole. The rate is higher than in any other county in England and Wales except Cleveland and Durham. Let us consider the childhood morality figures. The infant mortality rate in mid-Glamorgan is 9·4 per cent. higher than the average, whereas in Wales as a whole it is 8 per cent. higher. The perinatal morality rate in Mid-Glamorgan is 10·1 per cent. higher than the average; in Wales as a whole, it is 8·3 per cent. higher.

My first question to the Minister is this: what account is taken of social deprivation factors in calculating the moneys available to Mid-Glamorgan for health care? I understand that social deprivation is not taken into the calculation, and I am absolutely amazed at that. As I understand it, it is taken into account in some English regions. If that is the case, why cannot it be taken into account in the allocation of resources to health authorities in Wales? Social deprivation creates greater health demands, and extra resources are needed if only to introduce some equity into the health care provided across the whole of Wales.

The crucial problem facing us in Mid-Glamorgan is the underfunding of the service, which has culminated in the deterioration of the fabric of the buildings, although successive managements have tried hard to patch them up. The underfunding is also apparent in the waits for new and replacement equipment, and in the fact that consultant staff have to spend much of their time in argument—sometimes quite bitter argument—about equipment priorities.

Underfunding also means that proper staffing levels cannot be reached, and inadequate remuneration is available for those who are employed—particularly ancillary and domestic staff. Highly skilled medical secretaries are paid at levels way below those paid in outside industry.

Competent managers have struggled hard to balance the books to keep departments open but have sometimes failed. The high dependency unit in the district general hospital is a classic example. It has been completed for six months but it cannot be opened because of the lack of staff to operate it.

In the district general hospital, there are insufficient medical beds. I should have thought that, in this day and age, every patient with an acute medical illness ought to have the right to be admitted to a medical bed in a district general hospital. That is often not the case.

There are insufficient cardiac care beds. For a number of years, the health authority has admitted that the coronary care unit, which at present has only four beds, is half the size that it should he according to NHS norms. It is ironic that, in an area with a high incidence of coronary heart disease, many patients cannot be admitted to the specialist high care area to which they deserve to be admitted. My hon. Friend the Member for Pontypridd and I have been most concerned about the admissions policy of the health authority, and I am sure that my hon. Friend will wish to refer to that a little later, Mr. Deputy Speaker.

In Taff Ely and Rhondda, there is a shortage of medical consultant staff. There are almost twice as many medical consultants per head of population in Merthyr and Cynon valley as in Taff Ely and Rhondda. Underfunding has had a devastating effect on the morale of the staff in the service. It has led to the resignation of three of the nine medical consultants appointed to Taff Ely and Rhondda in the past 20 years. The fact that one third of those medical consultants have voted with their feet—something unheard of in other hospitals—clearly indicates the poor working conditions in the area and the demoralisation of the consultant work force. It cannot be said that these are the underpaid members of the health service. These are not problems of the past. The last consultant to resign left work only last week, and it has been disclosed to me that, because of the conditions in which they have to work, others are contemplating leaving.

The resources coming into the area as a whole are inadequate. We all suffer from this problem, but there is additional inequity in Mid-Glamorgan. Health resources are not distributed equitably, and once again the valleys are losing out. I emphasise that this maldistribution must be seen in the context of a total lack of resources. This reinforces my argument for the provision of more resources for the area as a whole. Reasons for the maldistribution have been put forward. For example, it has been said that the area of Bridgend has more representatives on the health authority than other parts of the county have. It is a question either of better lobbiers or of better voters. In any case, it seems to us that the traffic is one way—from the valleys to the south.

With regard to membership of the health authority, all Mid-Glamorgan Members of Parliament are appalled at the Secretary of State's appointment in the past year or so of authority members who do not even live in the authority's area. Those friends of the Tory party and friends of the Minister have not been appointed because of their involvement in the community. That is something that my hon. Friend the Member for Alyn and Deeside (Mr. Jones) will rectify as soon as we win the election, which will be shortly.

The Rhondda valley, which represents one half of the district, is obviously of particular concern to me. My constituents are extremely worried about the delay in the construction of a second community hospital in the lower part of the Rhondda. The Minister was present at the opening of the new community hospital in the upper Rhondda. That is a splendid facility, but the Minister will acknowledge that, with the closure of two older but perfectly adequate hospitals, there has been a decrease in the number of beds. Almost all the beds available in the community hospital are for geriatric or psycho-geriatric patients. There are no extra acute facilities.

If we get a new district general hospital, it will lead to the closure of the Llwynypia hospital in the southern part of the constituency, and the hospital service in the Rhondda will become a geriatric ghetto with no acute facilities at all. My constituents in the top part of the Rhondda will have a 20-mile journey for the most mundane examinations and treatment. Why are maternity services being transferred from Llwynypia hospital? Hospital births are not now possible in the Rhondda. When I have raised the matter, I have been told that there is no demand for those facilities and that the existing facilities are under-used. Yes, they are under-used, but that is because mothers are not encouraged to use them. It is a pretty old trick to run down a facility to such an extent that people do not or cannot use it and then to use that as an excuse for closing it down.

There is no 24-hour accident and emergency service, and out-patient facilities are appalling and cramped. Morale among staff working in such conditions is at an all-time low. I could quote from an unsolicited letter received on 20 December, but shortage of time prevents my doing so. The writer did not want to have his name divulged as he felt that if it were known that he had given the information he would be victimised.

The rundown in services has caused a substantial problem in the Rhondda. Communities such as mine have depended on heavy industry. If we are to keep our population, which is declining, and if we are to keep our young people in modern houses, which are being built in some sectors, they must have the facilities to keep them there. Otherwise, they will leave. The valley communities, with their special culture and special background, will end up empty—like wild west towns which have served their purpose and closed down. I recently visited an old friend with whom I worked in Montana, and I went to him to an old mining town that had been closed. Only two or three people live in the town, whereas about 4,000 people once lived and worked there. I do not want my communities to end up like that. That is why I am anxious that we get facilities back into the Rhondda.

I can remember when bad mistakes were made by the Welsh Office. I am not being political—I do not know when the original decision was made. When it was decided to build the University hospital in Cardiff and the so-called Cardiff plan was introduced, it was decided to have one centre of excellence in south Wales or in the eastern part of south Wales. The valleys were drained of services in Caerphilly, Aberbargoed, Llwynypia and Porth hospitals, to which the miners had contributed out of their own pockets. All the facilities and staff were drained out of Cardiff.

Fortunately, when the Mid-Glamorgan health authority was set up—I sat on the authority when it was set up in 1973—we stopped the Cardiff plan dead. We stopped the closure of those community hospitals. Medical opinion—or bureaucratic opinion. I should say—which runs the health service within our structures has now caught up with us. It now realises that the development of community hospitals is needed in our valleys.

We also have the problem of the district general hospital. By odd coincidence, although it serves primarily the constituencies of my hon. Friend the Member for Pontypridd and myself, it is situated in the constituency of my hon. Friend the Member for Ogmore, who therefore has a very strong vested interest in it.

I wish that the Minister would listen rather than talk to the Government Whip. Perhaps the Whip could leave the Minister alone for a moment so that I could address him. Is the construction of that district general hospital to go ahead? In a private conversation—he will not mind my repeating it—the Minister said, "We have given authority and approval." I went back to the health authority and said, "Why do you not go ahead and build it?" It said, "We have had approval for the design, but we have not had the money approved." I will gladly give way to the Minister. Will he give the assurance that he gave in answer to me during a radio programme as well as in a telephone conversation? Will he say that Mid-Glamorgan can have the money to proceed immediately with the district general hospital?

It is no good the Minister saying that it is up to the health authority. Under the new financial arrangements, it being an item worth more than £4 million capital expenditure, the decision is now to be made by the Welsh Office. The decision does not now lie with the health authority. Will the Minister give the assurance that he gave me, that the health authority can now proceed with the new district general hospital?

I shall do so when I reply.

I thank the Minister. While he is at it, could he also say what size it will be? The Percy Thomas Partnership did a survey on the need for hospital beds in the Rhondda some years ago. It said that, in order to meet health needs, a hospital of 800 beds was required. There is a huge population in that area. I now understand that there is a proposal to construct a hospital of 530 beds. That is just not adequate. It is smaller than the present hospital in Church Village. In 10 years, we shall have the same problems and, as a consequence, the service will operate on a split site.

There is enormous concern about the fact that psychiatric services will not be provided at the new hospital. A consultant has written to me, stating:
"I am writing to you to express my own very deep concern, and that of my colleagues working in psychiatry…that the new District General Hospital planned at Ynys Y Plwm will have no provision for the treatment of psychiatric patients as part of its first phase…The Mid Glamorgan strategy for the development of Mental Health Services has been based on belief in the idea of the devolution of psychiatric services from hospitals which are isolated from other parts of the medical and social services, instead of linking them with the mainstream of these services, as near as possible to the patients' homes…It is particularly ironic that the closure of one psychiatric ghetto, Parc Hospital, in 1993 will now be closely followed by the establishment of another, more so at a time when a new District General Hospital Psychiatric Unit is being built at Bridgend."
Will the Minister give us an assurance that psychiatric services will be included at the new district general hospital? We grew up with our mentally ill friends, families and neighbours being committed to vast institutions which depersonalised them. We moved from that Victorian concept of care for the mentally ill to the point where we look after them in the community on a decent, caring basis. It would be utterly wrong to exclude psychiatric services from the main stream of hospital services. We do not want another psychiatric ghetto in Mid-Glamorgan.

I shall conclude because several of my hon. Friends wish to speak. I plead with the Minister to look carefully at Mid-Glamorgan's case. We need extra money and decisions to be taken soon in the interests of serving the people of that area.

12.31 am

I hope that the Minister will realise that I, too, have a great deal to say, but no time in which to say it. I also hope that he will give us the straight answers that he often has in the past, although we might not have agreed with them.

I should like to amplify a couple of points that have already been made by my hon. Friend the Member for Rhondda (Mr. Rogers). We should like to know whether we are to have a new district general hospital at the Ynys-y-Plwm site, and how large it will be. Is the Minister aware of the concerns that have been expressed to us by consultants, staff, auxiliaries and everyone else who is concerned with health care about what they perceive to be a lack of adequate planned space and facilities at the new hospital? They are afraid that the new facility will be smaller than the existing one and that many of the units, many of which were named by my hon. Friend, will not be adequately replaced in terms of space and facilities at the new hospital.

They are especially worried about the departments of paediatrics and physiotherapy. There is a famous physiotherapy centre at Talygarn, which Mid-Glamorgan health authority proposes to close. We have been told that it will be all right and that "space will be found at the new hospital to replace it". But that is not the perception of those who have seen the plans, who are extremely worried that those important functions will not be catered for in the new hospital. I should like to know whether that will be the case.

The Minister will know that there is a spending crisis at East Glamorgan hospital. The funding crisis involves a current overspend of about £900,000. What will the Minister do to ensure that that does not involve the closure of wards or the non-reopening of certain wards that have been closed for refurbishment? I am sure that he agrees that in an area of social deprivation, such as Mid-Glamorgan, there are great inadequacies in the provision of speech therapy, physiotherapy, and occupational therapy for children. What will be those areas' future health provision under the new hospital provision plans that are being hatched in the Welsh Office and Mid-Glamorgan?

We are talking not simply about community services but about combined services by both hospitals and communities, in just the same way as is required for mental health services under the new legislation. Many of us are worried that ambulance services are greatly stretched in Mid-Glamorgan and especially in the Rhondda and Taff-Ely areas. We are worried that there may be instances in which adequate ambulance cover is not provided.

I ask the Under-Secretary to ensure that never again will an admissions policy such as that operated by Mid-Glamorgan for so long be pursued. The over-70s were treated almost as if they were the walking dead. They did not qualify for the cardiac facilities and treatments offered to people under that arbitrary age. I hope that the Minister has something to say about that.

The staff of Mid-Glamorgan and especially East Glamorgan hospitals are doing a magnificent job. They deserve much better facilities. The fabric of East Glamorgan is falling apart. I hope that the Minister will tell us that we shall get a new hospital.

12.35 am

I shall be brief because of the time factor. We want a response from the Minister to all the questions that have been put to him. We hope to see a hospital established one (lay. It will not be in the lifetime of the Government, because they have only a few months to go. There is no doubt that it will need a Labour Government to establish a hospital in Ynys-y-Plwm to cater for the population in the area, and especially in Taff-Ely, the Rhondda and the part of the Ogmore constituency that stretches to Ynys-y-Plwm.

Promises have been made in the past. My hon. Friend for Rhondda (Mr. Rogers) referred to the Princess of Wales hospital and the facilities in the Bridgend area. It took 25 years of campaigning in that area to establish the hospital in the Bridgend area. The services do not fulfil the promises made by the area health authority when it closed the small hospitals in the Ogwr borough area. The authority said that the Princess of Wales hospital phase I would be developed to replace the services. Indeed, the Minister of State, Welsh Office promised me in 1983 that he would have phase 2 established immediately following the completion of phase I. We are still waiting for phase 2 to be developed in Bridgend. We are well under-provided for in the Bridgend area.

Therefore, it is more necessary now for Ynys-y-Plwm hospital to be established. I eagerly await the Minister's reply, and promises not only from him but from the area health authority. I endorse what my hon. Friends have said about the disturbed condition of hospital services, especially in East Glamorgan. East Glamorgan is in a terrible state of repair, decoration and equipment. The staff are becoming frustrated daily and leaving the service. We cannot afford to allow that to continue.

I would like to speak for much longer, because the hospital will be established in part of my constituency. I hope that the area health authority will read in Hansardthe speeches made tonight and take note of them. I hope that, in future discussions about Ynys-y-Plwm, it will include me among those whom it invites to discuss the problems of some 15,000 to 20,000 of my constituents who will be in the catchment area. I hope that the Minister will have sufficient time to reply to the questions that we have put to him.

12.38 pm

The hon. Member for Ogmore (Mr. Powell) is a little optimistic if he thinks that in four minutes I can reply adequately to the debate. I assure the hon. Gentlemen who have spoken that I will look through everything that they have said and write to them.

I congratulate the hon. Member for Rhondda (Mr. Rogers) on obtaining this debate. It is an achievement to obtain an Adjournment debate. However—the hon. Gentleman knows that I am going to say this—most of the matters that he has raised are for the district health authority. I am sure that the chairman of the authority and his colleagues will look carefully at the remarks made in the debate.

I have visited seven facilities in Mid-Glamorgan during the past year. At five of them, I was opening new facilities; at one I was attending the opening of a new facility by Lord Tonypandy, which was named after him—ysbyty George Thomas. The hon. Member for Rhondda was present when Lord Tonypandy opened that facility. There have been considerable achievements in Mid-Glamorgan during the past year, one of which was the opening of a new regional treatment centre. Mid-Glamorgan now has two of the four centres.

I acknowledge that the Rhondda area is one of great social deprivation. Of the 11 wards, four are in the top five of the index and nine are in the top 50. That has been recognised in our urban programme. We have given £2 million to the Rhondda this year, a higher amount than to any other district in Wales. The health authority has received £16·5 million in total under the programme for the valleys initiative for 17 schemes, one of which was the new community hospital in the Rhondda, ysbyty George Thomas. The know-your-midwife scheme received £120,000 under the programme of my right hon. Friend the Secretary of State for Wales for the valleys initiative. A further £36,000 is being made available during the current financial year to complete the pattern of service in the Rhondda valleys.

The hon. Member for Rhondda mentioned the new formula. It helps health authorities because it weights the population of an area according to the social problems in terms of the age of the population and of ill health. It will be of great importance to the health authority.

The hon. Member for Rhondda asserted that the health authority was underfunded. We are spending about £204 million this year, which is a cash increase of 11·3 per cent. Expenditure in Mid-Glamorgan, after inflation, has risen by 34 per cent. since 1979. During the same period, there has been capital investment of £127 million. I am glad to say that, as a result, activity in Mid-Glamorgan has increased considerably. Between 1974 and 1979, in-patient numbers rose by 9 per cent., and they have risen by 40 per cent. since then. Day case surgery decreased by 29 per cent. under the Labour Government, but since then it has increased by 840 per cent. As for new out-patients, it was minus 2 per cent. during 1974–79; it has increased by 29 per cent. under the Conservative Government. I congratulate the Mid-Glamorgan health authority on its excellent work.

As the hon. Member for Rhondda said, my right hon. Friend the Secretary of State gave approval for a new district general hospital at Ynys-y-Plwm only last April. It will cost about £70 million, and it will have about 529 beds.

It will be a brand new health facility for the Rhondda area by the end of the century, and I believe that it will be the best in Europe. Far from criticism, we can see an excellent record of achievement by the Mid-Glamorgan health authority—new facilities, high expenditure and many improvements in the health service. I am committed, as the Minister who is responsible for health in Wales, to continue that.

I am sorry that I have had only four minutes to reply to the debate. I shall respond in writing to the detailed questions of hon. Members.

Question put and agreed to.

Adjourned accordingly at eighteen minutes to One o'clock.