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Singleton Hospital, Swansea

Volume 204: debated on Friday 21 February 1992

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

3.2 pm

I am sorry that I have had to ask the Minister of State to come here for this debate today. We last personally debated the subject together about seven years ago and we are now here to debate the proposal by West Glamorgan health authority to withdraw funding for the night casualty service at Singleton hospital.

It is a sad example of the determination of a quango to ignore the wishes of the people it is supposed to serve. As early as a decade ago, with no consultation, the predecessor of that quango closed the casualty unit completely. I campaigned to get it opened and, with the support of the then Secretary of State, it was reopened. But, even then, the authority defied the Secretary of State and refused to open at night. I then had to campaign again and, with the help of the then Secretary of State, we forced it to operate a night service.

Ever since the unit was reopened, that health authority has been determined to undermine it. From the moment it reopened it said that it would not allow casualty cases the use of the X-ray facilities or the X-ray staff in Singleton hospital, although those are under-utilised at present.

More importantly, the health authority has issued a ruling that is intended to kill the casualty unit—not just the night unit but the day unit. It has said that ambulances are not allowed to take patients, at any time of day or night, to Singleton unless it is a life-threatening case.

The authority has been manoeuvring for three years to get to this stage and it is within a week of the final consideration of its proposal to close the night unit. It is an example of the fanaticism and malevolence of certain individuals in that authority that the chief executive said, in a recent interview:
"No matter how much money the Government gives us, Singleton's casualty service will be a low priority."
Despite 30,000 signatures on a petition presented by the people of West Glamorgan to keep the unit open, that is the attitude of an unelected, unanswerable, self-opinionated bunch of Welsh Office placemen.

I wish to expose the cynical deception that underlies the case. The health authority's case is that it has to save £74,000, and that that is the only way to do so. Two of the people whom the authority has recently appointed to implement the Government's health reforms have salaries totalling £69,000. As those health reforms will lapse after the election, that money will be available immediately. However, that might be deemed to be a political point. Even the £74,000 figure is fraudulent because the unit general manager, David Williams, said that he is willing to provide the unit for £50,000, but the health authority has ignored the offer. In fact, Singleton makes £60,000 in income from its casualty unit.

The saving that the authority wants to make could be more than achieved if only it would lift its ludicrous ruling on the use of ambulances. I have figures from the authority showing that it costs £17 for an ambulance to take somebody from the Singleton area the 9·5 miles to Morriston, with the ambulance then returning to its depot. If we take it that the true saving that it needs to make is £50,000, it need only cut the number of return journeys by ambulance four times a day—that is, one journey every six hours. If it wanted to save that money, it would scrap the rule on ambulances.

I know that I have the Minister's support on that because he was kind enough to say so. On 14 November 1985, he agreed with the view of everyone in west Swansea, including the staff of Singleton hospital, that if Singleton is the nearest casualty unit, casualties should be taken there first. He said that
"any patient who cannot be treated properly at a minor casualty unit could, if necessary, be transported urgently by ambulance to Morriston."—[Official Report, 14 November 1985; Vol. 86, c. 785.]
He accepted that the logic was to take those patients to the nearest hospital first and, if the cases were severe, then take them to Morriston. I know that the right hon. Gentleman will underline that statement even more firmly today because, since he made it, two major units—the children's unit and the maternity unit—have moved from Morriston to Singleton, so the case is even stronger.

The deception is beyond all that. The authority tried to delude people with the idea that there would be massive provision of additional cataract operations when the casualty unit closed. When I met the chief executive, he spoke of hundreds. The Minister knows my habit of looking at figures and taking them apart. I did that with the figures from the health authority and found that the hundreds became 70 and, if the true amount needed to be saved were £50,000, the hundreds become fewer than 50.

So embarrassed is the authority and its chief executive by the exposure of that cruel con trick, that it has now started adding hip operations. It is nonsense. The Minister knows Swansea. Recently. a ship sank off Mumbles head. The ambulances drove straight past the entrance to Singleton hospital and went on for another 9·5 miles to Morriston, although every one of those patients could have been dealt with at Singleton. A fortnight ago, a school bus crashed into a nurses' home at the rear of Singleton hospital, yet 38 children were taken not to Singleton but the 9·5 miles to Morriston. They could have had immediate treatment at Singleton.

Under the ruling, eye cases, spontaneous abortions, accidents to children and so on, if they are dealt with by ambulance, have to go to Morriston then be brought back to Singleton at a return cost of £34 each trip. The Minister knows how difficult it can be for people. He said that he appreciated that there would be difficulties for patients who had not been severely injured to get to Morriston under their own steam. Bus services have now been severely curtailed.

I have support for my campaign from all the local councils and local Members—my hon. Friends the Member for Gower (Mr. Wardell), for Swansea, East (Mr. Anderson) and for Neath (Mr. Hain), Swansea city council, Clwyd Valley council, Neath borough council, Port Talbot borough council and West Glamorgan county council. The health authority ignored a petition of more than 30,000 on the ground that the signatures had been collected before it had spelt out its option on cataract operations.

Support for the health authority consists of 16 organisations, an bunch of eight slave committees and employees, plus Powys and Dyfed county councils. Heaven knows what they are doing in this consultation. Incidentally, the health authority is so desperate that it has even asked Gwynedd county council if it thought that the Swansea casualty unit should be closed at night. That is the degree of desperation. It can get no significant support for its campaign.

Public opinion is overwhelming. I again thank the Minister for his support when we last debated the matter and, on the basis on a petition of 7,000, he said:
"I can assure … 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."—[Official Report, 14 November 1985; Vol. 86, c. 782.]
In the past 12 months I have presented a petition of 30,000 signatures and next week I will present a new petition collected since the option was spelt out, which will consist of more than 40,000 signatures—one third of the electorate of the Gower and Swansea, West constituencies combined.

Evening Post opinion polls showed, before the options were spelt out, 4:1 in favour of keeping the night unit open, and on 29 January, since the options were spelt out, more than 26:1 in favour of keeping the night unit open.Where is the citizens charter? Or is there a special clause in it excluding West Glamorgan? The West Glamorgan health authority dedicated a whole edition of its in-house magazine to telling its employees about the requirements of the citizens charter. Unfortunately, it itself seemed to neglect to read that particular edition.

The people of west Swansea and Gower are disgusted at the health authority's suggestion that from 1 April 1993 the unit, if it is to continue, should be financed by "novel" means. What an attitude to a casualty unit for a city of that size. I urge the Secretary of State, as I did in a letter, for pity's sake, sack this wretched health authority before it does more harm to the people of west Swansea and Gower. Next week I shall present the petition to the Secretary of State and at the end of the week the consultation period will be over. The Welsh Office has already spent two years considering the case for closure. There is no reason for further consideration. It knows the arguments. All it needs to do now is count the heads.

After the petition has been presented we expect the Secretary of State to give us a decision before the general election—no messing about, no fudging. We want to know where the Welsh Office stands. The people of Gower and west Swansea will well understand if, after two years of consideration, the Secretary of State cannot announce his decision before the general election: it will be because he is afraid to tell them what he intends to do with the casualty unit.

3.13 pm

Although I fully realise the importance of these proposals to the right hon. Member for Swansea, West (Mr. Williams) and his constituents, I must make it clear that as the one-month period for representations to be made to my right hon. Friend the Secretary of State has begun, it would be wholly inappropriate for me to make any substantial comments on this matter. The right hon. Gentleman is well aware of that.

I can assure all those who have submitted comments on the health authority's proposals for the minor casualty unit at Singleton that their views will be fully considered before my right hon. Friend reaches his decision on this matter. I would also urge all those who wish to comment on the proposal, but have not yet done so, to submit their views to my Department before the one-month period for objections ends on 28 February.

It would be helpful, I am sure, if I briefly set out the type of service that the minor casualty unit provides, as I believe that there has been some misunderstanding about this. The minor casualty unit at Singleton hospital is very much a minor casualty unit offering a service that, in many ways, is comparable with that found in good GP surgeries or health centres. The unit does not have the back-up services that would normally be expected at a major accident and emergency department, such as Morriston hospital, where all such services are available.

The provision of a minor casualty unit at Singleton and the services to be provided by such a unit has, as the right hon. Member for Swansea, West emphasised, been the subject of considerable local debate in recent years. He and I debated the matter in November 1985. To assess the unit's possible future role and contribution, my Department reviewed it in May 1990. The review acknowledged that the unit was providing an important and useful daytime service to the public.

Owing to the very limited use made of the night-time service—I shall touch on this matter again later—the review questioned the need for such a service, while recognising that the decision on whether to maintain the service was one for the local health authority. The review was carried out purely to inform debate on the future of the service. At that time, neither the health authority nor my right hon. Friend had made any decisions on the issue. I can assure the right hon. Member and those who are concerned about the proposal that my right hon. Friend has an open mind about the future of the unit. Indeed, as I said earlier, he will consider in full all representations made to him on this matter before making any decision on the authority's proposals.

I believe that it is important not to lose sight of what the health authority is proposing for the unit. Under its proposals the unit would continue to provide a basic service between 8 am and 11 pm at night—that is, it would continue to provide a service to local people for 15 hours a day. Neither the existing day service nor emergency admission arrangements at the hospital would be affected by the proposals, so the proposal is limited to the service provided after 11 pm and before 8 am.

The authority's view is that the withdrawal of the night-time minor casualty service at Singleton would not have an adverse impact on the population of the area. The authority has pointed out that on average only four people attend the unit between the hours of 11 pm and 8 am, and that the full accident and emergency services available at either Morriston or Neath hospitals would provide a more than satisfactory alternative service.

How does the Minister reconcile that with what he said in 1985? He said:

"I appreciate that there could be difficulties for patients who are not severely injured in reaching Morriston under their own steam."—[Official Report 14 November 1985; Vol. 86, c. 786.]
The Minister applied that to the whole 24-hour period. It is even more relevant after 8 pm.

What I said in 1985 is, I am sure, still relevant to the position today, although of course one has to take into account whatever changes may have taken place. However, I explained to the right hon. Gentleman that I could make no substantial comment during this debate while the consultation period is still open. I do not think that he will interpret my reply to his intervention as being other than a contribution to the material that my right hon. Friend the Secretary of State will consider.

The authority believes that the funds used to purchase the night service could be put to better use. It has proposed that the savings should be used to improve the health status of the elderly population in West Glamorgan by dealing with the increasing number of elderly people waiting for cataract operations.

Although the procedures for cataract operations are not too complex, the impact that those operations can have on the quality of life of those who require such treatment should not be underestimated. I understand that the authority has forecast that the funds freed by these proposals would enable it to perform more than 70 additional cataract operations a year.

Whether the authority is right and the changes proposed in the provision of health care will lead to an acceptable service is a matter which my right hon. Friend will consider when reaching a decision on the proposals. I assure the right hon. Gentleman that his points will be carefully considered before any decision is taken.

It may help if I put this minor casualty unit in proper perspective and say something in defence of West Glamorgan health authority. Since 1979, the authority has increased its front-line staff—its doctors and nurses—by nearly 36 per cent., a rise of more than one third. That has enabled it to boost in-patient and day case activity by 60 per cent. over the period, with a dramatic 273 per cent. rise for day cases alone.

In 1991–92, the authority is forecasting an increase of nearly 2 per cent. in in-patient and day case admissions, with a rise of more than 15 per cent. in day case treatment alone. That significant increase in activity has allowed it to forecast that, by the end of March, no one in the county should have to wait more than one month for urgent treatment or more than two years for non-urgent care. Looking ahead to 1992–93, the authority's provisional health plan signals a 7·5 per cent. increase in new out-patient attendances and a 6 per cent. rise in in-patient and day case admissions—a rise of more than 4,700 cases compared with the projected outturn for the present year. That is a splendid record by any yardstick and the health authority should be congratulated on it.

Before the Minister concludes his apologia on behalf of the health authority, does he agree that it is absurd that it is costing £74,000 to keep the unit underused, whereas the authority would save more money, and therefore be able to do more cataract operations, if it changed the ambulance rule in line with the Minister's suggestion in the 1985 debate?

As I told the right hon. Gentleman, each point will be carefully considered by my right hon. Friend the Secretary of State, including the point that he has just made.

For those who are not familiar with it, it may help if I outline the details of the procedures that must be followed before a substantial change in the use of health buildings can be made.

Responsibility for the detailed planning of health services and for local consultation on the plans rests, in the first instance, with district health authorities. In developing their plans, authorities are required to have in mind the need to make the most efficient use of their available resources, bearing in mind the changing needs of patients. Ultimate ownership of all health authority buildings is normally vested in my right hon. Friend the Secretary of State.

Any proposals for permanent closure or change of use can and do have a significant impact on the local community. Special arrangements have, therefore, been designed to ensure that the public and all local interests are fully consulted. In addition, when there is any objection to the way in which services are to be developed, the procedure is that my right hon. Friend is required to decide on the proposals in full knowledge of any objections.

Guidance is given to health authorities in health service planning paper No. 5 entitled "Procedure for Consultation on the Closure and Change for Use of Health Buildings". That has been replaced by the guidance issued last summer, although the proposals for the Singleton minor casualty service were subject to consultation before the new guidance was issued.

The procedure being followed in this case can be summarised as follows: the health authority should first prepare a consultation document spelling out the reasons why changes are necesary, the implications for patients, such as travelling and transport; the options that have been considered and the arguments put forward in favour of them. The relationship between the closure or change of use and other developments in the district's plans should also be drawn out.

A three-month period of consultation is the next stage, with comments invited from community health councils, local authorities, joint staff consultative committees and other local interests. The health authority should then reconsider the proposed closure or change of use in the light of the comments received. Should the proposal meet with local agreement, and be in accordance with guidelines from the Welsh Office, the health authority may proceed with the closure or change of use without further ado.

If the result is either resolute opposition or a locally agreed conclusion that differs substantially from the original proposals, the authority is required to refer the matter with its recommendations and an outline of the alternative arrangements to my right hon. Friend.

So that members of the public who oppose the proposals may have an oppportunity to make their views known before a final decision is taken by the Secretary of State, a further period of one month is allowed and publicly announced. That is the position that we have reached.

West Glamorgan health authority has implemented this guidance as follows: comments on the proposals were invited in June 1991, with the closing date for comments being 9 September 1991. The authority's proposals on the future of the night-time minor casualty service at Singleton, together with copies of all representations received, were submitted to my right hon. Friend under cover of a letter dated 7 February 1992.

In presenting its proposals, the authority recognised that there was some local support for a continued 24-hour minor casualty service. As a result, the authority decided to continue to fund the service until 1 April 1993 while, at the same time, asking the local community to identify ways of maintaining the night-time service after that date. We are now receiving representations made in responce to the one-month period announced in the public notice on 31 January 1992. All these representations will be fully considered before the final decision is made.

Will the Minister of State avoid giving the slightly erroneous impression that the first that the Secretary of State heard of this was in February? Will he confirm that the details contained in that submission in February under a covering letter are exactly the same as those of which the Welsh Office has been aware for many months and which have been under discussion and exploration by his officials for many months? All he needs to know now is the magnitude and scale of the opposition to the proposals before making his decision.

As I said at the beginning, and as the right hon. Gentleman said, we are both aware that this problem has been around for some years. We are dealing with a different aspect from that with which we dealt in November 1985, but, essentially, the problems revolve around the casualty unit at Singleton. I also said that we tried to ensure that anyone who had not made representations and who wished to do so now had an opportunity to do so in the final month before my right hon. Friend comes to a decision.

Once my right hon. Friend has reached a conclusion on the health authority's proposals, a letter giving his decision and the reasons for it will be sent to the health authority. Copies of the letter will be sent to other people or bodies who have expressed an interest in the matter, including the right hon. Gentleman, and the decisions will be publicised by means of a press release. Once again, I assure the right hon. Gentleman and all those who have made representations to my right hon. Friend that he will give this matter the fullest possible consideration before he comes to his decision.

Question put and agreed to.

Adjourned accordingly at half-past Three o'clock.