I wish to raise tonight the question of the closing of the sanatorium at Longriggend, in my constituency. As far back as 6th May this year, I put a Question to the Secretary of State for Scotland. It was answered by the Joint Under-Secretary of State, who I understand, is to reply to this debate. On that occasion, he told the House:
When the necessary local consultations have been completed, my right hon. Friend hopes to make a comprehensive statement on the SU bject."—[OFFICIAL REPORT, 6th May, 1958; Vol. 587, c. 1007.]
This is now 26th November, over six months since we were promised a comprehensive statement by the Secretary of State. During those six months, the right hon. Gentleman has been completely silent, but decisions have been taken in this matter without its ever coming before the House.
I wrote to the Secretary of State on 10th October. I had a reply from him on 13th November. I was writing particularly about this sanatorium at Longriegend and in that reply he told me that the decision was taken on 31st October to close the sanatorium. I consider that the Secretary of State has been completely unfair to this House. I am not the only Member who has been concerned about this matter, and there were other hon. Members who were anxious that the Secretary of State should have their views before any irrevocable decision was taken.
On 6th May, the Joint Under-Secretary said that some of the hospitals that were no longer being used for tuberculosis—and we are all very glad that they are no longer needed for tuberculosis patients—would be used for other purposes and that others would be put on a care and maintenance basis. The only conclusion that one could draw from the statement that some of them would be put on a care and maintenance basis was that the Government were trying to save money. To me, that is completely indefensible in the matter of health.
The Government, however, have gone further. The Secretary of State's letter to me on 13th November said that the intention of the Western Regional Hospital Board was, not to put this hospital on a care and maintenance basis, but to get rid of it altogether. In his letter, the Secretary of State said that
sometimes the right thing to do with an empty hospital is to close it and use the resources so freed for necessary developments at other hospitals.
These necessary developments will, however, take time and during the period from the closing of the hospital until those necessary developments have taken place, many people who ought to be in hospital will be denied accommodation in hospital. It is for that reason that I have raised this matter on the Adjournment.
Only last year, the Western Regional Hospital Board spent £1,000 on the hospital's kitchen. Now, in the following year, it is decided to close the hospital. The nursing staff of 13 may be used elsewhere, but there are 17 other staff, including domestic workers, gardeners, boiler men and a part-time secretary. These people, I am almost certain, will not be used in any hospital. They live in an area where unemployment is exceedingly high. These manpower resources, therefore, will not be used.
I could think of many uses for this hospital, which has 52 beds, but tonight I shall deal with only two. Can the Joint Under-Secretary deny that there is a waiting list for hospital accommodation for mental defectives in Scotland? Of course not. I have a letter from the Secretary of State dated 14th August, which he sent to me during the Recess in answer to a supplementary question of mine. He was referring to Birkwood Institution, Lesmahagow, and, at the end of his letter, he said:
In view of the great need for additional beds, I am asking the regional board to consider whether there are any special measures they can take to assist the institution to obtain the staff needed to enable these empty beds to be brought into use.
The Secretary of State's own words were "the great need for additional beds."
I turn to the latest Report from his own Department of Health. On page 43 we find, in paragraph 160, these words:
With the accommodation at present available"—
that is, accommodation for mental defectives—
as the above figures suggest, only very slow progress can be made in reducing the existing waiting lists for admission to mental deficiency institutions.
Only very slow progress can be made, and, of course, the waiting lists are very great. If the whole story were known in Scotland it would really be a public scandal. The Joint Under-Secretary of State knows that as well as I do.
The hon. Gentleman also knows that not only are many of these children who should be in institutions suffering because they are not having that treatment, but that many parents are heartbroken, and other children, normal children at home, are suffering considerably. It seems to me that while we are waiting for the schemes, and, I think, good schemes, of having these children attached to bigger hospitals, and the suggestions which have been made by various committees, we ought not to have let any chance slip of at least getting another 52 of these children placed in hospital accommodation. This institution would have given 52 children and 52 homes great help. The Government have decided otherwise.
I turn now to the second category, our old people. I ask the Under-Secretary again: can he say that there is no single waiting list for hospital accommodation among our old people? Again, I say to him that he just cannot say that there is no single waiting list. I shall quote again from the Report of his own Department. It is important to read it, because I do not think that the Joint Under-Secretary or the Secretary of State really know, If they did know, they would not have acquiesced in the proposal of the Western Regional Hospital Board to close this institution.
This is what we are told in paragraphs 151 and 152:
As was shown in last year's Report, the percentage of admissions of persons over 60 years of age rose steadily"—
in the mental hospitals—
from 24·5 per cent. in 1930 to 45·4 per cent. in 1955.
That is a very steep increase.
It is not uncommon for an old person's acute phase of confusion to settle down quite quickly and many elderly patients are discharged after a short time in hospital.
Is it not scandalous that these old people should be taken from their homes and, because there is not accommodation in general hospitals, made to suffer the stigma of having been in a mental hospital? Because there is still a stigma attached to the inmate, or patient, as we say today, of a mental hospital. They go there, the phase passes, and they are ready to go home, and the stigma still sticks to them or their family. The Report goes on:
More than half of the certified patients over 65 years of age discharged from hospital in 1956 had been in hospital for less than six months and three out of every five for less than a year.
I find the next paragraph even more telling:
In 1956, however, about 2,000 patients…died in mental hospitals, of whom 70 per cent. were over 65 years of age. As the proportion of patients who are old is high relative to the proportion in the general population, this percentage is not in itself of special significance.
But it is the following words that are important:
Some concern may, however, be felt at the number of elderly patients dying within a very short time of reaching hospital. Some at least of the old patients dying within a few days of reaching a mental hospital need not have been sent there at all if alternative accommodation with suitable care had been available.
That is what the Secretary of State for Scotland tells us and Scotland.
The Report continues:
Similarly, so long as there is no such alternative, mental hospitals will require to care for a number of those old people who recover from their initial confusion, and who do not need, or no longer need, to be there.
What a tragedy. What a picture. Old people taken from their homes with all the stigma for their families and, within a few days. dying in a mental institution.
Again, though old people recover after being taken there, they are left in the mental institution until they die because they have nowhere else to go. That is a tragic picture of which none of us in Scotland can be proud. So long as these conditions obtain and there is such a crying need for accommodation, particularly for children in mental institutions and for the care of old people outside mental institutions, there is no case at all for the Western Regional Hospital Board deciding to close this hospital.
Longriggend hospital lies between two villages in which there will be no difficulty in finding the help needed to take care of old people. The town of Airdrie is also close at hand. Whether it is decided to use the accommodation for old people or for mental defectives, parents, relatives and friends would not be involved in long journeys to see either class of patient. A good bus service passes the hospital gates. I plead with the Joint Under-Secretary to reverse his decision. The staff is still there. Let him use the hospital for one of the two purposes which I have suggested.
I follow my hon. Friend the Member for Lanarkshire, North (Miss Herbison) only on one point, on account of shortage of time, but I have sat on these benches to await the debate because I feel so strongly about the Government's slowness in the use they are making at the moment of the empty sanatoria beds in Scotland. We were told, and I think that there are figures to prove it, that when the new techniques for the treatment and diagnosis of tuberculosis were put into operation, sanatoria beds would be left empty. We know that there is a great number now empty in Scotland. Those in Longriggden are one example.
My hon. Friend asked whether there was a waiting list for the acommodation of old people in Scotland. There are waiting lists in Glasgow and in many other industrial towns so large as to be disgraceful. It may not always be an official list, but the old people are there and there is no place to put them. This is particularly disgraceful today in view of the fact that with the great advances in the science of geriatrics there is some hope for these people when they go into hospital. Hospitals for the chronic sick are no longer what they used to be—places where old people took to bed for a long time before they were gathered to their fathers. These hospitals need not be a last port of call. These people can be rehabilitated and put into the stream of life again. But that can be done only if the basic number of beds is sufficient to give a sufficiently quick turnover.
It has been estimated by an expert on geriatrics that the average stay in hospital by the patient who can benefit from rehabilitation treatment is about 50 days; and that the average life of the patient who does not respond to this treatment is about three years. So, if the turnover is not quick enough—and it cannot be if the beds are insufficient—then these longterm beds tend to "pile up" with the result that those who could benefit by the treatment given cannot obtain a bed. This is a fact; it is not any sort of propaganda.
In the big industrial cities, such as Glasgow, there is something amounting to a scandal. There we have old people in lodging houses, and other completely unsuitable accommodation, who cannot get a bed in hospitals because the Government has been so dilatory in utilising these sanatoria beds.
I am grateful to the hon. Lady the Member for Lanarkshire, North (Miss Herbison) for having raised this question tonight, because, among other things, Longriggend is not an isolated case; but it is typical of the problems which have arisen, strangely enough, from the success in our fight against tuberculosis. Longriggend is a small, fairly isolated sanatorium of 52 beds to the north east of Airdrie, which closed on 31st October. After a very full and careful review of hospital needs by the Western Regional Hospital Board, it is now proposed that it should be sold.
Earlier this year, the Board concluded that this hospital could be closed, but before coming to a final decision, they consulted the Board of Management for Coatbridge, Airdrie and District Hospitals, who are responsible for the day to day management of this hospital; the Executive Council, and the Local Medical Committee for the County of Lanarkshire; the Lanarkshire County Council, and the Town Councils of Coat-bridge and Airdrie. None of these bodies raised any opposition to the closure of this hospital, although the Town Council of Airdrie suggested that its use for geriatric patients might be considered.
The Regional Board then gave most careful consideration to the other uses to which the hospital might be put, and the two main purposes, which have also been suggested tonight, are geriatric and mentally deficient cases. But the Regional Board is entirely satisfied that the hospital is not suitable for either of these purposes. I agree with the concern which the hon. Lady the Member for Kelvin-grove (Mrs. McAlister) has expressed, but it is not desirable to treat old people—geriatric patients—in separate small hospitals such as that at Longriggend. They should be treated in units which form part of, or are closely associated with, general hospitals in which specialist staff, active medical treatment, and facilities for rehabilitation are available. The staff needs also a variation in the type of patients.
I appreciate that; but the one thing which we do not need is a hospital where old people feel that they are only going there to die; that is one of the dangers of using a small, and rather isolated hospital. But the Board of Management is now considering the possibility of using geriatric beds which are no longer needed for tuberculosis patients in Coathill Hospital, and also at Lightburn Hospital.
I did not mention the word "geriatric" because we do want these old people, I agree, in larger hospitals. The people I am concerned about, and for whom this hospital could be used, are those old people—and particularly old, confused people—who are going into mental institutions.
For the reasons which I have given, the management committee looked at that, and decided that it could not be used for such a purpose.
So far as mental patients are concerned, the Committee on Mental Deficiency in Scotland reported in 1957. It recommended that institutional accommodation for mentally deficient patients should not be provided in small units. It recommended relatively large units comprised of not too large ward blocks or individual villas. Only large units permit the proper classification of patients and the best use of occupational and training facilities and the best use of staff.
The hon. Lady, quite properly, mentioned staff. When I give her the details I think that she will realise how properly the hospital authorities have treated the matter. At the date of closure there were 32 of a staff, of whom seven are still employed on care and maintenance. The staff knew what was in mind well in advance of the official decision, and they were informed immediately the decision was made.
Those wishing to continue in hospital employment were offered jobs either at Coathill Hospital, where there is an increase in geriatric beds and a further increase is pending, or at Bellshill where the building of the new nurses' home has already permitted a substantial increase in the number of maternity beds.
One or two of the trained nurses have obtained hospital employment in other areas, and some members of the staff have found jobs outside the hospital. I agree that it is of the utmost importance that the staff displaced in this way should have the maximum notice and consideration and should feel not only that the decision affecting them was taken after the most careful and exhaustive examination, but also that the change will enable them to make better use of their skills and of their devotion to the service of the sick.
I would like to look, as the hon. Lady has looked, at Longriggend, in the perspective of the national problem. The mass radiography campaign has been successful beyond our wildest dreams, though it is too early yet to assess the final results. We know already that the campaign, with the help of new and powerful drugs, is substantially reducing the number of T.B. sufferers in Scotland. The number of beds needed is steadily declining in spite of the large temporary increase in patients due to the mass X-ray campaign.
We have quite a number of small isolated hospitals originally built to meet the needs of many years ago. Now, with the development of medicine and the potentiality of regional planning, which were not available many years ago, these hospitals are no longer suitable and no longer essential for the best health service in the area.
The hon. Lady said that my right hon. Friend should not have authorised the closure of this hospital before he had made his general announcement. Of course, the Adjournment debate has rather overtaken events. My right hon. Friend will now be in a position to make his statement quite soon. I agree that there has been a rather long delay, but this has been an important matter. In fact, we told the Regional Hospital Board before a thought was raised about a formal announcement by my right hon. Friend that we were in general agreement about the closure of Longriggend, subject, of course, to the further fullest investigation with all concerned.
My right hon. Friend will make a statement quite soon about the actual T.B. hospitals concerning whose future the regional hospital boards have already made recommendations to him. There are others, of course, still under consideration, and this consideration must be a continuing process as the demand for T.B. beds falls still further and the pattern of the nation's health needs changes.
Two years ago the number of occupied T.B. beds was 4,290. At the end of last June it was 3,280, but the number of staffed T.B. beds is not 3,280, it is 4,700, and we are well aware of the urgency of clearing the waiting list and making the best use of these beds.
The regional hospital boards are now transferring large numbers of these surplus beds to old people. I agree with the hon. Lady that we cannot rely indefinitely on the mental hospitals, although I hope that in the public opinion, which I know she will try to foster, the stigma of the mental hospital will gradually fade away. These beds will be transferred to old people, the chronic sick, convalescents and mental defectives. Eighty additional beds were recently provided for mental defectives in the hon. Lady's region. Within this wide and encouraging trend we must leave it to the regional hospital boards, after consideration with all concerned, to look critically at the small hospitals.
The hon. Gentleman says that we must leave it to the hospital boards. Is not the Health Service in Scotland the responsibility of the Secretary of State? The hon. Gentleman has given many figures about tuberculosis tonight which were well known to us. Our concern is the long waiting list. He has said nothing which changes our opinion that this ought to be used until such time as he can safely say there is no waiting list. In these two categories he has not answered at all.
I have told the hon. Lady how the surplus beds are to be used. I had hoped I had convinced her that because a bed is surplus it is not necessarily the best thing to do to use it immediately for a short time for a purpose for which clearly it is unsuitable. The duty of a hospital board is to look at the clinical needs of the area, the finance available and the other resources in the area.
It is no good the hon. Lady saying, "Hear, hear." The boards' duty is to match the best possible treatment for the patients with the best use not only of the money, but, also, and even more important, the staff available to them. If, after consideration of all the factors involved, a regional hospital board decides to alter the use of a small hospital or put it on a care and maintenance basis, or close it, that board will have the full support of my right hon. Friend. As the hon. Lady well knows, we are not simply trying to save money. As I have said, the best use of our existing resources will only be possible if in this case—and there will be others—we are prepared to recognise that sometimes in the interests of the health of the people of Scotland the right thing to do with an empty hospital is to close it and use the resources for necessary development of other hospitals where they can do most good.
I am well aware of the fact that the decision to close a small hospital in any area must give rise to a great deal of heart burning. Many of these hospitals have been in existence a very long time, but we must be realists. We are extending facilities of many hospitals. Many hospitals have been upgraded, and we are relying more and more on modern treatments and modern methods requiring modern skills. We have satisfied ourselves, after the utmost scrutiny and after careful examination with all concerned that the hospital can be closed down or put on to care and maintenance without detriment to the health of the patients.
Having listened with the greatest care to the Joint Under-Secretary, I shall leave this building tonight convinced that he is letting this waiting list remain and that these categories of people for which my hon. Friend the Member for Lanarkshire. North (Miss Herbison) pleaded will be unprovided for just for the sake of saving a little money.
The hon. Gentleman stressed that the regional hospital boards were doing the best they could within the finance available to them. That is obviously the limiting factor which the boards have had to take into account in deciding to close accommodation while the waiting lists for accommodation referred to by my hon. Friend remain. That is a positive disgrace in Scotland at present and is quite out of keeping with what the Department of Health has said in the Report from which my hon. Friend quoted. I am very sorry indeed that the Joint Under-Secretary has felt obliged to make the kind of speech he has made to the House tonight.