As the hon. and gallant Member for Roxburgh, Selkirk and Peebles (Cammander Donaldson) said, this is not a party political matter. Particularly is this true, as we now see that the Conservatives have accepted planning. As Mr. Mark Arnold Foster said in the Observer yesterday, planning is no longer a dirty word in the Tory vocabulary. It must be obvious to all hon. Members that planning is especially essential for hospitals, when it takes so long from the moment of their conception to the moment when they are built and ready for use
I congratulate the Government on their Hospital Plan, and I hope that they will pay careful attention to my remarks, because in the many years that I expect to remain in the House I do not suppose that the occasions upon which I shall feel able to congratulate the Tories will be numerous.
The first question we must ask ourselves about the hospital programme is whether it is large enough. We have already heard that, some years ago, the British Medical Association said that we should be spending £75 million a year on our hospital building. That compares with the £50 million a year spread over the 'ten years of this programme. This takes into account the 90 new hospitals which it is proposed to build, the 134 Which are to be modernised, and the several hundred schemes of a smaller size.
If this could be achieved with the sums which are now earmarked, in fifteen years' time our hospitals should be very much superior to those that are in use today. No one can argue about that. But there is a very important question to which we must know the answer before we can say what likelihood there is of the plan's being fulfilled. We need to know whether the estimates are being calculated in terms of January, 1962, pounds or in money terms. It is important to know this, because otherwise the expenditure in the second quinquennium might be no larger than that in the first quinquennium. As this is such a vital point I hope that we shall have an answer from the Minister.
We must also bear in mind the fact that the plan has been hedged round with all sorts of qualifications. I believe it was the hon. Member for Abertillery (Mr. Ll. Williams) who referred to paragraph 46 of the White Paper, which outlines the restrictions. It refers to the possible factors which may inhibit the success of the plan, and, remembering what happened to the capital expenditure programmes of local authorities towards the end of last year, as part of the measures to meet the economic crisis, we may be forgiven for thinking that the remarks contained in paragraph 46 may be in the form of an apology for the non-fulfilment of the plan even before its first stage has been executed.
But let us assume that we succeed in building new hospitals and in modernising others. Several hon. Members have asked the very important question of where the staff to run these new hospitals is to come from. It has been pointed out that this subject is dismissed in one paragraph of the White Paper, although it is perhaps the most important feature of the lot. The Willink Committee estimated that 350 doctors were emigrating to the Commonwealth every year. Indeed, Dr. J. Seale, in a letter to the Guardian on 23rd January, put the figure at 500. Nobody has bothered to collect accurate statistics, and there is still room for disagreement. But all the authorities agree that this rate of emigration cannot be tolerated. This is mainly because of the miscalculations of the Willink Committee, which have now been generally admitted. It is known that we have not been training enough doctors to meet the increase in population and the growing demand of the hospitals.
If this is true of doctors it is even more true of the nursing staff. Here the problem has been aggravated by the very high wastage rates which have occurred in recent months, and which have been referred to in two recent debates. This morning I received a letter from the matron of a hospital, telling me about a nurse who had emigrated to Australia and who had written to her from there telling her that on the boat in which she travelled to Australia there were no less than forty trained nurses. I do not know whether that was coincidental, but if forty trained nurses are leaving on every boat to Australia it is clear that we are dealing with a problem of some size.
The Minister knows that the situation can be corrected only by offering the nursing profession pay and conditions which will stand the test of comparison with other occupations open to young men and women of intelligence. Yet he has refused to listen to the unanimous advice offered by the Royal College of Nursing, the Royal College of Midwives, the Confederation of Health Service Employees, N.A.L.G.O. and hon. Members from all three parties.
I now turn to a feature of the plan which must be examined with the
greatest scepticism. I refer to paragraphs 31 to 44 of the White Paper, under the general heading of "Care in the Community". The hon. Member for St. Pancras, North (Mr. K. Robinson), in referring to this section of the White Paper, said that it was full of pious hopes and unwarranted assumptions. I do not know whether paragraph 31 is a pious hope or an unwarranted assumption when it says:
the aim will be to provide care at home and in the community for all who do not require the special types of diagnosis and treatment which only a hospital can provide.
That is all very weld, but can it be done? The Medical World Newsletter of March, 1962, says:
The Local Authorities can produce schemes on paper to deal with these new domiciliary services, but who is to pay for them and who is to staff them?
Paragraph 37 of the White Paper refers to the number of health visitors, home nurses and home helps and says:
The numbers may be expected to increase further: the national figures are made up of local figures which show wide variations, and nowhere have the services yet attained their full development. As they expand both generally and in particular localities, the hospital provision forecast in the plan will require review.
What specific grounds are there for believing that these services can be expanded? I ask this question particularly because it is fundamental to the success of the Hospital Plan and also because it seems to conflict with the letter that I received from the Parliamentary Secretary, dated 15th May, in which she said:
Demands on the home help service in Kent are increasing but the availability of work in light industries in the area has reduced considerably the number of suitable women willing to work as home helps. The Council have as a result had to reduce the service provided for a number of people … often in the face of a real need for it.
I am sorry that the hon. Lady is not here at the moment. I wrote to her and told her that I would refer to this letter.
There is an obvious case for transferring some of the health functions of local authorities either to regional hospital boards or to a new regional health board which would be responsible both for the hospitals and for some of the local authority aspects of personal health.
There are three arguments. First, the home help is concerned primarily with keeping people out of hospital in the first place and with helping them to stay out once they have been released. Secondly, the services which home helps provide would be financed by taxation and no: through the rates, which are becoming very burdensome. If the regional boards were responsible for services such as home helps, there would be every incentive for them to provide an adequate service, because any amount of home help is still cheaper than hospitalisation. Local authorities have not this incentive, because if someone has to go into hospital in the end, the money comes out of another pocket, as it were. Thirdly, if the services were under unified control, there could be an improvement in co-ordination.
I had a letter from a well-known doctor about lack of co-ordination among the three elements of the structure of health service, and he pointed out to me that it often militates against the best interests of the patient who, after all, is the most important person in this discussion. I gave an example in speaking about home helps, but the same remarks apply with equal force to such matters as Part III accommodation and inoculation. There is room for much greater integration between the various aspects of the health service, and this must be considered if the Hospital Plan is to succeed.
At the risk of being accused of being parochial. I want to refer to some details of the plan as it affects my constituency. 'We are told that the old hutted unit at Sidcup is to be replaced by a new district general hospital, which will include a new major accident centre and will cover the whole of the Sidcup and Orpington district. Does this mean that casualties which occur on the A.21, which is an extremely dangerous road, must be taken all the way to Sidcup for treatment? If so, it seems to be a retrograde step.
The White Paper says that the ultimate closure of Orpington Hospital is envisaged as a result of schemes starting after 1970–71 but that it will still be in existence in 1975, with a reduced number of beds. That is all very well, unless it serves as an excuse for doing nothing about Orpington Hospital which, like the old St. Mary's, is an old hutted unit built in the First World War and totally unsuited to modern thought. A hospital such as this must be much more expensive to run than a properly planned modern unit. To take one example, the heating costs much be very much greater than those of a correctly insulated building.
Next, where is it intended that we should put the 234 geriatric beds, which at present arc in Orpington Hospital, once the hospital is closed? If these patients are to be accommodated in the new district hospital in Sidcup, it will be very much more difficult for friends and relatives to visit them. This is not a problem which is particular to Orpington, because several hon. Members have raised it with reference to their constituencies, but it is a matter which needs the closest attention. The same comment would be true about acute cases, but I infer from the White Paper that once Orpington Hospital is closed, these would be accommodated in Farnborough Hospital, although that fact is not specifically stated.
In conclusion, I say that the plan is some improvement on anything which we have had before, although that would hardly be difficult considering the very low priority which has been given to spending on hospitals ever since the war. I express the hope that the reservations to which I referred at the beginning of my speech will turn out to have been unnecessary and that over the years we shall build hospitals of which we can be justly proud.