I am glad to have the opportunity of raising today the question of the future of St. Teresa's Maternity Hospital, which is situated in my constituency of Wimbledon. I am fortunate that the matter has come up at this stage today, because we have a little more time than is normally available for such an Adjournment debate which will enable more to be said than would ordinarily be possible in a debate of this kind.
For 20 years past the South-West Metropolitan Regional Hospital Board has had a contract with St. Teresa's Maternity Hospital whereby the Board pays for 40 beds which are thereby made available for National Health Service patients. Recently the Board has given notice to bring that contractual arrangement to an end at the end of the present calendar year. This has caused the greatest possible concern and indignation in the area which is served by this greatly esteemed and much loved hospital.
The proposal for the termination of this contract arises from the fact that there is to be a new maternity wing at Queen Mary's Hospital, Roehampton, which is a branch of Westminster Hospital, and in that new wing at Roehampton Hospital, which I understand is to open in January next, there will be 50 maternity beds. It is claimed by the Board and by the Minister that those 50 beds, which is a net addition of only 10 beds in the area, will make it possible for all mothers who can reasonably expect to have their babies in hospital in the area to be accommodated in the maternity beds that will then be available.
In 25 years of public life in my constituency, I cannot recall any matter that has arisen which has produced the same intensity of feeling and widespread indignation as has been aroused by this proposal for the withdrawal of National Health support from St. Teresa's Hospital. On a recent Sunday afternoon, a meeting was arranged in the Wimbledon Theatre at which this matter was discussed. Most hon. Members are familiar with the difficulties today of attracting large public audiences at any time in any circumstances. Most hon. Members with any experience of organising meetings will know that a Sunday afternoon is generally the least propitious time for such an exercise. On this occasion, about 2,000 people were present at the meeting in the Wimbledon Theatre. They unanimously expressed their indignation and concern at this proposal of the Hospital Board.
A committee which has been organised to undertake the protection of the interests of this hospital has organised a petition for which signatures have been gathered in the area. I am told that up to the present 45,000 signatures have been attracted in what is, after all, a comparatively limited area.
My colleagues in adjoining constituencies whose constituents are also affected by this decision have, along with me, received scores, and in some cases hundreds, of letters from indignant constituents. Lobbying of Members of the House, of the Hospital Board, and of the Ministry, has been undertaken on a scale that must be almost unprecedented. Such has been the interest in what ordinarily might be regarded as only a local matter that not only the local Press but the national Press and T.V. have devoted a very large amount of time to reporting on this particular matter. Virtually without exception the action of the Regional Hospital Board and the Minister has come under severe condemnation.
If they are fortunate enough to catch your eye, Mr. Deputy Speaker, there are several of my colleagues from adjoining constituencies who want to say something about this matter on behalf of their constituents. I think that the hon. Member for Putney (Mr. Hugh Jenkins), whose Division is also much concerned, has expressed at any rate a degree of sympathy with what we are seeking to do. I am only sorry that he is not able apparently to be with us this morning to add his plea to those which my fellow Members and I wish to address to the Parliamentary Secretary.
I want to say a few words about some of the sources from which protests have come. The Wandsworth Borough Council, through its Health Committee—I probably do not need to remind hon. Members that this is a Socialist-controlled local authority—has passed a resolution condemning the action of the Board and the support given to that action by the Minister.
The Merton Borough Council, at its Health Committee, recently passed the following resolution:
That the Minister of Health be informed that the Council considers that there is already a local shortage of beds for maternity cases in the Borough.
That it is understood that this view is fully shared by the Local Medical Committee.
That the withdrawal of National Health Service support from St. Teresa's Hospital can only further aggravate the local shortage of maternity beds.
And that accordingly the Minister be asked to reconsider his support of the decision of the Regional Hospital Board to terminate on 1st January, 1968, the Board's present contractual arrangements with St. Teresa's for the provision of National Health Service maternity beds, and to arrange for the maternity service presently provided at the Hospital to be continued at least until the end of 1969.
I would like to pray in aid a useful statement on this matter from a source which will, I am sure, not be called into question by any hon. Member opposite. It is a resolution passed by the Merton and District Trades Council which says:
In spite of the intention to build a 50-bed maternity unit at Roehampton, we strongly urge the Minister of Health to reconsider his decision to discontinue sending National Health patients to St. Teresa's Maternity Hospital, Wimbledon.
We feel that, in view of the fine record of service this Hospital has rendered over the past 25 years, also the fact that the new unit at Roehampton will not satisfy the demand on the maternity service, the Minister of Health should continue supporting St. Teresa's and inform the management promptly.
The Regional Hospital Board and the Minister have found no support in the
area affected by the decision which has been taken. I am certain that I am not over-stating the case when I say that if a referendum could be taken locally on the continuation of National Health support for this hospital it would be carried in favour of continued support by at least 10 to 1.
There are three questions to which we must seek the answer in reaching the right conclusion on the facts of this case. I shall mention them and discuss them in turn. The first is: Is St. Teresa's efficient and satisfactory as a maternity hospital? The answer is, "Yes", and there is no doubt about it.
In a Press statement which was issued by the Regional Board it was stated:
Over the years, St. Teresa's has provided a very satisfactory maternity service for those patients admitted there.
In this House, and in letters, the Minister has expressed his agreement with that view. One of the great things to be claimed in favour of the hospital is that it has virtually never been short of nursing staff, which is a great advantage and a very exceptional state of affairs is an age when there is such a chronic shortage of nursing staff in many hospitals throughout the country.
Most of the nursing is undertaken by the nuns who run the hospital, and no one can speak too highly of the devoted service of these dedicated women. It is interesting to note that over a period of about 20 years there have been 19,000 confinements in the hospital, and not one single mother has been lost. I am advised that there is only one other hospital in the country with a comparable record, and, perhaps fittingly, it is the Churchill Hospital at Oxford. At the beginning of the period with which I am dealing, 20 years ago, I am advised that about one mother was lost per 1,000 confinements.
There has been a tremendous and welcome improvement in the figures over 20 years, and the national average is now about one mother lost per 3,500 confinements. At a rough estimate, if the average figure for the loss of mothers per 1,000 confinements for the country as a whole had applied in the case of St. Teresa's over the past 20 years, there would have been about 10 mothers lost on the 19,000 confinements. It is a remarkable fact that not one mother has been lost during the period. I do not know if the Parliamentary Secretary can give us the statistics at Westminster Hospital, which will be in charge of Queen Mary's Hospital, Roehampton, but my understanding, and I will be glad to be corrected, is that at Westminster Hospital, over five years, there have been 2,500 confinements and three mothers have been lost.
There could be no question that St. Teresa's is eminently efficient and satisfactory. The second question is: is there any saving of public money effected by giving up National Health Service beds at St. Teresa's? If it could be argued that there was a substantial gain in public expenditure by the new arrangements, that would be an argument to be weighed against the arguments in favour of continuing the present arrangements. The answer to the question must be that there is no public saving, quite the reverse.
In reply to recent Questions put to him by my right hon. Friend the Member for Kingston-upon-Thames (Mr. Boyd-Carpenter) and myself, the Minister admitted—we had some difficulty in extracting the information from him—that the cost per bed per day at St. Teresa's to the Regional Hospital Board was £4 12s. 11d. He said that the cost per bed per day at Roehampton was £6. One has experience of estimates with regard to future expenditure, and they have usually proved to be on the low side. If we accept the figure of £6 per bed, there must be some very good reason, of which I am unaware, for giving up a satisfactory service costing the Exchequer £4 12s. 11d. and substituting for it a service which at present is of unproved merit, and which is estimated to cost £6 per bed per day.
The Minister was not very fair or forthcoming in dealing with this matter in the short exchange that some of us had with him on 13th March. He tried to use a financial computation with which most people are entirely unfamiliar when applied to the Hospital Service. He tried to build up a case for saying that the cost of maternity beds ought to be based on the cost per case and not the cost per day or per week. All the statistical information that I have been able to find with reference to the costing of hospital service is always calculated on the cost per bed per day or week. It is difficult to see any other method of presenting reliable or relevant statistics.
The Minister said on 13th March that the cost per case at St. Teresa's was £57 4s. 8d. compared with £49 8s. 10d. in the case of the South-West Metropolitan hospitals providing full medical and surgical services. In reply to my right hon. Friend the Member for Kingston-upon-Thames, who asked if the figures were based upon a stay of equal duration, the Minister replied:
No, Sir. The average length of stay at St. Teresa's is 12 days, compared with nine days in the other hospitals."—[OFFICIAL REPORT, 13th March, 1967; Vol. 743, c. 26.]
I do not claim to be a statistician, but I would have thought that it was a fundamental statistical rule that where one makes comparisons one compares like with like. If one does not do so the comparison has no use or relevance. All that the Minister is saying in his effort to show that there is no additional public cost involved in his proposals is that he will make up what he will lose by the extra charge per bed per day at Roehampton by hustling out the patients more quickly following the confinement than has been the case at St. Teresa's.
As that fact becomes to be understood by prospective mothers it will arouse an increasing dislike for the Minister's decision and repugnance for the manner in which he proposes to save money at the cost of the interest and the well-being of those who go into hospital. No case can be made, on any proper examination of the figures, to lead one other than to the conclusion that a more economical method of providing maternity beds is being given up and that a more expensive method is being substituted for it.
My third question is this. If 40 National Health Service beds at St. Teresa's are replaced by 50 beds at Roehampton, will there be a sufficiency of maternity beds in the area? The Minister's answer is "Yes", but the answer of everybody connected with the hospital and medical service in the area is an emphatic "No", as I shall show. At St. Teresa's and other maternity hospitals in the area patients are, in normal cases, being sent home after six or seven days, which, in the view of most authorities, is too short an average period after a confinement. Such is the pressure on beds that some mothers are being hustled out of maternity beds 48 hours following confinement.
As recently as June of last year the St. Helier Hospital Group sent a circular to doctors practising in the area informing them that certain categories of cases would no longer necessarily get beds in the area. One such category specifically mentioned is that of a first confinement when the mother is between 18 and 25 years of age. Speaking as a layman, that would seem to be the kind of case that should have a very high priority for a maternity bed. This is certainly the view of competent medical men with whom I have discussed the matter.
In support of the proposition that the substitution of 50 beds at Roehampton for 40 at St. Teresa's will still leave a considerable shortage of beds in the area, I cite a letter from the Maternity Liaison Committee of the St. Helier Hospital Group, which stated that even when a new unit was opened in January at Queen Mary's Hospital, Roehampton, the Group would still be under considerable pressure for beds. Dr. Doody, Medical Officer of Health for the London Borough of Merton, who is a member of the Maternity Liaison Committee, has said that he is concerned about any maternity unit in his area being closed to National Health patients. The question of the Roehampton Unit did not matter, Dr. Doody has pointed out, because
Some hospitals in the area have to send patients home after 48 hours. This will still be so when the new unit is opened. This is permitted, indeed encouraged, by the Ministry of Health, but I believe the practice is bad. Maternity patients should be kept in at least eight days and, ideally, ten.
I have said enough to make it clear that all informed local opinion—and these people have, after all, long experience of working in the maternity service in the area—is persuaded that even with the addition of 50 new beds at Roehampton, there is still a need for the 40 beds at St. Teresa's if the reasonable requirements of mothers in the district are to be adequately served.
I must comment on the Minister's alternative proposal for the use of these beds at St. Teresa's if he ceases to pay for them under contract for maternity cases. The right hon. Gentleman has made a proposal to the St. Teresa's Management Committee that the Regional Board would be willing to negotiate a contract for these beds for geriatric cases, something that seems to me and others with whom I have discussed the matter as an entirely unacceptable proposal and one which I do not believe the Management Committee would contemplate in any circumstances.
There are two main objections to this course. The first is that St. Teresa's is equipped, with an experienced staff, for maternity work. For more than 20 years they have built up an unparalleled reputation in this sphere. To have, say, the ground floor of a comparatively small hospital occupied by geriatric cases—for which the building was not constructed, is not equipped and does not possess the right facilities—and to have the upper floors occupied by maternity cases is something that one cannot contemplate. After all, there would be the inevitable noise that must come from crying babies. Even the advances of medical science have not found a satisfactory method of preventing babies crying on certain occasions. It seems to the doctors and hospital experts with whom I have discussed this matter that this is an entirely unthinkable and inappropriate alternative for the 40 beds at St. Teresa's.
I do not want to spend time discussing what I would call the ideological view underlying the action of the Board and the Minister. It is only too obvious. What the Minister is doing in this case seems to be based on entirely contrary reasoning to the reasoning applied to fee paying schools. In that case the Government say that it is unfair that these should be reserved wholly for fee paying parents and that, therefore, local authorities should take a number of places, at public expense, to be occupied by the children of parents in general.
In this case, however, instead of the most admirable and sensible arrangement whereby half the beds in St. Teresa's are paid for by the patients who use them and the other half paid for by the Board and the Minister, the right hon. Gentleman is saying, "I am now going to take away from people who cannot themselves pay hospital fees any right to benefit from the services of this admittedly superlatively efficient hospital and leave all the beds in future for the privileged minority of people who can afford to pay for them. This is an inversion of the philosophy that is generally applied, and it is utterly inconsistent with what is sought to be done in respect of schools and other social services.
I beg the Minister to regard this as a human problem in which the health and happiness of thousands of mothers are involved in the years ahead. This is not a statistical exercise. If hon. Members would read the pathetic letters I have received from mothers who have been patients in this hospital, begging me to persuade the Minister to change his mind, they could not fail to be moved by their earnestness and sincerity.
St. Teresa's is an efficient, economical and necessary hospital, and the ending of the grant has no local support. The Regional Hospital Board, aided and abetted by the Minister, is engaged in nothing more nor less than the murder of a hospital. I beg the Minister to think again on this matter because if he proceeds with this project he will not be forgiven.
There has been some informal indication in the last few days that further consideration has been given to this matter. I very much hope that that is so; and that the Parliamentary Secretary will have good news to give us this morning. For that reason, and in that hope, I shall speak with more restraint than my feelings impel me to do in view of a decision which, if allowed to stand, seems to me to be the worst decision that has been made since the inception of the National Health Service.
I do not want to impale either the Parliamentary Secretary or the Minister of Health any further on the hook: I am only anxious to help them both off it. I very much hope that the hon. Gentleman who has shown in many respects great good sense in many matters of this kind, will himself be able to secure reconsideration of a matter which has, as my hon. Friend the Member for Wimbledon (Sir C. Black) has so well said, aroused local opinion in the areas which he and I and many of my hon. Friends represent more sharply than has any issue for many years past.
I beg the Parliamentary Secretary to understand the feeling that has been aroused. I have personally had more letters on this subject than on any I recall in 20 years membership of the House. I have had an immense mail—detailed, precise, bearing none of those indications of organisation which hon. Members have experienced and which they very easily detect. They have all been quite obviously spontaneous, and more than one have been from women who have written to say that they believe that the attention they got from the hospital saved the life of the child if not of the mother herself.
It is an issue of no party political significance, but one on which people of all political views in the area are unanimous in simply asking the Parliamentary Secretary, his right hon. Friend the Minister and the Regional Board, by whatever expedient they like, to get themselves off the hook and continue arrangements under which the National Health Service supports this hospital as a maternity hospital by paying a certain amount in respect of beds.
I should like to follow up one or two of the points made by my hon. Friend in what I thought was an immensely cogent speech. First of all, there is the cost factor. I put a supplementary question to the Minister of Health on 20th March last. I asked him:
As his own Answer to me … indicated that his alternative method of providing these beds was some 30 per cent. more expensive to the taxpayer, will he not reconsider the matter?
The right hon. Gentleman replied:
No, Sir; I do not accept that the alternative provision will be 30 per cent. more expensive to the taxpayer …"—[OFFICIAL REPORT, 20th March, 1967; Vol. 743, c. 1030.]
The figures on which I based my supplementary question are the right hon. Gentleman's own: £4 12s. 11d.—there is a rather curious precision about that figure—paid to St. Teresa's under the present arrangement, and about £6 at Roehampton; in both cases per bed per day.
Without relying on the point my hon. Friend very wisely made that it is one's general experience, as perhaps the Parliamentary Secretary will know, that particularly with new hospitals costs are higher rather than lower than expected, accepting the Minister's figures, it may be that my mathematics on my legs erred marginally, but I still make the difference between £4 12s. 11d. and £6 to be nearly 30 per cent.—perhaps 28½ per cent. At all events, it is a very substantial difference, and I would be obliged if the Parliamentary Secretary would explain why his right hon. Friend contradicted me when I made that assertion. The figures are there. It is purely a matter of fairly simple calculation. If I am wrong, will the hon. Gentleman tell me his right hon. Friend's view of the difference in cost?
I do not rely by any manner of means solely on these financial figures. This is such a good hospital that even if the financial arguments were the other way it would still be reasonable to retain it; but it certainly makes a more powerful case against change. If public opinion is to be affronted, if the public who actually are being served are to get what they think will be a less good service and, as an outcome of it all, the taxpayer is to pay more, it really seems to be the reductio ad absurdum of administration.
I come to the reasons which the Regional Board itself has given for this proposition. The right hon. Gentleman the Minister was courteous enough, when I corresponded with him, to send me a copy of the Press statement which the Board put out. Following immediately on the passage that my hon. Friend read out:
Over the years St. Teresa's has provided a very satisfactory maternity service for those patients admitted there
the statement goes on:
It is however the duty of the Board to provide its own maternity service, where possible in district general hospitals or Teaching Hospitals providing a district function. This policy was set out in the Minister's Building Plan and there will be a progressive reduction of contractual arrangements as the programme unfolds.
Whether this is right, whether this centralisation of hospital facilities in those hospitals that are the Board's own is right or wrong, could be argued at length. I know that there are many of us who feel that basically it is the wrong approach; and that if a voluntary hospital is satisfactory there is something to be said for variety, for alternatives,
for choice for National Health Service patients.
With respect, however, this point does not arise at this stage. No one knows better than does the Parliamentary Secretary how inadequate are the hospital facilities generally in this area. I think that he has visited Kingston Hospital. If he has, he knows the kind of urgent work in many directions in respect of many services that is simply awaiting financial approval from his right hon. Friend. It is really the biggest nonsense in the world, if a maternity service is properly provided already in a voluntary hospital, to set up the Board's hospital as an alternative, even if it were as good, when there are large numbers of other directions in which services are inadequate and to which I would suggest priority should be given in the allocation of resources. If a voluntary hospital already adequately serves an area, why replace it with the Board's hospital when the Board itself knows as well as anyone in how many other directions modernisation and extension work is required on its existing hospitals? I particularly stress that a very short time ago I saw the work required on Kingston Hospital.
There are really two points on which it seems that the Board's argument falls down. First, there is the curious proposition that everything should be bureaucratised into the Board's hospitals, and that there should be taken away from what are admittedly efficient hospitals the National Health Service support and patients. On this general issue I should like to argue at some length on an appropriate occasion. The second point is this. Even if the Board and the right hon. Gentleman are right about this proposition, it is not sense at this moment to go out of the way to replace satisfactory externally operated services by the Board's services before the Board has applied the resources which the right hon. Gentleman gives it to provision of what is so much lacking and where rebuilding and modernisation are already so much needed. These should have prior claims because the citizen is not getting the service either from the Board or from outside.
This would be an argument, if the Board and the Minister are in a conciliatory mood, for a change of view. It would be perfectly reasonable for the Board to say that it would prefer to apply its resources in other directions, and for the time being there would be St. Teresa's in operation doing the job which it has been doing so well for a number of years. I hope that the hon. Gentleman will grasp the opportunity which the situation offers him. I beg him to understand the violence of public reaction to this proposal.
Many of us thought from the beginning—some of us were here to say it at the time—that it was a pity to set up the hospital regional board system divorced from local authorities and divorced from local opinion. Surely the fact that a regional board is dependent solely on the Minister and has no constitutional dependence on other local organisations or local people demands that it should be the more cautious in not affronting public opinion. This is what in this case the Regional Board has done by this decision.
My hon. Friend did not exaggerate—if anything, I think he under-stated—the reaction in the whole area which this hospital serves. It cannot make sense for a regional board, because it is not responsible to local opinion or organisations but has to live and work with them, to affront local opinion in this way and go flat in the face of local opinion. There is so much that local voluntary organisations and locally-elected authorities can do to help a hospital board if there is co-operation with organisations such as "Friends of the Hospitals". Surely a regional hospital board, anxious to do a good job, would go a long way and would lean over backwards to carry public opinion with it.
This issue is the crunch in the relationship between the South-West Metropolitan Hospital Board and opinion in a large part of the area which it is supposed to serve. I do not want to rake over old sores, but the Parliamentary Secretary knows as well as I do that this Hospital Board has not had a happy history. The appointment of its present chairman was very much criticised as a political appointment. I had hoped that this was wearing down and that the Board and local opinion were beginning to live with each other. If the Board could show generosity—I do not ask that it should admit that it is wrong but that its action is premature—it could go along with local opinion which would help it in the job it has to do and would help the Minister.
We are in a democracy, and public bodies, whether directly dependent on public election or not, are right to pay attention to public opinion. They are doing their job foolishly if unnecessarily they defy public opinion. The Parliamentary Secretary has had some experience, not unsuccessful experience, of constituency work and dealing with public opinion. I ask him, if it be necessary, to use his own influence to persuade the Board, whatever its view of the precise merits of this particular proposal and whether or not they are contrary to what seems to himself to be right, that it should recognise that it will do the hospital service in this area much harm if it persists in a step which the overwhelming majority of opinion in the area regards as wantonly wrong.
I express regret that I was not here at the beginning of this debate to hear the whole of the speech of the hon. Member for Wimbledon (Sir C. Black). I had assumed that he would be rising about midday and I arranged my morning accordingly and had hastily to readjust it. I am sorry for that.
I did not agree altogether with what I heard of the speech of the hon. Member. Neither do I go the whole of the way with the right hon. Member for Kingston-upon-Thames (Mr. Boyd-Carpenter). I do, however, think that there ought to be found room for a compromise here. I think it possible that such a solution might be found. Indeed, and here again I agree with the right hon. Member for Kingston-upon-Thames, this whole situation would probably not have occurred if the regional hospital board were itself responsible to an electorate. I think that this can be adduced as an argument for something which many of us on both sides of the House feel it is time we moved in the direction of, the establishment of responsible regional government—
Appointed boards are no substitute for government responsible to an electorate. Regional hospital boards are not the only appointed boards which as soon as possible should be made responsible to election. I shall not press this point further, because if I did so I should be out of order, but we badly need the establishment of an effective form of regional government between national and local government, and this is an example.
We are in a position in which the board has firmly established its view and my right hon. Friend the Minister has firmly established his view. It is unreasonable to suppose that the Government will move back on their policy decision in the matter because the Government's view is a general one, and it would be unfruitful to ask the Government to change their mind on their whole attitude. Obviously, it would be quite impracticable to pursue that line.
What, however, I think, would be a practicable line to follow would be to ask the chairman of the regional hospital board, not to look at the principle of the matter again, but to look at its practical application in this case.
I am glad to say that Lord Addison has agreed to receive a deputation which I shall be taking to him consisting entirely of members of the women's section of the Putney Labour Party. That cannot be accused of having a political bias, against Government policy in this respect.
The right hon. Member says that it does not necessarily follow, but he will have noticed that I used the words, "in this respect".
In this respect at any rate, whatever may be the case in other respects, this group will be found when the discussion takes place not to be wishing in any way to say that the Government's broad and general policy is wrong. That is not the line which it will take. What it will say is that whoever is right and whoever is wrong in this matter depends to some degree on a series of estimates, a series of estimates on the need in the area, whether the facilities at Roehampton will be ready when the time comes, and upon a number of other factors which are largely imponderable.
One cannot say what the exact compromise may be, but I think it likely, because the group have already ascertained opinion, that it will press on the chairman the view that there ought to be some deferment here and that the Ministry should continue to utilise the facilities of St. Teresa's for a sufficient time, concurrently with the new facilities, until it is discovered whether the forecasts are correct and whether the facilities offered at the new hospital, excellent as I am sure they will be, will succeed in filling the need now filled by St. Teresa's.
I hope that my hon. Friend the Parliamentary Secretary will agree that this is a way in which a solution to this impasse might be found. Such an answer would give us time to discover who is right and who is wrong in this case. I hope that not only will the chairman and the Board see eye to eye with us on this, but that perhaps the Parliamentary Secretary will say that he would not frown upon such a compromise outcome.
My hon. Friend the Member for Wimbledon (Sir C. Black) said that this was in no way a party matter and the speech of the hon. Member for Putney (Mr. Hugh Jenkins) demonstrated that there is no difference between the two sides of the House on this very important issue. I was glad to hear his suggestion to the Minister and to have his support in what we seek to do, which is to cause the whole matter to be reconsidered. My hon. Friend the Member for Wimbledon covered the ground so well that I do not propose to detain the House for more than a few moments.
My constituency neighbours that of my hon. Friend, and many of my constituents have been patients in St. Teresa's Hospital. I wholly confirm what my hon. Friend said about the amount of local feeling aroused by the Regional Hospital Board's decision. I too have received many letters and have been approached by many people who know the hospital and are dismayed by the Board's decision to withdraw its contractual arrangements with it.
My first point concerns shortage of beds. I do not know whether the Parliamentary Secretary will try to prove to us that the replacement of 40 National Health Service beds in St. Teresa's by 50 in Queen Mary's at Roehampton will solve the maternity bed shortage in our district. I have grave doubts about that, because the average length of stay in the National Health Service hospitals in our area for mothers who go in for confinements is well below that recommended by the Minister. Even if the Parliamentary Secretary thinks that he can show that the replacement of 40 beds at St. Teresa's by 50 at Roehampton will solve the problem, will he consider that by the Board's action, whatever else happens, it is deliberately depriving the National Health Service of 40 hospital beds?
I do not believe that the Parliamentary Secretary could claim that the National Health Service as a whole has enough beds. I think that it was said on behalf of the Government in another place only about six weeks ago that there is a queue of about 529,000 people waiting for hospital beds. I admit that they are not maternity beds, but it is clear that this is not the moment to give up any hospital beds. Nevertheless, that is what the Board's proposal appears to do. I ask the Parliamentary Secretary to take that into account when deciding what should be done in the matter.
My other point relates to the question of cost. As both my hon. Friend the Member for Wimbledon and my right hon. Friend the Member for Kingston-upon-Thames (Mr Boyd-Carpenter) said, the replacement beds will be more expensive. Some of us view with a certain amount of suspicion the estimate of the cost of the beds at Roehampton, because it was also said in another place during a debate on these matters that the cost of a bed in a teaching hospital is £103 a week in London and £76 a week in the country.
The estimate the Parliamentary Secretary has produced for the cost of a bed in the hospital at Roehampton, which will be a teaching hospital, is £42 a week—much lower than the cost of beds anywhere else. I am not challenging flue figure, for he may be absolutely right, and I hope that he is, but he will understand if we view it with some suspicion. It is only an estimate, and the cost of £4 12s. 11d. per day for St. Teresa's is not an estimate but the actual cost.
Those two points should be taken into account by the Minister, and I hope that in view of all that has been said today, and the interest which this matter has aroused in my constituency and the neighbouring constituencies, he will undertake this morning that the matter will be reconsidered.
I am also glad to have the opportunity to speak and follow my right hon. and hon. Friends and the hon. Member for Putney (Mr. Hugh Jenkins) on this important issue, which affects so many of our constituents. The strange decision which affects so many of our constituents, taken by the Regional Hospital Board, supported by both the Minister and the Parliamentary Secretary, has puzzled many local people, not only in the constituency of my hon. Friend the Member for Wimbledon (Sir C. Black), but in others divisions. That has been made clear this morning.
The details of the case against the withdrawal of the maternity beds from St. Teresa's have been skillfully put by my hon. Friend the Member for Wimbledon, who has been ably backed up by my right hon. Friend the Member for Kingston-upon-Thames (Mr. Boyd-Carpenter), my hon. Friend the Member for Merton and Morden (Mr. Atkins) and the hon. Member for Putney, all of whom, like me, have seen an outburst of indignation in our constituencies over the past few weeks.
While the hospital of St. Teresa's is not in my constituency, large numbers of patients are drawn from my area, and I have had some of the largest number of letters I have ever received during the seven years I have been privileged to represent Richmond at Westminster. The extent of local indignation is underlined by the fact that in most of the lobbies that are built up on any public issue the letters sent to Members are quite often stereotyped; we know that an organisation behind the lobby is operating, though perhaps not skilfully enough, to convince Members of Parliament.
But I confirm that in this case the type of letter received is that from constituents who are obviously, judging from the letters' tone and the way they are written, very concerned and emotionally involved, perhaps because of past experiences of the hospital, where members of their family have been well looked after. They feel so strongly that they have decided to write.
That was confirmed by the incredible demonstration, including dozens of small children, which livened up the Central Lobby here recently, when people came to lobby their Members. The reaction of the national Press, which has also been mentioned, has underlined the extent of the very real local indignation.
I do not wish to speak at great length, as my hon. Friend the Member for Wimbledon has already very ably covered the case, and every point that should be made has been made. But I wish to back him up on one or two points that he has put forward. We have heard that a St. Teresa's Maternity Hospital Action Committee delegation went to see the Hospital Board recently to suggest an alternative. The Board's behaviour was rather strange. I have received a letter from the leader of the Committee, who wrote:
At this meeting it was suggested by our delegation that the special committee at present reviewing the maternity services of S.W. London could consider the possibility of retaining the services of St. Teresa's, and converting maternity beds in some other general hospital in the area to some other purpose for which there was a shortage, …
The point was made by my hon. Friend the Member for Wimbledon that St. Teresa's was a purpose built maternity hospital. To switch the ground floor to geriatric cases, mixing both geriatric and maternity cases in the same building could be very damaging. There is no need for me to detail that.
The Action Committee went on to say this:
It was felt that this would be cheaper than converting a purpose built maternity hospital, and would be a temporary solution and a compromise which would meet the Board's point that they can only allocate a certain proportion of their funds to maternity beds. At the same time it would allow the Board to provide a better maternity service than they will do by using beds in some very dilapidated and dirty old hospitals.
The Board officials said that they would look into this suggestion and refer it to the special committee. The meeting then came to an end.
The Board have since stated that such a reference can have no effect on their decision to terminate the St. Teresa's contract. This amounts to a unilateral withdrawal of a promise made and received in good faith.
The Action Committee is very upset by the Board's attitude. I should be grateful if the Parliamentary Secretary would comment on this.
All the points made by right hon. and hon. Members on both sides this morning boil down to three main issues. Why has this action been taken? Has it been taken for financial reasons? Has it been taken because St. Teresa's provides a very bad service? Has it been taken because there is a much better alternative elsewhere or a cheaper alternative elsewhere?
If the answers to all these questions could be, "Yes", it might be possible to make out some sort of case for taking the decision which the Board has taken. However, right hon. and hon. Members on both sides have made a strong case for showing that none of these points is true, that there are no good financial reasons for taking this action, that St. Teresa's provides an extraordinary good service, that there is no better alternative elsewhere, and that there is no cheaper alternative elsewhere. All the answers to these questions are in the negative. Surely these reasons alone are sufficient to justify the Minister's suggesting to the Board that it should reconsider its decision.
I support the comment made by my right hon. and hon. Friends regarding the bureaucratic reasons for this decision. In reply to a supplementary question asked by me, the Minister said this on 13th March:
If the hon. Gentleman has cost in mind, then nothing would be more extravagant or in my view, unreasonable than for the National Health Service to spend something like £70,000 a year subsidising maternity beds in a private hospital for which there is no longer a National Health Service need.
In reply to the hon. Member for Putney, the Minister said this:
I know that this hospital has provided good service to the regional board, but the fact is that there will no longer be any need for the contractual use of these beds after the end of this year. It has been the policy of successive Ministers—and it is my policy—that maternity units should, wherever possible, form an integral part of a district general hospital. This is in the interests of the safety of mothers and babies."—[OFFICIAL REPORT, 13th March, 1967; Vol. 742, c. 27.]
I find this an incredible reply. The Minister's answers make it plain that the only reason for doing this is that he considers that all beds should, if possible, be within the National Health Service ambit and that, even if a hospital which is outside it is providing a better service or a service as good as that provided by the National Health Service, still these beds must be closed and moved into a National Health Service hospital, for what are apparently purely bureaucratic reasons. Both sides of the House this morning have expressed their discontent and concern about this attitude.
At that time I maintained, and I still maintain, that this attitude was inhumane. I said that—and I continued to say it—because so far there has been no sign that the Government are prepared to reconsider their attitude. The letter which I have read shows that the Board is not prepared to reconsider its decision or take into account the local protests which are being made.
The Minister has refused to receive a deputation or listen to the case it wishes to make. In view of the widespread concern and real worry caused by the decision, the least the Minister should do is to agree to receive the deputation and undertake that, if the deputation can make a good case for his reconsidering the matter, as this is a democratic country he will review the facts again and reconsider his attitude.
I am sorry to have to use strong language. All I can say about the Minister's attitude is that his arrogance in refusing to listen to the views of a deputation, or even to receive it, supports the contention that the decision has been taken for bureaucratic reasons and that the Minister intends to back the local Board. On no occasion has he given any indication that he intends to reconsider his attitude.
I beg the Parliamentary Secretary to ask his right hon. Friend to think again. The hon. Gentleman is personally a humane and generous man. He has listened to the detailed and cast-iron case made by hon. Members on both sides. He has heard about the high degree of local feeling and indignation which exists throughout this part of London. I beg the Minister to reconsider the matter carefully and talk to the Board. As St. Teresa's is a modern, efficient and highly regarded hospital, which draws support from, and which has carried out a task second to none in this area of London, we all ask the Board, and urge the Government to press the Board, to seek a better solution than that which has caused distress to so many of my constituents.
I, for one, could not possibly complain about the moderation with which, with only two exceptions, the case has been put on behalf of St. Teresa's. The two exceptions to which I take objection were embodied in the speech of the hon. Member for Wimbledon (Sir C. Black), to which I shall refer later.
However that may be, I am grateful to the hon. Member for Wimbledon for raising this matter, because it gives me an opportunity to deal, I hope fully, with the various points which have been raised, not only this morning, but outside the House as well.
The question we are concerned with is a very sensitive one. It is natural for people to form an attachment to their local hospital, whether it is a National Health Service hospital or a private one. One is piling Pelion on Ossa when the hospital concerned is one which deals with maternity cases. Strong emotions become involved. The fact remains that the hospital authorities, under the Minister, have the duty to provide the best possible service for patients in their area.
That is what they are genuinely striving to do here and I hope that we shall not allow the matter to become too clouded with emotion. In the House, a speech which is entirely free from emotion tends to be a dull one. Therefore, I certainly do not complain about such emotion as has been displayed this morning.
To some extent the case of the Regional Hospital Board, and consequently the attitude of my right hon. Friend, has gone by the board. I do not underestimate the organising genius behind the perfectly legitimate agitation over this decision. There has been very good organisation and I do not think that the other side of the coin has been examined. It is important that I should draw attention to one of the main principles governing the development of the hospital service. This is that the hospital service should be based on a network of district general hospitals. This concept was first expounded in the Hospital Plan which was presented to Parliament by my right hon. Friend's predecessor, the right hon. Member for Wolverhampton, South-West (Mr. Powell), in January, 1962.
The Plan went on to state, in referring to maternity beds:
A maternity unit will be a normal part of the district general hospital where full and continuous consultant cover will be at hand for all beds …".
The concept was, and still is, that the full supporting services which are found in a district general hospital should be available to all maternity patients. It is in the implementation of this policy, that in the area of South-West London with which we are today concerned, Queen Mary's Hospital, Roehampton, is being developed as a district general hospital for the surrounding community.
In order that this hospital, which is part of the Westminster Teaching Hospital Group, should be able to undertake a responsibility for maternity services, my right hon. Friend's predecessor, the right hon. Member for Wolverhampton, South-West, five years ago, asked the Board of Governors of Westminster Hospital to plan a maternity unit at Roehampton.
Here, I will come to two points made by the hon. Gentleman the Member for Wimbledon. On reflection, he may consider that talk about hustling patients out of hospitals, and coming dangerously near to suggesting that the mortality rate for the Westminster, which is a very famous hospital indeed, was not as good as St. Teresa's, was mistaken.
The hon. Gentleman did not put it quite like that. He drew attention to a disparity of statistics, as known to him. The point that I am making is that St. Teresa's, in its own way an excellent hospital, cannot be compared with the responsibilities and duties of a great teaching hospital such as Westminster. The analogy was unfortunate.
This maternity unit is now under construction, and is expected to open for admissions from January next year. The new unit will embody many improvements which are the result of research and experience. It will contain 50 beds, consisting of 35 beds in single rooms or rooms with four beds, and a further ward similarly divided for 15 ante-natal patients. The full resources of Queen Mary's Hospital, Roehampton, will be available to mothers and to their babies whatever the complications in any case.
These will include full operating and X-ray facilities, and pathological services, a small isolation unit and a special care baby unit. In addition, paediatric cover will be available. The unit will also provide training for medical students, and student nurses for Westminster Hospital will receive their midwifery training there.
The new building, which will surround a courtyard garden will provide a fully modem service up to the high standards of a teaching hospital.
I mention the point about the courtyard garden, because as hon. Members will be aware, some of our older hospitals have these gardens. I am thinking of Queen Charlotte Hospital, with which I have some connection. This is not just an amenity, but in many cases, something providing an essential part of recuperative treatment. I am sure that Members will agree that the new hospital will represent a most valuable addition to services in the area.
Perhaps it would be appropriate for me to refer to the hospital services which are now available and which will be available for maternity services when the new unit is opened next year. My right hon. Friend's policy on hospital confinements is based on the Report of the Maternity Services Committee, which was under the chairmanship of the Earl of Cranbrook, published in 1959.
It is important, because we have been discussing certain financial statistics today and, as the hon. Member for Wimbledon has mentioned, one of the basic necessities in preparing statistics is that there should be a certain common factor. In this case, it is difficult to provide such a factor.
The objective recommended in that Report was that a national average of 70 per cent. of all confinements should take place in hospital on the basis of a normal stay of 10 days. That figure of 70 per cent. was to include women in the following classes:
There is, however, no objection in suitable cases to arrangements being made for early discharge, before the period of 10 days has elapsed. In that part of London with which we are mainly concerned, that is, the London Boroughs of Wandsworth and Merton, 85.4 per cent. and 85.9 per cent. of mothers were delivered in hospital last year—well above the percentage recommended in the Cranbrook Report. In providing this service, the South-West Metropolitan Regional Hospital Board has made use, on an average of about 40 beds at St. Teresa's Hospital, Wimbledon, a private hospital which caters also for private patients and with which it contracted to pay for maternity admissions.
I have already explained that 50 additional National Health Service beds will he provided in the new maternity unit at Roehampton next year. In addition to these beds, 10 additional beds for mothers from the Richmond area will be provided by Queen Charlotte's Hospital, and 12 more beds are to be provided at Kingston Hospital later this year.
I have seen a letter written by an obstetrician who has played no small part in this matter, in which he says that he has been advised that these beds are not to be provided. I can assure the House that this is not the case, and that the beds will be made available. A total of 72 beds will be added in place of the average of 40 beds contracted for at St. Teresa's.
I will refer to this later.
These figures of bed provision demonstrate conclusively that the National Health Service facilities which will exist next year will be fully adequate to meet the need for hospital confinements in this area. The Board has many other priority calls on its budget, and could not be expected to devote further finance to a maternity service which is already well up to the nationally accepted standard for confinements in hospital.
Given the policy which I have stated for the provision of maternity services, and given the practical implementation of this policy which I have described, hon. Members will surely see that the Regional Hospital Board had no option but to give notice to St. Teresa's Hospital that it would no longer need to maintain its contractual arrangement for maternity beds after the end of the current year. My right hon. Friend has supported the Board in the conclusions which it reached and in the action which it has taken.
I should perhaps explain that all contractual arrangements for hospital services are, by their nature, temporary and I understand that the temporary nature of the contract in question was specifically referred to during discussions which took place between the Board and St. Teresa's on at least two occasions before the formal notice was given in November, 1966. The earlier of the two alerts was given about the middle of 1964.
I should say, in parenthesis, that it is perhaps a little unfortunate that some of the financial anxieties as opposed to the other considerations with which the administration of St. Teresa's is confronted arise from the fact that it contracted to have built an extension costing, I am informed, about £60,000. I understand that it is nearing completion. The Regional Hospital Board has informed me that it was not told of this intention, nor was it consulted as to the future need for additional accommodation.
I take the point that St. Teresa's caters for private patients as well as for National Health Service patients. Therefore, what I have said is no criticism of the decision to build additional accommodation, but, in the light of what has been said since, the fact that St. Teresa's had this intention should perhaps have been a matter for consideration by and consultation with the Board.
Hon. Members have made many references to the comparative costs which have been the subject of exchanges in the House at Question Time on one or two occasions. The true comparison, in our judgment, can only be the respective costs per case, and these were, in 1965–66, £49 18s. 10d. in regional board hospitals and £57 4s. 8d. in St. Teresa's Hospital. These are the actual costs to the National Health Service.
Perhaps I can anticipate what the right hon. Gentleman wishes to say.
It is estimated that the cost per case at Queen Mary's Hospital, Roehampton, will be about £55. I accept the historical fact that estimates tend to go awry. But we are dealing with a new hospital which will incorporate tremendously expensive equipment, and its use and amortisation, and so forth, is an imponderable factor which will arise in any event.
The length of stay in regional board hospitals was on average 9·04 days in 1965 and in St. Teresa's Hospital 12·2 days. But even in the case of the latter hospital the length of stay was reduced in 1966 to 11·15 days. I mention this point because I referred earlier to the difficulty of finding a common denominator in assessing costs.
I should like to consider that question. I think that it does not.
So far as we can, we are comparing like with like, but what slightly upsets comparisons is the difference in the length of stay. I do not wish to imply any criticism whatsoever of the decisions taken at St. Teresa's to have a slightly longer stay than the national average or the average of that in National Health Service hospitals. That is a matter for medical assessment. Therefore, I deprecated—I do not wish to make a meal of this—the remark about hustling patients out of Health Service hospitals.
I do not quote these figures to make the point that St. Teresa's Hospital is more expensive, but to refute the argument that the Regional Board, in developing its own hospital services, will be failing to make use of a cheaper alternative which is available at St. Teresa's.
Since the hon. Gentleman has said that we should compare like with like, would he not agree that his right hon. Friend was less than frank with the House when he said that the right comparison was cost per bed and did not disclose, until it was pressed from him, that we were dealing with about a 30 per cent. difference in the length of stay?
I think that my right hon. Friend was perfectly fair. These figures about the length of stay were known to the people who have been raising this matter outside the House and my right hon. Friend had every right to assume that hon. Members, who have been well briefed, would know about these comparative figures. I think that the right hon. Gentleman knows my right hon. Friend better than that. He would not intentionally mislead the House.
I have not intervened because, clearly, this is not a party matter. It is a matter which reflects a great deal of local anxiety. But, so that we can judge the matter fairly, may we be told, for the purposes of comparison, exactly the cost per patient per day?
I will certainly provide the hon. Gentleman with that information. I do not have the figures at my disposal now, because I was not basing my case on that computation.
I assumed that the hon. Member for Essex, South-East (Mr. Braine) knew those figures. I am giving what I believe to be the correct comparison in assessing the economic argument about this case. I do not wish to base my argument purely on economic considerations. There were other considerations.
A further argument is that, as there is a general shortage of midwifery staff, it is wrong that use should not continue to be made of the trained staff at St. Teresa's. I understand that a substantial proportion of the nursing staff at St. Teresa's are lay nurses, and mainly nurses obtained on a fee basis from agencies. It is a free world. If the hospital authorities want to run the hospital in that way—it may be the only way in which they can run it—it is up to them. But it would be a pity if my right hon. Friend were jockeyed into the position of denigrating the great value of what is a minority of sisters of a distinguished order in this hospital.
I am glad to say that in the year to September, 1966, there was a national increase of 2·3 per cent. in midwifery staff in the National Health Service and 4·1 per cent. in nursing and midwifery staff taken together. This improvement is, of course, most welcome. Incidentally, no maternity beds in this area are closed because of staff shortage.
I should answer the question of the hon. Member for Richmond, Surrey (Mr. A. Royle) about ante-natal provision. The distribution of ante-natal facilities under the proposed plan is that Queen Mary's will cater for patients from Putney; St. Helier and Nelson will cater for patients from Wimbledon; Kingston Hospital will be self-sufficient; and Queen Charlotte's will cater for patients of this character from Richmond.
I am well aware of the esteem in which St. Teresa's Hospital is held by the local population. This private hospital has indeed rendered good service to the National Health Service since 1948 and I appreciate St. Teresa's proud claim never to have lost a mother and to have a record for stillbirths and peri-natal mortality of infants which is well below the national average. This is a fine record, but we must bear in mind that the hospital does not provide a comprehensive service to the local community.
The writer of the letter addressed to the hon. Member for Wimbledon—and I assure the House that I have seen the letter—an obstetrician who has been very much concerned with these activities, makes some play with the fact that only a minimal number of cases are not sent to St. Teresa's because of their complexity. The same comment could be made about cases which could not be catered for by a district general hospital.
It is true to say that certain cases would inevitably have to be referred to specialist hospitals, but I hope that the hon. Member for Wimbledon is not arguing that a modernly equipped and designed hospital will not have technical advantages over a hospital which—contrary to a comment made by the hon. Member for Richmond, Surrey—was not custom-built for maternity use. It is a very old hospital brought up-to-date, and perhaps the hon. Member for Richmond, Surrey, will reconsider his remarks in the light of what I have said.
Before 1948 the hospital acted as an annexe of the Royal Cancer Hospital, now the Royal Marsden, and cared for chronic sick patients. When the Regional Hospital Board notified St. Teresa's last year—I am referring to the formal notification as opposed to the verbal alert which was given during the administration of the right hon. Member for Wolverhampton, South-West—that it would no longer require the hospital's beds for maternity services, it offered to discuss with the hospital the possible use of beds for other purposes. I know that the Board had in mind the use of beds for geriatric cases. I very much hope that the hospital will consider very seriously whether it could not undertake this much needed service, and extend the reputation which it has already built up among the local residents.
I hope that I carry the House with me in saying that the developing problems confronting any Administration in the care of old people and of what are called the young chronic sick is getting so serious that we just cannot write this problem off on the grounds that maternity services are needed as well. Any Administration must try to take a balanced view of all this. That is why I say that the use, either for geriatric cases or for the young chronic sick are getting so a suggestion which I hope St. Teresa's will consider most seriously. If St. Teresa's accepted such a responsibility it would, to some extent, be reverting to the use which was being made of the hospital prior to 1948.
Hon. Members will appreciate that, as the hospital building programme gains momentum, there is bound to be a reduction in the contractual arrangements of the type which have existed at St. Teresa's. I assure the House that this is not a question of doctrinal bias, or ideology, but that it is in the nature of the responsibility which Parliament has given to the Government to provide a general hospital service. If ideological or doctrinal attitudes are to be alleged, I must point out—this is the only party point I will make today—that the decision in principle was taken when the right hon. Member for Wolverhampton, South-West (Mr. Powell) was Minister of Health.
During the last three years the number of contractual beds has declined by nearly 1,000 to 4,960. Under the National Health Service Act, 1946, it is my right hon. Friend's statutory duty to provide hospital and specialist services and he is continuing the policy of his predecessors that the services should, as far as possible, be provided in hospitals within the National Health Service. I am sure that hon. Members will agree that this is the right and, indeed, in the long-term, the only policy.
Reference has been made to the fact that my right hon. Friend refused to meet the Action Committee. The contract was, after all, entered into between the Regional Hospital Board and the hospital. The Action Committee has, as some hon. Members have pointed out, been seen by the chairman of the Regional Hospital Board. In addition, officers of the Board interviewed representatives of the Committee at the Board's offices last week.
A lot has been said about democracy. My hon. Friend the Member for Putney (Mr. Hugh Jenkins) mentioned that regional hospital boards were not democratic. One could criticise that comment. After all, what is the ultimate right members of the public have? It is to make representations through their M.P.s, and this has been done effectively today. I do not believe that there can be any complaint on that score.
Reference was made by the hon. Member for Wimbledon to a circular which, he said, had been sent out by the St. Helier Hospital Group, saying that certain cases could not be taken care of. I am informed that that circular was sent out not by that Group, but by consultants of the Group, a distinction, and that that was done without prior consultation with the Board.
As a matter of fact, the provisions of the circular have not been implemented. I understand that the document may be withdrawn for the reason that the provision of hospital accommodation has been forthcoming. Thus, it was a non-starter to begin with.
It has also been stated that there is a shortage of maternity beds in the Kingston area. The position in the area covered by the Kingston Group Hospital Management Committee is that, in addition to the beds available in the Kingston Group, 30 to 40 beds in London teaching hospitals are occupied by women living in the Kingston area. This is possible because of reduced pressure on London teaching hospitals. In addition, 12 more beds are being provided this year at Kingston hospital, as I have already mentioned. The relevant figure is that, in 1965, 75 per cent.—5 per cent. above the Cranbrook recommendation—of the confinements of women from the Kingston area were in hospital.
I draw the attention of the House to this changing pattern in the use of teaching hospital accommodation in the central teaching areas of London. There is considerable indication that available maternity beds at teaching hospitals are under much less pressure than they used to be. There are various reasons for this, including the decentralisation of population, and the gradual building up of the suburbs. Any Administration must see that the beds that are available, where local demand falls off, become available to people living on the periphery of London. I hope that nothing will be said to deprecate the efficiency and inspiration which is the proud history of our teaching hospitals. I emphasise this in view of certain remarks that have been made.
The right hon. Member for Kingston-upon-Thames referred to the loss of a good service. This is not a good factor in the argument because the facilities of this hospital can be used, and well used, for other requirements in the National Health Service. I hope that the House will accept that we would welcome co-operative attitudes on the part of St. Teresa's to the suggestion that has been made.
I have tried—although I fear that I have not answered all the questions that have been asked—to describe the back- ground to this hospital. I assure the House that we are not being dogmatic. We feel that, within our responsibilities, there is a case for this step. As to a proposal that Lord Addison may have had second thoughts, I cannot, naturally, anticipate what he might think, although, of course, the Department is always willing to listen to what he has to say.