I have on many occasions raised matters on behalf of my constituents, but never with greater passion or feeling that I do tonight concerning what has been the heart of one of my most heavily populated areas—the Willesden General Hospital and the plan for its future.
I am rather dismayed about the change in the original plan, which was carefully considered when the revisions took place after the first 1961 hospital building programme. I am also dismayed by the answer that I received from the Under-Secretary of State to a Question recently, which indicates that the North-West Metropolitan Regional Hospital Board has made up its mind to change the original plan to upgrade the Willesden General Hospital from a small acute hospital to a district hospital of 400 beds.
I speak with knowledge of the area and its transport, and from having served on both the hospital management committee for several years and the regional hospital board. Indeed, at the last meeting that I attended before I finished my service with that board, I moved the reference back of this item, which was accepted. Unfortunately by the time the reference back had gone through its due processes, I was no longer a member of the board to continue that battle.
The board wrote to the various local interests about this matter on 10th September, 1969. In any case, as the building programme is not due to start until after the second quinquennial, 1975 onwards, I naturally thought that there was more time.
But I still want to know why the change was made. I am not satisfied with the answer given by the Under-Secretary of State on 13th April, colunm 159, that this hinges on the amount of land available. My hon. Friend knows, as I do, that there is a vast complex number of questions on how the hospital service shall be organised, the specialties that it covers, the areas, and the kind of service that it will give the community.
The decision, as it would seem, to upgrade the Central Middlesex Hospital from its present 750 beds to about 1,250 has been dominated by the fact that there is plenty of land available in central Middlesex—61 acres. But this was known when the original planning took place. In fact, at Willesden General there are nearly 10 acres, even allowing for the new school which is part of the planning of that complex.
The borough planning department did a good job in depth when this was first decided. After considerable discussion, in October, 1965, the London Borough of Brent passed plans re-zoning about five acres of residential property to make sure that this complex of hospital and other local community services could exist in the heart of my constituency. It agreed to closing part of the Harlesden Road. This was part of a comprehensive approach to plan the kind of thing foreshadowed in the Green Paper, because it looked not just at the hospital service but at the community as a whole.
The planning department took into consideration the population projection for the next 20 years, the change in ages and numbers to be served, the way that the upper and the lower ages in the next 20 years are likely to be increased, and, therefore, way in which the district hospital facilities are likely to be called upon by those two sections of the community. It anticipated the Green Paper by looking at the possibility of a health centre and other local health authority attachments on this little wedge of land where Willesden General Hospital is now situated.
This very careful planning and thought owed a good deal to the inspiration and leadership of the then leader of the borough council, Alderman Reg Freeson, to whom I now have to refer as my hon. Friend the Member for Willesden, East (Mr. Freeson). He went to considerable pains to get integration between local authority planning and what was going on in the hospital service. As a result, both of his interest and of the tremendous work put in by the borough's planning and research department, which is one of the finest in the country, we were able to reach satisfactory conclusions about the way in which the hospital service could serve the people of Willesden, both my hon. Friend's constituents and mine.
In spite of the fact that the Minister's reply talks about a shortage of land, all this planning would still leave a large portion of unused ex-allotment land. In the light of these considerations, the council passed plans for a new outpatient department, for which the Board asked. A casualty and X-ray department costing £375,000 was opened in October, 1965, and only 12 months ago a new pathological laboratory, again at large expense, was opened. This not inconsiderable expenditure must not be wasted.
Central Middlesex Hospital, of which I am proud because it is one of the finest hospitals not only in England but in Europe, is already comprehensive. It has 750 beds, and already caters for a large number of specialties. But there could be improvements, and it may be that there is a case for increasing the 18 psychiatric beds to a larger figure, but this would be out of keeping with what is really required in establishing an access across my borough, especially in the populated part of Willesden Green where we have this 120-bedded hospital which has been in service for many years.
Central Middlesex Hospital is geographically in the wrong place. It is in the heart of a factory area. There are no houses within about a mile of it. It is in the corner of the constituency, and serves Acton, Ealing, and my constituency of West Willesden. West Willesden Hospital, on the other hand, is in the centre of a most heavily populated area, where the residential surroundings are such that they would demand a heart within them where health services and other services could be provided, and already the council has that in mind with the building of the new school, and with the possible provision of a health centre. This is good community planning.
In the argument put forward by the regional hospital board, it is looking to the borough as a whole, and it argues that a second district hospital could well serve the area because of the new North-wick Park Hospital being built in the far corner of Brent in the Watford Road area at the extreme end of Wembley. But geographically this is nonsense. This new hospital is a joint project. There will be 790 beds, 600 of which will be used for district hospital services, and 180 beds will be used by the Medical Research Council for clinical research. It will not in any way serve the needs of my constituency, because it is too far away. It will be almost impossible to get adequate service if one has to travel from West Willesden to Northwick Park.
I submit to my hon. Friend that in the interests not just of my constituents but of good planning and a comprehensive approach to the way in which we look not just at hospitals but at the whole of the health services, the proper access for the area which I represent is this first-class hospital, the Central Middlesex at Park Royal, and, secondly, the upgrading of Willesden General to a full district hospital.
There is a good case for a rationalisation of the Neasden Hospital, with 200 beds. It was previously a hospital dealing mainly with infectious cases, but it now takes ophthalmics and other specialties. If there is to be a ration alisation in terms of not just hospital service but the whole health service approach, there is a good case for releasing a large amount of land which is unused at Neasden not only by making Willesden General a 400-bedded hospital as was proposed in the Hospital Building Plan—I served on a committee which discussed this with the regional hospital board in 1966, which confirmed it—but also by adding in perhaps another couple of hundred beds and closing Neasden Hospital and marrying it to the Willesden General as a 600-bed general hospital. In that way, one could do a job of work for the community, by a really comprehensive Willesden General and by extending local authority welfare and health service with the site at Neasden.
At the moment those concerned with planning in the hospital services are thinking only in terms of hospital services and, I suspect, some of the aggrandisement and enlargement of the Central Middlesex, which is already a first-class hospital, and not in terms of the community or of expansion in general practice and domiciliary medicine, and all the other things which should be going on in the next few years. I repeat, it would be far better planning to look at the possibility of creating a district hospital in Willesden General and marrying the present services to Neasden.
Already in that hospital group, which covers quite a number of hospitals, we have joint consultant services. Already, all the consultants in all the specialties are available in the out-patient departments at Willesden General, at Acton and at Central Middlesex. Therefore, instead of thinking purely of a bricks and mortar project, we should think in terms of how the hospital service, irrespective of its institutional surroundings, can be suited to the people of Willesden. In terms of visits and bus services, general convenience and the affection of the community, Willesden General is the heart of an area. My hon. Friend cannot permit the regional hospital board to pluck it out in view of all the successful work that it has done for many years.
I urge my hon. Friend to use all his influence not just to return to the original plan so that we may think not just in terms of one hospital at one end of a very large area and one at the other but in terms of how we approach the general question. There has been no positive suggestion of what is to happen to the 120-bed Willesden General—just a vague hint that some use will be found. We should not plan in a vacuum: we should plan the lot. I urge my hon. Friend to use his influence with the regional hospital board to take this matter back and review it in the light of my submissions, and at least give Willesden people an opportunity of continuing this service where it should be—on their doorsteps, in the middle of the area which I represent.
My hon. Friend the Member for Willesden, West (Mr. Pavitt) is rightly known and respected in the House for his concern in and knowledge about health matters. I have listened to what he has said with great interest. He also represents his constituency very actively. Tonight he has combined both his health and his constituency interests. I am grateful to him for giving me an opportunity of discussing his views on hospital services in his area.
I think that, before I deal with the local problem that my hon. Friend raises, it is important to say something of the wider and more general policies of my Department for the development of the hospital service.
The pattern of development of the hospital service is based on the establishment of a network of district general hospitals, providing a wide range of facilities for in-patients and out-patients. For economic operation and to provide the most effective service for patients, the various specialties need units of adequate size, which means that there must be some concentration of services at selected hospitals. Because they enable a higher standard of medical care to be given, these hospitals are expensive to provide compared with other hospitals. But, given a network of these " district general hospitals ", a number of other existing hospitals will find their roles having to change.
In working out the blueprint for the future, decisions have to be taken on the areas or population for which a district general hospital must be provided as the nucleus of the service, and in doing this we have to consider the hospital provision that already exists. In some areas the only effective long-term aim is to build a new hospital on a fresh site. In other cases progressive rebuilding, in stages, of an existing hospital and its considerable extension by the addition of new buildings may be better.
The Hospital Plan published in 1962 recommended that district general hospitals should be planned to serve 100,000150,000 population. In fact, the increasing number of medical specialties and their inter-dependence, together with the inclusion of assessment and treatment facilities for geriatric and psychiatric patients, have resulted in some enlargement, so that the average district general hospital is now planned to have at least 1,000 beds.
There has been a similar increase in the size of population served by such sophisticated hospitals. A hospital of 1,000 beds could be expected to serve a population of 200,000 or more. Here I want to stress that there is no rigid rule. The Hospital Plan and the Hospital Building Programme, published in 1966, emphasised that the pattern of district general hospitals to provide comprehensive hospital services for the community would have to be flexible.
In particular, it has always been accepted that there must be wide variation in the pattern to take account of the varying distribution and density of population and the availability of sites. In practice, this has meant that the more sparsely populated parts of the country may have a district general hospital of fewer than 1,000 beds serving perhaps 150,000–200,000 population spread widely and often up to 20 or even more miles from the hospital. On the other hand, in densely-populated areas, such as the larger conurbations, district general hospitals now planned will tend to have more than 1,000 beds and will frequently serve densely populated areas containing between 250,000–350,000 people, all living within five miles of the hospital. Usually in such conurbations district general hospitals are not planned within five miles of each other, since experience has shown that this is a reasonable distance for people using public transport.
There is a strong medical argument for the district general hospital concept and the concentration of varied medical services in larger district general hospitals. Concentration of services into district general hospitals enables a complete comprehensive service to be given with, for example, 24-hour consultant cover in all the major specialties, including accident and emergency services with full supporting services, and enables the best use to be made of resources and manpower available.
To regional hospital boards falls the task of planning in the first instance the building development of the hospital service. They have the difficult task of determining needs and assessing priorities of competing developments. In all this they must pay proper regard to economic forms of development and the best interests of the patients.
My hon. Friend will recall that, in reply to his Question on 13th April, I said the regional hospital board has reviewed provision for his area in consultation with local interests and is now of the opinion that it would best be served by concentration of district general hospital facilities on the site of the Central Middlesex Hospital, and that this will be kept under review.
I would like to elaborate on this a little. My Department aims to standardise methods of approach to the planning of hospital buildings and has indicated the various stages through which a hospital building project must pass so that proposals to provide buildings can advance smoothly from inception to commissioning in published notes that set out the current hospital building procedures. The earlier stages of the procedures include formulation of proposals by the regional hospital board as to what the functional content of the hospital provision shall be, and these proposals and their associated cost have to be considered and discussed with my Department, which must be satisfied with them before giving its approval.
All this has to take place before the board can proceed with the detailed planning of the particular hospital buildings to contain the agreed functions. The plans go to my Department at a later stage for detailed consideration and approval so that, amongst other things, proper cost control is maintained.
I mention all this because I think it is important to make it clear that the board's plans for Willesden General Hospital are still at a very early stage. My Department has not yet even received the proposals from the regional hospital board to concentrate redevelopment on the Central Middlesex Hospital site, and no proposals for such a project have yet entered the hospital building procedures, let alone receiving any formal approval from my Department for the project to proceed.
I appreciate the anxiety that has been caused by a suggestion that a local hospital might have its use changed or even be closed, and I am confident that we now have a procedure for handling proposals to change the use of, or to close, hospitals which is intended not only to relieve that anxiety but to ensure that locally acceptable alternative arrangements are made, if indeed closure or change of use is the right course.
In fact, I understand that the board is not contemplating the closure of the Willesden Hospital, although it will have to consider the question of the best role for the hospital in the long term.
The first main requirement is that at an early stage in their planning hospital boards should give local interests as much information as they can so that there can be informed public discussion of their proposals. Then all opinions expressed in the light of this information should be properly considered and taken into account as planning continues. In cases of major building development it will probably not be possible at a very early stage for boards to make available more than the general outline of their plans and of their possible implications, but the process of consultation should be repeated as more specific proposals are formulated and again when the building is under construction.
The approval of the Secretary of State is required before a hospital board can put into operation a proposal to close or change the use of any hospital. My right hon. Friend does not give his approval unless he is satisfied that the implications of the proposal have been thoroughly considered and that the arrangements proposed for future hospital services in the area are quite satisfactory.
I would now like to turn to the present views of the regional hospital board. I understand that it was indeed its original intention that development in the area would take place at both Central Middlesex and Willesden General Hospitals. But, having regard to the hospital building trends that I have outlined, the board has formed the opinion that the needs of the catchment area of the hospital group, which will have a population of about 217,000 in 1981, would be best served by the concentration of the hospital services within one district hospital. Concentration of the services in this way on one site is a long and costly exercise; and the only available and suitable site in the board's opinion for major redevelopment is the 60 acres of Central Middlesex Hospital where a large area of vacant land is available, thus allowing the board to continue to maintain the service to patients in the area during the course of the redevelopment.
On the other hand, the site of Willesden General Hospital is a very restricted one of only some six acres, plus three acres defined for future use, and is mainly occupied by buildings which would need to be cleared before any major redevelopment could be started. These hospital sites are only about two miles apart.
The board says that, although perhaps it is not in the ideal geographical position in relation to the whole catchment area, communications to the Central Middlesex Hospital are good—
—as it is convenient to both the North Circular Road and to Western Avenue. It fully appreciates the public transport difficulties existing at present, but I understand that it intends that representations should be made to the Greater London Council on this point.
The board does not think it could envisage Willesden as a complementary district hospital to Central Middlesex. This would involve separation of specialties away from the full supporting services; it would be more expensive and provide a less effective service to the patient.
I would stress that the final concentration of the hospital services as proposed is a very long-term matter and the board does not wish to make at this point in time any firm proposals on the eventual use of Willesden General Hospital.
The board has had local consultations with the hospital management committee, the Middlesex Executive Council, the local health authority, and other appropriate local bodies.
I repeat that I am grateful to my hon. Friend for giving me this opportunity to explain the general position and how the board views the matter; but I can assure my hon. Friend that, if and when the board submits proposals for the concentration of development at Central Middlesex Hospital, all the points he has raised tonight will be taken carefully into account before a final decision is reached on the future of the services in the area.