First, Mr. Deputy Speaker, I should like to join my hon. Friend the Parliamentary Secretary to the Civil Service in wishing you every good fortune in your retirement and to express my appreciation and thanks for the patient way that you have so often presided over our affairs.
Secondly, I should like to express my gratitude to my hon. Friend the Minister of State, Welsh Office, who is a good friend of my constituency and always takes a close interest in the future of our hospitals. I realise that although he has come to listen and to speak tonight he is far from well. I express the hope that he will soon be restored to his normal robust good health.
I speak with a particular feeling of appreciation and gratitude for the country's medical services at a time when my wife has only recently left the intensive therapy unit of a London hospital following a serious post-operative setback. I am particularly glad to have this opportunity of expressing my gratitude for, and to say I can only wish for my constituents, the devotion and skill that I found in the last few days at the West Middlesex Hospital and earlier at University College Hospital.
On 13th July 1970 in my maiden speech I spoke about the hospital service. I make no apology for returning to that theme in one of the last debates of this Parliament.
There comes a time in any long-continuing drama when it is worth while stopping for a moment to review what has happened, to identify what still needs to be done, and to decide on the priorities for the future. It is particularly appropriate that we should do so at this time when a new area health authority will shortly be taking over responsibility for the affairs of the hospital service in my part of the country. This drama may be said to have begun in 1962 with the publication of the Hospital Plan for England and Wales, which envisaged the enlargement of the Pembroke County War Memorial Hospital in two stages.
Local pressure led to a modification of the plan, and in 1964 it was decided to build a new hospital at Wythybush "supportive"—that is the word that was used—to Carmarthen at a cost of £1½ million.
In 1968 the Chairman of the Welsh Hospital Board announced that a 314-bed hospital would be built at Wythybush at a cost of £3·15 million.
There were strong criticisms of the plan, and from the autumn of 1969 pressure mounted for a better hospital. This campaign, stimulated by strong complaints from some local doctors and consultants, received the widest possible support in the county.
On 17th October 1970, following my election as Member of Parliament, I led a deputation to see the Secretary of State, who then arranged for Dr. Bevan, the Chief Medical Officer, Welsh Office, to hold an inquiry. His report, also signed by Dr. Lovett, which was published in December of the same year, stated:
It is abundantly clear that the people of Pembrokeshire are dissatisfied with the existing hospital service. They believe that they are vulnerable in that emergencies cannot be treated expeditiously.
The problem is to provide for the people of Pembrokeshire a hospital service which will restore public confidence and which is compatible with the limited resources of skilled manpower and finance which are likely to become available, in the foreseeable future, for the hospital services in Wales.
The report went some way to alleviate public anxiety, but criticism has been maintained on a number of points—notably on the practicability and effectiveness of the accident unit that Dr. Bevan proposed and on the recommendation that the paediatric service should be centred on Carmarthen.
On the general history I would make three points. The first is that the public probably underestimate the very real difficulties of providing the complete service which, in an ideal world, we would like to see and also the considerable progress that has been made over the last three years.
The second point is that progress has, at least in part, been dragged from the Welsh Hospital Board stage by stage painfully, and not always willingly, by unremitting public pressure.
The third point—I think I may just be entitled to make it in passing—is that, apart perhaps from the doctors in Pembrokeshire, no one has been more deeply involved in the fight for improved services than I have.
It is only fair to say that the problems are real and not always acknowledged by doctors, let alone by the general public. While it is easy to demand a fully comprehensive hospital service, and while it is natural to demand for the sick parity of treatment, the practical difficulties of making such provisions for a widely scattered population are great. There simply are not the resources or the doctors to make it possible to have full in-patient departments in all specialities. Some compromises are inevitable.
I also freely acknowledge, and wish to put on the record, the great progress that has and is being made. The foundations of a new and large hospital have been laid; a new unit for the mentally ill is under construction in Pembroke Dock. When Dr. Bevan reported, there was one ENT consultant for the whole area; now there are two. There was only one paediatrician based at Carmarthen; now there are three—one at Carmarthen, one at Aberystwyth and one working partly in Haverfordwest and partly in Carmarthen. The accident unit has been strengthened and the ambulance service improved. Beds are to be provided at the new hospital for long-stay patients. I believe that over £400,000 has been spent in modernising the existing hospitals. This and other improvements I acknowledge and welcome. Those who seek to belittle the general high standard of medical care in the area perform no service to anybody.
I turn to the recommendations contained in the Bevan Report. Some, we are told, have been implemented. We have, as my hon. Friend informed me in a letter of 27th October 1972, integrated planning. Our hospital is to be called a district general hospital, and Carmarthen is to be regarded as a centre for West Wales when only one such centre can be justified. The new hospital at Wythybush is to have in-patient departments in certain specialities.
Every effort is being made, or so the Minister assures me, to provide accommodation near their homes for long-stay patients. I imagine that that statement is justified by the long-stay beds to which I have already referred. The severely injured are now being taken to the Haverfordwest Hospital which is the nearer hospital. ENT operations are being concentrated at Carmarthen. The ambulance service is being strengthened. These are recommendations—or the most important of them—that the Minister can claim the board has done something about.
What about the others? There was the suggestion that GPs should be encouraged to work in hospitals and to be given permanent hospital appointments. On 27th July 1972 my hon. Friend wrote to me that the recommendation that GPs
should be encouraged to work in hospitals by being given permanent hospital appointments has been accepted in principle by all concerned, but there have been difficulties of implementation. I understand that the general practitioners have little available time to devote to additional hospital appointments but several additional doctors have recently started practising in the area and the Board is continuing its efforts to arrange implementation of the proposals.
That was a year ago. Can the Minister tell me how much progress has been made? From conversations in the hospital I understand that my initial scepticism has proved unfounded and that some GPs have become available. If that is indeed so I am delighted to have been proved wrong.
There were two major recommendations made by Bevan for action in a rather longer time scale: first, that a psychiatric department should form part of the Haverfordwest Hospital with beds for mentally ill patients under psychiatric care; and second, that there should also be a geriatric assessment unit and the appointment of a geriatrician for the area.
No provision has been made in the plans for the new hospital or in the board's capital programme for these departments. But one of the first tasks of the new area health authority will be to decide on the future use of the War Memorial Hospital, which is in good condition and will be available for a fresh rôle on the completion of the new hospital at Wythybush. My own proposal is that it should be modernised and re-equipped for use as the new geriatric unit.
On 6th February 1973 my hon. Friend wrote to me a letter saying that the Welsh Hospital Board was in the process of preparing a consultative document on the hospital services in Pemrokeshire. He said:
The booklet being prepared will give the facts about the existing hospitals and asks for comments in the light of the new provision being made at Wythybush. All interested authorities and organisations will be fully consulted including, of course, the County Council who, along with anyone else, will be able to make their views known to the board.
I must tell my hon. Friend that I have heard nothing more about that so-called consultation, nor, I understand, has the medical staff at the hospital. How is it getting on?
I turn now to the accident and emergency services—the main cause of public anxiety in 1969 and 1970. Three months ago I would have said that we had not advanced far since then and that the people of Pembrokeshire delude themselves if they imagine that they have a properly organised accident and emergency unit.
Again, although the reservations remain, it is fair to say that our initial scepticism has turned out to be unjustified. One of the leading critics told me this week "We have to admit it is working pretty well within the limits of the type of unit". Bevan did not set out to create a full-scale accident unit, but rather a unit staffed to meet the needs of an exceptional area. His original proposals were strengthened when it was decided that an additional casualty officer should be of consultant status. The new consultant was not given an easy task, but it is encouraging to hear these favourable comments from those who have been most pessimistic. The new unit has the services of an additional anaesthetist, recommended by the Bevan report, and also an additional doctor. I am told that there is admirable co-operation with the consultant orthopaedic surgeon.
The major cause of anxiety now in this direction is about the facilities that will be available for the unit in the new hospital. They are not what one would expect for it because the hospital was not designed to contain a separate accident unit. Here is a major problem for three years hence. The sooner the new area health authority faces up to it the better. It will have to keep the development of the unit under close review.
I turn finally to the problem of the paediatric service. I am particularly pleased that at this point my right hon. and learned Friend the Secretary of State has joined us. I welcome the fact that the new consultant is living near Haverfordwest. We in Pembrokeshire are fortunate to have found someone so patient. I understand that he wanted to live in Haverfordwest from the start. He was told by the board that he must live within 10 miles of Carmarthen. There was an outcry, and the board changed its mind. By that time the consultant had nearly completed the purchase of a house in Carmarthen. Fortunately for the board the consultant was able to withdraw from the contract and acquire a house at Narberth. We are all deeply indebted to him. He is now, I am glad to say, spending as much time as one could possibly want at Haverfordwest, according to one of the leading consultants in the county and one of the strongest critics of the original proposals.
There are at present 24 beds for children at Haverfordwest. The new hospital at Wythybush will have only 10 beds, and it is easy to understand the bewilderment and the anger of the public confronted by this drastic reduction of the existing service. Originally we were told that 10 beds were used only for surgical cases and that all medical cases would go on to Carmarthen. But in his letter to me of 14th June 1973 my hon. Friend informed me that these would be for general use for children and that it would be for the paediatrician and the other consultants concerned to make the best use of them. The consultant, I am told, is at present making such good use of the 24 beds that they are now more intensively used than ever before and have in recent weeks been fully occupied. Why on earth should that situation change because we get a new hospital? If they are needed now, surely they will be needed in three years' time.
The solution which has now been adopted for paediatric care is substantially that recommended by Professor
Peter Grey in the special report commissioned by the Welsh Hospital Board. In that report, which made out an unanswerable case for strengthening the paediatric service in Pembrokeshire, he said:
This arrangement will necessitate the provision of some extra beds for medical paediatrics at Haverfordwest.
So it is not just a lot of cranks who are demanding this but the board's own adviser.
There should be no difficulty in enlarging the children's ward at the new Withybush Hospital as the plans indicate that it occupies only half the area which could be used. In his letter of 14th June 1973 my hon. Friend said:
The number of beds was decided on some time ago and the position now is that the Welsh Hospital Board propose to undertake a reassessment of the whole provision of children's beds in South Wales because of the Stacey Report and also because the scale of provision for children's beds which was used at the time Withybush was planned has now been revised and is more generous.
That sounds to me like an admission of inadequacy which, coupled with our experience following the appointment of the new consultant, provides an unanswerable case.
We have made a great deal of progress in the last three years. We are now so close to a hospital service for the area which meets our reasonable objectives that it would be tragic if we could not take the final steps to complete the work that we have begun. With a dozen more beds for children, a firm plan for the establishment of psychiatric and geriatric units within a reasonable period, the provision of the proper facilities in the new hospital for the accident unit and, in due course—I put it no higher than that—appointment of the extra consultants in obstetrics and gynaecology recommended in the Bevan report, the hospital service in Pembrokeshire, for so long the subject of anxiety and criticism, would deserve the pride, respect and confidence of everyone.
Before I start, might I say that there is an insufferable draught on the Front Bench? If it were possible, Mr. Deputy Speaker, to improve that situation, it would greatly help someone like myself who is just recovering from a dose of double pneumonia. I know that there are some people in the House who have the job of stopping the draught upon the Front Bench. I will only say that it has been greatly improved——
I welcome this opportunity to answer my hon. Friend the Member for Pembroke (Mr. Nicholas Edwards) on the subject of hospitals in Pembrokeshire. The fact that my right hon. and learned Friend has joined me on the Front Bench to hear what is perhaps the last speech from a Welsh Minister in the present Session shows that he, like myself, attaches the greatest importance to the responsibility of the Secretary of State for Wales for health and hospitals in the Principality.
My hon. Friend probably knows more than any other Member of Parliament about hospital and health problems. I know that he has studied these problems not merely in Pembrokeshire but in the whole country for a very long time, as his speech tonight has shown. He has spoken of the basic difficulties. I think we would all agree that wherever we live, in town or country, we want medical services of every sort to be as readily accessible as possible. If we live in the country we still need as high a standard of service as in the town, though we may expect to have to travel rather further to get it.
Unhappily, no country has the resources of money and, in particular, skilled medical, scientific and nursing manpower to bring every specialist service as close to everyone as we would like. That is so in Wales and in Britain as a whole. This has certainly posed particular problems for the Welsh Hospital Board. But we can and should recognise, and we have recognised, that in the special circumstances of West Wales something more than the average share of resources, something more flexible than the normal pattern, is justified. From this stemmed the decision to provide acute hospital services in the main hospitals at Carmarthen, Aberystwyth and Haverfordwest rather than in one single, more economical but less accessible major centre. A degree of interdependence between the three hospitals is essential because of the small-ness of the populations concerned and the need for 24-hour cover.
But this area will be the first in Wales to have all its major acute services in modern buildings. The new hospital of 324 beds now being built at Withybush will provide, within Pembrokeshire itself, services of very high quality over a wide range of specialties. I am glad to be able to tell my hon. Friend that work at Withybush does not have to be slowed down by reason of the general reduction in capital expenditure. Given the availability of steel and building supplies, I hope that it will open as planned in 1977.
My hon. Friend has referred to the progress made in implementing the recommendations of the report by the Chief Medical Officer at the Welsh Office, Dr. Bevan. He has spoken particularly about the additional appointments in paediatrics, ENT and accident and emergencies which have substantially improved the service available to the people of Pembrokeshire and of West Wales as a whole. My hon. Friend acknowledged this improvement.
Other consultant appointments have been made or are pending following approval. Over a wide range of important specialties the West Wales area as a whole will have significantly better cover in relation to population than the average area in Wales—or in England for that matter—and Pembrokeshire will benefit considerably from this. Of course we must look in the longer term to still further improvement here and in the country generally but this can only come with the gradual success of our long-term plans to expand the consultant manpower.
I turn now to those recommendations in the Bevan Report which have not yet been capable of implementation. First is the encouragement of general practitioners to work in hospitals. My hon. Friend will remember that Dr. Bevan acknowledged that there would be difficulties. There have been discussions over a long period between the Health Departments and the medical profession in which considerable progress has been made. These discussions are continuing. The matter is complex but all concerned recognise its immediate importance and the opportunity for the real and close integration of general practitioner and hospital services which is a basic objective of the reorganisation of the National Health Service. I can assure my hon. Friend that we shall persist in our efforts towards a solution.
Secondly, my hon. Friend wanted a psychiatric department to be established in Haverfordwest. The hospital board has had the need for such a unit in mind for the future but it has not yet found a place, against other competing priorities, in its forward programme. The new Dyfed area health authority will no doubt keep this prospect in mind for the time when resources permit further developments at Withybush. The buildings there have been deliberately located to allow for further long-term expansion. In the meantime there will, of course, be psychiatric out-patient services.
Next I come to the question of a geriatric assessment unit at Haverfordwest and the related appointment of a further geriatrician based at Haverfordwest, which Dr. Bevan recommended "when it became practicable". Here, too, I am afraid we must accept that with the particularly severe shortage of geriatricians it is bound to take time.
In Wales as a whole, excluding the teaching hospital, a geriatrician now looks after, on average, one and a half times the population served by the geriatrician at Carmarthen. The Dyfed area health authority will, I am sure, put forward its own case as the availability of consultants gradually improves.
My hon. Friend mentioned the future rôle which the War Memorial Hospital, Haverfordwest, might play. The Dyfed area health authority, whose responsibility it will be to plan the reorganisation of services in the area after the opening at Withybush, will no doubt bear his suggestion in mind. It will, of course, consult locally before making firm proposals. But I think it right to say that it will wish to consider whether it might not be best to associate such departments with the major new hospital at Withybush, where there will be 84 geriatric beds.
As regards the development of the accident and emergency service at Haverfordwest, I know that there are some who have reservations. But my hon. Friend will understand that we have made a new type of consultant appointment—the only one in Wales—to meet the special circumstances in a hospital which does not itself provide the range of specialties to enable any and every accident case to receive full treatment there.
We are providing a short-term treatment unit where, in addition to dealing with relatively minor casualties—always, happily, the majority—the consultant will give skilled, advanced life-saving treatment for major accidents and emergency cases before referring them, when necessary, to appropriate specialist colleagues. He will have the full-time assistance of an experienced and senior doctor, and the AHA will no doubt endeavour to secure the help of general practitioners and further support from junior hospital doctors.
There will be the normal facilities of a casualty unit, including a treatment room. The consultant will be able to use the operating facilities of the hospital and will have the use of eight beds for short-term treatment; in the new hospital he will have the use of day surgery theatres and day beds. He will, of course, always be able to seek the assistance of his consultant colleagues. I am sure that the AHA will keep this matter under review.
Lastly, my hon. Friend asked me to reconsider the provision of children's beds at Withybush. The building has been designed to contain a 10-bed children's ward. It would be for the AHA in due course to demonstrate the need for additional provision; but I am bound to say that the average occupancy of the existing beds is only about 50 per cent. and on this basis the new provision seems about right.
How recently were those figures collected? My information is that since the appointment of the new consultant and his arrival in the area the occupancy rate has risen very substantially. I think we shall find that one of the results of having a new consultant working in the hospital and living close by will be that we shall have a much greater demand and use for these beds.
My hon. Friend may well be right. He has a far closer knowledge of this matter than I. I shall certainly look at the source of my information. If my hon. Friend is right, this again is a matter which the area health authority in the future must surely look at.
The main base for paediatric services for West Wales is at Carmarthen, and this seems to be sensible. Withybush will provide facilities for acute surgery. The paediatrician will cover the obstetric unit in the hospital and home visits. There will be out-patient facilities for children; and children's accident and emergency cases, which at present use some of the existing beds in the War Memorial Hospital, will have the use of beds in the day wards at Withybush.
In the last three years, as my hon. Friend has generously said, hospital services have greatly improved in Pembrokeshire and West Wales. My hon. Friend has shown an informed and dedicated encouragement of this. He has certainly never let me forget the hospital needs of Pembrokeshire. Within the constraints which the Welsh Hospital Board has had to live with, it has done its very best for this area. I pay tribute, as has my right hon. and learned Friend the Secretary of State on more than one occasion, to what it has done.
From 1st April the new Dyfed AHA will have, through the new community health councils, the advantage of intimate knowledge of the needs and wishes of the local people. I am sure that the basic aims of National Health Service reorganisation—the progressive integration of all arms of the service and greater local responsibility—will be achieved and that the service will continue to improve.
For the last three and a half years it has been my responsibility to look after health and hospital affairs in Wales. I have been the Minister most intimately concerned with the National Health Service reorganisation. While naturally my right hon. and learned Friend the Secretary of State has ultimate responsibility, I wish to pay tribute to the fact that he has given me a very free hand in this matter and I am very grateful for that.
I have learned a great deal. I have met many doctors, consultants, nurses, ancillary helpers and boilermen—all those who make up the human fabric which sustains the health of the Welsh people. I have visited many hospitals. I have addressed many meetings and conferences. I have listened to many delegations. I have learned a great deal. I am aware of the gaps in my knowledge. But I know that the men and women who man the health service in Wales do a great job, and they deserve great credit. I pay tribute to those who have been members of the Welsh Hospital Board, those who have worked in the hospitals and those who are now joining them from the local authorities and last, but certainly not least, those who have worked in the Welsh Office, which is responsible.
It is for that reason, and not just because I have answered this debate, that I repeat the expression of my great pleasure in being able to pay this tribute to the hospital service in Wales.