This afternoon I raise briefly the subject of the future of the Elizabeth Garrett Anderson Hospital in my constituency. I much appreciate the presence of hon. Members on both sides, because I want to make it clear that there is a large measure of agreement about the necessity to ensure the survival of this hospital. If because of the shortness of time I must do less than justice to the subject, I hope that the House will forgive me.
The continuing uncertainty about the future of this hospital is demoralising to the staff and unsettling to the patients. I am sure that my hon. Friend the Minister of State will welcome the opportunity to tell the House something of his plans.
I start by referring to the Early-Day Motion which has now been signed by 45 hon. Members from both sides of the House. In it we say:
That this House, appreciating the unique historical traditions and special services of the Elizabeth Garrett Anderson Hospital, regrets the threatened attempt to close it, having regard both to the wishes of women patients from all over the country and to the oppor-
tunities for women doctors to reach consultant status in this hospital; and asserts the principle in the reorganisation of the National Health Service that small may be good.
The Elizabeth Garrett Anderson Hospital was founded in 1872 by Elizabeth Garrett Anderson, to serve women patients. It was also a place where pioneer women doctors, who were often excluded from other hospitals because of prejudice, were able to work. It remains one of the few hospitals where women can be sure of being treated by women. Some people express surprise that in these liberated days there should still be a demand for such a hospital.
The interesting fact is that the demand is by no means declining. All age groups are represented, together with many Muslim and other women from overseas who have special reservations. Luckily I do not share those reservations. Whenever I have needed the attention of a doctor I have not minded whether it was a man or a woman. I know that my husband's women patients were happy with him, but that does not entitle me or anyone else, least of all the Minister, to interfere with the freedom of choice of patients who wish to be certain of seeing a woman doctor.
The small proportion of women consultants throughout the National Health Service makes it difficult in general hospitals for the wishes of patients in this connection always to be met. In Committee on the Sex Discrimination Bill on 6th May, the Under-Secretary of State for the Home Department, my hon. Friend the Member for Halifax (Dr. Summerskill), said:
Fortunately, as quite a lot of women doctors are available, many women are able to choose to see a woman GP, or to go to the Elizabeth Garrett Anderson Hospital. Such choice is a factor in NHS medical treatment and it will continue to be."—[Official Report, Standing Committee B, 6th May 1975; c. 252.]
I am sure that my hon. Friend would not have given such a categorical undertaking in Committee without consulting her hon. Friend the Minister of State, Department of Health and Social Security.
The demand for the hospital is indicated by the fact that there has been a petition signed by over 20,000 patients. Continuing need is also indicated by the fact that 73 per cent. of the patients come from outside the area. They often travel long distances because they specially want to go to this hospital.
The geographical spread creates an administrative difficulty. The hospital is in the Camden Health Authority area, and it is clearly difficult for Camden to use a disproportionate share of its local budget to finance such a large proportion of patients. However, I am sure that some system of capitation fees or central funding could be worked out. Of course, if the patients did not come to this hospital they would have to go to a hospital elsewhere.
I know that a serious problem has arisen because of the withdrawal of recognition by the General Nursing Council for nurse-training purposes, but I would have thought a more constructive response to the problem would have been to consider the difficulties that the General Nursing Council found and to try to put them right. I understand from the hospital that many of its criticisms have already been met.
It is not surprising that when a hospital has been left for years in a state of uncertainty it may not be up to top-class standards in every respect. In the old days many of the nurses used to go to the Seamen's Hospital to get other parts of their training. However, because of the rigidity of divisions, that hospital happens to be in another area. I am sure that some peripatetic arrangements could be made, as happens in many other hospitals. I am always in favour of a positive response to criticism rather than negative acceptance.
In Early-Day Motion No. 45 we sought to assert the principle that small may be good. I share the feeling that is felt by many others that the real problem as regard the Elizabeth Garrett Anderson Hospital is that it does not fit on the Procrustean bed of the bureaucratic ideal of the National Health Service. It is a small hospital, having 107 beds. It is special and it untidies the pattern.
Business has taken over in too many spheres. Our new hospitals are mostly too big, our new blocks of flats are mostly too tall and our new office blocks are usually too large. Patients from the small, shabby Elizabeth Garrett Anderson Hospital—I am sure that no one will argue about that adjective—may not necessarily want to go to the enormous, shiny, new Royal Free Hospital. In fact, I know that many do not. There is a growing reaction against the concept that bigness is a virtue.
The onus should not be on those who want the hospital to prove why it should continue. It is for the authorities to prove why it should not continue. Unless there is a totally undemocratic and authoritarian régime in the Department, which I am sure there is not, the future of the hospital must be assured. Some of us still think that the purpose of the NHS is to look after patients and that patients have a right to join in decisions about the NHS.
The machinery of the new community health councils was supposed to ensure some element of democracy in the reorganised NHS. I quote briefly from a minute of the Camden Community Health Council, which I am sure the Minister will take into account. It is dated 19th January 1975 and reads as follows:
So long as there exists a demand for certain facilities to be provided by the National Health Service, however irrational, inconvenient or restricted such a demand may seem, it is the duty of the administration to take such a demand seriously and not to dismiss it lightly. It cannot be too strongly emphasised that considerations of conventional economics should not take precedence over the happiness and wellbeing of the patient.
In conclusion, the South Camden Community Health Council asks for an assurance that the hospital will continue to provide full services at the highest possible standard and that the district should meet the increased cost of nursing resulting from the loss of student nurses.
I close my brief remarks by asserting that, as has been made clear, the patients want the hospital to continue, the staff want the hospital to continue and the local community health council is looking forward to its survival. I look forward to hearing good news from the Minister today.
I am grateful to the hon. Member for Holborn and St. Pancras, South (Mrs. Jeger) and the Minister for giving me the opportunity to endorse almost every word the hon. Lady said. It is utterly inconceivable to me, as a member for the London borough of Camden, for this hospital to be closed in International Women's Year. Indeed, I think that the Secretary of State has a moral duty to ensure that she does not sell the pass in this year.
Many of my constituents work in the hospital and many attend it. I have had many representations about its closure. I hope that the Minister will tear up his Ministry brief, which I know will be extremely long and extremely informative. I wish he could read it into the record and tell us that he, as a humanitarian and doctor, will put the patients first and will be happy to upset the nice tidy minds of the civil servants in Alexander Fleming House. The hon. Lady has mentioned the South Camden Community Council. My wife is a member of the North Camden Community Health Council, and I shall make my views strongly known to her. I hope that the bipartisan approach may persuade the Minister not to accept the closure if the area health authority is foolish enough in the end to recommend it.
I congratulate the hon. Member for Holborn and St. Pancras, South (Mrs. Jeger) on the eloquent and forceful way in which she has put the case, and I thank her, as did my hon. Friend, for allowing each of us a moment to take part.
I have a personal concern in this subject, coming from a medical family, one member of which was on the staff of the Elizabeth Garrett Anderson Hospital, altogether for about 30 years. She began as a student and liked it so much that she returned to junior posts and ultimately returned as a consultant and acted in that capacity for over 20 years. She has remarked to me today about the friendliness, the enthusiasm and the skill of the staff at all levels. This is shown, incidentally, by the fact that the last class of nurses who were trained there had a 100 per cent. pass rate.
The General Nursing Council withdrew recognition of the hospital for training purposes. There are a number of reasons why this took place. It was partly because of physical conditions—now remedied—partly for administrative reasons—though these were not expressed—and also because there was not a complete training available. That argument is equivalent to saying that it is no good training anybody at Great Ormond Street Hospital because training is not available there in geriatrics. The staff problems at the hospital are now entirely due to the threat to the future of the hospital and the effect of the withdrawal of student nurses.
I wish to speak for three reasons almost symbolically. First, I am a man. Second, I speak from the Opposition side. Third, I represent a constituency in the Home Counties. Following the Balance of Sexes Bill, we should have a balance of support from both sides, and understand that this is not just an exclusive feminist lobby. Equally, there is concern in all parts of the House, shared by my hon. Friend. Equally, too, there are constituents of many of us many miles from London who have benefited from this hospital and express great regard for it.
Are we, then, with this admirable hospital, founded by the first woman doctor for the exclusive treatment of women, with women staff and women consultants, in a constituency represented by women, in International Women's Year, under a Secretary of State who is a woman, now to witness its closure or demise? Here are seven good, womanly reasons for reconsidering it before we reach some sort of inverted feminine apocalypse. I hope the Government in their own day of judgment in this matter will be suitably mindful of the case for preserving this long-established, widely-regarded, much-loved, uniquely constituted and consistently successful hospital.
Perhaps, Mr. Deputy Speaker, I might just say that I have received many letters from constituents expressing their tribute to the work of this hospital and expressing very great apprehension at the possibility of closure. I therefore support every word that my hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Jeger) has said, and I hope that the Minister will deal with this matter in a successful way.
In responding to the remarks of my hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Jeger), may I say that there are few people whose views I respect more on the health services in the area of London that she represents, with her long history and also the history of her late husband serving in that area. I would therefore be bound to listen very sympathetically to what she has to say.
As I have said before in this House, I am no advocate of size for size's sake. I have been one of the strongest critics of the very large district general hospital. I believe that, even on its merits, there is a very considerable case, let alone the financial stringency, which is forcing us to reduce the size of hospitals.
However, I should also like to say that this is not an issue involving civil servants or bureaucrats in Alexander Fleming House. This issue has hardly come to the Department at this stage. This is a matter which has been currently discussed by the area health authority. The devolved National Health Service has a considerable element of democracy, and I should like it to have a greater element of democracy. I must, however, put to the House that neither my Department nor the Camden and Islington Area Health Authority is in any doubt whatsoever of the historic nature of this hospital or of its widespread support from women's organisations and from individuals of both sexes. The letters which I have had emphasise this.
I have repeatedly emphasised in letters that my right hon. Friend the Secretary of State well recognises the hospital to be of a special character, and has therefore reserved the right to approve or disapprove any proposal affecting its future, so that the ultimate decision will come back to the Secretary of State, and she will be answerable for any decision in this House. I also emphasise that there has been constant discussion in relation to closure. Closure is one of the options that the area health authority has to look at. There are many other options.
The circumstances surrounding any hospital change are due to changing times and circumstances, and that is the case with this hospital. Changed circumstances require reappraisal of the need and of the available resources. We are in the situation in this House where everyone always resents any form of change of use, or closure or even examination.
We shall have to look at many hospitals up and down the country. Some will close. Others will not close. Some will change their use. Others will have no change made. We have to get away from the situation where, just because we open a process of consultation, everyone immediately leaps to the conclusion that that inevitably means closure.
What are the circumstances which have changed? The hospital is now no longer recognised by the General Nursing Council for the training of nurses. The General Nursing Council is an independent statutory authority with an obligation to maintain standards of education, and I am assured that the GNC's committee of investigation examined the matter with the greatest care. However, I understand that the Council of the British Medical Association received representatives from the Elizabeth Garrett Anderson Hospital on 2nd April when this decision was discussed, particularly my hon. Friend's complaint that the decision was reached without consultation with the nurses and doctors of the hospital. The council has agreed to refer the matter to the Central Committee for Hospital Medical Services, which is a sub-committee of the British Medical Association, for investigation.
There are now only seven student nurses at the hospital, and they will finish there on 9th June.
At present, the staffing of the hospital is being maintained by increasing the number of trained staff employed, including some 22 full-time equivalent agency nurses. This will cost an extra £60,000 in a full year, and the area health authority has agreed that the extra cost should be met until such times as the present uncertainty surrounding the future of the hospital is resolved. We are preserving the status quo and not pre-empting the options.
Secondly, the hospital's maternity home now stands some few hundred yards from the new Royal Free Hospital, which is one of the most modern in Europe, whose recent opening with excellent maternity facilities inevitably poses serious questions about the continuance of the home in its present form. Whatever my hon. Friend may say about new hospitals and about what her constituents may feel, this involves considerable sums of money in central London, and there are many other places in the country which would like a hospital like the Royal Free established in their areas.
Lastly, a not inconsiderable sum of money will be required to refurbish the present building of the Elizabeth Garrett Anderson Hospital to maintain and modernise its facilities. The site of the hospital is restricted, and, therefore, there are limits to what might be achieved on its present site, even if some of the ward space were to be sacrificed.
In the light of these altered circumstances, I believe that it is wholly reasonable for the health authorities to be looking at the options. The Camden and Islington Area Health Authority is the authority which administers the hospital. It is now examining the situation before making proposals to the Department through the regional health authority.
Is any thought being given to the problem confronting the area health authority in having to look after so many patients who come from a wider catchment area? That is the nub of its difficulty.
I am happy to deal with this point. Although the Elizabeth Garrett Anderson Hospital is often claimed to be a national hospital on the ground of the national nature of the service that it provides for women, there are undoubtedly too few women doctors, and my right hon. Friend and I are strong proponents of getting more women doctors. However, regardless of the national character of the hospital, the service that it provides is far more regional. Although only 27 per cent. of its patients may come from within the Camden and Islington area, 84 per cent. come from London postal districts, with the overwhelming majority from north of the Thames. In fact, 98 per cent. of the hospital's patients come from South-East England. Here, I emphasise that the current resource allocation takes into account the provision by the health authority of the hospital's services to those coming from outside its own boundary. So it is not financial pressures alone which make the authority feel that it must close or make a change of use.
I should like to explain the steps that we envisage being taken to bring the current discussions to a satisfactory conclusion. Informal discussions were held. The area health authority has now advertised widely for opinions to be expressed to it. Invitations have been addressed to the medical staff of the hospital itself, the South Camden Community Health Council, the staff associations and unions involved, Members of Parliament, the district management team and the London borough of Camden, amongst others. Replies have not yet been received from all those canvassed. However many opinions have been expressed to my right hon. Friend, and I am aware of the motion on the Order Paper and the pleadings of members of another place. The area health authority will also be aware of these opinions. This process is the first step in what is a detailed and democratic decision. I now expect the area health authority to consider all the opinions which have been expressed and to make recommendations.
It is obviously better that in the first instance an attempt should be made to reach a democratic conclusion acceptable to the constituents of the hon. Gentleman, to the staff of the hospital and to the area health authority. They may be able to resolve the issue amongst themselves before it needs to come either to the regional health authority or to me. If my right hon. Friend receives proposals—I do not think they are likely to appear until the late summer—consideration can be given to the effect of them in the light of the level of overall national resources.
My right hon. Friend knows well the serious economic difficulties in which the country finds itself and the problems facing health authorities. We are trying to make difficult choices. I cannot exempt one hospital without at least allowing the area health authority to examine the proposal first. I think that it would be wrong for me to say "Hands off this hospital "if an area health authority wanted to look at the option seriously. I am not prepared to do that.
In the present climate of opinion we must look at all the options. It is not only a closure option which is being considered. The most ambitious option would be a complete rebuild. The restrictions on what can reasonably be afforded in the years ahead are of great concern to Ministers. We must weigh the balance of special facilities, historic hospitals and the real affection and understanding which the EGA has evoked in the minds of many of the people who have made representations to us. It is against that background that we shall assess this decision.
I should like to enlarge on the question of treatment of women by women. I confirm that the statement in Committee was made as a result of discussions between the two Departments. The complexity of medical care and the ever-increasing recognition of the interdependence of the various branches of medicine in the treatment of individual patients have dictated an emerging pattern of hospital services where single-speciality hospitals are tending to be replaced by a district general hospital complex operating from a single building or at least from an integrated complex of separate buildings.
The most appropriate treatment and care of the patient, combined with the most economic use of precious resources, does not always mean large hospitals. It means looking at hospital facilities as a complex.
It is not possible to guarantee in the National Health Service that patients being admitted to hospital can designate the doctor who is to treat them. Nor is it possible to guarantee that such a patient can be seen by a doctor of one sex. To attempt to achieve that would mean discriminating between the sexes in appointments to hospital posts, and it would require doctors of both sexes to be constantly available to deal with emergencies. Nevertheless, efforts are made to meet the susceptibilities of individuals or groups in so far as that may be done. Of course, we must try to give as much degree of choice as possible. Of course, if there are women doctors of the relevant specialty and patients want to see a woman doctor on conscientious or other serious grounds they would normally be given every possible facility to allow them to do so. That is nowhere near as easy as in a hospital which is specialised and where it is made clear that it will be staffed by women doctors and women staff.
Similarly when demands come from religious or ethnic groups or from women's organisations, the health authorities will no doubt be willing to consider notifying such groups of the names of hospitals within their districts which have women doctors and notifying general practitioners of the names of hospitals having women consultants to whom women patients can be referred if they so wish.
I want the utmost variety of treatment to be offered in the health service. Some time ago I championed in debate the cause of privacy in the health service. I cannot champion the cause of the ability to choose our own doctor, because one of the resources which we must nationalise, I fear, is scarce skills.
Some time ago the question of the Bearsted Memorial Hospital was raised. There were special ethnic and religious factors involved there. We tried to deal with that difficult problem as sympathetically as possible.
With regard to the provision of special single-sex hospitals for women, we are aware that the Elizabeth Garrett Anderson Hospital provides a unique service to women who wish to be treated by women only. However, it has only 107 beds and the service that it provides is almost entirely restricted to London and the South-East. Within that framework it provides a facility which is clearly much valued.
I have explained the balance which will have to be set. My right hon. Friend the Secretary of State is most sympathetic to the aspirations of women. Indeed, in this International Women's Year she is co-chairman of the Women's National Commission, and she champions the interests of women. However, she does not champion the interests of women to the exclusion of any rational discussion of the problems faced in the Elizabeth Garrett Anderson Hospital or in any other area. Indeed, I think that we should do a disservice to women's interests if we were so sensitive as not even to be prepared to look at the issues in a rational and sensible way.
That is all that is being done at present, and I am confident that a solution will be found which will balance the needs of women in the area, the historic position of the EGA and, above all perhaps, the requirement of the National Health Ser- vice to try to reflect as much diversity of treatment as it can afford.
Those are the problems we face. The representation made in this debate will be one of the factors which I shall draw to the attention of the area health authority. But I counsel a certain forbearance, and I think it reasonable for me to ask that the authority be given time to look at the matter in a sensible way, without anyone thinking that decisions have already been made or that any preconceptions will influence the eventual choice.