In many ways this is a follow-up to the Adjournment debate of last December initiated by our former colleague, Sir John Eden, in which he highlighted the ever longer waiting time faced by our constituents in the east Dorset health authority for urgent orthopaedic surgery.
Tonight presents me with an appropriate opportunity to pay my own tribute to Sir John for his long service to Bournemouth as well as his distinguished service in Government to the country, and to thank him for his many kindnesses and his friendship during my five-and-a-half years in the House. I wish him every happiness and health in his new activities and his retirement.
My hon. Friend the new Member for Bournemouth, West (Mr. Butterfill) has just joined me, and I understand that he hopes to catch your eye, Mr. Deputy Speaker, after I have sat down.
In Sir John's Adjournment debate last December, my hon. Friend the Member for Hampstead and Highgate (Mr. Finsberg), then Under-Secretary for Health and Social Security, referred to the hopes that the health authority would be able to commence the construction of a new two-phase, 670-bed district general hospital at Castle Lane in my constituency. A categoric assurance that the building of this hospital will commence as planned by the authority next January is the main purpose of this debate.
In this respect, the debate could not have been better timed, because three weeks ago a health authority spokesman said that the authority was expecting my hon. Friend's Department—I congratulate him on his new appointment — to announce this month that the first phase of the hospital, with 281 beds, four operating theatres, X-ray departments, diagnostic facilities and residential accommodation for nurses and staff, would go ahead as planned.
This would enable tenders to be invited this month for a start in the new year, with completion by January 1987. There was every reason to believe that that announcement would be made last Friday, but as my hon. Friend will know, it was not. I hope that he will explain why. Better still, I hope that he will use this opportunity to make that announcement.
I must tell my hon. Friend in no uncertain manner that if the Castle Lane hospital does not proceed in the new year, as planned by the health authority, the Government will incur the wrath not just of my constituents but those of my hon. Friends the Members for Bournemouth, West, Poole (Mr. Ward), Christchurch (Mr. Adley), Dorset, North (Mr. Baker), and Dorset, South (Viscount Cranborne) — the areas to be served by the hospital when it is completed — as well as that of the entire medical and nursing staff who strongly believe that this area had been scandalously denied the proper facilities and resources to match local needs.
Castle Lane hospital has been promised for well over 20 years. When I was first elected as the Member for Bournemouth, East in a by-election in November 1977, the start date for the hospital was then expected to be 1979–80. I suspect that if it had not been for the cuts in the hospital building programme that were made by the then Labour Government, the first phase of the hospital would have now been opened. Changes in national hospital building policy and resource assumptions and objections by the authority and local medical staff to national standard design solutions have all contributed to delay in the submission of the present plans to the Department.
During the past seven years, the authority has understandably been reluctant to use capital resources to develop services in existing hospitals which would have become obsolete. This means that existing facilities are having to cope with demands for which they were never designed or built. The crisis will remain until the second phase of the new hospital is completed in 1990–91, according to existing health authority plans.
The authority and its acute services will be facing major problems over the next few years due to pressure on existing facilities and the ever-increasing demands of a rising and elderly population. There will not be enough hospital beds in Bournemouth and Poole to cope with the increased population that is anticipated and planned for the rest of the decade.
It was because of this crisis that last Friday the health authority discussed a number of complex options, including the reopening of a 15-bed ward at Christchurch hospital in four months' time. It is planned that the ward will be used mainly for orthopaedic patients who need physiotherapy. The options are designed to reduce the hospital waiting lists for operations, to which Sir John Eden referred and highlighted in an Adjournment debate in December 1982, and especially to provide short-term relief of the pressure on trauma beds in Poole hospital.
The situation is so acute at Poole that those who have been on the waiting lists have had to telephone the hospital on the morning of admission to check bed availability. It is not unusual for patients to face postponement on at least three or four occasions due to trauma overflow. Between January and April 188 operations had to be postponed at Poole hospital. Similarly, waiting lists for orthopaedic surgery at Christchurch hospital have often been postponed. Boscombe hospital has had to accept additional acute admissions despite its cramped space and old buildings.
The fiddling around with limited resources to produce stop-gap schemes is the cause of great frustration and concern to the medical and nursing staff, which understandably feels that the Department has failed to appreciate the problems that are facing the area. It is an area in which there are 93,000 people over the age of 65 years. That is nearly a quarter of the population and is one and a half times more than the average over-65 population. The area has more than twice the average level of people over the age of 75.
I should like to know whether these factors are given the special recognition that they deserve in the existing allocation of resources. I must tell my hon. Friend that we in Bournemouth do not think that they are. We regard the east Dorset district as one of the most underfunded districts in the Wessex region, which itself is an underfunded region in accordance with the RAWP formula.
I hope that my hon. Friend will be able to assure the east Dorset district that it will benefit in real terms from the increase of 1½ per cent. that my right hon. Friend the Secretary of State so recently announced would be available to the Wessex region. If it is so to benefit, the district will be better able to cope with the crisis that it will have to meet for the rest of the decade. Such an assurance will be extremely useful for all Dorset Members when they meet the health authority chairman and officers on Friday.
I wish to emphasis that such extra resources may make all the difference in finding a solution to another inadequacy that has long been a source of contention and concern among my constituents—the establishment of a seven-day, 24-hour casualty service at Boscombe hospital. This was the subject of a report published last month by the east Dorset community health council, which has published reports on the inadequacy of the accident service in its district almost every year since 1977.
Until recently, emergency cover at Boscombe hospital has been restricted to between 9 am and 4 pm between Monday and Friday, so that every night, every weekend and every bank holiday there has been no local cover. Someone who has sustained an accident that is not regarded as a medical emergency has to endure a long and painful journey, through congested town centres, to the Poole casualty hospital.
This is not the first time that I have referred in the House to the traumatic experience that my wife had in 1978, shortly after we moved into the constituency. She was carrying our son, who was then 12 months old, and tripped and dropped him on a stone path. As he was stunned, she took him to Boscombe hospital, where because it was nearly 4 pm on Friday, it was closing time for the casualty, which, anyway, had no X-ray facilities. The hospital advised her to take him to Poole hospital, to which she drove in despair in rush hour traffic, taking more than half an hour. That is an experience that has been shared by too many of my constituents and visitors to Bournemouth for too long.
I know that since May of this year, the minor casualty unit hours at Boscombe hospital have been extended to 7 pm Monday to Friday until September, but that is not good enough for a major holiday area such as Bournemouth. I hope that we shall hear tonight that support resources will be made available for a full day and night service, seven days a week at the Boscombe hospital, as the community health council has been urging with the full public support of my constituents.
I am grateful for the opportunity of supporting that which has already been said in the House by my predecessor, Sir John Eden, and that has again been brought to the attention of the House this evening by my hon. Friend the Member for Bournemouth, East (Mr. Atkinson).
The people of Bournemouth legitimately feel that they have been neglected for far too many years. As my hon. Friend told the House, the site for the hospital has been available for 20 years, and repeatedly, assurances have been given to the people of Bournemouth that the new hospital will be built "in the near future". However, this has not happened, despite the fact that new hospitals have been built in places such as Basingstoke and there has been a major hospital extension in Southampton. There is a justifiable feeling of grievance among the people of Bournemouth that they have been overlooked when their need is obviously so great.
Many consultants at the hospitals in Bournemouth, and particularly the Boscombe hospital, have made heartfelt complaints to me about the conditions under which they are being forced to work, and have told me of the danger in which critically ill patients have been transferred by a long and difficult road journey to Poole hospital, sometimes at severe risk to their lives. This cannot be permitted to continue, and I urge the Minister to give us the assurance that my hon. Friend the Member for Bournemouth, East has requested this evening.
Only this week, I had a letter from one of my constituents who lives in Bournemouth. She is extremely disabled, and it is extremely difficult for her to travel, but she had to travel to Christchurch to obtain medical treatment. She was transported there by ambulance. Due to the traffic conditions at that time of year when Bournemouth has many welcome visitors, she could not complete her journey in time for her appointment. When she arrived, the surgery had finished and she was then forced to travel in considerable discomfort to her home, having spent an entire morning travelling to and fro without receiving any treatment. The position is quite intolerable and must be remedied with all possible speed.
I congratulate my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) on securing this debate and on vigorously raising once again the issue of hospital services in his constituency. The critical question is whether the health authority can now invite tenders for the new district general hospital at Castle Lane, Bournemouth. My hon. Friend has been pressurising my Department, and my predecessors, for a considerable period. I thank him for his congratulations on my transfer from Stormont Castle to the Elephant and Castle. It sometimes takes considerably longer to get to the Elephant and Castle than it did to get to Stormont Castle.
I certainly appreciate my hon. Friend's long standing interest in health care and the well-deserved compliments that he paid to Sir John Eden, who served Bournemouth, West for so long and in such a distinguished manner. By becoming an hon. Member of the House at such a young age, he was able to retire with many years of honourable service behind him but with enough years ahead of him for one, two or three more careers. I was also extremely pleased that my hon Friend the Member for Bournemouth, West (Mr. Butterfill) was fortunate enough to catch your eye, Mr. Deputy Speaker, and to raise points about the needs and interests of his constituency. Having heard my hon. Friend briefly speak today, I am all the more sorry that I was not in the Chamber when he made his maiden speech on the Second Reading of the Housing and Building Control Bill.
The critical issue is the new district general hospital. My hon. Friend the Member for Bournemouth, East said that this hospital development has been waited upon for a long time. It has been given the highest priority in the district's plans and a high priority by the regional health authority. I understand that it is hoped to start work on the new hospital in January 1984. I stress the word "hoped". In view of the recent statement on 7 July by my right hon. Friend the Chancellor of the Exchequer about necessary adjustments in public expenditure in the current financial year, spending Departments, of which the DHSS is one, are having to reconsider their priorities. This means that we shall have to review our spending plans to assure ourselves that they are still feasible. Accordingly, regional health authorities have been asked to review their plans in the light of the new cash limits for 1983–84 and to start planning ways in which they can bring their proposed expenditure for this year into line with these new cash limits that restore our cash balance. My right hon. Friend the Secretary of State has decided that the overall adjustment will be made on a pro rata basis among the 14 regional health authorities. I am glad to reassure my hon. Friend the Member for Bournemouth, East—although on precious few other points — that the original differential effect of this year's cash limit will be maintained. My hon. Friend can be reassured that the position of Wessex relative to other authorities will not be affected by the revised allocation.
Clearly, regions will need time to look at their overall programmes in the light of their revised allocations and of their own, perhaps revised, priorities and to decide how that will affect their districts in turn. So a decision on whether tenders can be invited on the Bournemouth hospital scheme will have to be deferred for a little time yet, but I can assure my hon. Friend that there will be no unnecessary delay. I thought it important to point out the context in which that unfortunate and difficult decision had to be taken.
I know that my hon. Friend has been concerned about delays on this development in the past. I believe that plans for a new hospital in Bournemouth were first mooted as long ago as at the end of the last war—even longer ago than my hon. Friend suggested. I understand that my hon. Friend is already well aware of the history and reasons for the delay. These were set out in a letter to him from the district administrator on 6 January 1983. I will not trouble the House by running through them all again now, but, while I understand the feelings of frustration that local people have obviously felt at times. I should like to mention a couple of points that have been important in the history.
First, I am sure that my hon. Friends and their constituents must feel pleased in retrospect that the original plan for a huge 900-bed development did not go ahead. Present policies for hospital building reflect the general view that relatively smaller central district general hospital units providing a range of specialty services, supplemented by "satellite" hospitals strategically placed elsewhere in the community, are better able to meet local needs.
Secondly, the Wessex regional health authority overall has had to cope with a poor stock of hospital buildings. That has long been recognised by my Department and the region has been receiving an above-average capital allocation to help improve matters. The Bournemouth scheme has had to compete with several other badly needed new hospitals in the region's capital programme, and, although I recognise that this will be no compensation for residents in Bournemouth and the surrounding areas, the region as a whole has achieved a great deal already in improving its hospital provision. I hope that that is recognised locally.
New hospitals include the prestigious Southampton district general hospital, which provides teaching facilities for the whole region and from which east Dorset, too, can benefit. There is also the existing district general hospital in Poole in the eastern sector of the east Dorset health authority. So the district is not doing badly, although I am the first to admit that Bournemouth has not done well.
I do not underrate the pressures on services in Bournemouth and in the district as a whole produced by the necessary provision for elderly people. The plans for the new district general hospital would increase the provision for geriatric patients in the district. They also include the provision of new accident and emergency facilities.
In answer to the direct question of my hon. Friend the Member for Bournemouth, East, we take into account in the planning needs of the region, if not the district—the region determines the districts' allocations — the numbers of those over 65 and, increasingly, the numbers over 75 and 85 in our increasingly ageing society, with all the pressures on the public purse that result from that.
My hon. Friend asked about what will happen until the hospital is built and about the problems of providing adequate emergency care in the area. I appreciate that the district and its acute services face significant problems over the next few years because of pressure on existing facilities and the ever increasing demands of the rising elderly population. No significant additional resources will be made available before the second—and final—phase of the Bournemouth district general hospital is operational. It would be foolish to hope for more than that. Capital and revenue will of course be in short supply in the district and so interim relief on hospital services will have to be achieved at minimum cost.
I know that the DHA presently is considering this matter and various options to rationalise its acute services. It is a matter for the DHA. It would not be sensible for Ministers to become involved in such issues, in detail, particularly as one of the objectives of the 1982 Health Service reorganisation was to establish locally based health authorities to respond to locally expressed needs and be in tune with the needs of the communities that they serve. My hon. Friend is keeping in touch with the local health authority and its plans. Accident and emergency provision in the area is quite understandably a very emotive topic since until 1975 full accident and emergency services were available in Bournemouth. My hon. Friend has personal experience of what the lack of such services one Friday afternoon meant for him, his wife and young child.
Accident and emergency facilities in Bournemouth obviously need to be looked at in the context of the district's overall provision. Presently the major accident and emergency provision for east Dorset health authority is provided at Poole district general hospital, which has the full back-up facilities necessary to support a major accident and emergency department. This major service is supported by minor accident and emergency and casualty departments at other hospitals within the district.
The criteria for the setting up of a proper and modern integrated accident and emergency department are complex. I do not have the time to outline them tonight, but I shall set them out in detail and send them to my hon. Friends because they are of interest.
The population of Bournemouth is currently served by a minor accident and emergency department at the Royal Victoria hospital, Boscombe. This service is planned to transfer to the new Bournemouth district general hospital once the first phase of the development is completed. Bearing in mind the national policy on accident and emergency services, the district health authority is in no position even to consider reinstating a major accident and emergency service in Bournemouth until the second phase of the new hospital has been completed. At that stage the appropriate orthopaedic and other supporting departments will be available to provide the necessary back-up facilities to a full major accident and emergency department.
I was pleased to note that from 16 May this year the services are opened for a longer period from, 9 am to 7 pm —an extra three hours a day. We recognise the local concern about the accident and emergency services and about the hospital itself. I hope that the Department will be in a position soon to respond to the pressure brought by my hon. Friend. I thank him for raising this important issue this evening.