It is now just over 13 hours since I came to the Chamber. It has been a long wait to be 13 hours early after having been a few seconds late before.
I welcome the opportunity to discuss the proposed closure of the Carrickfergus and Smiley hospitals, in my constituency, and the implications flowing from that.
In answer to recent questions to the Secretary of State for Northern Ireland, I have been informed that the highest concentration of heavy industry in Northern Ireland outside Belfast is in the constituency of Antrim, East, which I am privileged to represent in this House.
Antrim, East has the highest total number of employees in energy and water supplies industries, extraction of minerals and ores, manufacture of metals, mineral products and chemicals, metal goods, engineering and vehicle industries and construction industries of any constituency outside Belfast.
In 1987 approximately 5,500 ships handled imports and exports through the port facilities at Magheramorne, Carrickfergus, Ballylumford and Lame, involving well over 5 million tonnes of cargo. In 1987, there were 5,107 ship visits to Larne harbour, with a total of 1,459,737 passengers and 614,506 vehicles, of which 308,746 were commercial and 305,760 were cars and caravans. There is no record available of the number of vehicles or persons leaving or meeting passengers at Larne harbour.
That information may serve to indicate the reason why there is total opposition by elected representatives and the community as a whole to the northern health board's proposal to build a new area hospital in Antrim, to provide acute services which are already available at Moyle hospital in Larne, backed by the facilities at the Smiley and Carrickfergus hospitals. If those proposals proceed, my constituents will be required to travel 24 miles from Larne, 35 miles from Carrickfergus, 40 miles via Lame from Carnlough, and 37 miles from Islandmagee to Antrim for acute hospital services that are already available and accessible. People in Great Britain do not expect to put up with such inconvenience or to be treated in that way. Is it any wonder that we are saying, "No thank you" to the proposals?
Roman Catholic, Protestant and dissenter alike are saying yes to equality of provision of acute hospital services for the consumers served by the Northern health board. Decisions on future hospital provision and planned closures have been taken by an undemocratic quango. The majority of health board members are accountable to no one—but many are place seekers appointed by a Minister to bulldoze through the decisions of the DHSS. Consultation is meaningless if those who make and take decisions will not listen to reasonable argument and amend policy that is unacceptable except to those in the immediate catchment areas of Antrim and Ballymoney/Coleraine.
In a report in the Ballymena Guardian on 28 April, when asked if the present campaign to try to secure a rethink of the whole strategy will make him change his mind, the Minister replied no. Asked also whether he would change his mind if campaigners succeeded in convincing board members to vote in favour of a rethink, the Minister again replied with a firm no.
Ulster Unionists are constantly accused of saying no, but when a Minister answers no to such questions, that is arrogant and contemptuous of the beliefs of intellectuals, members of the medical profession, experts from outside the health board, and my constituents, who reject what is being forced upon them.
General practitioners in east Antrim almost unanimously reject the proposals for Moyle, Smiley and Carrickfergus hospitals. Is the Minister prepared to ignore those experts on community care, or will he reconsider the ability of Moyle and associated hospitals to provide adequate acute services in east Antrim? The present proposals will never be acceptable in my constituency, and I predict that no elected Northern Ireland forum will fully implement them if responsibility is transferred in the next five years to a democratically elected body there. The Minister may proceed with phase 1 at Antrim, but when the right to take decisions is restored to elected representatives in Northern Ireland there will be no phases 2 and 3.
Does the hon. Gentleman agree that it is a disgrace that within the area covered by the Northern health board there is to be one acute hospital at Coleraine and a heart hospital at Antrim? Only the heart hospital is provided for. Yet in every other area there are more than two acute hospitals, and in many of those areas there is a smaller population. The vast majority of the hon. Gentleman's constituents and of mine will not be given the equality of service that is available in every other area in Northern Ireland. Does he agree with me that this is an example of deliberate discrimination against both Protestants and Roman Catholics in our constituencies? Hospitals are being closed and services are being removed, such as the heart unit at the Ballymena hospital which was made available through the donations of the people. That unit is to be taken away and the people will be robbed of something for which they paid.
I thank the hon. Gentleman for his helpful intervention. I concur with the arguments that he has advanced.
I believe that the Minister is unintentionally misleading when he proclaims that a large high-technology hospital is a necessity for the area. The Antrim hospital will not provide regional specialties under phase 1. Patients will continue to receive these services in the large Belfast teaching hospitals. Professor James McCormick estimates that about 10 per cent. of all ill health requires hospitalisation and that 90 per cent. of all hospital patients can be treated successfully in smaller hospitals. It is reasonable to conclude that only 1 to 2 per cent. of all illness requires the high technology that is already provided in Belfast hospitals. It is widely accepted that patients requiring treatment beyond the capability of their local hospital would request transfer to one or other of the Belfast hospitals rather than to an area hospital at Antrim and would be so transferred.
The proposed Antrim hospital will not provide anything which the existing hospitals, including Carrickfergus, Smiley and Lame, cannot provide. The consultancy skills to be available at Antrim will be the skills of consultants transferred from the existing small hospitals.
It makes no sense to twin phase 1 of the Antrim hospital with the old Masserene hospital at Antrim. It is miles away on a different site where no acute hospital services have been provided for years. In fact, I am deeply disturbed that the logical arguments put forward by Moyle action committee and the Federation of Action Committees have not been given the consideration that they deserve. The alternative plan to the existing proposals would give a fair and equitable provision of acute services to everyone involved. This is the main reason why the action committees have widespread support.
Most districts of Northern Ireland are within 15 miles of acute services. At present, people living in the Antrim district are only 17 miles, of which 14 miles are motorway, from the main Belfast hospitals. Removing acute services from Moyle in Lame would require many of my constituents to travel twice that distance—about 37 miles, of which only a few miles are motorway—along roads that are restricted to single-lane traffic by constant vehicle movement to and from Larne harbour.
The proposed Antrim hospital puts the whole of east Antrim outside the 15-mile norm for access to acute services. My constituents will suffer most from a gross reduction of hospital services for the most heavily industrialised constituency outside Belfast with the second largest port in Northern Ireland. Is this progress that is being proposed, or is it madness?
We do not object to equal provision of services for the needs of people in Antrim, but it must not be at the price of reduced services in east Antrim, where the hospital needs of everyone are now met. I challenge the Minister tonight to spell out what is to be gained by providing phase 1, with 300 beds at Antrim. The existing consultants are to be transferred there. The existing equipment and facilities are adequate to meet the needs, and nothing additional by way of services available at present is to be provided.
The scheme for the Northern health board area which the Minister inherited from his predecessors at the Department of Health and Social Services is a waste of public money. The Minister should arrange an independent appraisal. I ask him to invite the Select Committee dealing with health matters to visit Northern Ireland and carry out an appraisal of the existing provision, to invite consideration of the alternative put forward by the Federation of Action Groups and even perhaps to invite the Public Accounts Committee, with its expertise, to help by carrying out an appraisal of the expenditure proposed in the Antrim complex, rather than an inquest after irreparable damage has been done to hospital services in my area.
Let me quote briefly from the report of the Royal Commission that examined the National Health Service in 1979:
Acute hospital services are generally excellent, most of them provided by peripheral teaching hospitals, often in old buildings, ungenerously staffed…It should not be assumed that because a building is old it is unsatisfactory—the UK is not so wealthy that it can afford to scrap perfectly usable hospitals merely because they are old".
That was nearly 10 years ago. Moyle, Smiley, Carrickfergus and many other small hospitals have been upgraded, adapted and extended, and adequately serve the needs of the Northern health board. They would get glowing reports today from a Royal Commission. Some
£3·5 million has been spent on the Moyle and Waveney, £4·4 million will be spent on Whiteabbey and Mid-Ulster, and then they will be downgraded if the proposals for Antrim are fully implemented. Some £40 million will be spent on phase 1 at Antrim, unwanted by the majority of those in the area that is to he affected. Much less expenditure—about £25 million, we believe—could fully repair and modernise hospitals at Waveney, Moyle, Mid-Ulster and Whiteabbey.
The proposal to amalgamate Ballymoney and Coleraine on a new green field site seems reasonable for that area, but the proposed downgrading of all hospitals in my constituency, including the closure of Smiley, an essential part of the Moyle complex and Carrickfergus, is unreasonable.
Constituents ask whether the Government and Northern Ireland Office Ministers really care. I hope that the Minister will show tonight that he cares by indicating his willingness to look at representation beyond the ministerial brief offered by officials who have got it partly wrong this time. Two acute hospitals, as the hon. Member for Antrim, North (Rev. Ian Paisley) has already pointed out—an incomplete hospital at Antrim and another at Coleraine—will not be able to provide acute services for the whole Northern board area. Can the Minister assure us that the Eastern health board will provide acute services in the Belfast hospitals for 90,000 people and that the Southern health board will provide them for 20,000 from the Northern health board at the South Tyrone hospital in Dungannon? If the Eastern and Southern boards cannot provide for those 110,000 people, the concept of two acute hospitals is undermined and the alternative hospital proposals are more realistic.
The Moyle action group and others active in the Federation of Action Groups have still to be convinced that their proposals do not stand up to any reasonable scrutiny. They have commissioned a report by a highly respected former employee of Coopers and Lybrand. Will the Minister promise to examine the report carefully—it should be with him in a very short time, if it is not already —and take a new look at the suggestions put forward by the action groups on behalf of the people of my constituency before committing himself publicly to a full-blown phase 1, 2 and 3 hospital at Antrim?
The new career structures for junior doctors that are under consideration should provide adequate staffing for the smaller hospitals. The main teaching hospitals in Belfast must be more closely linked to the smaller hospitals providing acute services that would enable junior doctors to be allocated from a central pool in Belfast to any hospital in the Province when the need arises.
The community hospital concept has not been taken up and developed widely in Great Britain. This out-of-date concept, rejected on the mainland, should not be forced on the people of Northern Ireland. There is an opportunity for the rationalisation and modernisation of hospital provision for acute services that would attract increased support. There is overwhelming opposition from general practitioners, nurses, trade unionists, industry, elected representatives and the public as a whole. Alternative provision provides value for money and will have widespread support.
Will the Minister please further examine his Department's and the Northern health board's proposals? Has he considered the implications for the new Antrim hospital if patients are given the right to choose, which is very good Conservative policy, and they decide to take the monetary value of their operation to a hospital other than Antrim? Or shall we continue to be lectured and dictated to by those who think that they know what is best for us and who are unwilling to listen to reason and to engage in constructive dialogue?
I hope that the Minister will again accept the detailed documentation from Moyle and retain it in his Department for further consideration in relation to all those areas that will be more than 15 miles away from acute services based on an Antrim hospital now satisfactorily served by existing east Antrim hospitals. I am sure that we all aim to achieve what is best in the provision of acute hospital services for the Northern board area and at the same time have value for money, co-operation and widespread acceptance.
For those reasons, I oppose the proposed closure of Smiley and Carrickfergus hospitals in my constituency and the planned run down of acute services in east Antrim.
I am sure that the hon. Member for Antrim, East (Mr. Beggs) regrets as much as the rest of us do the 20 seconds delay that he experienced a fortnight ago in coming to the House, which has resulted in the rest of us being here for the last 14 hours. I am pleased that the hon. Member for Antrim, North (Rev. Ian Paisley) is in his place. I know that he has a close interest in the subject that we are discussing.
The hon. Member for Antrim, East rightly pointed out that I inherited the Antrim hospital proposals. They were far down the track when I arrived on the scene. I considered them carefully and, for reasons that I shall give the House, I decided that it was right to proceed with them. When I answered the questions of the hon. Members for Antrim, East and for Antrim, North, no and no, it was because the time had passed. The ship had left port, the rocket had left the launching pad, and, millions of pounds had been spent on the design project for this fine new hospital. It is now in the process of going to tender and it will be built. The question is, why is it to be built, and why is it to be built there?
As to why it is to be built, I accept that small, acute hospitals have had a remarkable history in Northern Ireland, particularly in the Northern board area. In the last century hospitals were built within one day's walking distance from where anybody lived in the Northern board area. They were run by dedicated surgeons who were capable of dealing with every aspect of surgical technology and surgical practice as it existed in those times.
As the hon. Gentleman knows, that is no longer true. On a recent television programme one of the councillors at Cushendall, in the constituency of the hon. Member for Antrim, North, said that he sat in his front room and looked out of the window and that if he ever had a coronary he could go up the road to the hospital. Unfortunately, if he went up the road to the hospital, when he got there he would find that no one was manning it and that the equipment there probably would not save his life. That is no reflection on the people. The technology just does not exist.
In the Northern board area we have to concentrate acute facilities in places of excellence that are properly manned and have the very best equipment and to which we can attract the best staff. We must ensure that there are community hospitals to which people can go for geriatric care, for community care, to be attached to health centres or to have minor operations. All those facilities must be available so that people can go into acute care for a short time and then go back to their community hospitals.
Let us consider the example of Ballymena. At their own expense the people of Ballymena opened up a very valuable heart department. As the Minister knows, the people of Ballymena can walk to the hospital if they have heart trouble. The record of the Ballymena heart ward is outstanding. That will be taken to Antrim, away from Ballymena. Is it fair that the people who have paid for and helped to run the specialist heart ward at the Ballymena hospital should be robbed of it? The people of Antrim did not pay for it.
I understand the hon. Gentleman's point. I have been to that coronary ward. There is nothing finer in terms of the dedication of the staff, the care and the equipment, but the hon. Gentleman must be the first to admit that the building is old and in an unsatisfactory condition. I believe that when those who work there see the facilities that will be produced in Antrim, they will welcome that opportunity. The hon. Gentleman asked how people would get there. The answer is that it is crucial that we have an ambulance service with all the right equipment to make sure that they get to Antrim as quickly as they possibly can.
The hon. Member for Antrim, East referred to the roads in Northern Ireland. I have some sympathy with the points that he raised, but we are building a dual carriageway to make sure that they will be able to get to hospital that much quicker.
I believe that we need a new acute hospital in the central and southern sectors of the Northern board. The hon. Member for Antrim, South (Mr. Forsythe), who is not here this morning, believes that it should be at Antrim, as do the friends of Antrim hospital and the Antrim council. The hon. Member for Antrim, North would prefer it to be at Ballymena and the hon. Member for Antrim, East would prefer it to be at Lame. Wherever we put it, it will not get universal approval. If one considers the long-term need for a major acute facility—and the Northern board has considered the matter very carefully—it has the delegated responsibility for such matters. It does not consist of my puppets, and I am sure that, on reflection, the hon. Member for Antrim, East will realise that. I know that the hon. Member for Antrim, North has been to the board and discussed the matters with the officers and the chairman and has had a very full briefing.
While I understand why, from a constituency point of view, the hon. Member for Antrim, North would prefer it to be in Ballymena and the hon. Member for Antrim, East would prefer it to be in Lame, I believe that the Northern Board has reached the right decision. I do not believe that we can continue with very small acute hospitals because we cannot staff them. There are already problems in the Southern board area, where large acute hospitals cannot adequately staff emergency units. In Downpatrick there are major problems with attracting and keeping staff because they want to work in major acute centres of excellence that will help them get on in their careers.
I know that the Minister does not want to mislead the House. No one knows the geography of Antrim better than the hon. Member for Antrim, East (Mr. Beggs) and the Minister himself. He well knows that Ballymena is the middle. He said that Antrim was central, but it is not. It is the southern extremity. So why not put the hospital there? There was no opposition from Lame when the decision was made that the Waveney hospital was to be the central hospital. It was to have an acute service to provide the necessary balance. Now all the acute services are being taken away and concentrated in the northern periphery.
I understand the hon. Gentleman's point. We have debated it at length, mainly in the columns of the newspapers, and not, unfortunately, until this evening in the House. In view of the geography of the Northern board area and the potential of phases 2 and 3 that are to follow, the greenfield Antrim site is the most sensible place. We can get people from Lame and Ballymena there and look after them in the finest possible way.
The main points of the debate are Smiley and Carrickfergus, about which I have not yet made a decision. I have listened to the points made by the hon. Member for Antrim, East and I shall be in a position to come out with a decision early next week. I am confident that I have the information that I require to make that decision. I see no need for a public inquiry. I have taken into account the opposition to these closures. The hospitals may well be able to be closed and transfers take place to the Moyle. That will not affect the quality of service that the people there will get.
It is right to ensure that there are proper-sized units for obstetrics. We can go forward with Antrim and the rationalisation of acute care in the Northern board area. That will provide the constituents of the hon. Members for Antrim, East and for Antrim, North with a better and more professional service than they are receiving now.