Prince of Wales Hospital, Rhydlafar

Part of the debate – in the House of Commons at 2:04 am on 3rd May 1989.

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Photo of Mr Rhodri Morgan Mr Rhodri Morgan , Cardiff West 2:04 am, 3rd May 1989

I am grateful that Mr. Speaker has seen fit to let me raise the question of the closure of the St. Nicholas children's ward at the Prince of Wales orthopaedic hospital in Rhydlafar in my constituency. This Adjournment debate is taking place in the early hours of what is an historic morning—in more ways than one, perhaps. It is a rather late hour at which to discuss a matter of such concern and it gives a new meaning to the phrase "five o'clock shadow".

The matter is of great importance, not only to my constituents but to those who live in the surrounding counties of Mid Glamorgan and Gwent. If the closure goes ahead, it will mean that children requiring orthopaedic surgery will not receive the standard of treatment that they deserve this year and in the years ahead. In order to determine the exact reason for the announcement about the ward closure and to understand the absence, as yet, of a statement about alternative provision, we need to look at the background to this year's financial provision for the South Glamorgan health authority which controls the hospitals in the county, part of which I have the honour to represent.

This year late notification about funding for the present financial year was given to the county by the Welsh Office. The county received that notification only in February. The funding meant that the county had to make savings on its budget of £2·3 million, or 1·3 per cent., and had to find those savings in the short time between February and March. All the unit managers were asked desperately to suggest ways in which they might contribute to those savings. They saw an impending financial crisis, given the few weeks that they had to try to find the savings.

The general manager of the area health authority, Gordon Harrhy, was interviewed on Radio Wales, and was asked what he thought about the budget allocation received from the Welsh Office. He said, "It is very interesting to me. I have frequently listened to Government spokesmen saying that each year the Health Service receives an increase in real terms. I am the manager of the health authority and I know that I have less money in real terms and less to spend in 1989 than I had in 1988."

The process by which the recommendations for savings were brought before the authority for acceptance or rejection took only a few weeks. The relevant proposals were put before the authority at its monthly meeting in March and confirmed at the April meeting. The savings package included weekend closures at the University hospital, the closure of a rehabilitation ward also in my constituency at Rookwood, and certain other smaller miscellaneous savings.

The one saving that brought the greatest calumny on the Government's head and on the head of the health authority was the proposal to close the children's ward at the Prince of Wales hospital, Rhydlafar. That hospital will always be known to the natives of Radyr, where I grew up, as the American hospital. It was the nearest hospital to the village of my childhood, and was built during the war for the American service men and gradually converted in the early 1950s into the primary orthopaedic hospital for south Wales and, with Oswestry, is one of the only two orthopaedic specialist hospitals serving the whole of Wales.

There is no question but that the March decision was a bombshell. All the operating theatres were new and had been opened only last August at a cost of £750,000. They are next door to the children's ward and there is a proud plaque on the side of the new operating theatre which says that it was opened by Alun Jones, chairman of the health authority, in August 1988. The Welsh Office paid for that, as it had paid £3 million to £4 million for the upgrading programme for the Prince of Wales hospital after the reversal of a previous decision for the closure for the whole hospital. That closure had been announced by the previous Secretary of State for Wales, Nicholas Edwards as he then was, in 1982.

The savings that would be achieved amounted to £40,000, and the total savings required were £2·3 million. No more than 2 or 3 per cent. of the total savings would come from the closure of the children's ward. However, the authority decided to proceed, although it was faced with misleading medical and financial statistics. Those of us who have been involved in the campaign to reverse the decision have had no hesitation in saying that the health authority based its decision on the papers which were put before it at its March monthly meeting, which were the result of those statistics.

The authority was told that it would save £47,000. Omitted was the fact that the education authority paid £7,000 towards the cost of the school. It is the only school in the hospitals within south Glamorgan that covers the five to 16-year age group. It is possible for someone within that group to do his or her O-levels or GCSEs at the hospital. That is more likely to be of importance to children requiring orthopaedic surgery than those needing general medicine because they have tended in the past to spend extremely long periods in hospital. Even today, children needing orthopaedic surgery may spend six months in hospital, notwithstanding the wonderful technology for correcting length of limbs and club feet, for example. Patients still spend a much longer period in an orthopaedic hospital than they would for most forms of hospital treatment. As I have said, there is a school provision, which is paid for by the education authority.

It is important that there were misleading medical statistics. In effect, the authority said, "We are going to close the children's ward because it is under-used. It is occupied for only 47 per cent. of the time that it is available for use." It is a 12-bed ward. The medical staff at the hospital keep its records carefully. It found that, if midday bed occupancy was taken into account, there is 65 per cent. occupancy. The staff say, for sound medical reasons, that midday occupancy is much more relevant than night occupancy. Children who require orthopaedic treatment are not ill in the conventional sense. They are not suffering from an infection, a fever or any recognisable illness. If it is possible for them to go home to be with their family, or even to attend school, they should be sent home overnight, to return the following day for their treatment. The midday count is the relevant one. The difference between 47 per cent. and 65 per cent. is relevant, because 75 per cent. is for all practical intents and purposes the maximum bed occupancy for a children's ward.

What else was wrong with the way in which the health authority went about its decision making? Most people were appalled that it was willing to announce closure of a children's ward without being able to say with any confidence that there was an alternative for the provision of orthopaedic surgery for children. In other words, it claimed that there were several options. What were they? One option was a move to the Coronation ward of the Cardiff Royal infirmary. The infirmary is in the constituency of the Under-Secretary of State for Wales, the hon. Member for Cardiff, Central (Mr. Grist). I am pleased to see him in his place tonight because I can say of him, with confidence, that if he required orthopaedic surgery, he, like myself, would probably attend National Health Service hospitals in South Glamorgan.

The Coronation ward at the Royal infirmary is a general children's ward. It deals with pneumonia treatment, bladder infection; or whatever. It is entirely unsuitable for cold orthopaedic surgery cases, which may require treatment for months but which are not suffering from infection. It would be wrong to mix them with pneumonia and bladder infection cases because they would be at risk of catching those infections during the lengthy period that they would be in the ward. At least the orthopaedic cases would have the same children's facilities, which is an attractive idea, but the ward would be unsuitable medically. Today, one of the senior staff of the health authority has told me that it was never on to opt for a move to the Coronation ward. I was told that it was never a practical solution. It seems that it was something written down in a moment of panic. The entire episode betokens strongly management by panic after a spot of government by panic following late notification of the budget.

The other alternatives relate to changes within the Prince of Wales hospital. One is conversion of the day ward used by outpatients for use as a children's ward as well. Another involves the conversion of an adult ward to provide a children's annex. Another option is touting for more business, as it was put, to draw more children in to the hospital and make greater use of the beds there.

The problem with converting the day ward is that outpatient treatment is a rapidly expanding aspect of hospital provision. The day ward does not offer enough room for adaptation, so that is a totally impracticable suggestion. I am reliably informed by the medical staff that day ward use is high and is increasing as many more people are treated on a day basis than used to be the case. They include patients for minor surgery to remove ganglia and trigger thumb, who do not need to stay overnight.

However, children could not share the same ward. They would play around and would receive their drug treatment while adults in the same ward would be receiving totally different drugs, needing peace and quiet as they recover for a couple of hours after undergoing surgery before returning home. It would hardly be ideal for such patients to share a ward with children staying in the hospital for months and who want to play on go-karts or computers as a diversion in the long months of their stay.

Converting an adult ward to include a children's annex is also totally impracticable without capital works, which would take away much of the £47,000 savings. The hospital's senior medical staff are on record as saying as much. The Minister may have read the remarks of Hans Weisl, the most distinguished orthopaedics surgeon, who wrote an open letter to the health authority that was published yesterday. He commented that such an option just is not on without major works. The senior medical staff all agree on that point and have pressed the health authority to forget that idea. It would cancel out most of the savings, leaving perhaps £10,000. What kind of contribution is that to the intended savings of £2·3 million?

It is appalling that the health authority should decide to close a children's ward without being confident that any of the alternatives it suggested, and loosely dangled before the health authority's decision-makers when they had to put up their hands to vote, are practical alternatives that the orthopaedic staff concerned are prepared to countenance as suitable, and without requiring expenditure that would negate the savings that originated that madcap closure.

Since the announcement of a campaign to rescind the closure decision, the health authority has reacted like a scalded cat. Its chairman, Alun Jones, sent a nonsensical letter to all the medical staff involved. It includes the following arrant nonsense: I must emphasise that wherever these services are relocated the current provision for children will be maintained and there is no intention whatsoever that children's facilities should be mixed with adult facilities on the ward. That cannot be done. It is not achievable. That comment suggests that the authority intends a move to the Coronation ward at Cardiff Royal infirmary, which I was told today is not on—and never was.

The authority must get into its head the principle that the medical staff have already emphasised—that children requiring orthopaedic treatment cannot be mixed with children receiving treatment for infectious diseases, or with adults receiving orthopaedic treatment. There is no way that Mr. Jones can make good the promise in his letter dated 26 April to the medical staff.

The health authority's other reaction was to send senior medical staff to the Prince of Wales to pore over the figures that the nursing sisters there thoroughly researched to try to disprove their bed occupancy figure of 65 per cent., taking into account midday occupancy. Senior nursing staff have spent until after 7 o'clock every night trying to double check and find fault with the figures, so far with no result. There are always two or three more children in the ward during the day than at night.

The staff who have led the anti-closure campaign have been browbeaten by senior medical staff from the health authority who told them quite incorrectly that no child is sent home at weekends for the good of that child, and that if it ever happens it is only five or six times in a year. That is not true. The sisters in charge of the ward have been told that it is only ever closed at weekends when there are no cases, but they know that it occasionally is closed at weekends as an economy measure and not because there are no cases.

In the few minutes that remain, I turn to the Yates report. The Minister will be well aware that the Welsh Office paid for John Yates, a distinguished consulting health economist, to prepare a report to assist the Welsh Office to attack the lengthy waiting lists in adult orthopaedic surgery. That report has now been prepared. Its contents are known. It recommends that the number of orthopaedic surgeons operating in South Glamorgan should be increased from six to eight, an increase of 25 per cent. That will obviously increase the throughput of adult work and will attack the 2,000-strong waiting list for adult orthopaedic work. That in turn will have a major impact on the way in which the Prince of Wales orthopaedic hospital is used. It is the height of irresponsibility for the health authority, knowing that the Welsh Office-commissioned report is about to be published, but before the report can be published, before the public can judge what it says, before they can act on it or consider its implications on the use of orthopaedic facilities for children and adults, to go ahead and announce the closure of the children's ward.

I hope that the Minister will step in. If the children's ward is closed, where will the children go? If the Welsh Office does not know the answer, if the South Glamorgan health authority does not know the answer, at least they should ensure that the South Glamorgan health authority suspends the closure until the Yates report is published and acted on and its implications for the treatment of children requiring orthopaedic surgery are fully worked out. After all, the children deserve the best, and they have nowhere else to go but to that ward.