I am grateful for the opportunity to raise the subject of the future of Victoria hospital, Accrington.
Thousands of people have signed petitions and written to their Members of Parliament and to the Secretary of State. A public meeting has been held. The chief executive of Hyndburn borough council has agreed that the lead in the campaign for Victoria hospital must be taken by the local authority.
Thousands of people have signed petitions and written to their Member of Parliament and to the Secretary of State. A public meeting has been held. The chief executive of Hyndburn borough council has agreed that the lead in the campaign for Victoria hospital must be taken by the local authority.
I have not made a mistake and repeated the first paragraph of my speech. The first paragraph referred to the position described in the Accrington Observer and Times of Saturday 7 October 1978; the second described what has happened since the meeting of the district health authority on 6 September 1989, when it was agreed that the Victoria should be a community hospital.
It is clear from the two passages that we are fighting the same battle now that we fought 11 years ago. It is equally clear that the people of Hyndburn wish to unite and fight. It is not a party political issue. In 1978, when the Victoria hospital's problems first arose, we had a Labour Government, a Labour Member of Parliament and a Conservative council. In 1989, we have a Conservative Government, a Conservative Member of Parliament and a Labour council. Those who try to turn the campaign into a party political battle do no service to Accrington Victoria hospital or to the people of Hyndburn.
Accrington Victoria hospital was founded in 1894 as a cottage hospital. It was paid for by public subscription, not least by people who worked for low wages contributing so much each week from their wages. No doubt that is part of the reason why is it held in such affection and why attempts to reduce services are met with such strong hostility, but that is only part of the reason. Over the years, we have come to recognise the superb care that patients receive from its dedicated staff, its friendly, almost family atmosphere and the special, almost indefinable quality that it has, which I have not experienced in any other hospital in which I have been a patient. For that reason, four years ago when I had major surgery, I chose to go to Accrington Victoria hospital. It was a difficult time, but four years on I am a good advertisement for the skill and dedicated care of the hospital.
Experts now tell us that surgery should be withdrawn and that services should be centralised on one site. They say that that is better for us. Experts once told us that we should demolish terraced houses and build high-rise flats. Ordinary folk said that they were wrong, and ordinary folk have been proved right. The same applies to Accrington Victoria hospital. Ordinary folk do not need experts to tell us what is best for us—we know instinctively. We know that for our benefit we want to retain the widest possible range of services at Accrington Victoria.
Over the years, services have been withdrawn from Accrington Victoria, and often the withdrawal of one service has been the reason for the withdrawal of the next. In 1952, the eye wards were no longer used as such. In 1962, the department of pathology no longer matched blood for transfusions, and shortly afterwards the pathology laboratory was closed.
In the early 1970s, junior doctors from the surgical and medical departments no longer helped by doing evening and weekend sessions in the casualty department. In 1978, it would have been closed on the retirement of its long-serving and distinguished senior casualty officer, Mr. J. H. Armstrong, but for local GPs stepping in and agreeing to staff it.
In 1979, the unit was no longer allowed to accept 999 calls. In 1984, the children's ward was closed temporarily, without notice or consultation, and never reopened. In 1985, the district health authority announced that it was to press for the closure of the maternity unit, which had been opened only eight years earlier, to have a greater chance of succeeding in getting the new high-tech maternity unit at Queen's Park hospital, Blackburn, in the region's capital programme. Many local GPs spoke out against the proposal.
In 1985, it was announced that Accrington Victoria was to be the site of a new renal unit. Ward 4 was closed in preparation and two staff were sent on a training course. It transpired that there had been some misunderstanding and that there was no guarantee that it would get the renal unit. The ward remained padlocked. I had an angry meeting with Sir John Page, the regional chairman, and it was eventually agreed that the unit will open at Accrington next year, ward 4 having been closed for four years.
Last year, the district health authority proposed to reduce the hours of opening of the minor injuries unit and to close GP ward 6. I sent a message to the meeting to inform it that an extra allocation of resources for the Health Service had just been announced and urged that the decision be delayed until we knew by how much our area would benefit. We received £250,000 and the ward and the unit were kept open.
In December 1988, the deputy dean of postgraduate studies at Manchester university informed the authority that trainee surgeons would no longer be sent to Accrington Victoria to train. In September 1989, the district health authority voted to develop Accrington Victoria as a community hospital. Earlier this month, it proposed the closure of wards 5 and 7 and a possible reduction in the hours of the minor injuries unit.
Finally in this saga, I refer to the maternity unit at Accrington Victoria. The Minister will be aware of the situation regarding maternity facilities at Queen's Park hospital because he replied to an Adjournment debate in April in which I urged that the new unit at Queen's Park —promised since 1979—be found a place in the capital programme. I explained at the time that the district health authority felt that, because of the dramatic increase in the birth rate, it would shortly have to turn patients away. The authority had decided that it had no option but to build a temporary unit at a cost of £300,000.
Thanks to the debate and to the Minister's intervention, that much-needed 19-bed temporary unit is to be built at the region's expense. Unfortunately, the district health authority has decided that, to staff it, the maternity units at Accrington Victoria and at Bramley Meade will close. That was not made clear when I made the plea on their
behalf. As yet, I have been unable to work out how closing 35 beds to staff a 19-bed unit is necessary or an improvement on what was supposed to be a desperate problem. Given that the district administrator, Mr. Paul Whitfield, had said in 1982
that the proposals do not mean either the closure or downgrading of Accrington Victoria hospital. Between now and 1995, there will be little change at Accrington Victoria hospital
and bearing in mind the events since 1978, and earlier, which I have outlined, it is not hard to understand the state of morale at the hospital. The staff are to be congratulated on their excellent work in difficult and uncertain times.
The people of Hyndburn now find it difficult to accept the continuing reassurances that Accrington Victoria hospital will not close. Since 1978, they have been actively campaigning for the hospital. At a public meeting held in May 1979, 700 people packed the town hall, with more than 100 people being turned away. They were all objecting to the plan put forward by the Blackburn district hospital management committee to remove surgical facilities and the children's ward and downgrade Accrington Victoria to a geriatric and community hospital. The people of Hyndburn were supported in their opposition by the then Member of Parliament, Arthur Davidson, my right hon. and learned Friend the Member for Ribble Valley (Mr. Waddington) and my hon. Friend the Member for Rossendale and Darwen (Mr. Trippier). As mayor of Hyndburn at the time, I spoke against the plans on behalf of the council.
In 1982, when we were beginning to feel that our campaign was succeeding, we were faced with a consultative paper, issued by the district health authority and entitled "District Strategy". Option 2, which proposed an 1,100-bed district general hospital sited at Queen's Park hospital, Blackburn, with community support throughout the district, was just a restatement of the 1978 proposals. Accrington Victoria was to be developed as a community hospital and in that role would have acute beds, with a substantial long-stay element of geriatric beds and day places. It would have an ESMI—elderly severely mentally ill—unit and retain some beds for routine surgery and support the overall maternity provision at Queen's Park hospital.
Option 3, which had the support of the people of Accrington and many from the surrounding area, would have seen the retention of the three existing acute hospitals in that role, together providing a district general hospital service. Queen's park hospital would have been the major hospital with 630 beds, while Accrington Victoria hospital would have largely retained its present acute and maternity role plus the ESMI unit, with 185 beds and 75 day places. The major attraction of this option was that it apparently reflected governmental thinking since 1979 whereby the 600-bed size for the principal hospital in a district is considered advantageous, with a more flexible role retained for smaller hospitals.
To our regret, the district health authority chose option 2, but part two of the resolution adopted said:
Accrington Victoria hospital should continue in its present role for at least 10 years, that is until after development at Queen's Park hospital as set out in the region's ten year capital programme.
It is clear that that part of the resolution has not been adhered to. When I met the chairman of the district health authority, Mr. Ian Woolley, on 20 November to discuss the latest proposals, he said:
The district general manager presented a paper on the 28th July 1989 to members identifying many options. The Members recommended the community hospital option to a full meeting of the health authority which was held on the 6th September 1989. When Accrington Victoria hospital becomes a community hospital, it will have far more acute and rehabilitation beds for local people of all ages, run by the GP's, plus a variety of other services including physiotherapy, radiography, minor injuries, day hospital for the elderly. In addition, there will be clinic facilities e.g. dental facilities, out patient consultant clinics, ESMI unit and the renal unit.
In view of the earlier fears that a community hospital would be nothing more than a geriatric hospital, which would be unacceptable, the present proposals are an improvement, but the people of Hyndburn still believe, as I do, that the hospital has a more important role to play in the life of the community than the one envisaged, given that we have a population of 80,000. The new Zeri theme park that is being built at Hyndburn is likely to attract 40,000 visitors a day when it is opened early in the 1990s, and it will put further pressure on hospital services.
Our worries about the present decision are increased by the fact that the proposals for a community hospital depend on the co-operation of local general practitioners. They have expressed an interest, but they have not agreed to staff it. Mr. Woolley is setting up a working party of GPs and others to work out the details. It seems that, with the best will in the world, we are still a considerable way from having a community hospital in Accrington. In the meantime, existing services continue to be whittled away, and it is possible that worse is still to come.
On 22 December the Royal College of Surgeons makes its quinquennial visit to review all surgical posts at senior house officer and registrar level throughout the district. The temporary recognition of these posts at the Accrington Victoria hospital will be reviewed, and the recognition will be extended or cancelled. Mr. Woolley feels that temporary recognition may be withdrawn. He has assured me that if that happens he will go to the regional health authority to ask for permission to continue advertising posts without recognition. Withdrawal of recognition will make it even more difficult, if not impossible, to recruit junior doctors.
Despite all this, the possible proposals to close two wards and to reduce the hours of the minor injuries unit, with accreditation likely to be withdrawn on 22 December, when I asked Mr. Woolley whether the hospital was to be closed he said:
We have absolutely no intention to close the hospital on the 22 December or on any other date.
The people of Hyndburn, to a man, want to believe that, but the experience of the past 11 to 20 years has made them sceptical. They will need a great deal of convincing that the intention is not to concentrate services at Queen's Park hospital. The knowledge that in 1982 the district health authority spent 12·4 per cent. of its budget on the AVH and now spends only 11·1 per cent.—a reduction of £400,000 per year—does little to reassure them.
The man in the street is bewildered. After years of campaigning for our maternity unit, we find that after only eight years of operation the DHA proposes to close it. Last year, tens of thousands of pounds were spent upgrading the former children's ward for use as an orthopaedic ward; now it is proposed for possible closure. The minor injuries unit last year dealt with 42,946 cases—27,778 new patients and 15,168 return patients. During the hours when it is proposed in future to close the unit, 15,184 patients were treated. Where will they go? The majority will have to go to Blackburn Royal infirmary.
Can the Blackburn Royal infirmary cope, given that the community health council reported recently that patients were waiting up to five hours for treatment? I know that Mr. Woolley is concerned about waiting at the BRI, and the problem is the subject of a study. He assures me that waiting times have been reduced. Nevertheless, to add a further 10,000 patients to an existing problem does not seem to make sense.
It would be remiss of me if, on behalf of the people of Hyndburn, I did not pay tribute to the Accrington Observer & Times for the continued support and enormous coverage that it has given this issue since 1978. The material that I have brought with me is a sample of what it has produced over those years. The campaign could so easily have floundered without that support. I pay tribute to the many people who have been involved in the campaign for so many years. They have all worked extremely hard. I pay tribute especially to Councillor Bill Parkinson, whose hard work has earned him the respect of all sections of the community.
The people of Hyndburn have had enough. We want to be certain that the Accrington Victoria hospital will continue to play an important role in health provision in the district, we want to retain the widest possible range of services at the AVH, and we want a plan for the future of the hospital that is acceptable to the people of Hyndburn as well as to the district health authority. Most important of all, once a plan is accepted it should be strictly adhered to so that the staff at the hospital feel secure. Until we get that plan, we seek assurances that no further services will be withdrawn.
I congratulate my hon. Friend the Member for Hyndburn (Mr. Hargreaves) on raising this important topic that deserves to be debated fully in the House and the local community. I have replied to many Adjournment debates this year and it gives me great pleasure to reply to my hon. Friend for a second time. I know that he holds dear the best interests of his constituents. He fights for them valiantly, is a great supporter of the health services in his constituency and pays close attention to their needs. The fact that he spoke from the heart about his constituents' needs clearly impressed other hon. Members. My hon Friends the Members for Basildon (Mr. Amess), for Maidstone (Miss Widdecombe) and for Great Yarmouth (Mr. Carttiss) are present to support him, not for a constituency interest but to pay tribute to his determination, personal courage and diligence in representing his constituents.
Acute services in the district are spread three ways: between Blackburn Royal infirmary, Queen's Park hospital and the Accrington Victoria hospital. My hon. Friend will agree that it would not be wise for central Government to attempt to do detailed planning of local acute services. Whitehall does not have the expertise or the local knowledge to match that available to local managers. That is why the Government have made a priority of developing strong, local management in the Health Service.
Before turning to the important issues affecting the Accrington Victoria hospital, I should like to outline the Government's approach to strengthening Health Service management and increasing resources to the NHS, particularly in the North Western region and the Blackburn health authority.
For many years management in the hospital service was hampered by the concept of collegiate leadership. That appeared to mean that no decision was ever made unless the medical, nursing, administrative and other interests could be reconciled. The system did not encourage careful, deliberate preparation and implementation of realistic plans. Unfortunately, it was a recipe for procrastination. The results are still with us in the shape of unsuitable buildings, poor maintenance and duplicated services. The appointment of general managers to be responsible for the performance of each hospital unit, district and regional authority has done much to focus management effort.
The Government's plans for changes in the NHS, which were presented to Parliament last week, include the appointment of smaller district authorities that should be able to work better with general managers in controlling the use of Health Service resources. Therefore, my first point is that following the first Griffiths's report we shall set up a management structure in the Health Service designed for clear leadership and support for smaller district health authorities, if the Bill is enacted. We shall then delegate responsibility and let local general managers and health authorities make decisions.
In last week's debate, which was initiated by my hon. Friend the Member for Fylde (Mr. Jack), we had a helpful discussion of the Government's intentions on resources for hospital and community health services next year. I pointed to an increase next year of 8·5 per cent. in cash terms, which in real terms, after an assumed 5 per cent. rate of inflation, is an increase of about 3·4 per cent. I assure the House that I am happy to repeat that the North Western regional allocation in 1990–91 will be higher in real terms than this year's figures. There will be real growth in resources.
In a few weeks' time the actual cash allocation will be known and then the North Western regional health authority can calculate each district's specific allocation. We expect those allocations to be made in the early months of next year. In the meantime, the over-pessimistic planning assumption in the north-west has meant that the districts have expected a cut in resources of 0·3 per cent., which has led them to examine the current pattern of service provision in search of efficiency savings. I am happy to be able to reassure my hon. Friend that those pessimistic assumptions are no longer valid. There will be real growth for the north-west and for the districts, consequent upon the specific allocations by the region.
Let me deal with the preoccupations and plans of the Blackburn, Hyndburn and Ribble Valley health authority. A few weeks ago, it met to consider its short-term programme for 1990–91, which has since been passed to the regional health authority. This is a comprehensive document and contains an impressive record of achievements.
The district authority has pledged to at least maintain the level of general acute services in the district. I hope that it will be able to do very much better than that. The authority is examining the way in which these acute services are provided in three hospitals—the Blackburn royal infirmary, Queen's Park hospital and Accrington Victoria. It should be noted that the district is currently achieving the highest ever levels of acute and other services. Since 1982, in-patient treatments have increased by 10 per cent., out-patient treatments by 15 per cent. and day cases by 20 per cent.
The question remaining is why the role of Accrington Victoria hospital should be reviewed. I am advised by the district general manager that the Accrington Victoria hospital lost its accreditation for the medical training of pre-registration junior doctors in November 1988, among other reasons, because there were not sufficient senior doctors with time available to give supervision to their junior colleagues. That arose in part because their duties were split between the three acute hospitals that I have mentioned.
I am further advised that representatives of the Royal College of Surgeons will be visiting the hospital in December—as my hon. Friend said—to consider whether the number and type of surgery cases dealt with there can any longer justify the hospital's accreditation for the training of senior house officers. The question arises whether the cases dealt with at the hospital include a sufficient number of major trauma cases to provide a broad range of experience for senior house officers. One of the criteria that the Royal College of Surgeons may well use is the existing size and scope of services at the hospital —doubtless a function of past decisions about what should be provided at the hospital. It is the proper job of the royal college to review the present range of services to see whether appropriate experience is being gained.
Against that background of changed requirements, developments elsewhere in the district and the consequences of the loss of accreditation, it was clearly the duty of the district health authority to consider what future services should be provided at the Accrington Victoria. The district health authority held a public meeting in Hyndburn on 16 May 1989 and further discussions on the provision of acute services followed in July and September. The district authority resolved that proposals to develop a community hospital at Accrington Victoria should be pursued.
That option, considered by the authority in September 1989, envisaged the transfer from Accrington Victoria of 25 surgical beds and an equal number of orthopaedic beds and the transfer in of a day hospital for the elderly and, possibly, an associated day centre for the elderly. The renal unit, out-patient clinic, minor injuries unit and existing beds for the elderly would be retained at Accrington Victoria. I have noted the possibility of Accrington Victoria becoming a community hospital and the fact that the district health authority's proposal envisages the future long-term use of the hospital for community services. I think that that will greatly reassure local residents.
The first of two assurances that I want to give my hon. Friend is that in the event of any proposal to reorganise services at Accrington Victoria or to close the hospital completely, the proposal must come to Ministers for final decision if the community health council objects. The process of considering the future deployment of services has only just begun, but if the CHC objects to any proposal concerning the reorganisation of services—I am advised that there is no prospect of the closure of the hospital—that proposal must come to Ministers.
I do not want to go into the merits of the case for centralising the acute services at Blackburn Royal infirmary and maternity and gynaecology services at Queen's Park hospital. That decision is essentially a local matter. The services are for people in the Blackburn area, and their views must be heard. I do not think that the authority can be faulted for its openness in setting out the issues in papers considered by the authority and discussed in public.
I remind my hon. Friend of the three key issues that have emerged in this debate. First, it must be remembered that, since 1978–79, the Government have increased resources for the North Western region by 13 per cent., and the increase next year for the NHS as a whole will be 3·4 per cent. in real terms. The exact amount for the North Western region and the Blackburn authority has yet to be decided.
Secondly, major developments in the region and in Blackburn at the Queen's park hospital are at the highest ever level, and inevitably require the review of existing patterns of service elsewhere in the authority area. Thirdly, the district authority should, as far as possible, be left to arrive at local solutions that meet the financial targets that have been set, but match as closely as possible the needs of the local population.
I come now to my second assurance. Although I have no desire to interfere with the proper local management of the Health Service, I can assure my hon. Friend that I shall come to visit his constituency and the hospital service there before any final decisions are taken. I do that not in a spirit of wanting to interfere with the district or the region but to express, with my hon. Friend, my interest in and dedication to the improvement of services for his constituents, as for the entire population of the country, in an improved quantity and quality of services in the NHS.
Question put and agreed to.
Adjourned accordingly at four minutes to Eleven o'clock.