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Wright, Dr Tony

Young, David (Bolton SE)

Tellers for the Noes :

Mr. John Spellar and

Mr. Jack Thompson.

Question accordingly agreed to.

Resolved,

That the draft Housing Support Grant (Scotland) Order 1994, which was laid before this House on 25 January, be approved.

ENERGY CONSERVATION BILL [MONEY] Queen's recommendation having been signified--

Resolved,

That, for the purposes of any Act resulting from the Energy Conservation Bill, it is expedient to authorise the payment out of money provided by Parliament of--

(a) any expenses of any Minister under the Act, and

(b) any increases attributable to the Act in the sums payable out of money so provided under any other Act.-- [Mr. Chapman.]

PUBLIC ACCOUNTS Motion made, and Question put, That Mr. Robert Jackson be discharged from the Committee of Public Accounts and Mr. Richard Tracey be added to the Committee.-- [Mr. Chapman.]

Hon. Members : Object.


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Meigle Cottage Hospital

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Chapman.]

11.43 pm

Mr. Bill Walker (Tayside, North) : I welcome this opportunity to speak about Meigle cottage hospital, which is a popular cottage hospital in my constituency. Consequently, it would be against Government policy for it to be closed--unless, of course, the Government can demonstrate that there are conclusive and undoubted logical reasons for the closure. I hope clearly to demonstrate that according to, first, the regional council, secondly the district council and thirdly Scottish Enterprise, Tayside, that the population projection figures used by the health board are neither conclusive nor undoubted.

I shall show that, contrary to the health board's claims, Meigle as it stands is a perfectly satisfactory clinical hospital.

The hospital was a gift from Mrs. Cox of Cardean and was built in memory of her late husband. Sadly, the hospital suffered a fire soon after it was built and had to be built a second time. Mrs. Cox had the hospital rebuilt. No one can dispute that it was a memorial gift to the community.

Mrs. Cox gave an endowment that guaranteed the financial viability of the hospital. There was no public subscription and no public sector funds were involved. Indeed, until the national health service was created there was no need for public money to be involved in the hospital. I shall read from a letter that appeared in the Dundee Courier on 4 February 1994, which I believe sums the hospital up. It is headed

"Meigle Hospital--desecration ?

Sir, --As the oldest surviving grandchild of Mrs. Cox of Cardean who gave the Meigle Cottage Hospital to the community, I note that very little has been said about the fact that it was built in memory of her late husband.

Surely the Government action in closing it is akin to the desecration of a gravestone ?"

That is signed by Betty Ogilivy-Wedderburn.

The ground conditions, the gift conditions and the absence of public financial input make Meigle a unique and special case. The building and ground may not be used for any other purpose. I have a copy of the ground title, the disposition by Sir George Kinloch Bt. of 4 May 1915, from which I shall read an extract.

It says that the ground may not be used as a

"tavern or public house or for the manufacture or sale of any ale beer porter wine whisky or other spirituouse or malt liquors or for the carrying on of any trade manufacture or business or for any purpose that might affect or deteriorate the vale or amenity of the adjoining lands".

The heirs are determined to enforce those provisions.

This popular cottage hospital is supported by all the GPs in Meigle, Alyth, Coupar Angus, Neutyle, Muirhead, Birkhill and Blairgowrie. It is supported by the churches, the health council for the whole of Tayside, the regional council, the district council and the community councils, all of which believe that Blairgowrie cannot cope. There will be too few beds to handle the demand from the Blairgowrie and Meigle catchment areas. The new extension at Blairgowrie, which is being constructed, provides eight extra beds.

Meigle has 12 beds, so there will be four fewer beds after the extension, in a catchment area where the


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combined population is growing and continues to grow. The Meigle occupancy rate is very high--more than 80 per cent. I welcome the presence of the hon. Member for Angus, East (Mr. Welsh) because of his interest in these matters. I remind my right hon. Friend the Secretary of State that in summer and winter we have a huge transient population in the catchment area.

I will read from one letter of the many hundreds that I have received, but it explains clearly the situation :

"My father, a widower living alone in Darkfaulds, Blairgowrie was rushed to Ninewells hospital in December 1993 for major bowel surgery which left my 73-year-old father extremely weak and traumatised.

Several days after the operation I received a telephone call from his Ninewells ward at 9.45 pm to advise me that his bed was required to enable them to carry out more operations before Christmas. They had inquired at Blairgowrie Cottage Hospital but they had no beds so they would like him to go home where the District Nurse could carry out bed baths, a home help could pop in and could we arrange for someone to keep an eye on him! I was stunned. Here was my father unable to get out of his chair himself, having to be supported when he walked to the toilet, having an infection in his arm where the drip had been and suffering from shock, being asked to go home to live alone.

Unbelievable!"

The daughter who was writing to me does not live near him at all, as is true in so many rural constituencies.

The letter continued :

"The next day I telephoned his family doctor (Dr. Sandy Young) who arranged for him to get a bed in Meigle Cottage Hospital. In Ninewells that day, the staff explained to me that they were only there to carry out operations, not for the recuperation of patients ! !

My father cannot remember the journey from Dundee to Meigle due to his state of shock. The staff at Meigle were excellent, and after two and a half weeks there, he was able to go home and cope for himself. While he was in Meigle, the staff assured me that he would not be discharged until he was fit enough to go home. What a relief that was for us.

I should add that my father is a diabetic and had been seriously ill on three occasions during 1993 so it would have been very worrying to us if Meigle Cottage Hospital had not been able to admit him."

That letter is typical of many that I could produce.

Is it any wonder that the people and general practitioners in the Blairgowrie and Meigle catchment areas are questioning the clinical judgment and population projections used by the health board, which until now have been accepted by the Government ? The population projections of the general registrar's office are suspect. They do not take adequate account of the large number of planning approvals given or of the number of houses that are currently under construction. For example, Perth and Kinross district planning department advises me that, between 1981 and 1991, there was a 7.2 per cent. increase in population--from 15,499 to 16,613--in the Blairgowrie, Coupar Angus, Alyth and Eastern Landward area, all of which Blairgowrie copes with.

It is true that, in the small village of Meigle itself, there was a small decline in population, from 908 to 874, but Meigle's catchment area of Airlie, Eassie, Newtyle and Ruthven, experienced an increase of 4.8 per cent., from 1,401 to 1,469. The combined population figures for the catchment areas, excluding Muirhead and Birkhill, show an increase of 6.44 per cent.--or 1,148 people--in the period during which the health board has been determined to close the hospital. There has been a massive increase in population. The Muirhead and Birkhill practice, which also


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uses the hospital, has increased its patients by 320 in the past three years and as of today has three patients in Meigle Cottage Hospital.

It is amazing how bits of paper arrive on one's desk. I have been advised today that 66 new accommodations are to be built by the East Perthshire housing association in Blairgowrie. Every week I am being advised of additional houses being built. In Dundee, figures cited by Scottish Enterprise Tayside--another independent body--show clearly that, although there has been a decrease in population in Tayside, with a minus figure of 8,074, in the Perth and Kinross area there has been an increase of 4,275, well over 1,000 of which--1,700--were in the Meigle-Blairgowrie catchment area. The age distribution figures show clearly that that area has a lot of young families who use hospital facilities and a lot of elderly people.

More than 500 houses with planning approval are to be built in Blairgowrie alone. If Alyth, Newtyle and the others are added, we can expect an increase of another 1,500 within the next couple of years or so. Over the past five years, during what can only be described as difficult building industry conditions, the following houses have been completed : in Blairgowrie, 50 per annum ; in Coupar Angus, two per annum ; in Alyth, four per annum ; in Eastern Landward, 20 per annum ; and in Newtyle, six per annum. I suggest that, as the market improves--and it is improving--those figures will substantially increase and we will get nearer the figures that we had in the mid-1980s.

In that case, Blairgowrie and district, which has become a commuter area, will again demonstrate clearly that young families want to come to live there. The number of expensive houses that are planned or are being built will mean that a larger number of elderly people will retire to the area. The young and the elderly require hospital facilities.

The number of beds in the Blairgowrie and Meigle areas and the cost per patient per day are important factors. I shall not disturb the House tonight with all the figures other than to say that Meigle, if we had two extra beds there, could have a cost of about £90 per patient. We need those beds, which would give us the lowest figure for bed occupation costs in the whole of Tayside region. What is the real cost of retaining Meigle ? It is less than 0.2 per cent. of the Tayside health board's revenue budget. I firmly believe that we need all the beds at Blairgowrie plus those at Meigle, and probably more. My case is not built on the popularity of the hospital alone ; it is built on the reality of the population growth since 1981, when I first had to do battle with the health board. My case is built on the reality of house building and planning consents over the next five to 10 years. It is built on the fact that neither I, nor the doctors, my constituents and the local authority officials accept the logic of the health board's case. I shall not be deterred from pursuing the matter further.

The Minister responsible, my noble Friend Lord Fraser, tells me that he did not receive my letter requesting a meeting. I cannot forget that there have been other problems within his Department ; Glasgow is just one example. It is with deep sadness and without any malice that I have to tell my right hon. Friend the Secretary of State that this matter is so important to me and my constituents that I will use every parliamentary device available to expose the flaws within the Department and


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the ghastly way in which the health board has ridden roughshod over the clinical judgment of the GPs and the wishes of the people. If the hospital closure goes ahead, the way in which I shall deal with the matter could lead to demands for resignations, especially in view of the letter I received from my noble Friend Lord Fraser on 13 January. He tells me that almost £500,000 will be needed to bring Meigle up to standard. So what ? What about all the money spent when the hospital was first built ? At today's values, that is an enormous amount.

My noble Friend goes on :

"Enhanced accommodation and a wider range of services are available in Blairgowrie Cottage Hospital situated only 8 miles away."

If the matter was not so tragic, that could be funny. That must be the distance as the crow flies. I invite the Minister to walk that eight miles ; he will not get anywhere near the hospital. The Minister's letter refers to the

"split between the 2 closely situated hospitals".

They are not closely situated. By public transport, the distance between the hospitals at Meigle and at Blairgowrie is nearer 15 miles.

The letter says that one site offers

"better accommodation and a wider range of service provision." I believe that Meigle is perfectly adequate. The letter continues :

"The Health Board has in particular undertaken to ensure that people will have a choice of recuperating in Blairgowrie rather then remaining in Perth or Dundee if they wish to be closer to home." What about all the letters I have received which ask where, if Meigle closes, people are to go ? I have not referred this evening to just one isolated letter.

The matter is out of all proportion to the size of the hospital. My constituents, without exception, feel that the proposed closure is wrong and mistaken, that it borders on being malicious and that it desecrates a memorial that was funded adequately at the beginning and which would have been functioning adequately today if it had not been acquired by the national health service. All that must be answered for. That is why, in the final analysis, my right hon. Friend is given the opportunity in law to make the judgment. Only he can take into account all aspects of the background to the case. I am confident that he will.

11.58 pm

The Secretary of State for Scotland (Mr. Ian Lang) : I congratulate my hon. Friend on his success in securing a debate on the closure of Meigle cottage hospital. I understand the importance that he attaches to the matter, and the strong attachment to the hospital that has developed locally.

The services provided by Meigle hospital have, over the years, been much valued by local people who have appreciated the ready access to acute care or the choice of convalescing close to home after treatment in Dundee or Perth. This debate gives us an opportunity to consider the planned transfer of those services to Blairgowrie and to address the concerns that have been raised by local residents recently since my noble and learned Friend the Minister of State announced the planned closure of Meigle cottage hospital. What I hope to do tonight is explain the background to the planned transfer of services, the implications for patients and visitors and the adequacy of planned bed numbers in Blairgowrie in the light of projections of the


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growth of the population in the area to which my hon. Friend referred, and especially growth in the population of the elderly. Two main factors lie behind the decision to approve the health board's plans to transfer services from Meigle to Blairgowrie. First, with continuing medical advances and new techniques and technologies, Tayside health board has found, in common with all other health boards, that fewer acute beds are needed to deliver the same or an increasing level of care.

Secondly, Meigle cottage hospital is not suitable to deliver modern acute care. The health board faced a choice of investing £500,000 of capital to bring Mei to take on the work from Meigle and releasing about £280,000 of overhead costs which are currently tied into running services from two sites in close proximity for other health purposes.

In the light of those considerations, the health board, after much careful thought, decided to seek approval to close Meigle and transfer services to Blairgowrie. Blairgowerie has a wider range of services than Meigle and can offer better integrated care for patients. The health board canvassed widely for views on the proposed closure of Meigle and got the clear message form local residents that extended stays in Perth and Dundee were not an acceptable alternative to local care.

The health board has therefore made provision at Blairgowrie to ensure that anyone who would have expected to receive treatment or convalesce at Meigle will be offered the choice of care at Blairgowrie as an alternative to Perth or Dundee, and that the 56 general practitioner acute and long-stay beds at Blairgowerie will be used flexibly to meet local needs. There should therefore be no need for people to travel to, or remain in, Dundee and Perth longer than necessary.

That was taken into account when my noble and learned Friend and I considered the health board's proposals alongside the views expressed by the local people. We decided that, on balance, the benefits to patients of the more extensive range of care available at Blairgowrie outweighed the inconvenience to visitors of travelling to Blairgowrie. We therefore approved the health board's plans to close Meigle and transfer services to upgraded facilities at Blairgowrie. As for the implications of the planned transfer of services for patients and their visitors, current trends show that in general four fifths of Meigle patients are directly under the care of local GPs. Those people will, under the planning new arrangements, be transferred to Blairgowrie.

Mr. Bill Walker : I understand clearly what my right hon. Friend is saying : there will be four beds fewer. If they cannot cope now, how will they cope with four beds fewer ?

Mr. Lang : I have already covered my hon. Friend's point. I made it clear that the health board estimates that there will be a reduction in the need for beds as a result of changes in the length of stay of average patients. I can assure my hon. Friend that the health board has gone into this very carefully--as, indeed, has my noble and learned Friend.


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I was referring to the implications of the transfer of services to patients of visits. The one fifth who presently use Meigle to convalesce prior to discharge will be given the choice of remaining in Perth of Dundee or convalescing at Blairgowrie. My hon. Friend referred to mileage, and those matters can be easily checked. My officials have been told by the health board that the distance between Meigle and Blairgowrie is seven miles along a bus route. They were informed that it takes around 25 to 30 minutes by bus and under 20 minutes by car to travel between Meigle and Blairgowrie.

Mr. Bill Walker : Will my hon. Friend give way ?

Mr. Lang : I must reply to the other points raised by my hon. Friend. I must press on, if he will forgive me.

Mr. Walker rose--

Mr. Lang : My hon. Friend has made his point. I am telling him what the health board told my officials. The matters can be checked and if, of course, it turns out that the information which I have been given is incorrect, I will correct it with my hon. Friend.

I understand that buses run hourly from Monday to Saturday, and two-hourly after 7 o'clock in the evening. Buses also run every two and a half hours on Sundays.

The average length of stay of a patient at Meigle is about 19 days. On average, about 190 people a year receive in-patient care and around 150 receive outpatient treatment in Meigle. I accept that, for those people and their visitors, there will indeed be the added inconvenience of travelling to Blairgowrie. In most cases, however, we are talking about a period of only two or three weeks offset against the ready access to X-ray, out- patient, geriatric and occupational therapy services, in addition to the full range of services provided from Meigle. In terms of the level care that can be provided, this is worth the extra inconvenience for a couple of weeks.

Moreover, by withdrawing current services from Meigle, there is the opportunity to use the building as a community resource, and as a focus for day care and health and social care in Meigle. In September 1993, health board officers met the chairman of the local community council and the local regional councillor to discuss alternative uses for Meigle hospital, in the event that the board's proposals were accepted. Those discussions raised the possibility of various community care uses which might involve local community voluntary effort should they wish to be involved.

An approach to the social work department following those discussions progressed the possibility of using Meigle as a day care facility. I understand that subsequently both region and health board are now planning for this development. My hon. Friend mentioned costs. I should point out that Meigle now costs around £100 per in-patient day. Even with two extra beds at £90 a day, Meigle is still more expensive than Blairgowrie, whose costs are £76 per day. The third main issue on which there has been much debate in recent weeks--my hon. Friend also raised it tonight--is whether the planned bed numbers at Blairgowrie cottage hospital are adequate to cope with the influx of activity from Meigle. Last week, my hon. Friend drew to my attention the detailed population statistics of


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Perth and Kinross district council. My noble and learned Friend the Minister of State undertook to re-examine the population figures in conjunction with the projections used by Tayside health board. He also undertook to take into account the planning approvals granted in the area.

The main population trends in recent years have been a decline in the population of Meigle of between 3 and 4 per cent., and an increase in the population of Blairgowrie of around 8 per cent. In 1991, the district council issued building warrants for 200 homes in Blairgowrie on a phased programme of development which is on-going. That is likely to attract families to Blairgowrie, and to continue the trend of population growth in that area.

No similar developments are planned for Meigle and, if current trends continue, the population of Meigle is likely to continue to fall. In assessing the number of beds needed at Blairgowrie to provide for the transfer of services from Meigle, the health board took into account recent trends and the registrar-general's projections for the population of Perth and Kinross.

The health board's estimates indicated that the population of Blairgowrie and surrounding areas would rise from 14,500 to 18,500 by the year 2001. Those projections, on which health board plans were based, overestimate the population number significantly. The district council's statistics provided by my hon. Friend indicate that the current population is only 13,300, rather than 14,500 used in health board calculations. The health board paid particular attention to the projected growth in the number of people over 75, because older people tended to be heavy users of health services. Over the next 10 years, projections indicate that there are likely to be around 400 more people in the Blairgowrie/Meigle area.

Of those, between 50 and 60 will be over 75. The health board assesses that the health needs of those people, along with those of the existing residents of the area, can be met comfortably within the 56 beds to be provided at Blairgowrie.

Recent trends in both the acute and long-stay sectors of the health service show declining bed occupancy rates and shorter lengths of stay, with more people receiving care in their own homes or in a primary care setting. That is as much a trend in Perth and Kinross as elsewhere in Scotland, and it means that fewer beds are needed to provide the same level of care. Neither Meigle nor Blairgowrie hospitals are fully used at present. On average, there are two empty GP beds at Meigle and four at Blairgowrie. The health board assesses that the increased demand from the increasing population in the area will be more than offset by the continuing trends in bed usage. The health board, however, has assured me that if its projections of bed use prove to be wrong and further beds are required, appropriate arrangements will be made at Blairgowrie to provide additional beds.

My hon. Friend also referred to the origins of Meigle cottage hospital and, in particular, the generous donation by the Cox family. As I mentioned, the health board and the regional council are planning for Meigle to be used to develop community day-care facilities and also respite care which will help people to remain at home in the local area. My present understanding is that that would meet the broad objectives of the original endowment. It would be the board's intention to seek to recommemorate the Meigle site when it transfers to a new community care use, thus allowing continuation of the association between the building and the local community.


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In summing up, I compliment my hon. Friend on the close interest that he has taken in an important constituency interest. I can understand the concern that might be felt in some quarters at the recent announcement. I hope that what I have said will to some extent reassure my hon. Friend and his constituents, but I emphasise that my noble and learned Friend and I are presuaded that the health board has fully taken into account the likely changes in the population of Meigle and Blairgowrie in its planning and that it has planned adequate provision at Blairgowrie to provide for the transfer of services from Meigle.

We believe that local concerns to retain a valued local service have been met by Tayside health board in arranging for the transfer of services to Blairgowrie and that significant benefits to patients will result from the transfer of services which outweigh the inconvenience to visitors of


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additional travel. Moreover, the planned changes pave the way for new community care developments and the provision of day-care facilities in Meigle, which will be of particular benefit to older people in the area.

I will, of course study further the Official Report of what my hon. Friend has said. I know that my noble and learned Friend intends to follow up his recent meeting with my hon. Friend and will write to him about the various points that were raised. I hope that, thereby, what I have said this evening and what is being followed up by my noble and learned Friend will help to put matters into a fuller perspective for my hon. Friend, and I again compliment him on securing the debate.

Question put and agreed to.

Adjourned accordingly at twelve minutes past Twelve midnight.


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