§ THE EARL OF CORK AND ORRERY had given Notice that he would ask His Majesty's Government whether their attention had been drawn to the conditions as regards their food under which the military patients live in Horton Hospital, Epsom; and whether the 209 Government would appoint an inquiry to look into the matter; and move for Papers.
§ The noble Earl said: My Lords, it is not my intention in this Motion to make any direct attack upon the Horton Hospital which is named in the Motion, and certainly not on the medical treatment which the patients receive therein, for that, I understand, is first-class; and, after all, that is the first essential in a hospital. I bring this forward rather in an attempt to stop the rumours which are going about as to the general treatment and administration of this hospital, and also to draw attention to the difficulties under which hospitals are now labouring. It seems most unfortunate that at this moment, when we may expect the country to be flooded with wounded, any doubt should exist as to the conditions under which those men will be treated when they get into hospital. In view of the great number of men who have passed through this very large hospital to which I am referring, there can be no hesitation in saying that that doubt must be widespread.
§ The Government answer may dispel this doubt, and I hope that it will. I hope that it will sweep away from the minds of the public generally any anxieties which they may feel upon this subject. This will be the result if the noble Earl who is going to reply for the Government can say that an inquiry has been held into the administration of this hospital; and that it has been found that everything is quite satisfactory. It may, of course, be said that that is asking rather too much. But is it? We have now been at war for four years and three-quarters—plenty of time to get the hospital administration working efficiently and smoothly; the more so as the emergency medical service has not had the strain put upon it which had been anticipated and which it was designed to meet. If the administration of this hospital was wrong, then either the system that the authorities are administering is bad, or it is a good system badly administered; and four years and three-quarters should have allowed ample time to ascertain which wants changing.
§ To go into detail, the chief complaints that I have heard have been in regard to the quantity and quality, and the service of the food, but from different sources, both military and civilian, I have also 210 heard of overcrowding in certain wards, inattention to the patients and a general want of system in the whole administration. It has been suggested that by raising this question I am hindering the war effort. I do not think so; I consider that I am directly assisting the war effort, for people will feel very much better for the knowledge that if their husbands, or sons, or brothers are wounded and come back to this country, they will be restored to health under the best possible conditions. And the soldiers, too, if they think about it at all, will derive a certain encouragement from this knowledge.
§ I am not speaking in ignorance of hospital administration. I am a vice-chairman of the Seamen's Hospital Society, which has four hospitals, a sanatorium and a convalescent home, and I know the difficulties which face the administration in carrying on under present conditions. It is an uphill task in hospitals to-clay, and it would have been impossible if it had not been for the loyalty and devotion of the nursing staffs who, true to their traditions, have undertaken all sorts of work in order to keep a hospital going and look after their patients at the same time. Why have they had to do this? Because there are no domestics available, and no cooks can be obtained. I know the matron of one of these hospitals who has herself on many occasions cooked for days at a time for seventy people, in addition to doing her own work. It is not fair to ask the nurses to do this work, but there is nobody else forthcoming. Now women are being asked to volunteer for domestic work in hospitals as a priority service; but is not that rather like locking the stable door after the horse has been stolen, because these women have all been drafted into other work? Applications to local authorities have had little or no result. Where they have had a result quite the wrong class of people has been sent, people of low intellect, who have been much more of an anxiety to the hospital than a help.
§ I mention this because I suppose, if the Government have found shortcomings in this particular hospital, one of the reasons given—and probably a very true reason—is lack of staff. But that this position would arise has been represented to the Government for months past. There is nothing new in it, and the situation as it exists at present ought never 211 to have been allowed to arise. If faults have been found with this hospital, I hope that we shall be told that steps have been taken not only to put this particular hospital right, but every hospital in the country to which wounded may be sent.
§ There is one other point as regards the food. In the spring of 1941, in your Lordships' House, I put in an appeal for the merchant seaman that he should be treated when in hospital on the same footing as the Service rating, and should get the same food. The then Minister of Food did make equality between them, but this was much more by levelling down than by levelling up. The result was that the Service man got his ration reduced. Perhaps this may lie at the bottom of the trouble at this particular hospital. A soldier, when he begins to recover, gets hungry and misses the ample rations he had with his unit. I understand that it has been recommended to the authorities that the Service men should get more food, but that suggestion has been turned down from above. The experts require it, but the Government do not allow it. Yet even this would not explain the constant complaints of the poor quality of the food and the service and why the food is not hot. One reason I have heard given is that the hospital was formerly a lunatic asylum, but why lunatics should not have good food nobody has explained.
§ It may be said, of course, with a certain truth, that soldiers and sailors are very apt to grumble about their food, both the quantity and the quality. I know from experience that that is so. I have also heard of similar complaints about the amount of food at one of the hospitals I have mentioned being made to a Member of Parliament, and that was gone into. But in this particular case, since I put down my original question, I have been told from medical sources, from the vicar of a neighbouring parish, from a man whose wife was in the hospital, and from a very large number of other people, that there are very substantial grounds for believing that there is something wrong with the administration of the hospital. It is alleged that the food is lacking in quality, and it is not quite certain that the patients get the food to which they are entitled. All this does not help the recovery of the patients. 212 There is something wrong, I believe, and I hope that the noble Earl will be able to tell us that it will be put right. I feel very strongly that the public have a right to be assured that if their men folk have the misfortune to be wounded, when they come back to this country they will have the very best conditions to enable them to get back their health. I am sure that is what the nation desires and will insist upon. Therefore I hope that the Government will be able to give us that assurance. I beg to move for Papers.
§ VISCOUNT DAWSON OF PENNMy Lords, it is admitted that the feeding arrangements at Horton have not been satisfactory. There is no dispute on that point, and very considerable efforts have been made to put it right. But knowing Horton through and through, as I do, and being in the Emergency Medical Service, I have often thought when I have been going round it: "Thank heaven I have not got to administer this place." The actual building is good, but it was never meant for a hospital in the ordinary sense of the word; it was merely a place for mental patients in the old days. We have to remember that under the stress of war a great many buildings which none of us would have accepted for a moment in time of peace have had to be brought into the pool, in order to find accommodation for the very large number of patients that we might have. This hospital is spread out—it is almost a Sabbath-day journey to go from one part of it to another—and the only way in which you could provide hot food in some of the more distant wards would be by means of hot trolleys. But I understand that the difficulty of getting trolleys has been extremely great. That does not mean to say that they should not have been in some way provided. I am not trying to justify it. But we have to remember that as far as industrial work is concerned, this country is down to the bone. We can less and less get what we want.
What I want to say quite briefly is this, that that hospital is one of the best. I am not talking of the culinary side of it, but that hospital is reckoned by those of us who know as one of the best hospitals for good work for the sick and wounded that we know of. We put it in the first class. But the place itself is the great difficulty. I do not pretend 213 for a moment that that is a justification and that these difficulties should not be overcome, as I think to a large extent they are gradually being overcome. But it is only fair to say that the difficulties are there, owing to the fact that this is an improvised hospital, and not one that you would use in peace-time for hospital services at all.
§ THE PARLIAMENTARY UNDER-SECRETARY OF STATE FOR INDIA AND BURMA (THE EARL OF MUNSTER)My Lords, before I reply to the specific question dealing with Horton Hospital which has been addressed to me by the noble and gallant Admiral, I should like if I may to make a few general observations on emergency hospitals, and my remarks will have some bearing on the Motion that stands in the name of the noble Earl. For some time now my right honourable friend has done everything possible to ensure that the feeding arrangements in all hospitals are satisfactory and that the high standard we have set ourselves is permanently maintained. On many occasions considerable difficulties have confronted us, but as a rule we have been able to surmount them, and I can confidently say that the general administration in all hospitals is undoubtedly good. In a very few cases—and I repeat in a very few cases—the conditions revealed after inquiries have shown the necessity for some improvement. Active steps have then been taken to raise the standard of administration and feeding to the high level which, as I have said, we have always endeavoured to maintain. Early this year the headquarters staff of the Ministry of Health was increased by the appointment of two hospital dietitians to enable a more systematic inspection of hospitals to be made. The reports of these inspectors show that the feeding arrangements are good, but they have indicated that some hospitals have had difficulties in recruiting domestic and kitchen staff. My right honourable friend has received the most cordial cooperation and help from the Ministry of Labour in tackling difficulties of this kind.
I might mention to the House, for the information of my noble friend and others, that during the period from January 1 to April 14 this year, in all hospitals and institutions, the number of 214 nurses increased by 3,200 and the number of domestics increased by 2,200. The question which has been raised in the past—and my noble friend referred to it again tins afternoon—is whether in hospitals receiving a substantial number of Service patients the civilian rations, particularly of meat, are adequate. I have been advised that, taking into account the fact that many of the patients will be on low diet, it is thought that with appropriate management and avoidance of waste the rations at present supplied should be sufficient. Indeed, from the point of view of scientific dietetics, there is no doubt whatever that ordinary civilian rations should suffice. It has been agreed, however, that there are other considerations to be borne in mind—the fact, for example, that Service men have been accustomed to considerably larger meat rations and therefore provision should be made for a necessary margin. It has been decided, after discussion with the Service Departments and the Ministry of Food, that when the number of Service patients—that is to say the casualties and sick—in a hospital is substantial, and difficulty is being experienced in providing sufficient meat for such patients, the hospital may apply for an increase in the allowance of meat normally permitted. If, after investigation, a claim is made out, extra meat will be made available by the Ministry of Food on the basis of the full home Service ration for each Service patient undergoing treatment.
With these few general observations on emergency hospitals in general, I should now like to turn to deal with some of the points made by the noble Earl in the course of his remarks. Horton Hospital is administered by the London County Council under arrangements made with the Ministry of Health under Section 50 of the Civil Defence Act, 1939, a measure which, incidentally, I introduced into your Lordships' House myself. The London County Council are responsible for the administration of the hospital, but general supervision is exercised by the Ministry so as to ensure that the arrangements for the treatment and welfare of the patients are satisfactory. I might mention here that my right honourable friend has the fullest co-operation and assistance from the noble Lord, Lord Latham, and from the London County Council in investigating the state of affairs existing at Horton and also in determining what action can 215 usefully be taken to meet some of the difficulties which have occurred.
As was mentioned by the noble Viscount, Lord Dawson of Penn, this hospital is one of the largest Emergency Service hospitals in the country and is capable of accommodating 2,300 patients. It was, before the outbreak of war, an institution for mental cases. The lay-out of the hospital is therefore that of a mental hospital, with large wards, some of which in the old days were used as dormitories and the others as day rooms. To-day all the wards are filled with beds, and the ward kitchens have now to serve the needs of nearly twice as many patients as the number for which they were originally designed. Moveover, some of the wards, I am told, are a very considerable distance from the main kitchens which, in addition, have to cater for the patients and the staff as a whole. Consequently the facilities for cooking and serving meals are very inferior to those which would be met in a normal general hospital. Horton was visited under the new scheme of inspection in February last, and it was found that the general standard of the feeding arrangements was not satisfactory. A further visit was made to the hospital on May 30 last by officers of both the Ministry of Health and the Ministry of Labour, and although the feeding arrangements were then found to have been much improved, it was clear, so I am told, that further action was still needed.
The inspectors in their report pointed out that although the kitchen equipment, as such, was quite adequate, the serving arrangements were unsatisfactory. They accordingly recommended that steps should be taken to introduce a greater variety into the menus and that a catering administrator with domestic science training and experience should be appointed. All these recommendations were accepted by the London County Council, and a catering administrator is to be appointed at once. In addition, the London County Council have decided to relieve the present steward who, after many years of excellent service, is retiring for reasons of ill health. The inspectors also reached the conclusion that the difficulties were not due to any shortage of staff, but nevertheless, having regard to the new work which the hospital may at any moment be called upon to perform, it was decided that the staff 216 should be immediately increased. The Ministry of Labour have submitted to the hospital the names of six additional assistant cooks and thirty-four additional kitchen maids, and in the higher administrative posts they are prepared to provide three assistant kitchen superintendents in addition to the two already employed. Difficulties have also been experienced in the ward kitchens at the two extremities of the hospital through, I am told, insufficient pressure of gas. My right honourable friend has approved the laying of new mains, one of which has already been completed, while the second one is well under way.
Perhaps I may be permitted to make a few observations on the state of the equipment in the hospital. One of the chief drawbacks is that owing to the lay-out of the building the haul for food trolleys is so long that food becomes cold before it gets into the wards. That point was mentioned by the noble Earl opposite. This difficulty is being solved by fitting electrical elements to some trolleys and by the adaptation of others. The first trolley unit is on the point of completion and it will be tested this week. If the experiment is successful, and there is every reason to believe it will be, a large number of additional trolleys will be adapted and supplied to the hospital at the very earliest possible moment. At the request of the London County Council my right honourable friend the Minister of Health has recommended the Board of Trade to issue a licence to the Council to enable them to purchase electrically operated potato peeling machines, and he is also prepared, on the receipt of an application from the Council, to recommend the issue of further licences to cover the purchase of an electrically operated meat slicing machine and an additional mixer for the mashing of potatoes. Twelve refrigerators have already been supplied and these are now being installed.
§ THE EARL OF MUNSTERThey are in course of being put in now. I apologize for wearying the House with all this detail but, as the noble Earl must know very well, attention to detail can probably remedy many of the existing difficulties. Both the Ministry of Health and the 217 the London County Council are naturally concerned to see there should be no further complaint against the hospital. My right honourable friend is satisfied that there has already been a considerable improvement and he believes that the further steps which are being taken will ensure that the feeding of patients, both Service and civilian, is entirely satisfactory. I need hardly say that it is his intention to keep a very careful watch on the position at this hospital and in any other hospital at which there is reason to believe the conditions are not altogether satisfactory. From all I have said the noble Earl will probably agree that it is pretty obvious there is some justification for the complaints which have lately been received. Quite frankly, there is, and I do not for one moment deny it, but I certainly hope that with all the action which my right honourable friend and the London County Council are now taking, these difficulties will finally be resolved.
Perhaps I may say in conclusion that I sincerely hope my noble friend will not press the suggestion for the appointment of a committee of inquiry for in point of fact my right honourable friend has examined this matter with minute care, and has really been Chairman and Managing Director of the inquiry as well. I can only hope that, with all these actions which have been taken, the difficulties experienced by the hospital in the past will be finally resolved, and that my noble friend and others who have naturally been concerned with this matter will have no further cause for complaint.
THE EARL OF CORK AND ORRERYMy Lords I thank the noble Earl for his answer and I must congratulate him on having a very fine smoke-screen. I am astonished to be told by the noble Viscount, Lord Dawson of Penn, that this is one of the best hospitals in the country for attending to the wounded. If that opinion goes out to others who know the truth about the hospital, they will be very disturbed and very disappointed. There are other lunatic asylums that have been turned into hospitals. I have heard mention of one in the Southern Counties which has 1,800 beds and is laid out on very much the same lines as Horton. It is perfectly managed and well regulated and the food is ample. If that can be done there, surely it can be done else- 218 where. The noble Earl says that the Minister has appointed thirty-three or more people to the staff. That will be a great easement of the situation as will the provision of refrigerators and the other things mentioned. They have even gone as far as to discover that you can have hot trolleys to take the food about. That is a great advance.
But what, I complain about is that after having been at war for four and three-quarter years we should find these things; in one of the very largest hospitals to which the wounded are sent. I do not know who administers this hospital. I was told it was the London County Council. You cannot shoot the whole of the London County Council, but you might shoot one of them. There must be somebody responsible. We have heard of a steward being retired, poor fellow, on account of ill-health. I should like to hear of somebody being retired because he has failed in his duty to the wounded. I do not intend to press this to a Division now that we have heard of all these things being done, but I do ask the noble Earl to assure the House—I understand that he has done so—that these things are being seen to in every hospital up and down the land to which the wounded are being sent, so that we shall be in a position to carry on with the war in the knowledge that the wounded are being well fed and cared for. I ask leave to withdraw the Motion, but in doing so I should like to say that I think your Lordships will agree that I and my friends who have been working on this matter have not impeded the war effort by bringing it forward, but have helped it.
§ Motion for Papers, by leave, withdrawn.