HC Deb 30 November 1938 vol 342 cc505-60

7.42 p.m.

Sir Francis Fremantle

I beg to move, That this House recognises the call upon medical services in case of air-raids as a cardinal factor in such an emergency; is of opinion that a complete and detailed scheme is required providing for the medical and auxiliary personnel, the institutions, equipment, communications, and transport entailed; and demands that both policy and administration shall be devised without delay and carried out under responsible co-operation between the British Medical Association and other representatives of the medical profession and of the hospitals, with the several Government Departments concerned. I now asked the House to turn from questions relating to the defence of our export trade to the defence necessary in case of air raids, and to consider what may be necessary in regard to the medical services in the defence of this country. All are concerned in this question of civil defence. I will simply take two recent terrible experiences to illustrate the air developments in warfare. We read of how a single shell fell upon Shanghai killed 200 people and inflicted injuries upon innumerable others, and of how, on the other hand, in Madrid at one time 200 shells fell upon the city resulting in the killing of only four persons and in only 13 people being injured. Why was this the case in Madrid? Because the sufferings that the people had undergone had taught them how to protect themselves, and the lesson had been effective. In Shanghai the people had not learned how to protect themselves when the danger of air bombing was upon them. In the recent crisis we had a test, and in my own county of Hertfordshire we had the advantage of a test and a black-out upon a recent Saturday night, which was fortunately chosen to synchronise with the feast of 5th November. The black-out was complete in Hertfordshire but not outside, and the illuminations in the surrounding counties gave directions to the aircraft by which they could have wiped out Hertfordshire. A test was made at the same time of the air-raid precautions all through the county, and many different deficiencies, overlapping and difficulties were found, to which I wish to direct attention.

I hope that we shall have a useful and constructive Debate. I propose to make no accusations against those who may or may not have been responsible for the deficiencies, but I wish to use those deficiencies as an index to those parts of our defences to which attention must now be paid. In this sense I apologise for the length of the Motion, which is in three parts. In the first part I contend that we have to recognise the medical services as a cardinal factor. As I originally worded the Motion I went so far as to say that they were the chief factor, but in order not to claim priority, I say that they are a cardinal factor in civilian defence. In the circumstances the Motion says that a scheme should be devised with four ingredients which are, first, the personnel of the medical and auxiliary services; secondly, the institutions and their equipment; thirdly, the method of communication between different parts of the medical services and the civilian defence service; and, fourthly, the ambulance service for the transport of the wounded. The third part of the Motion submits a definite method of devising and administering the work of the medical services effectively.

There is no intention in this Motion of wishing to put arguments forward for the glorification of the medical profession or to raise the profession above the proper position it should occupy in civil defence. I wish only to suggest that, owing to the actual requirements of the case and the experience of previous and present wars, and owing to the training and the services of the medical profession, there is a definite position which they must be given, not only incidentally but responsibly, in the whole organisation. The intention and desire of the medical profession and the auxiliary services is to contribute of their best to the national advantage.

My own first experience, after I left the hospital, was as a civil surgeon in South Africa. At the beginning a few of us were reinforcing the Army Medical Staff at Cape. Town at the first big general hospital of the war. The wounded came down from the first three battles of the war, at Elandslaagte, the Modder River and Belmont. The three ambulance trains were crammed, and, in addition to there being an insufficient staff, both of nurses and of medical men, no proper accommodation had been arranged. I do not wish to go further into history except to say that, as a result of the appalling want of preparation and planning, the then Secretary of State for War, Mr. Brodrick, appointed a Departmental Committee on the Reorganisation of the Army Medical Services. On that committee I was privileged to serve as an assistant secretary, and the effects of the equipment, organisation and administration which resulted from its recommendations were seen in the late War. In the late War we had an organisation which was not only complete for the Expeditionary Force as sent out, but was capable of extension as the need arose. The lesson of that bit of history is that you require planning for definite requirements on the basis of definite experience.

You also want an opening of the eyes of those people, whether in authority or otherwise, who look upon the medical service as being only, so to speak, a technical extra. That happened at the War Office in the last century. When Sir Garnet Wolseley on coming back from his expedition in Egypt, was asked why he had given no decorations and honours to medical officers, he replied, "Because they had nothing to do; our troops were so healthy." It was only after he was gone, and a fresh generation had arisen, that it was recognised that the health of the Army was of first importance, and depended upon the medical officers, whose job it was, and that they were entitled to a good deal of credit for it afterwards. The same thing has to be done now. The medical services must be given their proper position.

What is their position in this matter of civil defence? I am certain that under the Home Office the Under-Secretary and his staff and the local authorities did their very best. It is extraordinary what was done during that time. They had an almost inconceivable task, with unknown requirements. The medical officer, Major Blackmore, died at his post as a result of overwork. He ought to have been given help, but he was understaffed. Moreover, the great difficulty of all the authorities and all the people engaged on this job was the fact that the public were perfectly tepid on the subject until September. They might read the papers and talk about it, but in the main people were not going to have their summer holidays interfered with by A.R.P.; that, they said, was the job of the Home Office, the local authorities and so on. You could not get a move on in that respect. As a whole, the public were tepid until they suddenly came back from their holidays in September, and the whole country recognised what was the situation against which preparations had to be made.

The Medical Officer of Health to the London County Council the other day described in one of the medical papers his own experience. He said that since 1930 he had sat on five committees on the subject, under three Government Departments. In the case of the first four Committees, nothing, so far as he knew, seemed to have been done; the Committees seemed to terminate ineffectively. Only the last one, the Wilson Committee, moved effectively, presenting its interim report in the middle of July. The Ministry of Health would naturally be expected to take the main part, but at first, I understand, they were given no part. Afterwards, certain responsibilities were transferred one by one to the Minsitry of Health. In June of this year a special branch was created to deal with the emergency medical services, and Dr. Hebb, the Director-General of Medical Services at the Ministry of Pensions, was transferred to it for the time being. But still the fact passed without any attention that they were understaffed. They ought to have had a considerable increase of staff, and much remained to be done. The difficulties and deficiencies were due a good deal to understaffing. It is naturally difficult in the ordinary way of any business, whether Government or otherwise, to know when is the right time to increase staff, and when is the proper time to rely upon keen, energetic officials to overwork themselves by working overtime. It is unquestionable that they were, and still are, understaffed, and perhaps the Parliamentary Secretary may have something to say on that subject if he takes part in the Debate, as I hope he will.

Meanwhile, the Committee of Imperial Defence have asked the British Medical Association, as the main body representing the medical profession, to inquire into the scope of the medical services available. That they did over 18 months ago. We have been talking a good deal in this House on the question of a national register, but I am proud to think that my own profession took the bit between its teeth and started a register of its own members, at its own expense, with a very complete questionnaire, no less than 18 months ago, in May, 1937. But a register is useless unless it is kept up to date. Even doctors move house sometimes; the ordinary population moves a great deal more. Even doctors change their minds as to what they want to do, what they can do, and what they are best fitted to do. For the register to be of any use, it must be revised every year. The Government came forward very handsomely, and have, as I understand, undertaken the cost of revision of the register, which amounts, I think, to something like £500 in England and £200 in Scotland for the year. The result of the questionnaire sent out by the responsible voluntary body of the medical profession is to show that 43,000 doctors have undertaken to serve, stating their equipment and experience, and 95 per cent. of them are prepared to give their services in one way or another. It includes such demands as were made at the time, and may be made in the future, on the War Office. But, although it is agreed that the Government Departments and the hospitals should be staffed, in case of an air raid, only through this register and according to this register, irregular applications from some Departments and officials still continue to be made, indicating that that part of the position has not yet been made generally known and understood.

Of all the difficulties that arose when the crisis came, perhaps not the least in this organisation was the uncertainty as to the actual position and equipment of, and the demands that would be made on, the first-aid posts. It is recognised that in the case of casualties, as in the field in a war, you must first of all have some kind of collecting stations, some kind of first-aid posts, where patients can be sorted out and sent on to the casualty clearing stations, as they are called, where they receive primary treatment and from which they are sent on to base hospitals. The position in London, as far as I can make out, was that, according to the Home Office, first-aid posts were not to have any medical officer at all; they were to be lay posts, from which the patients would be sent on to such of the general hospitals as had been earmarked for the purpose and cleared of their ordinary patients so that they might be used as clearing stations, which might be working day and night or might have nothing to do at all. The patients coming to them would be sent on by ambulance to base hospitals at some distance out in the country.

What was to be the position of the first-aid posts where no medical officers were to be available? Those medical men who had had experience of the late crisis, as well as those who had previously thought over the matter theoretically, were almost unanimously of opinion that first-aid posts would be perfectly useless without a medical officer. If there were no medical officer, all that could be done, after the administration of sal volatile, alcohol of one kind or another, and the application of bandages, would be to send the patients on, and the result would be that the casualty clearly stations would be absolutely blocked up with a great mass of perfectly minor cases. It must be remembered, too, that in an air raid you might not only have numbers of the civil population wounded, but you might have a large number of medical cases among the civil population—cases of nervous breakdown, hysteria, mania, and mental cases—with which it would be very difficult to deal. Moreover, some of the primary cases might need morphia, which you could not allow lay people to administer. Last week, at a meeting of the Association of County Medical Officers of Health, the county medical officer of one of the chief home counties was absolutely definite in his view that you must have medical men at these first-aid posts.

It is all very well to say that you must have this, that and the other, but the question is, can you have them? Is the supply sufficient? I am sure it would be in London, but the question is whether it would be elsewhere. We had the Home Office laying down what was required, and saying that the first-aid post had nothing to do with the Ministry of Health, while the Ministry of Health have charge of the hospitals and the medical personnel. That is the reason for the need for co-operation between these two Departments and the medical profession. At a meeting of the Hampstead Branch of the British Medical Association last week, the same opinion emerged—that it is perfectly useless to have first-aid posts without medical officers. In a military system, you always have medical officers at first-aid posts. It is wrong to think that these first-aid posts must necessarily be static, requiring the presence of a medical man night and day. Someone should be in charge, preferably a medical man in practice in the neighbourhood, who could run in and out and be available. Many local authorities at the time of the crisis decided that there should be medical officers at their first-aid posts, and therefore there was great confusion. Why should the first-aid posts be under the Home Office, while ambulances, stretcher squads, casualty clearing stations and hospitals are all under the Ministry of Health? That seems to be a very wrong proposition. The Prime Minister said in this House, on 1st November: We have the Home Office, dealing with, perhaps, the major part of the work, especially police work, as well as fire brigades, gas-masks and so forth. Then we have the Ministry of Health, which is in close touch with local authorities, and is also responsible for the medical services, including nursing and ambulance provision."—[OFFICIAL REPORT, 1st November, 1938; col. 84, Vol. 340.] To this has now been added the whole subject of evacuation, with which I do not propose to deal to-night. This will require co-operation between these two Departments and the medical profession. The position is so serious that the British Medical Association, the Royal College of Physicians and the Royal College of Surgeons together took 'a joint deputation to the Minister for the Co-ordination of Defence on the 8th of this month. The Minister was attended by representatives of no fewer than eight Departments, and he had a very full statement put before him by Sir Kaye le Fleming. This showed that the British Medical Association had established a central emergency committee, with associated committees of reference of the Royal College of Physicians and the Royal College of Surgeons, this central emergency committee being the supply organisation—the organisation for the supply of medical services. But they still wanted some body to co-ordinate the actual demand that they would have to meet. In his reply, the Minister said that this was of obvious importance, and everyone would agree with it. It would be the Ministry of Health, and to some extent the Home Office, which would take charge of these discussions. We got the promise from the Minister for the Co-ordination of Defence that there would be this coordinating committee. I hope that that will be the case, because it is very seriously needed.

In considering the medical services, the position of the medical officer of health, especially in the countryside, is commonly forgotten. His position is very difficult. He has still to be in charge of the sanitary services. These do not only include the material services, which come under the surveyors and engineers but which he has to see are sufficient from the health point of view. He is also responsible for the personal services in schools and in county hospitals, and for the whole Poor Law system. This system would be much affected in an air raid. On the question of evacuation, the medical officer for one county told me personally that in one of his villages he recently had to close the school because of a virulent outbreak of diphtheria, yet he was informed that 100 children were to be evacuated from that village. That shows the lack of any proper scheme for co-ordination.

The Parliamentary Secretary to the Ministry of Health (Mr. Bernays)

Can my hon. Friend give me the name of that place?

Sir F. Fremantle

I will tell it to my hon. Friend privately when I have leave to divulge it. I think it will be a little awkward, possibly, for the medical officer in charge. In connection with air-raid precautions, this medical officer of health, according to the air-raid handbook, is the controlling official of first-aid parties, first-aid posts and ambulances. He has to do this in addition to his ordinary work. What is his position as controlling officer for nine districts? And what is his status in regard to the voluntary hospitals, the municipal and auxiliary hospitals, and the training and staffing of these? What is the position in connection with the St. John Ambulance Brigade and the Red Cross Societies? That has to be made clear. We are told that in Madrid the people, of their own initiative, insisted on digging trenches in the streets, regardless of the water mains, sewers and all the rest. Just think what complications that brings to the medical services.

So I emphasise the three different parts of my Motion. The first part points out that the health services are a cardinal factor. Think of a bomb falling in the midst of a congested population. The first thing people think of is, Where is the doctor? He will be called for on every side, with the nurses, the ambulances and the first-aid men. The medical services are not merely a factor, but a cardinal factor, in not only treating the people, but in giving confidence—for it is that that the doctor is able to do better than anyone else, among his own flock. The Committee on Evacuation, presided over by the present Lord Privy Seal, reported in July, and in their report they made no mention of health services, except for two lines only. I asked the Lord Privy Seal—that was before he was Lord Privy Seal—what was to be done with the doctors, and he said, "Oh, they will be brought in by the local authorities." They will be brought in, as if they were menials, to clear up the mess.

The position taken up in this Motion is, clearly and definitely, that looking at the whole position and the requirements of the case, if the medical services are a cardinal factor, medical men will have to play the chief part in co-ordinating these services, the chief part in administering them, the chief part in organising them, and the chief part, or, at any rate, a cardinal part, in devising them from the very first. My Motion says that the scheme must be complete, and it must be detailed. There must be, first of all, the medical personnel, which will include also retired men up to a certain point. Many retired men have written to me to say they are thirsting to play their part, and yet they have no part given to them. They will be an extraordinarily useful factor in the situation. So will medical students. Yet the position in regard to the students is difficult, because we have to keep up medical education, otherwise we would be creating difficulties for the physicians and surgeons on the staffs of the hospitals.

Then there is the question of auxiliary personnel. I have referred to the difficulty of co-ordinating the St. John Ambulance Brigades and the Red Cross. In a village I know well, a medical man from a neighbouring town, who was interested in the St. John Ambulance, overbore the local Red Cross lady and her helpers in the village and insisted on bringing in his own ambulance service from outside. The nurses, dispensers, laboratory workers, clerks, stretcher-bearers and messengers must all come in as an essential part of the organisation. They cannot be brought in as a crowd. They have to be brought in with proper organisation. We come to the question of institutions and equipment. I am leaving it to my hon. Friend who will second the Motion and my hon. and gallant Friend opposite to deal with that. They will have a great deal to say about it. The question of communications is too often forgotten. In an air raid the medical services will be powerless if they are not able to communicate with medical men, to find out where to send patients and where the ambulances are. If the telegraph wires and telephones are all broken down it will be necessary to have boys and girls to go about, either on foot or on bicycles, and carry on. There will also have to be commandeering of private cars, which could be used to some extent without adaptation, and would to some extent require adaptation.

There must be a proper organisation. The policy and the administration must be devised and carried out under responsible direction. It means that there must be a responsible co-operation in which the bodies concerned with this committee that has been suggested can undertake the responsibility of devising this, that and the other, instead of the Ministers and the Government Departments having to be responsible. There must be this coordination. Hospitals must be completely represented, together with the medical profession, all the Government Departments concerned and the local authorities. Cases have come to light where the Services, quite naturally from the point of view of their traditions, made their demands regardless of everybody else. There was one case of a medical man being engaged by the local military unit to inspect the troops in a town 10 miles away from his own surgery, although in that town there were several doctors who could have done the work just as well. That kind of thing cannot be allowed. Yet we have to fit in the organisation of the Territorial services with this civil employment. These units now being built up—anti-aircraft units, searchlight units, and so on—all over the country, will all have to have their own medical officers probably, unless we have proper co-ordination regardless of the greater requirements of civil defence.

I end by referring to the fact which appeals to so many of us who were responsible members of the medical profession during the Great War, namely, that there was practically no breakdown in the medical services on the Western Front. When the soldier went out on behalf of us all and over the top, he knew that if he was wounded and got through he would be properly cared for. From the start right through to "Blighty" and to the finish this knowledge was of the first importance to the morale of the troops and to the confidence of the public at home. This is an essential part of our defence arrangements. It is our object to be prepared, and to be known to be prepared. The medical profession offer their fullest help. They ask for powers to enable them to do their work properly, and then success may be assured.

8.16 p.m.

Sir Henry Morris-Jones

I beg to second the Motion.

Like my hon. Friend who moved the Motion, I may have some critical words to say in regard to the Government and the general organisation of medical services, and I am glad to notice my right hon. Friend the Lord Privy Seal is on the Front Bench, in addition to my hon. Friend the Parliamentary Secretary to the Ministry of Health. My criticisms will be criticisms of a friendly character, and, I hope, constructive. I may have to ask my hon. Friend the Parliamentary Secretary a number of questions which possibly he may not be able to answer tonight, but he may give the answers to them at a later date. I think that all Governments in the main base their preparations for war on the basis of the last war, but every war is different from a previous war. The strategists themselves do not seem to be able to tell us exactly what will happen in the next war, if we are unfortunate enough to have a war. They are like the economists; they differ. [Interruption.] And doctors too, I have no doubt.

There is one thing of which we may be quite sure—I think all strategists agree—and that is, that however well organised our defensive measures may be in the air, a certain amount of bombardment will take place, that a certain number of bombers will get through, and there will undoubtedly be casualties. The estimates of casualties vary from thousands to hundreds of thousands. We do not know what they are likely to be, but we are sure of the one fact that there will be a large number of casualties in our great centres of population. Not only will there be casualties, but there will also be cases, as my hon. Friend said, of illnesses of a diverse character, physical and mental, dependent upon the repercussions of this type of intensive warfare which we visualise, not only in its effects on those in the immediate area of the bombardment but also in its effects upon those who have to be evacuated from those areas and who are leading abnormal lives in entirely abnormal conditions.

We have not only to deal with the problem on the humanitarian ground of actually saving lives in war, but we have to deal with it on a more comprehensive basis of helping the moral of our nation and our people in time of emergency. Therefore, it is important that we should see that our medical, nursing and ancillary services are so well organised beforehand that there will be no serious hitch when the time comes. I may say without any undue boasting—I am merely stating a simple fact—that on the whole, in the last War, from 1914 to 1918, the medical services both in the line and behind the line were efficient. I think that that part of our organisation during the last War came out of the great ordeal with as little criticism and comment as any part of the organisation. During the last War I was a medical officer both in the base hospital and in the field ambulance, as well as medical officer of a battalion in the line, so that I saw something during those four years of the casualties in their various aspects. Although, as I said before, casualties in the next war will not be of the same character, the experience of the past may guide us to some extent.

The first question I want to ask my hon. Friend—it has been touched upon by my hon. Friend the Member for St. Albans (Sir F. Fremantle)—relates to the evacuation of the wounded and the sick, the helpless persons. Have any plans been decided upon by the Government with regard to aid posts? Where are they to be? Are they to be in trenches in the parks of London or in annexes to the big hospitals, or are they to be, where I consider they ought to be, in concrete underground shelters? It has been mentioned, according to the Home Office, that no medical officers are supposed to be in charge of these aid posts. If that is still the situation there ought to be reconsideration of that point of view. It is vital that the immediate casualties, diversified in character as they will be, some of them simple and some of them very grave, should be segregated, and they can be segregated only by a medical man who is acquainted with the wounds. Mild cases of shell-shock and minor injuries, and all kinds of illness of a diverse and minor character will tend to block the main hospitals in London. Many of these cases could be sent home right away because their injuries were not of a sufficiently serious character as to require detention in hospital. I hope that we shall have some of these concrete underground shelters as aid posts, as I visualise a very difficult time for anybody who is in charge of aid posts in the open or in places where large masses of wounded are congregated, for they are likely to be bombed from the air. I trust that this part of the policy has been decided upon.

There is the serious question of the position of hospitals in London and in other big cities. We know that, generally speaking, our voluntary and municipal hospitals are under separate management. In such places as Manchester and Oxford there is a joint management of both voluntary and municipal hospitals, with one central governing body, which is a very good idea. In London, as far as I understand, 15 voluntary hospitals and 19 municipal hospitals have been earmarked for use as casualty clearing stations. All the remaining hospitals, a large number of voluntary hospitals, including some of the big teaching hospitals, tuberculosis hospitals, children's hospitals and maternity hospitals, are to carry on as usual. That was the policy until recently and I do not know whether it has been changed.

I take the view that it is extremely questionable whether, in the event of an intensive bombardment of London or any big city, we ought to keep any ordinary cases of sickness in the hospitals. What would be the position of any Member of this House or any person outside who was ill in a London hospital which was the centre probably of day-to-day and night-to-night bombardment? I hope the policy will be adopted, definitely and clearly, that hospitals in London, of whatever kind, unless they are clearly outside the radius of possible bombardment—and I do not know what place would be outside the radius of possible bombardment in the Metropolis—ought to evacuate all their sick to their homes, if they can be evacuated, or to hospitals in the interior of the country.

On the boards of management of hospitals there is very serious concern and misgiving at the present time in regard to their position. I have been reading resolutions from various hospitals, and I will give a few quotations to indicate what is felt. Here is a report from a hospital not very far from London: Since the passing of the international crisis my committe9 have been reviewing the resources of the hospital in the event of a similar crisis occurring in the future, and they feel rather unhappy about the haphazard instructions which were received from time to time regarding the Ministry of Health's accommodation requirements. It is felt that the Ministry of Health should prepare a plan of requirements which would he necessary if hospitals are to be brought into any scheme in connection with home defences. Here is a letter from a hospital in Scotland: Do you think that the Government have reached any conclusion as to what they expect from large hospitals such as this? Looking hack on the chaotic conditions which would certainly have followed a declaration of war, one hopes that if any such a crisis arises again we shall know our line of action more precisely than last month. Here is a letter from a big hospital in the north of England: Our great difficulty was to discover what was expected of us. When the crisis arose, nothing had been decided; the medical officer had no instructions, while no preparations had been made for his temporary first-aid hospital to which the staff here was to be transferred further inland. What would be most appreciated is a definite lead, or instruction, as to what is expected of this hospital in any future emergency.' Here is the view expressed with regard to a hospital which concerns us very much in this House. It is a hospital in the heart of Westminster—the Westminster Hospital. If any of us in this House were injured by a bomb, I take it that it is to Westminster Hospital we should be sent, either from this House or from its immediate neighbourhood. I mention this case particularly because this happens to be the centre of the seat of Government, with all its ramifications round about. The secretary of Westminster Hospital said recently: The greatest difficulty had been the complete lack of any co-ordination between the Ministry of Health, the Home Office and the local authority. They have been told that there might be queues outside the hospital up to thousands in number, yet no directions appeared to have been given to the police or to the local authority for the proper control or temporary accommodation of the crowds seeking admission. Representations had since been made to the Home Office by the hospital direct and through the King's Fund. Still, however, there had been no information as to whether there would be a single co-ordinating body to direct the various schemes. He goes on to say that: He questioned whether it would be wise policy for a hospital in such a vulnerable position as the Westminster to be called upon to admit to its wards up to 50 per cent. above normal capacity, and whether, indeed, it would be wise to fill a hospital in such an area with casualties. That gives an indication of what some of the hospital authorities feel.

Then there is the question of the operating theatres in the clearing hospitals. Are any preparations being made to have these operating theatres underground? One can visualise the position of an operating theatre in a hospital above ground, where the surgeons were performing an operation during a bombardment. Steps ought to be taken to see that some of these operating theatres are placed underground. The Home Office appointed a committee which presented an interim report a few months ago. The report has not been published, and I do not know why that is so. It would be very interesting to those who are concerned with this matter, and to a very large number of people, if we could have that report. Much good work has been done, by Dr. Hebb, and I think the public would be interested to see what is stated in the report. The personnel of the committee was a very able one and it did really good work.

In connection with the hospitals there is one further point which is important, although it may seem a small matter. I refer to the question of finance. In the last crisis in September many of the orders given by hospitals were without legal sanction. Their staffs acted often without regard to the hospital's charter. Many hospitals obtained surgical and other equipment which normally they do not need, and since they work on such narrow margins the King Edward Hospital Fund for London made a distribution of £100,000 in advance of this year's grant.

I should like to say a few words about the equipment of the hospitals. Are they adequately equipped, and is the country adequately equipped in regard to drugs, dressing, blankets and so forth, for an emergency? I have a hospital in my constituency the medical officer of which wrote to me a short time ago: Having been asked on the Tuesday before the zero hour"— that would be round about black Wednesday, the 28th September— to be ready to equip a building as a hospital at 12 hours' notice, I decided to order in preparation for this, dressings, drugs, etc., equivalent to two years stocks for this sanatorium. By this means I should be ready to start the hospital in case of war, but none of the firms written to—wholesalers I always dealt with—could supply me. All were sold out; they would take my order and deliver in rotation. Certain of the orders I cancelled; others I let stand. No delivery has yet been made, a fortnight later. Morphia was ordered from one of our biggest wholesale and retail firms of manufacturing chemists. None was available. They wrote me they had built up their stocks; but the demand was unprecedented and could not have been foreseen. Since then I have had from the Ministry a reply which gives me some assurance with regard to the provision of medical supplies, and I hope that we may regard the position as rather more satisfactory than it was a few months ago. I should like to make one suggestion. Why not make it compulsory for every motorist to carry surgical dressings, a pocket dressing? It would be useful in times of peace in case of an accident and would be a great help in time of war. It is perfectly easy to do this and it would involve no labour. Then there is the question of stretchers. We want hundreds and thousands more than we have, and they should be of a uniform pattern. Outside a hospital now you will see stretchers of all patterns, hospital stretchers, police stretchers and private stretchers, all varying in size and some in shape. We ought to have some assurance on this point, especially as there is the important question of transport from the hospitals in London and the great cities to safer places in the country. Then are motor ambulance drivers being trained to drive with their gas masks on and their lights dim? That is not so easy as it would appear to be, and I trust that a large number of these drivers are being trained so as to be ready for that emergency.

I should like to see more use made of our waterway systems. Is any use to be made of the Thames for the transport of people? There are many steam launches on the Thames going up as far as Oxford, and they can carry from 200 to 250 people. They could be converted into hospital launches, and in that way you could daily evacuate from London, in greater safety than you can along the roads and railways, thousands of injured people. After all, the River Thames is going to be about the safest place at a time of bombardment. It may be a mark for the bomber but it will not be a target. There is no incendiary bomb made which can set the Thames on fire, as far as I know, and I think the high explosive bomb will not do so much damage when it is dropped in water. Then there is the Grand Junction Canal from Brentford right up to the Midlands, which might be used to carry people into regions which are safer, and it will be safer to do this by canal than by the roads and railways.

I think that on the whole the Medical Association has done very well in the way of organising personnel. It has a register which the Government might well envy, and 95 per cent. of the work has been done by the officials working late into the night. It is essential that there should be no waste of personnel. The staffs of hospitals should know whether they will be wanted in the hospitals, in the Territorial service or in their own civilian occupations, and there should be a mobilised force of doctors which could be transferred to any centre which has suffered intensive bombardment. In other ways overlapping can be avoided. Then as to medical students; are you going to keep them in London or send them into the country to complete their course and become fully qualified?

I hope the Government are taking steps to organise the medical services. The question of evacuation depends upon it I know cases where it was proposed to, send children to be billeted on people many of whom were unsuited in many ways to have charge of children. I could name three bachelors who were to have had children billeted upon them. My hon. Friend who moved the Motion is a bachelor. I wonder how he would like to have had three children billeted upon him without any means of looking after them. I think children should be billeted largely in hospitals and be under proper maintenance and supervision. I hope that the Government are not losing sight of the importance of these medical services, because in their ramifications they have a most direct consequence on the lives of our people in the time of emergency which we are visualising, but which we hope will never develop. There is a vast body of medical service at the disposal of the nation and of the Government. Many are asking in what capacity they can serve. I want the Government not only to organise but to give the appearance of organising in order to stimulate this vast body of people who want to do what they can. It may mean all the difference between victory and defeat in a war.

8.44 P.m.

Colonel Nathan

My hon. Friends who have proposed and seconded this Motion are distinguished medical men. I am a layman. I do not know whether they have had the experience of organising a hospital to meet the recent crisis. I have had that experience. I had it by reason of the fact that I was chairman, and still am, of the Air-Raid Precautions Committee of the Westminster Hospital to which the hon. Member has referred, and am chairman of another hospital not very far away, the Infants Hospital in Vincent Square. Both those hospitals were detailed as Grade A casualty clearing stations for adults during the recent crisis, and a main part of the responsibility for organising them for that purpose fell upon my shoulders. I do not now speak in the name or by the authority of any hospital. I say that because the hon. Member quoted a passage from a statement made by the very able and experienced secretary to the Westminster Hospital as if that statement were made by him either on behalf of the hospital or in his capacity as Secretary to it. I think the hon. Member will find that, in fact, it was part of a contribution—and a most valuable one—that was made to a discussion at a meeting of hospital administrative officers. I speak merely for myself, basing my observations upon my actual experience.

I do not propose to embark upon any controversy, for I do not think this is a subject which at this moment requires very much argument. My object is to give a few pointers, based upon experience, to which the attention of the Government might well be directed in connection with these matters. I would add that I speak with experience in London alone, which of course presents its own special, peculiar, and most difficult problems. Nor am I able to speak from any standpoint save that of the two voluntary hospitals with which I have been closely connected in this matter.

The first requirement is that the hospital should know with whom it has to communicate and from whom its orders are to come. I suppose this problem may be regarded in this way, that it begins at the first-aid post and ends in the mortuary. In the recent crisis, the first-aid posts and the mortuaries came under the aegis of the local authority. The hospital emergency administration in general came under the Ministry of Health, but in regard to gas it came under the Home Office. It was indeed impossible for those who had responsibilities in the matter to make quite sure that they were in touch with the right authority. All possible assistance was given, after the initial stages of the crisis, by Colonel Hebb and his assistant for London, Dr. Dobbie, of the Emergency Services. No words of praise are too high for the devotion which they gave to their arduous and responsible duties. But whoever the persons in charge may be, the hospitals must know with whom they are to communicate. Therefore, the first suggestion I make to the Parliamentary Secretary to the Ministry of Health, who is to reply to this Debate, is that the hospital services should be told well beforehand from whom they may expect to receive instructions and guidance. I make the suggestion that, whatever inter-Departmental arrangements there may be, there should be one authority, and one authority only, with whom the hospitals should communicate.

I agree entirely with the remarks about first-aid posts made by the hon. Member for St. Albans (Sir F. Fremantle) and the hon. Member for Denbigh (Sir H. Morris-Jones). I agree with the hon. Member for Denbigh, who seconded the Motion, that it is indispensable, if time will allow, that the first-aid posts should be in places where at least they are safe and able to carry on their functions as first-aid posts. I agree with both the hon. Members that it is fundamental that there must be medical men in charge of those posts. I am not quite sure from where the medical men for these posts are to come. I think the Parliamentary Secretary will have to look into that matter. They cannot come from the hospitals, because the hospitals cannot spare them; they will want all, and more than all, the staff they already have. Both hon. Members referred to the register of the British Medical Association. Undoubtedly, that is a most valuable piece of work, but it is to be noted that when the crisis actually arose, the register was not of such immediate use as might have been expected; for I was informed, on making inquiries from the Emergency Services Administration at the Ministry of Health, when I wanted additional staff for one of my hospitals, that the register would not be operative for at least a fortnight after any crisis arose. It is imperative that, if the register is to be really effective, it should be operative from the moment the crisis arises, and that there should be no gap.

The first fortnight or the first month will be particularly vital from the point of view of protecting the morale of the people. We are dealing with the unknown. If we should find ourselves at war, it will be in entirely unknown conditions and there will be many completely unforeseeable factors. We have to make certain assumptions. We must make the assumption that there will be air raids and casualties, but we must not make the assumption, in considering this matter, that the air raids will be overwhelming and that it will be impossible to deal with the casualties; for no organisation could deal with that situation and it would have to be dealt with, if and when it arose, in the circumstances of the time, and possibly under conditions of martial law. We have to contemplate a situation in which the area of destruction and the amount of casualties are manageable, and all we can expect to do is to organise ahead on that basis. I do not think we can organise ahead for more than the preliminary stages. We shall have to learn by experience. Having some responsibility as far as hospitals are concerned in the matter, I should be completely satisfied if I could see an organisation on foot which was likely to take us through six weeks of a manageable period. During those six weeks we should learn a great deal, and we should have to adapt ourselves to the new situation. I want to impress upon the Parliamentary Secretary the necessity, from the point of view of the morale of the people, for having some well-defined and well-considered service which is known to the public beforehand, so that people will know where they are going, if they should have the misfortune to become casualties, and what is going to happen to them. It is very necessary that the hospital organisation should know what it has to do in such circumstances.

We may assume that, at the time when the crisis first arises, the hospitals will have their beds full. The first thing they will have to do will be to get rid of their patients. During the recent crisis, I evacuated from the infants' hospital all but 10 of the patients who could not be evacuated. I did that having in mind the difficulty in the immediate emergency of getting either the mothers to come for their small children or finding people to take the children to their homes. I sent them to their homes at once. As far as the hospitals for adults are concerned, the position can be allowed to wait a little longer until almost the onset of a crisis. There will, of course, be walking cases—those who can be sent to their homes by means of transport which can be provided locally.

There will, however, be stretcher cases which will have to be sent outside London so as to clear those hospitals which are to be used as casualty clearing stations. It is essential that the hospitals should know where they are to look for the ambulances in which the stretcher cases are to be taken outside London. Further, they ought to know where these cases are to be taken. I do not mean geographically. I mean to what kind of place are they to be taken outside London and what is to be the relationship of that place with the main hospital in London? Are they, as was contemplated in the last crisis, to be sent to some place outside London with tickets or labels showing the nature of the various cases and left in some general hospital, where patients from other hospitals are also to be left? Is that to be the position? I am not suggesting that it should not be the position. It is a perfectly tenable view. Or is there to be associated with each great London hospital, another hospital in the country under the same organisation which will be its satellite hospital? Is it intended that, ultimately, each great hospital will have two units, its London unit which will be primarily a casualty clearing station in the first instance, and its country unit, to which it will draft casualties, that country unit to be under the same general administration, the same medical staff, and the same nursing staff as the London hospital. Either view is tenable. The Government will have to make up their mind whether either of those courses is the correct one, and, if so, which.

Whichever course we decide to adopt, it will be necessary greatly to increase the available hospital accommodation in the country districts outside London where at present it is probably not more than sufficient to deal with the local population in normal circumstances. If large numbers of casualties are to be drafted into country districts, the local hospitals will be unable to accommodate them. I, therefore, suggest that whichever of these schemes they decide to adopt the Ministry should now set about the extension of existing hospitals or the building of new hospitals in the country. I am not suggesting that these should be of a very elaborate character, but at least they should be one-storey bungalow buildings, such as we had in many places during the late War. These could be brought into use immediately and either attached to local hospitals or made satellites of one of the great London voluntary hospitals. Unless something of that kind is done before any future crisis, I fear there will be increasing difficulty and dislocation during that crisis, and it may then be impossible to provide the necessary accommodation.

There is such a vast field to be covered in the short time at my disposal that it is difficult to select the matters which are most important, but I think my hon. Friend will agree that it is of vital importance to establish a relationship between the voluntary hospitals in London, the most vulnerable centre, and some satellite institutions in the country to which patients can be evacuated. There is, of course, the problem of the civil population which will remain in London. However much evacuation there may be, it will make no substantial or observable difference in the requirements of the population in London for normal hospital accommodation. Citizens will still have appendicitis, and there will still be expectant mothers. What accommodation is to be provided for those who are left in London? Something must be done for them. In many hospitals—I take the Westminster Hospital as an example—beds are booked months ahead for expectant mothers and for those who are suffering from complaints requiring operations. Arrangements must be made for them somewhere. There will be illnesses referable to taking refuge from air raids. I believe that the amount of pneumonia, typhoid and other illnesses, which will result from resort to the trenches, will be very remarkable and will make great demands upon the available accommodation, apart from the casualties inflicted by shell or gas.

I think one requirement is that hospitals should not be asked to take walking cases. Those cases should be dealt with at the first-aid centres and the cases at the first-aid centres should be divided into categories, as, for instance, gas cases, shell-shock cases and surgical cases, and they should arrive at the voluntary hospitals with an indication of the result of that preliminary sorting. Otherwise it will be impossible for a hospital to deal with the great simultaneous rush that will arise immediately after a bombardment. There must be a preliminary sorting at the first-aid centre. I think it will also be necessary to have another sorting, not in the hospital itself, but in premises adjacent to the hospital, by the hospital medical staff, if there is not to be great congestion and if the hospitals of which I am speaking, in the danger centre in the most vulnerable part of London, are to be able to take, as they have been told they must be ready to take, 400 cases each per hour. A tremendous rush of cases may arise all at once as the result of a single air raid. It will require tremendous skill to cope with an emergency of that kind. I think the Government will have to take power to enable hospitals to commandeer adjacent premises for use as sorting stations. I also ask my hon. Friend to consider whether the same thing would not have to be done in regard to gas cases. There are great disadvantages involved in bringing gas cases into a hospital until there has been complete decontamination. Otherwise there may be serious infection of other patients. I think, therefore, the Government must visualise giving power to the hospitals to acquire premises in the immediate vicinity for these purposes.

One word with regard to the medical staffs. The medical staffs of the hospitals must know, and must know well beforehand, what is to be expected of them. There are numbers of medical men on the honorary staffs of our great hospitals who are attached to more than one hospital and who have, legitimately, more than one loyalty. I will give a striking case. One of the honorary surgeons of the Westminster Hospital is also an honorary surgeon of the Infants' Hospital. Is his loyalty to be in connection with the West-minister Hospital, or it is to be in connection with the Infants' Hospital? That is the sort of question that is bound to arise. The hospitals want to know that they can keep their medical staffs, that they will have the first call upon their medical staffs, and indeed, I would add, upon their administrative staffs too, of the highest rank, and they feel that there will have to be some adjustment between the Ministry of Health and the War Office as to who is to have first call on the lay staffs and on the medical staffs. That must be decided beforehand. The hospitals must be able to lay out their plans, on whatever general scheme the Government may adopt, in the certainty that when the time comes the staffs on which they rely will be there.

There also arises the very important and grave question as to whether it is right to keep the highest skilled medical men in London at all, whether it is right, from the point of view of the country at large and of the future of the profession, and of teaching, that those who are the heads of their profession and who are on the consulting and honorary staffs of great hospitals should be risked in one hospital, so many of them, at one time. A bomb dropping on the Westminster Hospital just outside this House of Commons might destroy, not only the lives of many medical men, but an immense amount of irreplaceable special skill and medical learning. The question arises even in regard to the nursing staff too. There is a very limited number of trained nurses available in this country, a lamentably small number. I hope and pray that they may increase, for it would be a fine profession if it were made more attractive, but can we afford to risk several hundreds of nurses in each of the great hospitals in London? May it not be necessary that they should be sent to satellite hospitals or provincial hospitals working in association with the main hospitals?

The same question arises with regard to medical schools. Are medical students to be treated as orderlies, which I think is probably the best kind of training, up to a point, which they can have in an emergency? No doubt many of them will be accelerated and given their degrees and things of that kind, but, on the whole, are the medical schools to be retained in London, or are they to be brought to an end, or are they to be transferred to the country? These things have to be considered, for the future of the medical profession is a matter of very great importance to the country as a whole.

I end as I began. It is essential that the hospitals should know with whom they are to deal, what their functions are to be, and by whom those functions are to be performed. I am not sure whether I entirely agree with all the emphasis which the hon. Member for St. Albans laid on the part played by the medical profession. Hospitals cannot be run without the assistance of the medical profession—they are an integral part of it, they are the fulcrum—but the voluntary hospital system is not run alone by the medical profession. The voluntary hospitals have their own special and dispensable functions to perform, and it is one of the functions of laymen to provide the conditions under which the medical profession can best fulfil its task. I have experienced it myself. I am a layman, I have had a main responsibility for two hospitals, and I do not think anyone will question that they were as ready as, and perhaps more ready than, any other of the voluntary hospitals in London during the recent crisis. The medical staffs of both those hospitals have told me that it was not their job, that they would not have felt able, to organise the hospitals as hospitals, though obviously all the work relating to the medical end must be in the hands of the medical staff. It is for them to say what they want, but it is for the layman to provide it. I make that slight qualification of what my hon. Friend said, with so much of which I agreed.

We do want what I would call a war book. We want the whole plan laid out, and I hope the Ministry will consult both with the indispensable medical element and with what I venture to think the equally indispensable element, those who have experience of the lay administration of hospitals.

Sir F. Fremantle

While I recognise the extreme value of the boards of governors of hospitals, I think it is right that they should have as colleagues, and not as officials, some physicians and surgeons, perhaps recently retired from their active staff, sitting on the board, equally responsible in an equal capacity.

Colonel Nathan

What the hon. Member preaches the hospitals certainly try to practice; I entirely agree. Whether the war book that I suggest should be prepared by the hospitals and then submitted to the Ministry, or whether it should be prepared by the Ministry and then submitted to the hospitals, I am not quite sure. There are advantages in both courses. The Government know how far their authority can extend, but I do not think I am doing the Ministry an injustice when I say that it knows precious little about hospitals or about their day-to-day administration and the problems with which the voluntary hospitals are confronted. I would like the hon. Member to consider which way it should be, whether a scheme should be submitted to the Ministry or whether a scheme should be submitted by the Ministry. That there should be co-operation between the two, that there should be a war book, which should reach its final stage only after consultation between all those concerned, I am sure is vital, and I hope that even when what might seem finality has been reached there will still be a standing committee set up which may from day to day concert new proposals with the Ministry in the light of fresh experience.

9.13 p.m.

Mr. Simmonds

I should like, first of all, as chairman of the Air-Raid Precautions Committee on this side of the House, to congratulate my hon. Friend the Member for St. Albans (Sir F. Fremantle) on his initiative in raising this matter as a result of his fortune in the ballot. Many of us who have been working at this problem know of the yeoman service that he has rendered as a medical man, and we are delighted that he has had this opportunity of bringing his views before the House. Secondly, I was most interested in what was said by my hon. Friend the Member for Denbigh (Sir H. Morris-Jones) in seconding this Motion, and I propose to deal very briefly with one point to which he referred. He spoke of the necessity of having medical services in underground shelters. I have had the privilege of seeing something of air-raid precautionary services, not only in France and Germany, but also, under action, in Spain, and I think anybody who has studied this problem closely will agree that it is a fantastic proposition to expect that medical services can operate with even a fair degree of success in the centre of highly vulnerable and congested areas.

It is an elemental justice to those who man these medical services that the Government should immediately change their policy fundamentally by seeing that the first-aid posts and casualty clearing stations in our great centres of population are put beneath ground. There can be only two reasons why that is not done. The first is that the Government have not the faintest knowledge of We scope of the problem, but I do not believe that that is true. The second is that the Treasury have not been willing to face the expenditure that would be involved. That is an issue which my right hon. Friend the Lord Privy Seal is facing, because in the very able report which he framed with other hon. Members just before the Recess he emphasised that shelters and evacuation must go hand in hand as the main part of any air-raid precautions scheme.

I can indicate how far we lag behind in this problem if I instance what has already been done in Paris. France has a great deal less finance available for defence than this country has, and yet this is what they have achieved. In Paris in over 30 of the districts there are large underground casualty clearing stations. These are, in general, about 12,000 square feet in area, and the smallest is about 8,000. They have about 200 beds and they can absorb about 6o people per hour. They are all completely underground, with heavy reinforcements, and could certainly withstand direct hits by 200-lb. general purposes bombs, and in many cases by 500-lb. bombs. Those who have been under intensive bombardment will know that that degree of overhead protection places the services which are being operated in an entirely different position from services which are attempted to be operated above ground when buildings are being bombed and, as we saw time after time in Spain, when buildings round the place where bombs fell are falling down under the effects of blasts.

It is absurd for the Government to hope that in the centre of London, Birmingham, Manchester and other great cities they will in a day or two be able to operate the medical services if they propose to do it above ground in the present great hospitals. The underground casualty clearing stations in Paris are admirably planned and equipped. They have staff quarters with beds, and there will be 73 doctors, nurses and attendants in each of the stations. I will give instances of the plans which the French made before the crisis had arisen. They did not wait until a week or fortnight had passed by in utter chaos, such as we experienced here in September. On entering the casualty clearing station people are to be checked for contamination by gas and then divided into three classes, wounded, gassed and asphyxiated. At the entrance of each of these three special sections there will be an infirmary major who will check the names and addresses of each of the invalids, and a doctor who will check the section into which they should go. There will then be three further sub-divisions in each of the sections for men, women and convalescents. In the different sections full equipment is provided. It is not left in some central store, in the hope that somebody will be able to bring it to the section during the first 24 or 48 hours of an emergency. It is there now, and when I paid a visit we turned on a tap and saw that the oxygen was ready in the bottles for an emergency.

The general equipment of these stations down to the last detail is amazing. There is equipment for testing every 15 minutes the purity of the air, both inside and outside. That would enable the medical staffs to know when it was safe to evacuate to their homes those people who had been attended to. That, clearly, is a matter of prime importance, as I am sure my hon. Friend who is interested in hospitals will know. The intake of patients cannot be maintained unless they can be evacuated as soon as the gas is clear. Another example to show the thoroughness of the organisation in Paris is that if the electricity supply fails there is, first, an auxiliary semi-Diesel plant and if that fails batteries are available. If these, too, fail all the signs and the arrows in the shelters are painted in a luminous paint. These casualty clearing stations will not only deal with those who are brought into them, but will act as pivotal points for squads with doctors and bearers to go out into the streets where there has been bombing. The doctors will have a small trailer attached to their motor cars and attention can be given to those who have been wounded on the pavement. Then they can be distributed to other hospitals or to the shelters from which the squad comes.

Lastly, and most important of all, because it struck us so vividly when we bore in mind our lack of preparation here, the name of everyone of the staff in each of these casualty clearing stations was on a list on the wall. There was no question of hoping that people would turn up if they had not some other job to do. They would be mobilised, and immediately an emergency arose they would be in the hospital at their duty. We have in this country to re-orientate our policy completely in regard to medical services in A.R.P. I hope that my right hon. Friend the Minister of Health and the Lord Privy Seal will work together to see not only that we have a proper scheme for these medical services, but that we put them underground in shelters so that they can work even under the most intense bombardment.

9.24 p.m.

Dr. Edith Summerskill

I am pleased to be able to speak on this question, which I believe is one of vital importance to the civilian population. I am in the curious position to-night, as are some of my hon. Friends on these benches, that we agree with almost everything that has been said on the benches opposite, particularly by the last speaker. I, too, have been in Spain and I saw the underground shelters that he mentioned, but I am afraid he is a voice crying in the wilderness. I believe the Government will not supply those underground shelters until we have experienced what the people have experienced in Spain. I found these shelters being built in Barcelona in July, but only because it was absolutely necessary to build them in order to prevent panic. I hope the National Government will provide these shelters before a war comes. Since the crisis many people have referred rather frequently to that week as a dress rehearsal. So many mistakes have been revealed in our Defence services that I am pleased to think that that week was only in the nature of a rehearsal. I, and I believe most who have spoken to-night, think that the medical service is as important a measure of civil defence as any other service, and it is essential that it must be well equipped and that it must inspire confidence.

What surprises me about the speeches opposite is that their criticism is so mild. The organisation that the Government proposes to set up during the next war consists firstly of first-aid parties—men and women who will go out and bring casualties to the first-aid centres—a service of first-aid posts. The staffs of these posts will serve casualty clearing hospitals and these hospitals will evacuate their patients to other hospitals. That was the plan, but what happened when the crisis came? We found this plan not operating at all in many places, we found a condition of general muddle and chaos in others, and in some important casualty clearing hospitals we found a lack of equipment just where there should be extra supplies. I know of many a conscientious medical officer of health who had already earmarked his buildings for first-aid posts but was desperately looking around for personnel.

I want to tackle that problem first of all. How are we going to find our personnel? We have heard that 95 per cent. of the doctors of the country have already offered their services. We have also to remember that many doctors will be called up and, although I have a great admiration for my profession, I might suggest that probably many have offered their services thinking that that will be in lieu of conscription. Can you blame them? The doctor's outlook during the next war will be rather a grim one. He will have to leave his practice, and when a doctor leaves his practice it means that his patients will be distributed amongst those who are left, and when he returns he will have little chance of re-forming his practice. We cannot necessarily depend on the 95 per cent. who have offered their services.

The position was put to me this morning when a surgeon from the West coast of Scotland came to see me. I mentioned that there was to be a Debate of this character to-night, and he said, "You might mention my case. I was a Naval reservist." He was probably one of the 95 per cent. who had already offered their services. During the crisis he was immediately called up. He left his practice to an older partner, who was already very much overworked, and he said, "In a small town of 40,000 inhabitants there was no medical service planned at all and we were told that within 48 hours 19,000 children were going to be sent to that small town from Glasgow." There was no medical service sufficient for the inhabitants and they had to provide for 19,000 more children. The air-raid precautions circular in June, 1936, said that personnel was to be provided by the St. John Ambulance Brigade and the Red Cross Society. I agree that these are two very excellent institutions, but they are voluntary organisations. They may function well in some districts but in others there will not be sufficient of these people to go round. The Government made another bad mistake in the matter of propaganda. It has told the public constantly about the need for air-raid wardens. In an air raid I should much prefer to know that there was an. efficient surgeon, an ambulance and a dresser waiting for me, rather than an air-raid warden somewhere round the corner.

While on the subject of personnel, there is the question of women's organisations. The hon. and gallant Gentleman the Member for Central Wandsworth (Colonel Nathan) deplored the fact that we have not sufficient nurses. It is not a question that the nursing profession is not effective. It is simply a question of low wages and long hours, something that could be remedied overnight if only a Bill was introduced to give nurses better conditions. I believe we have decided to recruit women in order that they shall take part in air-raid precautions. I am not being flippant when I say that, in my opinion as a woman, the National Government has not approached this problem in the right way. We see on hoardings all over the country pictures of a very beautiful woman, with "A.R.P." underneath. That may attract the male eye, but that is not the way to improve recruiting in our women's auxiliary services. If the Government suggested to women that there was interesting work to do in first-aid stations, that would be some encouragement to improve recruiting, which I understand is very poor.

There is another thing I should like to say about these organisations. It has been mentioned that those who have been chosen to organise the women have not been chosen in the right manner, and when it has been suggested from these benches that perhaps women better qualified to organise these units should have been chosen, the Front Bench has always been inclined to laugh. I feel very seriously about this matter, because I believe that women can make a big contribution during the next war. The chief qualification of most of the organisers of the women's units seems to me to be that time has been hanging too heavily on their hands. I can assure the Under-Secretary that women who work are not inspired by that kind of leadership. It may be that the youth and inexperience of the Under-Secretary for the Home Department were so great that he did not like to say "No" when those ladies approached him, and I know full well that the Minister who is going to deal with this matter and to rectify what I believe was a cardinal error will have to be a very bold and courageous man.

I want next to deal with hospitals. A lot has been said about the necessity for evacuation, and I agree with the hon. and gallant Member for Central Wandsworth that it is very necessary to have country hospitals to which cases can be sent. I wish to point out to him and to my medical colleague opposite that just as we have been reminded that women will still have babies when a war comes, so we shall also still have old people to look after, still have our civilians falling sick, and still have what we in hospitals call "our chronics," and that these people will not even be able to have the attention at home which they might expect during peace time. Where are those people to go? Also, there is the case of those who will be evacuated immediately war is declared. In this last crisis I found many cases of hardship among patients who had been evacuated from our casualty clearly hospitals and simply sent to their homes because there was no bed for them elsewhere. Either hospitals should be built in the country immediately or some buildings should be earmarked for patients.

It was only in June, 1938, that the Home Secretary virtually acknowledged that the scheme had broken down, as h[...] handed the whole of the medical services to the Ministry of Health, and the fact that the fantastic suggestion was made that tents should be used as casualty hospitals shows how little real understanding of this problem exists in either the Home Office or, it appears, the Ministry of Health. The British Red Cross in Abyssinia pointed out that tents were a favourite target and that there would be no protection at all against splinters, gas or blast. I hope the Parliamentary Secretary will assure us to-night that there is no intention of relying upon tents during the next war. I believe that the medical services have suffered as a result of the deplorable muddle of A.R.P. As a member of a large local authority I have been shocked by the unending wrangle between the local authorities and the Government as to what proportion of money should be paid for A.R.P. Further, the Home Office has suggested that local authorities should engage air-raid precautions officers. Many local authorities which have done nothing at all about air-raid precautions have felt that immediately an air-raid precautions officer was employed all their responsibilities were over.

I ask the Parliamentary Secretary what the qualifications of an air-raid precautions officer are. I can tell the House of one experience. An air-raid precautions officer was advertised for. We found that most of the applicants had one qualification only, and that is that they were old Army pensioners. They wanted to make a little extra pocket money and thought they could apply for this new profession of air-raid precautions officer, that it would only need a short course of training for a few months. In one case I was so struck by the inefficiency of the man who was chosen that I said to some of the members of the committee "How on earth did you choose this man?" and one Army man said, "Well, look here, I understand that he spent many years in India and had a very good way with the natives." He got the job at £500 a year, but in a month's time it was felt that he was so inefficient that the poor local authority had to get someone else who knew a little more about the job. It is these men who in great part are organising the medical services in relation to civil defence.

Sir H. Morris-Jones

Was it the local authority to which the hon. Lady belongs which chose this particular man?

Dr. Summerskill

As somebody answered the Parliamentary Secretary just now, "I might tell you afterwards." Oh, if there is a suggestion that the local authority which I belong to has a Labour majority and therefore was so inefficient as to choose that man, I say, "No." Actually it has a 70 per cent. Conservative majority, and that, of course, is why the Army was favoured. I suggest to the Parliamentary Secretary that he might advise local authorities who are still choosing A.R.P. officers that they must have certain qualifications, let us say some experience of engineering or chemistry or public health work. I know that he will probably say that besides these A.R.P. officers experts were sent round to the hospitals to advise. The Home Office, I know, have consulted experts of every kind, and no expert has been asked to go outside his subject. The experts on gas have reported and fortunately have suggested some A.R.P. methods which the Government found very cheap, and therefore it has favoured them. The fire experts, too, produced a scheme. The explosive experts never dared report, because their schemes would have been too expensive, and would have included the underground shelters of which an hon. Member spoke. Out of all the schemes offered to the Home Office, the National Government have in every case chosen the cheap parts.

To continue, the experts have taught minor experts, and those minor experts have then descended upon the country and taught the poor laymen. I have attended one or two of the meetings. At one meeting a minor expert was heckled with intelligent questions and replied, "Now look here, I have been sent here to tell you and not to answer questions." What happened when these experts approached our hospitals? Does the Parliamentary Secretary know this? A gas expert called on one of our biggest hospitals in a vulnerable area and told the superintendent that all the patients must be kept very high up. In the same month a fire expert called and told the superintendent that the patients must all be kept very low down. It is incredible. I have not yet heard what happened when the explosives expert went.

I do not want to keep the House, because I need medical attention myself to-night, and I come finally to my most serious criticism. I am surprised that the hon. Member for Denbigh (Sir H. Morris-Jones) when he read those letters, which were very instructive—I wish he had raised his voice a bit more—was not more severe in his condemnation of the lack of medical services. In one hospital in London where there are 2,000 beds and which is situated in a most vulnerable spot, the medical officers were expecting the kind of thing mentioned by my hon. and gallant Friend the Member for Central Wandsworth, namely, 400 people being brought in every hour. When the crisis came, that hospital asked for a supply of instruments, cotton wool, dressings and morphia. They found great difficulty in obtaining any of them. They asked for plaster of paris, a most necessary item for the treatment of fractures, but that huge hospital, one of the most important casualty-clearing hospitals in the whole of London, could obtain only 2 cwt. of plaster of paris. They wanted something like half-a-ton. Splints have been mentioned. That hospital expected many fractures, but it could not get splints, so the medical superintendent ordered boards and set the staff to work sawing the boards down to make splints.

There is a further illustration in regard to bleaching powder. We have heard much to-night about decontamination centres. My hon. and gallant Friend the Member for Central Wandsworth said that ambulatory cases should be treated at the first-aid centres, where there should be a doctor. It is frivolous to suggest that a first-aid centre should be set up without a doctor, and at the first-aid centre there should of course be a decontamination centre. In many areas there were no decontamination centres. In the area which I have already mentioned the only decontamination centre was one which was quickly made at the casualty clearing hospital, which meant that all the patients burned with gas would walk through the streets or be brought in ambulances to the casualty clearing hospital. And what would happen when they arrived there? I will tell the House. They would find that there was not sufficient bleaching powder there to treat them. All that that hospital could get in the week of crisis was two hundredweight, sufficient perhaps to treat a few patients in one day.

I hope that the Government will listen to these criticisms and recommendations. I agree with the hon. Member for St. Albans (Sir F. Fremantle) that the medical profession are treated as technicians, but I do not mind. We are technicians. We are not all-powerful, but we do say that as technicians we know more about this problem than do the laymen, and that if we are to have a medical service which will function and without which no defence service is complete, it is necessary to co-ordinate all these different parts. Not only that, but they must be coordinated with one end in view, to give medical service in those parts where it is needed. I ask the National Government seriously to consider the national control of medical supplies. I have illustrated that such supplies are needed. They could be forthcoming if there were some kind of Government control. The supplies could be sent to the areas which needed them most. I ask the Parliamentary Secretary seriously to consider these recommendations.

9.50 p.m.

Mr. Storey

I think the House will agree that my hon. Friend has performed a useful service in calling attention to the need for a well-planned medical service in war time, particularly as such a plan, unlike many of our Defence preparations, would have a definite peacetime value. That is particularly true as regards hospitals, because such a plan could help the co-ordination of hospital services and co-operation among hospitals, which is so dear to all who want to see proper health services for the nation. That such a plan was not prepared for the recent crisis is regrettable, but it is not surprising. If we were asked, all of us would have to admit that we had not made adequate preparations for the crisis in regard to our own small responsibilities at home and in our factories. If the crisis were to happen again, it would be a matter worthy of the greatest blame if, after the warning we have received, we again failed to be prepared and failed to take full advantage of the willingness to serve which was rendered manifest during the crisis.

If that willingness to serve were properly organised it would play a very important part in our emergency medical services. Upon the efficiency of our first-aid posts, under proper medical services, will depend whether our hospitals and our medical staffs are to be overwhelmed with minor cases or are to be unhampered and left free to deal with very serious cases. If our hospital services are to be efficiently organised, I agree that we must have some definite statement from the Government of what is required from the hospitals. That is the first essential of any plan of organisation. The Ministry of Health, on whom responsibility now lies for all hospital services, must decide at which hospitals war cases are to be treated, whether general hospitals are to be taken over wholly for war work, to what extent they are expected to carry on their ordinary work and to what extent they have to dispose of it to other hospitals in other areas. They will have to decide whether the general hospitals which are not required for war work, and the hospitals which do specialist work, shall carry on their work in dangerous areas, or whether they shall be evacuated to safer regions.

Those are only a few of the problems which the Ministry of Health must decide before any scheme can be worked out for utilising the hospital services of the country to the best advantage. Before the general policy is decided on I hope that the British Hospitals Association will be consulted and that their services will be fully utilised in working out the details of any such policy. As hon. Members who are interested in voluntary hospitals are well aware, the British Hospitals Association acting on the suggestion of the Voluntary Hospitals Commission, is at present engaged in preparing plans for co-ordinating hospital services and securing closer co-operation between hospitals. The country is being divided into hospital regions. Such regions are being based, not upon the narrow limits of local government boundaries, but on the best means of meeting the hospital needs of the country. Each region will be based upon a key hospital, at which will be centralised those consultant and specialist services which will be available to the other hospitals of the area; and in each region there will be a council who will be responsible for relating hospital work and needs, and seeing that there are neither gaps nor overlapping in the hospital facilities. The recommendations as to regional boundaries will soon be tabled, and progress can then be made in coordinating the facilities in each region.

Such work will need the collaboration, not only of the voluntary hospitals, but of the local authorities who control public hospitals, and I am sure that such cooperation will be welcomed by the voluntary hospitals, for in some such plan of co-ordination lies the solution of the problem of voluntary or public hospitals. To a regional council on which both are adequately represented, both voluntary and public hospitals could surrender control of general and major policy, while maintaining the domestic management of their own institutions. Only by such a surrender, only by such co-ordination and cooperation, by the elimination of wasteful overlapping and the filling of obvious gaps, can a proper hospital service for the country be built up. That coordination and co-operation is a very pressing need in peace-time; it will be essential and vital if ever this country has to face war. The means of that cooperation are being worked out under peace-time conditions. I hope that that will be expedited and hastened by the urgent need for seeing that, if we are ever at war again, that co-ordination and co-operation shall be forthcoming. My plea to the Minister is that in anything he does he will bear in mind that such plans are being worked out at the present time, and that he will see that those who are working them out will be supported and encouraged in their work, and that out of war-time necessity we shall achieve something which will be of value to peace as well.

9.59 p.m.

Mr. Bernays

I should like to begin by congratulating my hon. Friend the Member for St. Albans (Sir F. Fremantle) on his success in the ballot and on the way in which he has used it. He has certainly inaugurated a most interesting and, from the point of view of my own Depart- ment, most valuable Debate. I should also like to congratulate my hon. Friend the Member for Denbigh (Sir. H. Morris-Jones), who seconded the Motion. He asked me a great many questions, but was kind enough to say that I need not answer all of them. I agree with a great deal of what was said by the hon. and gallant Member for Central Wandsworth (Colonel Nathan), in a speech which, I know, appealed to all parts of the House on account of the valuable and practical suggestions which it contained. I agree with what he said as to the importance of our people knowing what is being done for their safety. I am certain that, if they believe that our plans and our organisation are on the right lines, they will do everything they can to make them work.

I was in Geneva for most of the time of the crisis; in fact, I only returned on the Sunday before the crisis was liquidated; and what impressed me on my return was the staunchness of our people. When I came back and saw what was being done—trenches being dug, gas masks being fitted, Charing Cross Underground Station closed for reconstruction, and constant supplies of stretchers being produced—I felt that these were scenes that might well have struck terror into the boldest hearts. But our people who saw what was being done, who saw those dangers that were ahead of them, did not flinch; and I believe that that exhibition of calm courage may well be a salutary reminder to any potential aggressor that the British people are not soft. I believe, too, that there can be no greater deterrent to a potential aggressor than the knowledge that we were organised as fully as possible to meet the dangers of air raids, and I am sure that that knowledge also is important in upholding our own morale.

What have the Government in mind for the expansion on a great scale of the medical services of the country in time of war? Every speech in the Debate has stressed the need for a plan, and I think I can show that the Government had a plan. Briefly, it was a regional organisation for dealing with casualties on the basis of first making beds available in the existing institutions, and then expanding those facilities by means of satellite annexes. For personnel, there was a register of doctors and a scheme for filling all needs from that register on a unified basis. The emergency gave us a working plan, and we are now at work on a series of further plans which will form the basis of regional discussion.

The House is no doubt anxious to know what was done in the emergency, and what is being done now, and perhaps it will be for the convenience of the House if I adopt the scheme of my hon. Friend's Motion, and deal separately with each of the items that he includes. First of all, he stresses the importance of medical and auxiliary personnel. Some months ago the British Medical Association—not entirely, as I think my hon. Friend suggested, on their own responsibility, but on the invitation of the Committee of Imperial Defence—compiled a register of the medical personnel that would be available in time of war, and this register now includes 95 per cent. of the doctors of the country. Personally, I have a rather higher opinion of the profession than the hon. Lady the Member for West Fulham (Dr. Summerskill), and I feel that—

Dr. Summerskill

I do not think that that is really fair. I said that probably I was able to analyse the figures better than the hon. Gentleman could.

Mr. Bernays

I understood the hon. Lady to say that she thought that some of them had put their names on the register because they wished to evade conscription.

Dr. Summerskill

I would ask the hon. Gentleman to withdraw the word "evade." I did not use the word "evade."

Mr. Bernays

Then I will say "avoid."

Dr. Summerskill

Which is very different.

Mr. Bernays

The hon. Lady is entitled to her point of view, but I thought she was a little unfair to her own profession. If war had come, the medical personnel would have been directed, through the Central Emergency Committee of the British Medical Association, to the places where the needs were greatest. I think it was my hon. Friend the Member for St. Albans who suggested that the doctors, having signed this register, heard nothing more of the matter. I would point out that the register was a file, not an order to move. Its object was to obtain the information upon which alone orders to move could be given. I think the House will agree that it was quite impossible to give the order to move until the air raids actually began, because it was impossible, as so many hon. Members have pointed out, to estimate where the main attacks would be delivered. Clearly, at the outbreak of war the best place for the doctor is to be with his own patients. There is bound to be a heavy strain on his practice, particularly if he is in an area to which great sections of the populations from the crowded areas are being evacuated. In any case, the most obvious air-raid dressing station is a doctor's own consulting room. He may well find, in the first few hours of war, that where he is needed most is on his own doorstep, and I think the House will appreciate that it is most important to avoid any immobilising of doctors by concentrating them in one place before there is actual need for their services.

Sir F. Fremantle

That is a complete volte face from the original idea of the Home Office, that the air-raid posts would not have doctors at all. Obviously, they could not be in the doctors' surgeries.

Mr. Bernays

I am coming to that. Of course, the position is different now that the Ministry of Health has taken over the matter. The hon. and gallant Member for Central Wandsworth suggested that the doctors might have more than one loyalty, and clearly proper co-operation is most important. A big step has been taken towards it by an arrangement that not all the Territorial Army hospitals originally designated will necessarily be mobilised at the outbreak of war. That will mean that hundreds of doctors and nurses will be available for the treatment of civilians. Meanwhile discussions are taking place between the Departments on the whole question of requirements that might be conflicting, and it is a problem to which my right hon. Friend the Lord Privy Seal is giving particular attention.

With regard to nurses, during the crisis arrangements were made to put hospitals in touch with the local nursing organisations; but experience has shown that some more complete organisation is necessary, and a central register of nurses and nursing auxiliaries who would be available in time of war is being established. The next item referred to in the Motion is the institutions.

Sir F. Fremantle

With regard to nurses and auxiliaries, will there be some arrangement by which the function of the St. John Ambulance and the Red Cross will be clearly defined?

Mr. Bernays

Yes, that is under consideration now.

Colonel Nathan

Were nursing auxiliaries to be auxiliary to the hospital nursing service as a whole, or were they, as far as possible, to be detailed beforehand to some particular hospital?

Mr. Bernays

I would like notice of that, in order to be able to give a more informative answer.

Dr. Summerskill

Do the Government contemplate any training scheme for the nurses and any new method of improvement?

Mr. Bernays

Yes, there is under consideration now a plan for the recruitment of additional nurses and for giving a training to girls, at any rate, to do first-aid work. The Government have, of course, been deeply conscious of the need for a greatly expanded potential hospital service, and, as a preliminary to this, they undertook early this year a survey of the whole of the existing hospital accommodation in England and Wales, while the Department of Health carried out the same piece of work in Scotland. In England and Wales, the survey covered just under 3,000 hospitals and institutions, and just over 400,000 beds. Having made a census of the beds available, the next problem was how to organise the accommodation for an emergency.

Hospital officers—I suppose the hon. Lady would refer to them as experts, but they are none the worse for that—from our medical staff at once proceeded to every region in the country with instructions to prepare schemes for freeing as much hospital accommodation as possible in the most congested areas of their regions, so that if an emergency should develop before it was possible to evolve more elaborate schemes, there would have been thousands of beds available immediately for air-raid casualties. On the outbreak of war there would have been 150,000 beds available for air-raid casualties, and we were confident that, at the end of a fortnight, that 150,000 would have been increased by an additional 100,000. Meanwhile the Home Secretary had already appointed a committee of medical experts, under the chairmanship of Sir Charles Wilson, to consider what was required for a casualty organisation in the London area.

That committee presented a number of conclusions of great value, and I am sure the House will be grateful to them for the self-sacrificing haste with which they worked. The committee set down conclusions on all the general issues arising out of a casualty organisation. Nobody would suggest that a committee should undertake the detailed work of applying the conclusions to individual hospitals, but their conclusions were embodied in a circular which was sent to every county council, county borough council and voluntary hospital authority in the country, informing them that every hospital must be ready to clear as many beds as possible on receiving warning from the Government that an emergency had arisen, and also that they must prepare schemes for expanding their hospital accommodation. That is some answer to the criticism that the hospitals were left without instructions. As this circular shows, every effort was made so that the hospitals should be informed as early as possible of what would be expected of them.

Colonel Nathan

I am sorry to interrupt my hon. Friend, but, while I speak on correction—I am charging my memory—I believe he is completely mistaken in thinking that any such circular was sent to the voluntary hospitals. I say nothing of the county council or municipal hospitals, because know nothing of them.

Mr. Bernays

Of course, I will inquire into that, but here is the circular itself, which, I am informed by my advisers, was in fact sent to all these organisations. If it has not gone to the hospital my hon. and gallant Friend has in mind, I will inquire into it. In addition, there was, of course, the hospital officer on the spot, ready to assist in working out particular schemes on the general lines laid down in the circular. Later, the Ministry of Health made direct contact with some hundreds of hospitals. The House will appreciate that we could not possibly allot a precise part to every one of the 3,000 hospitals in the country, since, after all, we had no more fore-knowledge than anyone else of what the nature of the emergency would be.

The hon. and gallant Gentleman the Member for Central Wandsworth raised also the point of what he called the provision of a war book, and in answer to that question our objective is, if humanly possible, to work out a detailed war book, or scheme of operations with which the hospitals can conform. Hospitals are not the first, but in a sense they are the last, stage in the treatment of air-raid casualties, and I fully appreciate the importance that has been laid in this Debate upon air-raid posts. It is perfectly true that many casualties will not require treatment in hospitals, and indeed it is most important that hospitals should not be choked up with what one might call cases that are not sufficiently serious for hospital treatment. It is most important that in an air raid there should not be a stampede upon the hospitals. For what I might call the walking wounded, an air-raid post or dressing station is required, and dressing stations will also give, probably, the immediate treatment necessary even for those who will afterwards have to go on to the hospitals. My hon. Friend the Member for St. Albans and my hon. Friend the Member for Denbigh and other hon. Members have asked me who will be responsible for the air-raid posts.

Sir H. Morris-Jones

I am sorry to intervene here, but before my hon. Friend comes to that, would he give the House an idea of the form these air-raid posts are to take?

Mr. Bernays

I am trying to deal with one question at a time.

Dr. Summerskill

The hon. Gentleman has dealt with the casualty clearing hospitals, but he has not dealt with the base hospital, which is so important. Would he mind telling the House what our experts have decided to do about the base hospital, and also whether they are no longer going to put up tents as hospitals?

Mr. Bernays

That will come out in the course of my speech. I do not want to be interrupted on this very important point of air-raid posts. The first question that has been asked about them is, Who is to be responsible for them? My answer is, the Minister of Health and my own Department. We have now been given that responsibility and also that of the ambulance services. They have now both been transferred to the Ministry of Health, so that both the transfer and the treatment of air-raid casualties are under one Department, and there is now a complete chain of responsibility from the time a casualty reaches the air-raid post to, I will not say the time that it goes to the mortuary, but the time when the patient reaches the convalescent home. Another question is, Will there be doctors there? My reply to that is that it is the policy of my Department that every air-raid post shall be staffed by a doctor. I have also been asked where we expect to get the doctors from. It is our view that the best man for the air-raid post is probably the man who is in a local practice in the area in which the air-raid post is established. My hon. Friend the Member for Denbigh asked where the air-raid posts will be?

Sir H. Morris-Jones

I asked what kind of aid posts they are to be? What form will they take? Will they be concrete aid-posts?

Mr. Bernays

My hon. Friend did ask where they would be. They will be in positions most suitable for working in the closest possible conjunction with the hospitals. Various hon. Members have asked me whether the air-raid posts will take the form of underground shelters. I am not in a position to give a reply tonight. This whole question of underground shelters is very much before my right hon. Friend the Lord Privy Seal at the present time, and he and my right hon. Friend the Minister of Health will take very careful account of the powerful speeches that have been made on this question to-night. A circular dealing with these questions will shortly be issued to local authorities. Local authorities will continue to be responsible for preparing schemes for an ambulance organisation and also for first-aid posts. The Ministry will see that these are properly complementary to the hospital service, and that the first-aid posts are so placed and designed as to relieve the hospitals so far as that can possibly be done. The advice of the Department's medical officers will be at the disposal of the authorities in preparing their schemes.

I come now to the question of additional equipment. Of beds and mattresses we have ordered 50,000 of each. In regard to stretchers, orders have been given for 90,000. Large quantities have already been delivered and we expect the final delivery in a few weeks. With regard to surgical equipment, I will give one instance of what we are doing in that direction. The London County Council have been authorised to spend £4,000 in equipping 10 of their large fever hospitals, which were allocated for evacuation, with surgical equipment. On 14th September we instructed our hospital officers to get into touch with the hospitals and advise them to lay in a reserve stock of drugs and dressings sufficient for four weeks, in the event of an emergency arising. I have taken note of the facts that have been raised in Debate in regard to the difficulty at the last moment of getting some of these necessary medical requisites, and I can say that the question is being very actively taken in hand in my Department.

Mr. Simmonds

Hon. Members have heard that a number of hospitals purchased instruments during the emergency and have been unable to obtain authority to receive payment for them. Can my hon. Friend say whether that position has been completely rectified?

Mr. Bernays

I am glad to have an opportunity of dealing with that point. With regard to the stores that were laid in, the great majority of them, I understand, can be used in the future, and, therefore, they do not involve a loss. With regard to any other exceptional claims, the Ministry of Health has already expressed its willingness to consider them if the voluntary hospitals will make their claims.

With regard to transport, the last item mentioned in the Motion. Transport is a vital question in clearing the hospitals. The size of the problem in London alone will be realised when I tell the House that, in addition to the patients who were to be sent home, between 3,000 and 4,000 patients taken from 34 of the larger general hospitals in London which would be most valuable to the casualty organisation were to be removed on stretchers to much smaller towns approximately 50 miles distant. That, I think, answers one of the points raised by the hon. Member for Denbigh. Our policy was to evacuate as many as the medical officers thought were fit to be evacuated. It may be asked, how were we going to do it? Take London. These details, I think, will show the great extent of the preparations which were made, and for which I do not think sufficient credit has so far been given. At 12 to 24 hours notice 300 Green Line buses were to be converted into ambulances each capable of taking 11 stretchers, and the fitters were ready to stand by in order to make the conversion. With the co-operation of the railway companies 21 ambulance trains were available at selected stations, not the London termini, and each of these trains had a compartment in the rear specially prepared for doctors and nurses. The St. John Ambulance Brigade arranged to provide stretcher bearers to carry the patients from the buses to the trains. Detailed plans were worked out between the London Transport Board and the railway companies to ensure exact synchronisation, and on 24th September the necessary number of stretchers was distributed to each evacuating hospital. From that point onwards the hospital evacuation scheme for London could have been put into force at 12 hours' notice.

I have now taken point by point the matters raised in the Motion, and I hope I have shown that effective action was taken on all of them in the emergency, and that, where necessary, steps are being taken to supplement the organisation. I would like now to say a word or two on the question raised in the last lines of the Motion, that is the need for a long-term plan carried out under responsible co-operation between the British Medical Association and other representatives of the medical profession and of the hospitals, with the several Government Departments concerned. We are very glad that the House is urging us to devise a scheme without delay. It is already in existence. All that it requires is amendment in the light of what happened during the crisis. This is what we are doing now. Hospital officers have been reviewing the hospital accommodation in their regions to determine where it must be increased and where it must be improved. The plans for this are now complete, and the next step is for the hospital officers to get into touch with all the hospital authorities concerned and agree with them exactly what part they will be expected to play. That is the stage reached at present, and individual local discussions have been arranged. It is hoped shortly to arrange a series of regional conferences at which proposals can generally be considered, not only with the hospital authorities but also with representatives of the medical profession. So soon as plans are settled—and it is hoped that for the most part they will be settled before the end of the year—equipment will be distributed and work undertaken to improve facilities where that is required. The next stage after that will be to consider what is required in the way of completely new hospital accommodation, either by ear-marking for the purpose existing buildings which could be converted in emergency or by preparing sites where huts or tents could be erected. On the subject of tents, I would say to the hon. Lady the Member for West Fulham that the question is still under discussion, and in fact, as yet a decision has not been arrived at as to whether tents would be a suitable method of dealing with this problem.

Into the whole problem, of course, enters that of civilian evacuation. I fully agree with the hon. Member for St. Albans upon the importance of medical services in that connection. If civilian evacuation is carried out on a big scale, a heavy strain will be thrown on the medical services of the receiving areas, and in working out the emergency hospital schemes my Department is giving considerable attention to this problem. The two pieces of work will be closely co-ordinated. As soon as the civilian evacuation plans are more advanced, the Department will seek the assistance of the medical profession in considering what emergency services must be provided. Already the Society of Medical Officers of Health are formulating suggestions as to what should be done, and it will be necessary to concert plans with the British Medical Association for transferring doctors to country districts where the influx of new patients calls for a strengthening of the medical organisation in those districts. That, then, in terms as briefly as I could make it, is the organisation of medical services in civilian defence.

In conclusion, I want to say in all sincerity that we have found this Debate most valuable, and that we shall take into very careful account the suggestions that have been made. If I have not been able to answer all the questions that have been put to me to-night, it is not because I do not realise their importance. The problem, after all, that we have had to face at the Ministry of Health during these last few weeks is of a kind that no medical organisation in history has ever been called upon to face. In ordinary times the local services are liable to be called upon to deal with street accidents, mining disasters, railway disasters, and shipping disasters. These services have never failed to meet the needs. What we have had to envisage during the last two weeks is the possibility of a series of these disasters occurring in several parts of the country and probably simultaneously. Our task at the Ministry of Health has been to do our utmost to strengthen and supplement the local organisations and to make available for them additional reserves of personnel, accommodation and equipment. Of course, our proposals have had to be in many cases hurriedly improvised, but I do believe that what was done in the weeks before the crisis was right and sound and that it would have stood the test.

Sir F. Fremantle

Will my hon. Friend say whether this organisation of which he has spoken is in absolute, vital touch with the Army, Navy and Air Force, especially as regards the demand on medical personnel and the hospitals?

Mr. Bernays

Yes, I can certainly give that assurance.

10.36 p.m.

Captain Elliston

We have had such a full and reassuring statement from the Parliamentary Secretary that it only remains for me to emphasise a few of those points which have caused a good deal of anxiety to some of my hon. Friends on this side of the House. I was delighted to hear from my hon. Friend that he intends to make the fullest possible use of the register which has been compiled by the British Medical Association. I think, despite what was said by the hon. Lady the Member for West Fulham (Dr. Summerskill), that the compilation of that register was an act of great patriotism. It is remarkable that the members of a great and busy profession were, to the extent of go per cent., prepared to place themselves at the disposal of the nation in a time of emergency. That register exists to-day and we have heard that there is also to be an advisory committee which, in consultation with the British Medical Association and the various services, will utilise that list to the best advantage.

One has been told that at the time of the last crisis various services were helping themselves out of the pool created by that register; that the Royal Army Medical Corps, the Royal Air Force and the Royal Navy were drawing on that list without full consultation with the organisation of the profession which had prepared the register. Now that the register will come under the charge of the Ministry of Health, I take it there is no danger of such a thing happening again. I take it that not only will the Ministry go to that register to find the men available, but that it will consult with the advisory committee regarding the services which each man on that register can render. One man can best serve the Air Force, while another is obviously best qualified for the Navy, another for the Army and others for service to the civil population. It is not only the Army, Navy and Air Force which will want medical officers. If we are to evacuate great masses of the population they must take their doctors with them, or the men on the spot must be utilised to deal with that influx of population. One hopes that with the register and the advisory committee we shall avoid those difficulties which occurred in the last War. I remember being much surprised to find the medical registrar of one of our greatest medical schools detailed to act as a regimental medical officer. That man to-day is a great teacher, a great physician, and one of the leading consultants in London, but in the War it was nobody's business to see that he got the work for which he was best suited. Instead of being a consultant physician in a military hospital, he was doing what was almost first-aid work, at the front. For that reason I am sure that my hon. Friend the Member for St. Albans (Sir F. Fremantle) and his medical colleague who seconded the Motion will have felt very pleased that full use is to be made of the B.M.A. register.

There has been an attempt to disparage the work of local authorities and to make a great deal of the blunders committed by Departments of the Government. For my part, I think it is very remarkable indeed that the blunders were so few and that the work achieved was so good. I am a member of a local authority, and I have served on its air-raid precautions committee since its formation, and I can assure this House that six weeks before the crisis one had the greatest difficulty in persuading the members of the public to take the least interest in the subject: they were quite indifferent. One could go to responsible firms, to men with large works, and so on, and one was as it were laughed aside when one talked about the necessity of precautions. Those are the people who to-day are telling us in this House haw the Government neglected to take precautions in this direction or in that. It is true, as we have heard tonight, that there are many local authorities which refused to take their A.R.P. duties seriously, and I should like to ask the hon. Lady the Member for West Fulham to tell us what some of her friends have done in this connection. If there are local authorities which showed that irresponsible way of dealing with the appointment of A.R.P., officers, they must be very exceptional. It is easy enough to laugh at A.R.P. officers, but where are you likely to find a man better acquainted with the effects of explosives or the necessary engineering measures than a retired officer, for instance, of the Royal Engineers? In many cases such retired officers have been appointed and are doing their work remarkably well.

I have also had experience of air-raid precautions work in the county borough of Blackburn, which it is my privilege to represent here. I have been fortunate, I think, in seeing A.R.P. committees at work in two areas which have set a good example to others. Blackburn were pioneers in undertaking duties in connection with air raids, and I believe their example has been copied by many towns, especially in the North of England. In the City of London again I have seen a very energetic A.R.P. officer putting excellent schemes into effect, and nobly supported on the medical side by the medical officer of health. I have no doubt that in most cases medical duties are assigned to the medical officers of health in the district, and it is certain that if we expect to get efficient medical services and efficient training of the personnel for the various A.R.P. purposes, we shall have to have medical officers of health administering and co-ordinating medical aid in every area. Many A.R.P. committees were told by their experts that they must make their plans on the expectation of raids on a large scale, repeated perhaps at short and frequent intervals, with high explosives, with or without poison gas, and incendiary bombs. In that expectation we accepted the principle that it was essential that our first-aid posts must be underground, resistant to high explosive bombs and splinter-proof.

Without that underground shelter it is certain that the work of the first-aid posts could not be carried on with any degree of efficiency. We also accepted the principle that we had to provide for these first-aid posts personnel and equipment which should be available not only for services there, but for services in neighbouring stations where they might be called to do duty. In London, where the metropolitan boroughs and the city corporation have been doing the A.R.P. work, it must be very desirable to have some co-ordinating body that can make their services, as it were, interchangeable, so that various units can be transferred from place to place where their services may be required. The same thing might apply in Lancashire, where there are boroughs very near to one another. If we are going to multiply the effective forces at our disposal, they should be transferable under some coordinating body.

I am glad that the Parliamentary Secretary has reassured us on the subject of qualified medical practitioners and first-aid posts. We are convinced in the city that without the provision of medical officers at these posts there would be nothing but misunderstandings and difficulties. It has been said this evening that the distinction between a light and a serious case is whether the patient can walk. In the city we do not think it necessarily follows that all cases that are unable to walk will be serious cases. They may be such cases as simple fractures or bums, which may be treated as light cases, but which may not be capable of walking. Such cases should be dealt with at the first-aid posts. If they are sent to the hospitals because of the absence of a doctor to state the extent of the injury, there will be serious overcrowding and confusion. The subject of personnel is very important.

If we are to secure the discipline, efficiency and completeness of training that are necessary for this work, the workers at the first-aid posts and in other connections should be enlisted on the same lines as the Territorial Force. They should be treated in the same way, and in their training period should have pay as in the Territorials. It is only so that you can establish a contractual obligation which will enable you to insist on complete training and efficiency. I hope the Minister will consider that point and other matters of importance, such as that of compensation for death and injury to those engaged in air-raid precautions work. A point that occurs to me is that the character of these first-aid posts may change altogether and that in certain circumstances it may be necessary to take even serious cases. That, I hope, will be duly considered. I do not wish to disturb the House with gruesome reflections, but the question of the identification and disposal of the dead came before our consideration in the City. Our advisers are strongly of opinion that all civilians should carry identification discs. The disposal of the dead is also a matter that should be provided for. It is necessary that these things should be considered in advance so that we are not likely to be taken by surprise.

I think everyone must have been impressed with the account given by the Parliamentary Secretary of what had been accomplished in a short time and in the face of great public indifference. I have heard from an independent source that the transport arrangements were quite remarkable and unsurpassed in a time of emergency such as came upon us so unexpectedly and at such short notice. I have heard, too, of the fine work done by the Board of Control in connection with the mental hospitals. If the whole story was told of the provisions that have been made for the transfer of patients, for the provision of country hospitals, for the evacuation of women and children and in other directions, I think we should be rather proud of our record, instead of continually apologising and raking up little incidents and examples of inefficiency that occurred. I congratulate the Parliamentary Secretary on the account that he gave us and I wish to express my confidence in what we may expect from the Ministry of Health in the administration of this responsibility. They are accustomed to work with local authorities and with doctors and they are likely to avoid possible mistakes. The doctors have set us all an example of public service in placing themselves at the disposal of the country, and I think the Ministry can be relied upon to use their services to the greatest advantage and in full consultation with the profession, so as to avoid difficulties which have been referred to, such as that of the man taken away from his home and seeing his whole living imperilled.

If the British Medical Association are responsible for these arrangements I think we can be certain that steps will be taken to protect the practices of those doctors who go on active service. Their colleagues will safeguard their rights as far as it is possible to do so; there will be a genuine give-and-take throughout the profession, so that they can go without undue anxiety to undertake any duties assigned to them. We are all very much indebted to the hon. Member for St. Albans for bringing up a matter of such great importance to the whole country. It has given others an opportunity of making useful contributions to the Debate. We have heard two excellent speeches on the subject of the hospital side of A.R.P. work, and it is gratifying to know that laymen are so closely interested in co-operating with the medical profession in the arrangements for dealing with casualties.


"That this House recognises the call upon medical services in case of air raids as a cardinal factor in such an emergency; is of opinion that a complete and detailed scheme is required providing for the medical and auxiliary personnel, the institutions, equipment, communications, and transport entailed; and demands that both policy and administration shall be devised without delay and carried out under responsible co-operation between the British Medical Association and other representatives of the medical profession and of the hospitals, with the several Government Departments concerned."

The remaining Orders were read, and postponed.

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