HC Deb 07 August 1941 vol 373 cc2216-25
Dr. Morgan (Rochdale)

We have had a very interesting Debate on agricultural workers and their wages. We have been discussing healthy agricultural labourers, and I want now to ask the House to consider the position of injured agricultural workers and injured workers in other industries. I see on the benches opposite an hon. Member who represents one of the industrial centres of Hampshire. I am a medical Member. Does the hon. Member opposite realise that an injured worker in that county, in Southampton, or in Portsmouth, cannot obtain adequate fracture treatment, in grade I hospitals, according to the recommendation made by one professional committee and one Inter-Departmental committee, without travelling as far as Oxford? I know this subject is very uninteresting to most hon. Members. A healthy person does not bother about medical treatment, but the moment he is injured or ill he takes a completely different view. I have seen medical Members of Parliament sick and dying, and seen the agony of their household and their relatives when they were suffering, and I realise that an injured or a sick person is an entirely different person from one who is continually in good health.

This question of fracture treatment and rehabilitation has a fairly long history. In 1935 it was realised that all the good fracture work and treatment of the injured in the last war had been allowed to go down to rock bottom. A B.M.A. committee was organised, and that Committee was composed of medical experts, who reported on professional fracture work in the best hospitals. That Committee, as the Minister of Health knows, made a very valuable report. They stated that there was inadequate organisation of fracture treatment, imperfect surgical treatment in the best hospitals by the best tutors and by the best surgeons, failure in putting fragments together, and failure in keeping fractured fragments completely immobile and at rest—in other words the fragments were wobbling all over the place. There was failure in giving proper functional activity to prevent the injured parts from getting stiff. I will read a quotation from the report. This is what they say: Everywhere joint stiffness has been inevitable, and recovery has been delayed frequently by the adoption of passive methods to the exclusion of active exercise. Stiff joints have become stiffer as a result of injudicious stretching, and the belief that massage alone will cure. Much wasting and recurring oedema (wasting) has been responsible for months of delay. In other words, workers who have been injured in the course of their occupation, or as a result of an air raid, road accident, or home accident, have been crucified and maltreated in the exclusively protected, privileged order of barbed-wire professional indifference and laxity of hospital organisation. This may sound harsh, but it is true and unchallengeable, and has been proved 100 per cent. This surgical chaos is not due to lack of surgical technique or prowess, but to the lack of real organisation. The report laid down certain principles of fractured treatment, which the Committee recommended should be followed. These included segregation in one department, so that cases could be uniformly handled by a specially trained and experienced staff, and so that there could be team work and unity of control. Secondly, they recommended that there should be definite treatment at successive stages until the injured man was ready and fit to return to his occupation. They also provided that there should be after care, perfect records kept and provision of rehabilitation centres. They also asked for extra-institutional co-operation between one institution and another.

This scathing report created such an impression that the Government appointed an inter-departmental committee to make a special inquiry. The Delevingne Committee confirmed these recommendations after making a very thorough inquiry throughout the country. They asked specially that fracture treatment should be organised. The Delevingne Committee stated in its report that the principles of fracture treatment were accepted by Government Departments. I wonder if the hon. Lady who is to reply will do me the privilege of telling me whether the principles are accepted by the Ministry of Health and the expert advisers of the Ministry on this subject. The recommendations are to be found on pages 28, 29, 30 and 31 of the report, and the only case where surgeons disagreed was in the case of a group of Glasgow surgeons.

I again wish to draw the attention of the House to a small point I made a few days ago in regard to industrial wastage caused by unorganised fracture treatment. Take, for example, the case of a fractured thigh-bone—the lower limb is very important, and you cannot get about if it is damaged. If, as is recommended, Organised treatment is followed thoroughly, the period of disability is 37 weeks, but when the treatment is unorganised it amounts to 66 weeks. If treatment is organised 9 per cent, are permanently incapacitated, whereas if it is unorganised 57 per cent. are permanently incapacitated, or more than half of the cases. In Wales, for example, which is notorious for its high accident rate in the mining and shipping industries, up to the time of the Committee's report there were only three hospitals classified in grade I. I should explain that the Delevingne Committee classified hospitals in six grades. It is in grade I only where the principles of treatment reported by the Committee are followed.

There were only three hospitals in Wales where adequate treatment could be obtained. There was no orthopaedic hospital. If there has been any improve- ment since then, I should be glad to hear of it. In Scotland there was only one grade I hospital. Recently the Secretary of State stated that there were six new orthopaedic hospitals in Scotland, but he did not tell me whether those hospitals were up to grade I standard. In England, where there are also large industrial centres, only 74 hospitals are in grade I out of a total of 1,100. Therefore, 10 per cent. of the hospitals only are giving this proper treatment.

The Delevingne Committee stated that there was soon to be evidence of rapid headway in the reorganisation of fracture treatment. I should like to know where this fracture treatment has progressed, or whether there is still dry rot in the departmental handling of this pressing need. I do not think the present Minister of Health or the Parliamentary Secretary are responsible. Since they have been in office they have tried hard to amend matters and make good progress. But I think they are hampered by the conditions in the voluntary hospitals, and by the lack of organisation. Even the Voluntary Hospital Association are dissatisfied with the position. They say they are willing and anxious to do it, but that they have not got the money to provide for the necessary extensions.

This delay in the recovery of men is very vital from the point of view of production. I would like to ask whether the problem is being handled with the speed that is necessary. What is the position in Germany? Unfortunately, I cannot speak of anything that has happened in Nazi Germany, but as far as pre-Nazi Germany was concerned fracture treatment was properly organised. If there are German figures available for comparison bow, I would like to know them. Certainly in the United States, and I believe in Russia also, as far as my information goes, the organisation of fracture treatment is ahead of fracture treatment in this country. I am not speaking of surgical technique but of organisation.

I do not want to bore the House, but I want to ask the hon. Lady certain questions. The emergency hospital scheme was planned by the Ministry of Health for two years. We have had two years of war. I would like to know, not in a vague way but from definite figures, what progress has been made in regard to grade I hospitals. Grades II, III, IV and V are of no interest, because they do not come up to standard. I want to know what progress has been made in grade I orthopaedic hospitals or ordinary hospitals. Cither grades are unimportant. The supplementation of orthopaedic centres is not enough. More organisation is needed. Even now I hear very disgraceful statements being made, and some of them have been authenticated, about these emergency hospitals. Equipment is incomplete, sometimes disgracefully so. Sometimes there are actually dangerous instruments, because I understand low tenders and inferior designs have been accepted. Have these instruments been scrapped, and at what cost? Even now dangerous X-ray instruments are said to be supplied.

It was said in the "British Medical Journal" last week that X-ray instruments are being supplied of such quality and such danger that after one minute's screening the radiographer not only burns the skin off the patient but almost sterilises the patient—that is, sterilises him from proper activities in the future—because it is difficult for a radiographer working in the operating theatre not to obey the surgeon's orders. It is not impossible that some of these skin troubles put down to plaster idiosyncracy are in fact due to excessive X-ray exposure of one minute, or defective instruments. It is an essential part of fracture treatment that the surgeon should have good instruments in the operating theatre. Are these instruments referred to in the "British Medical Journal" last week still being supplied? I know the hon. Lady would not approve of that. Are the Ministry of Health properly advised from the professional point of view? I am dubious about that. I want to see hospitals brought up to grade I at every stage of treatment in the wards, in the massage department, in the electrical department and in the re-training of patients to use their limbs and to use their muscles when they are sent to rehabilitation centres.

Now I want to refer to the latest circulars issued by the Ministry, Circulars 2346 and 2346A, sent to hospitals and local authorities. Certain additional classes have been put in for whom the Minister accepts financial responsibility. I would like to know how much financial responsibility. According to the circulars, patients are still supposed to pay according to their means. Are the patients still to be bothered with almoners' inquisitorial inquiries, and what does financial responsibility really mean? Are accounts sent to the Minister? Are they vetted? Are they made periodically? Let me mention one or two anomalies: Civil Defence personnel is included, presumably whether injured on duty or not on duty, and presumably whether male or female. But part-time workers are not mentioned and presumably are not included. Is that so? Are they expected to pay? Are fire watchers included? If not, why not? In the circulars certain grades of workers are mentioned; others are not. For example, municipal workers are not mentioned. Shop assistants, plumbers, clerks, hospital workers—even nurses—are not mentioned. Why this differentiation?

I should like to ask the hon. Lady some questions. If she cannot answer them now, perhaps she will do at some other time. Do the Minister of Health and his Departmental advisers accept without reserve the recommendations of the 1935 British Medical Association Fracture Committee, accepted and confirmed by Delevingne Inter-departmental Committee, both with regard to treatment and organisation of fracture treatment amongst persons injured by accident? Is it the policy of the Government to implement the recommendations as soon as possible, especially of the Delevingne Committee with regard to grading? What real progress has been made in the last 24 months in this direction, seeing that fracture treatment is vital in war-time owing to increased casualties? Does the Minister of Health accept the grading of the hospitals in which the grade I hospitals are the only ones carrying out fully the organised fracture service? What is the progress in grade 1 hospitals? Why did the Minister classify his hospitals on new lines rather than the grading of the Delevingne Committee? What is the progress in the orthopaedic hospitals, especially for adult fracture treatment? What are the national finance commitments to hospitals, voluntary or other, approved by him as providing fracture treatment, or is his commitment only reserved for grade 1 hospitals? What is the estimated cost to the taxpayer of the financial implications for this Peter Pan service on no sure future foundation? What is the supervision? When are reports given and accounts rendered?

I think I have said enough. I intend to continue pressing this subject as far as I can until I see some real results accruing from my poor endeavours. I appreciate very much the efforts of the Minister herself, but I want to see that further pressure is put on the hospital authorities, and I hope in a few months she will be able to report great progress in grade 1 hospitals and in orthopaedic centres up to the grade 1 standard.

The Parliamentary Secretary to the Ministry of Health (Miss Horsbrugh)

I think the hon. member, who put a good many questions at the beginning of his speech and concluded with eight questions at the end, fully realises that it may not be possible to give him clear answers, "Yes" or "No," to all of them, but those that I cannot reply to at the moment I shall be glad to answer later on. Although he said he thinks both my right hon. Friend and I have been interested in the subject and are trying to do our best, I think he is still under the impression that there are people who are trying to prevent this scheme going forward and that it is not going forward as he and I would like it to do. I wish he would put some of those anxieties out of his mind. I wish he would go about the country and find out for himself, or come to the Ministry—

Dr. Morgan

I was recently in Scotland and was asked specifically to visit the Glasgow and Edinburgh hospitals, and I did. In the Debate on the Scottish Estimates I stated the conditions that I found there. Not one of the hospitals was grade I in the 23rd month of the war.

Miss Horsbrugh

I am not saying anything about what the hon. Member said in the Debate on the Scottish Estimates, because I have to remind myself from time to time that, although Edinburgh is my home and Glasgow is very near it, and I know them both, speaking as Parliamentary Secretary to the Ministry of Health, I have no responsibility and practically no knowledge of the actual work that is being done in those hospitals. I am speaking to-day about hospitals in England and Wales, and the hon. Gentleman having put these questions to me, I would like to put one to him. Will be give us the facts? He has told us that in certain places the instruments are disgraceful and that this work is not going on in particular places. It would be more helpful if he came to the Ministry and said to me or my right hon. Friend, "Such and such hospital treatment is not as I think it ought to be." This Emergency Hospital Service, set up and worked during the two years of the war, has been one of the marvels, I would almost say miracles, of organisation. The setting up of these extra hospitals and the work which is being done by devoted men and women is something of which we may well be proud, because I know that suffering has been mitigated and cures have been made which have hardly been equalled before in history.

I am willing for the hon. Gentleman or anybody else to criticise the organisation, but it is a pity that when he criticises that he does not also put before the public the marvellous work that has been done. The hon. Gentleman asked particularly about orthopaedic centres and asked why the grading was not the same as suggested by the Delevingne Committee. We agreed to their recommendations, but the reason centres were not graded in the same way is that we are now working under war-time conditions and there are certain hospitals in vulnerable areas on which we do not want to rely for long-term work because they are in vulnerable areas. We have, therefore, had to make a difference with regard to certain hospitals which in peace-time would be giving a long-term treatment.

Although I cannot reply to all the hon. Gentleman's questions now, I can tell him some facts which ought to re-assure him. The work has been divided up into new orthopaedic centres and new fracture departments, "A" and "B." "B" are short-term ones because generally they are in vulnerable areas. Apart from the Ministry's consultant advisers who are dealing with this problem, we have in each region consultants for this particular type of treatment to see that there shall be organisation and segregation of the people to be treated and that they shall have their treatment from start to finish. That is going on. now, and I am sure it will rejoice the heart of the hon. Gentleman. I am told that in the orthopaedic centres there are about 5,000 beds and in the fracture "A" departments 5,000 beds, making 10,000 for this scheme alone.

Dr. Morgan

Is that 10,000 new beds? If so, it is a small drop in comparison with the size of the problem. In Scotland, with 20,000 casualties a year, let us say that 10,000 are receiving treatment in grade A and another 50 per cent are not. That would be equivalent to the loss of nearly 200,000 working days per year.

Miss Horsbrugh

I have tried to explain to the hon. Member that at the moment I am speaking of England and Wales, and the new scheme of the Emergency Hospital Services and of what improvement has been made. The hon. Member said that 10,000 beds are nothing, and that his argument would be just the same if I said there were none. I do not agree. I think that 10,000 new beds in this scheme are something of which we can be proud. The hon. Member does not agree.

Dr. Morgan

I think it is a tortoise pace.

Miss Horsbrugh

The hon. Member does not think that 10,000 beds are the slightest use. On the contrary, I say that these extra 10,000 beds will give many thousands of people an opportunity to get this up-to-date and carefully-arranged treatment. The hon. Member may not be pleased, but the people who will be treated will be pleased, and as he has taken an interest in this matter perhaps he will be able to take some pleasure also in the pleasure of other people who are getting this treatment. He also spoke about treatment being available only for certain people, asked whether there was to be payment and also raised the subject of part-time Civil Defence workers—I am not attempting to answer all the eight questions, but taking his case in outline. As he knows; the original scheme was for casualties. It goes further now to include transferred people, those moved from one hospital to another, and evacuees, those evacuated under Government schemes and those who have evacuated themselves.

Then the hon. Member asked why this applied to full-time Civil Defence workers and not to part-time workers The answer is that the part-time Civil Defence worker is another worker during the other part of his time, and he may quite naturally come into some of the other categories. We have made the broadest list we can, and it is no use going beyond the accommodation that may be available, because we have to face the fact that in addition to heavy casualties from air raids there may be casualties from military or naval engagements. There is no reason why munition workers, shipbuilders and all the other categories of workers who might be mentioned should not be part-time Civil Defence workers. We have put in the full-time Civil Defence personnel because with them Civil Defence work is a full-time job. If the hon. Member will study the list, he will see that those within the Emergency Medical Services comprise a very large proportion of the population, especially when he realises the number of people who have been transferred to other areas. The other question he asked me was as to the pay—how they paid? The position is exactly the same as it would be in times of peace. Many of them are members of societies and organisations which make payments.

It being the hour appointed for the interruption of Business, the Motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, "That this House do now adjourn."— [Major Dugdale.]

Miss Horsburgh

It makes no difference to the payment at all. My right hon. Friend has given a list of those who come within this organisation, and I look forward very much to giving a full and definite answer to the hon. Gentleman. Most of it, I may say, will be in the affirmative.