HOSPITAL (PATIENT'S DISCHARGE) (Hansard, 21 March 1944)

§ Mr. Driberg (Maldon)
I am very glad that the Parliamentary Secretary to the Ministry of Health, after her arduous and, if I may say so, successful last two Sitting Days, has been good enough to come down to the House at this late hour to deal with a comparatively limited point. It has taken us rather a long time, I am afraid, to raise this matter on the Adjournment. The incident to which I am referring took place last November, and I raised it at Question Time in January. I do not think, however, that that matters very much, because it was not something which required urgent administrative attention—although there are one or two points of principle arising out of it which I think may be of some slight interest.
First, I must explain that I am raising the case of a soldier who was discharged from a hospital, as we maintain, before he was really fit so to be discharged. In fact, he was taken quite seriously ill soon after his discharge, and it is a very fortunate thing indeed that he recovered, because he was not a strong man and had a bad health history from early youth, and if he had, by any tragic misfortune, succumbed, a great deal more would have been heard of the case and it would have been very unfortunate for all concerned. When one remembers the fuss that arose out of the tragic episode of Rifleman Clayton, one can only be thankful that nothing like that occurred in this case—although I do not suggest for a moment 816 that there is anything comparable in this case as regards deliberate cruelty, or anything like it.
My second point is the nature of the reply of the Minister of Health when I raised this matter at Question Time. The chief intention of his reply, as it seems to me, was to cast doubt on the facts stated in my Question. Before putting the Question down in the first instance, I had, of course, checked my facts, but, when such general doubt was cast on them in the Ministerial reply, I naturally hastened to re-check them: I re-checked them with the man concerned, his family, the doctors who have attended him and also with the local branch of a highly reputable ex-Servicemen's organisation which happened to be fully cognisant of the man's home circumstances and all the facts of the case.
My re-checking, I am afraid, showed completely that the facts originally given in my Question were correct, and that the Minister's reply, although ingenious, was also rather disingenuous. It was, in fact, a collection of half-truths, omissions and evasions; and although, of course, it referred only to a special local point, it was in effect, therefore, misleading to the House as well as to the public generally and to my constituents in particular. It would be Utopian to expect the whole truth and nothing but the truth in a Departmental reply; but I do feel that the general sense of what is put out at Question Time from that despatch-box must be substantially accurate and not misleading to the House. I fully realise, incidentally, that the Minister is not personally responsible for the brief prepared for him by his Department.
My Question on 27th January, which gives the facts of the case, as I still maintain, as briefly as possible, was this. I asked the Minister of Health: Whether he is aware that Craftsman Staines, R.E.M.E., was discharged from a hospital, of the identity of which he has been informed, instructed to rejoin his unit several hundred miles away, and obliged to walk four miles to the nearest town, although he had been in bed for ten days with acute bronchitis and complained that he was still unfit; that on arrival at the town he was taken seriously ill and found to be suffering from pleurisy; and if he will take steps to ensure adequate inspection of all patients in this hospital before discharge. To which the Minister replied: I have obtained a report on this case which does not bear out the facts stated in the 817 Question, and I will, with permission, circulate a summary of it in the OFFICIAL REPORT. As a supplementary, I asked: Is the right hon. Gentleman aware that it is not disputed that, within an hour or so of being discharged as fit, although he complained that he was still unfit, this man collapsed with pleurisy? To which the Minister replied: I think my hon. Friend had better wait until he sees the facts as I understand them to be. The summary that was circulated in HANSARD is quite a brief summary—about 20 lines or so—but in the course of it occur no fewer than six, or possibly seven, statements which, on re-checking my facts, I found to be obviously deliberate suppressions or evasions or mis-statements of the truth. I will run through it briefly, pick out these points, and analyse them for the benefit of the hon. Lady. The whole tenor of the summary, I should explain, was to cast doubt on the facts as stated in my question. I do not think there is any positive untruth in the summary, but there is a great deal of false suggestion by omission and by half-truth. The summary goes like this: The Report shows that, although the patient was in hospital for ten days, he was not at any time during that period more than slightly ill; First suppression of fact—because this man, before he went into hospital for 10 days, had been in bed at home for four days, and his own doctor said that he was well on the way to recovery when admitted to hospital. It goes on: —that for several days before discharge he had been up all day; that on the day when he was to be discharged to his unit he asked and was granted leave to visit his home in the neighbouring town— To put it like that in this context is to imply that he wanted to leave hospital and is, therefore, to blame for the consequences. In fact, he only asked that he might go to his home in the neighbouring town—where, by the way, he was taken ill originally while on leave—when he realised that otherwise he would have to travel straight to Scotland. That might, in the condition in which he felt himself to be, have had very much more serious consequences than did actually transpire. The summary goes on: …his home in the neighbouring town, two and a half miles away"— A point which is obviously inserted to suggest that my Question was inaccurate, 818 because I said that he was obliged to walk four miles to the nearest town. In fact, the centre of the town is two and a half miles away and the man's home is one and a half miles beyond the centre of the town, so that he was obliged to walk four miles to his home in the neighbouring town. I am sorry to go into these rather fiddling little details, but I am analysing this summary to show that it is generally undependable. …to which there is a bus service"— another dig at my Question, because I had said that he had been obliged to walk to the town. Although it is true that there is a bus service to the town, no buses pass the hospital between 8.48 a.m. and 12.33 P m. Craftsman Staines was discharged about 10 or 11 a.m., when no bus was available, and, as he has told me since, he did have to walk all the way to the town; no bus passed him, and he was not lucky enough to get a lift. When leaving the hospital he complained of a sore throat but he had no temperature, and was not seen by a medical officer, having been seen by medical officers on the two previous days. At this point there is a discrepancy in the evidence, because the man himself and his mother, who had been visiting him in the hospital, insist that he was not seen by the medical officer on the two previous days but only on one of them. This perhaps is not a point of special importance; but they claim that he was seen on the Monday but not on the Tuesday. The important thing is that he was not seen on the Wednesday morning, before his discharge, although he complained of feeling ill. It goes on: …that on the day after he arrived home he was reported to be unwell, and was at once re-admitted to hospital. That is obviously intended, again, to cast doubt on the facts as stated, because I had said that, …on arrival at the town he was taken seriously ill and so on. Again it is completely misleading to say that on the day after he arrived home he was reported to be unwell and was at once re-admitted to hospital, because what actually happened was that he definitely reported sick within an hour or two of arriving home, went to see his own doctor, and was admitted to another hospital on the same day and transferred to the original hospital on the following day—which I think the hon. 819 Lady will agree is not quite fairly put by the wording of this summary. …he was found to have some rise of temperature and a sore throat, but no pleurisy as alleged."—[OFFICIAL REPORT, 27th January, 1944; col. 851, Vol. 396.] And then the summary goes on to say that he rapidly got better. Well, "no pleurisy as alleged" is a very difficult matter for me to deal with. I am not a medical man and I do not know exactly what the technical medical definition of pleurisy is. Possibly it is a condition about which two doctors might differ in their diagnosis; it may even be that it is a condition which rapidly changes and is ameliorated, and two doctors might honestly give different opinions about it within a day or so of each other; but I do know that I have checked again with the man's own doctor, and there is no question at all that the doctor diagnosed pleurisy and has, since my question and the Minister's answer, definitely confirmed his diagnosis of pleurisy.
What actually happened in the original hospital in the few hours before the man was discharged was this. During the night he complained of a cough and was given frequent doses of medicine and advised to tell the ward sister in the morning. Before he could do this, however, he was sent for by another sister and told that he would be discharged that day. He protested that he was still feeling very unwell and that his throat was bad. Remember, he had been ill for ten days or a fortnight with bronchial catarrh or bronchitis; but the sister, although she did not actually accuse him of it, rather hinted that he was "swinging the lead," as they say, and insisted that he was fit to return to his unit. It was only then, when he realised that he would have to leave hospital, that he asked for permission to visit his home before returning to his unit, and when he went home he was quite obviously ill. He called at the police station to ask what he should" do about going back to his unit. Here he was: he had been turned out of this hospital and was feeling wretched. They advised him to see his own doctor, which he did, and both his own doctor and his partner saw him at various times, sent him to another hospital on that day, and now confirm again that he had pleurisy. As I say, however, I am not laying too much stress on the name of the condition from which 820 he was suffering; it simply seems to me to be fully established that he was much too ill to have been discharged from hospital that morning. That is the main point.
I am sorry to have detained the House so long, but I do hope that I have said enough to emphasise the extreme importance of as careful a check-up as possible of all patients before their discharge from any hospital. Particularly if they complain that they are unwell, they should, at least, be allowed to see a doctor—although one realises how busy doctors are—and this is especially desirable, I think, when it is a service patient who is going straight back to his unit. The hon. Lady will appreciate, I am sure, that I am making no general accusation against hospitals, or against this hospital in particular. This hospital, I know, like all other hospitals, does magnificent work under extremely difficult war-time conditions. Whether one goes to hospital as a visitor or as a patient—and I have been both in the last few months—one is astonished by the wonderful and tireless work of the staff, the doctors, the nurses, all of them. Really, what I want to do by raising this matter is to encourage such staffs to feel that the most meticulous attention to detail is never wasted. However difficult the conditions, however intensive the rush of war-time—and I know how difficult it is—it is never safe to trust to luck where the health of a soldier or a civilian may be endangered by haste or negligence. That is my main point. My secondary point is once more to impress upon departmental staffs, if I can, not to trifle with facts when they are preparing them for presentation to this honourable House.

§ The Parliamentary Secretary to the Ministry of Health (Miss Horsbrugh)
I was glad that the hon. Member for Maldon (Mr. Driberg) referred to the good work which has been done by hospitals and said he did not wish to criticise them in any way. I agree that the greatest care should be taken, whether the patient is a soldier or civilian, before he is discharged. Perhaps the House will bear with me if I give the details of this case, which I have carefully checked and about which I have all the documents referring to temperature and so on. This man was admitted to hospital on 30th October, on the last day of his leave. He was suffering from a mild infection of the upper respiratory passages. His chest was X-rayed on 2nd 821 November and there was no evidence of pleurisy or anything being wrong.

§ Mr. Driberg
He had been ill before.

§ Miss Horsbrugh
I am giving the facts when he reached hospital. There was no rise in temperature during the whole of the time the man was in hospital. He then began to get up for part of the day and by 8th November was up all day. Generally, in these cases a patient takes exercise outside as well as inside the hospital, but we have not been able to get definite evidence that this man actually went out. That we cannot check. The resident physician examined him on 8th November and passed him fit for discharge. The assistant medical officer entered on the man's case paper, on 9th November, that he was fit for discharge, and he told the ward sister. On 10th November the man told the ward sister that he was not feeling well and she took his temperature, but found he had no temperature, although his throat was slightly red on one side. This man went to the military registrar, but he did not say that he was feeling unwell. His conversation with him was entirely taken up with pointing out that he was on the last day of his leave before he entered hospital and was very anxious to have that day. The military registrar, when asked if he could not make up that time, arranged with this man that he could go home and travel to his unit by night.
If this man had been feeling really unwell I would have thought that he would have told the military registrar, and that he did not want to travel by night. Now we come to the fact that the hon. Member said that this man was obliged to walk. As the hon. Member said, a bus did pass, but not until 12.33, and this man was discharged at 10.30 a.m. I think that the House will agree that there was no thought of turning the man into the road at 10.30. The bus passing the hospital gates, and going to the town in which the man lived, could have been taken. He had to wait only a short time. But on his own initiative he walked to the town. There is also a railway station about one mile away, but one would have thought that this man, if he had been feeling unwell, would have taken that bus. Anyhow, on his own initiative he walked and did not take the bus.
The next we heard of him was that when he was at home he felt unwell. I 822 am told that his family doctor was absent, but he saw another doctor. He said he was suffering by that time from a pain in the left side of his chest and back. His temperature was taken. It was 100.2 and the doctor said he detected a slight pleural rub in the neighbourhood of the pain. He admitted him to another hospital and prescribed treatment. He was reported on the next day to the hospital that he had left, and he was at once transferred back. That was on nth November. He was X-rayed on that day and no trace of pleurisy was found, but on a clinical examination it was found that he was suffering from tonsillitis. A bacteriological examination showed that it was of a simple type. The temperature settled down within 48 hours, and I think the hon. Member will realise that in some cases, when there has been a rise of temperature, pains in the back may be associated with it. But the doctor who admitted him to hospital did not see him again. When he came back he was X-rayed, there was no pleurisy but slight tonsillitis, the temperature was normal within 48 hours, and stayed normal, and he was discharged to a convalescent depot on 30th November.
As to general treatment in hospital, it is the practice, when there is any long stay of the soldier, when the military registrar says he is to be discharged, to go to an auxiliary hospital of the Red Cross or St. John or the Army Convalescent de pots. He had only been in hospital for a short time. He had no temperature at all while there and had only had a mild infection of the upper respiratory passage. It was not thought necessary then to send him to a depot. He was anxious to have a day's leave. He did not suffer from pleurisy before or afterwards. When these facts are known, I think it will be seen that the hospital did its duty. The military registrar who arranged for him to go home did so because the man asked for it, and made arrangements for him to travel by night. A bus was passing the gates within two hours, but he chose to walk, I do not think it can be said that the hospital in any way neglected its patient. He came back the next day and was again X-rayed and received proper treatment for the slight tonsillitis. On these facts I think the hon. Member will agree that the hospital discharged its duty and that the man 823 did not in any way suffer from the treatment he received. The tonsillitis which he had developed by that time was not of long duration and he was able to be fully restored to health.

§ Mr. Driberg
If, on the hon. Lady's own showing, there was slight redness of the throat before the man's discharge, and if he complained of feeling unwell, does she not think that he should have been allowed to see a doctor before he came out?

§ Miss Horsbrugh
I should have thought that when he went to the military registrar he would have said, "I do not think I am fit for discharge; may I see a doctor?" What he said was, "May I go home, because I have missed a day's leave?"

§ Mr. Driberg
I tried to interrupt before on that point, because there is a conflict of evidence. My recollection is that the man says he told the military registrar he felt ill, but that he said he was not concerned with the medical side.

§ Miss Horsbrugh
We checked that carefully. We are told that he said that to one of the R.A.M.C. people, but when it came to the point of dealing with the registrar, the one topic the man talked of was that he had come into hospital on the last day of his leave, and could he go home and make that one day up? The registrar said that he could if he would travel at night. The man did not complain at all.

§ Mr. Driberg
But he said something to one of the R.A.M.C. men?

§ Miss Horsbrugh
What he said to the military registrar was that he had missed a day's leave in coming to hospital and he wanted to go home. It was arranged that he should go home for the day and travel at night to his unit. If the man had been feeling ill he ought to have staved in bed and not asked the registrar for a day.