HC Deb 10 October 1944 vol 403 cc1709-18

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

6.0 p.m.

Sir Waldron Smithers (Chislehurst)

The Motion for the Adjournment this evening, which I regret to say will keep the House a few minutes longer, raises a very important point concerning my beloved county of Kent. It arises on Questions put to the Minister of Health on 6th July, column 1296 of HANSARD, and 27th July, column 887 of HANSARD. It concerns the tragic circumstances surrounding the death of a constituent of mine, Mr. Hopper, who lived at Petts Wood. I welcome the fact that the hon. Lady the Parliamentary Secretary to the Ministry of Health is here to reply, but I would ask her if she would ask her right hon. and learned Friend to read this Debate and see if it is possible to do anything.

First, I want to stress the human side of this increase of tuberculosis in Kent and the lack of institutional accommodation for patients. I had a heartbreaking letter from Mrs. Hopper. When I went to see her husband he was in a dying condition. Mrs. Hopper had to do everything for him besides nursing a five months old baby; furthermore, her sister and child of five were living in the house and were thus liable to infection. Mrs. Hopper told me that her husband was getting worse and that she felt that they were up against a brick wall. On 2nd June the panel doctor gave his opinion that Mr. Hopper had gone back considerably in the previous six weeks, and that one of his lungs had ceased to function. In a subsequent conversation with the tuberculosis officer he agreed with me that Mr. Hopper's case was tragic but said that there were hundreds more like it. Here, I want to pay a tribute to the Brompton Hospital. Directly I found how ill Mr. Hopper was, I telephoned the hospital and without any ado the medical officer said, "Put him in an ambulance and send him in." I will refer to that again in a moment. May I quote a sentence from the "Kent Messenger" of 4th August, 1944? It was reporting a meeting of the Kent County Public Health Committee, and it said: There are at present 350 patients awaiting institutional treatment and, owing to the shortness of beds and staff, men cannot be accommodated for at least three months and women and children for about five months. This matter was first brought to the notice of the Kent County Council in May, 1943, and then they voted £35,000 for premises and £10,000 for equipment. But, after all that expenditure, something broke down in the administration and the patients could not get institutional treatment and were dying in their homes. It was said at the time that the Health Committee feared a breakdown of the service. I want to ask the Ministry whether they were aware of this and what they did about it. The Chairman of the Health Committee said there was a waiting list of 357. All the time the infection was spreading and the patients were dying. He also said the Minister of Labour would be contacted. I should like to know what steps that right hon. Gentleman took to help in this tragic situation. The most pathetic thing of all is the words at the end of the report in the "Kent Messenger": "The report was approved." As far as I can see, there was no protest. In the old days there might have been a Jack Cade or a Wat Tyler who would have had a meeting at the Maidstone Town Hall and made a public protest against this condition of affairs.

The incidence of tuberculosis goes up in war time, and that is a fact which the Minister of Health must have known perfectly well. In answer to a Question on 27th July, I got the information that the rate per thousand went up from ½704 in 1938 to 1.248 in 1941, 1.017 in 1942 and back to ½984 in 1943. While realising all the difficulties was every possible step taken to see that all available staff and accommodation was economically used? For instance, I have been told that a certain number of patients were relatively convalescent—artificial pneumo-thorax cases—which might have been put into some other institution; or, however tragic a situation it would have created, there were aged and infirm in certain wards in certain hospitals, but they were not infectious cases and they might have been moved somewhere else, where they would have been quite comfortable, to make room for tuberculosis cases. After all, the Government and the Minister in war time have tremendous powers. I am sorry to say I do not think they use those powers to the utmost to get hutments or other accommodation or to commandeer big houses and get staff.

On 6th July, in answering my Question, the Minister tried to cover up his tracks and put as good a case as he could by saying that the number of deaths, which was considered the truest guide to the incidence of the disease, showed only an increase of 0.1 per cent. over the same period. It is not a question of the number of deaths but of the terrible danger of infection which is now being spread. An expert told me that tuberculosis cases allowed to be free in their own homes or in contact with the public, infect on the average nine other people, and to put it optimistically, he said, it would take 10 to 15 years to break down the present firmly established vicious circle. That is a serious statement coming from an expert, and I would ask the Minister of Health to take it into consideration. The admission of patients is strictly in accordance with the date of recommendation. Why should the admission be strictly in accordance with the date of recommendation? Surely some consideration should be given to the state of health, age and home surroundings of the patient. I got a letter from the medical officer of health for Kent saying that his object was to get the patients back to the labour market. That seems to be to me a callous and soulless remark to make. It is the same as if a milkman said to the vet., "Get my pony fit again as soon as you can so that he can go back to work."

The next point I want to make is that the conditions at the clinic at Bromley, to which, although it is not in my division, my constituents have to go, are appalling. There are no beds, and the accommodation for patients and the dressing rooms are most primitive. I want to pay a tribute to the tuberculosis officer at that clinic. He is a splendid man. He is heartbroken at the distress around him and his inability to help. What is the position when patients suffer unnecessarly or die prematurely, if their relatives want to take action against the Minister of Health, because, war or no war, there is no excuse in law and the Minister of Health has failed to carry out his statutory duty. He is responsible for the treatment of tuberculosis and delegates his power to the local authorities. When Mr. Hopper went to Brompton Hospital both the county medical officer and the Brompton medical officer said he was in a moribund state, but the hospital was able to make him comfortable in his last hours. Yet the Minister of Health, in an unfair argument and in order to cover up his tracks, wrote to me that Mr. Hopper's condition was, in the opinion of his advisers, worsened by his journey to the hospital.

There is another important point. The medical officer of health for Kent, who has written pages and pages of foolscap, wrote to me: You will appreciate that the doctor at the clinic at Bromley is an officer on my staff, but as tuberculosis officer to the Bromley area he is not familiar with the questions of policy raised. In any event, as a subordinate officer on my staff, it would be improper for him to answer your questions. Did the House of Commons ever hear such an amazing statement—that I cannot get official answers to my questions from the expert on the spot? Here is a foretaste of a State-run medical service, a service run too much by people sitting in offices and tending to get out of touch with the realities of medical practice.

Sir Henry Morris-Jones (Denbigh)

Was this an ordinary member of the staff or a qualified medical practitioner?

Sir W. Smithers

Yes, he was a very highly qualified medical practitioner. I say quite sincerely that I do not think the best efforts were made to overcome the difficulties of war time. If we had had a strong Minister of Health, he would have sat on the doorstep of the Minister of Labour until he had got the necessary staff and he would have taken the necessary action in the economical use of what supply was available. I am certain that much more could have been done.

There is another important point. The medical officer of health complained that I showed the report which he wrote to me to Mrs. Hopper, and that if he had known what I was going to do he would not have felt it right to comment in any way on his position in this matter. What is the good of sending a report to a layman like me? I got every bit of evidence I could on this case, and I had it copied and circulated to Mrs. Hopper, who is one of the bravest little women I have ever met, and to his medical officer in the hope that they would alleviate the condition of Mr. Hopper's case. Why all this secrecy and hushing up? I think that the health authorities of Kent are frightened of publicity. Now the medical officer of health in Kent says: "If my letters are to be shown to a third party I must obtain the instructions of the members of my committee as to my future course of action." I have strained every nerve to get all the evidence I could about this case, and now I am threatened with not being given the necessary information should any future matter arise.

Terrible as have been the conditions of war—I have talked to the hon. Lady about it and I do not want to minimise them—the war bogy has been overdone. We have an enemy in the Germans, and another enemy is tuberculosis in Kent. I understand, since I put this matter down for the Adjournment, that it is bad all over the country. The Minister has a very grave responsibility in this matter in trying to alleviate to the utmost the human agony and suffering, which might have been avoided in some degree had be been a stronger man and shown some foresight and some courage.

6.18 p.m.

Sir H. Morris-Jones

I am not going to take more than two or three minutes from the time of the hon. Lady who is to reply, but I want to make one or two observations. The remarks of the hon. Member about what was said by the chief medical officer about his subordinate officer is characteristic of what is likely to happen in this country when we get a National Health Service under the State. There was a medical man who, when asked his opinion, was not allowed by his superior officer to give it. The thing would have been quite impossible in a voluntary hospital, and is a foretaste of what we shall get in this country when the State scheme comes into operation.

My hon. Friend has rendered a service in raising this matter. I am not conversant with the facts of the particular case, but I know that the position in regard to institutional vacancies and in regard to tuberculosis cases which are compelled to be in homes which are often overcrowded, is very serious in this country. I am not sure that the Ministry of Labour should not be represented on the Government Front bench, because it is quite as much a matter for them as for the Ministry of Health, although my right hon. and learned Friend is actually responsible. I know the conditions in my Principality of Wales are very serious and are growing more serious. I entirely agree as to the strain of the war on civilian life. I was very much impressed by the article written by a war correspondent the other day in which he stated that the position of women in Germany right though the war has been infinitely better than the position of women in this country. They have been provided with slave labour, and all through the war they have known nothing about domestic difficulties to the extent that the women of this country have. I think it is time now that the Minister of Labour should release generally morel women for domestic and institutional help.

6.20 p.m.

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

We all realise what difficulties the hospitals are facing at the present time. The hon. Member for Chislehurst (Sir W. Smithers) talked about the "war bogy." I would be very glad if he or any others could tell us how he defines as a "war bogy" the lack of staff, when we realise how large a number of women are working throughout this country in various jobs to do with the war. The hon. Member for Denbigh (Sir H. Morris-Jones) said he wished more women could be released. I quite agree. The point we are up against is that there are not enough women to do what we all regard as essential work, such as this work in hospitals. I think the words "war bogy" are perhaps not the most suitable for the hon. Member to have used in view of the difficulties of the war situation, when so many people are working in munitions and other essential work in order, in many cases, to release men who are fighting overseas.

Before I take up the wider question of the difficulty of providing sufficient beds; in other words, sufficient staff, I would like to say one word on the particular case to which the hon. Gentleman has referred. I think those who have looked into the matter had doubt whether Mr. Hopper's case was one in which institutional treatment would be a remedy or would postpone death. I think it might be of some consolation if it were realised that it is not the case that because institutional treatment was not arranged at an earlier stage any difference was made to the recovery of this particular patient.

Sir W. Smithers

But he was spreading disease.

Mr. Evelyn Walkden (Doncaster)

So are tens of thousands more.

Miss Horsbrugh

I have not very long to reply but I thought I ought in fairness to make that statement. I would point out also that it was not only the Government or the local authority who were concerned. Mr. Hopper's private practitioner asked the hospital on 25th March if his patient could be X-rayed. This X-ray was carried out on 28th March. On rith April—there were a few days lost I think—a letter was sent to this private practitioner stating the result of the X-ray examination. The private practitioner on 15th April communicated with the tuberculosis officer. That was the first time there had been any communication with the tuberculosis officer. He was then seen by the tuberculosis officer, who stated that he was suffering from pulmonary tuberculosis of an intermediate type. He was recommended for sanatorium treatment. In the meantime it was advised that he should stay in bed and that he be given vitamins A, B, C and D. At that time the health visitor talked to Mrs. Hopper, the wife of the patient, and discussed with her the difficulties of treatment in the home and the necessity of certain precautions against infection. The health visitor later called again at the house, but on that occasion was not able to get in.

We now come to the next stage, when my hon. Friend said that on his taking the matter up with the Brompton Hospital the patient was admitted at once. At that time the Kent County Council had already applied to the Brompton Hospital—on 11th and 22nd February and on 21st April—for vacancies; and the hospital had not got them.

I agree that this was at a different time; but when the hon. Member says that we have to make economic use of what we have got, I would point out that there is this question of priority. Those who know about such cases will know which cases would benefit most from sanatorium or hospital treatment and rest; we have to take those cases before other cases which, although distressing, would receive no real, lasting benefit from treatment. I agree that we should have sufficient beds and institutional accommodation both for those cases which cannot be cured, but who could be made comfortable in hospitals and prevented from spreading infection, and also for those who, if they can be treated at an early stage, can be properly cured. That is what we should aim at. Can it be done? Even in war-time we have practically the same amount of beds as we had before the war, but that was not enough. The real difficulty is the question of staff—nursing and domestic. My hon. Friend spoke of requisitioning hotels and hutments, but the difficulty really comes down to how staff, both nursing and domestic, is to be found. The pool of trained nurses has at present to be drained for service all over the world.

Mr. E. Walkden

Was not this a pre-war problem?

Miss Horsbrugh

I agree that, even before the war, we had not enough—I have said that already—but now we have to drain this pool of trained nurses for service all over the world—wherever our Services go, and in this country. We are asked for more midwives, more mental nurses, more staff for sanatoria, more general nurses. The Minister of Labour and National Service has set up a National Advisory Council for the Recruitment and Distribution of Nurses and Midwives. But it is just as important to see that we have a sufficient supply of domestic workers—and that I feel has never been put sufficiently in the forefront. We have asked the Minister of Labour to do more on this problem. Throughout the country we are facing this difficulty. We are glad that the death-rate from tuberculosis is down practically to the figure for 1938—there is a small increase in the number affected, but nowadays we are looking more for the disease, and discovering it earlier. The hon. Member spoke about the fact that Kent had voted money. It is not a matter of money at this moment. The point is that we must have buildings, and, above all, trained men and women to look after these people. The Ministry of Health and the local authorities are doing their best. I believe that there is, at this moment, an economic use of our facilities. The facilities are not great enough; and I hope that, when this war comes to an end, we shall be able to get on with a bigger and better health service, and that that will have the approval not only of this House, but of the country as a whole.

Question put, and agreed to.

Adjourned accordingly at Twenty-nine Minutes after Six o'Clock.