§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Joseph Henderson.]
§ 10.1 p.m.
§ Mr. Skeffington (Lewisham, West)
I am sorry to have to worry the House again on the subject of the future of medical supply industries under the new National Health proposals, but last time I had the privilege of raising this matter I was the victim of an unfortunate count. I did not mind that so much personally, but I regret that the Minister and the officers of two Departments had to spend so long a time in the House on that occasion without the matter coming to a conclusion. I hope the practice will not grow up in this House of attempting to count out Adjournment Debates which are, after all, one of the important means 2088 by which Private Members can bring to the notice of the House, and the Government, matters in which they are particularly interested.
There is, perhaps, one advantage that I shall have on this occasion, and that is that I need not state so fully the first part of my argument, because it is the same as it was when I first raised this matter on 2nd December. Briefly, there are two major factors to which I want to draw attention. We in the United Kingdom are extremely fortunate in possessing a number of small, but highly skilled industries in the field of medical supplies, whose high standards are not equalled anywhere else in the world. There has grown up a tradition of skill which has reached a standard which is not equalled anywhere else. That is a most important asset which we must harness to the full in connection with the new national health proposals. The second point to which I drew attention on 2nd December was that there is bound to be an enormous increase in the demand for every type of medical equipment as soon as those proposals are in operation. That has been the experience whenever a comprehensive health service has been instituted. It was my own experience when I was getting estimates from our Dominions for the purpose of procuring their supplies during the war. I found that in the State of Queensland, which has had for some years a State service, the demands per head of the populations were nearly three or four times the demands of any other State in the Australian Commonwealth. A similar fact has come to light in connection with the medical services in New Zealand, where there is also a State service.
This means that when medical services are available to all types of people in the community, irrespective of the cost, there will be a much higher demand. Unfortunately, large numbers of people who are neither insured nor catered for in any other way do not seek medical assistance except as a last resort, but under the new scheme this will change, as it has changed in other places, and the Government will be faced with enormous demands in every field. I am, therefore, anxious to know how far those demands can be met, and what arrangements have already been made by the Government in anticipation. During the war the medical supplies of 2089 this country were most successfully mobilised by the Directorate of Medical Supplies.
It must be remembered that with the United States we were responsible for supplying the whole of the non-Axis world with medical equipment. It is true to say that this is the first occasion in history where medical supplies have not been subject to some form of scandal, and although we were very near the margin on some occasions, in no theatre, either for our own troops or in connection with our Allies, was there any shortage. I attribute this as much as anything else to the fact that there was an authority set up for the purpose of looking after the industries and co-ordinating the demands of our Allies and ourselves, allocating raw materials, and, in other words, taking the steps which alone made it possible to get high production.
I am anxious to know what steps the Ministry has so far taken to prepare for the huge demands which we can see will come and which will be far in excess of normal prewar demands. I would emphasise the point of my question by referring briefly to one or two of these highly specialised industries. I said a good deal, on the last occasion, about the X-ray industry, and I do not wish- to repeat it. It was a very small industry, employing a small but highly skilled labour force, and during the war by a system of partial standardisation and coordination of our demands, so that the industry knew our demands at an early date, we were able to achieve phenomenal production.
I am certain that if we are to make good the grave shortage of X-ray equipment in this country, then the industry must know at an early date what is expected of it. Because of the highly technical character of the product and because some of the firms are small, I think that it will be necessary for some authority to take such steps as may be necessary, as we did in wartime, to organise the industry for this particular purpose. I would like to know what has been done. On 28th January, 1946, I asked the Minister of Supply what steps were being taken to fit this small but highly-skilled industry for its postwar development, not only for our own country, but for export so that it could take advantage of the connections made during the war, when we were able 2090 to send equipment to Russia and other places, and to build up for ourselves potential good will and customers.
The Minister of Supply told me that inquiries were going forward. I would like to know what decision the Committee has reached as to the industry being able to meet these requirements. Have estimates been made as to what will be required in this country? And have the Committee, and those of His Majesty's advisers responsible, come to any conclusions about the degree of standardisation which will be necessary? Any hon. Member who knows anything about this industry will realise that with the competitive background that has grown up, there are a variety of patterns, components, and of tube heads, plugs, etc., which in many cases are unnecessary or which could be subject to simplification, so that there could be a much greater interchange of components than there is today. Some of these extras, I think, were largely to support a sales service. Today we have far more important considerations than that, and I should like to know what has been done in that connection.
Lastly, I should like to know whether the Government have been able to formulate any system of financial assistance to the industry, particularly in relation to research. As I pointed out on the last occasion, there were only 14 firms in this kind of industry some of whom are very small, and amalgamations have been made recently; but it is true that in some firms of the industry there are no research workers and no physicists at all, and it is quite impossible to build up a satisfactory service. It is quite impossible to build up a satisfactory service of X-ray manufacturing unless there is adequate scientific backing.
This is particularly important, because prewar we were entirely dependent upon the United States of America for deep therapy equipment and certainly for the tubes used for deep ray therapy. One of the most hopeful branches of medical treatment lies in its use for therapy purposes. There is a great possibility here and we ought no longer to be dependent upon America. When I first came to the industry one or two small firms were considering the possibility of going into the production of X-ray therapy, and at one stage the Ministry of Health very ill advisedly I think made an allocation to 2091 a firm of £20,000 for the production of deep therapy tubes. I understand that in four years two tubes were produced, which is a rather expensive rate of production. However, with the bigger interests now connected with the industry I hope it will be possible to work out a scheme to give adequate financial facilities which I think it must have so that the British X-ray industry can stand on its own feet and give an all-round service in all branches.
I should like to refer to another industry in this field which has some of the same characteristics in that it is a small industry though highly competitive and one in which it was highly difficult to get cooperation until the war, when there was a super authority established. I am glad to see the hon. Gentleman the Member for South Edinburgh (Sir W. Darling) present because the last time I used the words "super authority" he asked me what I meant by it. I told him then and I will tell him again that it is an independent authority placed above the industry, and until such an authority was established it was impossible for this industry to play its full part in a cooperative spirit.
§ Mr. Skeffington
In the surgical instrument industry there are something like 118 firms, most of which are very small and many of them have grown up in the shadow of our great teaching hospitals. The bulk of the highly skilled craftsmanship in the industry is still retained by a small labour force of some 600 men who have to make by hand instruments that are required. It is true to say that that side of the industry is without parallel in the world. The best surgeons all over the world insist upon British instruments just as the best housewives all over the world insist on British steel needles. I think that the House should know there are probably only six men in this country who can make the delicate eye instruments which we require. The labour force pertaining to the industry will have to be expanded if we are to achieve the production which we achieved in the war by the measures I have outlined. In one year in 1943 we were able to produce in hand forged instruments something like 300,000 different instruments covering a 2092 range of 22,000 patterns. That is the nature of the problem we are up against.
§ Mr. Skeffington
The industry and the co-ordinating authority, which was the Ministry of Supply, a combination which alone made this work possible. We produced in the same period something like 4,400 oil base operating tables and 115,000 items of aseptic hospital furniture, and any one who knows the capacity of the industry will realise just what a great achievement that is. I should like to know what investigations have been made into the industry; whether there does exist arrangements for meeting new demands; and whether the Minister does not consider that something in the nature of a working party might not be set up so that this industry, small but important though it is, can play its part. I had hoped to say several things about the laboratory industry, which has added burdens in that we have to supply the medical requirements and also the requirements of the scientific field. There are building schemes which many of these firms want to put into operation, a number of them in the London area. They have difficulty in obtaining any kind of priority, partly because of the housing drive and partly because of the very good principles under which the Government wish to see the location of industry in different places. Where there is already an efficient industry which must be in the metropolis I hope that no arbitrary application of these principles will prevent its development.
The last point concerns administration. I want to ascertain from the Minister tonight which Department is to be responsible for this co-ordination and for placing the demands or for seeing that the contractors concerned are taking the necessary steps which alone the Government can decide. Is it the Ministry of Health or the Ministry of Supply? I am not one of those who indulge in the popular and usually inaccurate attacks on the Civil Service, but I must say from my own experience that unless the supplies department of the Ministry of Health is changed out of all recognition it just cannot do this job. It is not altogether the fault of the Department because it has not had experience of this kind before the war. The L.C.C. used to buy supplies for the Ministry of Health itself and therefore it has never 2093 had that type of experience of obtaining medical supplies. My experience was that the supplies department could never give me any information about the requirements of the Ministry of Health. Our Lend-Lease demands had to be placed in America largely on the basis of the best guess we could make from sample investigations carried out by my own Department.
I should like to know whether the supplies department has been overhauled or whether the Minister will not take advantage of the fact that there do exist already some of the best qualified persons in a working team in the Ministry of Supply and direct them to do this essential work. They have done this work most successfully during the whole period of the war. Whether we take the people from the Ministry of Supply to the supplies department or vice versa does not matter in my view, but some decision ought to be taken now. The industries want to play their part as I know from personal contact, and I beg the Minister to inform them of the total demands as soon as possible and to take the steps now so that in 1948 we can obtain the medical requirements which we shall want if we are to make the new health scheme a success.
§ 10.18 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Key)
We are very grateful to the hon. Gentleman for raising this matter, and particularly for raising it so confidently and with so great a knowledge of the subject. So far as the National Health Service Act is concerned, it was only recently placed on the Statute Book. and the Minister has not yet taken control of the hospitals of the country. When the scheme gets into full operation and the hospitals are transferred to the Government, it will be much easier than it is now to assess the requirements for the supplies of this character, and not only surgical and medical supplies but also domestic goods that are required for the hospitals as well. But of course we have not been sitting idle until the appointed day comes before the hospitals are to be taken over, and a great deal of thought has been given by the Ministry to the problems that are involved in meeting all the requirements of the hospitals.
I ought to say that during the war through the Emergency Hospitals Scheme 2094 and so on, substantial quantities of medical supplies and apparatus were secured by the Department through the Directorate of Medical Supplies of the Ministry of Supply, and these were issued to the hospitals to enable them to provide the necessary additional beds or to enlarge the scope of their medical and surgical work. With those supplies which were then provided, we have decided that we will leave all of the equipment with the hospitals for use under the new service. I am sure that the hospitals have been very glad to receive it. The number of items covered at that time in that Service ran into something over 2,000, and some idea of the quantity of material which the Government supplied is provided by the statement, for instance, that no fewer than 250 fixed X-ray sets were made available to the hospitals.
I want to make it clear, however, that all these supplies were additional to those that were got by the hospitals, because the ordinary hospitals maintained their necessary supplies for their current service, and during that period these hospitals were in the habit of purchasing their supplies to their specifications. They are still doing that, and the Minister had no power to interfere with it, and it is therefore going to be a very big undertaking to overhaul and improve the supply system when the appointed day for the National Health Service comes. In addition to those supplies to the Emergency Medical Service, substantial quantities of medical and surgical supplies have been thrown up as surplus by our Armed Forces as well as by the Canadian and American forces, and in cooperation with the Ministry of Supply, which is the disposal Department, we at the Ministry of Health have arranged to acquire such of these surpluses as are needed for issue to the hospitals in this country. The hospitals will not be required to pay for apparatus so supplied. It will remain Government property, but they will be able to use it in their ordinary day to day work as soon as they receive it.
So that in effect we are gradually building up the supplies that are being provided for hospitals, but in addition we have to look to the future because, of course, it will be the responsibility of my right hon. Friend the Minister to see that the supplies are there. He has for that purpose set up a number of expert working parties with 2095 which are associated representatives of the Ministry of Supply as well as experts from the Service Departments who consider the requirements for these Services in various parts of the medical field. The terms of reference of those working parties are, first, to assess the probable requirements of those Users of medical supplies for which the Health Departments ace to be responsible, beginning with radiological and laboratory supplies, and, secondly, to make recommendations, when considered necessary, on such matters as the specifications for apparatus and the measures necessary to ensure their supply.
Proceeding from the X-ray laboratory supplies, which are being considered first, other groups of apparatus under consideration are theatre ward equipment, equipment for special departments of hospitals such as ear, nose and throat, physio-therapy, dental apparatus and ambulances. Of course it is not an easy thing, before we assume full control, to find out precisely what some 3,000 or so hospitals already hold in the way of such apparatus, and how much will be required to meet their needs in the immediate future, but the problem is easier when we are considering items of major expensive apparatus, some of which, of course, is still in very short supply. There are continual developments in medical and surgical technique. The apparatus which was considered satisfactory a few years ago may now have to be replaced by something which is an improvement, and we have to go into this business on sound lines so that we may be able to ensure that the best apparatus has been supplied.
In connection, however, with making specifications of this sort, I want to enter a caveat here that we have to remember that the practice of medicine and surgery is an art. Therefore, we must not be too rigid in our approach to the problem of the apparatus. We must not carry standardisation too far because we have to appreciate that various people who have to use the apparatus concerned are bound to have a preference for particular types of instruments, just as skilled artisans have a preference for their own particular type of tools. I repeat, therefore, that we have to be particularly careful not to go too far in the way of standardisation. Nevertheless, there are items of major apparatus which ought to 2096 be standardised, because it is obviously a wrong thing for hospitals to have expensive pieces of apparatus and not be able to get the necessary spare parts for them. We are very anxious to see, in that connection that manufacturing capacity is used to the best advantage, and one way of doing that is to get specifications for particular types of apparatus, based on approved prototypes, that can be manufactured much more easily. The working party on X-ray apparatus has been able to submit to us a report which the Minister has considered—
§ Mr. Key
No, it is a working party consisting of representatives of the Ministry of Health, the Ministry of Supply and the Service Departments. They have made a report and recommended a programme of forward purchasing of approved types of apparatus in order to ensure a continuous supply of this to the hospitals. I would also remind the House that a good deal of the X-ray apparatus in use in British hospitals is of foreign manufacture, and therefore we have to see to it that arrangements are still made for the importation of the necessary supplies to maintain it. We decided therefore—this is the point I think my hon. Friend wants to know—to place orders for X-ray sets and ancillary apparatus, such as screens, couches, gloves, developing tanks, viewing screens and so on, and those orders will be placed through the Ministry of Supply, which is in continuous consultation with the industry and, as the sets become available, they will go direct to the hospitals.
We have decided also to place orders for apparatus required in pathological and bacteriological laboratories, and that brings us into the field of scientific glass-war. Here it is quite obvious that improved specifications are very much needed and, as a result of the investigation of the working party, prototypes will be obtained, tested out under expert supervision, and when satisfactory, orders will be placed on a large scale.
§ Mr. Skeffington
Will the hon. Gentleman say which Department will be responsible for making them when improved and placing the contracts?
§ Mr. Key
At present that will be done through the Minister of Supply. As to whether ultimately, when the hospital scheme comes under Ministry of Health control, that will be the situation, will have to be settled in the future. As I say, these working parties in other fields are continuing their inquiries, and we shall go forward in order to ensure that 2098 necessary supplies are available, particularly on the date when the new service scheme comes into operation.
§ It being Half-past Ten o'Clock, Mr. DEPUTY-SPEAKER adjourned the House, without Question put, pursuant to the Standing Order.