§ 69. Sir Ernest Graham-Littleasked the Minister of Food in how many cases in the last six months his medical advisers have overruled advice as to dietetic and other requirements given by medical practioners in actual charge of the patients concerned whom his advisers have not themselves seen at any time.
§ Mr. StracheyDuring the six months to 31st December, 1946, 235 applications which had been individually referred to the medical advisers were refused extra supplies of rationed foods as a result of the advice which was tendered.
§ Sir E. Graham-LittleHas there been direct personal contact by the advisers in any of these cases?
§ Mr. StracheyWhen we reach the next Question but one—No. 71—I will be able to give a full answer.
§ 70. Sir E. Graham-Littleasked the Minister of Food how many members of the Special Diets Advisory Committee, by whose direction applications by doctors for special dietetic allowances have been refused, are under 40 years of age; are in active practice as consultants and as general practitioners; and at what date the schedule of ailments with recommendations to deal with each was last revised.
§ Mr. StracheyOne member is under 40 Six members are in active practice as consultants. There are no general practitioners. The schedule of ailments is constantly under their review.
§ Sir E. Graham-LittleIs my right hon. Friend aware that the average age of these ten persons is 55 plusand that no member of that Committee has had any acquaintance with general practice and personal experience of the doctor-patient relationship?
§ Mr. StracheyI think we will avoid complications if the hon. Gentleman asks the next Question.
§ 71. Sir E. Graham-Littleasked the Minister of Food if he is aware that the withdrawal from a patient, in the care of certain doctors in Birmingham, of an allowance of fat essential to the maintenance of the patient's life, was followed by his death within a few days, and if he will take steps to prevent a recurrence of this overriding of the opinion of doctors in actual charge of a patient.
§ Mr. StracheyIn the very sad case referred to by the hon. Member, the patient died of inoperable cancer. My medical advisers inform me that the grant or refusal of an extra fat ration can have had no influence whatever upon the course of this tragic disease. Extra milk and eggs were granted on medical grounds to this patient, and an allowance of butter was, in fact, granted, after being discontinued for only two days, on compassionate grounds.
I should like to take this opportunity to inform the House of the system under which these special allowances of rationed foods are given. In 1940, the then Minister of Food, the right hon. Member for Cirencester and Tewkesbury (Mr. W. S. Morrison), obtained the help of the Medical Research Council in this difficult matter. The Medical Research Council set up a Food Rationing (Special Diets) Advisory Committee. The function of the Committee is to advise the Minister how best to dispose of the very limited amount of extra food available for invalids. This independent, honorary and authoritative Committee advises the Minister of Food what categories of illness require special rations, and establishes scales of the additional foodstuffs needed for each category. A list of these categories was circulated to every medical practitioner in the country. The certification from the practitioner that the patient is suffering from the illness specified is always accepted without question. It was so accepted in this case, and the official concerned had to inform 224 the practitioner that in such cases two points of milk daily and three eggs a week were allowed, but not additional butter. The lay official transmitted an incorrect reason for refusing the butter. The practitioner then appealed, but, there being no reason given for regarding this case as in any way different from others in this category, the Committee confirmed the refusal, giving the correct medical reasons for doing so. The Committee also considers applications from medical practitioners for additional foodstuffs for patients who would be excluded on a strict application of the scales of allowances laid down for each type of illness or condition. The Committee, therefore, acts as a court of appeal on borderline cases.
This admirable system was continued by successive Ministers of Food, and I have every confidence in it. In fact, I should like to pay the warmest possible tribute—with which I am sure each of my predecessors in my present office would associate himself—to the eminent medical men who have, through all these years, carried out these arduous and difficult duties.
The membership of the Food Rationing (Special Diets) Advisory Committee of the Medical Research Council is as follows:
- Sir Edward Mellanby, K.C.B., F.R.S., M.D., F.R.C.P., (Chairman).
- Professor L. S P. Davidson, F.R.S.E., M.D., F.R.C.P., Professor of Med. University of Edinburgh.
- Professor Sir Francis Fraser, M.D., F.R.C.P., FR.C.P.E., Professor Med., University of London.
- Lord Horder, G.C.V.O., M.D., F.R.C.P.
- Dr. R. D. Lawrence, M.D., F.R.C.P.
- Professor R. A. McCance, M.D., F.R.C.P.
- Dr. M. L. Rosenheim, M.D., F.R.C.P.
- Dr. Norman Smith, M.D., F.R.C.P.
- Professor J. C Spence, M.D, F.R.C.P., Professor of Child Health, University of Durham.
- Professor H. P. Himsworth, M.D., F.R.C.P., Professor Med., University of London (Secretary).
- Lord Dawson of Penn, the then President of the British Medical Association, was an active member of the Committee until the time of his death.
§ Mr. ChurchillIs there any reason to believe that doctors have been abusing the right of giving advice as to extra diet to their patients in the past few years, and has this abuse amounted to such dimensions as to make an appreciable effect upon the general problem of food supplies?
§ Mr. StracheyWell, Sir, I should not like to accuse the medical profession of abuse in the matter, but the amount of extra milk given on medical priority grounds has caused concern to myself, and, on other occasions, to my predecessors, and to this medical Committee, and we have asked doctors, through the medical Press, to have regard to the need, particularly in the case of milk, for restricting the extra amount which is granted on medical grounds.
§ Colonel Stoddart-ScottWill the right hon. Gentleman tell us how frequently this distinguished Committee meets, and why it took from 3rd August to 20th December to get them to agree to provide white flour for a man for whom it was too late, as he died on the 23rd? Why did it take all that time for the consideration of what is called a borderline case, and will he tell us how often the Committee meet to consider borderline cases?
§ Mr. StracheyI cannot tell the hon. and gallant Member without notice whether it is a weekly meeting or whether it is arranged in regard to the business before them. I could give him the information if he will put a Question down.
§ Mr. ChurchillThe right hon. Gentleman the Minister has read out a long and impressive list of all these great authorities whose high standing is supposed to flatten out all criticism of their work, but has he not taken the opportunity, when examining all their credentials and qualifications, to find out how often they meet and how long it takes them to get a borderline case dealt with? Is he now sure, as we all recognise the intelligence which he is giving to his task, that this impressive apparatus at the top is effectively dealing with the many urgent matters which arise in practical instances in ordinary life?
§ Mr. StracheyIf there were any reflection on the work this Committee is doing, or on the assiduity with which they are performing their functions, I should resent it very much indeed, because I think they have performed these functions over a number of years—very arduous and often invidious functions—and they have done so voluntarily and in an honorary capacity. I certainly think they have performed them as well as they could be performed. I was most careful to find out the average 226 time which appeals made to the Committee take, and it turned out to be nine days, which seems to me to be a not unreasonable time by any means. I was asked how often the Committee meet, and that I cannot say.
§ Mr. ChurchillI presume, nevertheless, that the right hon. Gentleman will give us the exact dates of the meetings of the Committee in the last year or 18 months.
§ Mr. LoganI wish to ask the Minister if he will withdraw what he has just stated and give power to medical men to give prescriptions for extras to be given to their patients? In the poorer areas, it is absolutely essential that the medical man's advice shall be taken: lives are saved by medical men, and not by committees.
§ Mr. StracheyI could not possibly change the system.
§ Mr. StracheyFor reasons which all my predecessors, including those of the party opposite, appreciated—that all the reasons which applied when this Committee was set up still hold today, and I believe that it would be entirely wrong to change the system. In the case of milk, which I have given, and I do not wish to use any but the most moderate language, it certainly appears, from the amount of milk given on medical prescriptions, that there must be some eminent and independent medical authority reviewing these cases.
§ Mr. ChurchillYes, but might not the process be conducted in reverse, namely, that if a medical man, a doctor attending a patient, certifies that the matter is urgent, the diet should be given, within the approved limits, pending reconsideration by higher authority?
§ Mr. StracheyThat would be very good if it could be done. The medical Committee has laid down the categories of illnesses, ailments and conditions which qualify for the extra ration.
§ Mr. ChurchillThe right hon. Gentleman has not really dealt with the point. The point is that a doctor attending a patient should have the responsibility of saying that special patients shall be allowed to have the extra rations until the matter is dealt with by the higher authority.
§ Mr. StracheyIf the doctor certifies that the patient is suffering from a condition which, on the scales laid down by this Committee which I have read out, carries with it the extra ration, then he does automatically and immediately receive that extra ration.
§ Lieut.-Commander Gurney BraithwaiteThe patient has to have the right disease before he can have it?
§ Mr. Norman BowerSince 135 recommendations have been overruled in six months, and there are not less than 10 members of this medical Committee, would it not be possible for patients to be seen by at least one member of the Committee before the recommendation was overruled?
§ Mrs. Jean MannIs my right hon. Friend aware that the answer he has given has greatly relieved the anxiety caused by newspaper reports, and that hon. Members opposite are now filled with chagrin at the fact that the diagnosis and determination of the distribution of this food are in the hands of such an eminent authority; further, is my right hon. Friend aware that hon. Members opposite—
§ Mr. SpeakerThe hon. Lady is making a speech and is not asking a quesiton.
§ Mr. LipsonMay I ask the Minister it he has taken into account the effect on a patient where his own doctor has recommended that a certain diet is necessary for his recovery and where that is refused by the food office? Can he say how much food has actually been saved over the past year by rejecting doctors' certificates?
§ Mr. StracheyNo, Sir. It would be impossible to do that. I repeat that we must have scales of specific illnesses and conditions. If hon. Members press me on that point I shall have to return to the instance of milk where a doctor's certificate for dyspepsia carries with it an increased milk allowance which has a very marked effect on the consumption of milk.
§ Mr. R. S. HudsonHas the right hon. Gentleman also considered that it may well be the opinion of the individual doctor that more milk is required today in view of the shortage of other foods? It is all very well to talk about scales laid down by his predecessors, but it should be remembered that other foods were then available.
§ Mr. SpeakerI think we are now getting rather heated and had better go on to the next Business.