HC Deb 10 March 1947 vol 434 cc1095-104

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

11.2 p.m.

Colonel Stoddart-Scott (Pudsey and Otley)

I wish to raise the question of the refusal of the Ministry of Food to grant extra rations to sick people when their doctors have recommended that they should have extra rations. Everybody on both sides of the House will admit the importance of nourishing and well-balanced food if we are to maintain the health of our people, and it will be agreed in the case of sickness it is even more essential that there should be nourishing and appropriate food, if by the treatment of the patients, their ailments are to be cured, and, in some cases, if their lives are to be saved. There is no doubt that since rationing was introduced during the war, and also since the war, there has been no drop in the mortality rate. There is equally no doubt that there has been an increase in the number of sufferers from gastric ulcers and other gastric complaints, in nervous diseases, and cardio vascular diseases, and that the rise in the incidence of tuberculosis, coincides with the reduced diet. The Minster of Fuel and Power has told us that increased absenteeism in the pits is, in some way, connected with some minor unnotifiable diseases. Recently a survey by the Oxford University Institute of Statistics with regard to the food rationing in the City of Oxford during the month of November last reached certain final conclusions. They said: The most important point which emerged from the survey is that the present rations for adults are insufficient for their proper maintenance. That view is supported by the view of Sir John Boyd Orr, who is recognised by everyone as one of our greatest nutritional experts, and who is indeed the Director-General of the World Food Organisation. Speaking last August in Copenhagen, he said: In the United Kingdom it is estimated that the additional food needed to bring the diet of the whole population up to the desired health standard would represent an increase of 25 per cent. of meat, and 65 per cent to 75 per cent. of other animal products, and fruit and vegetables. So, even maintaining a healthy level, our diet is to some extent deficient, and since Sir John Boyd Orr made that statement last August, we have had a cut in the bacon ration and we have had our meat ration lowered by twopennyworth per week. Therefore, it is more essential where there is sickness that extra rations should be made available for the treatment of disease and for prolonging the life of the individual and, in some cases, for saving the life of the individual.

I want to speak about the 235 cases which, during the last six months of last year, were refused extra rations by the Minister of Food although the doctors attending these patients persisted that it was essential for those patients that they should have these rations. I know that 235 are but few compared with the many thousands of cases granted extra rations during the last six months of the year, to patients for the treatment of their sickness. But these 235 were turned down by the Ministry of Food on the advice of their medical advisers, although the doctors treating these people urged that the extra rations were essential. The Ministry is advised in these cases by the Special Diets Advisory Committee, which is composed of ten distinguished physicians and research people in the medical profession. Six are consultants, and none are general practitioners, but all have the benefit of age on their side, as the average age is well over fifty-five.

Dr. Morgan (Rochdale)

That is a good age.

Colonel Stoddart-Scott

This committee, which meets rarely—only twice during the last six months—draws up a list of diseases with the diets appropriate to them, but does not deal with the individual cases. The individual cases recommended by a doctor as in need of extra rations are dealt with by individual members of the committee. Therefore, when a request for extra rations is turned down by the Ministry of Food, it is turned down, not on the advice of the committee, but by one or two of its members. That system was used in war time, and it may have been all right when we were engaged in war. One did not know what would be the result of the U-boat campaign against our food supplies, nor the effect of enemy bombing, nor how long the state of emergency would last. One did not know fully the calls which would be made on our food supplies as a result of evacuation and the presence in this country of added foreign troops. Such a rigid system was probably necessary in time of war, but none of the things I have mentioned now exist, although we are probably worse fed now than during the years of war. I do hope that the hon. Lady, when she replies, will tell us something, which will give hope for the future with regard to our food supplies.

The subject on which I am speaking this evening is a relatively small problem. After all, if the 235 cases to which I have referred had been granted the extra rations recommended by the doctors it could not have affected the efficiency of the rationing scheme in this country, nor could it have affected our food supplies. There is public feeling—and the fact is doubtlessly known to the House—on the failure to grant these extra rations when they had been persistently recommended by doctors.

I want to be constructive, and not in any way critical. I believe that the people are anxious, because doctors who recommend that, in their honest opinion, it is essential to have extra rations for the cure or treatment of their patients have those recommendations turned down by the Minister, on the advice of one or two doctors who have not seen the patients concerned. I believe that is the chief cause of anxiety among the people of this country. Therefore, I think it is the duty of this House to consider how we can help those sick people, and their relations, by relieving them of this avoidable anxiety.

I want to make two suggestions. If we were to establish, in the different regions or divisions into which this country is divided for Ministry purposes, medical advisory committees; and if, in each of the cases thought to be border-line cases, or where there was doubt about the necessity for extra rations, one of the doctors on the advisory committees were to visit the patient, and make a decision on the spot, before the Minister finally turned down a plea for extra rations, then much of the anxiety would disappear. I believe, from inquiries I have made, that it would be possible, certainly in the provincial areas, to set up such committees of medical and scientific men, who would be prepared to advise the Minister in those few cases.

Dr. Morgan

Who would appoint them?

Colonel Stoddart-Scott

I suggest that the Minister of Food himself should appoint them, just as he appoints the central committee here in London. Perhaps, the hon. Lady would be good enough to consider this proposal, and to tell us if there is any difficulty in appointing the members of these committees. It may not everywhere be possible for them to act in an hononary capacity as they do in London. But this is so small a problem that, if small fees were attached to these visits, it would cost the Exchequer very little. I think the time has now come when consideration should be given to providing extra food, not only in those cases in which the provision of extra rations is needed for the treatment or curation of disease, but also in those in which it might relieve suffering, in cases of operation, or in inoperable cases. We could give extra rations, not only for the cure of the patients, but to prolong life, or to make the conditions of those patients more comfortable.

It is the duty of this House to consider those who are sick and suffering. If we can ease their suffering, by being a little more liberal in our rationing scheme. I think the time has now come to do it. Therefore, I suggest that we should have small advisory committees in the country from which, at least, one medical man would go to visit patients for whom extra rations were asked, to advise the Minister on those cases, before the Minister finally decided. Thus, if the requests were turned down, they would be turned down only after complete investigation by a man acting on behalf of the Minister. My second suggestion is that it is now time that extra rations should be granted not just for the treatment of cases, but for the alleviation of discomfort and to help to prolong life. I believe that if the hon. Lady will grant these two requests she will remove what is at present, in my view, justifiable anxiety, and justifiable anger in the country.

11.15 p.m.

Mr. Somerville Hastings (Barking)

I think we must all be very grateful to the hon. and gallant Member for Pudsey and Otley (Colonel Stoddart-Scott) for bringing this important question before the House, though I differ from him on one point. I think both the public and the medical profession are very well satisfied with the arrangements that have been in existence for many years, and which seem to me to be working admirably. The position of the doctor in private practice is by no means an easy one. He is economically dependent upon his patients, and he is in competition with other doctors. If he turns down an application for extra milk, he may offend his patient, and if the patient is vindicative, that individual may try to influence his other patients as well.

There can be no doubt, as the hon. and gallant Member has said, that we are short of certain foods, and that many patients—the majority perhaps—would benefit by extra food and extra milk. The doctor, as I have said, is in a difficult position if he refuses his patient's request. But it seems to me his position will be safeguarded and strengthened if he can say "I am sorry. I agree that you would benefit by extra milk, but there is a confidential list of diseases on which I am entitled to authorise this extra nourishment, and your case does not come within that schedule." I suggest that his position is very much strengthened in that way, and that most doctors are very grateful for that list and for the help it gives them in selecting the cases which would be most benefited by extra nourishment. I do riot think all hon. Members realise the difficulty of the doctor's position and how hard it is for him to say "No" to the patient. Some doctors undoubtedly succumb to the pressure of their patient. How else can one explain the extraordinary figures that I obtained quite recently from the Ministry. These figures showed that the proportion of individuals receiving extra milk was more than three times as great in Hampstead, as in the Tyneside or South Wales.

The suggestion made by the hon. and gallant Member was that a panel of doctors should be provided in each area, and in all cases of dispute one of these doctors should be called in. The hon. Member said that cases in dispute in the past had been few. I suggest that if the doctor asked for one of these specialists to come and visit his patient there would be no end to the number of cases in dispute because no doctor would willingly refuse his patient. No doctor does so at the present time. The doctor would be able to say "I am sorry, the only thing I can do is to call in the specialist", and the work of those specialists would be very much increased. As I see it, there is nothing unusual or erratic or irregular in what is taking place at the present time. It is exactly what happened during the war in relation to other therapeutic goods in short supply. I myself suffered because of the shortage of penicillin, and cases under my care had to be taken away from me and referred to one of my juniors and pupils, who happened to be in a penicillin centre where special observations were being made. That was the right thing and I do not complain. I do not think that many doctors at the present time are complaining of these slight difficulties in regard to ordering for patients what they feel to be in the best interests of those patients.

11.21 p.m.

The Parliamentary Secretary to the Ministry of Food (Dr. Edith Summerskill)

I think that this is a Debate of specialists and it is interesting already to see the conflict of medical opinion which has arisen.

Colonel Gomme-Duncan (Perth and Kinross, Perth)

The hon. Lady is the umpire.

Dr. Summerskill

It is very difficult to be umpire in a case of this kind. A conflict of medical opinion has already arisen. I must confess that I was very surprised at the contention by the hon. and gallant Member for Pudsey and Otley (Colonel Stoddart-Scott) that the incidence of disease has been greater during the last few years when the country has had to submit to rationing. If he examines the public health statistics he will find that that is not borne out. I think I am right in saying that there has not been any widespread epidemic during the whole of the war years, nor in this very bitter winter which is unprecendented in our lives. A certain number of complaints are levelled at the Ministry of Food but there has certainly been no epidemic that might be traced to low resistance due to shortage of food supplies. The task presented to the Ministry at the beginning of the war was formidable in so far as the allocation of food was concerned. We had to maintain a balance between the physiological needs of the community as a whole, and the medical necessities of those suffering from some pathological condition. Medical men will agree with me that that was and is a very delicate matter. We had, of course, to establish certain priorities, and I welcome this opportunity to explain how these priorities were arrived at.

We begin with the group of children under five. I think that it will be generally agreed that the most hazardous year of life is the first year. The subsequent years are fraught with certain risks and because of that we felt it necessary to give this group extra rations. Then we decided to give expectant and nursing mothers more food for the same reason. It was their task to protect the young and unfortunately scientists have not yet discovered a food which is equal to nature's food. Therefore, it was necessary to give the nursing mother extra milk and extra eggs, in order that she would be able to feed what I consider is the most valuable commodity in the country—the babies. Then we come to the young people in the age group five to 18 who are subject to all sorts of infectious disease and need body building foods. We decided that milk particularly should be given in special allocations for school children, and that there should be milk in the schools. Now we come to the hospitals and the invalids who are being treated by the private doctor. This was the class to which reference was made by the hon. and gallant Member. Here we have to distinguish between the medical foods which were needed for therapeutic reasons, and medical comforts. Doctors here tonight will agree with me, that that decision itself presents certain difficulties.

For this reason, one of the predecessors of my right hon. Friend the Minister of Food decided to convene a committee to which the hon. and gallant Gentleman has referred—the Food Rationing Special Diets Advisory Committee—to help to decide some of these difficult questions. This Committee has among its members some of the most distinguished men in the country, men who are highly responsible, who are authorities in their particular field, and who have a wealth of clinical experience. The hon. and gallant Gentleman said that only six of them were consultants, but he would agree that it is impossible to become a consultant, without having had a great deal of hospital experience. The functions of this Committee were, in the first place, to advise the Minister how best to dispose of the very limited quantity of extra food available for invalids. The Committee, however, does not pass judgment on the treatment. It advises the Minister on the applications from medical practitioners for additional foodstuffs. It is, in fact, an appeal board, and I think that, on the whole, it has performed its functions very well. It has been operating for seven years. It would be very surprising, of course, if no hon. Member had ever had a complaint from a constituent or a doctor that he had been unfairly treated by the Advisory Committee, and I know the hon. and gallant Gentleman feels aggrieved over a case which he submitted. But taking the seven years, it is surprising how few complaints there have been levelled at this committee, and I also ask the House to remember that it is a voluntary committee and that these men have done this work in a selfless manner.

It is the fact that we rely on one or two members of the Committee, but these men are highly qualified, and it would be very difficult, and certainly not expeditious, to have to refer each case to every member of the Committee. The hon. Member suggested that we should set up committees in different parts of the country. That would mean, in fact, that we should have to set up 17 more committees in different parts of the country to advise on special cases. He very kindly told me of his proposal last week. I would reply that we are considering the whole matter, but I would remind the hon. Member that these are busy men, and that these busy men in these areas, could not be asked to serve on these committees because it might entail long journeys. When we come to the younger men who have yet to make their way, some hardship might be entailed, because they would be expected to work without remuneration. The hon. Gentleman suggested that they should be remunerated. We will consider all these points, and the chief reason why I oppose the suggestion at the moment, is that I am afraid that these committees might be called into being and then might find them- selves redundant, and not called upon to do any work at all. Perhaps not one case would be referred to a committee over a period of a year. We now propose to regard medical comforts as having a bigger place in our allocation scheme than they have had heretofore. Therefore, I am a little reluctant to call into being a committee of busy people who might feel, over a period, that they had been ignored.

The question has been asked whether another doctor should see these cases. I think the hon. and gallant Gentleman would agree that it would not be for purposes of diagnosis, but for the purpose of seeing the general picture. It may be that we can devise some scheme whereby another doctor could see the patient, see the general picture and report to the Committee. We will consider the whole question, but I am a little afraid that the proposal might in effect prove cumbersome, and that we might be imposing on our already efficient machine, another machine which might never be called upon to function. That is one reason why I cannot, at the moment, agree with the hon. and gallant Gentleman. But, as I say, we are considering the matter easefully, and I will let him know the conclusions we come to, in as short a time as possible.

Question put, and agreed to.

Adjourned accordingly at half past Eleven o'Clock.