HC Deb 27 April 1949 vol 464 cc335-42

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

10.13 p.m.

Mr. Ivor Thomas (Keighley)

The question I wish to raise on the Adjournment is one of whose importance no one who has had any connection with our Colonial territories can fail to be aware. The gravity of the medical problems that arise in them is a story so familiar as to be almost platitudinous. The diseases that we meet there are partly diseases that are familiar in this country, such as tuberculosis, but are met with on a scale that we do not see in these islands. There are other diseases more serious still that are peculiar to warmer climates, such as leprosy and malaria. We in this country with our great imperial responsibilities are bound therefore to take a deep interest in the treatment and teaching of tropical diseases.

The question I want to raise tonight is the provision that is to be made in this country in these post-war years for such treatment, teaching and research. Up to the outbreak of the First World War this country held a leading position in the treatment and teaching of these diseases. The names of Sir Patrick Manson and Sir Ronald Ross, who between them diagnosed the cause of malaria and the method of its transmission, are famous throughout the world. The story which I am outlining tonight really begins in 1898, for it was then that Mr. Joseph Chamberlain, who was Colonial Secretary, Sir Patrick Manson and Sir Percival Nairne, Chairman of the Seamen's Hospital Society, founded the London School of Tropical. Medicine. It was located at the Albert Dock Hospital, because it was among the merchant seamen of all races who came to London that the clinical material which was essential for teaching, treatment and research in this subject was to he found. It was the essence of Manson's idea that teaching, treatment and research should be carried on by one organisation in one group of buildings, and it is that ideal which I should like to see perpetuated if possible.

At the outbreak of the First World War the London School of Tropical Medicine was closed. When that war ended the Hospital for Tropical Diseases was established in Gordon Street, Bloomsbury, and the School was reopened there in 1920. In 1924, the original School was merged in the new London School of Hygiene and Tropical Medicine. This meant a separation of teaching from the treatment of disease which I think was unfortunate but, nevertheless, this country did maintain a very high place in the teaching and treatment of tropical diseases until the outbreak of the Second World War. The building in Gordon Street then had to be closed because it was unsuitable for use as a hospital under threat of air attack, and a litle later it was made untenable by a land mine which fell behind it. It then became necessary to consider what provision should be made following the war for this important subject, and in April, 1941, Lord Moyne, who was then Colonial Secretary, with his usual farsighted vision, appointed an inter-Departmental Committee to go into the question.

I need not go through all the deliberations that took place during the war. Let me mention only that in February, 1945, the Royal Society entered this field as well, and convened a conference the importance of which was so recognised by my right hon. Friend the Member for Woodford (Mr. Churchill) that he attended in person, although he was Prime Minister and the war was at its sternest. The war came to an end in due course and a temporary hospital for the treatment of tropical diseases was reopened in Devonshire Street. Very good work has been done there, although accommodation has been very limited. The staff have rendered devoted service, but no one would claim that this temporary hospital is an adequate centre for the treatment of these diseases and for the other activities that ought to be associated with treatment. My own view, as one who has thought much about this matter during recent years, is that we should set up in London a really comprehensive hospital for tropical diseases, a centre which should have a legal entityas a post-graduate teaching hospital, with its own board of governors, and that it should be erected within the curtilage of the University of London in order to be in immediate proximity to the London School of Hygiene and Tropical Medicine. It would be an ambitious scheme and would probably cost £1 million, but my own view was that nothing short of such a scheme would really be worthy of the imperial responsibilities of this country and the gravity of the problems to be treated.

About that time under the National Health Service Act the responsibility for these matters passed from the Colonial Office to the Ministry of Health. I confess that I felt some anxiety on this account, for on the surface it would not be expected that the Minister of Health would pay so much attention to the problems of, say, Kenya as he would to those of, say, Ebbw Vale. I felt that my disquiet was justified when I put a question to the Minister of Health about what plans he had in mind for the creation of a tropical diseases hospital in London and received the following reply: It is proposed to develop a tropical diseases centre as a unit of the University College Hospital group. The Colonial Secretary and I are most anxious to ensure that development shall be worthy of the object in view, and shall take place as rapidly as building and other difficulties permit."—[OFFICIAL REPORT, 10th February, 1949; Vol. 461, c. 87.] It was not a forthcoming reply and did not seem to me to fulfil what I should like to have seen, and what the very distinguished body of men who had been associated with me desired. It seemed to us that such a worthy tropical diseases hospital should comprise in-patient accommodation of 150 beds; an adequate out-patient department of the polyclinic type both for the diagnosis of disease and for the determination of the fitness of persons seeking to work in the tropics; laboratories for routine parasitological, bacteriological, serological, haematological and pathological work; research laboratories for the Professor of Tropical Medicine, the Colonial Medical Research Service and the staff of the Colonial Office engaged on research into nutrition; a radiological department; full facilities for the instruction of post-graduate students; a hostel with accommodation for nurses; a hostel for selected medical and administrative students from overseas; and—a subject that would naturally appeal to me with my background—an inoculation department for vaccination against smallpox, and inoculations against yellow fever and other diseases. In these days of air travel a very large number of inoculations are, of course, given daily.

Having those ideas in mind I was rather disappointed with the reply I received on 10th February from the Minister of Health, but since that date I understand that the Minister of Health has, in fact, been very much more forthcoming and the plans that he has in mind are such as I could not quarrel with in the present circumstances.

Mr. Haydn Davies (St. Pancras, South-West)

The plans for that hospital group were made by the Governors long before the reply of 10th February so that the hon. Gentleman is really barking up the wrong tree.

Mr. Ivor Thomas

I am not a governor of the hospital and I do not have the advantage of the hon. Member. I merely happened to be the chairman of a rather distinguished inter-departmental Committee which considered this subject for a long period. All I am asking now is what plans the Minister of Health has in mind. I understand that his plans are such that in the present stringency of building I could not complain about them, and all I am asking him to do is to make a statement about those plans. My own view remains the same that we ought, having regard to our imperial responsibilities, to have a worthy hospital in the area of the University of London in close association with the London School of Hygiene and Tropical Medicine. I realise that we cannot get the ideal at the present time, but I should be very grateful to learn from the Parliamentary Secretary what plans the Minister has in mind.

10.25 p.m.

Dr. Haden Guest (Islington, North)

I intervene only on one small point. The hon. Member for Keighley (Mr. Ivor Thomas) has referred to the distinguished committee over which he presided some time ago. I would emphasise the words "some time ago," because I think the hon. Member is out of touch with the present very great difficulties in regard to staffing. The Hospital for Tropical Diseases is very efficient, but anything like the scheme which the hon. Gentleman has suggested is completely out of the question at the present time. I say that with all due deference to anything which my hon. Friend the Parliamentary Secretary will be saying. We just have not the personnel to do that kind of thing; nor is it necessary to do it. I do not think it is necessary to have anything like 150 beds. It is necessary to have a teaching institution, but I propose to leave that part of the question to other hon. Members to deal with. As one who is particularly concerned arid interested in the subject of tropical medicine, I should like to say that the scheme outlined by the bon. Gentleman is impossible of realisation at the present time.

10.27 p.m.

Mr. Haydn Davies

With the hon. Member for Keighley (Mr. Ivor Thomas), we should like to see this matter developed to the very best possible degree, but I think that the figures which he has given are completely exaggerated. They have no relation to the number of beds required or occupied. Tropical medicine should become a very important part of hospital life in London, and I can assure the hon. Member, and I am certain that the Parliamentary Secretary will say very much the same thing, that we shall do everything we can to get this accomplished. I am also certain that some of the things which the hon. Member has proposed are the wrong way in which to achieve that end.

10.28 p.m.

Dr. Stephen Taylor (Barnet)

As a governor of University College Hospital of comparatively recent appointment, I must confess that my interest in tropical diseases and things tropical is also comparatively recent. One practical difficulty which we have been experiencing is the collection of tropical cases. Until recently, the places in the existing temporary hospital were nothing like filled, which was partly due to the fact that many medical officers and specialists in London had been in the Forces and had had experience of the treatment of tropical diseases, and were anxious to use that experience in the treatment of cases in non-tropical disease hospitals and general wards in London. Perhaps the hon. Member for Keighley (Mr. Ivor Thomas) is thinking on too big a scale, certainly with regard to the number of cases available, apart from anything else.

I can assure the hon. Member, on behalf of the Governors of University College Hospital, that it is our desire to see a really worthy tropical disease hospital and unit developed as part of University College Hospital. The hospital has a very great research record. Perhaps it is in many ways the best research hospital in London. I feel that the study of tropical diseases will benefit greatly from the intimate association of the general medical school which was founded by the Rockefeller Foundation in the inter-war years in University College.

With regard to the plans for hostels for Dominion post-graduate students, I am not certain whether it would be a good idea to segregate medical postgraduate students from other postgraduate students. A better plan might be to mix them, and to mix people from different faculties, allowing them to have something other than purely medical experience outside their working life. It will, in its new location, or what we hope will be its new location, in the old St. Pancras Hospital, be closer to the University of London or not much further away than it was in the old building. It will be a more suitable building than that in which it was accommodated in the inter-war years.

10.31 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)

I am grateful for the opportunity to explain the position as it is today on this very important issue of the proper provision of accommodation and facilities such as we all, I think, desire to see in London not only for the treatment of tropical diseases but for teaching in tropical medicine. We know the interest which the hon. Member for Keighley (Mr. Ivor Thomas) has taken in this subject in the past. As he knows, I think, after the report had been submitted of the interdepartmental committee to which he referred, it was decided that instead of going forward on the line he had then suggested, which was rather out of keeping with the development of the National Health Service, which had later come into being, that it would preferable to develop not so much a completely isolated and separate hospital, but a separate unit which would be in the closest association with one of our large teaching hospitals.

Of course, following that decision, the Devonshire Street Hospital, which is the existing hospital for the treatment of tropical diseases, was associated with the University College Hospital group, as it is, of course, today. It has become a unit within the teaching group of the University College Hospital. But it was realised that that was not a satisfactory permanent arrangement. I have been there myself, and it is true that the accommodation is too crowded, although I would like to associate myself with the remarks which have been made about the very valuable services which have been given there. Indeed they have some very good equipment available at these premises.

It is now being proposed to improve the facilities to some extent by the addition of an inoculation centre more adequate than the present arrangements. But as I have said, it was agreed that this could only be regarded as of a temporary character until further arrangements could be made. As my hon. Friends have said, a proposal is now being considered by the University College Hospital group which would, we feel, provide a very considerable unit which would be distinct from, but at the same time, would be associated, as we desire it to be, with St. Pancras. The suggestion is that they might utilise there a modern block which is not only distinct from the rest of the buildings, but would have the great advantage of having the facilities of a great hospital by its side which, I think, is both economical and good sense, and would be of great value to its development. We hope it will not be long before a decision is reached on that proposal.

There are difficulties, as there are difficulties in every kind of proposal of this sort, because, quite properly, the University College Hospital, the teaching hospital, must have regard to other factors as well. If this accommodation is to be used for this purpose, it means reconsideration of plans for other purposes which they had under consideration. Therefore, it is only natural that it must take them some time to come to a proper decision about it. But I am quite satisfied after seeing both premises and meeting some of those who have been concerned about it, that the University College Hospital is just as anxious as we are to see that proper facilities should be made available and to ensure that everything possible should be done to do that just as rapidly as can be done.

I should like also to say that we realise the very good work in this field that has been done in the past, though I think it would be fair to say that in the past it has always been felt that the accommodation was inadequate for the sort of development we wish to see. We hope that, as it becomes more possible to undertake larger building projects, other schemes, if it is felt desirable, can be undertaken. I think we have got to face the realities of this present position, and I think the proposal that is at present under consideration will meet the immediate needs very fairly and very adequately. I hope that this will reassure anyone who had any doubt about our own desires in the matter and indeed about the practical solution of the difficulties that have been met.

I would once more say that we appreciate very much what has been done in difficult circumstances, in rather difficult accommodation in Devonshire Street, and that, in spite of all the difficulties there, both the matron and staff and those who work in these difficult circumstances have done a job which has, I believe, maintained our very high traditions in this country for service in tropical medicine.

Adjourned accordingly at Twenty-three Minutes to Eleven o'Clock.