X-RAY FILM SUPPLIES (Hansard, 22 February 1949)

§ Mr. Maude (Exeter)

In raising the question of the shortage of supplies of X-ray film for hospitals, I should like to state at the outset those questions which I very much hope the Parliamentary Secretary to the Board of Trade will be able to answer. I hope, too, that he will regard them as helpful to him and his Department in explaining a situation that is in grave need of explanation, particularly in relation to the fact that persons who are in-patients of hospitals are in grave danger if they are not able to have proper dental X-ray examinations. The absence of such facilities is of grave importance in respect of serious diseases.

I should like to tell the House some of the things which concern doctors in dental examinations. First, there are ulcers of the stomach; then there is the poisoned condition of the thyroid glands; the grave and tragic circumstances of the two forms of arthritis—osteo and rheumatoid; valvular and other heart diseases; grave eye conditions and, last but by no means least, high blood pressure. All these things the clinician, as I understand he is called, is anxious to have examined by X-ray examination of the state of the teeth in a search for what the doctor calls focal infection.

I understand there is an undoubted shortage of X-ray film in hospitals, not 1824 merely for dental purposes but also for general purposes. In order that I may show the House that this is a matter requiring some explanation, let me recount how I came to be interested in it. It was on 10th November, 1948, last that the X-ray department of the Royal Devon and Exeter Hospital drew my attention to the fact that, for the first time in their history, it was quite impossible for them to acquire any X-ray film whatsoever. The Ministry of Health had contracts with three firms—Kodak's, Ilford and Barnet—and when we communicated with them the answer was that no films at all were available. I am not talking now of only dental films. It is important that the distinction should be drawn.

On 8th November, two days before hand, Kodak's had written a letter, which I have here, which disclosed the fact that the normal increase in demand for X-ray film for many years past, before the health scheme came into effect, was 20 to 25 per cent. per annum. Naturally, the National Health Service caused extra demands, but no clear provision had been made. I make no claims merely against the present Government. There had been no clear provision in times past for the normal expected increase, as is quite clearly shown by the letter from the company, which said: All over the country, so far as our information goes, there is this present shortage of X-ray film and the Government have been warned for years, but even during the war, when the need was equally urgent, they were not prepared to grant any priority whatsoever for the production of X-ray materials. The Parliamentary Secretary will see therefore, that I am not blaming any one party. There was a general lack of provision in this respect.

Because the hospital was desperate I then raised the matter in the local Press, with the result that temporary supplies were forthcoming from private sources, from Bournemouth or somewhere else on the South Coast. But on 13th December I received a letter from the Board of Trade disclosing their attitude, which, I thought, was not satisfactory. The letter, written on behalf of the President, revealed that, The Minister of Health and our President have been in consultation on the whole question of supplies to the home market. As a result there will bé some increase in the quantity of X-ray film available for distribution to 1825 hospitals at home and, though we cannot guarantee that supply will match the greatly increased demand, we hope that the position will become progressively easier. I would put it to the hon. Gentleman in this way. Although one is anxious to provide money by sales in the export market, nevertheless I believe that the sensible thing to do is to make the fullest possible provision for the health of the people. One should not hesitate to face this question, if I may so put it: Is John Bull to be X-rayed or is some foreigner to be X-rayed? My own belief is that the proper way to deal with this matter is to see to it that our own people have X-ray treatment, not only in the case of the grievous diseases I have mentioned, and others such as cancer, but also in respect of dental examination.

On 31st December last year, Kodak's, one of the three firms with Government contracts, were out of all stock of dental film. They had a telegram sent to them by the Royal Devon and Exeter Hospital and the reply was that that company was out of all stock of dental film. Up to 1st January the Royal Devon and Exeter Hospital had been out of stock of dental film for a week. The result of that sort of situation is extremely grave. But on general principles, not merely with dental film but with medical film for ordinary examination, if the Board of Trade are not able to make arrangements for the proper and necessary supply of film to the hospitals, the radiologists will be faced with an impossible situation.

Supposing, for the sake of argument, that 100 patients per week are sent down to the radiologist and only 60 per cent. can be dealt with; is the radiologist to examine the first 60 who come to him and are the remaining 40 not to be examined? Or is he to act as a sort of sieve or censor and decide which of the 100 whom the clinician wants examined are to be examined? It produces an intolerable difficulty.

On 18th January I wrote to the President of the Board of Trade. I do not greatly complain about the reply to my letter, which for some reason they called "of the 21st January," which saved them three days—but that is by the way. The answer of the President did not seem very satisfactory. In respect of general supplies of X-ray film, there was an admission that there was a 1826 shortage of X-ray film for general purposes and he drew my attention to his reply to a Parliamentary Question on 20th January. I wish to draw attention to that because I believe that the Parliamentary Secretary would like to enlarge on it. When asked whether he would take steps to increase the supply of X-ray film available to hospitals, he said: Supplies of X-ray film to the home market have been increasing, but not enough to meet the increased demand since the war, and especially in the last six months. Manufacturers have been doing all that they can to increase production, and after consultation with my right hon. Friend the Minister of Health, I am asking them to supply a larger proportion of their output to the home market. What larger proportion of the output of the manufacturers is to be supplied to the home market? I do not ask the Parliamentary Secretary to give many figures, or anything like that, but percentages. Suppose that something like 65 per cent. is absorbed here by our own people in examinations, has that figure been altered recently to any really substantial extent? In his reply, the President of the Board of Trade continued: There is, however, a shortage of X-ray film, not only here but throughout the world, and my right hon. Friend and I would make an urgent appeal to doctors, hospitals and all others who use it to exercise the utmost economy. I do not complain of that provided that there is really sufficient to meet the demands. The information which I received from the hospital, which deals with an area in which there are half a million people, is that they are not frittering away the film. I am sure that the Parliamentary Secretary would believe that. If there is to be any careful allocation of film, one must trust those who are gravely overworked in the hospital to see that there is no wastage. There were supplementary questions. The hon. Member for Norwood (Mr. Chamberlain) drew attention to one hospital in London which was supposed to be working on one week's supply. The right hon. Gentleman replied: … since a year ago the consumption of this material has increased by over 30 per cent. That may well be so. I do not complain that that is false in any shape or form. My information from Kodak's is that for 1827 years the increased demand for X-ray film has steadily been advancing at the rate of 20 to 25 per cent. I ask the Parliamentary Secretary to tell us the real facts and what has been done to cope with that position. There were other supplementary questions which I do not propose to deal with, except to say that it was suggested that: … the amount of money obtained for this film abroad is far greater than the Ministry of Health in this country is prepared to pay and that that is very largely why there is such a great shortage."—[OFFICIAL REPORT, 20th January, 1949; Vol. 460. c. 320–1.] I suppose that the hon. and gallant Member for Worthing (Brigadier Prior-Palmer) meant that it was considered better to sell goods abroad than to look after the health of the people of this country. I do not believe that could possibly be true. I urge on the Minister that one should be extremely careful now to show the people that the Government are determined that in hospital treatment there should be a maximum 100 per cent. supply if possible. That should apply not merely to diseases such as heart disease, and so on; in addition, there are occupational diseases. I have already mentioned arthritis but not chronic rheumatism. All sorts of suffering are involved.

In conclusion, I wish to say that I have tried my best to make it clear what I am trying to achieve. I want answers to certain specific questions. What has, in fact, been done to step up production? Is the Minister satisfied that what has been done is sufficient? What proportion of the home product is exported and what proportion was exported until this matter was raised recently in the House? I had the opportunity, for which I was grateful, to give the Parliamentary Secretary notice privately of these questions so that he would not be taken by surprise and so that it would be clear that there was no attempt to make any silly capital out of it. What has been done to obviate the bottleneck created by packing facilities? I understand that there is a bottleneck there. What arrangements have been made for supplies to be imported from the United States of America? I do not think that it would be possible for the right hon. Gentleman to tell us the exact quantity, but I should like to know the date of delivery.

1828 Was it not a fact that the annual increase was between 20 and 25 per cent. in years past, and what steps were taken by this Government, not only to deal with the purely statistical increase under the National Health Service, but by way of licensing, to facilitate the construction of factories, and, therefore, the production of this X-ray film in order to meet this well-recognised large annual increase? What percentage of the demand calcilated as being necessary in hospitals is likely to be met during the remainder of this year? This is the most important question of all from the public point of view. Have the Board of Trade been careful to assess the quantity of films, both for dental and general purposes, which is likely to be made during the remainder of this year, and are they satisfied that the radiologists in both the great and the lesser hospitals will soon be able to satisfy these demands made upon them?

I appreciate that in the old days, hospitals had to look very carefully after money which was not easy to raise, and therefore there may have been less freedom in recommending X-ray examinations, but I beg the Parliamentary Secretary to take into consideration that, in hospitals which are so intensely busy, and with which most hon. Members are in touch in one way or another, it is extremely unlikely that doctors and others would be wasting any of that material which is so valuable. I think it may be possible that, where persons simply going to dentists are concerned, there might not have been the same care in the use of the X-ray apparatus in order to conduct an examination of teeth which might be of some importance in order to deal with pyorrhoea. Nevertheless, I hope that, as a result of what the Parliamentary Secretary may say, special care may be urged upon dentists to keep in mind the fact that those who are acutely and chronically ill in our great hospitals are in desperate need of these films, and I hope that the Parliamentary Secretary may be able to be of some assistance in clearing up this matter.

§ The Parliamentary Secretary to the Board of Trade (Mr. John Edwards)

The hon. and learned Gentleman has drawn attention to a very important matter, for it is serious when an essential material 1829 which is used in a most helpful branch of diagnosis is scarce. I shall try to answer all the questions which he put to me, but I should like to say at the outset that, after the end of the war, with the considerable acceleration in the installation of new apparatus in hospitals, we began to see the demand grow, and even before the introduction of the National Health Service the demands of the hospitals seemed to have increased beyond normal. My information is that the normal rate of increase before the special circumstances prevailed was of the order of 15 per cent. per annum. That is a lower figure than the one quoted by the hon. and learned Gentleman, but it is the figure which has been given to me as covering the whole field. Up to about the middle of last year, the production of X-ray film was, in general, up to demand, but even before the new Health Service came into operation it was realised that production was reaching saturation point, and that unless new manufacturing capacity was created there was bound to be a shortage.

To meet the ordinary increase in demand, manufacturers had been making alterations to factory lay-out and improving packing factilities, but there was, of course, a limit to this. The two largest manufacturers have for a long time been working 24 hours a day on six or seven days a week. Machines have been seriously overworked, and there have been very few opportunities for essential overhaul and maintenance. When the Health Service same into operation there was naturally a tendency for the demand for X-ray examination to increase, and this meant a considerable extension in the demand for X-ray film.

By about September, it was estimated that the annual increase in demand had risen from the normal 15 per cent. to somewhere between 20 and 25 per cent., and even then it looked as though the demand was likely to go up to something like 30 per cent. It was in these circumstances that the Board of Trade, the Ministry of Health and the manufacturers got together to see what could be done, and the action taken was really along two lines. First of all, after consultation between my two right hon. Friends and the manufacturers, it was agreed by all concerned to reduce exports from 45 per cent. of the output to 40 per cent., the 1830 whole matter to be reviewed again in June of this year.

Then, secondly, plans for the expansion of capacity of the biggest manufacturer were pressed forward, and a licence with an immediate starting date was granted in January. But I do not want to mislead the hon. and learned Gentleman because, of course, the provision of complicated machinery and buildings will take some time. It is unlikely to be really completed for some 18 months to two years. A further small measure was taken to help to bridge the gap between supply and demand. A small manufacturer who was able to expand his output agreed to try to expand his production by 50 per cent. by July, and to treble it by the beginning of next year.

I would repeat that this, of course, all takes place in a situation where there is a world shortage of X-ray film. Even in the United States, supplies to hospitals have to be rationed. That is why X-ray film can so readily be sold in almost any market of the world. I ask the hon. and learned Member to bear in mind that we depend on what we sell overseas to buy food and materials that are essential. Looked at from that angle, it was a considerable economic sacrifice which was made in the interests of the nation's health to reduce our exports by five per cent.

To sum up on the general point, the demand for X-ray film in 1948 showed an increase over the whole year of about 24 per cent. above 1947. Production rose by approximately 14 per cent. over the previous year. It is estimated now that the demand for 1949 will be 30 per cent. above last year's, but as a result of efforts to obtain the greatest possible production from existing plant, output this year should be approximately 27 per cent. above 1948.

May I turn to the special position of dental X-ray films? Before the war we got almost all the dental X-ray films that we required from the United States of America. Home production had to be built up during the war. The difficulty of expanding production here has been due to the fact that dental X-ray film packs require a unique type of packing and special machinery is needed for this work. Demand for dental X-ray packs since the introduction of the National Health Service has increased very considerably and 1831 by December, 1948, it had increased by about three times that of May of that year. In terms of production it is now estimated that demand is about double the present rate of output.

Steps have been taken to provide increased packing facilities and new machinery but, of course, that will take time. But in about six to nine months' time a substantial increase will be made in the amount of dental X-ray film packs that will be available to hospitals and dentists. In the meantime, however, to try to bridge the gap between supply and demand, arrangements have been made for the importation of a substantial quantity of dental X-ray film packs from the United States of America. I anticipate that the first deliveries will reach this country in from four to six weeks' time and that these deliveries, which will then continue over the rest of the year, will go a long way towards relieving the present shortage. During the last 12 months exports of dental X-ray film packs have been reduced by about 5 per cent., and this together with a small increase in total production has meant that in 1948 approximately 9 per cent. more has been provided for home use than in the previous year. Although 1832 this percentage does not seem to be great, the actual number of individual film packs, I would assure the hon. and learned Member, is very considerable indeed.

Perhaps I may conclude by mentioning again the very great need for economy. When I say "economy" I mean it in the strict sense, as the distribution of scarce means over diverse ends. Although I doubt whether it is desirable to introduce formal categories of priorities, it is certainly desirable that those who have to take decisions in this sphere, if their supplies will not meet all their requirements, should put the really urgent cases before the less urgent cases. I am not wholly satisfied myself that the utmost economy is being effected and I would appeal in this connection to all hospitals, doctors and dentists and to every one who uses the materials, both from the point of view of my right hon. Friend whom until recently I served at the Ministry of Health and my new right hon. Friend, the President of the Board of Trade.