§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Bowden.]
§ 10.13 p.m.
§ Mr. Mellish (Bermondsey)
Tonight I am raising a matter which I think is of great national importance and one which is above party politics. In the short time at my disposal I want to be factual and constructive. The matter I 642 have to raise is the shortage of nurses in tuberculosis sanatoria. To be factual it is necessary to give the House some figures which. I hope, hon. Members will find interesting. I say straight away that I believe the position is certainly very much better than it has been for some time but, nevertheless, it still remains very grave indeed.
Some short time ago Dr. Toussaint, who is the medical officer at Willesden Chest Clinic, made this statement, which was given a great deal of publicity in the Press:There are thousands of beds lying empty waiting for the nurses to staff them whilst, at the same time, the number of patients on the waiting list is gravely increasing.643 This was replied to by a Ministry of Health spokesman who said that out of a total of 27,763 T.B. sanatoria hospital beds in England and Wales, 4,409 were unstaffed by 30th June this year. He went on to say:There is approximately a waiting list of 11,000 people in England and Wales who have tuberculosis and are waiting entry to hospital. A considerable contribution to T.B. nursing could he made if nurses would come forward to man these unstaffed beds.It is in that spirit that I am raising the subject tonight, hoping that if it only results in 50 people coming forward it will have been worth while.
I have the honour of being a member of the South-Eastern Regional Hospital Board and take a personal interest in these matters. I can give the figures for my region. In our tuberculosis sanatoria, of which we have 15, there are 1,485 beds occupied, but also 521 that are empty through lack of staff. Yet we have an enormous waiting list throughout the whole region. Last week the Minister was asked a Question on the Floor of the House as to what is the waiting time for entry into these T.B. sanatoria and he said it all depended on local circumstances, which, of course, is true. In my region—I am not suggesting it is the same for the whole country—males must wait on an average five months before they can hope to go to hospital and females wait from 10 to 12 months.
In my constituency it is a great problem. The housing is mostly flats and waiting in flats is far more dangerous than for people living in houses, because of the close proximity of the patient with other people. In my borough, which has a population of 60,400, last year 611 people were under treatment for T.B. and it is interesting to note that 317 of these were new cases discovered in the main by mass radiology. It is a great thing, which we all welcome, but it is adding to our burden because when we find these cases it is futile if we are unable to deal with them quickly. In Bermondsey last year 42 people died of this complaint. Figures for the whole region, which caters for over three million, were: 24,000 receiving treatment and 208 deaths last year.
One of the reasons why we cannot get nursing staff is. I believe, due to the fact that there is a great fear of infection 644 among the staff. Nurses themselves feel that by going to tuberculosis sanatoria they might contract the disease. One of my objects in raising this matter is to try to remove that fear. I have figures which show that in the 15 institutions in my region there is a staff of 424 full-time and 66 part-time male and female staff and last year there was not a single case of infection among the nursing staff in those hospitals.
I must also add that there were four cases of people who had T.B. before and had a recurrence. In the general hospitals under our control there were five cases of nurses who contracted tuberculosis last year and it is established that where hospitals are catering for T.B. alone and take the necessary precautions, plus the use of B.C.S. vaccine, the danger is less than it is where T.B. is treated in a general hospital. I hope this fact will be borne in mind by all nurses.
The Minister has already taken some steps to overcome this problem. He has asked the regional boards to do what they can to open wards in various general hospitals for these types of cases. In my own hospital in Bermondsey we are anxious to open a ward but are unable to do so because, although we have advertised for over three months for a T.B. sister—we have no one there with T.B. training—we have not been able to get one. In other words, the fundamental answer to this problem is to get more staff for these beds.
I want to make one or two practical suggestions. First, it ought to be obligatory on the General Nursing Council to insist that all student nurses should do three months in a T.B. sanatorium as part of their training. The resulting turnover would mean that many more beds were staffed. Then I believe we ought to increase the pay of these nurses more than that of the nurses in the general hospitals. The Whitley Council machine has made an award that after 12 months' service a sister in a T.B. sanatorium will get extra pay. Many of us feel that this period ought to be six months.
All the wishful thinking in the world does not prevent thousands of our people suffering with this complaint in their own homes today. We have to be realistic. First of all we must educate those parents, wives or husbands who are nursing these 645 people. They should be given simple instruction on how to avoid infection. We should make certain that our public health departments send their sanitary inspectors along so that there is co-operation all the time between the local public health department and the people in their own homes.
We are spending a lot of money on all sorts of things these days, including posters. Let us spend some on an appeal to the nation. There is enormous good will among our people. I believe that many would come forward for part-time nursing and would be welcomed. In view of the figures I have given, we can guarantee that contagion is remote in these institutions. There is, of course, compensation for those who contract the disease, but I say that we must remove that fear entirely. I hope my hon. Friend the Parliamentary Secretary will take drastic measures to attract more nurses. The problem is so urgent that anything we can do, not only now but in the future, is worth while.
§ 10.24 p.m.
§ Mr. J. Enoch Powell (Wolverhampton, South-West)
I am sure that in raising the question of nursing in sanatoria the hon. Member for Bermondsey (Mr. Mellish) has put his finger upon the key point of the whole problem of tuberculosis. When we compare the position today with that in the years before the war we find that the then gradually and evenly descending curve of mortality was suddenly halted at the beginning of the war and has not resumed the fall which we have since had a right to expect.
That phenomenon is associated with another phenomenon, namely, with the enormous rise in the waiting lists for admission to sanatoria. The hon. Member gave the figures for last year. Let us compare them with those for 1939, when there were 26,000 people under treatment and only 1,250 on the waiting lists.
§ Mr. Powell
Yes, but on the other hand we must bear in mind that the figures on the waiting lists are, in a sense, underestimates, for the following reason: that doctors, if they do not regard a case as a useful subject for admission to a sanatorium under the present delay, do not 646 add that case to the waiting list. We have to take that into consideration. At any rate, we must admit that the increase in the waiting lists has coincided with this phenomenon of the halt in the fall in mortality; and anyone with any contact with the problem knows that it is manpower, or rather nurse-power, which is the limiting factor.
We have to ask ourselves what it is that suddenly happened over this last 10 years to create so acute a problem in the staffing of T.B. sanatoria. If we could find what has changed, then we ought to be able to find the remedy for the shortage. It is no use looking at static factors; for example, that T.B. sanatoria are remote places and, therefore, unattractive to nurses. They were remote in 1939; if anything, they are less remote in 1950. We have to look for factors which have changed, and the factor which I believe has changed—the decisive factor—is that there has been opened to nurses and potential nurses a wide field of employments, both inside the Health Service and outside medicine altogether, which were only developing in 1939, so that T.B. nursing is now in a worse relative position. If I am right, our task is to restore T.B. nursing, to use a hackneyed term, to that "parity of esteeem" which, for the reasons given, it has lost.
I believe that the hon. Member was on the right lines in the suggestions he made, to which I would like to add one or two. He suggested that the General Nursing Council should impose three months in a T.B. sanatorium as part of the general training. I suggest we should go further. A nurse who has done a year in children's fever or mental nursing can offset that year against the required length of her general training. That does not apply to work in a T.B. sanatorium, which means a definite deterrent to a nurse obtaining her training in a T.B. sanatorium. The hon. Member referred to the T.B. nursing bonus of £30. I entirely agree that it should be available sooner, but I also suggest that it should be available pro rata, so that a nurse who does 11 months, or 11 months and 15 days, does not—as at present—lose the bonus entirely.
As regards the general atmosphere surrounding the whole subject of tuberculosis, I believe it is not only outside 647 the hospitals that we have to combat prejudice against T.B. nursing, but also in the senior ranks of the nursing profession itself, among its elder members who have so much influence over the younger people. I would quote an experience which occurred in Wolverhampton as a result of opening a ward in the isolation hospital for T.B. cases. It was said:The local hospital management committee has made a ward available to us in the local Infectious Diseases Hospital, and the nurses on duty there are amazed to find how interesting the work is. They had not expected either to have such cheerful patients or to find so much to be done in the way of treatment.I believe there is a great deal to be done inside the nursing profession itself in educating people about the value and interest of T.B. nursing.
§ 10.29 p.m.
§ Mr. Anthony Greenwood (Rossendale)
My hon. Friend the Member for Bermondsey (Mr. Mellish) has done a great service in raising this matter tonight and I would add only one or two points to those which he has made. On the question of poor working and living conditions in sanatoria, I think there is, in fact, a good deal in that; one has to remember that since the days before the war the scale of values of these jobs and the availability of employment have changed considerably. Nurses are not prepared to put up with the conditions which existed before the war and which they are still expected to put up with in some of the smaller sanatoria.
Another point I would mention is the need for adequate housing, and especially for adequate housing for male nurses. Recently, in two sanatoria, at Black Notley and Preston Hall, they had to turn away applicants for the position of male nurse, although the applicants were fully qualified, because there was no housing accommodation available for them. The third factor which discourages recruitment is what is believed to be the lower status of tuberculosis nursing. There seems to be a general idea, both in the profession and outside it, that tuberculosis nursing is of lower status than other forms of that noble profession.
I would like to refer, briefly, to the fear of infection, to which my hon. Friend referred. This is obviously a prevalent 648 and deep-seated fear. It may be true that statistically we can show that it is unjustified but nevertheless it exists among the girls, and, I think, to an even greater extent among their parents. What the Ministry of Health has to do is to disabuse the minds of both parents and girls of this fear. But that is not enough. It must also remove the possible dangers which do exist and which in some of the less well-equipped sanatoria are very real dangers.
I want to suggest five points which I think should be rules in sanatoria and hospitals where tuberculosis patients are nursed. The first is that sputum mugs should be completely abolished and replaced by destructible cartons. Secondly, nurses should be free from the duty of counting dirty bed linen and the soiled clothing of patients. Thirdly, there should be facilities for cleaning the clothing of patients who are able to walk about and work among the other patients. Fourthly, there should be facilities in all wards for boiling crockery and cutlery; where tuberculous patients are being treated in general hospitals that is of particular importance. Last, there should be electrical appliances for cleaning wards.
Of the suggestions my hon. Friend has made I do not want to say anything further, but I would suggest to the Ministry of Health that it should consider setting up a tuberculosis nursing corps, that it should do something imaginative to capture the imaginations of these girls, and, if possible, secure Royal patronage for such a corps.
§ 10.33 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)
I am grateful to the hon. Member for Bermondsey (Mr. Mellish) and the other hon. Members who have spoken tonight, because I think we all agree that within the general field of health and health treatment in this country there is no subject more important than tuberculosis, nor one about which the general public in the country is more properly concerned. I should like to say at the beginning that we are very grateful for the practical and useful comments made from both sides of the House this evening, as we shall be for any suggestions which I hope will be made tomorrow in what will be, as it were, a continuation debate on much the 649 same subject. I will try to restrict my remarks now rather severely to the subject of nursing recruitment, so that we can deal rather more fully with some other points tomorrow.
Let me say first how the position stands today, compared with what it was a year or two ago, because I am anxious that we should realise the progress that has been made during the last two or three years, though at the same time appreciating how much more we have to do. When the National Health Service was introduced, we had just over 4,000 full-time and just over 600 part-time nursing staff in sanatoria and tuberculosis hospitals. At 30th June this year, the number had increased to some 5,300 full-time and more than 1,000 part-time nursing staff. That is a very valuable increase of more than 1,000 full-time and nearly 400 part-time nursing staff. We are very glad to record that improvement, which has meant an increase in the number of staffed beds from 21,800 in 1948, when the National Health Service was introduced, to 23,300 this year. That is what has happened in that period. I am anxious to make that point, because it is important that we should think of this matter in its proper proportion.
It is the case, unfortunately, that we still have a heavy list of unstaffed beds. This is declining, I am glad to say, but even so, some 4,400 unstaffed beds are with us at the present time and the number of nurses still required for this vitally important tuberculosis service is some 2,900. I do not minimise that fact, nor the tragedy for those awaiting admission to our hospitals, but let us try to deal with this in a practical way, with the best methods of recruiting, and so try to reduce the waiting lists.
As has been said, one of the most potent factors in restricting the effectiveness of our campaign for more nursing staff has been the fear of infection. But I am glad to say that it has been possible to improve the position, thanks largely to the advance of medical knowledge, and the use of B.C.G. vaccine, and so on, during the last few years. First, on the question of the nurses' health, we are anxious, as indeed all the hospitals are, to take all the measures possible to check up on the health of the nurses themselves, and I am glad that my hon. Friend the Member for Rossendale (Mr. Anthony Greenwood) 650 has stressed some of the problems of hygiene in the hospitals, which are vitally important both in sanatoria and in the general hospitals, where very many tuberculosis cases are being nursed.
This B.C.G. vaccine offers great opportunity for advance; it gives us a much greater opportunity of meeting the, perhaps natural, fears of those who might otherwise go into the tuberculosis nursing service. It is being made generally available for sanatoria and general hospital staffs as well as in the domiciliary fields. This is highly important, especially in connection with possible contacts.
Another matter of importance is the question of special allowances for nurses undertaking tuberculosis work, but this is a matter for the Whitley Council particularly, and they, of course, have already agreed certain improved scales of pay which we hope will make this nursing more attractive than it has been in the past. The further points raised in the debate will be kept in mind; as, for example, the qualification period for special allowances, but this again is a matter for the Whitley Council machinery to deal with. There is also the question of recreation and transport facilities, which is very important.
These matters are important, but perhaps the most important of all is the question of the secondment of nurses from teaching and other hospitals to work in sanatoria. My hon. Friend the Member for Bermondsey has said this should be compulsory. It is, of course, a matter for the General Nursing Council and not for us, as all training matters must be. it would be hardly practicable that it should be made compulsory; but we are undertaking consultations with the teaching hospitals to work out some detailed plans for secondment from those hospitals, and I hope that this will make a very real contribution to the solution of this problem.
These arrangements will have to be on a voluntary basis. The fact that they will be encouraged actively by the Ministry with the full support and co-operation of the General Nursing Council, on the basis of proposals carefully worked out by the Nursing Advisory Committee of the Central Health Services Council will give them, I hope, very much more authority and very much more publicity than has been possible for the one or two small 651 voluntary schemes that have been in operation before.
There is the further point, as most hon. Members on all sides of the House know, that my right hon. Friend did issue a special circular to hospitals and, indeed, to local health authorities at the same time, drawing attention to certain matters where immediate and emergency help can be given. In particular, we are anxious to secure the greatest possible accommodation in general hospitals, as has been mentioned, provided that adequate and proper precautions can be taken against any contacts and so on. That means either separate blocks or at least separate ward accommodation. Reports are being made to let us know just what progress can be made in this way and, again, we are hopeful that there will be a very valuable increase in the number of immediately available beds, resulting in a steady reduction in the numbers on our waiting lists.
Finally, on the problem of the care of patients at home. Again, there is the question of the recruitment of nursing staff for domiciliary nursing and there is the very important point raised by my hon. Friends of proper information being given to all those who have the care of 652 the patient at home. That is a matter, again, which has been brought to the attention of the local health authorities, and they are most anxious to co-operate with the hospital authorities in a joint attack upon this very real problem.
With reference to the point raised by the hon. Member for Wolverhampton, South-West (Mr. Powell), on mortality rates, we are proud of the fact that the rate is steadily declining as it is also, I understand, in Scotland after a certain increase on what they experienced a year or two back. That is in spite of the increase in the incidence rate which is largely, if not entirely, due to the development of mass radiography. We want the people generally in the country to have some proper sense of balance in this problem. We are most anxious, with their co-operation, to do everything we can to shorten the waiting lists and to secure the treatment we are sure can be made available.
§ The Question having been proposed after Ten o'Clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at Seventeen Minutes to Eleven o'Clock.