HC Deb 19 February 1951 vol 484 cc1020-30

10.2 p.m.

Miss Irene Ward (Tynemouth)

I wished very much to take part in the last debate, but I had to restrain myself because I was extremely anxious to raise this important matter relating to beds for tuberculosis patients in Switzerland, and I am very grateful to the Parliamentary Secretary to the Ministry of Health for having come at such short notice to answer the points that I want to raise.

Last July, I put down a Question, as, indeed, did the hon. Member for Inverness (Lord Malcolm Douglas-Hamilton), to the Minister of Health asking him whether, in view of a decision recently taken at that time to accommodate tuber- culosis patients in general hospitals, he would introduce legislation to enable him to subsidise tuberculosis patients recommended by local authorities for treatment in Switzerland. The hon. Member for Inverness asked the same Question, and also whether the Minister would take steps to provide funds to enable tuberculosis patients in the lower income groups to undertake sanatoria treatment in Switzerland, as is at present done by Holland and as was done by our own local authorities prior to 1939.

The Minister said in reply that he could not undertake in present circumstances to add to the cost of the National Health Service as proposed, but that he had recommended to hospital authorities action for making the best use of our own resources. At that point the matter dropped, and we heard nothing further about it until the early part of this year. When I say that we heard nothing further about it, I mean that the matter was not further pursued in Parliament. Of course, even at that period, there were a certain number of people going to Switzerland for treatment after having obtained the necessary permission from the Treasury regarding currency.

But I think the matter really did not come to a head until Sir Stafford Cripps went to Switzerland for a considerable period—and we are delighted to know his health is improving while he is there. It then transpired that a committee had been sitting, through the operations of the Ministry of Health, to which anyone who had been recommended for treatment in Switzerland was able to apply for the additional currency necessary for the carrying out of treatment. If I remember rightly, the figures given were that there had been nearly 300 persons who had applied for this special permission, and practically all the applications had been met and agreement had been reached with the Treasury.

As I said, nothing more happened in the House of Commons. The question was not pursued, except that people in the country who were desperately interested in obtaining as many facilities as they could for the treatment of tuberculosis began to raise with the Minister the question of the sanatorium at Montana in Switzerland. In January of this year, when the House resumed, a Question was put by the hon. Member for Fife, East (Mr. Henderson Stewart), to the Secretary of State for Scotland in these terms: … if he can now report on arrangements made for securing places in Swiss sanatoria for Scottish tubercular patients."—[OFFICIAL REPORT, 23rd January, 1951; Vol. 483, c. 20.] The Joint Under-Secretary of State for Scotland replied that she was satisfied with the report of the investigations which had been carried out in Switzerland, apparently on behalf of the Secretary of State for Scotland, and that the matter was under discussion with her Department and with the Treasury to obtain the finances necessary to subsidise patients to go to Switzerland. When pressed in a supplementary question, the hon. Lady asserted that what the Scottish Office had in mind was the provision of some 300 beds.

At that point I asked whether the same provision was to apply to England. I could not quite make out whether some controversy had developed between the Minister of Health and the Secretary of State for Scotland, or whether the Secretary of State for Scotland had been somewhat alarmed at the curt dismissal by the Minister of Health of the wishes of those interested in the treatment of tuberculosis and had stolen a march on the Minister of Health. The whole situation seemed to be entirely wrapped in mystery, because it was quite "out of the blue" that this new approach to the problem appeared before the House. At that point, therefore, I intervened and asked whether similar arrangements were in operation for those who were looked after by the Minister of Health. I was very glad to receive the assurance that, in fact, similar steps were being taken, though it was a little difficult to get the information from the Minister on a subsequent Question which I addressed to him.

No Minister was very forthcoming on this matter, nor were we able to elicit any information as to whether these proposals of 300 beds for Scotland, with no figure given for England at all, were linked with the pressure exercised from all parts of the House about the provision of the sanatorium at Montana. The whole matter again went into oblivion and, as far as I am aware, we have not yet heard from the Minister of Health or the Secretary of State for Scotland how far the proposals have really proceeded.

I am bound to say that we were all delighted to know that at any rate the edict of the Minister of Health given so emphatically to the House last July was no longer valid. I am not at all certain whether the situation was altered because the Minister of Health went to another Department and a new Minister of Health was appointed, but, at any rate, everyone who is interested in finding every possible facility for the treatment of tuberculosis was very glad indeed to know that the two Ministers were in consultation with the Swiss authorities to try to work out a scheme. I presume, although it has not been said in specific terms, that when reference was made to conversations which were going on with the Chancellor of the Exchequer, the idea was that we should revert to the old pre-war scheme which gave power to the local authorities to subsidise patients who had been recommended specifically for Swiss treatment.

One recognises that we have the best medical advice and attention in this country, and I am quite certain that the Minister of Health and the Secretary of State for Scotland are addressing themselves to this great problem of shortage of beds and of staff for looking after tuberculosis patients; but there is no doubt that in certain circumstances treatment in Switzerland is of very great benefit to certain classes of patients, and I am sure it would be the wish of everybody in all quarters of the House that if such treatment is regarded as necessary for restoring a patient to health, we should not like the power of the purse to rule, and if certain doctors are recommended to people in the lower income groups they should also be able to obtain the benefits of treatment in Switzerland.

I therefore raise this question tonight in the hope of being able to elicit from the Parliamentary Secretary two things: first of all, how far the negotiations have got; and secondly, providing that proper arrangements can be made with the Chancellor of the Exchequer, whether it is proposed to revert to the old system which was in operation before the outbreak of war, and whether it is the intention of the Minister to see that where treatment in Switzerland is essential, all sections of the community shall be able to benefit from that mountain air. I should be very glad also if the hon. Gentleman could give me an assurance that England and Scotland will be treated on an equal basis. I shall not take up the time of the House any further, but I should be glad to know what the position is.

10.14 p.m.

Mr. Edgar Granville (Eye)

I intervene for a few minutes to support the plea which has been made by the hon. Lady the Member for Tynemouth (Miss Irene Ward). I had the opportunity very recently of studying some of the work of the English sanatorium in Montana. As the Parliamentary Secretary knows, the English sanatorium there is a first-class establishment. It is directed by an Australian doctor who has had great success; but unfortunately, unless something is done, it will close, and he will return to his native country, I believe, in April. I understand it is the only English sanatorium in that part of Switzerland.

On the whole, the patients have been drawn from people who could afford to pay the fees and could afford to do so in Swiss currency, but I should have thought it would have been possible for the Minister of Health to get into contact with his opposite number in the Swiss Government and to discuss with him some reciprocity arrangement under the National Health scheme. Indeed, I would not rule out of all consideration the possibility that the Swiss authorities might have been able to make some arrangement with us in sterling rather than to permit this sanatorium to close, this distinguished doctor to return to Australia and his staff, as I understand it, to be disbanded. I hope that the plea of the hon. Lady will not be in vain and that the Parliamentary Secretary will be able to tell us that something specific will be done in this matter in the near future.

10.16 p.m.

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

I am grateful to the hon. Lady the Member for Tynemouth (Miss Irene Ward), for raising this subject tonight, even though the debate has started rather later than we might originally have expected or hoped. It is important that it should be understood that there is no desire on the part either of my right hon. Friend the Secretary of State for Scotland or my right hon. Friend the Minister of Health to prevent facilities from being made available, if they would be of real value to the patients concerned. It is our anxiety to try to ensure that the maximum amount of accommodation is made available for patients under the very best medical care that we can provide.

Sir Hugh Lucas-Tooth (Hendon, South)

rose—

Mr. Blenkinsop

If the hon. Gentleman will permit me to continue a little longer he may find something which he wishes to discuss with me, and he might then like to interrupt.

There is no contradiction at all between the attitude taken by Scotland in this matter and that taken by ourselves. We have been jointly examining the position, we are jointly considering what is the best thing to do and we are having joint consultations with the Treasury. It would be quite wrong to imagine that there is any difference of opinion between us.

Sir H. Lucas-Tooth

I think there is a certain obscurity in what the Parliamentary Secretary said. The hon. Gentleman said that he and his right hon. Friend are determined to make all possible accommodation available. Does that mean available within the National Health Scheme or does it mean available in any circumstances, because if private patients can be taken to Switzerland that may make beds available within the National Health Service in this country.

Mr. Blenkinsop

It is, of course, true that now that there has been a further release of foreign exchange, private persons can go rather more freely to Switzerland than was possible a little time ago. I do not deny that that is the position. What I meant was that we must make a clear differentiation between the number of beds which may be available in Switzerland, in the sense that they are empty, and the number of beds which we could conscientiously say it is in other respects desirable we should use. We must have in view the amount of medical care which would be available for patients in Switzerland and also, of course, the whole social arrangement which exists there.

We have to think of the nursing and medical care which is available in many of the sanatoria where beds are empty, and which hon. Members will realise is on rather a different basis in this country, so far as the treatment of tuberculosis is concerned, from that in Switzerland. We have also to think of the general social surroundings, to ensure that not only would patients secure proper medical care but that there would be a reasonable chance of their being happy and at ease in the conditions they would meet in Switzerland.

First and foremost, we have to consider the availability of medical care to carry on the treatment which has been started in this country—started not necessarily in hospitals but before the patients have entered hospitals or sanatoria in this country. When we consider these matters, we find that the number of beds of which we could make use in Switzerland is, in fact, very small indeed in relation to the problem.

As the hon. Lady mentioned, the Joint Under-Secretary of State for Scotland referred to a figure of some 300 beds which, after investigation by a Scottish party that went over to Switzerland, it was thought might be made available. We have had our own team of both lay and medical experts over in Switzerland, and it seems that, though there may be some extra beds, it is still hard to say whether there would be any more than that 300 mentioned. If it became practicable to work this scheme, the beds would naturally be made available for patients throughout Great Britain.

Miss Ward

That would be the total covering both countries?

Mr. Blenkinsop

Yes. I was just saying that we think that there might be something more than 300 as a total; but there is certainly no prospect in any conditions that we can conceivably accept on medical grounds of anything in the nature of the 1,000 or more beds that have been talked about in the House. Therefore, the contribution that this can make to our problem is inevitably very small indeed, and we must face that fact.

We must also, it seems to me, face the problem of the expense involved, not because we are not desirous of making the very best contribution that we can to patients and to those who are on our waiting list, but because we have to think whether, if we are going to involve ourselves in what is really a heavy expenditure for a relatively small number of patients, we should not do more with that available sum of money in this country; and I think the truth would be that we undoubtedly could. That is a matter that we are considering at this present time. It is not, as I say, a matter of our desiring to stand in the way of making extra beds available for our people, but we do not want anyone to be misled by the idea that we are really going to find here some solution of our waiting list problem. I am afraid we cannot hope to do that.

It is also our view that the medical care available in Switzerland, with the exception of a very small number of individual cases, is certainly not better than that in this country, and the problem is, therefore, essentially one of trying to ensure as rapidly as we can the solution to our problem of the waiting list, if possible within our own country. That would be so still even if we were to find ourselves able to accept offers which still have not been put in any very final form, although we have been in discussion and negotiation with all the authorities concerned. In Switzerland they are closely linked, I may say, with the tourist organisations, because very many of these sanatoria in Switzerland are like very delightful and luxurious hotels and do not bear very much relation, perhaps, to what we think of as our ordinary sanatoria provisions in this country, in terms of the amount of nursing staff and so on that one would normally expect to find and, of course, the sanitoria where the standards are probably the highest are the sanitoria that have little or no contribution to make to us because their beds are, broadly speaking, already filled.

Mr. Granville

Montana Hall?

Mr. Blenkinsop

The information I have is that the Australian doctor, who is a very fine doctor indeed, who has been in charge of this sanatorium, will, in any case, be leaving. It is no question at all of whether we could manage to save this sanatorium or not. In any case, he will be leaving, and it would be a problem to decide whether in all the circumstances the medical provisions and the other provisions there would then be what we would require. I ask hon. Members to realise that we would have to take the responsibility for ensuring the proper treatment and care of the cases a very long way from us, and it would be extremely difficult to achieve that control, both of transport to Switzerland and also of the care in Switzerland. It is something that I ask hon. Members on both sides of the House not to press on us too quickly without the most careful consideration of all the very real difficulties involved, for the sake of the patients themselves as well as everybody else.

Mr. F. Longden (Birmingham, Small Heath)

It is not a matter of costs?

Mr. Blenkinsop

It is not really a matter of costs, except in the sense I have already mentioned. We would regret being, as it were, forced by the House to spend a very large sum of money which could benefit only relatively very few of those on the waiting list when the same sum of money could do more benefit if we could use it in this country. It is entirely a matter of balance That is the point I ask hon. Members to keep clearly in mind.

The hon. Lady was not quite accurate when she said the question of T.B. beds in Switzerland had not been raised in the House apart from Questions being asked in July last year, and again in January and February of this year. We had two very valuable Adjournment debates on the treatment of tuberculosis generally, one raised by a Member of the Opposition and one by one of my hon. Friends, and the question of the use of beds in Switzerland was then also discussed and we made our position on the matter clear.

Mr. Granville

Would the hon. Gentleman tell us exactly the position with regard to individual patients and the possibility of their getting currency to go there if they want to?

Mr. Blenkinsop

I have seen the general announcement, which I expect the hon. Gentleman has seen, that in view of the present currency situation the Treasury are making currency more freely available than it was a little while ago. The information is available to everyone in the country.

Before finishing I do want to make clear that we have secured a very striking increase in the number of beds available in this country during the last couple of years, and particularly during the last six months. The figure has been given on previous occasions. In point of fact, there have been some 3,500 extra beds for tuberculosis since the schemes of the Health Service came into operation.

Miss Ward

In general hospitals.

Mr. Blenkinsop

No, not all. Very many in sanatoria, and of course very many in consequence of our desire to open up other hospitals, especially for tuberculosis purposes. I am glad to be able to say there is every likelihood that we shall be able to have a further 2,000 beds, if not more, this year by the cooperation of both the general hospitals and the teaching hospitals, under careful supervision, and we can be assured that the treatment in those newly opened beds will be of the very best. We are having the full co-operation and help, for which we are very grateful, of all the specialist teams from the teaching hospitals, and I feel that in that way we shall be able to do what we are so anxious to do—to get the full use of the early diagnosis of tuberculosis, which we are achieving now, to ensure a very much more rapid treatment of those cases we are now detecting under our mass radiography scheme.

I feel sure the House will be satisfied with the knowledge that, while we are still prepared very carefully to consider, in conjunction with the Chancellor of the Exchequer, the possibility of making use of this limited number of beds—we are not ruling it out by any means—we realise that the major contribution must still be made in this country, and we are determined to make full use of it.

Question put, and agreed to.

Adjourned accordingly at Half-past Ten o'Clock.