HC Deb 26 June 1951 vol 489 cc1334-44

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

11.2 p.m.

Mr. Peter Thorneycroft (Monmouth)

I rise to call attention to the question of the analgesia service in Coatbridge. Whatever may be said or not said about the merits of my argument, it is an easier subject to understand than that which we have just been discussing. It has no related schedules.

Analgesia, as the House is no doubt aware, comprises all those methods of relieving pain without loss of consciousness, and, in particular, it is the method which is used to reduce the pain of childbirth. I am concerned with the specific case of the analgesia service in Coat-bridge, but I may say, in general, that analgesia does not eliminate the pain of childbirth, which still remains a matter which requires some faith and courage in most women, but that it does relieve a good deal of unnecessary suffering, and in recent years its use has been considerably extended.

For that I think we have to pay tribute to the devoted work of the domiciliary midwives, organisations like the National Birthday Trust, and the energy of private pioneers in this field, such as my friend Lady Juliet Rhys Williams and Doctor Elam, of the Barnet Hospital, and many others including, may I add, to show how non-party I am, the right hon. Lady the present Minister of National Insurance, who has always been a faithful worker in this field. I hope that when I have heard the hon. Lady's reply I may add the Scottish Office and the Ministry of Health as being on the same side, but nothing that has happened so far has given me encouragement as to their energy and enthusiasm.

I have taken some interest in the progress made in this subject, and for that purpose I have from time to time, thanks to the courtesy of the hon. Lady and the right hon. Gentleman, had furnished to me the figures of analgesia administered in Scotland, England, and Wales. On 13th April last the figures for Scotland were sent to me for 1950, and they showed in the case of Coatbridge: domiciliary midwives practising, 11; the number trained in the use of analgesia, 7; the number of gas and air machines available to these midwives, nil; the number on order, 7.

My immediate reaction was that it was extraordinary in this day and age that someone should have gone to the trouble of training seven of these midwives in the use of this service and not provide them with the mechanics of doing so. I wondered how long it had been allowed to continue, and I looked back to see what had been done. I found that a year ago I put down a similar Question about Coatbridge, and on that occasion I found that the answer was that no gas and air machines were available in this area but that the hon. Lady or her right hon. Friend were taking, according to the answer, "energetic steps" to see that something was done.

I want to know what has happened in that year. What efforts did the Scottish Office make to see that during that 12 months something was done to remedy a state of affairs publicly drawn to their attention as much as 11 months ago? I then put down another Question to see what could be done. I received a letter from the Secretary of State for Scotland on 24th May last, and in that letter the right hon. Gentleman made it plain that the position was rather worse than the official figures disclosed because seven machines were not on order, but only one. It seems to me that that is really a rather shocking state of affairs.

Not only did the local authority take no steps to see the midwives provided with the necessary machines, but they did not send in a correct return to the Scottish Office. It must have been an accident. I think it was. I think there was no deliberate intent to deceive, but it showed a lack of interest to allow a return of that kind to go in, with inaccurate information.

The figures which the hon. Lady furnished me related to the number of cases in which analgesia was administered, first of all by the gas and air machine, and, secondly, by pethidine, which is the natural method of giving analgesia. In both cases the return was nil. It emerges that in this respect the information supplied by Coatbridge was wrong. I am now informed by the Scottish Office that in 138 cases pethidene was used. I am sure that the medical officer of health of this constituency does not seem to have taken a great deal of interest in this return.

What was more interesting was that I was informed that in 166 cases trilene was used. Opinions differ as to the use of trilene in the analgesia service, but the important point to note is that the Royal College of Obstetricians and Gynaecologists has stated that it should not be used except under the supervision of a doctor, for reasons well known in the medical world.

It is fair to say that the Secretary of State for Scotland said that he was fully aware of the limitations placed by the rules of the Central Midwives' Board on the use of trilene by midwives acting in the absence of the doctors. He added: This has been made fully clear and, as I have said, they are now proposing to acquire a reasonable number of gas and air machines to enable their trained midwives to provide this form of analgesia. I am bound to add that it is about time this local authority did start buying gas and air machines. People talk about their being on order or not available. Ten days delivery can be quoted by any firm now. They are ready and available. This letter was dated 13th June. I hope the hon. Lady will be able to inform us that by now Coatbridge has got these machines. The method is known and is safe, and the latest kind of machine is very easily portable by any midwife in any area, in any conditions.

I am not here to pillory Coatbridge or even to make a particular attack upon the administration of the service by the Scottish Office. I am only concerned that all that can be done to get this service available to the people of Scotland and this country should be done at the earliest possible moment. The following facts emerge from the particular case of Coat-bridge. I hope the hon. Lady who represents it will realise that I have chosen it only as an example; it is not an isolated case.

Mrs. Mann (Coatbridge and Airdrie) rose—

Mr. Thorneycroft

I hope to allow time for the hon. Lady to speak. She will prefer that, rather than to interrupt.

There are other cases where this kind of thing is going on, as the Parliamentary Secretary to the Ministry of Health well knows. The first point I would make is that the figures supplied by the Scottish Office have been wholly inaccurate. That in itself is very bad. They were wrong about the number of gas and air machines on order; they were wrong in their figures about the use of pethidine, which they said was nil when, in fact, 138 cases had been treated.

Under the National Health Service Act for Scotland the local health authority must have put up a scheme for its midwifery service long ago to the Scottish Office. What did that scheme say? Did it say that they were going to use trilene, or did the local medical officer of health decide to carry it out without submitting a scheme to the Scottish Office? If the Scottish Office were informed, did they approve? Is it the only case where it happened, in Scotland or England? The Scottish Office ought to be much more fully informed about what is going on with regard to the administration of analgesia throughout Scotland. I do not restrict this to Coatbridge.

On the use of trilene, I am not blaming the midwives for using it at all. What else could they do? That was the only thing made available to them—no one would hold that against them for a moment. But in March, 1949, more than two years ago, a committee of the Medical Research Council was set up expressly for the purpose of considering new methods of using analgesia and improving the old ones. What has happened to that committee? It was their job to report on trilene. What is their view? Is a midwife entitled to use trilene in the absence of a doctor, provided a doctor has been employed in the case, or not?

It is a point that ought to be known, and one on which very different opinions are held in different local authority areas. There was the decision about C.M. equipment, which would greatly improve the efficiency of the ordinary gas and air machine—one local experiment only allowed in two years. When I think of what this country could do, if it wanted, in the solving of scientific problems, of the problems it did solve in war, with acoustic mines and the like, I submit that the problem of improved analgesia methods, such as the use of trilene or of improved gas and air machines, could have been solved easily within the past two years. What is wanting is some direction and drive from the top. I should like the hon. Lady to tell us what has happened to that committee and when we may expect to have their final report.

My third and last point is this. We do not get a full picture of the analgesia service by reading statistical returns given to offices in Whitehall. We have to see what is happening on the spot. I once introduced a Bill into the House to make it compulsory for local authorities to provide these services. It was rejected by the House on the advice of the Government, rejected on the ground that the Government had full powers, so they said, to see that these services were put into effect. I say to the hon. Lady: if she has these powers, use them. If she has not, then come to the House and ask for them.

Mr. Woodburn (Clackmannan and East Stirling)

The hon. Gentleman has said that the Government should push on with research. Can he explain how the Government can push medical research workers into making discoveries more quickly?

Mr. Thorneycroft

The first thing that the Joint Under-Secretary can do is to ask for an immediate interim report from that committee, showing how they are getting on, and publish it to the House.

11.17 p.m.

Mrs. Mann (Coatbridge and Airdrie)

I am greatly indebted to the hon. Member for Monmouth (Mr. P. Thorneycroft). The affairs of Monmouth in matters of midwifery must be in such excellent order that the hon. Member can turn his back on his own constituency and come right up to Coatbridge to act as midwife to the mothers in that area.

Some time ago I heard the hon. Member tell the House that there was not one mother in Coatbridge who had had the advantage of analgesia. He was promptly contradicted the following day in the Scottish newspapers, one of which headlined that there were a thousand satisfied mothers in Coatbridge. They were satisfied not because they had gas and air machines: indeed, like most mothers I know, they would have been highly dissatisfied if they had gas and air machines. The hon. Member said it is the method which is used to relieve pain in childbirth. Is it used in Royal circles? Is it used in the homes of hon. Members opposite?

Mr. P. Thorneycroft

It is used in my family.

Mrs. Mann

Then the hon. Gentleman is very out of date. It is more than ten years since my son, a doctor, bought one himself and took it to his confinements, leaving it with the nurse when he had to leave the case. There is no member of my family, of whom many members are doctors, or any friend or member of the medical profession I know, who would urge gas and air machines. I still wonder what is the particular interest of the hon. Member in trying to foist gas and air machines on us, when in Coatbridge we had last year 633 confinements, of which 487 were in charge of a doctor.

Why should the hon. Member for Monmouth want midwives to use gas and air machines—third-rate treatment—when the women of Coatbridge have doctors in charge of their cases and have analgesia by the use of trilene, pethidine, chlor- form and ether, whatever their doctors prescribe. I object to this third-rate treatment being thrown out to the women of Scotland.

England is short of doctors. Scotland exports doctors to England, but I insist that we keep them in Scotland, keep them in charge of our mothers when they are going through this trying time, and that all the most modern and up-to-date analgesia used in the Royal household should be used in Coatbridge. They should not be fobbed off with gas and air machines.

11.21 p.m.

The Joint Under-Secretary of State for Scotland (Miss Herbison)

The hon. Member for Monmouth (Mr. P. Thorneycroft) has raised two specific questions. One was that of analgesia, and the other how far research had gone in the use of trilene by midwives alone. The hon. Gentleman has already got much information from my right hon. Friend the Secretary of State on this matter, but I think he was less than fair to Coatbridge when he quoted the mistakes that had been made.

It is true that they made a mistake in saying that they had seven machines on order, when it was not the case. But the hon. Gentleman has had from my right hon. Friend that when Coatbridge and other authorities were asked the number they had on order and in use at the time, and the number of domiciliary confinements in which analgesics were administered, Coatbridge took it for granted that all they had to do was to set out in that particular column what use was made of the gas and air machines and also what use was made of pethidine, and they took it that because they had no gas and air machines they need not give any account.

Mr. P. Thorneycroft

They returned "nil" for gas and air and pethidine separately.

Miss Herbison

I am trying to explain that they took it for granted they had to make the one return.

It is true that there has been some misunderstanding by Coatbridge about their powers and duties under the various Midwives Acts. They took it for granted that they could permit their midwives to use trilene provided the doctor in charge of the case, although he was not present at the case, specifically prescribed trilene. They are now fully aware that they have been wrong in this matter— wrong as far as the powers they have at the moment are concerned—and they did decide at their last meeting to order four machines and these should be in Coat-bridge any day now.

In Coatbridge, in 1950, the number of births where doctors were not present was 520, and my hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann) is right when she says that not all the 520 had analgesia of any kind. In 166 cases trilene was administered, in 138 pethidine was administered and in another 36 both trilene and pethidine. In all of these instances it was specifically prescribed by the doctor in charge. That makes a total of 340 out of 520 cases where some form of analgesia was administered to the women of Coatbridge.

The hon. Gentleman has asked if, when the scheme was presented to the Scottish Office, anything was included in it about gas and air. They included in their proposals the training of their midwives and the equipping of them with gas and air machines. I think it might help us all if we tried to get this important and interesting topic into perspective. From the remarks of the hon. Member who raised this subject to-night, it would seem that little has happened in Scotland since 1948, and he even suggested that in some places in England, little had been done. I can speak only for Scotland, and I can tell him that, for a long time, domiciliary midwifery in Scotland has been based on the combination of the doctor and the midwife—the doctor being in charge of the case, and deciding the extent to which it is necessary for him to be present during the actual confinement.

The parallel of the Midwives Act, 1936, in England, was never followed in Scotland, and the Maternity Services (Scotland) Act, 1937, required Scottish local authorities not only to provide a service of domiciliary midwives, but also to make arrangements to secure medical examination, medical treatment, and medical supervision. It was not until late in 1946 that midwives were empowered to use gas and air analgesia in Scotland, although English midwives had been able to do so since 1936.

But in Scotland in 1950, both a doctor and a midwife were engaged in more than 32,000 out of 34,000 domiciliary births— that is, in 94 per cent. of all these cases. The National Health Service, when it came, continued the established Scottish practice of providing a doctor as well as a midwife, and it also required each of the 55 local health authorities in Scotland to submit for approval their proposals for carrying out their midwifery duties; and these proposals included what were their plans for training midwives and also included the provision of suitable gas and air machines for use by trained midwives.

The Clause included in the amending Bill of 1949 made this point doubly clear, and the Secretary of State has left local authorities in Scotland in no doubt whatever that it was their duty to provide for the administration of analgesia by midwives where it was medically approved, and where the mothers themselves desired it.

What progress has been made since 1948?

Mr. P. Thorneycroft

Do not forget the Medical Research Council.

Miss Herbison

I shall not forget that, but let me continue by saying that at the beginning of 1949, only 28 per cent. of the midwives were trained; there were only 205 machines available for them, and only 800 mothers in Scotland had had gas and air analgesia. By the end of that year, there were 53 per cent. of the midwives trained, 272 machines were in use, and 3,265 mothers had had gas and air provided.

In 1950, the figures were 78 per cent of the midwives trained, 515 machines provided or on order—although most were in use—and 7,510 of the domiciliary births had analgesia. In addition to the gas and air, there were 3,609 cases where pethidine was administered by midwives. I would say that that gives a very different picture from that which the hon. Member has tried to present of what is happening in Scotland.

I should now like to come to the point about the use of trilene. In May, 1949, the Medical Research Council set up a committee on analgesia under the chairmanship of Sir William Gilliatt, President of the Royal College of Obstetricians and Gynaecologists. There is no doubt, surely, in the minds of hon. Members that such a gentleman would not be doing his best to find a machine which was safe, and which should be completed soon.

Copies of the specifications were sent to manufacturers in Britain who were interested in the making of that type of apparatus. Since that date, four prototypes have been produced from those manufacturers. These have been tried but none of them precisely fulfilled the Committee's specifications. These inhalers have since been modified to meet these requirements. They have been tested on a small scale in hospitals and seem likely to be satisfactory. To ensure that they are really safe, of course, in domiciliary practice, they must be tried on a fairly large scale in hospitals and in the homes of the patients.

The arrangements of these trials are to be in the hands of a new joint subcommittee, a sub-committee of the Medical Research Council's present Committee and the Anaesthetic Committee of the Royal College of Obstetricians and Gynaecologists. This sub-committee will be convened as soon as sufficient models of the new inhalers are provided for these tests. It is unlikely these clinical tests will be completes for many months but it shows clearly that, far from sitting back and needing to be prodded by Government Departments, this Committee certainly has been doing a good job of work.

They have not only been giving their time, their energies, and their thought to producing a machine that would be safe for a midwife to use without a doctor, but if I had time tonight I could have covered other points that this subcommittee has been dealing with. But I will give these points later to the hon. Gentleman because I am certain that he will be interested in them. I should like to say, finally, that we wish wherever possible that where a woman desires to have some form of analgesia and where the doctor decides that she is a suitable subject for that, then the mother will have it.

The figures I have given show the great improvement that has taken place in Scotland. They show that the Scottish Office has kept closely in touch with local authorities all over Scotland and all that I want to say is that if there is any woman in Scotland who wants analgesia and who is being denied it, let her raise her voice as high as she can because that will be heard by the local authorities.

The Question having been proposed after Ten o'Clock and the debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Twenty-eight Minutes to Twelve o'Clock.