HC Deb 07 March 1952 vol 497 cc973-84

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

4.2 p.m.

Mr. Edward Short (Newcastle-upon-Tyne, Central)

I wish to raise the question of the incidence of tuberculosis in the Tyneside area. At the outset I should like to make it clear what I mean by the Tyneside area. I am speaking of 16 miles from the mouth of the river on both sides. Most of the figures I shall give will relate to the Newcastle area, because it is fairly typical of that large urban area.

For very many years the incidence of tuberculosis on Tyneside has been very much in excess of the incidence in the whole country. In 1919 the incidence of tuberculosis of the lung was pretty much the same on Tyneside as in the rest of the country, but in the next 20 years the rate for England and Wales was halved, while the rate for Tyneside dropped only very slightly.

During the 10 years from 1939 to 1949 the rate for England and Wales increased only slightly, while the rate for Newcastle-upon-Tyne and most of the Tyne area became almost double the national level. Since then—since the war period—there has been a very great improvement, due largely to the introduction of the National Health Service and to full employment on Tyneside, which has considerably raised the level of nutrition in that area.

I wonder, when people talk about the cost of the National Health Service, if they ever consider the other side of the balance sheet—the added productivity we have gained in industrial areas such as this, let alone the human happiness and contentment that it has brought. I admit that the actual position has considerably improved, but the relative position has not improved at all. Indeed, in some respects the relative position between Tyneside and the rest is worse than it was.

For example, as recently as 1950 the number of deaths in England and Wales per year per 100,000 was 36. In Newcastle-upon-Tyne the number of deaths was 7 per 100,000. That is very nearly 100 per cent. more, whereas in 1948 it was only 70 per cent. more. So, although there has been an actual improvement, which I am glad to admit, there has been a relative worsening in the death figures.

We lie in an intermediate position between the lower incidence of the South and Midlands and the slightly higher incidence of the Scottish industrial area. This high incidence in Scotland was mentioned in an article by the right hon. and gallant Member for Glasgow, Kelvingrove (Lieut.-Colonel Elliot) in the "British Medical Journal" in August, 1949. We very nearly reached that level. At any rate, our figures are much higher than anywhere else in England and Wales. When speaking of this problem I should mention that the lung cancer position is now very nearly as bad as that of pulmonary tuberculosis. Indeed, in Newcastle last year there were as many deaths from cancer of the lung as there were from T.B. of the lung.

That is the statistical side of the problem. Now what are the factors which make up this picture? First of all, it obviously started in the beginning of the industrial era. There was a rapid influx of population from the rural areas, with shocking housing conditions; for as far back as I can discover, the figures were very bad, and we have never really caught up with the problem because of the infectious nature of the disease. There has been a succession of slumps and depressions which have hit the Tyneside area perhaps worse than, and certainly as bad as, anywhere else in the country, and because of that we have this very high incidence.

Again, the population of the Tyneside is much younger than in most other areas. There is a very large child population and the schools are very overcrowded. Indeed, the school my own children attend has classes of up to 62, and I hope that the hon. Lady will consult her right hon. Friend to see whether she cannot help the school building programme in Newcastle which is at present held up by the new standstill on building. There is also the question of Irish stock. There is a large Irish population, and the incidence of T.B. among that population is very high, as it is in the Liverpool area.

The area is largely dependent, or has been in the past, upon one or two heavy industries—coalmining, engineering, and particularly shipbuilding—and it is a well-known fact that the workers in these industries are less immune from tuberculosis than workers in light industries. It may well be that the policy of the Government in the last six years to create a diversity of industry has helped materially in the reduction of the tuberculosis figures. I do not know, but that may very well be one of the unforeseen beneficial results of spreading industry and giving these areas a number of lighter industries.

Then there is the new tendency in the North-East of married women remaining at work. This is something new for the North-East, which started on a large scale during the war, and it may have helped to increase the figures for tuberculosis, because I have discovered that the incidence among women between the ages of 15 and 45 has increased much more than the incidence among any other age group. I think that points to the need for more diagnostic work in factories which employ a large number of women, and I should be grateful if the hon. Lady would look into that question. There are on Tyneside a number of large new factories where very good work in the diagnostic field could be done.

There are two factors which, I think, call for considerable research, which I will mention briefly. The first is the climatic factor. I have already mentioned the article by the right hon. and gallant Member for Kelvingrove in the "British Medical Journal," pointing out the high incidence in Scotland. It appears that the T.B. rate increases the further north one goes. This climatic factor may well have a large bearing, and there should, therefore, be a great deal more research in this direction.

A number of authorities have raised the question of research in dietetic factors. It is well known that there are deviations in dietetic factors in the North-East from the South and Midlands, and this may have some bearing on the problem. At any rate, the questions of climate and diet need to be examined.

The character of the Tynesider also has a little to do with this, at any rate so far as the following up of contacts is concerned. They are very reticent people about this sort of thing. From the point of view of following up contacts, a good deal of propaganda could be carried out in factories, in pits and, perhaps, through trade unions about the need to follow up contacts.

But the greatest single factor of all, at any rate in the Newcastle area, is that of poor housing. The question of Newcastle's housing has been raised here before, and I do not want to mention it again now except to say that it is a very poor record indeed. People are living in most appalling conditions. By the Housing Act, 1936, standards, more than 20 per cent. of the population of the city are overcrowded, and with the highly infectious nature of the disease this is no help to the problem.

I do not want to minimise the difficulties of housing in Newcastle, but I think that the Minister of Housing and Local Government could be more helpful. I should like the hon. Lady to have a word with her right hon. Friend about this and see whether he cannot do anything to get more houses for the city, which, as I have said, has one of the worst housing records in the Kingdom.

Night sanatoria have been tried very successfully in London, and it might help if something on this line could be provided where people who live in overcrowded conditions could go for the night. There is also the question of hostels for children living in infected households. The hon. Lady will realise that the family is the unit in dealing with T.B., and something will have to be done on family lines.

Time permits only of very brief mention of these points, but I must include hospital and nursing provision. Excellent work has been done by the Regional Hospital Board, and I should like to take this opportunity of paying tribute in the House to the excellent work they have done. The number of beds available is now, probably, sufficient, but the proper use of the beds is handicapped by the number of nurses who are available for T.B. work.

I have three suggestions to make: first, that the financial side of the nursing of T.B. patients should be considered, especially the financial aspect when a nurse contacts T.B. Second, it might help if nurses in their general training, providing they were agreeable, could undergo a short training in T.B. work. Third, there is the question of the use of B.C.G. vaccination. I know that its extensive use is not countenanced by the Ministry, but if it could be used more widely for nurses in this work more nurses might be willing to take it up.

There is evidence that the best use is not being made of beds. For example, beds which could be used for a succession of early cases are often blocked by chronic cases, who are unlikely to respond to active treatment, and beds may indeed be used for inaccurately diagnosed cases. The result is that there is too long a gap between diagnosis and institutional treatment. This is a point which might well be looked into.

Second only to housing, the question of bringing the G.P. into the picture is of the greatest importance. All the reports I have read—and I have looked up a great number in the last week or two—stress that the G.P. must be brought more actively into the picture. He could be given better X-ray facilities at the clinics and more opportunity for consultation with chest physicians. At any rate, he should be made more aware of T.B.; he is the first line of defence against it. Greatly improved diagnoses is essential to the whole campaign.

There is also the question of after-care arrangements which need looking into and I ask the Minister to look into this question in Newcastle. I think there should be a great deal more activity by the local authority under Section 28 of the National Health Service Act. There is also the treatment of rare kinds of T.B. in which the region is deficient, as are many other regions. There should be a great deal more propaganda for mass radiography and the public should be made to realise its importance. Between 1943 and 1949 3.4 per cent. of all the people examined by mass radiography were found to have unsuspected active tuberculosis of the lung. If that information were widely disseminated, I think a great many people would submit themselves to this very useful examination.

The problem of ascertainment in the schools is pre-eminent. A great deal has been done because of the National Health Service and improved standards of nutrition, but these two factors have led to a national improvement so that the relative position is not any better than it was; indeed, in some respects, it is worse and it appears that the factors which make for the high incidence on Tyneside are still operating. Last year there were 485 new cases of T.B. of the lung in Newcastle alone.

I think that is a challenge to the Minister and to the Regional Hospital Board and the local health authority and general practitioners in the area. There is a great deal of useful liaison at present and, in particular, a very useful bit of co-operation between the child health department in the University of Durham under Sir James Spence and the local authority in respect of T.B. among children. I think this co-operation should be further extended, in view of the abnormal problem and the fact that the number of deaths is 100 per cent. more than the national average.

The Minister should take the opportunity of setting up ad hoc machinery to deal with this problem. I suggest that he should set up a Tyneside tuberculosis committee to investigate the whole problem and make a really concerted attack on this scourge. Let us remember that it is a scourge of the industrial areas in particular and one which exerts its greatest effect on the age groups which are of the greatest value to the productive efforts of the nation. Quite apart from humanitarian aspects, the conquest of T.B. has great relevance to the country's economic problems and I hope that the hon. Lady will look into the points I have raised.

4.18 p.m.

Miss Irene Ward (Tynemouth)

I will not detain the House long, but I wanted to put on record how very glad I am that the hon. Member for Newcastle-upon-Tyne, Central (Mr. Short) has raised this very important question for Tyneside today.

For a long time I have been puzzled over one aspect of this matter and I should be grateful if my hon. Friend the Parliamentary Secretary could look at it from this aspect. It is that there is such a wide variety in practice as between one local authority and another and the measures taken to deal with this question.

For instance, some local authorities always gave priority in slum clearance and overcrowding schemes to dealing with families where there was a member of the family suffering from T.B., but other local authorities did not follow that practice. If my hon. Friend were to look into the practices of local authorities, she would be surprised at the differences of treatment meted out as between one local authority and another.

The hon. Member has very rightly laid emphasis on the fact that we in the North of England are still relatively worse off compared with the rest of the country. I would urge on my hon. Friend that the Ministry of Health should now look at the matter and find out which local authorities have had the greatest success in reducing tuberculosis now that the National Health Service has come into full operation.

If she can discover what local authority methods are the greatest success in dealing with this scourge, she should then consult the Minister of Housing and Local Government to see whether a method cannot be devised, at Ministerial level, of ensuring that those authorities which fall behind the best are persuaded to speed up their interest and attention in this matter.

I will not say any more, as I do not wish to intrude on the time which my hon. Friend has for her reply to the hon. Member's representations, but I think that the wide variety in practice of local authorities needs serious consideration at Ministerial level. I hope that my hon. Friend will bear that point in mind.

4.22 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

The hon. Member for Newcastle-upon-Tyne, Central (Mr. Short) will know the importance which my Department attaches to this problem. Indeed he has paid tribute to the immense amount of work that has been done over the years towards attacking this great scourge.

I am grateful to the hon. Member for giving me advance notice of the points which he intended to raise today. I do not wholly accept the implications which he drew from some of the figures which he quoted this afternoon. While I would not deny that the incidence of tuberculosis on Tyneside has been higher for many years than in other parts of the country, it is fair to record the manner in which that figure has been tackled and the steps that have been taken to reduce the incidence in that locality.

They can perhaps best be judged by the mortality figures. The number of deaths from tuberculosis are now half the number they were 20 years ago, despite the greatly increased population. The figures show the really striking decrease in the last few years, in Newcastle-upon-Tyne, of deaths from respiratory tuberculosis. In 1945 these were 227 and, in 1950, 183, a reduction of one-fifth.

In Northumberland, the figures in 1945 were 186 and, in 1950, 124, a reduction of one-third. The figure for the whole of England and Wales over the same period shows a reduction of one-third. The figures for 1951 are not wholly available but there is in general a substantial reduction in the figures for tuberculosis mortality.

Mr. Short

Before the hon. Lady leaves that point, does she agree that the number of deaths on Tyneside from tuberculosis is still twice that for the rest of England and Wales?

Miss Hornsby-Smith

No, Sir. I do not agree with the hon. Member. I do not make a one-fifth reduction only half of a one-third reduction.

Mr. Short

The hon. Lady said that the rate for Newcastle-upon-Tyne had dropped by a fifth and that the rate for the whole of England and Wales had dropped by a third. That does not improve their relative position. The relative position is that the number of deaths per 100,000 is 36 for England and Wales and 7 for Newcastle, that is, approximately twice the level.

Miss Hornsby-Smith

I did not deny that the Tyneside figures were higher than those of some other areas, but it must be borne in mind how they are being progressively reduced. I am sure that the hon. Member would agree that notifications are not always a good guide. We wish to encourage mass-radiography because by so doing the more we shall be able to find of those who suffer from T.B. We have regard not so much to the trend of incidence because, to us, that is a measure of its ascertainment. The more detected at the early symptomless stage the better chance of successful treatment and the better chance of preventing the spread of the disease.

The figures for notification are not falling so fast largely because increased numbers have been detected by mass-radiography. The number of notifications for Newcastle and Cumberland are, for Newcastle, in 1945, 580; and, in 1950, 532. They are still falling, but not as fast as the incidence of mortality. In Northumberland, the figures are, for 1945, 608 and, in 1950, 519. Both the hon. Member for Newcastle-upon-Tyne, Central and the hon. Member for Tyne-mouth (Miss Ward) laid great stress on housing conditions. They will appreciate that that is a subject for another Department, but I will bring their remarks to the attention of my right hon. Friend.

May I give the hon. Member a few answers within the limits of the time at my disposal, showing the work done to achieve these results on Tyneside. So far as facilities for in-patients are concerned, the shortage of nurses is our greatest problem and the recruitment of nurses and the nursing of T.B. patients is a matter closely and continuously considered by the General Nursing Council.

The waiting lists for in-patient treatment are much better in the Tyneside area, and I welcome the tribute paid to the Newcastle Regional Hospital Board who have done a tremendous amount of work in combating this great disease. During 1951 the Board opened 259 additional beds and since July 1948, 561 additional beds have been opened with the result that the number of patients not found a bed within 10 days was reduced from 540 at the end of 1950 to 420 at the end of 1951. The period of waiting is also much shorter, generally, for every patient requiring in-treatment. Patients requiring active in-patient treatment are found a bed within four days to a month according to the degree of urgency and the average for other cases is four weeks. I admit that there is a greater delay in cases requiring thoracic surgery due to the present restricted sources of thoracic surgery units and thoracic surgeons.

So far as mass-radiography is concerned, I welcome the observations of the hon. Gentleman and I wish there was less reticence among the population towards taking advantage of this machinery by which they can ascertain whether or not they have this disease. There are 60 units in England and Wales and five are operating in the area of the Newcastle Regional Hospital Board and examined 170,000 persons a year in that area.

I hope that, in addition to what is done through the trade unions, as was suggested by the hon. Gentleman, every hon. Member of this House will take the opportunity, when these units are in his or her area, to lend their support; and show that there is nothing to be worried about in taking the test.

So far as B.C.G. vaccination is concerned, this is offered to all hospital nurses, medical students and persons in close contact with patients suffering from T.B. The scheme is limited to all within that field if they desire it. The limitation of the scheme is, as the hon. Member said, in accordance with the expert medical advice which we have about the use of this vaccine at present.

With regard to climate and diet, the hon. Gentleman placed rather greater stress than my medical advisers feel applies to those two items in creating conditions under which tuberculosis spreads, but I will bring his points to the attention of my officers. I assure him that they will receive the greatest consideration.

Research on tuberculosis and methods of treatment is constantly proceeding. The record of the past few years shows that immense strides have been made. These strides are reflected in the area which the hon. Gentleman represents. I assure him that not only have important advances been made, for example, in the use of streptomycin, but there are possibly even more effective agents which are now being investigated and developed. We hope that with the use of these and with the determination, experience and knowledge which the whole of the Service has, we shall ultimately wipe out this scourge which all hon. Members wish to see eliminated.

Question put, and agreed to

Adjourned accordingly at Twenty-nine Minutes to Five o'Clock.