§ Motion made, and Question proposed, "That this House do now adjourn."— [Mr. Redmayne.]
§ 10.11 p.m.
§ Mr. George Thomas (Cardiff, West)
The question I wish to raise tonight is entirely a constituency matter, but I know that the House will appreciate that from time to time constituency matters have to take priority in the attention of hon. Members.
On Thursday, 8th May, I addressed a series of Questions to the Minister of Health concerning the hospital service in Cardiff and I received written replies in the name of the Parliamentary Secretary, who I am glad to see in the Chamber after her, I trust, happy visit to the Principality today and yesterday.
The Questions I addressed to the Minister asked the number of people on the admission waiting lists of the Cardiff Royal Infirmary, St. David's Hospital and the Llandough Hospital respectively. The hon. Lady replied that the numbers are 1,863, 161 and 1,318 respectively. That gives us a total of 3,342. But neither the Questions nor the answers gives the full picture of the waiting list for the Cardiff hospitals; for my figures of the actual list for the Royal Infirmary and the Llandough Hospital amount to nearly 6,000 people on 31st March last—5,688 —and this is without counting St. David's Hospital.
The apparent serious discrepancy between the reply of the Minister to me and the figures which I have just quoted can easily be explained, because both sets of figures are correct. But the larger 1756 total includes those people on the waiting list who are not resident in Cardiff. The essential fact, which I trust will be in common agreement between us, is that there is a disturbingly long waiting list for admission to the Cardiff hospitals and there is consequently a correspondingly long waiting period which everyone deplores, and which serves only to aggravate the complaints from which these unfortunate people are suffering. It is because of this long delay that I have sought this Adjournment debate tonight.
Since the operation of the National Health Service Act, Cardiff has been recognised as the teaching centre for the whole of Wales. I concede at once that it is a good thing for the Principality to have a teaching centre of this sort. We are very proud that the Cardiff hospitals were selected for this purpose. Both the Royal Infirmary and the Llandough Hospital are hospitals of which we are proud. But the Llandough Hospital, as the Minister will know since her visit there yesterday, is one of the finest in Great Britain. I should like to express my appreciation of the fact that the Minister went out of her way yesterday, so I am informed, to visit Llandough herself and to see the place about which I want to speak.
Both the Cardiff Royal Infirmary and the Llandough Hospital are required to accept patients from a wide area outside the City of Cardiff. Before the introduction of the National Health Service, the Llandough Hospital was under the control of our local authority and, therefore, catered in the main for citizens of Cardiff and district. It is abundantly clear that although the new arrangement serves Wales as a whole well—and South Wales very well—Cardiff citizens are at a serious disadvantage compared with their previous position.
Our largest general hospital is St. David's, a well-organised and well-conducted hospital of which we are very proud. But it has its own problems to which I shall refer briefly. It is crystal clear that more hospital beds must be 1757 made available in Cardiff. The Board of Governors, who I believe are appointed by the Minister, for the United Cardiff Hospitals have recognised this need for more beds and have submitted to the Ministry a scheme for a new teaching centre at the Heath, Cardiff. But for all practical purposes, I believe that this hospital is not a likely proposition for many years.
I asked a Question about it last week. I asked the Minister when building was likely to begin on the new hospital. The hon. Lady, in a written reply, was kind enough to say that she had nothing to add to what the Minister told me on 15th November last. I looked up that reply and I found that the Minister told me then that he was not in a position to tell me anything. Therefore, the prospects for this hospital are, I suggest, very remote. It will cost something in the region of £5 million. The only grant which has been forthcoming towards it this year has been a grant for boring purposes.
The plans have yet to be agreed upon, and then they will have to be submitted for approval before we can talk about building. Indeed, the hon. Lady's Department has imposed a cut of £12,000 this year on the estimated ordinary capital expenditure for hospitals in the Cardiff area. We are most anxious to have this new teaching hospital. We need it, but our need for beds is too urgent to allow us to wait for that hospital.
Fortunately, there is a ready solution to our difficulty. The Llandough Hospital, with which the hon. Lady is now familiar, is capable of expansion for the very purposes we have in mind. It has the necessary land, the boiler house, the kitchen and the administrative block for between 800 and 900 beds, and it could help us within a few months to reduce substantially the waiting list at our hospitals. I earnestly hope that the Minister will realise that it is imperative that Llandough should not be wasted as it is at present. It is a magnificent hospital with about 350 beds in use at the present time. We could have 900 beds there. The land is there and all the facilities are available if permission could be obtained to get on with the building. Delay is a false economy which can only be practised at the expense of human suffering.
There are two other issues to which I want briefly to refer because they are 1758 complementary to the main issue of the waiting list. The first is accommodation for the chronic sick and infirm in our city. We are very proud of our homes—I hardly know the term we should apply; "hostels" is a cold meaning word—that we have for our old people, but the chronic sick and infirm who ought to be in hospital are increasing in number in our city.
The hospital which has been used is St. David's Hospital, which is in the very heart of my constituency. I am very proud of St. David's because of the service and the spirit of everyone connected with it. But the wards in St. David's are continually being taken away from the use for the chronic sick and infirm and are being used for other purposes. I hope that tonight the Minister will be able to assure me that steps are being taken to ensure adequate and proper accommodation for this special category in our community, because the old folk have a very special claim upon us.
My last point is, of course, likely to be a little more controversial, though I trust not. The consultants seem to have a priority in obtaining admission for their patients to the Cardiff Royal Infirmary. I addressed a Question to the Minister last week on this subject, and she said —I do not really blame her; I can quite understand her giving such a reply—that if I would let her have examples she would inquire into the matter.
I ask the hon. Lady tonight if she will inquire of the Board of Governors how many beds have been allocated to consultants for their patients during the past 12 months. I know of instances where people have paid their three guineas in order to jump the queue and to get into hospital. One cannot blame them for doing that if they have the money and if there is a chance of getting in quicker. I know people who are very reluctant to let their names be used, but it is not fair to those who on principle refuse to pay the fee in order to see the specialist first or to those who cannot afford the three guineas. It is morally wrong.
I have sought in this debate to deal with urgent issues of very real concern to Cardiff citizens. I have not sought, deliberately at least, to gild the lily or to overstate the case. Indeed, I have tried to be guilty of English understatement, which is not easy for a Welshman. But I do urge the Minister to give 1759 some sign when she stands at the Box that she not only appreciates the gravity of our problem in Cardiff, but is going to show real initiative in tackling this problem.
We are a very patient people in Wales when we think that justice is being done, but if we see signs of slackness or lack of interest, then impatience is our virtue. I trust it will not be necessary for us ever to show that particular quality towards the hon. Lady and I ask her to do her utmost to see that Llandough Hospital is extended and the extra provisions made available.
§ 10.25 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
It is by a happy coincidence that I have just had two days in the Principality, and in Cardiff, and have been able to see some of the hospitals about which the hon. Member for Cardiff, West (Mr. G. Thomas) has spoken with such great knowledge and feeling. I would say, and I am sure he would agree with me, that when the National Health Service Act came into operation in 1948, Wales was woefully short of hospital accommodation and there was a very substantial leeway to be made up. I think it is fair to say that not only has the Principality had its fair share of the general moneys, but that each successive year an effort has been made to make up, within the financial limitations imposed upon us, some part of that leeway.
The hon. Member will be aware that already that effort to make up some of the leeway is reflected in three projects which are already in operation—the new maternity home which is to cost £400,000 and provide 80 beds, the new orthopaedic hospital which is to cost £500,000 and provide 240 beds—and one of the longest waiting lists is for orthopaedic cases—and also the conversion of an infectious diseases hospital into an ear, nose and throat hospital, which provides 52 beds for children and is now in commission. These are evidence that the Principality is having a fair crack of the whip within the limitations imposed upon us.
I should like to deal in detail with the new hospitals mentioned—the proposed new teaching hospital and also the Llandough hospital. I had the great 1760 pleasure of being shown round that hospital only yesterday. The hon. Member would be the first to challenge my Department if we were to override the decision come to by the Welsh Board of Governors or the Welsh Regional Board in Wales.
I know that the proposed new teaching hospital has been the subject of great discussion and argument within the Principality amongst those who feel that 'there are very great difficulties about the expansion of Llandough Hospital and that it will not fully meet their desires for a new teaching hospital; and among those who think that a little in hand quickly is better than a larger prospect in the future. But I think it is fair to say that the decision has been made by the authorities within the Principality, and my Ministry are supporting the decision so made on the spot.
§ Mr. G. Thomas
I intervene only to ask if the hon. Lady is aware that the Board of Management or Board of Governors really want two things. I am asking that if she cannot give them the larger, will she please give them the smaller?
§ Miss Hornsby-Smith
The decision has been made, as I said, and every second person I spoke to—and I spoke to several hundreds in the last two days—put forward one point of view or the other, so I am pretty well apprised of the discussion on both sides. The new teaching hospital is a project which has majority support in Wales. A site of 50 acres has been taken for it and surveyed, and it is proposed to build there a hospital of 800 beds.
Representatives of United Cardiff Hospitals, the University of Wales, the Welsh National School of Medicine and the Welsh Hospital Regional Board are already working on the project. It is a lengthy and intricate task. It will cost approximately £5 million, and the Principality want it to be the best in existence when it is finished. They are preparing a schedule of accommodation, because they have decided that there shall be an architectural competition, and there is not inconsiderable discussion locally on what must be included in this project. Final decisions which will form the basis for competition are expected to be ready probably at the end of the year.
1761 Again I say that this is the decision of the authorities in the Principality, and the hon. Gentleman would be the first to challenge me if we made any effort in the Department to override it. It will probably mean that it will be two years before building could be started, but the planning of this great scheme, which is a very large and very intricate one, is at the present time proceeding without any restraint, without any restriction. There has been no halt in all this, and, in fact, we have provided the permission for which they asked this year to allow them to go ahead with planning the architectural competition, and there has been a grant of £10,000 which, I was assured, would not all be spent this year.
So there is no restraint whatsoever on the progress being made by the Welsh authorities on this great undertaking. We hope that after the plan of the planning authority has been accepted, and after the skilled and fortunate architect has submitted the winning plan; that after probably a two—year stage—and this will not be for probably at least another two years—when we hope happier economic conditions will prevail, that the building of this great project will be able to go forward.
As for the Llandough Hospital, which, I agree with the hon. Gentleman, is a very fine and spacious hospital, there are at the moment 328 beds used. I understand that the Cardiff Corporation originally intended it should have 600 beds. The main services are there—water, and vast and very fine kitchens, which I had the pleasure of seeing yesterday.
I do appreciate that there is a solid body of opinion amongst those who are on the Board of Governors that they would like to see that extension go forward immediately, and I feel that the hon. Gentleman shares their views, but the decision not to extend this hospital and to make this hospital into the teaching hospital for Wales is a local one, which has been threshed out and decided by the authorities of Wales, and it has been made in the light of the evidence available to them and of those who serve medicine in Wales. One of the greatest disabilities is, I believe, its inaccessibility. It is not as accessible as the new site in Cardiff and the argument against this development of Llandough is that the Welsh Planning Authority has 1762 limited capital resources at is disposal, which can be used to better advantage elsewhere.
I come to the question of the chronic sick. Hon. Members will be aware that in many cases relatives today are less inclined to continue looking after very old people. In some cases it is due to shortage of housing accommodation, which makes it impossible for them. One of our greatest difficulties, not only in Wales but throughout the country, is that once an old person is admitted, even if his health is partially restored, it is very difficult to get him out again and into somebody's home. As the hon. Gentleman is aware, great work is being done at St. David's where there are 246 beds and where there is a waiting list of 140—
§ Miss Hornsby-Smith
No, chronic sick. There is a waiting list of 140 chronic sick. The turnover is lamentably slow, and, once a patient is admitted, even if he is restored partially to health, it is difficult to get him out again. I should like to congratulate Cardiff Corporation and Glamorgan County Council on the tremendous work they are doing in the home help service and in the nursing, and also in their old people's homes. I had the pleasure of visiting one of the homes at Dinas Powys yesterday afternoon. I should like to congratulate them and all those who are concerned with the care of the aged in the Principality. They are alive as we are alive to the great problem, which is one common to the country as a whole, that, with an increasing aged population, there is more reluctance on the part of young people to look after their elderly parents. It is a problem which is felt in every area, and not only in the Principality.
I should like to come to a more controversial topic, which the hon. Gentleman raised. I discussed this matter yesterday with officers and members of the Board of Health, the Regional Hospital Board and the Hospital Management Committee and Board of Governors. The implication is a very serious and very grave one indeed. The implication is that, through the medium of private consultation, specialists are allowing such persons as may pay them a fee to jump the queue. Hon. Members will be in no doubt of the gravity of this charge, and 1763 they will also be conscious of the fact that no layman can properly judge whether or not one patient is more chronic than another.
§ Miss Hornsby-Smith
No, Sir. The decision as to whether or not a patient has priority in sickness must be one for the specialist. It would be quite wrong if a layman, a member of a committee, or a Member of Parliament, assumed to himself the right to choose above a medical decision who had priority to go into hospital. The priority must be judged on the medical health and urgency of the patient, and that decision can only be made by the qualified specialist.
The officers and members of the Welsh Board of Health and of the Hospital Board to whom I spoke are convinced that the strictest impartiality is maintained in admissions to the Cardiff Royal Infirmary and the Llandough Hospital, and they categorically refute any suggestion that there is queue jumping. But if the hon. Gentleman can produce any evidence I can assure him that I will be quite ruthless in having it investigated.
I am sure he will agree with me, however, that it would be very wrong if this grave charge went out against specialists who are doing magnificent work in the hospitals in Cardiff. We must realise that there will be occasions when private patients will be more seriously ill than others who have been waiting. With long waiting lists for many ailments in the Principality, it is inevitable that people will get disgruntled and disheartened because they have not been admitted as early as they would wish to be.
I must say again that the decision must rest with the specialist. He is the only person who knows the beds available in the hospital, and has the case papers of all the patients before him. If I may say so with respect—and we are all guilty of it—hon. Members sometimes write very vehement letters about patients.
§ Miss Hornsby-Smith
I would remind hon. Gentlemen that they see only the cases that are brought to their attention. They do not know all the cases on the 1764 waiting list, and they have not the specialist knowledge by which they can judge. We must rely on the specialist's knowledge to choose those in any section or group of patients who are the main priority case. Irrespective of the circumstances of any consultation it must be for the specialists in the medical profession to determine the relative urgency of patients who need admission. No layman, not even an ordinary doctor, is able to do it.
If the work of these specialists is to be challenged—and I think it will be generally accepted by all that only they can make the decision—then it must be substantiated with evidence. We must be sure before we spread a charge as grave as this—and it is a very grave reflection indeed upon the consultant service—we must be sure that we have our evidence, and I can assure the hon. Gentleman that I shall be only too happy and ready to look into any case he likes to bring before me.
§ Mr. Thomas
Will the hon. Lady help these people to be examined by a specialist free of charge, and then see how many of them go in?
§ Miss Hornsby-Smith
If people chose to go to a private doctor rather than an ordinary National Health Service doctor they are at liberty to do so. I repeat, it is a very grave charge indeed that the hon. Gentleman is levelling.
§ Mr. A. Roberts
Does the hon. Lady agree that there will be an administrative officer who will play a part in the admission of patients?
§ Miss Hornsby-Smith
Yes, I do, but the medical decision must lie with the specialist. I took great pains to discuss this matter with members of the Welsh Regional Board, and Board of Governors and others, and if the hon. Gentleman has evidence I shall be happy to investigate it; but until I have that evidence, in fairness to those- who are doing this great work in Wales, under great difficulty because of shortage of beds, until we can prove that there is this queue jumping, we should not lay as grave a charge on these men who are doing such fine work.
§ Adjourned accordingly at Nineteen Minutes to Eleven o'Clock.