§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Oakshott.]
§ 10.1 p.m.
§ Mr. Bernard Braine (Billericay)Some months ago my attention was drawn to the very serious shortage of accommodation for mental defectives, particularly mentally defective children, in my own county of Essex. To find out just how serious was this particular problem, I put a Question down to my right hon. Friend the Minister of Health—I think it was in July—asking him if he would give figures, not only for the North-East Metropolitan Region, which includes the county of Essex, but for the whole country.
The answer I received was frightening. Apparently, the number of beds which ought to be provided, or which at that time ought to have been provided, in the space available was 46,431, of which over 2,000 could not be used for lack of staff. The answer also revealed that institutions in England and Wales were accommodating some 49,000 defectives, while, outside, there was a pathetically long waiting list of some 8,000, of whom half were children.
It is with that waiting list that I am concerned tonight. The House will understand the gravity of the position when I say that, whereas in cases of mental disorder, a cure is possible, mental deficiency is incurable. While some 70 per cent. of admissions to mental hospitals are subsequently discharged, the turnover for mentally defective institutions is of necessity much lower. Indeed, the problem is worsened because the death rate is low, and has become lower since the introduction of antibiotics and sulphonamides. 287 As a result, many children on the waiting list remain there for years. They grow into adults and become an increasing burden to themselves, to their relatives, and, as the House needs no reminding, to society itself.
It is true that all high-grade mentally defectives, once they are stabilised, can be returned to the community and become useful citizens. Obviously, the earlier the training begins, the quicker and better the results. If children are admitted early enough they can acquire simple skills and some control over their habits, but the tragedy is that too often they are not admitted until it is too late for anything to be done for them, or until they come into the institutions through the courts because they have got into serious trouble.
I should explain that there are three categories of defectives. There are the feeble-minded, who, given sympathetic guidance and training, can become useful citizens. The men make good farm workers, and the women good domestic servants. Below these high-grade defectives, there are two tragic categories—the imbeciles and the idiots.
It is true that imbeciles, as defined by law, include a very large group who are able to perform routine tasks, and very many who can be returned to their homes on licence and can take employment. But below these are a whole tragic group of creatures in human form but incapable of looking after themselves, and needing constant care and supervision. Little is said about them. Nobody wants to say anything about them. They are generally hidden away from sight by parents who bear their burden with Christian fortitude and devotion. If they are seen by the parents of normal children the sight saddens and horrifies, but is quickly dismissed or thrust aside.
The nation must be made to understand that this is a subject which cannot be thrust out of sight. For many unhappy social consequences follow from the lack of accommodation. It is a fact, for example, that a good many who might have benefited by training, had they received it at an early age, commit antisocial offences and arrive at the institutions through the medium of the courts. It is a fact too, that the mental and physical health of perfectly normal 288 parents is often impaired by the burden of caring for an imbecile child.
It is a fact, also, and to this I would particularly draw the attention of my hon. Friend, that beds in ordinary hospitals are taken up by defectives who have been admitted for a variety of reasons, and in some cases have been abandoned by their parents. I have been told of one case in Essex where a child was kept for 11 years caged like a wild animal in an iron cot in an old men's ward. Just imagine the effect of that upon the staff or on the other patients in that ward.
But the accommodation problem is growing. Take one institution—which happens to be a very famous one—in my own county of Essex. It should house no more than 1,443 patients. It has nearly 1,700 and a waiting list of 543 most of whom are children. The numbers on the waiting list for this institution have grown five-fold since the appointed day.
It may be argued that earlier ascertainment of a mental defective condition is the main contributory cause to the growth of the problem, and that is perfectly true. But it is not the only cause. There is the stress and strain of modern life, as many hon. Members know only too well. Thus the housing problem over the last few years has added to the burdens of mothers, often in ill-health, who have to care for a mentally defective child. For them the burden has been made quite intolerable. The figures I have quoted do not tell the whole story. I cannot possibly convey to the House the tremendous burden of suffering which has to be endured in countless homes.
Let me drag out into the full light of day five cases on the waiting list in Essex, one in my own constituency. The first is a girl of five, a helpless imbecile, destructive and mischievous. Her mother has been in a mental hospital and threatens to murder the child. The second is a girl of 13, a microcephalic idiot, living in a family of 10 in the care of grandparents who are in poor health. She has been known to knock her grandmother down.
The third is a boy of 3½, a helpless imbecile. The mother is in hospital and the father, who has had to leave his work to care for the child, is threatened with the loss of his job. The fourth is a girl of four. The mother has cancer of the jaw. The husband is a serving soldier. The child is jealous of a younger and 289 normal brother and has attacked him. The mother has threatened to kill the child unless something is done.
The fifth case is that of a girl of 11, an imbecile, subject to fits so violent that she has pulled out her own teeth. She is confined in an iron cot built like a cage. In this case there is a younger and a normal child whose backwardness at school is considered to be attributable to the conditions in which she is obliged to live. I might say that when this case was brought to the notice of one authority the suggestion was made that the normal child should be taken away, but that nothing could be done in respect of the other one.
Such cases shock anyone who investigates them. Yet nothing can be done for them. The accommodation is lacking. Some cases have been on the waiting list for years, and that is where they will remain unless it is possible for my right hon. Friend to conceive some method of tackling this problem.
What can be done? There are three main requirements: first, increased accommodation; secondly, more staff; and, thirdly, more voluntary workers to care for defectives outside the institutions. The accommodation problem is acute all over the country. I do not say that it is more acute in Essex—in fact, I think it is actually less acute—than it is in some other parts of the country. But in Essex we have to cater for patients from outside our county, and the problem is not within sight of solution.
I want to ask my hon. Friend if she is satisfied that regional hospital boards have been spending a fair proportion of their limited capital resources on accommodation for defectives. I want to ask her if there is not a case for another institution in Essex. I want to know if she is satisfied that everything possible is being done to remedy the shortage of staff, because in my belief that is the greatest problem of all. Mental deficiency nursing makes tremendous demands upon the individual. It is not congenial work. It calls not only for competence but compassion and understanding of a high order.
Is my hon. Friend satisfied that everything possible is being done to attract men and women of the right type? I ask this because, frankly, my researches have led me to believe, first, that male 290 student nurses and assistant nurses are not sufficiently well paid to attract the right type of man; secondly, that State registered general trained nurses are not encouraged to take up mental deficiency nursing, because if they do the pay is less than that of staff nurses, and, thirdly, there are no bonuses for uncongenial work such as the care of low-grade defectives. Anybody who has visited an institution and has seen what these devoted men and women have to do for these unfortunate children must realise that there is a case for bonus payments to attract more people into this work.
Fourthly, insufficient elasticity is allowed to hospital management committees in the appointment and pay of their staff. This last point is one of some importance, because the care of mental defectives has always been—I do not think there is any dispute about this—the cinderella among social services. Indeed, there are people who say—I am not saying it myself, but the opinion is widely advanced—that since the introduction of the National Health Service the position has deteriorated. At least, in the past committees had the power to raise standards and pay staffs as they thought fit. Now rigidity has replaced elasticity and centralised organisation has replaced local interest.
Surely it is wrong for a hospital management committee not to be in a position to pay the rate for the job to an assistant matron, general trained, who is doing whole-time work with the sick. Yet it is happening. Surely it is wrong that a sister at a general hospital, who is anxious to do mental deficiency nursing, because she feels she has a vocation, can only receive the pay of a probationer nurse if she transfers and must start at the bottom of the scale. Yet it has happened. I can give my hon. Friend examples. I do most earnestly ask her to press upon her right hon. Friend the Minister himself the necessity for freeing hospital management committees from arbitrary and often quite absurd financial restrictions on the appointment and pay of nursing staff.
I would ask my hon. Friend if she is satisfied that Regional Boards—who do excellent work; I am not criticising them in any way—pay sufficient attention to the question of mental deficiency? Is she aware that there is no psychiatric representative on some regional boards, and 291 that I can think of one where the regional psychiatrist, excellent though he is, is only a part-time officer.
Lastly, there is the question of arousing public interest in this grave social problem and attracting to the care of mental defectives outside the institutions the right men and women to do ordinary voluntary work. I am sure that if the problem were well known—and it is not well known—more people would come forward, because this is a field in which a great success story could be told. Wonderful work has been done in equipping mental defectives to take their place in society; but it has only been achieved as a result of long, painstaking and devoted work by men and women who possess a superabundance of loving kindness, sympathy and patience.
Will my hon. Friend say whether anything is being done to interest men and women in this important social service?
§ 10.16 p.m.
§ Mrs. E. M. Braddock (Liverpool, Exchange)Although the time is short, I want to add my weight—if I can put it that way—to the plea which has been made in reference to accommodation for mental defectives. Liverpool has a very particular problem because in the past it had no mental defective accommodation at all. Its accommodation was controlled by the Lancashire County Council and in the change-over I am afraid that the difficulties of Liverpool in this matter were to some degree overlooked.
It is a terribly difficult matter when a mentally defected child is at home, where the parents are not trained to look after it but, because there is no accommodation, the parents, in their inexperience, are compelled to take responsibility for every action the child does, although it is actually certified. In Liverpool at the moment we have 104 cases on the waiting list, and many of them have been on the waiting list for a long time. They are in four different sections and there are 77 cases of the highest urgency. In September of this year the maximum number of vacancies that we obtained from the Manchester Region was four.
In order to put the matter in its right perspective I want to quote some of the highest urgency cases, without quoting names and addresses because the circum- 292 stances are so terribly distressing and the parents have so much responsibility that it would not be fair to make their position any more difficult. These are also cases taken from the Mental Health Committee of the Liverpool Corporation. I have been a member of that committee for the past 22 years, and I have drawn attention to this matter in the House on more than one occasion.
A boy of 7 years of age has been waiting for three years. There have been sixteen separate reports on him since he was certified. The home is comfortless, dirty, overcrowded and in condemned property. The family consists of a father who is a labourer and a mother with six children. She is emotionally unfit and incapable of supervising the child. There is continual friction with the neighbours. The boy is in the imbecile grade and is incontinent, dirty and continually fighting. Among his exploits is the injuring of a neighbour's baby by throwing half a brick at it, upsetting a handcart full of cement and slamming an iron grid in the road on his penis. This is a distressing business to parents of that sort, and there is no possibility of a vacancy being offered.
Another case concerns a boy of 11 years of age who has been waiting for one year. This is quite a different type of case. The home is clean and comfortable, except that the defective has ruined all the furniture which he has been able to touch. There is one other child in the family. The parents have struggled hard to keep their defective boy at home. The mother is worn out. The defective is restless, uncontrolled, epileptic and rapidly deteriorating. He was tried at an occupation centre, but had to be excluded as he kicks and punches. He is impossible to take out, and scratches passengers on buses. He turns on gas taps. What a responsibility for an ordinary man and woman to have to accept. That is a certified case which has been waiting for 12 months for admission to an institution, with all the deterioration, upset and distress that arises.
I have eight similar cases to which I could refer, had I the time. This is a matter of the utmost importance. I might say that the decision now being made by the Minister and the regional hospital boards in reference to the stand- 293 still on staff and the reduction of nursing staff will definitely accentuate this very difficult problem. We are short of nurses. It is mostly lack of staff that is the difficulty.
The Manchester Regional Hospital Board have vacancies but they have not the necessary staff. If there is an economy cut on the nursing staff at present in the hospitals, how much more difficult will it be to deal with these particular types of cases. As I say, this matter comes up regularly each month before the Health Committee of the Liverpool Corporation, and the councillors are summoned to the meeting so that they shall be confronted with the situation and realise how it is growing. Believe me, this difficulty is increasing because we are not getting vacancies from the hospital board.
I believe that this is a matter which should be discussed and attention be drawn to it, not in a 25 minutes' Adjournment debate, for the position is so serious throughout the country that it deserves very full consideration so that those Members concerned may have an opportunity of fully expressing their opinions and pointing out the difficulties facing the various local authorities.
§ 10.23 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)I am grateful for the restrained manner in which my hon. Friend the Member for Billericay (Mr. Braine) has introduced this important debate. I am sure that the House welcomes it, because Members on both sides are very seriously concerned with the gravity of this problem. I have no desire to minimise the difficulties which face us in this matter. I am anxious frankly to give, in the short space of time that I have, some of the very vital statistics connected with this great problem.
There is a serious shortage of accommodation. But one cannot say that nothing has been done. On the contrary, 3,066 new beds in the regional hospital board hospitals have been open for mentally deficient cases since the appointed day. In addition many under-staffed beds have been equipped, but in spite of these 3,000-odd additions, the waiting list has risen from 3,933 on the appointed day to 7,929 at the beginning of this year. One has to face the fact that the demand is 294 growing faster than we have been able to open beds. I must add that possibly the latter figure is more correct than the first one, and may include cases not quite as urgent as the priority class in the first figure which I gave.
There are also 5,000 mentally deficient cases in mental hospitals which should be in mental deficiency institutions, and there are other cases in children's homes and institutions which should be in mental deficiency institutions. We do not seek to hide the gravity of this problem, and I thought that the House should have these figures. We need 15,000 new mental deficiency beds. We have at the moment 2,145 idle for lack of staff.
I should like to enforce what both hon. Members have said with regard to the unfailing devotion to duty of the nurses who, in overcrowded institutions, with grave shortage of staff, carry on and do an absolutely magnificent task looking after these patients.
We have to face the fact that far too little attention was paid in years prior to the National Health Service to the provision of accommodation, and that the National Health Service inherited a legacy of very serious shortage in this field. It must also be admitted that in the first years of the National Health Service regional hospitals boards did not all pay as much attention to this side of their medical responsibilities as they did to others, and an instruction from the Ministry last year, stressed again this year, has pointed out to the boards that they must devote an adequate proportion of their capital expenditure to this side of the Service. That has brought results.
Hon. Members will be interested to know that the average percentage of hospital capital expenditure allocated to mental health, for mental treatment and mental deficiency treatment, rose from 19.8 per cent. of the total capital expenditure in 1950–51 to 26.1 per cent. in 1951–52, and we estimate that it will be 30.2 per cent. in the present year. Therefore, the fears of the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock) that any economies have fallen on this side of the Service are unfounded.
For mental deficiency treatment alone the proportion of capital expenditure allocated in 1950–51 was 7.1 per cent., in 1951–52 11.4 per cent., and in 1952–53 it will be 10.9 per cent. In the hon. 295 Member's own area there has been a substantial effort to increase accommodation, and in mentally defective institutions alone the allocation has risen from 6.4 per cent. in 1949–50 to 19.3 per cent. last year.
There has also been an appreciable increase in nursing staff. The figures I am now giving cover staff and beds in hospitals which are mainly for mentally defectives. In 1948 on the take-over the total of full-time nurses was 5,941, and this year it is 6,542, and the staffed beds were 48,793 and they are now 54,025. I admit that the increase is not great enough, but there has been steady progress, and the Ministry is seeing that even greater accent is put on the problem by the regional boards.
One disquieting fact is the decline in the recruitment of student nurses. To meet this the various advisory bodies who make recommendations to the Ministry of Health and the Ministry of Labour and National Service on the problem have been discussing the questions of pay and training in an endeavour to see if a shorter period can be provided for training nurses who are already generally trained nurses and who then opt to go over to mental nursing. Student mental nurses receive £30 a year more at all stages than student nurses in general hospitals, and trained staff up to assistant matron and assistant chief male nurse get £20 more than the equivalent grade in the general hospital. The Whitley Council has recently agreed to an increase for all nurses, and I believe that will do much to help us in our recruitment of nurses.
I think my hon. Friend's zeal rather led him away when he asked for bonuses for uncongenial work. It would really be impracticable to draw a line between the various aspects of nursing service. The nurse is trained for all types of work and is paid on that basis, and the rate for the job is determined nationally by Whitley agreement. It would be quite impossible if 400 hospital management committees were allowed to depart from these general 296 standards of pay and if there were uncontrolled salary or wage fixing and competition between one hospital management committee and another for staff. It would create injustice and very grave inequality. Any addition must be on a national basis and must, in the normal way, be decided by the Whitley Councils.
In my hon. Friend's own area there are two hospitals for mentally deficient cases, the South Ockenden Institution and the Royal Eastern Counties Institution, where at the beginning of the year there were 3,047 patients. Besides these, there are three certified institutions in the region, outside the National Health Service, which take 230 patients, 48 cases in approved homes, making 3,325 mentally deficient patients in the North-East Metropolitan region.
Since the appointed day the North-East Metropolitan Board have opened 165 additional beds for mental defectives, and they have schemes in hand for a further 127 beds of which 80 are in two villas at South Ockenden. There is also a long-term plan for that region of 420 further beds in South Ockenden. It is fair to say that there are no unstaffed beds in the North-East Metropolitan area, the area in which my hon. Friend is particularly interested.
I regret that time will not permit me to give many of the other details that I should have liked to give the House. I am sure all hon. Members will agree with me that this is a grave and serious problem. It is a long-term one. We can only hope that the emphasis given to this problem tonight will awaken responsibilities generally and encourage still further the efforts which the regional hospital boards are making to meet this said and tragic problem.
§ 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 Twenty-nine minutes to Eleven o'Clock.