§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Wills.]
§ 4.11 p.m.
§ Mr. Cledwyn Hughes (Anglesey)
I am glad to have the opportunity of raising some of the difficulties connected with administration of hospital services in North-West Wales. It is a matter of general agreement that the National Health Service should operate as efficiently and effectively in the rural areas as it does in the cities and in the towns. In this context there was far more leeway to be made up in our countryside than in our urban areas. In some respects it is right to say that our rural areas are still at a disadvantage. One example of this is the difficulty which regional boards are experiencing in filling junior posts in peripheral hospitals and even in regional centres.
At the Caernarvon and Anglesey Hospital at Bangor two registrarships have been vacant for about 18 months, apart from short temporary duty by junior staff members. The posts have been advertised continually throughout that period, but there have been no applicants and no permanent appointments have been made. This gives rise to a serious position because it means that the consultants have inadequate assistance and are often overburdened with work.
As the hon. Lady will know, the registrar is the young doctor who has decided to specialise in a certain field, he is studying for a higher degree and learning how to run a department in his special subject. He also accepts more responsibility as he advances in the various grades and, in time, he becomes an invaluable assistant to the consultant.
Of course, it is not hard to find the reason for the shortage of candidates for these posts outside the great teaching centres. There are obviously better facilities for training at the big hospitals, and consultant appointments are made from amongst doctors who are already at the teaching hospitals. Therefore there is obviously a grave conflict between the needs of the hospitals on the one hand 1064 and what is advantageous to the young doctor on the other. I do not think that anyone would blame the young doctor for thinking of his career.
What we must not forget in all these matters is that the interests of the people are paramount and if, because of the conflict I have mentioned, posts are left vacant for a long time, then consultants, however able and hard-working they may be, will not do their work thoroughly and the people will suffer as a result. That is why I am worried about the position at Bangor, and I have no doubt that there are parallel cases in other parts of the country.
What is the solution? I should like the Minister to give her views upon it, bearing in mind that the future consultant can gain invaluable experience at outlying hospitals—excellent clinical experience—and more responsibility. As I see it, there is a need for some compromise on this matter, and I cannot see why arrangements cannot be made for registrars with perhaps two years' experience at a large teaching hospital to be seconded to the outlying hospitals for a further period. Such an arrangement as that would benefit the doctor, the hospital and the public.
I now wish to deal specifically with the Caernarvon and Anglesey Infirmary at Bangor. As the Minister will be aware, there has recently been a difficult chapter in the history of this hospital, to which I will make no more than a passing reference because I hope that the committee, the doctors and the nursing and administrative staffs there will now work together in complete harmony.
But when I consider the recent tension in this district, I wonder how much of it was due to the inadequacy of the hospital building itself. After all, this is the central hospital of a group of 23 hospitals and is totally inadequate for the work it has to do. It was never intended to do the work it is doing today, and I would draw the Minister's attention to a description of this hospital contained in the survey of the hospital services for the South-West area. It says:Considered as a building, this is an old-fashioned hospital of rather poor quality, not well-designed for modern work. … Some of the passages are narrow and inconvenient, and there is a deficiency of storage accommodation. …1065 There is only one operating theatre. There is no room for extension or rebuilding, and all the available space has been built upon. The present position of Bangor is serious and completely unsatisfactory. The siting, I understand, of the proposed new hospital has not yet been agreed upon, although I believe there have been discussions. But we need action because a new modern and well-equipped hospital with a sufficiency of beds is essential in this area. I urge the Minister to see that everything possible is done in order that this hospital may be built as soon as possible. If she can give me some information today as to the prospects I shall be very grateful.
The Minister will also be aware that there is another hospital at Bangor, the County Hospital. Before 1948, this hospital was under the Caernarvonshire County Council, and since then has been largely a maternity hospital. I will give some figures to illustrate the gravity of the position. There are 78 beds for maternity cases, 24 are allotted to gynaecological cases, and there is a waiting list of about 300. It is really a most serious position when we think that today 300 women are suffering pain and anguish because of the shortage of accommodation.
In the same hospital there are 35 children's cots, and here again there is a long waiting list. There is one operating theatre in the hospital, and to get to it one must go through a ward in which there are patients. The feeling of the patients in that ward can well be imagined when other patients are wheeled in for operations or wheeled out after being operated upon. I understand that there are cases on record of patients who have become ill after witnessing other patients being wheeled out after an operation.
A new hospital in Bangor is absolutely essential and I call upon the Minister to see that it is given urgent priority Again, the accommodation for nurses at the hospital is completely inadequate. There are 40 to 45 nurses who have to live in lodgings, a state of affairs which provides no incentive to young women to enter this essential profession. They stay in their sitting room in the hospital and have their meals in the hospital, and then have to turn out late at night or early in the morning to go to a bedroom in lodgings.
1066 I now turn to the subject of tuberculosis. The House will know what a dreadful scourge that disease has been in Wales, and particularly in the area with which I am now concerned. I am very glad to be able to say that there has been some improvement in the position, but the death rate from tuberculosis in Anglesey and Caernarvon is at least 50 per cent. higher than in the country as a whole. It is a matter of urgent necessity that here, again, the provision of beds should be proportionately increased.
On the basis of three beds per death we should have 250 beds. At present in the three sanatoria, Bryn Seiont Hospital, the Druid Hospital at Llangefni, and the Llangefni Sanatorium we have 41 beds for males and 53 for females and we have also 40 to 50 patients at the Llangwyfan Sanatorium. In all we have 140 beds at our disposal and there are nine males and 50 females on the waiting list. The average wait for females is two to four weeks. That is reasonable. But for males the average waiting period is from six to eight months. That is a most serious situation and we are in acute need of from 50 to 100 beds for tuberculosis sufferers.
Again, there is an increasing number of cases of senile tuberculosis in the area and because of their infectivity they have to be admitted to hospital. This deprives younger patients, for whom more active treatment can be given, of a bed. Surely there ought to be separate accommodation for cases of that sort. The problem is acute in North Wales because of the high incidence of silicosis in the slate quarrying areas, and these cases are often complicated by tuberculosis. There is no provision for non-tubercular chest diseases and those cases have to go to Liverpool and have to wait for anything up to two years for a bed. There is a need in North Wales for the establishment of a thoracic unit for the treatment of tubercular and non-tubercular conditions of the chest and to attract the best men we must have beds for both types of cases.
May I say this about the three tuberculosis hospitals in the area: The Bryn Seiont Hospital is an old converted private house. Several wards and out-patients' departments are much too small. The staff has very poor accommodation. In 1948 the hospital was high on the list for 1067 scrapping and architect's plans had been prepared for a new hospital. Nothing but essential maintenance has been done since 1948. The Druid Hospital at Llangefni is a temporary war-time building formerly used for cases of infectious diseases. There is no recreation room for patients and the staff quarters are absolutely deplorable.
The Llangefni Sanatorium, as the Minister will remember, was badly damaged by fire last year. The nurses' quarters were completely gutted and one wing was badly damaged. Now there are 17 beds where there were formerly 30. There is plenty of land available for building and for extension. I appeal to the Minister to look into the matter. It is not a question of not being able to afford it, and arguments of economy will probably be advanced. The fact is that we cannot afford not to take some action soon in North Wales in this matter.
I should like to quote from a report by Doctor J. Glyn Jones, the Area Chest Physician, who says:I think that pressure should be brought to bear on the responsible body to have this institution fully re-established as soon as possible.He goes on:It is still my contention that the provision of more beds remains the most urgent necessity in the fight against tuberculosis. The energetic steps taken in recent years are now bearing fruit, the battle is proceeding favourably. Let us not, however, relax but rather redouble our efforts until final victory has been achieved.I should like to mention the place of the small peripheral hospitals in the scheme of things. These are giving first-class service to the community in the rural areas. I know that this is true of small hospitals in Caernarvon, Anglesey and Merioneth and I could speak enthusiastically and for a long time upon the merits of the Stanley hospital at Holy-head. I know that there is a school of thought which would demote these small peripheral hospitals and reduce them to the level of clinics. I know that the protagonists of this school of thought can deploy strong and effective arguments in favour of their case. The sort of argument that they use is this: "The equipment, staff and facilities are available in the big hospitals. Let us, therefore, bring all the patients here."
1068 In my submission, it is dangerous to generalise in that fashion. Civil servants and others, too, often tend to think in terms of a twopenny tram ride to the nearest hospital in the city. It is not as simple as that in the countryside. In North Wales, as the Minister knows well, there are long distances to be travelled over very difficult country, and in many cases it would be better for one healthy consultant to travel 25 miles than for five ill patients to travel the same distance.
We must have a sense of proportion in this matter. Certainly let the patients travel to the big hospital wherever it is possible and advisable that they should do so, but let us develop our small hospitals so that they can continue to give effective limited service as hospitals in the communities in which they are sited.
I have been somewhat disturbed recently by the number of non-Welsh speaking appointments made in predominantly Welsh-speaking areas. I refer to administrative and some medical appointments as well. In saying this, I hope it will not be thought that I am being bigoted. I am speaking from a commonsense point of view. The Minister will see from the last census that the number of people who speak Welsh is overwhelming. A number of people speak Welsh only, and the predominant part of the population would prefer to express themselves in Welsh. Welsh is their first language, and although many of them can speak English, they prefer to speak Welsh.
I was speaking the other evening to an Anglesey doctor and he told me that when he sees his patients he has to speak Welsh to over 80 per cent. of them; certainly over 80 per cent. of his patients prefer to speak Welsh to him. In the case of the special relationship between patient and doctor, surely this is natural.
§ Mr. David Llewellyn (Cardiff, North)
I am obliged to the hon. Gentleman for giving way. Would he agree with me that the first consideration should really be the skill of the doctor, and that the doctor with the best skill should get the job, regardless of whether he speaks Welsh or English?
§ Mr. Hughes
Surely we have Welsh doctors who are as brilliant as English, Scottish or Irish doctors. Where the skill is equal, I think that the question of the language should be the balancing factor. I concede that where the non-Welsh speaker is more skilful and is better qualified, he should be appointed.
Let me give some figures about administrative staff. The secretary, the deputy secretary, the finance officer, the deputy-finance officer, the deputy-supplies officer and the superintendent at the Anglesey Hospital are all admirable people. I know some of them. They are able men, but they do not speak the language of the people in the countryside.
May I take this opportunity of paying a very warm tribute to all those doctors, nurses and administrative staff who have worked in Anglesey, Caernarvonshire and Merionethshire, giving great and unselfish service to the people without thought of reward or return, and often in very difficult circumstances.
§ 4.29 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to the hon. Member for Anglesey (Mr. C. Hughes) for the very fair manner in which he has drawn attention to the unquestionably difficult problems in the area of Anglesey and Caernarvonshire. I feel sure that he will forgive me if I dodge some of the pronunciations which, I admit, are quite beyond me, but I hope that he will recognise the districts to which I may be referring.
I am sure that the hon. Member would be the first to admit that one of the greatest problems we have in this very rural area is that of the natural geography of the place, the very sparse and scattered population and the poor communications. The absence of any really large centres, therefore, makes the organisation of hospital services in this area an extremely difficult one.
Arising immediately out of that, the hon. Member raised the question of the difficulty of securing suitable candidates for registrar posts in non-teaching hospitals. That is a problem common to many areas, but one which is particularly acute in Anglesey and Caernarvon. As 1070 the hon. Member pointed out, the regional hospital board have been endeavouring, by repeated advertisement, to fill certain posts in Caernarvonshire. They will do their utmost to bring such posts to the notice of those qualified and possibly desirous of filling them but, unfortunately, so far it does appear that registrars do not easily go to this area.
It is very difficult to see what other steps the hospital board could take, as I am sure the hon. Member would, with me, be against any suggestion of departing from the principle that we should not direct any members of the profession to serve in a particular area. I can assure him that the matter is under discussion nationally in the profession and is being treated as a matter of urgent concern as to how registrars and similar appointees can be persuaded to go into what are admittedly very difficult areas.
The hon. Member raised two questions on the functions of peripheral hospitals and they link one with another. He suggested that it is our policy to demote such hospitals. That I refute outright.
§ Mr. C. Hughes
I did not suggest that it was the policy of the Government, nor of the Department, but I said that there was a school of thought on the subject.
§ Miss Hornsby-Smith
I thank the hon. Member for the correction, but I can assure him that whatever that school of thought may be it is not the policy of the Department to demote hospitals. There must be a balance and a limit to which we can go in upgrading a very small unit, and the extent to which we can impose upon it all the specialities normally available in a large general hospital serving a greater area.
I know that there have been protests at the refusal of the regional hospital board to upgrade certain small institutions in the area. There has been some controversy over Bryn Beryl. I think it fair to say that that small hospital was originally a villa residence. It was requisitioned and added to during the war by the Admiralty and since then it has been turned over to a small hospital; but it is a small unit and it would be quite unrealistic to upgrade it to such a status that it would be able to deal with serious or speciality cases.
1071 We have to get a balance between the extent to which we can improve these small units and the extent to which we can impose upon them the full upgrading of what we regard as a full general hospital. I think there has been a compromise by the regional hospital board whereby X-ray has been provided, but any really serious emergency or surgical work has to go to Bangor or Llandudno. There is a compromise whereby smaller surgery work can be done at Bryn Beryl to meet the needs of the local people.
Small hospitals can cope with many types of illness, but there are many other cases which are beyond the competence of small units and it is essential that the patients should be able to go to larger hospitals where the range of pathological and radiological services are available with specialist and nursing services. Any suggestion that these small units could be brought up to that status would be quite unrealistic, if only from the point of view of the immense capital expenditure involved to provide so many special facilities for so few beds.
The hon. Member dealt in great detail with the shortage of beds for tuberculosis cases in North Wales. I realise that they have a serious tuberculosis problem there and that, as he truly says, Anglesey and Caernarvon have some of the worst figures in England and Wales. The waiting list is 58—that is, waiting to go into T.B. hospitals in the area; but it is not so much a problem of finding new units as of providing nurses. The real shortage is not one of beds but one of nurses; in fact, there are 223 unstaffed T.B. beds, of which 66 are in Llangwyfan, the T.B. sanatorium near Denbigh. There has been a vigorous recruiting campaign for nurses to serve in T.B. sanatoria. Efforts have been made in particular in that area and also at the Sully Sanatorium, South Wales.
There is the problem to which the hon. Gentleman referred in an area 12 miles from Caernarvon town, where the incidence of T.B. has been especially grave. The regional hospital board have applied special attention to that area so that this year a mass radiography survey has been undertaken with the intention of making a complete 100 per cent. survey of the population there. So far, the 1072 response of the workers has been most satisfactory, and I hope that it will not be long before the whole survey is completed and a report made.
Turning to the question of Bangor Hospital, we acknowledge the need for a new hospital in this area. The hon. Member will know that there is a suggestion that a hospital of 500 beds should be built but, as he will also know, the priorities are established primarily by the Welsh Regional Hospital Board. The first priority for Wales has been allocated to the new teaching centre at Cardiff, which is the first major capital project which will be permitted when it is possible to provide the vast capital expenditure necessary for such an undertaking.
There are other rivals for second place, but I have no doubt that the claims of Bangor are very high in the list. This much has been done: a site has been acquired at Penrhyn Park and application has been made for its designation under Section 5 of the Town and Country Planning Act for the purposes of building a hospital. There are some objections to be heard from the trustees and others who do not particularly want this site to be chosen, but that is a matter which, as the hon. Member will appreciate, must be thrashed out later.
I regret that I cannot begin to give him the date of the start for that building. It would be misleading to try to give a date by which we believe it might be possible to make a start on this hospital. There is, however, no doubt that its building is agreed in principle. Efforts are being made to find a site and there is no reason why every effort should not be made to start the plans so as to be ready the moment it is possible to make the capital allocation for this admittedly most important unit.
§ Mr. C. Hughes
I understood that Bangor was next on the priority list to the teaching hospital at Cardiff.
§ Miss Hornsby-Smith
That may be the hon. Gentleman's view, but I am advised by the regional board that there are rivals in two other areas for this claim, and I would not presume to make a decision in something which is so much a local matter for the people in Wales.
1073 Time is against me, but in the few minutes remaining I can assure the hon. Gentleman that the question of accommodation for nurses has not been overlooked. Four units have been opened since the appointed day and have provided 65 more beds in the area in which he is particularly interested. As a temporary measure, at any rate, every effort is being made to provide living accommodation outside, so that if we get the staff at least we can use them in the units where they are most urgently required.
Finally, dealing with the question of Welsh-speaking staff, I assure the hon. Gentleman that it is the policy of the Welsh Regional Hospital Board to make 1074 the priority which my hon. Friend mentioned—that the first consideration must be the qualification and skill of the man appointed to a post. Beyond that, if two men are equal, then preference is given to a man who is Welsh-speaking. As for the hon. Gentleman's complaint about the staff of the hospital management committee, I would inform him that the committee appoint their own secretary and staff and that the committee are primarily Welsh-speaking, so that the decision really lies in their hands.
§ Adjourned accordingly at Nineteen Minutes to Five o'Clock.