HC Deb 01 April 1953 vol 513 cc1316-34

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

8.58 p.m.

Mr. A. Hargreaves (Carlisle)

I wish to draw the attention of the House to the personal case of one of my constituents. Its discussion at this time cannot, unfortunately, help him, but I hope that the recital of the facts of the case may help to stimulate the Ministry of Health to avoid a similar occurrence in future.

The facts are that my constituent, Mr. Frederick Maw, who was 55, and lived at 42, Westmorland Street, Carlisle, left work on Friday, 22nd August, 1952, and travelled to London on holiday to stay with his wife's sister in London. Six days later, on 28th August, he had a sudden collapse—some kind of stroke—and was admitted to Lambeth Hospital in a dangerous condition. His wife was summoned to London from Carlisle. She visited him in the hospital on the following day and arranged to continue to stay in London with her sister to be near her husband.

Mr. Maw was on the special visiting list, as he was dangerously ill, and his wife was able to visit him frequently. I should make it clear at once that Mrs. Maw had no complaint of the treatment which her husband received while he was a patient in that hospital. He was, however, discharged on 22nd September; travelled by train to Carlisle in the care of his wife; was admitted to the City General Hospital in Carlisle on the following day, and died one week later, on 29th September. I understand that the layman's explanation of the cause of death was progressive paralysis of the spine.

Now I come to my complaint of the treatment which this unfortunate man received. First, I assert that he was not fit to be discharged from the hospital, or to undertake the journey from that hospital to Carlisle—a total journey of well over 300 miles. No arrangements of any kind were made by the hospital authorities for his transport and no nursing care was provided for him during his transit home.

His wife had to arrange transport from the hospital at South Lambeth to Euston Station at very short notice. She reserved two seats in the train and had to care for her husband during the train journey of seven hours. He was in a desperately ill condition and on reaching Carlisle she had to convey him and the luggage from the station to their home. I want to speak in as restrained and factual a way as possible with regard to the details of the journey, but it cannot be denied that it must have been a very great ordeal for the man's wife.

Her husband's throat was paralysed and he was totally unable to communicate with her in any way. He could not walk unaided. He had no control over the muscles of his throat, by reason of the paralysis, which was centred at the base of his skull, and so he could not swallow his saliva and he dribbled continuously. In addition, he was incontinent, and during the journey he caused himself, his wife and the other passengers in the compartment very great embarrassment, to which I think they should not have been subjected.

On reaching home his wife found that he was suffering from bed sores, probably caused by the fortnight or so that he had been in hospital in London. Those bed sores, which were on his ankle and hip, must have caused him intense pain. I am not suggesting—and his widow has never suggested—that the cause of his death was the fact that he had to undertake this quite distressing journey, but I do suggest that the bare recital of the facts which I have placed before the House makes it abundantly clear that this man was not in a fit condition for discharge from the hospital and ought not to have been made to undertake that journey.

I raised the matter immediately it was brought to my notice, very shortly after the man's death. I wanted—as most hon. Members would want—to spare the relatives any public recital of these matters. I did not proceed by way of a Question on the Order Paper; I raised the matter in correspondence with the Minister, in order that undue publicity should not be given to the case, for the reasons I have stated.

I wrote to the Minister on 21st October, 1952, and his reply was dated 3rd December, 1952. In it, he argued a number of points. He stated, first, that the patient had been discharged at the request of his wife and, secondly, that the patient was not incontinent; and he made the point that if a brother-in-law of Mr. Maw could drive Mr. Maw to Euston Station, there was no need for the provision of an ambulance.

There were discrepancies in this reply— this delayed reply, I think I can fairly describe it—and I therefore placed those arguments before the widow and went into the circumstances more fully. I wrote to the Minister again on 2nd January, 1953, sending him my constituent's denial of the statement contained in the Minister's letter. The Minister's reply to that letter did not reach me until 16th February. I have spoken of two letters, but between the times which I have mentioned I had reminded the Minister that I was awaiting his reply.

It is not unfair to suggest, I feel, that this considerable delay in answering the requests of a Member of this House for information in connection with a case of this kind, this conduct on the part of the Minister, is deserving of the very serious consideration of the House. I suggest that the delay was completely unreasonable for this reason: a Member of the House is entitled to approach a Minister in the way which I adopted—by means of correspondence, in order to avoid publicity— in the expectation that, if he is convinced that there is at least a prima facie case for investigation, the Minister will without delay make the full particulars of the case available to the hon. Member so that the reasonable requests of a constituent may be fully met and satisfied.

The Minister may point to the administrative machine of the hospital services and suggest that it is responsible in some measure for the fact that it took from 21st October, 1952, until the final letter which I received from the Minister on 16th February this year—a lapse of months—before I was able to obtain the information which I required.

I followed that correspondence by a Question which I placed on the Order Paper on 12th March. That Question was by no means satisfactorily answered, which is the reason I have brought the matter before the House tonight. I suggest that the Minister ought to seek means of satisfying the legitimate requests of a Member for information along the lines I have indicated and of giving full satisfaction with the minimum of delay. He ought to be able to speed up the administrative machine so that a Member need not wait months to have his reasonable requests for information met. As is plain from the bare recital of the facts I have given, this was a perfectly legitimate request, and it ought not to be necessary to keep a Member waiting so long for information in such circumstances.

Now to deal with the actual replies of the Minister. Here, again, I think I have a reasonable case for complaint. The Minister's reply to my Oral Question on 12th March suggested that I was wrong in one particular and that the hospital authorities had reserved seats on the train for this unfortunate patient. On that point the Minister is proved to be wrong. I have the facts, and I advised the Minister accordingly so that he might investigate them before replying to this debate. The Minister also, at a later stage, admitted that on another point his reply to my submission was incorrect.

I said earlier that this patient was still incontinent on discharge, and I referred to the distress and embarrassment caused to his wife by that circumstance. That was denied by the Minister in the first place, but it was later admitted. It is admitted also that the man was discharged with bed sores. It is suggested by the Minister that a nurse escort should have been made available for this exceptional journey.

As to the point that the Minister made that the discharge from hospital had been made at the request of Mrs. Maw, the lady has continuously and strenuously denied that. Her account of the circumstances is corroborated by three of her relatives resident here in London who accompanied her on her regular visits to her husband in the hospital. Here is a point that the Parliamentary Secretary may take note of in that connection. I imagine that if this patient had been discharged in the care of his wife at her request, the hospital authorities would have asked her to sign a form of consent. Such a form was not presented, and such a form was certainly not signed by Mrs. Maw.

Mrs. Maw, who had no nursing experience of any kind, had to care for her husband in the condition I have described during a very long journey which lasted more than seven hours. It placed upon her a responsibility that few of us would care to undertake. She had to rely entirely on her own resources. Her husband was discharged on Monday. The day before Mrs. Maw asked her brother-in-law, at very short notice, as I have said, to convey her husband to Euston Station from the hospital. Mrs. Maw booked the seats on the train. That is now corroborated, although it was earlier denied by the Department.

Mr. Maw reached Carlisle late in the evening, and was taken home, and his own doctor saw him the following day and ordered his immediate removal to hospital. I do suggest most forcibly to the Minister that this fact, that the man was at that time obviously in need of hospital treatment, supports my contention that he was unfit to undertake the journey to Carlisle, and unfit for discharge.

I think that this is a case which, after months of correspondence, deserves a searching inquiry. I suggested to the Minister in a letter and by means of a Question in the House that this inquiry ought to be held. But the Minister all along has stubbornly resisted the obvious conclusion to be drawn from these facts, which I have recited to the House. As I have already remarked, I have been factual and restrained in the way I have presented them.

If it were necessary to discharge this patient from hospital—and I do not admit that it was—every possible care should have been taken by the hospital authorities to convey him from that hospital to the station. The hospital authority could perfectly well have undertaken his careful conveyance by rail from Euston to Carlisle, which is open to them to do in a way that is not open to the ordinary travelling passenger by rail, who cannot command exceptional facilities. I also suggest that the hospital could quite easily have arranged for a nurse escort during that journey and for conveyance by ambulance from Carlisle station to Carlisle Hospital.

All along I have asked myself why this case was dealt with in this way. Is it because there is such a desperate need for economy in the transport and other services connected with hospital treatment when a case of this kind occurs? From my own knowledge of the circumstances that obtain in the county of Cumberland, I hesitate to suggest it would not have been quite easy to make ambulance conveyance available to the station. That is my experience in the more sparsely populated areas in Cumberland.

Whatever economies may be considered necessary by the Minister—and his statement today gives me no very great hope —I suggest that he would have the support of public opinion if he put in a claim that the hospital services and the needs of hospital patients should come first. This is a national hospital service. It is not a service in which London hospitals are kept for London patients, or Carlisle hospitals are kept for Carlisle patients. Every patient, wherever he may come from, is entitled to receive treatment. Every patient ought to be assured on his entry into hospital that the same high standards will prevail wherever he may be. That is the least that we can expect from the hospital service.

I indicated earlier that the Minister's announcement today may be a reason for the unfortunate happening in connection with this particular case. Directing my remarks to the Minister, may I say that it is evident that he thinks that parts of the National Health Service—and that includes the hospital service—can be subject to economies. The announcement which he made today announcing the setting up of a committee under the chairmanship of Mr. Guillebaud, suggests that he envisages economies can be made in parts of the service.

Ever since this case was brought to my notice, six months ago, I have sought for a reason to explain the extraordinarily bad treatment of this patient. It may be that the Minister thinks that the cost of the National Health Service takes up too much of the economic resources of the nation. That is the point of view he appeared to be expressing at the Dispatch Box this afternoon. I can fairly say that this case is completely unjustifiable on any grounds of economy, and I suggest again to the Parliamentary Secretary that if she can assure the House that this case is deserving of a formal inquiry, she should seriously consider making representations to the Minister that such cases ought not to be permitted to happen, because they weaken the confidence of patients in the hospital service.

We ought to endeavour to sustain confidence in that service by doing our utmost to prevent any possibility of treatment of this kind occurring again. All of us here, and anybody with knowledge of the hospital service, would pay a tribute of respect and affection to it, and to the staffs who are engaged in the service for the devotion and skill that they give to the people. We ought, therefore, to ask the Parliamentary Secretary to give a full and complete answer to the case that I have laid before the House tonight, in the interests of the service. I leave it there, Mr. Speaker, in the hope that I can receive from the Parliamentary Secretary what I want and what I hope she will be glad to give me.

9.24 p.m.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

I am grateful for the opportunity that the early ending of the previous debate gives me to follow one or two points that my hon. Friend the Member for Carlisle (Mr. Hargreaves) has raised. We all listened to the tragic case that he has outlined and to the valid point he raised as to whether or not there can be any connection between a case of this kind, if not this particular one, and the drive we hear about for the general reduction of expenditure in the National Health Service. He was certainly not alone in his anxiety when he heard, as the rest of us in this House heard, the announcement made by the Minister of Health today that a new committee is to be appointed, apparently to put forward proposals for a reduction in the Health Service. We should be lacking in our duty in this House if we did not take the first available opportunity to make clear the dangers that this course involves.

There must be a good deal of misunderstanding about the cost of our Health Service. It seems to be evident that the Minister is accepting without question as a fact that it is costing far more than is necessary, and that great economies can be carried out without danger to the service and to the treatment provided for patients within it.

Naturally, we are anxious as to whether, in this drive for economy, we may not hear about countless more cases of the kind mentioned by my hon. Friend and, of course, cases covering a much wider field. We cannot emphasise too strongly the fact that, far from the overall expenditure in the Health Service being too great, we must examine the point as to whether or not extra additional expenditure is not urgently required for the benefit of the community.

I would be the first to agree that economies can still be made in the Health Service, but we are all too well aware of the fields in which large sums of new expenditure are required. In fact, over these last few years, due to the imposition of an overall ceiling upon health expenditure, at the same time as costs have been rising, the services given within the service have had to fall. We are oppressed by the fact that as this becomes more severe, especially this year, the pressure upon every hospital authority to deal with rather less than its customary good will with individual cases is bound to grow. Where a hospital authority could take a risk in the expenditure of money on the kind of case to which my hon. Friend has referred, there will certainly be strong financial pressure on them to make the economy. Yet my hon. Friend is right to say that, unless hospitals are able to incur this kind of expenditure, the quality of the service can be endangered.

Because the costs of the service are rising, including food costs, the hospitals, like other sections of the service, are having to face all the time the need to cut down what they can provide, and this at a time when in our interests as a community we should expand many of the services that richly need expansion. What is more, there is a lot of loose talk as though the total sums that we spend upon our Health Service were in some way astronomical and quite beyond our ability to pay.

Is that really true? No one has attempted to examine our total costs today as against the total costs of health care in the days before the Health Service was introduced. I challenge the hon. Lady or any one to say, bearing in mind the increased costs, whether we are indeed paying more today for our total health care than before the Health Service was introduced. It is a matter of very great doubt.

It is certainly true that we spend a much smaller percentage of our national income on health care than is done in America. While it may well be said that America is a rich country, it is just in countries like our own, which have very great economic difficulties, that a greater proportion of our resources may well need to be given to ensure the maintenance of a fit and effective population for all our economic needs.

Therefore, the hon. Lady need not be surprised that we should take this first opportunity to sound a note of very real warning about the announcement that was made by her Minister today. We can see before us the very real dangers of the service that has been built up and in which every Member might well have taken great pride being slowly and gradually whittled away until the great inspiration that it offered at one time may well become a matter of general derision in the House and in the country.

We know all too well the tragic position of hospitals that are not being given sufficient funds to enable them to maintain properly the fabric of the hospital buildings. As the years go by, and if not enough money is put into this work, we will be faced with enormous costs later on. There are great jobs of work that need to be done and which, in the interests of economy, ought to be carried out. I have great fears that if the present procedure is carried on, if we maintain this artificial ceiling that has been running for some four, if not five, years, we are in effect denying to the Health Service the finances that it must have if it is to develop properly.

Therefore, I say to the hon. Lady that, when she replies to this individual, case, I hope she will bear in mind and take this message to the Minister: we regard this case as possibly the forerunner of very many that will come before the House if the present policy of her Minister is followed and if we are to see a steady diminution in the value of the services that the hospitals can perform.

At one time we could say to the world at large that we had a health and hospital service which was the pride of the world and which many people came to see and to watch at work. Are we sure that in the steps now being taken we may not be cutting off and destroying that great leadership that we offered to the world in the past and may not be endangering our whole position in the great field of health? I make this appeal to the hon. Lady to take this message to the Minister from this House, that he should think again about the announcement that he made this afternoon and ensure the protection of the service that he is there as Minister to protect.

9.35 p.m.

Mr. Harry Wallace (Walthamstow, East)

I would not have intervened in this discussion but for the fact that I happen to be in close association with Lambeth where, at the moment, I occupy the position of mayor. I do not know the details of the case raised by my hon. Friend the Member for Carlisle (Mr. Hargreaves), but I hope that the Parliamentary Secretary will give a full and adequate reply. I do know the hospital; I think I have visited every ward and spoken to every patient of that hospital within the last two or three months. I have no hesitation in saying that the hospital has a very good reputation in Lambeth.

My hon. Friend was most restrained. and I am glad that he did not indict the character of the hospital generally. I do not want to go into a general discussion of the statement made this afternoon. There will be opportunities for that, but I am concerned that this particular case should be cleared up because I am rather jealous of the reputation of this hospital. I hope the Parliamentary Secretary will give a full and adequate reply and, if it should be necessary to have a full inquiry, I imagine the hospital would welcome it in the interests of its reputation and the reputation of the National Health Service generally.

9.36 p.m.

Lieut. - Colonel Marcus Lipton (Brixton)

Like my hon. Friend the Member for Walthamstow, East (Mr. Wallace) I can claim to have some close knowledge of this hospital. It happens to be in the borough of Lambeth, part of which I have the honour to represent in this House.

In addition to knowing the hospital well since I became the Member for the Brixton division of Lambeth, I can also claim, some time before the National Health Service came into operation, to have been an in-patient of this hospital. Therefore, because of pre-war and postwar knowledge of this hospital, I can corroborate what my hon. Friend the Member for Walthamstow, East said. It is a good hospital with a very fine reputation and it is all the more necessary that that reputation should be maintained, even if, as my hon. Friend the Member for Carlisle (Mr. Hargreaves) pointed out, this unfortunate case has happened.

It is within our knowledge that from time to time mistakes take place in diagnosis, errors of judgment are committed by medical men, and, as a result of a combination of those circumstances, there is an unfortunate episode of this kind. Like my hon. Friend the Member for Walthamstow, East, I am not fully acquainted with the details of this case. I do think, however, that my hon. Friend the Member for Carlisle has a grievance arising from the delay with which the Ministry generally deal with inquiries of this kind.

I have had occasion in the past to take up one or two unfortunate cases of a similar character with the Ministry and it has struck me that an inordinate time elapses before the Ministry completes inquiries from the medical staff of the hospital concerned and other people. It would be in the public interest if the Parliamentary Secretary could assure the House that if and when the unfortunate necessity does arise of asking the Ministry to investigate a particular case, every possible endeavour will be made to see that the hon. Member raising the matter receives a reply. It is of supreme importance that the confidence of the public in our national hospital service should be maintained.

One way in which public confidence can be maintained is that when an unfortunate case of this kind occurs the Ministry should be at pains to ensure, both for the sake of the hon. Member concerned as well as, if not more so, for the sake of the relatives of the patient, that the speediest possible inquiry is made. I hope that the Parliamentary Secretary will agree that, irrespective of this unfortunate case, the reputation of the Lambeth Hospital is highly regarded by the Ministry; because such a statement will be welcomed by those who know of the fine work which this hospital has done and is doing.

9.41 p.m.

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

The House will agree that the general circumstances of this case are distressing and that a complaint concerning the death of an in-patient is a matter which requires our concern and sympathy. I would reiterate, as my right hon. Friend has done both in correspondence and at Question time in the House, the real sympathy we feel for Mr. Maw's widow and the keen regret that she has been caused this distress.

I would deal first with two points on which we are agreed. It is agreed that the patient was suffering from an incurable illness of which the medical staff had informed his relatives. They knew that he had only a very limited time to live. It was also agreed by the medical consultants, both at the Lambeth Hospital and at Carlisle General Hospital, that the train journey had nothing to do with Mr. Maw's death.

Now may I deal with the complaint about delay. As this Adjournment gives me the time, I should like to give the exact diary of proceedings concerning this inquiry. The hon. Member wrote to my right hon. Friend on 21st October. The letter was received and acknowledged on 22nd October. He will know that in a procedure of this kind the Ministry have immediately to contact the appropriate regional hospital board and in turn, in a matter of medical inquiry such as this, their senior administrative medical officer has to see that the proper inquiry is made at the hospital.

A reply from the hospital board not having been received by 6th November, my right hon. Friend sent an interim reply to the hon. Member for Carlisle (Mr. Hargreaves) saying we were still awaiting the final report of the Lambeth Hospital. They had to make inquiries in some cases from people who had left the hospital and who had to be interviewed and their evidence obtained. In one case an almoner was in China. I do not think it quite fair to blame my right hon. Friend, because the 6½ week period does not represent the speed with which he dealt with the evidence.

On 10th November we received a report from the Lambeth Hospital Management Committee via the South-West Metropolitan Regional Board. We were still awaiting evidence from the Carlisle General Hospital, because it is obvious that we had to check not only Mr. Maw's condition on leaving but his condition on arrival at Carlisle and the medical opinion in Carlisle as to whether or not the journey had contributed in any way to his death. The report from Carlisle was not received until 29th November. On 3rd December my right hon. Friend sent his first full reply to the hon. Member for Carlisle.

It took 6½ weeks, but I would emphasise that not all the staff were available when the inquiries were made. The hospital management committee had to take longer than usual in order to obtain the evidence and the opinions from the consultants, the registrar, the almoner and some of the sisters. In comparison with the period of 6½ weeks, the hon. Member took 4½ weeks to get his constituents' reaction and a rebuttal of some of the statements in our letter, and, when one puts these two cases side by side, one case of direct check and the other one involving many channels and persons, we can see that it does not make our 6½ weeks look quite as bad as the hon. Gentleman made it out to be.

On 2nd January, the hon. Member for Carlisle wrote to my right hon. Friend and contested some of the statements in the Minister's letter. That letter was acknowledged on the 5th, and a further request was sent out again to Lambeth to check up and get the evidence on the spot. The reply from the Lambeth Hospital Management Committee, through the regional hospital board, was received by us on 5th February, and my right hon. Friend replied again to the hon. Member for Carlisle on the 13th, and subsequently there were Questions in the House. I think it is only fair to give that time-table, because otherwise the suggestion was that my right hon. Friend took 6½ weeks in which to answer the original letter.

As to the points of conflict, there are four. First, there is the question of discharge from hospital and the delay, with which I have already dealt. There was the question of incontinence, the question of accommodation on the train, and, finally, the question of bed sores.

Mr. Maw was admitted to Lambeth Hospital on 28th August while he was on holiday in London. He was admitted with a lesion which was likely to end fatally, and this matter was discussed with the relatives, who were aware of it. He was in hospital for 25 days, and passed from a state, on admission, of near-incontinence and paralysis to one in which he was able to walk about the ward. This is the medical report and the evidence which we have had from the consultant and the registrar, and which has been confirmed by inquiries which we have made with the nursing staff. He was able to get about the ward and was also able to swallow, and, although he was not able to speak perfectly, he could, to an extent, make himself understood. He could understand simple questions, and could read the print, but not the writing, of some of the correspondence he received.

With regard to his continence, when he entered hospital he was regarded as incontinent during the period from about the 4th to the 12th. Contrary to what the hon. Member for Carlisle said, my right hon. Friend in his reply to the suggestion that the patient was incontinent on discharge, said that the hospital concerned had said that he was incontinent, and it is only fair to say that the hospital record shows that he was so only between the 4th and the 12th, and that his subsequent record in that respect was reasonably good.

Mr. Hargreaves

The Minister previously denied it.

Miss Homsby-Smith

The question which the hon. Member originally raised was that when Mr. Maw travelled he was incontinent, but my right hon. Friend said that, when he travelled, he was not. The evidence which we have on admission to hospital was that he was incontinent. Here, we have the evidence from the registrar, from the consultant, the sister, and also evidence in the files of the Department. I regret to say that we are in direct conflict here, though we have on two occasions gone over all this with the responsible officers, with all the evidence at our disposal and that obtained by direct inquiries.

The hospital authorities maintained that Mr. Maw's family were anxious that he should go home. They knew that he had but a short span to live. They were on holiday in London and it is not unnatural that they felt that they would like to have him home. I am sorry that we are in conflict with the hon. Member on that evidence, but through all the discussions with Mrs. Maw and with Mr. Maw's niece, the officers concerned are quite firm that the family and relatives desired that Mr. Maw should go home.

In this respect, Mrs. Maw herself was interviewed by the consultant physician, by the registrar and by the house physician, who warned her of the patient's future poor outlook and advised her—he is very emphatic about this—to get in touch with her own doctor immediately on her arrival in Carlisle.

So far as the bed sore is concerned, this has never been denied. The ward sister mentioned to Mrs. Maw that her husband had a small bed sore on the sacrum and advised her how to treat it.

Next we come to the question of transport. In view of the relatives' desire that the patient should go home, consideration was given to the best form of transport. It was felt that an ambulance journey of 300 miles which, with reasonable stops, would have taken at least 12 hours, was out of the question and that a fast six-hour train to Carlisle on which seats had been booked was the best method of transport.

It is the duty of the medical officer concerned in a case to decide the form of transport on medical grounds. In this case, the doctor, on the information that he had from the almoner's department, was aware that private transport was being provided by a relative of Mrs. Maw, and, in fact, all the evidence we have assessed confirms that the almoner had been told that a relative would be collecting Mr. Maw and would drive him to the station.

I cannot refute too strongly the quite unjust suggestion that has been made that this was the result of economy, and the attacks that have been made on my right hon. Friend. The ambulances were there, and the staff was there. There is no question that had an ambulance been required it could have been provided, and no question that had it been decided to send an escort then an escort from the hospital management committee group could have been provided.

There has been a misunderstanding, which I readily admit, over the question of tickets. Here we have been in difficulty. As I say, the almoner is now in the Far East and we have had difficulty in checking the records which we had from that department. My right hon. Friend, in his letter to the hon. Member for Carlisle of 13th February, said that reserved seats were obtained for the journey. That was according to the record we had, and I freely admit that we inferred from that—and the hospital, in fact, led us to believe it—that those seats had in fact been booked by the hospital.

As I say, I readily admit that they were not, in fact, booked by the hospital who probably took as the work of their almoner the record that seats were booked, when, in point of fact, Mrs. Maw did the booking and the almoner was informed that seats had been booked. We were wrong in assuming that the seats had been booked by the hospital, but it is on record that seats were booked.

Mr. Hargreaves indicated dissent.

Miss Hornsby-Smith

The hon. Gentleman shakes his head, but it is on record in the hospital that seats were booked.

Mr. Hargreaves

I have the almoner's letter here.

Miss Homsby-Smith

I am not saying that the hospital booked them; I am saying that the almoner knew that seats had been booked. I admit that we were misled and that the seats were not booked by the hospital.

My right hon. Friend, in his reply to questions, said quite frankly that he thought there were some errors of judgment on the part of the hospital, and in fact he has most closely inquired into this matter on two separate inquiries. Certain of the evidence which we had was challenged by the hon. Member. We have gone over the investigation and have had the closest questioning of the responsible officers concerned. The hospital acted within the letter of the law, but my right hon. Friend agrees—and he said so in his reply to the hon. Member's Parliamentary Question—that there should have been more welfare and humanity, in the interests of the patient, in the manner in which his discharge on leaving the hospital was conducted.

He said, and I am only too ready to confirm it tonight, that the hospital should have reserved a whole compartment for this patient. He has told the hospital that he considers that they have failed in their duty by not doing so. He has also stressed and told the hospital, as he has told the hon. Member, that they should have provided a nurse escort. He has brought these errors of judgment, as he considers them, to the notice of the management committee, and instructions have been sent to hospital authorities and all concerned so as to prevent, as far as is humanly possible, a recurrence of these unfortunate circumstances.

I assure the hon. Member that every factor connected with this case has been very fully investigated. We have scrutinised all the evidence available and the statements of the hospital management committee; and the senior medical officer has investigated it with all the officers concerned in this case. We do not believe that a formal inquiry would add anything to what has already been achieved. It would entail more reiteration of statements of facts long after the event, which is always difficult. Since inquiry would obviously have to be made on the other side it would also cause distress to Mr. Maw's relatives, and we feel doubtful whether it would in any way resolve some of the points of conflict. They are very difficult to establish in a time of loss with persons who perhaps had to make a difficult decision as to whether a patient, whom it was known had a short span of life, should go home or stay away from home and friends in hospital in London.

My right hon. Friend regrets as much as I do the unfortunate circumstances of the manner in which this journey was undertaken, but we do confirm that, so far as we have most deeply investigated this matter, the patient was taken out, we think quite rightly, in view of the special circumstances, by the relatives. We believe that the train journey did not contribute to Mr. Maw's death. I can only express, on behalf of my right hon. Friend, our deep regret to Mrs. Maw and the relatives for the distress caused by the carelessness, if I may say so, in respect of the journey from the hospital to the train and the fact that they did not have a compartment and an attendant during the journey.

Mr. Hargreaves

May I be permitted to ask the hon. Lady a question arising from her reply? This kind of argument and rebuttal has gone on for a long time. I should like to call her attention to the fact that a moment or so ago she argued with me about incontinence. I should like to refer her to her right hon. Friend's letter of 3rd December in which he said: He was not incontinent in the ward. That is a denial and I rebutted it. I suggested that the Minister was wrong, and at a later date he admitted that he was wrong.

Mr. Speaker

Order. The hon. Member is making a second speech. He rose to ask a question.

Mr. Hargreaves

Mr. Speaker, I want to call the attention of the Parliamentary Secretary to a further error in connection with the statement which she has submitted to us. The hon. Lady suggested—

It being Ten o'Clock, the Motion for the Adjournment of the House lapsed, without Question put.

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

Mr. Speaker

If the hon. Member can conclude his remarks quickly, it will be in order. I do not desire in any way to limit his opportunity to speak, but he must realise that he has already spoken once to this Motion.

Mr. Hargreaves

I wish to ask the hon. Lady to reconsider the question of the reservation of seats. I have here a letter signed by the almoner requesting Mrs. Maw to reserve seats. In those circumstances, can the hon. Lady reiterate the statement which she made a moment ago? This kind of to-and-fro argument has gone on for a long time.

Miss Homsby-Smith

May I deal first with the point about incontinence? It is fair to say that in that letter my right hon. Friend says that on admission to hospital Mr. Maw was very ill. He had a very considerable recovery a week later and he continued to make satisfactory progress, except that he was unable to speak, until his discharge on 22nd September. On 22nd September I understand that he could walk, read and write and swallow quite well, and although he could not speak, he could understand, and he was not incontinent in the ward. My argument is that from the 4th to the 12th the medical evidence is that he was incontinent. At that time, on the 22nd, when he was discharged, his continence was fairly good and I do not think that anything my right hon. Friend has said has been an attempt to mislead the hon. Gentleman. I think it honestly tallies with the medical record of the patient.

As far as the tickets are concerned, I have admitted that we were misled on the booking and that it was, in fact, done by Mrs. Maw. I do not think the letter refutes my subsequent statement that the almoner had recorded, because that letter was written to Mrs. Maw before she made the final arrangements for the discharge of the patient, and when she again saw the almoner she informed her that tickets were booked. It is recorded that seats were booked. I apologise for the fact that we were misled into thinking that the almoner had done it, but it is recorded that the seats were booked and I admit that they were booked by the relatives.

Question put, and agreed to.

Adjourned accordingly at Two Minutes past Ten o'Clock.