WELSH HOSPITALS (ACCOMMODATION) (Hansard, 20 January 1954)

The Rev. Llywelyn Williams (Abertillery)
I think that it is both fitting and proper that any discussion on the accommodation in Welsh hospitals today should be prefaced by a tribute to the excellent work being done by the Welsh Hospital Regional Board in general and the work of the Chairman of that Board, Sir Frederick Alban, in particular. I have been unable to ascertain the figures for 1953, but the information I have received gives me authority to inform the House that the picture is slowly improving with regard to hospital accommodation in the Principality.
I should like to offer to the House some comparative figures as between 31st December, 1951, and 31st December, 1952. The total bed complement for 1951 was 25,880. In 1952, it was 26,095. The number of unavailable beds—closed for lack of staff and for other reasons—on 31st December, 1951, was 1,445, and on 31st December, 1952, it was 1,049. Available beds in the year ending 31st December, 1951, numbered 25,228; in the year ending 31st December, 1952, 25,832. The average daily number of occupied beds over the year 1951 was 22,107; in 1952, 22,533.
Now we come to the vexed question of amenity beds. For both 1951 and 1952 the total complement was 130. The number of patients occupying such beds on payment increased from 606 in 1951 to 725 in 1952. The average number of patients passing through each bed—I am not now referring to amenity beds—in 1951 was 6.39; in 1952, 6.7. This satisfactory progress in what is called "high 1161 occupancy" or quick turnover of beds is due to a number of reasons. One is early ambulation or early rising from bed after an operation.
The Nuffield Provincial Hospitals Trust published an excellent report for the years 1948 to 1951, and in a chapter, "Function and Design of Hospitals," it has this observation to make after an intensive survey: It could, moreover, be inferred from the data that under a fairly strict early-ambulation régime the present number of bedfast patients could be drastically reduced, probably to less than a third in surgical wards, and to less than a half in medical wards—a very important nursing consideration. Another reason for this improvement is the better use made of existing buildings, and another substantial reason is the increase in the splendid work done in the out-patients' departments. The total out-patient attendances during 1951 were 1,026,322; in 1952, 1,046,172. The inestimable value of the out-patients' departments must be evident to the House. The new patients attending these out-patient departments in 1951 numbered 323,887; the number went up in 1952 to 330,041.
I should like to quote a statement made by Dr. H. Trevor Jones, senior administrative medical officer, in the Annual Report of the Welsh Regional Hospital Board: The experience we have gained in recent years in the better use of out-patient departments—and the ideas which are now being adopted in their design and equipment—may make us radically revise our ideas of the number of beds which are necessary or even desirable. This development appears to thoughtful observers to be one of the most important indications for the future. Combined with other features in the modern treatment of disease, particularly the control of infection, and the quicker and more exact possibilities of diagnosis, all these things make both the necessity for a stay in hospital avoidable and reduce the length of stay. For all the admitted excellence of the work done by out-patients' departments, however, there are still some serious criticisms to be made of certain aspects of their operation. The most annoying, vexatious and uneconomic is the wasting of time between appointment and consultation.
I have had some personal experience of this. A year or so ago I had to attend a local hospital for an X-ray examination. 1162 The appointment was for two o'clock. I was there very early and was first in the queue. At about 1.55 p.m. I was told to undress and be ready for the examination, and there I was shivering away until 2.50 p.m. I had a similar experience with my little daughter, who went to a hospital in Newport for an orthopædic examination last year. I remember very well the rush to get her there for 9 or 10 o'clock in the morning, but the examination did not take place until the afternoon. I am not unmindful of the difficulties and I would hazard a guess that the consultants in our modern hospitals are probably the most hard-working section of the community. But surely something can be done in this connection.
The Nuffield Provincial Hospitals Trust has conducted two surveys on the question of showing the relation between consultation time and out-patients' waiting time. It may supply the key to the question of the intervals at which, in any particular circumstances, patients ought to be called to attend at hospitals. Since the rate and volume of patients passing through clinics will then be predictable, rationalisation and economy in planning and staffing the out-patients' department as a whole will be much facilitated. As things are now, the Trust says: It is still rare to find an out-patients' department in which the complicated problems of organising and integrating the various parts of the service have been so well solved that the patients pass through the clinics and away without being unduly delayed or hustled at any stage. The Welsh Regional Hospitals Board feels that it has turned the corner with regard to the increasing waiting lists, and pro rata they compare more than favourably with those in England. London hospitals however are better placed in this respect. In 1951, the waiting list was 39,078; in 1952, it was 36,824, an appreciable drop. I was glad to read in the "Western Mail" on Monday that Professor Picken, the Provost of the Welsh National School of Medicine, was able to announce that a serious scientific investigation is to be made, I believe for the first time in the history of Britain, by the Welsh Regional Board into this question of the waiting list and what can be done to analyse these lists much more scientifically than previously. The Welsh nation will be very proud to 1163 be leading the whole of Britain in this respect.
The waiting list for eye, ear and throat in-patients show a substantial decrease from 12,353 in 1951 to 9,168 in 1952. The out-patients' list was reduced from 2,949 in 1951 to 2,841 in 1952. The figures for tuberculosis that erstwhile terrible scourge in Wales, are also encouraging. The intake of both in-patients and out-patients show an increase, and very much more thoracic surgery is being done. In December, 1951, there were 941 on the waiting list. In December, 1952, the figure was 921. Even so, much remains to be done, as is revealed in the following quotation from a letter which I have received from a physician: It is obvious to me that in your position it is most difficult to appreciate the unfortunate conditions prevailing in South Wales so far as sufferers with pulmonary tuberculosis are concerned. In recent years there has been a complete swing over in the views taken with regard to treatment. Minor collapse therapy such as artificial pneumothorax induction has been virtually abandoned. Regrettably, the facilities for carrying out major chest surgery on the large number of patients needing such operative treatment are hopelessly inadequate. A short time ago I was told there were approximately 800 people on the lists of the Welsh Regional Hospital Board awaiting sanatorium treatment and of these approximately 400 were booked for major chest surgery. Until more centres are opened up it is obvious that nothing can be done to relieve this situation which apparently was not envisaged some three or four years ago when such drastic changes in policy regarding treatment were made. There is no doubt in my own mind that sufferers from tuberculosis constitute a victimised group of patients under the Health Scheme as things stand today. Patients requiring operative treatment in any other branch of surgery can get the necessary procedures with little delay. The prevailing circumstances are particularly unfortunate in South Wales, because of the fact that pulmonary tuberculosis in this part of the country is of the florid type. This fact makes it very difficult for clinical surveillance being sufficient to control cases as out-patients and check deterioration. It is probable that there is a racial susceptibility also. We are all alarmed by the acute problem centred around our overcrowded mental hospitals. The "Western Mail" is known as the national paper of the Principality. I read in that newspaper on 18th January these words by Dr. Henelly, a leading psychiatrist, referring to the vast incidence of mental disease: 1164 It is considered to represent in England and Wales something of the nature of one million people…. That is a most staggering figure and the paradoxical situation is that although people are more secure materially they appear less secure in themselves. There are many reasons for this state of affairs in these days. Time does not permit me to enter into the reasons for this very unfortunate vast incidence in mental diseases, but I was glad to read in the "Manchester Guardian," on 16th January, that a very fine experiment had been carried on in the Oxford Day Hospital with regard to mental patients. I will quote from the article in the "Manchester Guardian": The day hospital, as its name implies, cares for its patients from shortly after breakfast, when they are collected from their homes, until early evening when they are returned to them. There is scope for voluntary effort in transport since most patients can travel by car The patients receive occupational therapy, which is recognised as a good form of treatment for selected mental patients of any age, remedial exercises in the physiotherapy department if they have any physical disabilities, and a good midday meal. It is because the same patient so often needs both forms of treatment and because so many start with a spell in the 'acute' wards of the main hospital that the clinical director of Cowley Road (Dr. L. Cosin, known for his pioneer work in geriatrics at Orsett Lodge Hospital, Essex) is convinced that the day hospital can work at full efficiency only as a department of geriatric unit. I think that that is a very helpful pointer to possibilities of the future to try to relieve this terrible overcrowding in our mental hospitals.
I should like to refer to the excellent piece of work which was incorporated in a Ministry of Health publication, some time ago, called "The Reception and Welfare of In-Patients in Hospitals." I should like to praise the sympathetic suggestions in that pamphlet and to think that our modern hospitals are dutifully observing those excellent suggestions. I have been to hospital myself as a patient on two occasions, and it is surprising how even educated people have been treated almost as if they were infants. No questions are to be asked; any suggestion of an inquiring mind in any shape or form is frowned on, and the response very often is impersonal and meaningless. I believe that there are hospitals—since I am speaking not only of accommodation in quantitative terms but also in qualitative terms—which 1165 have now moved forward from the old days when patients, because they were poor, were treated quite impersonally, to more enlightened days when patients are treated as individuals and personalities.
My last few words refer to the administration of our hospitals in South Wales, because this has its impact on the accommodation in Wales. The people in the Welsh Regional Hospital Board tell me that their main difficulty is that Government accounting falls into two categories where hospitals are concerned: maintenance expenditure and capital expenditure. Their desire is that this division should not be so artificially regarded. If they were to receive larger sums for capital expenditure they believe they could substantially cut down on what is called maintenance expenditure. These may seem very random remarks thrown together in the hope of ventilating the excellent work done by our hospitals. We are proud of them, but we also hope that where good things are now being done better things may be done in the future.

§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to the hon. Member for Abertillery (Rev. Ll. Williams) for the manner in which he has raised this debate, and, in view of the shortage of time, I hope he will forgive me if I do not go into detail on all the figures he has given, which I accept as those coming from the Report of the Welsh Regional Board. But it would, perhaps, be more helpful if I give him some more up-to-date figures, which prove that steady progress is not only going on but is actually being expanded. I would also like to endorse the tribute he has paid to the Welsh Hospital Board, and for their very intensive activity to obtain all they can and more, if they can get it, for Wales.

§ Mr. Roderic Bowen (Cardigan)
My hon. Friend did not give figures for cancer treatment or refer to the facilities for cancer treatment in Wales. Can the hon. Lady give us some information on this aspect, because I believe that very much could be done in this respect?

§ Miss Hornsby-Smith
I have the information, and will endeavour to give it in the short time I have, otherwise I will see the hon. Gentleman afterwards.
1166 The projected schemes completed since 1952 or to be undertaken in the near future will add 1,133 beds to the various specialities. The additions to the bed complement since 31st December, 1952, which are mainly schemes already completed, include, as the hon. Member will know, the new Rhydlafar Orthopaedic Hospital, near Cardiff, providing 240 beds, making a great contribution to reducing the list of waiting patients, and where a particularly large number of children are being treated. Further, there will be another 96 Civil Defence beds in this unit.
There is the new maternity block of 87 beds in the Cardiff Royal Infirmary Hospital. Hensol Castle (Glamorgan) has new pavilions for mental defectives amounting to 210 beds, and there are 55 beds in the new mental deficiency institution at Llanfrechfa Grange (Monmouthshire). In the pneumoconiosis block at Llandough Hospital there are another 50 beds. Of the schemes planned to start in 1954–55, there are 80 beds in the radiotherapeutic centre at Whitchurch Hospital, Glamorgan, one of the units in which the hon. Member is particularly interested, and the medical block at St. David's Hospital, Carmarthen, has a further 100 beds.
There are 50 in the pavilion addition to North Wales Mental Hospital, Denbigh, and approval has just been given for the Oakwood Park Estate, Conway, mental deficiency colony, which will provide 165 beds in the current programme, and ultimately when the extended programme is carried out in full it will provide 500 to 600 beds in all. So, with other beds completed since 1952, there are 738 now in operation, which, with the projected schemes will bring the total to 1,153 in what were regarded as special priorities.
In all, therefore, since 1948, the Welsh Regional Hospital Board and the Board of Governors of the United Cardiff Hospitals have spent a total of £2½ million on capital works, adaptations, and extensions, including moneys made available over their ordinary regional allocation, as, for example, the £400,000 for the maternity department in the Cardiff Royal Infirmary.
There have been other capital projects including the operating theatre and X-ray department for Llanelly Hospital 1167 costing £90,500, the pneumoconiosis treatment centre at Llandough Hospital costing £114,000, and half-a-million which was spent on a new centre for orthopaedics. Several properties have been purchased for hospital purposes at a cost of £175,000, so that, generally speaking, there has been a steady expansion in hospital works and available beds throughout the Welsh Hospital Board's programme. The hon. Member will be aware that the Minister places a very high priority on making up the leeway—by no means common only to Wales—in the treatment of mental health.
I wish to say a word about out-patients and I would endorse what has been said by the hon. Member about the necessity for reducing the waiting time and seeing that the treatment in the out-patients' departments is as speedy as possible. But it is a two-way traffic. Sometimes consultants are not on time and sometimes patients are late. When visiting hospitals and asking patients how long they have been waiting I have been shocked to hear that they arrived at 11 o'clock for an appointment at 9.30. And then there is the type of patient, to which the hon. Member referred, who has the habit of arriving an hour-and-half before his appointment time in the hope of being able to get to the head of the queue. We must obtain co-operation on both sides.
I can assure the hon. Member that we are doing our utmost and I know that the Regional Hospital Board is following the recommendations contained in the circular issued by the Minister about the treatment of out-patients, the methods to be employed in the appointments system and the need to obtain the co-operation of both the staff and the public to remedy some of the difficulties of out-patient service.
It is difficult, particularly with new patients, to assess exactly how long any consultation will take. It may prove to be a matter of minutes or of half-an-hour. But, with all that, we are as anxious as is the hon. Member to increase the efficiency and speed of treatment in out-patient departments. To help with that it has been possible to do a considerable amount of work on 1168 structural alterations in the Welsh hospitals, because it is recognised that out-patient treatment is no less important than in-patient facilities. I agree that out-patient departments, if properly run, can save time, money and bed space.
Since the introduction of the Health Service there has been spent on out-patient facilities in Wales, or there is in process of being spent, nearly £250,000. This money has been expended on various schemes, many of which have been completed during the last year, while others are in the course of completion. Seven schemes costing a total of £90,000 have been completed. A further five schemes are in process, and there are three more schemes for the 1953–54 financial year. In every field, substantial progress is being made in Wales, and priority is being given to those services which had leeway to make up. So far as my Department is concerned, any application for priority from Wales is treated with the greatest sympathy, and we are anxious to give every possible help that we can within the limit of our material and financial resources.

§ Mr. Goronwy Roberts (Caernarvon)
I appreciate the way in which the hon. Lady has dealt with a difficult question. We know it is difficult for hospital staffs and consultants always to arrange things for people who have to travel long distances, perhaps having to change buses on the way, and for these people to be accommodated at the time at which they have been informed that they should attend the hospital; but could something be done to see that sick people who have travelled long distances are accommodated in reasonably warm, not to say fairly comfortable, surroundings when they have to wait?

§ Miss Hornsby-Smith
I think that is one of the main purposes of the plans being carried out at present in out-patient departments.