§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Vosper.]
§ 4.1 p.m.
§ Dr. A. D. D. Broughton (Batley and Morley)In my constituency there is the Batley General Hospital which was opened in 1883 with 20 beds and which has now grown to a hospital containing 100 beds. It has served a most useful purpose throughout its 70 years of existence, and it is held in high regard by many of my constituents. I can say that the hospital management committee and the house committee comprise people keenly interested in the hospital. I know many of them personally and can vouch for their being able administrators.
The problem which now faces them is that of a shortage of resident medical staff. It is not a new difficulty, but it has now become serious. At this hospital there is an establishment for a resident medical staff, one registrar and two house officers, but the hospital has been without a resident medical staff since the end of March.
There are now 66 beds which are empty, 50 of them are deliberately being kept vacant, because there is no resident medical staff, and 16 are vacant because of structural alterations. Consultants and visiting specialists, rightly, will not operate and leave patients unattended by a resident medical staff. This is a matter of concern to my constituents. All the local newspapers have reported this unsatisfactory state of affairs, and there is much talk about it in my constituency.
Last week one of the local newspapers, the "Batley News," a copy of which I have in my hand, carried a front-page headline, "66 vacant beds at hospital," I noticed, also on the front page, a report of a bus accident in which a man was injured. I was interested to observe that, instead of being taken to Batley Hospital, which is only about a half-mile from the scene of the accident, the casualty was conveyed to Dewsbury, a much longer distance to travel. I give that as an illustration of the way in which at present the hospital is not able to serve the needs of the people. 861 I have given an account of the Batley Hospital as an example of a problem which is widespread. The House will remember that on 7th May last year my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) asked the Minister of Health if he was aware of this difficulty. The Minister replied:
I am aware that this problem is widespread, particularly in the remoter hospitals. 1 am considering how it can be solved …The Minister replied to a supplementary question by my hon. Friend:The best solution may well be along the lines of seeing what happens as a result of the pre-registration Act which has come in this year."—[OFFICIAL REPORT, 7th May, 1953: Vol. 515, c. 551-2.]We have waited, as the Minister insisted, and we have seen. It appears that the position now is no better than it was when it was mentioned in the House last year; in fact, it seems to be worse. Therefore, I now urge the Minister to give more serious consideration to the problem.In the few minutes at my disposal, I wish to take the opportunity of considering the reasons why the problem has arisen. We ought first to ask ourselves what the reasons are for the shortage of junior medical staff in the smaller hospitals. Medical men and women seeking hospital appointments prefer posts in larger hospitals because there they find more clinical material and they gain a wider clinical experience. I believe that is the main factor. There is another factor, however, and that is that in the larger hospitals the junior house men and women are members of a team, which is an important point.
The second choice of applicants is hospitals in the most pleasant parts of the country, such as seaside resorts. There is a tendency to avoid smaller hospitals in remote areas and industrial districts. Applicants go for either rich experience or a good holiday. Who can blame them, since the salary is precisely the same in all the hospitals.
The salary is an important factor. For the first post held by a resident medical officer the salary is paid at the rate of £425 per year; for the second post, at the rate of £475 per year; and for the third and subsequent posts, £525 per year. From that salary, £125 per year is deducted for residence. Therefore, the work of medical men and women 862 holding junior appointments in hospitals is less profitable to them than is that of a medical officer serving his period of National Service in the Royal Army Medical Corps, and there is a strong contrast with assistantship in general medical practice where £1,000 or more per year is often paid.
There is another factor which I should like the Minister to bear in mind. The recent substantial increase in the number of actions for negligence brought by the public against junior house staff is, I believe, having an effect in deterring recently-qualified men and women from undertaking duties which expose them to the danger of such charges. A charge of that kind, even if not substantiated, can seriously affect and even ruin a young man's career. In a small hospital, where there is only one or possibly two junior residents, the danger is there, apparently, and particularly in the casualty department, but also in the wards. The malady of "compensationitis," if I may be forgiven for coining such an ugly and cumbersome word, appears to have become more prevalent in recent years.
Medical men and women are not afraid to accept responsibility, but they see no point in exposing themselves unnecessarily to the danger of a legal action for damages and possible disaster to their careers. When speaking of the larger hospitals, I mentioned teams, and, in these larger hospitals, there are many resident doctors. Responsibility is shared and the work is more supervised by senior medical staff. The danger of legal action is therefore considerably less in that case than it is with a man working in the casualty department of a small hospital, but, of course, if patients feel that they have suffered negligence, they have a perfect right to make a claim, and, apparently, they have no hesitation in doing so, and thus the reputation of the medical staff becomes involved in a legal dispute.
The position has recently worsened, and junior medical officers now try to avoid the smaller hospitals. We must ask how this problem is to be solved, and I should like to know what are the Minister's intentions. Is the Minister prepared to allow these hospitals which have difficulty in obtaining junior medical staff to offer a higher rate of salary? That was the policy of the smaller hospitals before the same rate 863 of pay in all hospitals was brought into operation under the National Health Service. If that proposal is not acceptable to the Minister, and if the Minister himself has no solution to offer, would he consider allowing beds to be used for patients under the care of general medical practitioners, for that would serve the needs of the people far better than keeping the beds empty?
I am very grateful to the Parliamentary Secretary for coming to the House to reply to this debate, and I hope she will be able to inform us that the Minister has given serious thought to this urgent problem and will be able to tell us of the ways and means which she intends to adopt in order to solve what is really a very serious problem.
§ 4.14 p.m.
§ Mr. H. A. Marquand (Middlesbrough, East)I would never dream of intervening in an Adjournment debate concerned solely with a constituency problem, but I think my hon. Friend the Member for Batley and Morley (Dr. Broughton) has already made it quite clear that, while this problem exists in his own constituency, and to quite a considerable extent, it is by no means confined to that area. My hon. Friend quoted the Minister himself as saying that the problem was widespread. I have no idea how widespread it is, but I should like to say that I have encountered it elsewhere than in the constituency of Batley and Morley.
There is a great deal in what my hon. Friend has said in his moderate and reasonable speech, and I hope that the Parliamentary Secretary will be able to tell us that her right hon. Friend, after having had a year's experience of the Medical Act, 1950, is considering ways and means of alleviating the situation, which does not seem to have been as much improved by that Act as we had hoped when it was passed. In particular, I think there is a great deal in what my hon. Friend said when he suggested that general practitioners should be used rather more in these hospitals.
When I was Minister, representations were frequently made to me by general medical practitioners as to the desirability of their using the hospitals. I always said that I was in favour of doing everything possible to enable general 864 medical practitioners to take the hospital treatment of their own patients. I commend most warmly the remarks that have been made by my hon. Friend the Member for Batley and Morley. I will listen with the very greatest interest indeed to what the hon. Lady the Parliamentary Secretary to the Ministry of Health has to say about this problem.
§ 4.16 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)I am grateful to the hon. Member for Batley and Morley (Dr. Broughton) for raising this extremely difficult problem in such an objective manner. We agree that it is widespread. It has been under very close consideration, and during the past two years various methods have been tried to deal with it. Some progress has been made, but the causes lie very deep and are not capable of immediate solution.
Many remedies have been put forward. Our aim is, first, to get a general understanding of the problem for long-term improvement, and, secondly, agreement on short-term measures to meet immediate difficulties such as those outlined as occurring in the Batley Hospital, where I know the situation is difficult.
The two main features are supply and demand on the one hand, and on the other hand the distribution of the available staff fairly over the whole country. The supply of junior hospital staff falls short of the maximum establishment by something under 10 per cent. The maximum establishment represents the number of posts filled or temporarily vacant on 5th December, 1952, plus any additional posts that have been approved by the competent authorities.
These establishments, once fixed, are not inviolable. As the hon. Gentleman knows, where new specialists are needed, the establishment rises. We are, however, seeing some advance, although not of such a kind as would meet the demand, in consequence of this check on establishments. It means that while the teaching hospitals and the large hospitals have no difficulty in getting staff, there is also a trickle to the other more needy and in some ways less attractive hospitals. This control enables us to put the brake on expansion in the bigger hospitals. We feel that the priority needs of the small 865 hospitals should come first and this policy has already brought results.
The overall shortage of junior hospital staff has been reduced from some 15 per cent. at 31st December, 1952, to less than 10 per cent. at 31st December, 1953. I do not pretend that we are in any way satisfied, but the trend is undoubtedly in the right direction. Much of this improvement may be due to the pre-registration year. The hon. Gentleman will be aware that universities select the hospitals where this year shall be taken, and that in the main they include only the large regional hospitals and the teaching hospitals.
So far as staff is concerned, I can give some indication of the demand. We had 7,212 officers of the various grades in 1952; the total in 1953 was 7,815, so it is steadily increasing. The establishment, as I have said just now, is 10 per cent. higher, at 8,499. The number of officers has very substantially increased, but it is not keeping pace with the demand.
It is in distribution that we come up against the most difficult problem, which is particularly felt at the peripheral hospitals, especially those dealing with a narrow range of work like infectious disease, tuberculosis, mental and orthopaedic work. Generally speaking, the teaching hospital and the regional hospital can get what staff they want merely by advertising for them. As the hon. Member has said, in the smaller, more specialised peripheral hospitals there is a very acute problem. The cause is not that there has been any decrease in the supply. There has been a very substantial increase in demand in the last few years, in many respects due to the upgrading of the smaller local peripheral hospitals with additional specialities. That is a process which we all applaud. There have been further increases in 1953.
One problem is that compulsory military service takes away doctors, single men, who before they went into the Army were prepared to take these resident appointments. When they come back they are married and not prepared to take such posts. That is a problem over which we neither have, nor desire to have, any control.
Before I outline some of the solutions which we believe can be applied, and which indeed are being applied, I should like to take up the hon. Member on one or two points. From the record of claims 866 in the Department we have no evidence that claims for damages arise more particularly in respect of the peripheral hospitals than elsewhere. There is no desire to "have a go" at the smaller hospital because it may not be able to, stand up so well for itself as a larger hospital might.
The hon. Member has already outlined the recent increases in pay. He will be aware that, while the earlier grades of salary may compare less favourably with those in other spheres of industry—or indeed in medicine—the ceiling of a specialist is considerably higher than that in many other professions. It must be remembered that the houseman's first year particularly is a continuation of his training as a qualified doctor.
Assuming the need for doctors, which we all agree cannot be reduced, what remedies are there? We can increase the total supply of junior hospital medical staff and we can improve the distribution of such staff. We do not believe that it is practicable to increase the number of qualified doctors. At present there are about 2,000 a year. We have to recognise that we must compete with the demands of other professions. The capital cost of increasing the medical schools would also be a real deterrent and it would also involve delay. At present the number of probable vacancies in "career" posts appears to be fairly well balanced in relation to the intake which, a little while ago was a source of great concern. It was then thought that too many were being encouraged in relation to the number of senior posts. We feel' that we have a reasonable balance there now. It would be wrong to turn out qualified doctors in excess of those who can have a reasonable prospect of a satisfactory career and security.
We cannot reduce the number of doctors called up. Apart from the undesirability of treating doctors exceptionally, the Services could not do without them. The most hopeful lines—and I am happy to agree with both the right hon. Gentleman the Member for Middlesbrough, East (Mr. Marquand) and the hon. Member for Batley and Morley—are to encourage general practitioners to work in hospitals and to encourage men returning from National Service to return to hospitals for a period rather than to go straight into general practice It is 867 these lines which we are particularly pursuing with representatives of the medical profession. My right hon. Friend believes that, given good will and understanding of the problem by both sides, a real contribution can be made to a solution on these lines.
On the question of extra pay, the hon. Member will be aware that at the start of the National Health Service it was open to the Department to approve a special additional payment of £50 a year for house officer posts which were particularly difficult to fill. We have not found this an efficacious method, since it tends to blacklist a hospital, and may make the applicant think that there must be something wrong with the place if it has to offer more for the same job. We feel that other methods must be considered.
We look with considerable reserve on the idea of incentive pay for what should be a comparable job and also on any suggestion that posts should be graded above their true worth, as has been suggested in some quarters—for example, that house officer posts should be treated as senior house officer posts solely on account of the fact that they are difficult to fill. The difficulties and the complications which would arise from that are, we feel, scarcely justified.
We have, of course, no say in the approval of the posts for the pre-registration year, which is under the control of the universities. We do recognise the very real difficulties which exist and particularly in the Batley Hospital with which the hon. Gentleman is so particularly concerned. I have gone into the records, and I admit that this is a most difficult case. Before 1st April the casualty department was looked after by 868 two general practitioners doing three mornings each, with the same two and one other doing a session weekly to cover time off.
The regional hospital board and the hospital management committee have themselves given most serious consideration to this matter, and they are discussing ways to meet the difficulty either by employing general practitioners, which we feel is probably, in the short-term, the best possible solution for this area, and trying to provide a service giving 24 hours cover, or by seeing whether, by regrouping the casualty departments in the hospitals in the group, the appointment of a senior casualty officer would be justified. That would require consideration by the Department, but we shall certainly watch most carefully any recommendations that Batley put forward to meet their very difficult situation.
The hon. Gentleman referred in correspondence to the impossibility of direction in this matter, and I agree wholeheartedly with him. It is a most difficult problem. The medical men must have the freedom of choice, within limits, of jobs offered to them, and yet at the same time we must see that these difficult and in some ways less attractive hospitals are adequately staffed. I can assure the House that my right hon. Friend is deeply concerned about this problem and he will be only too happy to lend his support to anything which can be done to facilitate negotiations to meet the shortage either by the extended use of general practitioner services or by other means.
§ Question put, and agreed to.
§ Adjourned accordingly at Twenty-eight Minutes past Four o'Clock.