HC Deb 07 April 1955 vol 539 cc1386-94

2.30 p.m.

Miss Margaret Herbison (Lanarkshire, North)

Mr. Speaker, I want first to thank you for allocating time today for this important subject. On 22nd March I put a Question to the Secretary of State for Scotland, and I was shocked to find from the reply that the right hon. Gentleman had taken a decision to give up the use of 70 beds that we have had for Scottish patients in the Wolfgang Sanatorium in Switzerland.

Like everyone else in Scotland, I welcome the improvements that have taken place in the treatment of the dread disease of tuberculosis, and at this early stage I want to thank the nurses, the doctors, the specialists and everyone else who has played any part in bringing about those improvements. At the same time I have to ask myself, as I know our people in Scotland are doing, have we got this dread disease under control yet in Scotland? Is the position such that we can afford to give up those 70 beds in Switzerland. From the figures I shall quote, I hope to show that the answer must be a definite "No."

From 1945 onwards every Secretary of State for Scotland has found that the incidence of and the deaths due to tuberculosis have provided one of the biggest problems he has had to face in his work as Minister. My right hon. Friend the Member for Greenock (Mr. McNeil), when Secretary of State, inaugurated a scheme whereby patients could go from Scotland to sanatoria in Switzerland, and I as Joint Under-Secretary at that time played a little part in its inauguration.

As the hon. and gallant Gentleman knows, this scheme was inaugurated because of shortage of beds in Scotland for these patients and because of the appalling waiting list of people suffering from tuberculosis. I am relieved to learn from the figures given in official reports that the list has been cut down considerably, but it is still far too large for any Government to give up 70 beds which could be so well used. To prove this I shall give figures which apply to the death rate from this disease and to its incidence.

In 1949 100 out of every 100,000 of the population in Glasgow died from tuberculosis. In 1951 this figure dropped to 60, in 1953 to 43 and in 1954, for which we have only provisional figures, to 33. If we take a comparable city in the United Kingdom, Manchester, we find that in 1949 the figure was 60 as against 100 in Glasgow, in 1951 it was 45 as against 60 in Glasgow, in 1953 it was 28 as against 43 in Glasgow.

Taking Scotland as a whole, in 1949 the deaths were 60 out of every 100,000 of the population, in 1951 they were 37, and in 1953 they were 23. For the rest of the United Kingdom, England and Wales, we discover that in 1949 the figure was 40 as against 60 in Scotland, in 1951 it was 28 as against 37, in 1953 it was 18 as against 23 in Scotland. If we go outside the United Kingdom, to Denmark, we find that in 1949 it was 16 as against Scotland's 60, in 1951 it was 12 as against 37, and in 1953 it was eight as against 23 in Scotland. In Holland in 1953 it was 7 as against 23 in Scotland.

From those figures it is clear that the largest toll of this disease, not only in human suffering but in deaths, is in Scotland. I know that the figures for Eire and for France are higher, but our aim should be to emulate those countries which have a better record than Scotland.

Now I want to turn to the notifications, which have not shown the improvement we find when we examine the mortality figures. It is because of our worry about the notifications that again I stress that we ought not to give up those 70 beds. In Glasgow notifications per 100,000 of the population were 257 in 1949, 202 in 1951, 218 in 1953—an increase there—and the provisional figure for 1954 is 203.

These are very serious figures indeed for the city of Glasgow; and of course they are not figures but are human beings about whose suffering we are speaking today. We find that the incidence for London in 1949 was 168 against 257 in Glasgow. In 1951, for London it was 146 against 202 for Glasgow. In 1953 it was 140 against 218.

For Scotland as a whole, per 100,000 of the population, we get the figure of 167 in 1949, 152 in 1951 and 147 in 1953. Compared with Scotland as a whole, Glasgow seems to be the black spot, but let us compare the whole of Scotland with England and Wales, because these beds apply to the whole of Scotland. In England and Wales the incidence of new notifications in 1949 was 102 against 167 for Scotland; in 1951 it was 97 against 152; and in 1953 it was 93 against 147.

Those figures show very clearly that the incidence of tuberculosis in Scotland is much higher than that in England and Wales. But, in spite of this, the Government have decided to give up those 70 precious beds in Swiss sanatoria. In answer to my Question, the Joint-Under Secretary said that the waiting lists had fallen from just under 2,000 to around 500, and he gave various reasons for this fall and for the decision to give up the 70 beds. Among those reasons was, the more efficient use of … other resources in Scotland."—[OFFICIAL REPORT, 22nd March, 1955; Vol. 538, c. 1883.] I want to ask a question about that. Does it mean that more patients are being treated at home? Has the waiting list been reduced in this way? I have had sent to me this week a report which has just been published—the Joint Under-Secretary of State may have seen it—it is the first Report on T.B. in Glasgow produced by the Glasgow District Trades Council. I want to congratulate the Trades Council on the fine work which it has done in collating the material in this Report and in publishing it. The Council has this to say about people being treated at home and about the great reduction in the waiting list over a short period—and this appears on page 15: We shall certainly inquire about this, to see how far it has been achieved by a change in the attitude to home treatment. I, too, have doubts about how this great reduction has been achieved, and I feel that the Joint Under-Secretary must give to me and to those who are most concerned an answer about it.

My doubts were strengthened when I turned to the latest Report published by the Department of Health for Scotland, for I find on page 24, dealing with tuberculosis: The part use of domiciliary management and treatment is, of course, important in the plan for increasing the turnover, but the extent to which this can be employed depends on both social and medical considerations. I wonder whether it has been employed to such an extent that these social and medical considerations have been put in the background.

On page 25 we read: The use of beds, however, for serious relapses and returns to infectivity where housing and other conditions are unsatisfactory must be in competition with the demand for the early treatment of new cases, and it is often a matter for careful judgment by the physician and a matter of anxiety for the medical officer of health which case should on occasion get priority. This has always been a problem in the tuberculosis service and it has not yet been solved. I emphasise that this was the latest Report of the right hon. and gallant Gentleman's own Department. Can he tell us that this problem, which has always been with us and which the Report said had never been solved, has in fact been solved? If he tells us today that it has not yet been solved, then it is completely and morally wrong that these 70 beds should have been given up.

For the life of me I cannot understand the Government's decision at this time. According to the Minister's own figures, we have 500 patients awaiting treatment for this dread disease. I want to quote again from the Report of the Glasgow District Trades Council. Dealing with the figures for Glasgow of those suffering from tuberculosis, the Report states: These figures represent thousands of young people whose lives have been blighted at the outset by a wasting disease which at best takes long months perhaps years, of treatment to cure and whose homes have been darkened by sorrow, economic privation and often despair. Let us consider the mental strains and stresses of those 500 people, apart altogether from their physical illness and suffering, for anyone suffering from tuberculosis is often in a very depressed frame of mind. Each one of those 500 is a human being, with all the hopes and aspirations which other human beings have. If we consider these, we can come to only one conclusion—that the Government's decision is both wrong and heartless. If we consider also the dangers of infection from these 500 people, then the Government's decision is wholly indefensible and, I very strongly suggest, should be revoked.

What a psychological uplift it was for T.B. patients and for those who were nearest and dearest to them to know that the responsible powers in Scotland were doing everything they possibly could to combat this disease, that they were looking on these sufferers as individual human beings and that they felt that nothing should be left undone which could possibly help these people to find a cure. I believe that the Government's decision has destroyed that psychological uplift.

Finally—because I want to give the Minister plenty of time in which to reply—I beg the Government to reconsider the matter. Surely a Government who have been able to find almost £1 million to subsidise private interests in commercial T.V. can find the money to keep these 70 beds in Wolfgang Sanatorium for the T.B. patients of Scotland.

2.50 p.m.

The Joint Under-Secretary of State for Scotland (Commander T. D. Galbraith)

The hon. Lady the Member for Lanarkshire, North (Miss Herbison), has raised a matter of very great importance. I gather that she attacks the decision of the Government to curtail the Swiss scheme. I do not consider that this is a decision which needs any defence at all. On the contrary, we should welcome it as a sign of real progress in Scotland's campaign against tuberculosis.

The scheme has not been curtailed—and I would emphasise this to the hon. Lady in view of her last remarks, which I thought were very unfortunate—on financial grounds; it has not been curtailed because it is defective; it has been curtailed because it is no longer needed on the same scale as in the past four years. Far from that being a destroying of the psychological value of which the hon. Lady spoke, encouragement and increased hope should be brought to every sufferer from this disease by the fact that the Government have found it possible, as I shall explain, to curtail the scheme.

The hon. Lady gave us a number of figures concerned with the death rate and the rate of notifications. I want to put on record in round figures what the death rate has been. In 1950—that was the last full year before this scheme came into operation—there were 2,439 deaths from respiratory tuberculosis; in 1954, there were 1,012; in 1950, there were 8,135 notifications, which is 1,019 more than the provisional figure for 1954. Preliminary figures indicate that the reduction, both in deaths and notifications, has continued during the first quarter of this year. Of course, there is still room for improvement. No one would be stupid enough to deny that, but the downward trend which I have indicated, and to which the hon. Lady referred, is encouraging.

The present high rate of notification is attributed to a very large extent to the improved case-finding procedures which have been bringing to notice cases of milder disease which would not have been found, or not found so soon, in the past. It is not possible to estimate the extent of this effect, because earlier records did not show the severity of the disease found. For that reason, at the beginning of last year a new form of reporting was introduced which will make it possible to study the future trend of new disease, both in terms of severity and number of cases. What appears to be happening is that we are now uncovering a larger part of the reservoir of the disease.

When I made my statement in the House on 22nd March, I explained that during the last 12 months the waiting list had fallen from about 2,000 to about 500. I also pointed out that the chest physicians—after all, it is they who have to judge—have for some time been finding it increasingly difficult to fill beds in Switzerland allotted to them. In that situation, it was obviously incumbent on us to examine the scheme closely, and we were forced to conclude that we would have to give up at least part of it.

Miss Herbison

This is a very important point. We are not given the reasons why the chest physicians—

Commander Galbraith

If the hon. Lady will give me a minute or two, I will deal with that point. Patients for the scheme are now coming forward only from Glasgow, Renfrewshire, Stirling-shire and Dunbartonshire.

The hon. Lady referred to the waiting lists. At 28th February this year the total Scottish waiting list was 505. These were people waiting for treatment in sanatoria, and I have confirmed from the regional hospital boards that for cases of new tuberculosis the waiting time for admission to hospital is generally about one to four weeks, though less urgent cases may have to wait three to four months. The point which the hon. Lady must get hold of is that in choosing patients for treatment in Switzerland we have to be selective in the sense that they must be fit for the journey and temperamentally suitable to undergo treatment far from home and away from their personal friends and other affairs.

We found that the shortening of the waiting list for admission to Scottish sanatoria has made patients who would be suitable for treatment in Switzerland reluctant to accept it. Indeed, we are also finding that patients prefer to wait for a few weeks for admission to a sanatorium near their homes, rather than accept immediate admission to sanatoria at a distance—and not a great distance—from their homes.

There are several reasons for the substantial fall in the waiting lists. As a result of the policy which has been followed by successive Governments of giving first priority to the needs of respiratory tuberculosis and since December, 1951, there has been a very substantial increase in the number of staffed beds available. They have increased from 5,335 in December, 1950, to 6,098 in December, 1954. The main limiting factor in the increase has been the availability of nursing staff.

Accompanying that rise in the number of staffed beds there has been, as the result of improved therapeutic methods, a fall in the average period of stay in hospital and a corresponding increase in the turnover of beds. The discharges—and this is another reason for the decrease—rose from 6,762 in 1950 to 8,254 in 1953; and in the Western Region in 1953 there were 5,572 discharges and 6,812 in 1954, while the average numbers of days' stay in hospital fell from 200 to 169, that is, a reduction over the year of one month. This is equivalent to an 18 per cent. increase in the number of beds available.

At the same time as there has been this increase in hospital treatment, there has been, particularly in Glasgow, a substantial increase in the number of patients undergoing out-patient or domiciliary treatment. That was a point which the hon. Lady raised. She thought it might be bad, but as a matter of fact I am told that it is not bad at all.

Earlier figures are not available, but at present there are 2,700 patients in Glasgow receiving such treatment in one form or another, about 1,900 of whom are undergoing active chemotherapy, in other words, drug treatment. Some of these patients will receive hospital treatment in the form of thoracic surgery, but from the results being obtained at present it is expected that most of them will complete their treatment at home. The hon. Lady thought that these people were in danger of infecting others. I am given to understand that for the most part those undergoing treatment at home are not suffering from the disease in an infectious form.

In these ways we are keeping ahead and pulling down the figures of people who can go to be treated in Switzerland. There are fewer people on the waiting lists who are available to go, there are people who do not want to go because they can be admitted to sanatoria in their own country by waiting merely a week or two and then there are those other people who have to have serious operations. The hon. Lady would agree that it would not be right to send those. It has never been done. People who have had operations in Switzerland are those who were already there and for whom it was discovered that an operation was urgently required.

When all those matters are taken into consideration, the simple fact emerges that the doctors cannot find the patients to fill these beds in Switzerland. The hon. Lady must abide by the decision of the medical profession. Doctors judge whether these beds are required or not, and in their judgment the beds are not required simply because there are not the people to fill the 70 beds which we are giving up in Switzerland.

No question of finance is involved in this matter at all, and I should have thought that the hon. Lady would have been generous enough to have admitted that this Government, and any Government, would do all they could to cure people of a disease which has created such havoc in our country and which we have been fighting by every means in our power for many months, indeed, years.

The whole question is whether or not the people can be found for these beds. We are tackling the position in Scotland at all points and we are not in the least complacent or self-satisfied. We are still striving might and main to find reasons why tuberculosis should affect our country more than certain other countries; but that is something which we cannot force. It is something which the medical men and the scientists are trying to find out. Nowhere in the world have men been able to explain why tuberculosis should be more prevalent in certain areas than in others.

A meeting of a representative group of Scottish thoracic surgeons was recently convened by the Department to make a fresh assessment of the needs and to consider how best the resources available might be deployed. As a result, the possibility of further inter-regional transfers is being explored. I want once more to reiterate that there is no question of finance in this matter. The sole question at issue is: have we got the patients to fill the beds? The answer that we have from the doctors most concerned is that they are not available. It would be stupid and ridiculous to maintain accommodation which is not required.