§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. R. Thompson.]
§ 10.29 p.m.
§ Mr. George Thomas (Cardiff, West)
I propose to draw the attention of the House to the National Health Service, with particular reference to the hospital service in South Wales. We heard from the Minister this afternoon of the improvements that have taken place in the Health Service since the hospitals were nationalised. Many of our problems have been solved, but it is my task to draw attention to some of the problems which still remain for us in the Principality.
Since the hospitals were taken over there has been an increase of nearly 40,000 a year in the number of in-patients in Wales. There has been an increase in the number of out-patients of over 160,000 a year, but there still remains a waiting list of 36,000 people who are anxious to get into hospitals for treatment. In the City of Cardiff alone there are no fewer than 10,000 people awaiting admission to hospitals. Some of them have been waiting for years. This is nearly a third of the waiting list for the whole of Wales, and of the beds that are available in the Cardiff hospitals, 60 per cent. are in buildings which were established before the First World War, and some of them as long ago as the last century.
In view of our problem, many hopes were raised by the Minister's statement in the House last week. They were false hopes. We have had the principle of the establishment of a new teaching hospital in Cardiff approved for the past five years. This Government and the previous one held up the establishment of that hospital for various reasons. The statement made by the Minister last week was misleading in the case of Wales at least, for people believed that he would not have made a statement to the House about the provision of this new teaching hospital in Wales unless the Government really proposed to do something about it or provide more hospital bed accommodation in the City of Cardiff.
522 The Minister's statement, on examination, makes it perfectly clear that neither this Government nor the succeeding Government will have to pay for the provision of a teaching hospital in Cardiff. We shall be very lucky if the Government after the next one will be dealing with this question of a new hospital. What is clear is that we shall be more than fortunate if, during the next decade, we have a new teaching hospital established within the boundaries of the city.
The Board of Governors of the United Cardiff Hospitals have, understandably, gone on record in favour of the new teaching hospital as opposed to the extension of the Llandough Hospital, but I am hoping that, in view of the waiting list of 10,000 in the City of Cardiff and 36,000 in the Principality of Wales, the Minister will now communicate to the Board of Governors that he will sanction the immediate development and extension of the Llandough Hospital.
This is not propaganda, but something practical that the Minister can do to relieve our problems in Wales. The Llandough Hospital has all the facilities for a hospital of 900 beds. It has about 350 beds. It has the administrative block, the kitchen and the laundry and all the equipment necessary for the 900 beds. Llandough Hospital is itself a teaching hospital, and at a minimum cost we could provide nearly 550more beds within the year. Also, we could provide new medical teaching in the Principality.
We have a right to ask for urgency and priority in this matter. There is in Wales an overall shortage of 3,000 beds, compared with the facilities here in England. According to the information that I have been able to glean, Wales has about 1,000 more beds for tuberculous patients than exist in England, and we are better off for accommodation in mental hospitals, as distinct from hospitals dealing with mental deficiency, than our English brethren. We are better placed for maternity beds, but, for general beds, Wales is 1,000 down and is also 1,000 short in accommodation for the chronically sick. In mental deficiency we are 1,500 beds short, compared with England.
It is not fair merely to recite problems to the Parliamentary Secretary; I want to put one or two constructive suggestions which, I hope, will help her examination of the problems. The problem of the 523 chronically sick disturbs anyone in public life. They would be far better off if treated in their own homes, if adequate nursing and other facilities could be provided. Will the Ministry consider the establishment of a wider domiciliary nursing service for the chronically sick? They will feel better in their own homes, and the hospital beds can be given to acute and urgent cases, thus helping to relieve the waiting lists.
The Minister is faced with an urgent need for more nurses. In South Wales, we have by agreement to transfer nurses from general hospitals to tuberculosis sanatoria. Could the Minister ask the General Nursing Council to include in the qualifying experience of nurses that they shall serve a period in tuberculosis sanatoria or mental hospitals? I make those suggestions with the best intentions, and I hope they will be looked at.
Last week, the Parliamentary Secretary created the impression that a lot of new building is to go on in Wales. How many hospital management committees in Wales have, during the current year, been prevented from spending what they thought was necessary for the ordinary amenities of their hospital service?
§ Mr. Thomas
I am indebted to my hon. Friend, who is well-informed on this subject. I am told that the Talgarth Sanatorium was prevented by the Minister this year from providing 50 lockers for the patients to have alongside their beds. Mean and squalid economies have been made during the past year. I earnestly hope that the Minister will be able to give hospital management committees in Wales a message of hope by her reply tonight.
§ 10.39 p.m.
§ Mr. Raymond Gower (Barry)
I support generally the case put forward by the hon. Member for Cardiff, West (Mr. G. Thomas). He put it extremely fairly. As he said, Wales is better off in provision for tuberculosis and certain cases of mental illness, and even for maternity cases, but is decidedly and dangerously worse off than most of the country for beds for general cases and mental deficiency. At this very moment the Department are considering three or four cases which I have 524 sent of persons who have been waiting for a very long time to enter a hospital for treatment which their doctors say has been necessary for a long time.
As I think my hon. Friend will appreciate, that is not the whole picture, because I do not trouble her Department unnecessarily with these cases. I generally take them up, first of all, with the local health division so that they may, if possible, be dealt with locally. I can assure her that, in addition to the cases which are being considered by her Department, there are certain other cases which I have had referred to me by constituents.
I should also like to stress that we have heard with great interest in Wales, as in the rest of the country, of the new plan for hospital building which has been announced. I have a Question to put on that topic shortly. I hope—I am sure that the hon. Member for Cardiff, West does, too—that Wales will have a fair crack of the whip in respect of the new development.
§ 10.41 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
The hon. Member for Cardiff, West (Mr. G. Thomas) has tonight ridden at least one of his pet schemes on which he knows there is certainly not majority agreement in the Principality of Wales.
I will first deal with the very controversial comments that he has made about the new Cardiff teaching hospital. I think it is fair that we should get the matter in proper perspective. This is quite the largest single hospital building scheme that has been projected since the war. In fact, a teaching hospital has not been built since the 'thirties, when the Middlesex Hospital was completed.
The need was accepted by the then authorities in Cardiff and was confirmed after the appointed day by the board of governors, and the Ministry accepted the governors' proposals and conceded high priority for the scheme. As the hon. Member was fair enough to say, no hospitals, small or large, were started during the six years of the previous Administration, and it was not until last year that we were able to start, when the first new hospital under the National Health Service began building, and that was a mental hospital.
525 The three-year programme announced by my right hon. Friend takes nothing away from the priority given to the Cardiff hospital scheme. The first problem in connection with the Cardiff scheme—I think it is fair to give the time-table of the negotiations—was to find a site. That was agreed in March, 1950, when 53 acres were obtained from the city council.
The hon. Member for Cardiff, West knows very well his countrymen's desire to run their own show in these matters. He also knows the enormous amount of planning involved and the many technical changes in hospital construction which have taken place since the last hospital was built in the 'thirties. The four parties concerned—the University of Wales, the Cardiff Medical School, the Board of Governors and the Welsh Regional Hospital Board—formed a working party, and its report giving detailed schedules of the requirements desired in respect of the hospital was not ready until April, 1953, when it was presented to the Department. With an estimated cost of £5 million for the hospital and £1 million for the school, the total expenditure came to more than half the whole of the capital expenditure for England and Wales in any year since the Health Service came into operation.
§ Miss Hornsby-Smith
This Government are, at least, projecting doing it.
The document was then submitted to the Ministry of Health and the University Grants Committee. In a very great and what will be a lasting project of this kind, which involves the expenditure of £6 million, it is obvious that a very detailed and critical examination is called for. In view of the building programme with which it is now possible to go ahead, I can assure the hon. Member that the matter is being treated with urgency. However, he has to consider the decision agreed by the Welsh authorities. It is a great project, being the first of its kind in the country and the first of such magnitude in Wales.
To get the benefit of the best possible design for this most important development it has been agreed by the authorities in Wales to put this out to architectural competition. That, I frankly admit, makes the job longer, although I think that it must be agreed that, for a project 526 of this great importance, it is the right decision to take. It has been necessary to go very deeply into this project, and there has been the precaution taken in respect of the rules of the Royal Institute of British Architects whereby the winning architect automatically becomes entitled to his fees from the time that the plan is accepted; and, had that run through the time of the past and the present Government, it would have gone into several thousands of pounds of money which could be better used elsewhere in the National Health Service.
But the Treasury has accepted the principle of a competition and it will be possible to launch the scheme as soon as the schedules of accommodation are agreed with the authorities in Wales. Since this method of competition has been agreed and accepted by all parties, it would be wholly misleading to talk of an early start for building. There is no delay on the part of the Ministry, and it would be, as I have said, wholly misleading to try to think of a date within the next two years.
The experts on this subject give their opinion that an interval of two years—for research by entrants, for completion of designs, for the adjudication, for the final detailed drawings, and for quantities and tenders—would be unavoidable. That is a purely technical problem which is, to some extent, the result of there being an open competition. I would, however, reaffirm the statement made last Wednesday by my right hon. Friend the Minister of Health, that this project has top priority, both in England and Wales. I reaffirm that we approve the project and want to see it fulfilled and that there will be no unavoidable delay on our side.
§ Miss Hornsby-Smith
But we have given it the "go ahead."
This project is planned to provide 1,000 beds, and although I know that it has been a proposal raised more than once in this House by the hon. Member for Cardiff, West, neither the Welsh Board of Health, nor the Board of Governors, has accepted the Llandough Hospital scheme. It is all very well for the hon. Gentleman to think that this is a temporary measure, but it would, in fact, entail a considerable building project which would take 527 resources from other projects required permanently; whereas, when the new Cardiff hospital is provided, the thousand beds to which I have already referred, will be adequate for that particular locality.
Llandough Hospital is three miles outside the city—it is not in Cardiff—and it has not the accommodation available for the residence of students who would be required; and it is not readily accessible to meet the demand which he makes for out-patients from outside Cardiff. All the Welsh authorities have turned down the scheme, and, had I taken a contrary view, the hon. Gentleman would have been the first to have told me to leave the matter to the authorities on the spot.
I should say something about capital developments. Since July, 1948, the Welsh Regional Hospital Board has spent about £3½ million on capital works. The hon. Gentleman knows of the new maternity home at Cardiff Royal Infirmary—that was £400,000—and the new X-ray department for Llanelly Hospital; the new pneumoconiosis department at the Llandough Hospital, and the new orthopaedic centre which has so dramatically reduced the waiting list in what is a very grave problem in his area. When one looks at the whole thing, there are no fewer than 23 items of capital work. Few regions in the country can show such an impressive list of capital schemes authorised, and either completed in the last 12 months, or nearing completion, as South Wales. This is surely ample testimony of the very fair slice of the capital expenditure which this area has had.
On the question of the hospital management committees and the necessity for keeping under the regional allocation, and, in turn, the national allocation, the committees were not coerced into a reduction. Many committees, in submitting their estimates, put in figures which in the aggregate came to more than the regional hospital boards were obtaining; and we at the Ministry do not keep back a nest egg that we can dole out in bits.
We give the maintenance allocation to the 12 regional boards. If, during the year, there is under-spending—as sometimes occurs if hospitals have estimated to open a wing and it is not opened in time with the result that there is a saving on staff and on food, and so on—then we 528 deliberately give the additional allocation, where we can, to another region.
In point of fact, the Welsh Regional Hospital Board is being allowed £13 million for running costs, and the Cardiff Board of Governors is being allowed £860,000. I want to make it plain that when the Regional Board asked for the co-operation of the hospital management committees in trying to prune their estimates, to keep within the overall budget, we have had the greatest co-operation from 21 out of 22 hospital management committees. Even though they did make certain economies, there was quite a considerable over-spending, some of which will be met by the Supplementary Estimate, the acceptance of which I moved in Committee earlier today. Certainly, Wales has not been treated more unfairly than any other region; it has had a very fair share of capital and of maintenance money.
I cannot accept the hon. Member's high figure of a shortage of 3,000 beds. He very fairly said that in tuberculosis, and mental health as distinct from mental deficiency, and in maternity beds, Wales is much better off than England. It is expecting a lot that the hon. Member should want to be better off than England in everything, although I do not deny that we should like to remedy the deficiencies in every area. In general hospital, mental deficiency and chronically sick beds they are less well placed.
The Cardiff Teaching Hospital will provide 1,000 more beds. On the mental side, expansions already under way will provide for some 440 beds, and further plans are being considered for providing between 400 and 500 more. So, progress is being made. Taking the questions as they come, the beds are being provided for orthopædic cases, extensions are being provided on the mental deficiency side, and the main general hospital—the vast project of the teaching hospital—is also approved.
I agree with the hon. Member on the question of the chronically sick. Their problem in beds is 0.9 per 1,000 as against 1.1 in London. Admittedly, there is a real problem. I agree with the hon. Gentleman that a great deal could be done by the local authorities. Indeed, my right hon. Friend has pressed for increased facilities for the local authorities not only to prevent people who could be nursed at home from going into hospital, thus to 529 leave beds available for those who must be admitted for treatment, but also to enable people who can be rehabilitated to go home again if they can get some domestic help. One of the problems, particularly in industrial areas, is obtaining staff and many local authorities would increase the numbers if they could obtain the additional staff. This is a matter on which we are very ready to see the services expanded to meet the needs of the people.
There has been a real improvement in the tuberculosis figures all over the country, particularly in Wales, where the problem was graver than in most areas and where the number of beds per 1,000 of the population is substantially higher than in England—1.2 per 1,000 against 0.74. There are now 2,900 beds available, including 324 made available from other services not now required. Of these,170 are unoccupied through lack of staff. I agree with the hon. Member about the urgent need for staff for nursing tuberculosis patients. It is difficult, because there is still prejudice which seems to be very apparent in South Wales. The Welsh Board of Health and the regional boards are co-operating with the hospital authorities and doing all in their power to concentrate recruiting on this and mental nursing. Various methods of recruiting nurses are being pursued, and I hope that there will be some response from the local population.
The hon. Member will be aware that the General Nursing Council sets the 530 curriculum and standards of nursing. While not making it compulsory, it has encouraged teaching hospitals to second nurses to take special tuberculosis training. We have had much help from that source in the London area. It is a voluntary measure which has proved successful over the country. It is considered that compulsion would not achieve better results and might deter some people from taking up nursing altogether. The voluntary appeal has been very successful where it had the full support of the matrons who were losing nurses, which is a very important factor.
Results in Wales have not been as good as we could wish, and there are empty beds which we should like to see opened if the necessary staff could be obtained. The general figures are dramatically better, in the incidence, in the deaths, and, indeed, in the admissions of tuberculosis patients. I am sure that the hon. Member knows that two thoracic consultants have been appointed and that this has done much to reduce the waiting list of thoracic surgery.
The picture is one or great improvement in many specialities over the past three years, and I believe that before three Governments hence the hon. Member will be able to attend the opening of his Cardiff hospital.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Eleven o'clock