HEALTH SERVICES, SCOTLAND

HC Deb 19 July 1955 vol 544 cc212-70

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Buchan-Hepburn.]

3.33 p.m.

Miss Margaret Herbison (Lanarkshire, North)

Today we are to discuss health services in Scotland. The Reports from the Department of Health for Scotland and the Scottish Health Services Council cover a wide field and it would be quite impossible in this short debate for me or for all those who speak to cover even what we would consider to be the urgent and vital matters contained in those Reports. I intend to concentrate on what I regard as one of the most important matters covered in the Reports, and later to ask a few questions about a number of other subjects.

The matter on which I wish to concentrate is the care of our old people. I think all of us would agree, no matter on which side of the House we sit, that, in spite of the provisions so far made for old people, the plight today of some of our old men and women could be described only as tragic. It is not until all our old people are really well cared for that any of us have the right to be at all complacent in this matter.

There are many facets of the problem of old people. Most people will agree, I think, that the very best place for old people is in their own homes and that everything possible should be done to keep as many of our old men and our old women in their own homes as long as it is possible to keep them. For a number of reasons, old people are much happier in an environment which they know. They are happy when they have around them all those things that they have gathered together over the years, all those things which they cherish and which mean very much to them. Above all, they are happier in their own homes because they can still hold on to a feeling of independence. Therefore, I begin from the point that as a Government and as a nation, including local authorities, we ought to do everything we possibly can to keep our old people in their own homes.

Are we doing sufficient for our old people? If we are honest, I think that the answer must be a quite emphatic "No." After having decided to devote the main part of my speech to this problem, I was interested at lunch-time today to find in the "Scotsman" a leader on the care of the aged. In it, I found these words: For it is now becoming clear, as has been borne out by our correspondence columns, that before many years are over the care of the aged will be one of our main social problems. We do not have to wait until even one year is over for the care of the aged to be one of our main social problems. I think that the care of the aged is one of our main social problems today.

That leader went on to say: Those most closely associated with the services recognise that their existing scale is inadequate, and that this inadequacy may become much more pronounced unless public interest is quickened. The writer was commenting on a survey given yesterday by Mr. H. R. Smith, of the Department of Health, and I am in full agreement with that statement.

If we are to attempt all that we ought to do for our old people, there are a number of things to which we must give serious attention. First, if old people are to be able to live in their own homes, they must have adequate money for their needs. I know that if I tried to develop that theme, Mr. Speaker would quite rightly say that this was not the debate in which to develop that matter. I would say, however, that there is no doubt that the latest financial provisions made by the Government for old people are hopelessly inadequate. They are particularly so for the over one million old people who are the very worst off.

Since the Secretary of State for Scotland has the responsibility in Scotland for the health and welfare of old people, he ought to be using some of his charm and his ability on the Chancellor of the Exchequer to have him ensure very quickly that all our old people will have money adequate for their needs. I pointed out in a previous debate that the wants of old people are not very great, but even these simple wants cannot be satisfied today.

There is another matter which would help considerably in keeping old people in their homes. Provision for houses for old people should be made in every local authority housing scheme, and such houses should have facilities suited to the needs of old people. Facilities to suit the needs of young people do not always meet the needs of the old. I know that certain local authorities have done very good work in building houses suitable for old people, but too few of these houses have been built so far. I hope that members of local authorities will read reports of this debate and take heed of what is said by all who speak in it.

The Secretary of State could use his position to urge local authorities in Scotland to pay greater attention to the provision of houses for old people in all their housing schemes. It is not only a question of the interior of the houses meeting the needs of old people. Old people do not want to be isolated. If they were housed in housing estates where there are young couples with children they could see the children play and the young children, who often love to do it, could visit them and talk to them. In other words, the old people would have the companionship which so many of them lack at present.

I have heard of cases where local authorities have not only built houses for old people, but have placed a house at the disposal of a person called a "warden." The warden's job is to act almost as a guardian angel for old people, to see that they are not lying ill in bed and unattended. I am sure that most hon. Members will appreciate the kind of work that such a warden could do for old people without my elaborating it further. The Secretary of State and the local authorities should give some attention to the provision of a warden or guardian who would be motherly and kind to old people.

Another factor which would help to keep old people in their homes is the much wider provision of a home help service. The existing service has proved a real godsend to thousands of old people in Scotland. The Reports of the Department of Health for Scotland and the Scottish Health Services Council for 1954 show that all but two of the fifty-five local authorities in Scotland provide domestic help. I should like to know which two local authorities are so reactionary that they have not taken steps to provide this most essential service not only for old people but for other people who sometimes desperately need home help. I should like also to know how many of the fifty-three authorities which provide home help engage a sufficient number of home helps to meet all the needs.

The Reports state that there is an increasing demand for this service. Is the number of home helps keeping in step with the increasing demand? My information inclines me to think that it is not. I also find that 49 per cent. of all the home helps in the country are used for the care of chronic sick including the aged and infirm. Does the 49 per cent. cover all the old people who can definitely do with this invaluable help?

How many local authorities provide home helps at night? Quite a number of old people might possibly manage without home help during the day but very much need help during the night. Are local authorities providing these home helps? In some cases, because they have no help during the night, old people have to leave their homes and go to a residential home. I hope that the Minister will be able to give the House information on this subject. If he cannot, I hope that the Department will take steps to find out and to urge that, if this service is not provided at present, it certainly should be provided by local authorities.

Accidents in the home are one of the greatest causes of tragedy among old people. The home help can assist greatly in avoiding these accidents. The local authority in Edinburgh issues fire-guards on loan to mothers of young children. Fire-guards should be available in the homes of old people where there are open fires. Old people are frail and unsteady on their feet and it would be a great comfort to those who are interested in their welfare to know that they have this minimum safeguard. All local authorities could very well follow the example of Edinburgh, and I hope that the local authority in Edinburgh will extend the service there to cover the homes of old people.

A much better provision of meals in their own homes would also help greatly in keeping old people in their homes. One of their difficulties, if they are a little infirm or frail, is the inability to cook for themselves even one substantial meal a day. If there were much greater provision of meals at home, a number of old people who ultimately find themselves in residential homes could well remain in their own home for a number of years longer. The Reports state that meal services are provided in forty-six areas. We should like to know which areas do not provide even a skeleton service of meals for old people.

It is true that about thirty are using the school meals kitchens, and where they are used the project has been a great success. It seems to me that where such kitchens can be used there is no excuse for not providing this service of at least one good substantial meal each day. I feel that very much more could be done here than is being done. Even where local authorities and voluntary organisations, some of whom are doing wonderful work, make this provision, it is covering only a very small percentage of these old folk. I hope that the Secretary of State, through the local authorities, will do everything possible to increase the provision of meals. I know that wonderful work is being done in one of our villages by a voluntary organisation, but if one looks at all the villages even in my constituency there are many where not one meal is provided at all.

One of the most distressing complaints from which old people suffer is trouble with their feet. Because they are not having chiropody treatment that will help them in this matter, many of them find themselves in residential homes or as patients in hospital using beds which are badly needed for other cases. Are we doing anything here? Again, I fear, the answer must be "No."

I find that twenty-six authorities in all—I have included the ones offering a partial service—have some kind of chiropody service, but even those twenty-six authorities do not cover by any means all the old folk who desperately need this treatment. It seems to me we cannot be satisfied until there is for every old man and woman in every village and town easy access to a chiropody service.

There are two other points on which I want to touch. One of the worst evils affecting old people is loneliness. Many of them attain a great old age and, by outliving their friends, cannot have the companionship to which they were accustomed. Often in the newspapers we read that an old person has died and that death was discovered because milk bottles or newspapers remained on the doorstep for several days. What that old person must have suffered before death brought relief! This is not something that can be organised by the Secretary of State, but the local authorities might help with it because it is really the very best form of voluntary work.

Some of our churches do good work here, but I say quite frankly, as a member of the Church of Scotland, that even our churches are not doing all they can to help to expel loneliness from the lives of these people. Our church guilds could do a great deal more than they are doing. Each member of a guild might make herself responsible for at least one home in which an old man, an old woman or an old couple are living. In almost every village and town there is a Co-operative Women's Guild and in the main, they, like the church guilds, do good service. But, here again, more could be done than is being done.

We have our youth organisations attached to the churches and to other bodies. Some old people are not able to do their own shopping, and that could easily be done for them by arranging for volunteers from these organisations in each village and community, who would be willing to undertake this work. Some old people are not very able to do their shopping, but prefer to go about it. They feel they want the companionship that they meet in the shops. Here, again, volunteers from the organisations I have mentioned could accompany them to the shops, because many street accidents are caused by frail old people being unable to cope with the traffic. These are some of the ways in which the voluntary bodies could help.

The last point with which I want to deal is places for old people. The Secretary of State and his Department might help with finances much more than is being done now. Some of the local authorities have done good work, but some could have done much more to provide in each community a place where these old folk could congregate and meet their friends, where they could sit and talk or play games if they wanted games. But so many of them just want to sit and talk about old times. Just across the road from where I live the local authority has opened a hut, which is surrounded by a little garden for the aged. It is wonderful to see the old men just sitting in that hut talking, but there is nothing for the old women.

I hope that my hon. Friends and hon. Members opposite will add to the list of things that could be done to keep our old people in their homes, in comfort, in cleanliness, and well fed, all of which would ensure their happiness. I know that this particular facet of the problem is that if everything I have mentioned were achieved, we still would have a number of them for whom provision other than in their own homes would have to be made. What is the present provision for them? I know that the Joint Under-Secretary of State will tell us that that has greatly improved since 1948, but that it is far from adequate.

Those responsible for the accommodation which is provided will also agree with this. The local authorities, or the voluntary organisations working for them, provide accommodation, I understand, for about 4,740 old people and the voluntary and private homes provide accommodation for 4,300. I am not sure, from reading the Reports, whether the latter figure includes accommodation which they provide for the local authorities, but if it does not, as far as I can gather from the Reports, in these residential homes we have 9,000 places for old men and old women. Under the Act of 1948 the local authorities have provided 62 new homes either in old buildings that had been used for some other purpose or in completely new buildings.

Has every local authority used the provisions under the Act? In other words, is there any local authority in Scotland which, since July, 1948, has made no new provision for its old people? I feel that far greater urgency needs to be shown in the provision of these residential homes than so far has been shown. Here again, the Secretary of State could help greatly by urging the local authorities to do much more than some of them have done already.

Then there is the great problem of the chronic sick and of what are sometimes called the senile. This is where all of us have failed most. This afternoon I am trying to make no party point but to focus not only the attention of this House, but the attention of the nation, on this great problem. Far too many of our old people are in beds in mental institutions, which is a great disgrace on all of us. Sometimes they are termed "confused"—confused just because they are old and because they are losing some of their faculties. How wrong to dub them as mental patients. Yet I have been told that often this is the only way of finding accommodation for them and, because they are a little confused in mind, they find themselves in a mental institution.

Not only do some of them go into the observation wards of mental institutions, but a number of others are certified as mental patients. This is a disgrace for decent old men and women who have led good lives for many years. And not only is it wrong for them, but it is bad for their families and for succeeding generations, because it is then said that they had a relation in a mental institution. I know that we are beginning to adopt a different attitude towards mental illness, which is more and more coming to be regarded as equivalent to physical illness, but there is still some stigma attached to it and we ought not to allow this to continue.

What can we do that we have not done? In Scotland, we have emergency hospitals, four of which were built and ordered to take the war casualties of the Second World War. The one I know best now provides accommodation for between 700 and 800 people. It is an excellent hospital which has built up its prestige quickly but in it, as in others, old people are using beds which they should not be using.

When I look at that emergency hospital, which is airy, clean and sunny, I think that we could provide quickly, perhaps attached to our general hospitals, a similar type of accommodation which would meet the needs of our old people for beds. Not only would this make more beds available for urgent cases and give us a quicker turnover, but it would make it possible for us to use, in the care of old people who often do not need specialised nursing attention, many motherly types of women who would be glad to do that work. In other words, what in a way emergency we could erect so quickly it is incumbent on us at this stage to provide, first, to prevent our old people from going into mental hospitals and, secondly, to free the beds in our general hospitals. In addition, this kind of accommodation would meet the needs of many old people who are still in their own homes but who need care.

Now I want to touch briefly on three other points quite different from the ones I have dealt with already. The first I have raised by Questions in this House and in an Adjournment debate. The Report, in page 24, deals with tuberculosis and, in reference to the waiting list, states: The waiting list for hospital treatment has been reduced during the year from 1,794 to 515. …. The reduction has not been matched by a proportionate fall in the number of new notifications or an increase in hospital beds but has followed recent surveys of the lists. …. I have asked before, and I should like to know today, what the recent surveys did to bring down the waiting list. If it was by increasing domiciliary and outpatient management, are we certain that the number of people who have been taken from the list and are now classed as patients who can be treated at home will not be infecting other people? If we are not certain of that, it is wrong to reduce the waiting list in this way. I ask this question because I find at the end of the paragraph these words: A careful adjustment between demand and provision is needed at all times. That sentence has something sinister for me—"A careful adjustment between demand and provision." In other words, we have so many beds that we can use, and, instead of saying that we have a big waiting list, we adjust it by saying that we will take so many off the list and treat them in their homes. The hon. Gentleman must tell us clearly whether that number has been reduced by leaving people at home who might infect others. If that is the case, then it is one of the greatest indictments that could be levelled against the Government.

My second point concerns the remuneration of chemists. We find, in page 38 of the Reports, a paragraph dealing with this matter, which was raised by the Public Accounts Committee, and it was very dissatisfied with the way in which the remuneration was computed for chemists in Scotland. I find that the the Scotish Office took cognisance of this, and we are told that it referred it to the arbitration tribunal set up in 1951. The members of the tribunal ruled that what the chemists are getting at present is in accordance with the award made in 1951. Does that mean that our Ministers have decided to do nothing more about the very strong point which was made in the Public Accounts Committee, which pointed out clearly that chemists in Scotland were doing very much better financially than chemists in England?

My last point—and this is perhaps a hobby-horse of mine—is that we have in Scotland only one unit in a hospital which specifically deals with the treatment of men suffering from pneumoconiosis. I have asked the Government to establish a unit near every coalfield in Scotland. So far, they have resisted that request, yet tomorrow we are to have a debate on coal which will probably discuss, among other things, the lack of recruits to the coal industry. It is not surprising that there should be lack of recruits when we realise that miners suffer from this disease, and that so little has been done, both in research and in providing units, to deal with them. I know that many of my hon. Friends wish to take part in that debate, when some will be elaborating this, and that others will be bringing forward fresh points in this matter of the health of our people in Scotland.

4.12 p.m.

Colonel Alan Gomme-Duncan (Perth and East Perthshire)

I followed with the very greatest interest the speech of the hon. Member for Lanarkshire, North (Miss Herbison), and particularly her references to the care of the old people, a matter which, I have always thought, has been rather neglected in our country when compared with the care given to youth.

We have heard so much emphasis put on youth that I think that many of our young people are beginning to think that they are entitled to all kinds of things, without any effort on their part. I think that the real tragedy—the hon. Lady used that word—is that some of our old people are discovered, quite unexpectedly sometimes, to be living entirely by themselves, without a soul in the world who has the slightest interest in their well-being. In some cases—I hope a very few cases—callous relatives have neglected them, and in others all their friends and relations have died.

We have in Perth a society known as the Society for Indigent Old Men. It may have an old-fashioned, early-Victorian title, but it deals with these old men whom we find in the back streets in Perth, sometimes quite unexpectedly, and without anyone to look after them. It keeps in touch with them and does the kind of work which the hon. Lady has recommended should be extended. The work which that small society does is a proof to me that much more could be done, but funds and voluntary workers are required.

In Perth, there is a further interest in this matter which is evidenced by the fact that the war memorial for the last war is a home for old people. Some of them live in the mansion house, acquired within the bounds of the city, for those who have no wives or husbands living, and others live in small hutted houses in the grounds where they can still live their own life as couples, but under supervision in case of necessity. This type of work is of the greatest possible social value and is a responsibility which we must not shirk. It is very easy for us to say that, but it is a fact.

Most of these old people, some in small ways and others in greater ways, have done their best for their country, and it is hard to think that at the end of their days, although they have a pension, they have no one to look after them. I hope that the Minister will be able to tell us that more effort will be made in this direction, because I think that these old people are well worthy of support and of help in the evening of their days. I hope that the Minister will give us some encouragement that this matter will be dealt with in a rather different way from that in which it has been dealt with up to now.

4.15 p.m.

Mrs. Jean Mann (Coatbridge and Airdrie)

I am very glad to follow so closely my hon. Friend the Member for Lanarkshire, North (Miss Herbison), who dealt with the question of old people. I must, however, dissociate myself from her remarks when she said that the Church might do more, and when, in particular, she left out the most influential pressure group of all, namely, the National Federation of Old Age Pensioners' Associations. As a member of a Church of Scotland, I agree with most of what she said. At the same time, I certainly think that this powerful group, which can exercise so much pressure on Members of Parliament, could go a long way to fulfil some of the desires expressed by my hon. Friend today. I know that it meets every week.

Miss Herbison

When I mentioned churches, guilds, and so on, I was dealing only with the voluntary type of work of providing people to visit old people. I know, of course, that the Federation does wonderful work in that field.

Mrs. Mann

I was just coming to that if my hon. Friend had allowed me to proceed. I started my sentence by saying that I knew that the Federation met every week. It cannot possibly meet every week to discuss how much the Government are to give them. It cannot be having reports every week. Surely, once in a while, it knows whether it is to get anything, and usually it knows that it will not get anything, and then it has a meeting about what it can get from the corporation. Would it not be a good thing if the Federation devoted one of its meetings every month to finding out the position of its own colleagues?

Mr. Thomas Hubbard (Kirkcaldy Burghs)

I am grateful to my hon. Friend for giving way. That precisely is what the branches of the Federation do, not only once a month but every week.

Mrs. Mann

I am very glad to have my assertion so powerfully reinforced, and to know that this great body is doing this work. Therefore, I imagine that it is unnecessary to ask the churches and other people who are much more remotely concerned than the Federation. I am glad to know, as my hon. Friend said, that the old-age pensioners are running messages, are taking each other across places where there is dangerous traffic, and are watching that their own old pals are not suffering from loneliness. We are glad to have that assurance from the hon. Member for Kirkcaldy Burghs (Mr. Hubbard), who has been so long and so honourably associated with the Federation.

My hon. Friend referred to something else which we all deplore, and that is old people suffering from arterio-sclerosis, commonly known as senility, being put into mental hospitals. It is really worse than my hon. Friend stated. She said that these people are taken in as mental patients. They are, in fact, certified as imbeciles or lunatics under the Lunacy Acts.

It is almost three years since I tried to get the Government to help me to introduce a Bill under the Ten Minutes Rule. I was not lucky in the Ballot, but I should have thought that right hon. and hon. Gentlemen opposite would have helped me to get the Bill through the House. I am sorry to say that I was put off with some statement about the Russell Report. When I inquired into that Report, I found that it had very little to do with this aspect of old age.

I want now to refer to a matter which, although it is the greatest single cause of death in Great Britain, is never raised in the House of Commons, and less is done about it than about any other cause of death. I refer to accidents in the home. No notice is taken of the matter and little money is spent on it. Never in any debate in the House of Commons have we turned our attention to it. We have talked about the need for research into cancer and coronary thrombosis, but we have never talked about research into accidents in the home or propaganda to make people conscious of this ever-present danger.

I understand that we spend about £129 million a year on the prevention of accidents on the roads. Yet all we spend annually on the prevention of accidents in the home is £3,000, which is given to the Royal Society for the Prevention of Accidents, of which I am a vice-president. The withdrawal of even that amount was threatened two or three years ago, and I had to raise the matter in the House.

I recently asked a Question about the number of deaths in Scotland resulting from accidents in the home and accidents on the roads in 1953–54. I was told by the Secretary of State that 1,134 deaths from accidents in the home occurred in 1953 and 1,106 in 1954, while deaths from road accidents numbered 600 in 1953 and 561 in 1954. That means that almost twice as many fatal accidents occurred in the home as on the roads.

If we turn to the figures for England and Wales, we find something which ought to make every Scottish man and woman think. In 1953, there were 5,895 deaths resulting from accidents in the home and 4,493 deaths from road accidents. While the number of deaths from road accidents is still much below the number from accidents in the home, the proportion of deaths from accidents in the home in Scotland is very much greater. It is clear from reports on this subject that Scotland suffers very much more severely than other parts of the British Isles from overcrowding, and it is largely from this that the accidents in the home arise.

Another aspect is lengthy treatment in hospital. My hon. Friend spoke of the necessity for providing hospital beds. I wonder whether it can be estimated how many beds are occupied by victims of accidents which could have been prevented. I also wonder whether an estimate can be made of how much money is spent as a result of accidents in the home. An inter-Departmental committee, appointed by the Labour Government, estimated the cost of treatment following accidents in the home to be £4 million or £5 million a year, and that figure does not take into account accident victims treated by general practitioners.

What is being done about that? In Scotland, very little. My hon. Friend mentioned that Edinburgh has a fireguard scheme. Edinburgh has a very enthusiastic medical officer of health, Dr. Seiler, who has often presented papers to the Royal Society for the Prevention of Accidents, and he has a very enthusiastic home accidents committee set up under the aegis of the local authority. I am told that the money available to that committee for road and home accident work—I think most of it is devoted to the roads—is £75 per annum. It is a ridiculous amount. I find that there are about 540 home safety committees working under local authorities in England. There are only two in Scotland.

I find it very difficult to believe that my persuasive oratory should be sending to sleep so many hon. Members opposite, particularly the hon. and learned Gentleman the Solicitor-General for Scotland, whom I wish most to impress. I assure the House that a very small hat will fit me in future. There seems to be a very soporific atmosphere. However, I see an hon. Gentleman stirring. While there is life there is hope.

Mr. Thomas Oswald (Edinburgh, Central)

We thought hon. Gentlemen opposite were dead.

Mrs. Mann

We ought to be a little more serious, particularly when I am dealing with a subject such as this.

In England, 450 committees have been set up; in Scotland two. The two were in Edinburgh and Glasgow, and last year one was set up in Kilmarnock—and I am very glad to say I was in at the start of that—and I believe that this month one was started in Aberdeen. Apart from that, the Secretary of State appears to be leaving it to voluntary bodies and to a great many small, sporadic attempts here and there for propaganda, but nothing is actually being done.

I was in Belfast in connection with this subject and found a great campaign going on there. From the hospital endowment fund £1,00 had been taken and a most intensive campaign was going ahead. There were lectures, window displays, B.B.C. broadcasts, leaflets, and postal publicity. I have an envelope which came to me from Belfast and across it is written, "Protect your child." The authorities went further than that. They had uniformed firemen at the schools and the firemen delivered leaflets. The education authority co-operated and prizes were offered to the children for the best essays on the leaflets.

Belfast had been worried about the amount of time, nursing and hospital services spent in treating accidents which were preventable. When I was there I saw a young girl whose breast was completely burned away and who had had 52 weeks' treatment in hospital and who had received 31 pints of blood. She is now on her feet. The accident happened because she was wearing a nightdress and because there was a mirror upon the mantlepiece. I know that if the fire had been properly guarded that nightdress might not have caught fire; but I also know from our statistics that there are 12 million open fires in Britain and 5 million appliances, electrical and gas, which are not protected, in spite of the Heating Appliances (Fireguards) Act, 1952, because the Act applies only to new appliances coming on to the market. The Act refers to an offence only after a disaster has actually taken place. That seems to be like bolting the stable door after a horse has gone.

Meantime, something can be done. Mirrors should not be above the fireplace. One surgeon with whom I am very intimately acquainted, and who works in the Royal Hospital for Sick Children in Glasgow, constantly tells me to let mothers know that they ought to put girls in pyjamas, because all the accidents of that kind are with girls in nightdresses. Indeed, the report of the inter-Departmental committee says that 38 per cent. of the deaths from burning are due to the wearing of nightdresses.

In the English inter-Departmental report—I am sorry to say that there is nothing in the Scottish report—I notice that an attempt is being made to procure material which will be non-inflammable. That will be a big job, because the texture of the material must not be altered. We do not want something that will be as hard as wood in place of flannelette, or winceyette. It must not cause a skin rash. It must not wash out in the wash, as have so many former attempts. It must not appreciably increase the cost and must not leave a char which will develop into a flame.

While the Department of Scientific and Industrial Research is investigating this type of material—and I have talked to surgeons in Belfast, Edinburgh, Glasgow and Kilmarnock who are all agreed—we must adopt the simple expedient of having girls wear pyjamas instead of nightdresses. How is it that it is always girls and not boys who are burned in this way? The surgeons reply that girls wear nightdresses and boys wear pyjamas.

My hon. Friend the Member for Lanarkshire, North spoke of the hospital attention required by old people. If the figures of the causes of death from home accidents are broken down, it will be found that they are mainly to children under five and old people over 65, and usually in the 65-year-old group it is from falls rather than from burns.

I was very interested to get a very long letter from the Secretary of State about accidents in the home. In fact, I think that it is the longest letter he has written.

Mr. E. G. Willis (Edinburgh, East)

That is why we never see him here.

Mrs. Mann

In that letter the right hon. Gentleman drew my attention to a leaflet prepared by the Department. I have already said that I am a vice-president of the Royal Society for the Prevention of Accidents, which has 68 leaflets in circulation. I consider that this leaflet from the Department is the best I have yet seen. It is most expressive and I am sorry that it is regarded as being too expensive to deliver on a wide scale. Indeed, it is suggested that it should be used more as a poster.

I know of nothing that would bring home to young children in the schools a consciousness of accidents more than would this leaflet. In all the investigations which have been undertaken it has been discovered that accidents take place around tea-time, when mother is in the kitchen, when the children are home from school, when father is home for his tea; when pots are pulled over, the table cover is pulled and a child is scalded, or someone brushes against the fire. If we could make schoolchildren of eight to twelve years of age really accident-conscious, we should have so many more little policemen in the kitchen to see that nothing happens to the toddlers of eighteen months of age and to those under five.

The Secretary of State could do a great deal if he would invoke the aid of the education authorities, if they brought the firemen to the schools wearing their uniforms, which would make the children talk when they returned home, if they would issue leaflets, and offer prizes in the schools for the best essays. If he invoked the aid of the hospital boards, I think we could get a lot of money out of the endowments. Belfast got £1,000, and I think it would be possible to get some money from the hospital endowments and allow our young surgeons, and even the elderly ones, to go to the schools or to public meetings and deliver lectures on what is happening in the hospitals.

If the local authorities received more encouragement and had permission to engage lecturers among the consultants, the plastic surgeons and those dealing with accidents, who are so deeply and seriously concerned about the day-to-day tragedies which they see, they could do a lot of good. Perhaps one has to have an accident in one's own home to realise this situation, and I myself am enthusiastic about it because I personally drank the dregs of that cup myself. It may be that if the surgeons who see it all, instead of making a domiciliary visit, made a visit to deliver a lecture, we could rouse the consciousness of the people and save the tragedy and despair—and the cost to the Exchequer—of something that could and should be prevented, and, at the same time, provide more money, more hospital staff and more beds for this necessary work.

4.42 p.m.

Captain J. A. L. Duncan (South Angus)

I think that the hon. Lady the Member for Coatbridge and Airdrie (Mrs. Mann) has done a service to Scotland today by making the speech to which we have just listened. As I knew before, the fact that there are roughly double the number of fatal accidents in the home to the number of fatal accidents on the roads has never been brought into public view adequately before, and I hope that the speech which the hon. Lady has made will have the necessary effect on the Government, on the local authorities and on public opinion outside. I would assure her that, as far as her oratory is concerned, I did not go to sleep, at any rate, but that I was very interested in what she said.

The hon. Lady the Member for Lanarkshire, North (Miss Herbison) spent most of her time speaking about the old people, and I do not necessarily disagree with most of what she said. I agree particularly with the general theme of her remarks to the effect that, as far as possible, the old people should spend the evening of their lives in their own homes. I think that it is far better that if that can be done it should be done; for those who cannot do this, of course, there are obligations under Acts of Parliament on local authorities to set up old people's homes.

The only cloud I would cast on her enthusiasm and energy is this. First, I think there is still and ought to be some obligation on the other members of the family, if there are other members of the family, to look after their old people, and, secondly, I think that we must remember that the old people of today have the old-fashioned, but I think right, Victorian pride in being able to be independent, and very many of them are not anxious to take advantage of the facilities that are provided today.

As an example, in a town not far from where I live, a meals service was organised. It is a town of over 2,000 people, but the old people's committee could find only 15 old people of that area to take advantage of the service offered, which goes to show that, apart from monetary considerations, there is this sense of pride among the old people. They do not want to be considered the object of charity, but would much rather live in their independence, the virtue of which has been brought down to them from their Victorian forefathers. I do not think that we ought to overdo these provisions, but ought to help the old people to maintain that pride in their independence.

None the less, one of the most important social services—and I agree with the hon. Member for Lanarkshire, North—is the provision that is made to combat the loneliness of old people. I do not believe that the Government can really do very much about this. It is much more a matter of local voluntary social service and for the local old people's committees, people with a friendly touch, who can sit down for a chat over a cup of tea with the old people in their own homes. They can take them out for an outing, as we do in our part of the country, and organise a motor car service to take them to local beauty spots, or encourage them to watch a bowling match on a nice summer evening by giving them a ticket to admit them to the bowling green.

That is the sort of thing which can be done by other members of the community to enable the old people to forget their loneliness, and I believe that it is that sort of thing which is most important in helping our old people today. As my hon. and gallant Friend the Member for Perth and East Perthshire (Colonel Gomme-Duncan) said, it is not a question of money, but much more a question of the psychological approach in dealing with old people today.

I have been reading the Reports for 1954, and I should like to draw attention to one or two matters in them. First, I think that the statistics, and particularly those given in page 106, are so dramatic that they are worth a little attention. Let us look at the figures of maternal mortality. The number of women who died in childbirth between 1936 and 1940, on the average, was 424 per annum, whereas the number of women who died in childbirth last year was only 70. That is a very dramatic reduction, and, of that figure of 70, 10 per cent. were due to abortions and 15 were due to puerperal sepsis.

Both of these could be avoided, and it seems to me that, even though these figures are so dramatically good, there are still opportunities for making childbirth a much safer thing than it has ever been thought to be in pre-war days. There were over 92,000 births, and only 70 mothers died. I am sure that, with better attention even than we have today, we can get that figure down still further.

Let us take the figure of infant deaths. Between 1936 and 1940, the average figure of deaths under one month was 3,241. In 1954, there were only 1,904. Taking the figures of deaths under one year, between 1936 and 1940 the yearly average was 6,600, whereas, last year, there was only 2,861, a reduction of 50 per cent. in a few years. And so it goes on.

I am not claiming that the Government are responsible. I believe it to be due to the advancement of medical science, to the discovery of new drugs and the many things discovered, invented and developed by medical science and nursing throughout the years.

Mr. Hubbard

And to better housing.

Captain Duncan

Yes, and to better housing—

Mr. Hubbard

And clinics.

Captain Duncan

Yes, but they were also in evidence in 1939. The results are dramatic enough for attention to be called to them, and the same thing applies to the figures for tuberculosis, which are also extremely good.

I wish to ask my right hon. Friend a few questions about the mental services. I do not regard mental illness as a stigma. I think it a mistake to talk in that way, as did the hon. Member for Coatbridge and Airdrie I was present at the opening of Gowrie House by Lord Strathclyde, a couple of months ago. This open door mental institution has been extended from 70 to 100 beds. No door in the whole place is locked. All the patients are voluntary patients and can walk out at any time. There is a throughput of patients of over 100 per cent. a year. That may be a specialist institution, because an enormous number of special cases are treated there which are peculiarly susceptible—

Mr. Cyril Bence (Dunbartonshire, East)

What does that mean?

Captain Duncan

Patients who stay for a year in the hospital.

Mr. Bence

Over 100 per cent? I do not understand how it can be more than 100 per cent.

Captain Duncan

It may be more. The average stay of a patient is less than a year. All the patients leave.

That does not apply to other mental hospitals. This is a specialist institution where special types of patients are treated and receive special treatment. But even in the ordinary mental institutions the throughput, that is to say the cure of patients, is much quicker than is generally realised. Broadly speaking, the type of patients whose numbers accumulate from year to year are people who are so old, whose mental faculties have broken down, that they have to be kept in an institution. That is a difficult problem for mental institutions.

I was glad to hear recently from the Government, and it is contained in these Reports, that plans are ready to improve the mental hospitals in Scotland, particularly at Westgreen, which is a mental institution in my part of the country. It is important that improvements should be made there as at present it is in a bad state.

May I say a word about the much more difficult problem of mental deficiency? I am glad that at last two new blocks have been erected at Baldovan Institution. One of the old buildings was a most appalling place which I am glad has been closed. In page 56 of the Reports it states that plans are being made for two new blocks for high-grade mental defectives. I wish to know when they are to be started, because when they are provided we shall be able to meet the problem in our area for some time to come.

In the Scottish Grand Committee this morning I raised the question of slaughterhouses—

Mr. Oswald

It ought to be splashed all over the Chamber.

Captain Duncan

Page 77 of the Reports states: It has been shown incidentally, that the removal of control has, to some extent, altered the pattern of the meat trade; in particular more animals are being killed in the beef-producing areas instead of being sent live to English markets. Statistics are being collected by the Department to show the trend of slaughter. I should like to see those figures, and I wish to ask my hon. Friend whether he will make them available, not only to this House, but to local authorities; because in the future siting policy of slaughterhouses it is essential to meet the needs of each district.

I think it is becoming more apparent, as time goes on, that the trend will be to increase slaughtering in the producing areas and reduce it in the consuming areas. It will be much more economical, and better for the animals, to send meat on the hook in the railway van or lorry than to send the animals for miles on the hoof in vans. I hope, therefore, that my hon. Friend will provide us with these figures and give them to the local authorities when the future policy for slaughterhouses is under consideration.

In page 99 of the Reports reference is made to rural water supplies. There is a lot of information about rural water supplies, but it is difficult to get a clear picture of what is happening. I gather—though I should like my hon. Friend to confirm this—that there are 300 rural schemes for water and 224 sewerage schemes which have been completed since the war. I am excluding the big town schemes. There are 64 water schemes and 42 sewerage schemes proceeding now and, so far as I can understand the Reports, there are, in addition, 418 water schemes and 163 sewerage schemes authorised.

This adds up to a formidable total, if I have interpreted the figures rightly. I wish to be assured that the authorised figure means that local authorities are getting on with the work. If 418 water schemes are put into operation during this year, it will mean a big extension in the rural areas, particularly in districts where water is so badly needed if we are to keep the people in the countryside. A piped water supply is one of the amenities which people living in the countryside have come to expect.

I wish to know how many of these schemes are in operation, how much money has been authorised by the Government in grants and how much money local authorities are expected to spend this year. When main trunk pipes are being laid I hope that the by-pipes to neighbouring farms and villages will be laid at the same time, and that it will not be necessary to come back the following year to open up the trench again in order to install them.

In page 114 of the Reports there are statistics of the beds available in the regional hospital board areas. I notice that in the Eastern Regional Hospital Board area there is a reduction from 836 beds in 1953 to 577 in 1954. I should like an explanation of this figure. I do not cavil at a reduction in the number of beds because, thanks to the notable reduction in the incidence of tuberculosis, we are able to cater for all diagnosed cases of tuberculosis in our area straight away; in fact, we have spare beds which, I suggest, might well be used by people from other areas if there is any overcrowding in those areas. There has been a remarkable reduction in the disease, but I should like an explanation of how the reduction in the number of beds has come about. I should like to know whether the beds have been transferred to other purposes.

I congratulate the Government upon the Reports. They are reports of progress—better health and better conditions for old and young alike. Although the housing figures are not a record they are the second highest ever for Scotland. I hope that this progress will continue during this year and that we shall be able to congratulate the Secretary of State and the Scottish Office next year upon as good Reports as those now before us. If we can do so, I believe that Scotland will be getting her share and her due.

5.1 p.m.

Mr. Thomas Hubbard (Kirkcaldy Burghs)

This debate has ranged over a very wide area. I have been interested in many of the speeches which have been made and would dearly like to follow my hon. Friend the Member for Lanarkshire, North (Miss Herbison), who spoke about the care of the aged, which is a subject very close to my heart. I am afraid, however, that upon this occasion I must leave that subject and take up the subject of the cheerful and much better Report of the Department of Health for Scotland, which was referred to by the hon. and gallant Member for South Angus (Captain Duncan). Taken generally, it is true that this is a cheerful and much better Report. Nevertheless, I should like to draw the attention of the House to a matter which is to be found in page 29, and which is dealt with in what is probably the shortest paragraph in the Report.

This paragraph deals with the biggest killer disease in Scotland, namely, coronary thrombosis. This paragraph makes it clear that the incidence of deaths from coronary thrombosis has gone up by leaps and bounds. It has increased five times in the last twenty years. Although this is the biggest killer disease in Scotland it receives the briefest mention of all the multitude of items appearing in the Report. The incidence of deaths from this disease have increased by five times, but we are glad to know that the increase in other heart diseases is not going on to the same extent. The number of deaths from rheumatic heart disease, indeed, is very low. This emphasises the very serious nature of coronary thrombosis.

The paragraph says: … there is clear evidence that the coronary group is showing a heavy increase. It is not known for certain why this should be, although various different reasons have been adduced from time to time. I am sure that the Joint Under-Secretary will agree that if there is anything which we should concentrate upon in connection with a report of this kind—which, as the hon. and gallant Member for South Angus rightly claimed, shows an improvement in every other direction—it is the question of the incidence of death from the disease and the incidence of the disease itself.

There is quite an improvement in the research into this disease. I thanked the Secretary of State for Scotland and his Department in the debates which took place last year and the year before for having made possible greater research into the causes and treatment of the disease, but I am satisfied that that research has not gone far enough. Recently, some progress has been made by the discovery of an anti-coagulant, which has the effect of slowing up the coagulation of the blood. This has been found to be helpful, but it is not generally given unless the patient concerned has had recurrent attacks of thrombosis. I hope that encouragement will be given in this matter and that the Medical Research Council will go into the possibilities of further development of the use of this anti-coagulant in the treatment of thrombosis.

The tragedy is that the great bulk of the people making up this high and ever-increasing figure of deaths from the disease never knew that they had it, because most of them were killed in the first attack. It is, therefore, of great importance to find out the causes of the disease. I make a very special plea to the Joint Under-Secretary and to the Secretary of State, which I hope will be taken note of, because of the importance of this issue. A scheme has been started in Kilmarnock under which the local authority has agreed to make coronary thrombosis a notifiable disease. That scheme has already been accepted by the Fife County Council, but in this instance it does not include the large burghs of Dunfermline and Kirkcaldy.

The purpose of making this disease notifiable is to make possible the collection of facts which are bound to be useful to the Medical Research Council in its efforts to ascertain the cause of the ever-increasing incidence of the disease. I do not know very much about the Kilmarnock scheme, but I know that a questionnaire is issued in connection with it. I know something of the Fife County Council's scheme, and I compliment the medical office of health for the county, and also the medical officer of health for Kilmarnock, for their enterprise in introducing such schemes, which are of great value to research into the causes of this killer disease. The incidence of the disease in England and Wales is about the same as it is in Scotland, which proves conclusively that this killer disease is getting worse and worse.

Under the Fife County Council scheme all the general practitioners in the area are asked to complete a questionnaire giving full particulars of the victim of an attack of coronary thrombosis. If the unfortunate person has died with the first attack, not a great deal of help is available, but if the victim survives that first attack the general practitioner completes the form and passes it on to the medical officers of health for Kilmarnock and Fife County Council. They, in turn, contact the sufferer and obtain from him the answers to a whole number of questions. They ask what his background is; where he works; what type of food he has; whether he has had any other kind of disease; whether he has suffered from diabetes, and whether he is overweight or underweight.

It is rather remarkable that, according to the figures which I have been able to obtain, 80 per cent. of the people dying from the disease belong not to the classes which do hard physical work but to those who suffer from mental strain. That, in itself, should tell us something. It would be interesting to find out whether there is any history of coronary thrombosis or angina in the parents of the victims. These experiments could be very useful.

I cannot anticipate the results, but the collection of information relative to the ever-growing number of victims suffering from the disease is bound to be of great value to the Medical Research Council in its endeavour to arrive at the cause of the disease. Only when we find out possible causes can we take preventive measures to reduce the incidence of disease.

To reduce the incidence of death from this disease and the ever-increasing number of people who become victims to it, would the Department of Health for Scotland and the Secretary of State for Scotland encourage local authorities to try a period of voluntary notification of those suffering from coronary thrombosis and angina?

Captain Duncan

The hon. Gentleman started by saying that in Fife and Kilmarnock notification was compulsory. Which is it?

Mr. Hubbard

I must apologise to the House. If I said that, I said it wrongly. It is a voluntary scheme, both in Kilmarnock and in Fife.

The value of the voluntary scheme will not be fully felt until we have wider information. The Fife scheme might be made to include the large burghs of Kirkcaldy and Dunfermline. We miss out that large group of people, but we should include them in order that the scheme may be a success. The information from the wider scheme could be of value to us. The medical officers of health and the general practitioners of Kirkcaldy and Dunfermline should be brought into the scheme, to co-operate and collect information to be passed on to the Medical Research Council and others who are doing research in cardiology and matters of that description.

Mr. William Ross (Kilmarnock)

Would my hon. Friend ask the Secretary of State what is going on in this direction? I gather from the medical officer of health for Kilmarnock that there is a lot going on in other places as well as in Kilmarnock.

Mr. Hubbard

I hope that is true. I can only speak of the experiments which I know are being carried on. I am glad to know that Kilmarnock's was the original scheme. It has been an original place for many things.

Mr. Ross

And it is still going strong.

Mr. Hubbard

To get the full value of this type of research, could the Secretary of State ask Scottish local authorities to agree to voluntary notification of coronary thrombosis for a period, say, of two years? I am aware that the Secretary of State has no power of compulsion, but I am satisfied that if local authorities knew that they had the blessing of the Secretary of State they would co-operate and help to collect information.

I am not speaking as one with great knowledge of the subject but as one who, with quite a bit of personal experience, would like to know more about it. Most sufferers would like to know more about this matter. I understand there are particular ages when this disease becomes more evident, especially in women, and that there are kinds of occupations where the disease is more common than in other occupations. I believe that one of the causes of the disease is too much fat in the blood. It would be interesting to know the type of food that such people should eat, so that we can advise parents and people generally what to avoid in order to minimise the danger of contracting this rather horrible disease at a later stage in life.

I am sure that every local authority and every general medical practitioner in Scotland would give such schemes their blessing and co-operation. It may be said that medical officers of health of different local authorities are busy, but I doubt whether they have too much to do. They used to carry out a great deal more work for local authorities in the past than they do now. The introduction of the National Health Service removed a lot of their responsibility. I know they are a kind body of men who would be anxious to help, and they could provide us with the real information we need.

It is interesting and disturbing to realise the increasing incidence of death from this disease. We do not know the number of people who suffer from it and there is no way of knowing. This fact is out of keeping with our times. We have to notify an attack of measles, which is a comparatively mild ailment—it is contagious, I admit—yet it is nobody's business to collect information about the number of people suffering from coronary thrombosis. We know, of course, the number of deaths but not the number of sufferers. We hope that every encouragement will be given to the Medical Research Council in dealing with this complaint. I am sure it will be delighted to have the co-operation and encouragement of the Secretary of State and of local authorities.

I understand that for the first time there is to be a world conference on this disease. I am glad there is to be an interchange of research information on thrombosis, and also on poliomyelitis. This subject is common to all political parties. It has to be common to be common there. We are getting co-operation in research on poliomyelitis. The world conference on coronary thrombosis will be of great value. It has been made possible as the result of the Secretary of State for Scotland and the Minister of Health in England making greater sums of money available for research and interchange of information. I hope that something will come of it.

I hope we shall get further information about the use of anti-coagulants, and that a message of hope to those who suffer from recurrent attacks of thrombosis will go out, as well as to those who deplore the ever increasing mortality figures. I trust that the Under-Secretary of State will agree, as a result of this debate, to ask local authorities for their cooperation.

5.20 p.m.

Sir Ian Clark Hutchison (Edinburgh, West)

As I understand that it is desired to conclude this debate at seven o'clock I intervene for only a few minutes to raise two points, one of which I do not think has yet been mentioned. When the Scottish Standing Committee discussed the Scottish Health Services last year I commented on one paragraph in the 1953 Report which dealt with German measles. I asked the then Joint Under-Secretary—now the Minister of State—whether he had any information about research into that particular disease. I always understood it to be of a rather minor character, but it may apparently have very serious effects on expectant mothers. The then Joint Under-Secretary was not able to say very much in reply.

In the 1954 Report I find no reference to German measles. This is an important subject because, as everyone knows, it is infectious and very common, and particularly liable to spread in a family where there are a number of young children and where, therefore, there may be a risk to the mother. I have heard interest in this matter very properly expressed in a number of quarters, and I should be grateful if the Joint Under-Secretary could say a word about research into the effects of this disease.

My other point is the highly important subject of the campaign against tuberculosis. Everyone must feel satisfaction in knowing that the death rate from that disease has dropped considerably in the last few years, and that the campaign for mass radiography is showing good results. Page 23 of the Report shows the areas in which the campaign has been carried out, but I wonder whether the Joint Under-Secretary could say what other areas are to be surveyed during the current year.

I am particularly concerned with the district of Pilton, in my own constituency. Greenock had, I believe, the first survey, and I think that Pilton was second. Some disappointment has been expressed by the organising committee at the lack of sufficient apparatus to enable follow-up procedure to be made in the ward itself. On 14th June last I asked some Questions of my right hon. Friend the Secretary of State for Scotland. I appreciate that it is necessary to deploy such resources of mass radiography units as are available to the best possible advantage, but I would urge the Secretary of State to try to get more of these invaluable units.

If a proper follow-up procedure could be arranged in those areas where the original survey has been made, it would be a great encouragement. I agree that lack of equipment will probably make it impossible to do that at very short intervals, but I would hope that it could be done within a year or two of the original survey, because it is important that people should be encouraged to use these facilities. It would help the battle against tuberculosis if there was this further check on the people who may be affected. Perhaps the Joint Under-Secretary will comment on the two points I have mentioned.

5.25 p.m.

Mr. E. G. Willis (Edinburgh, East)

I should like to reinforce the plea made by the hon. Member for Edinburgh, West (Sir I. Clark Hutchison) for follow-up procedure. Two districts have now been covered. I also asked Questions about this of the Secretary of State for Scotland, and from his answers he seemed to think that we wanted a follow-up in connection with people who had already been dealt with.

The Committee at Pilton wishes to have another campaign to cover those not previously examined. That requires a mass X-ray unit. I notice, too, that the Edinburgh Town Council is expressing concern at the seeming shortage of equipment in Scotland for these campaigns. The Secretary of State ought really to regard this more seriously, and when the committees themselves are anxious voluntarily to undertake the work of persuading the people to be X-rayed, he should give that encouragement which can only be given by providing equipment.

I want to return to the original theme of this debate—the care of the aged sick. During the past few months it has become clearer that the size of the problem has been underestimated; that the statistics have been too low. This was brought out very clearly in the survey carried out in Edinburgh, which I mentioned during the debate on the Gracious Speech. That survey showed that of over 5,000 who were examined, 40 per cent. were found to have various needs. Following that survey the "Scotsman," in a leading article, pointed out that the size of the problem was much larger than had been thought possible. It said: The findings of the survey indicate that the suspicions are well founded; that the degree of silent suffering among the elderly is considerably greater than is conveyed by official statistics. It went on to indicate that that was also true even of those requiring hospital treatment. The article continued: But the survey confirms that the number in need of institutional care is greater than is evident from the waiting lists. The survey revealed that 40 per cent. of the old-age pensioners had some need. If we apply that to the whole of Scotland, where we have just over half a million old-age pensioners, we find that 200,000 have some need—either nursing need, hospital need, a need for therapy, a need for rehabilitation, or something of that kind. That represents an immense pool of human need in our midst, which I do not think it really being met. Certainly, the information provided in the Department's Report for the last year does not seem to indicate that the problem is receiving the urgent attention that it deserves.

There is, first of all, the actual problem of hospital accommodation. The Report for last year says, The problem of making adequate provision for the large numbers of old people who need hospital treatment remains one of the most serious facing the Regional Boards; I do not suppose the Secretary of State will reply to the debate, but he has looked into the Chamber for a few minutes and, as we see him occasionally, I should like—

The Secretary of State for Scotland (Mr. James Stuart)

The hon. Member is not being fair in view of the fact that I sat through the early part of the debate and have now returned to the Chamber.

Mr. Willis

I had not noticed the right hon. Gentleman more recently, and I am bound to say that I have not seen a great deal of him during recent Scottish debates.

Arising out of the question of hospital treatment, can the Government give a clearer picture of how the increased expenditure which they have authorised is to be spent? What part of the £300,000 announced some time ago is to be spent on extending hospital accommodation for the aged and what part on extending accommodation for the mentally deficient, which is another pressing problem in Scotland? Every Report I have seen about mental hospitals indicates that there is gross overcrowding which nobody can prevent and a grave shortage of accommodation. What is being done about that?

The paragraph concludes by saying, To some extent the present shortage of beds reflects the difficulty in finding suitable accommodation elsewhere for patients well enough to be discharged. This raises the question of other accommodation, which comes under the local authorities. Here again we find the same shortage of accommodation. From the figures in the Report I gather that we have accommodation for about 10,000 under the local authorities, the Church of Scotland, the Old People's Welfare Association, the Aged Christian Friends' Society and various other organisations. That seems to be far short of the accommodation which we need.

The annual report of the Edinburgh Corporation published this year said that a large amount of additional accommodation was required. What progress is being made? From the Report of the Department of Health, I gather that local authorities increased the accommodation available last year by about 300, which seems a very small increase in view of the size of the problem. In view of the great need for this accommodation, I should have thought that more ought to have been done.

When we consider the facts provided by the Edinburgh survey carried out a few months ago, we get some idea of the problem. That Survey revealed that 22 of the bedridden patients were living alone and 90 were living with spouse only. Of those whose movements were restricted, 112 were living alone and 213 with spouse only. Figures were given for those whose out-of-door movements were restricted, and it was shown that out of 990 people living alone, 537, or 10 per cent. of all those taking part in the survey, were either completely bedridden or were restricted in their movements. That indicates a need for a great deal more to be done than is being done at present.

We also require those services which my hon. Friend the Member for Lanarkshire, North (Miss Herbison) mentioned in her excellent opening speech. When we try to go into the problem we find difficulty in finding out the facts because the services seem to be in the hands of so many different organisations—regional hospital boards, local executives, local authorities and half-a-dozen or more charitable organisations. They are all doing a good job, but it seems obvious that we ought to have a little more coordination between them than we have at the moment, first of all to get the facts and, secondly, to use the facts for finding the remedy.

According to the Report for 1954, Local Advisory Committees, representing Boards of Management, local authorities and Executive Councils, are now functioning The Report says these have played an important part in securing better co-ordination of services for the aged. I do not know whether these are the same committees as were referred to by Sir Humphrey Broun Lindsay, chairman of the South-East Regional Hospital Board, in April. If they are, he had a very different story to tell. Referring to the 25 local co-ordinating committees which had been set up in Scotland, Sir Humphrey said that five of them had met more than five times, seven more than once, and five once. Eight had not met at all. Among the subjects discussed, eight committees had considered the chronic sick. Thus only eight out of these 25 co-ordinating committees have considered what is obviously a very great question. This speech of 1st April this year belies the self-satisfied sentence in the Report of the Department of Health that these Committees have played an important part in securing better co-ordination of services for the aged That is a different story altogether.

What has the Joint Under-Secretary of State to say about this? Is what Sir Humphrey Broun Lindsay said true? If it is true, then obviously the Government are not treating the matter as urgently as it ought to be treated nor are they treating it with the importance which it deserves. We ought to have some explanation from the Government about this.

The more we look at this problem and the more we assess some of the facts concerning it, the more it stands out plainly that this is one of the most important problems not only of today but of the future because of the increasing numbers of aged people. I trust that the Government's reply tonight will be better than the information contained about this matter in the Annual Report.

5.40 p.m.

Mr. John Taylor (West Lothian)

I feel sure my hon. Friend the Member for Edinburgh, East (Mr. Willis) and the House will forgive me if I do not deal specifically with the single problem of the aged sick but return to a general review of the annual Reports, not that I disagree with anything that has been said on the problem and its magnitude and the great work we still have to do before we can feel satisfied that we see the end of that problem.

I think it due to the Department of Health, to the Scottish National Health Services Council and to the people of Scotland to have a few more words from the back benches on the Reports now before us. The Report of the Department of Health opens with the words: While Scotland's health record showed no outstanding features in 1954, there was evidence of progress in many fields. As a subdued under-statement that would take a lot of beating. It is a remarkable Report, indeed every annual Report on our health services in Scotland since 1946 has been a remarkable and dramatic document. The record of steady progress made in that decade is surely many times greater than in any previous decade in history.

The hon. and gallant Member for South Angus (Captain Duncan) suggested one or two reasons for that. He suggested that probably the main reason was the development of medical science, advances in medical knowledge and curative science, possibly the discovery of penicillin, the discovery and use of sulpha drugs—we hear a lot about sulpha-conscious doctors—and the growth of mass radiography. These and other advances in medical science are no doubt part of the cause.

In my view an equally important and effective contributory cause of our increased national health lies in other social reasons. It lies partly in improved housing, although we have still a long way to go there, but I think more particularly in the continued incidence of full employment and the fact that full employment brings so many attendant blessings—regular good meals for the family and, most important of all, freedom of parents from worries and anxieties.

Although there are no figures to prove this, I am convinced that the chief reason, apart from medical scientific improvements, for the really spectacular drop in our maternal mortality rate, which at one time was such a great disgrace to us as a nation, is that mothers have been free from worry and anxiety to a greater extent since the end of the war than ever before.

I think we should look at one or two specific subjects in the Report. My hon. Friend the Member for Kirkcaldy Burghs (Mr. Hubbard) mentioned perhaps the most serious and worrying section in the Report—the growth of thrombosis as a killer disease. This makes us very uneasy. As my hon. Friend said, this disease is not peculiar to Scotland; it is common to Britain and to all countries which—perhaps rather quaintly—call themselves civilised. It is a disease of civilisation; a result of the increasing tempo of our times.

It is as well to turn to consideration of one or two diseases which used to be killer diseases, diphtheria, for instance. What a remarkable record we have had in that disease. It is no longer a killer disease. We can now claim to have killed the menace of diphtheria. The Report points out that for six years no immunised child in Scotland has died from diphtheria —not a single one. Yet, in one year—13 years ago—514 non-immunised children and three immunised children died from that disease. That is a remarkable change and something for which the Department and we who have had something to do with popularising immunisation may well be proud.

I wish to say a word or two about mass radiography, which the hon. Member for Edinburgh, West (Sir I. Clark Hutchison) and my hon. Friend the Member for Edinburgh, East mentioned. The Report points out that, in round figures, 188,000 people in Scotland were examined in six months last year. That is a very large number, although, as the two hon. Members pointed out, scope for expansion is still wide. It could be extended almost universally if we had more equipment readily available in different areas.

I noticed one significant fact about the figures in the mass radiography table. Unit No. 3 in Glasgow reported that the number of active cases discovered was about 10 times more than the average for any other unit in use in Scotland. It is a most amazing and remarkable fact that one single unit got more than 3 per cent. whilst every other unit had under 1 per cent. of cases and 0.5 per cent. was the general percentage. I should like to know which districts in Glasgow are covered by unit No. 3. My guess is that they include densely populated areas comprising most of the slum property. If so, that is unmistakable proof that bad housing conditions are the cause of respiratory tuberculosis.

Looking at the figures for T.B., we find very good reasons for encouragement. The average of the incidence of the disease in the years 1919 to 1923 was 38 deaths per 100,000 of our Scottish population. The average last year was two deaths per 100,000 of our population. That shows that T.B. is no longer a killer disease. We are almost able to claim that we have conquered the menace of T.B.

I mention these things because I want to make a comment upon them. A complete cure for T.B. is now almost the norm, and in so many cases it is now a certainty. That is so to such an extent that one wonders why so many employers of labour have not recognised the fact. How many hon. Members have shared my experience of having constituents who have been cured of this disease come to them and tell them that they find difficulty in finding employment because employers see on their record that they were once treated for tuberculosis?

A person who has suffered from tuberculosis and has been given a clean bill of health by the medical authorities is just as healthy as one who has suffered from a bad cold in the head, or from gout, or any normal disease which medical science is now curing. It is a sorry thing, particularly for female labour, after a patient has so joyously returned to general employment to find that the record remains as if it were something to be ashamed of and that she ought not to be allowed to mix with other members of a community.

I am a little disquieted about the scantiness of information in the Report on the school dental services. All the Report tells us is that the number of dentists now in the Service continues slightly to increase, and the graph tells us of the total number of school children treated by the School Dental Service. The number of children on the school registers in Scotland total nearly 828,000. Rather less than half—340,000—were examined during the year under review. We should aim as soon as possible to reach the stage when all our schoolchildren have their teeth examined at least once a year. The remarkable feature is that of the 340,000 who were examined, no fewer than 255,575 were found to require treatment. That represents a higher incidence of necessary treatment than in any other service provided by the public.

It is an astonishing, deplorable and sad fact that nearly half the children in our schools are found to require dental treatment. The number could be reduced if we were to bend our endeavours and energies towards increasing the number of dentists who devote their time to perhaps the less remunerative section of the Service but, certainly, the most valuable side of their profession—the examination of the teeth of the young and the prevention rather than the cure of disease.

I should like to say a word or two about the blood transfusion service. It is clear from the Report that nearly 100,000 bottles of whole blood were obtained in Scotland by the Scottish National Blood Transfusion Association. Of that number, 77,500 bottles were used. It would seem from these figures that the supply is adequate and that the number of donors is rather more than equal to the demand. But we ought not to be too complacent about this and rest upon the laurels we have already won in the steady and remarkable growth of this service.

The number of cases, of types of cases and of types of diseases and troubles, for which intravenously used whole blood is required grows steadily every year. Every month it is found that the introduction of blood into the bloodstream of patients is a cure for an increasing number of diseases. At one time it was never dreamed that stomach ulcers or ulcerations of the stomach could be helped by blood transfusions, but I understand that transfusions are now a regular method of treating this other growing disease of civilisation.

In other fields of medical therapy there is increasing use of whole blood and of blood plasma for the cure of diseases, and this is likely to continue. And so the number of donors required continues to grow. While we pay our tribute to the efforts of the Association and to the voluntary donations of their blood by the increasing army of donors, perhaps it is not out of place as a concluding word in this debate to say to the public of Scotland at large that those who feel that they can give in this way a valuable life-saving donation from their own bloodstream perform one of the greatest services that any man can give to his fellow man or woman.

There are so many other things in this very human, interesting and graphic Report which we have been discussing, that one could speak for hours about it and about all the work now being done in Scotland. Perhaps it might be appropriate to say that there has never been in the history of our country a greater tribute or a more graphic description of the value of the public conscience and of the effectiveness of public service than is given in the Report.

5.55 p.m.

Mr. Thomas Oswald (Edinburgh, Central)

This short debate has served a very useful purpose in bringing to the notice of the Government the necessity of improving the health services in Scotland. I am certain that I echo the sentiments of Members on both sides of the House when I say that it must be apparent that the major theme today has centred on one or two particular subjects.

The hon. and gallant Member for Perth and East Perthshire (Colonel Gomme-Duncan), my hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann), my hon. Friend the Member for Kirkcaldy Burghs (Mr. Hubbard), my hon. Friend the Member for Edinburgh, East (Mr. Willis) and my hon. Friend the Member for West Lothian (Mr. J. Taylor) have all touched upon this point. Therefore, this evening I intend to draw attention to the position of our aged people in Scotland.

The numbers of aged persons in the community are increasing, but their span of life has not expanded in any way. Indeed, page 19 of the Report states: More people are becoming old but people are not living longer. I was rather amazed at that statement, but it appears to me to be perfectly true.

The problem of the aged and the chronic sick is one that must be tackled immediately. As far back as August, 1953, the Secretary of State for Scotland called for a survey. Strange though it may seem, he again called for a survey in August, 1954. In the one case it is almost two years ago, and in the other case almost twelve months ago. I ask the Joint Under-Secretary, who is to reply, to say when we are likely to have those reports and how long the Government will take to examine them.

Mr. Ross

They will want a survey of the reports.

Mr. Oswald

They will probably have a survey of the reports by appointed surveyors. Then, by the time that the results reach the Scottish Office, there will probably be another General Election. We on this side want an answer to that question, because the situation is very serious and requires to be tackled forthwith.

Recently, in the City of Edinburgh, some 159 doctors participated in a survey covering 5,086 elderly persons. My hon. Friend the Member for Edinburgh, East has on two different occasions prior to his speech this afternoon spoken in the House on this very important subject, as has also my hon. Friend the Member for Kilmarnock (Mr. Ross). It has been raised so that the Scottish Office could not complain that it had no knowledge of the subject.

I want to give great credit to the Edinburgh general practitioners for their co-operation. It is indeed a momentous achievement, for we must appreciate that the task which was undertaken by the doctors in Edinburgh was in addition to the every-day job of work that doctors are called upon to perform. Valuable information has been compiled from their efforts, and the evidence produced has brought to light the conditions which exist among many old people whose plight has never been fully appreciated.

A very significant feature of this important survey was that out of Edinburgh's total of 261 doctors the survey covers the reports of only 167. Because of incomplete data 387 patients' cards were excluded from the analysis and, owing to late returns, 379 cards were not included. The latter number was the quota of eight doctors. However alarming the findings may appear to be, it is obvious that they completely under-rate the real dimensions of the problem and serve only to emphasise the urgency of its necessary solution.

Records kept by the doctors reveal that in the course of one month 40 per cent. of these people were found to have some kind of need. It was recorded that out of the total of 5,086 patients, 1,270 required some form of medical attention and that need was not being met. It was further revealed that 1,274 required home or domestic assistance and, as my hon. Friend the Member for Edinburgh, East has already pointed out, 10 per cent. of them required physiotherapy but are still left in need. Had they been given some form of physiotherapy it might easily have eased the pain and the difficulty which they now have to suffer.

Out of the 1,274 whom I have already mentioned as requiring home or domestic assistance, 936 needed help with their domestic affairs, and 730 needed help with with domestic affairs or with their personal hygiene. It was found that 411 of them lived alone and another 336 lived with their spouse only. It is important to note that half of them either lived alone or only with their spouse, and nearly half of that number were women. Quite a number were bedridden or completely confined to their homes. Surely this factor strengthens the urgency of the claim for home or domestic assistance.

An examination of the analysis of the 1,270 patients who had some medical need showed that 301 of them were living alone. Seventeen of that group were completely bedridden and 72 restricted in their movements both indoors and outdoors. Of another group of 320 who lived with their spouse only, 44 were bedridden and 112 were restricted in their movements. It must be clear to all of us in the House that the nursing and hospital needs of this large group, who are either completely immobile or handicapped and restricted in movement, demand immediate attention. Six per cent., or 304 persons, of the total sample taken over the month required nursing care.

I hope that I have the attention of the Joint Under-Secretary of State for Scotland, because this is of paramount importance. I hope that he will not carry on a conversation with his Parliabentary Private Secretary, because I want a reply to these points before the debate is over. Those who already enjoy nursing care are not included in the tables. I underline the word "not." It may be that if all the doctors in Edinburgh had been able to furnish a complete picture for one year instead of for only one month a number larger than 304 would have come to light. The present position is serious enough, but the thought of the many others not yet accounted for is equally important. We are quite unable to measure their needs, because the information is not available.

Another important point is that it was found that 20 persons needed nursing equipment although they did not necessarily require nursing assistance. Twenty-one of the 304 required nursing care and nursing equipment. There is no reason at all why 41 aged and infirm people cannot be supplied immediately with this very necessary nursing equipment. The moment is past for making excuses. The doctors' opinions are that the articles are needed, and the task of the Government is to cause those articles to be supplied now.

It should be strongly emphasised that the 658 cases requiring institutional care is very much a minimum estimate. There are 152 on the waiting lists and 35 of them are living alone. Five of them are bedridden, 12 of them are restricted even in indoor movement. Forty of them were living with their spouse only, 11 of them bedridden and 13 restricted indoors. Of the remaining number living in households, 25 were bedridden.

The Edinburgh survey discloses that of the 658 patients who were not on the waiting list 217 were living alone, 12 of them bedridden and 51 restricted indoors. Another 159 were living with their spouse only, 27 of them bedridden and 52 restricted indoors. Among the remaining cases living in households, 72 were bedridden. Institutional care is urgently required to bring relief to those who are at this very moment laid aside by sickness. It rests with the Secretary of State for Scotland to make this matter a priority in the Department of Health for Scotland and, furthermore, to confront his colleagues in the Cabinet with this appalling situation in Edinburgh alone.

Mr. Ross

And in the rest of Scotland.

Mr. Oswald

If the Secretary of State took cognisance of what is happening in Edinburgh, as revealed by one month's survey, and multiplied it over and over again, he would be in duty bound to take into account the situation in the rest of Scotland. There is a continuing demand for home helps, for home nursing and for all other assistance to all those who are most in need.

All this was brought out by the general practitioners in the Edinburgh area, and the importance of hospital accommodation for the old people cannot be stressed too strongly. This aspect is borne out by the Report itself, because in page 52 under the sub-heading "The aged sick" there is underlined the fact that the problem of adequate provision for the large numbers requiring hospital treatment is one of the most serious confronting the regional hospital boards.

But the Report is in no way making a very substantial record of any major steps to tackle the subject as it should be tackled. It is merely a Report. The number of additional beds in hospitals is totally inadequate for this urgent and pressing problem and it should be tackled with vigour and determination really worthy of the Scottish Office and the people of Scotland.

Over the past year the Department of Health for Scotland fixed an arbitrary figure of £460,000 to cover the needs of the hospitals within the South-Eastern Regional Hospital Board. The original requirements by that group of hospitals arising from the respective management boards for their estimated costs for continuing and new schemes was £1,062,268. The Scottish Office asked them to pedal along on £460,000. If that is the pattern of restriction of capital funds, then the suffering of the aged sick requiring hospital treatment will be unnecessarily prolonged.

I find that in page 67 of the Report, under the title "Welfare Services," mention is made of the slow progress in securing residential accommodation for old people and others. It goes on, quite glibly, to say: The use of the adapted mansion house is of receding importance. With greater freedom to build the authorities can look and plan ahead with a stricter regard to basic requirements, one of which is a substantial amount of sleeping accommodation on ground floors. The local authorities are unable to make substantial progress through lack of funds.

During recent weeks it has been my privilege to visit several homes and institutions in my constituency and Edinburgh generally. I have seen what can be done to improve the surroundings of people residing in those homes and institutions. A great deal more can be achieved by increasing Exchequer contributions and thereby assisting local authorities all over the country to make progress with the ideas already agreed upon for improvement. Those ideas and plans are delayed, because of lack of finance. If the Government claim that we are living in a prosperous era—and all Government spokesmen keep on repeating that parrotwise—then the moment is with them to begin spending money in relieving the misery of the aged and the chronic sick in Scotland.

The Exchequer contributions are quite inadequate. According to page 70 of the Report, I note that payment by Exchequer grant for 51 homes in Scotland is the "colossal" sum of £10,642. I wonder whether anyone has taken the trouble to divide 10,642 by 51. The total equals the price of five cheap bungalows at £2,128 8s. each. Yet there are 5,780 old people in residential accommodation and 128 people in temporary quarters, a total of 5,908, so that Exchequer contributions fall well below £2 per head per year.

Mr. Ross

That is generosity.

Mr. Oswald

That is the prosperity that the Government are talking about. That is setting the people free.

Mr. Ross

And yesterday it was £7 a week rise for the dentists.

Mr. Oswald

A much larger sum is required to enable local authorities to overtake their requirements and help to ease this appalling situation. It is agreed, as the Report so rightly says, that the major consideration is to find means of prolonging the active productive life of the aged. The Report says that what is required is … for the sick and infirm a hospital and welfare service based on the principles derived from the modern studies in gerontology. This factor of hospital accommodation requires a more dynamic approach than that at present being followed by the Government if we are to achieve the sentiments so aptly expressed in the Report.

When we consider the Edinburgh report as only a partial survey, it is rather alarming to think of the vast numbers that must be similarly placed in the City of Glasgow, in the industrial areas of Dundee, Aberdeen, Kirkcaldy, and many other Scottish towns. We have not got surveys from them, yet the appalling figures I have quoted are from a partial survey of only 61 per cent. of the general practitioners in the City of Edinburgh and for only one month in the year.

The magnitude of this question is one that must be given speedy examination if we are to save the older generation from pain and unnecessary suffering. Arising from our knowledge, plans should be prepared without delay; indeed, there is no reason for any further delay. It is obvious that the steps already taken have not secured any substantial improvement in the health services for the aged, but have touched only the fringe of the problem of the aged people of Scotland.

I suggest that immediate action must be taken to secure more hospital accommodation and the recruitment of a sufficient number of suitably trained staff. We require closer co-ordination between the general practitioner, the local authority and the hospital. More than ever we need improvements in local authority services whether in an institution or in the patient's own home.

My hon. Friend the Member for Lanarkshire, North (Miss Herbison), in an admirable opening speech, brought out the importance of the care of the aged in her references to the speech delivered only yesterday to the Edinburgh Council of Social Service by Mr. H. R. Smith, the Secretary of the Department of Health for Scotland. Mr. Smith emphasised that public interest must be quickened if we are to alleviate the difficulties confronting an ageing population. Those who are in a position to know strongly underline that the present scale of services for the old people is quite inadequate.

This is not a debate into which partisan politics have entered. The range of the subject has been in the interest of the general public, and it has pinpointed the need for a revision of the present outlook in so far as the health services in Scotland are concerned. Several hon. Members have not only shown an interest, but have shown their anxiety about the necessity of more having to be done by the Government of the day.

The opportunity is now afforded, and the Government should be cognisant of the necessity to act quickly. Our old people must be given the opportunity to come back into the life of the community, and this can be done if the false economies which are threatening the adequacy and efficiency of the National Health Service in Scotland are abolished forthwith. Surely it is reasonable to suggest that we must not look upon men and women at 65 years of age merely as industrial discards. Surely the nation must regard the older people with respect for all the efforts that they have made in the past to make Scotland a great nation.

It seems strange to me that we have a Society for the Prevention of Cruelty to Animals, but conveniently overlook the cruelty suffered by the older generation. It is not a crime to grow old. Our people should be enabled to retire in dignity and in comfort. That is no more than they deserve and it must be apparent that their welfare should be of the very best that our nation can afford. The country can and must afford better facilities for the chronic sick. This can be accomplished if we have the will to do it. Everyone looks forward to peace of mind and contentment on retirement from their normal activities. So this House has a duty to perform to make that thought a practical piece of social justice for each one who is unable to look after himself or herself through ill-health or infirmity.

I plead with the Government to take immediate action to ease the burden of each one at present having to suffer because of years and lack of facilities. They do not ask for any sympathy. All they ask for is attention to their needs, which should be theirs by right. The tremendous sacrifices that our aged folk have made are worthy of consideration by a thankful populace. It is not too much to ask that in the evening of their days they should be given ample reward for their long and active industrial contribution by way of decent pensions and subsistence in honourable retirement.

We on this side of the Chamber believe in human beings. We believe in loving and caring for those who pioneered before us—hon. Gentlemen opposite should not laugh. If they do not know what humanity means, we do—

Lieut.-Colonel W. H. Bromley-Davenport (Knutsford)

On a point of order, Mr. Speaker. We are trying to write letters next door and this well-read speech is making so much noise that we can hardly hear ourselves think. Could the hon. Gentleman make a little less noise?

Mr. Speaker

The hon. and gallant Gentleman is the last person who should complain of an hon. Member speaking up.

Mr. A. Woodburn (Clackmannan and East Stirlingshire)

Is it not important to be considered well-bred as well as well-read, Sir?

Mr. Speaker

These matters are extraneous to the Question before the House. I find myself in no discomfort in listening to the speech of the hon. Member who is addressing the House.

Mr. Oswald

Thank you, Sir, I am deeply grateful to you. I wanted to point out that some hon. Gentlemen opposite seem to think that this is a laughing matter. We on this side of the House take it extremely seriously. As a consequence I may be emphasising it in a loud voice, but if so, it is only because I sincerely believe that something must be done on behalf of the aged and the chronic sick in Scotland. It is sheer impertinence on the part of an hon. and gallant Gentleman opposite, who has not been here during the course of the debate, to enter the Chamber and make an interjection and complaint of such a character.

I repeat that we believe in loving and caring for those who have pioneered before us. We shall not relax our efforts on this side of the House continually to press the Government to bring about relief for our aged and chronic sick, and we ask the Government to take immediate steps, starting from the moment the Joint Under-Secretary of State for Scotland rises to speak on their behalf.

6.27 p.m.

The Joint Under-Secretary of State for Scotland (Mr. J. Nixon Browne)

The hon. Member for West Lothian (Mr. J. Taylor) and my hon. and gallant Friend the Member for South Angus (Captain Duncan) spoke of the figures set out in the Reports as dramatic, and in this debate we have talked in the perspective of dramatic improvements and, quite rightly, of applying our minds to the problems that lie ahead.

In attempting the difficult task of replying to this debate, which has roamed over so wide a field in so short a time, I would, first, like to thank hon. and right hon. Members on both sides of the House for the moderate and helpful way in which they have put their points. There is little disagreement between us about the desirability of nearly all the proposals that have been put forward for expanding and developing the health services, and especially the hospital service. However, since no more than a fair share of the resources of the nation can be devoted to this purpose, the crux of the matter, in practice, lies in selecting from the wide range of projects which we would all like to undertake those advances that are most urgent.

First, the hon. Gentleman the Member for Edinburgh, East (Mr. Willis) asked about the new hospital building programme. The new feature recently introduced into the building programme, as announced by my predecessor in this House on 9th February last, is that additional sums proposed by the Government should cover the cost of major hospital building schemes in the next three years. Schemes for this purpose have been selected by my right hon. Friend from among those put forward by the regional hospital boards and will be financed centrally by the Department. Since the original announcement there have been detailed consultations with the regional boards and hon. Members may wish to have this rather full account of the projects now in view.

The total provision for hospital building is to be increased from its present level of £1,900,000 to £2,200,000 in 1956–57 and to £2,500,000 in 1957–58. A small part of the additional funds to be made available will be used to supplement the special programme of plant renewal on which we have now been engaged for some time and on which £800,000 is expected to be spent in the three years 1955–56, 1956–57 and 1957–58. The balance is to be used to increase the number of major building schemes undertaken.

I will deal, first, with the schemes already begun. Under existing programmes there are two major schemes, involving between them an estimated total cost of £640,000. They are both in Edinburgh and both at the Western General Hospital. The first of them is the radiotherapy institute of 100 beds for the treatment of and the research into malignant diseases. The main part of that work is now practically complete. The second project is a new unit of 60 beds for neuro-surgery.

The schemes for 1955–56, that is, the current year's programme, include a start on three major projects. The first is the reconstruction of the Westgreen Mental Hospital, in Dundee, due to start in September, at an estimated cost of £250,000. The second, due to start in August, is the erection of a surgical unit of 120 beds at the Victoria Hospital, in Kirkcaldy, at an estimated cost of £450,000. The third is the provision of a new maternity hospital at Bellshill, Lanarkshire, involving an expenditure of about £500,000. The first phase in the Bellshill Maternity Hospital undertaking is the provision of a new nurses' home, the building of which will begin next month.

Now for the schemes for 1956–57. As the House is aware, and as my hon. and gallant Friend the Member for South Angus reminded us, one of the major problems with which the hospital boards are at present contending is the shortage of accommodation for mental defectives needing institutional care. With this in mind, it has been decided that a substantial part of the additional capital moneys to be provided will be applied on extensions at mental deficiency institutions.

Three major development schemes, providing between them for about 850 additional beds, together with ancillary facilities, are programmed to start next year. These are at Ladysbridge, near Banff; Baldovan Institution, near Dundee; and the Royal Scottish National Institution at Larbert. The three extension schemes together are estimated to cost about £1,200,000, and the work will take some four or five years to complete. We have already started some of the preparatory work at Ladysbridge, including work on the new boiler house there.

Let us look to the future—the third year, 1957–58. Planning work is already in hand on the three major schemes due to start in 1957–58. The first of these is a radiotherapy and research unit at the Glasgow Western Infirmary. This unit will have the latest facilities for the handling of radioactive isotopes and will be complementary to the unit now being built in Edinburgh where radiation of other types will be employed. A firm estimate of the cost is not yet available.

Secondly, in Edinburgh a large-scale reconstruction of the Royal Mental Hospital is to be begun at an estimated cost of £450,000. In addition to general improvements and the installation of a new heating system, the scheme will provide new admission and treatment units and 160 beds. Thirdly, in Lerwick we shall see a start on the replacement of the Gilbert Bain Hospital by new buildings at a cost estimated at £250,000. The schemes which I have mentioned are the major works that we intend to start in the period up to 1957–58.

Mr. Hubbard

Has the promise to build the new general hospital in the County of Fife now been abandoned? That was agreed to two years ago, and I have not heard any mention of it since then. I am wondering whether it has been withdrawn.

Mr. Browne

I was coming to that later. The point is that there are so many schemes that the order of priority cannot please everyone. I do not think it would be right to say that any scheme is abandoned. It is a question of dealing only with the three years under review, and this scheme is not in the three years that I have been taking.

Mr. Hubbard

Two years ago the hon. Gentleman's Department approved the building of a new general hospital of 250 beds in the County of Fife, in view of the tremendous need for them in the area, especially as there are 17 patients waiting for every bed when it becomes empty. There has been no improvement, but many more people have been going into Fife, and many more are likely to go there. Will the Minister have another look at the promise given two years ago?

Mr. Woodburn

This was one of the major schemes to relieve the pressure on the Royal Infirmary at Edinburgh and to prevent the flow of nearly all Fife's serious patients into the Royal Infirmary. The idea was to create a general hospital in Fife which would gradually build up its own prestige and be able to deal with the people north of the Forth.

Mr. Browne

I am well aware of the difficulty and the disappointment which must be felt when there is only a certain amount of money to go round, and someone has to take second place or be put behind in the queue.

Mr. Hubbard

Can the hon. Gentleman say why the building of the new general hospital has been put back? Why has it been removed from the list? Can he give any explanation for it? It is not sufficient to talk about priorities when the decision has been already taken and the plans have been prepared.

Mr. Browne

The regional hospital boards and the Secretary of State together have to decide priorities, and I hope that this demand for priorities will go on for a very long time, because there is so much to be done.

Miss Herbison

My hon. Friend the Member for Kirkcaldy Burghs (Mr. Hubbard) has asked why this particular hospital has not been included in the priority list. It is not good enough for the Joint Under-Secretary of State to say that the Secretary of State and the regional hospital boards make these decisions. My hon. Friend has a right to know what were the considerations which made the Secretary of State and the regional hospital boards put out of the priority list something which was already in it.

Mr. Browne

I am sure that the House will acquit me of discourtesy when I say that, without notice, it would be very difficult for me to give a detailed reply. I will, of course, write to the hon. Gentleman.

The schemes I have mentioned involve a capital expenditure of just under £4 million. There is also £800,000 to be spent on the work in the hospitals which will make a considerable saving in revenue expenditure on heating systems and things like that. In addition to these two items of expenditure, one must remember that the regional hospital boards will be carrying out their own projects—that is, capital projects of under £250,000—at a rate involving an expenditure of about £1,300,000 a year. I think we can be satisfied that a start has been made, but do not let us ever say that it is an entirely satisfactory start or that we cannot do any better.

The question of tuberculosis was raised by a number of hon. Members and I should like to turn now to that subject, because none of the major projects which I have mentioned relate to the problem of tuberculosis, and in view of the importance which many hon. Members, including the hon. Member for Lanarkshire, North (Miss Herbison), have attached to this subject in their speeches, its omission may be surprising.

Without underestimating the size of the remaining task, I am happy to report considerable progress in this field. The death rate from respiratory tuberculosis in 1954 was 20 per 100,000 population compared with 23 in the previous year and, do not let us forget, 66 per 100,000 as recently as in 1948.

The first quarter of 1955 shows further progress. Although the figure is always relatively high in that particular quarter, at 22 this year, it is more than one-fifth below the rate of 28 in the first quarter of 1954. Even so, although the hon. Member for West Lothian was rightly optimistic, there were still over 7,000 notifications in 1954, and the final victory over this disease is still some way off.

Progress in the provision of effective treatment has also been striking. Thanks to advances in medical care made possible by the newer drugs, the average period of stay in hospital has been considerably reduced. Furthermore, given good home conditions, more patients can be cared for without ever entering hospital. In some areas this has been encouraged by administrative rearrangements linking the facilities for out-patient supervision and care more closely with the hospital facilities for in-patient treatment. The object of the arrangements is to ensure that if a patient under treatment at home proves at some stage to be in need of in-patient care he can obtain it without delay and while remaining under the ultimate clinical charge of the same specialist.

The hon. Lady the Member for Lanarkshire, North asked how and why patients returned home, who permitted them to be there, and whether there was any danger in their being at home. The answer is that the decision on the suitability of patients for domiciliary treatment is entirely a matter for the tuberculosis physician, who has been given no instructions to keep the lists down in that way. We are satisfied on that very important point, and I think the hon. Lady can be satisfied, too.

With regard to waiting lists, as a consequence of all this—this answers my hon. and gallant Friend the Member for South Angus—the number of beds equipped and stalled for the treatment of respiratory tuberculosis is much less inadequate to our needs than it has been for many years. For the whole of Scotland the total number of patients awaiting admission is now fewer than 500. This may seem a considerable number, but when it is compared with the figure of more than 9,000 admissions in 1954 it falls into proper perspective.

In many areas of the country today there is, indeed, no significant waiting period at all for persons in urgent need of admission to hospital. In other areas there are still small waiting lists of such patients, and this is usually because the patients prefer to wait three or four weeks and then be admitted to hospital near their homes than to be admitted without delay to a hospital at some distance.

My hon. Friend the Member for Edinburgh, West (Sir I. Clark Hutchison) and the hon. Member for Edinburgh, East referred to mass-radiography. The position is that the series of intensive local drives directed to the general public is continuing, in addition to the more routine activities of the mass-radiography units in screening factory and office workers and other special groups. Some of the drives have been particularly successful in gaining public participation, especially that in central Leith last March, when the number of persons examined represented an average of more than 2,000 per unit per week and 37 hitherto unknown cases of tuberculosis were brought to light.

We are now fully persuaded that these drives to bring the public to have themselves photographed are well worth while, and in settling the future scheme of work—it has to be fixed many months ahead; one has to get staff, voluntary support and the necessary publicity, or else a scheme is a failure—we intend to increase the emphasis on this side of mass-radiography activities in future years.

The hon. Member for Edinburgh, East asked for some particulars about the programme. The 1955 programme has to date covered central Leith, Dumbarton. Dundee, and a part of Glasgow, and to come are a part of Fife—Cowdenbeath and Wemyss—Motherwell and Wishaw.

My hon. Friend the Member for Edinburgh, West and the hon. Member for Edinburgh, East also asked about repeat surveys. We still do not think that repeat surveys after one or two years would be profitable compared with breaking new ground. We cannot do both without taking staff from other work. I assure hon. Gentlemen that there is a very severe staffing difficulty. It is the staff and not the equipment which creates the difficulty about going over too wide a field in too short a time.

The hon. Member for West Lothian asked about the percentage of cases found by Unit 3 in Glasgow. The unit is used for symptom groups and contacts from all parts of Glasgow, not for unselected groups as other units are. Hence the high figure of cases found, which does not reflect bad conditions in any particular district.

My hon. and gallant Friend the Member for Perth and East Perthshire (Colonel Gomme-Duncan) spoke about some of the things which could be done for old people. We are very grateful for his suggestions. The hon. Lady the Member for Lanarkshire, North referred to the tragic plight of old men and women, and the hon. Member for Edinburgh, Central (Mr. Oswald) directed his speech to the attention which is rightly given to the care of the aged. It must be recognised that there are still deficiencies to be made good in the services provided for old people. Although various authorities have already done much to improve them, hon. Gentlemen and, indeed, the whole nation realise that much yet remains to be done.

The hon. Member for Edinburgh, East and other hon. Members referred to the accommodation problem. Year by year regional boards have been able to devote more beds to the care of the aged. The hon. Lady the Member for Lanarkshire, North also referred to this matter. Some indication of recent progress in providing hospital accommodation is given in pages 52 and 53 of the Report of the Department of Health for 1954. In some areas the provision of long-stay beds is probably already almost adequate; we believe that in most areas the main need is for more beds for assessment and active treatment, where the patient's disabilities can be rapidly assessed on admission with the aims of rehabilitating him so that he may as far as possible return to an active life. Good results are already being obtained by assessment and treatment units, notably at Maryfield Hospital, Dundee. and at Stobhill, in Glasgow.

There have recently been appreciable increases in the hospital medical staffs engaged in the care of the aged; and it is hoped that the opening of a training school for assistant nurses at Foresthall Hospital, Glasgow, will help to ease the difficulty of finding nursing staff to undertake the work of caring for aged patients.

The hon. Lady the Member for Lanarkshire, North said that old people are generally happier in their own homes. With that in view, we are anxious that the local authority services which can help them to live at home should continue to develop. In this matter the home nursing service is very important, and the number of patients attended and visits paid by home nurses have been increasing year by year. In 1954, the number of visits was 2,915,000, and about 161,000 patients, of whom it is estimated that about half were aged or chronic sick, received attention.

Health visitors, too, are being called on more and more to give advice to elderly people and their families on the prevention of disability. All but two of the fifty-five local health authorities are pro- viding a service of domestic help which can be of great value in the care of the elderly at home. I am glad that the hon. Lady the Member for Lanarkshire, North asked for the names of the authorities not providing such a service, for they should be given. They are Angus and Dumfries County Councils.

I was asked whether we were satisfied about the adequacy of the service provided. It would be too difficult to give details in this debate, but the valuable suggestions which have been made, especially by the hon. Lady, will be most carefully noted. The hon. Lady also spoke about the "meals on wheels" service and similar problems, and asked whether local authorities could give some financial assistance towards chiropody services. The problem which the hon. Lady the Member for Lanarkshire, North raised was one of co-ordination between the local authorities and the voluntary bodies. She was so right when she said that there was such a wide field for voluntary help. I heard her discuss—not argue, nor even cross swords—with the hon. Lady the Member for Coatbridge and Airdrie (Mrs. Mann) whether it should be the task of the old-age pensioners' associations or the church organisations, but surely every one of us should do what we can to help the old people.

Miss Herbison

I must get this point clear. Giving help through services like the chiropody service I emphatically believe to be the job of the local authority, the regional hospital board, and so on. There is a very wide field for voluntary workers, but not in these matters which ought to be provided as part of the Health Service, through whatever body is the right one.

Mr. Browne

On the question of chiropody in general, I agree with the direction of the hon. Lady's thoughts. At present we are doing rather better in Scotland than is being done in England in providing chiropody for old people and in some areas local voluntary bodies are used. That that is a desirable permanent feature I should not like to say, but we are feeling our way and working in the right direction and I am seized of the hon. Lady's point.

The hon. Lady and my hon. and gallant Friend the Member for South Angus spoke of the loneliness of old people and also their pride. In helping them in their loneliness we have to bear their pride in mind, and the desire of some of them to stand on their own feet and keep their sturdy independence. Any hon. Member who has suggested to them that they should go to the National Assistance Board, and who has seen them start to cry because that is the first time they have heard that suggestion, realises exactly what I mean.

I want to talk not only about coordination between local authorities and voluntary institutions, as is so necessary, but of another vitally important matter. It is the arrangements for co-ordination between the various bodies responsible for the care of the aged. In the light of comprehensive reports recently received, it may be said that in some areas these arrangements are already working well. To take one example, in the Dundee area there is a local advisory committee on the welfare of the aged, representing Dundee Town Council, the executive council, the local medical committee and the boards of management concerned. By arrangement with all these bodies, the senior geriatric physician in the area has been able to establish excellent informal arrangements among the hospitals, the city health department and the general practitioners in the area. In some other areas there appears to be room for improvement in effective and immediate co-operation and the problem must receive continued attention, both centrally and locally, until it is satisfactorily solved.

The hon. Lady the Member for Lanarkshire, North asked other questions which I should like to answer. One was about payment to chemists. The rates of payment to chemists are under review in the light of comprehensive information about expenses that has been collected from chemists. We do not take the view that the 1951 arbitration award rules for all time. While, for some items, it may be true that Scottish chemists get more than English chemists, I doubt whether their overall profit is any higher. The cost of drugs per head in Scotland is actually a shade less than in England.

The hon. Lady for Coatbridge and Airdrie, in a most valuable speech, which, I hope, will receive the greatest publicity, drew attention to accidents in the home. Only ten days ago the Chief Medical Officer of the Department of Health held a successful Press conference, which brought the subject into prominence. Research into home accidents is a difficult problem and we hope that the local authorities and the medical officers of health will take an increasing interest in the whole matter. The hon. Lady had with her, as I have, an excellent pamphlet which points out that for every seven children killed on the roads, ten die from accidents in their homes. That is the first statement that the mothers see.

The pamphlet has been sent to county clerks, town clerks, the W.V.S., the medical officers of health and the Scottish Council for Health Education, and talks on the subject have begun. I think that the hon. Lady was right to ask whether the pamphlet was too expensive and whether there was any more we could do. I will give her a promise to look at that and to treat it as seriously as she treated it. If any more can be done, we will try to do it.

My hon. and gallant Friend the Member for South Angus asked for some statistics about slaughtering. The Scottish figures are included in the United Kingdom figures, which are published in the Monthly Digest of Statistics issued by the Central Statistical Office. The separate Scottish figures appear half-yearly in the Digest of Scottish Statistics. He asked me another question, about which I will write to him, as it would take too long to answer here.

I was also asked about coronary thrombosis. An increase in the number of deaths from heart disease is to be expected from changes in the age structure of the population, but that is certainly not a complete explanation of recent trends; and in coronary thrombosis especially there remains a great part of the increase which cannot be accounted for in this way, nor through greater precision in certifying causes of death. The notification of coronary thrombosis and the collection of information generally was also mentioned by the hon. Member for Kirkcaldy Burghs (Mr. Hubbard), who referred to voluntary arrangements in Kilmarnock and Fife. We are doubtful whether there is any great value in duplicating this all over the country at present, but we agree that authorities might experiment with modifications or variations and the Secretary of State will consider this matter with the authorities in the light of what the hon. Gentleman has said.

In conclusion, there is one general point I should like to make. It is, of course, a bad thing for political parties to set about outbidding one another in promising a bigger, better, or freer Health Service, but the House has an inescapable responsibility for a Service that costs, in Scotland, over £60 million of public money a year. Many of us forget that the stamps we pay meet less than 10 per cent. of the cost and that the balance is met by the taxpayer. It is, I am sure, the concern of all hon. and right hon. Members that the best possible value in terms of health should be obtained for this expenditure.

So far as this depends on questions of organisation, or administration, we expect shortly to have the advice of the Guillebaud Committee. Whatever it may have to say on these matters, however, and whatever our political views, we cannot hope to succeed without the co-operation of the public, as users of the Service, in the avoidance of abuse.

This, then, is the message I should like to go out from today's debate. The Health Service is a most important and valuable feature of our national life and we ought to take every care of it. Let us all, everyone, treat it as such. The family doctor is our skilled adviser and friend. He will prescribe medicines if we need them. It is not for us to demand this or that of him. The ambulance service is there to take people to hospital. Let none of us look on it as a mere convenience, or, by calling on it unnecessarily, risk causing delay or suffering to someone who really needs its help. By this and other means we can all do our part to safeguard the efficiency of the health services and remove from them any ground for criticism that our national resources, to however small an extent, are being squandered by any action of ours.

Miss Herbison

Before the hon. Gentleman concludes, may I ask whether he could give us some information about units for the treatment of those suffering from pneumoconiosis? Is there any chance of any further units being set up?

Mr. Browne

I have an answer for the hon. Lady, who referred to the special unit for research into and treatment of pneumoconiosis at Bangour Hospital, which continues to serve as a specialist centre for both in-patients and outpatients. Although this is the only unit set aside for the purpose, the full range of facilities in general hospitals and in the chest clinics is available for patients suffering from this disease. Medical advice favours provision for pneumoconiosis within the general chest diseases service, as well as in specialised units.

The Parliamentary Secretary to the Treasury (Mr. P. G. T. Buchan-Hepburn)

I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.