§ 9.59 p.m.
§ Mr. Arthur Moyle (Oldbury and Halesowen)
This evening I am raising the subject of mental hospitals and the farms and farmlands coming under their administration. The first question I wish to ask is whether the action taken by the Minister of Health some time ago when he issued Circular 23 to the regional boards was taken because he was legally compelled to do so. That is the first question. The second question concerns the future——
It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed. That this House do now adjourn.— [Mr. E. Wakefield.]
§ Mr. Moyle
My second question to the Parliamentary Secretary is what is the future of the farm and garden staff who are affected by the Minister's decision, in so far as their future is uncertain? In the first paragraph of Circular 23 the Minister sets out the four main reasons which constitute what he describes as the criteria on the basis of which mental hospitals should have acted. They should not have acted in excess of the criteria which is laid down in detail here. After having explained this, the Minister in paragraph 2 goes on to say:The Minister has no authority, and consequently Boards and Committees have no authority, to run farms except insofar as they are an essential part of the running of the hospitals.I read the debate which took place on the Adjourment in December, and I found that my hon. Friend the Member for Huddersfield, East (Mr. J. P. W. Malla-lieu) had on that occasion raised a similar point. The Parliamentary Secretary's reply is quoted in c. 1362 of the OFFICIAL REPORT of 14th December. It says:My right hon. Friend would be pleased if he could continue to run farms in conjunction with mental hospitals at a profit, but it has been found that under the powers conferred by the National Health Service Act he has no power to run farms as such.Then comes the operative point of this part of the statement—He can only run them within the strict limit that they should provide considerable occupa- 719 tional therapy for the patients."—[OFFICIAL REPORT, 14th December, 1955; Vol. 547. c. 1362.]I have gone through the National Health Service Act, 1946, and I can understand the Minister saying that he has no authority. Am I to understand that when the Minister says that he has no authority to approve the things which have been done in excess of the criteria which he has laid down in Circular 23, that is to be regarded as equivalent to saying that if he approved them he would be acting outside the law? In short, would he be acting illegally as a Minister?
I think that the Parliamentary Secretary is under an obligation to answer that question. I am glad to see the Minister here this evening. May I wish him, on personal grounds, a happy time in his new office? The Minister is under an obligation to render Parliamentary accountability for the action he has taken. May I ask him whether the action which he has taken would have been regarded as illegal if he had maintained the position which existed in 1954, before the issue of the Circular?
This action has not met with popular approval throughout the country. Many local hospital boards, and some regional boards, have resented the action taken. From the standpoint of tidy administration of the hospital or from that of the interest of the patient and the maintenance of social amenities, nothing good can be said about the action taken by the Minister in 1954. It created an administrative upset and no advantage appears to have accrued to the welfare of the mental hospital services from the step taken.
Having been associated for some years with the mental hospital services, I know that this development of farmland and the establishment of home farms has largely arisen from a desire on the part of the authorities in the past to establish a reasonable standard of privacy. Secondly, it has been to provide a reasonable facility for occupational therapy whereby patients can do some useful work as part of their curative treatment. Thirdly, it has developed general farming, fat stock farming, dairy farming, arable farming and horticultural production for the purpose of making the mental hospital unit as far as possible self-sufficient in so far as the 720 provision of fresh foodstuffs are concerned.
Incidentally, it has provided added reasonable measure of social life for the resident staff, particularly medical and nursing staffs, who, by reason of their work, are confined to the precincts of the hospitals. It provides them with a welcome opportunity to get some relaxation by strolling round the farmlands before undertaking night duty, and so on.
I think that the Parliamentary Secretary is under some obligation to make perfectly clear to all concerned exactly under what statute this action has been taken so that there may be no doubt about the position. I do not know whether any economic factor is involved. Many of the farms are paying their way and making good profits, but I am not in a position to say that all of them are in the same category as I do not know the facts.
If the Minister was compelled to put himself right with the law, why was action not taken earlier? That would have given an opportunity for the former authorities who owned the hospitals and farmlands concerned; they would have had the right of prior purchase. It could have been provided that within five years of the appointed day the former authorities, such as London County Council, should have an opportunity of acquiring what was theirs before the Health Services came into operation.
I also want to raise the question of the farm and gardening staffs. They are mainly male employees, but there are some women and they come within the purview of the Whitley Council for Ancillary Staffs within the Health Service. Their conditions of service are determined on that basis and have no connection whatever with the rates and conditions of service which are determined by the Agricultural Wages Board. In fact, they are part and parcel of the general Health Service, and, as the Parliamentary Secretary knows, the rates paid to agricultural workers at mental hospitals are equivalent to what is known as Grade 2 of the general porter staff. This applies throughout the country. These employees, who have been in the service for many years, have to their credit many years of pensionable service.
Secondly, a number of them have for many years been cottage tenants on the 721 farm. On what basis will compensation be paid to these employees for the loss of employment or for any diminution of their earnings? Thirdly, will the position of the cottage tenant, for example, be dealt with sympathetically. Does it follow that the cottage tenant must vacate the cottage when the farm is purchased and owned by another agency or person? Does it mean that the cottager will be given notice that he and his family must quit immediately? I should like the Parliamentary Secretary to make the tenant's position as clear as possible, for a great deal of anxiety is being caused to the farm and gardening staff concerned.
While the Minister himself is present, I ask that in dealing with this matter of the future of these staffs he should consider as sympathetically as possible the assimilation of these employees in alternative work within the Service, so that their pensionable service will continue without prejudice and will remain intact, because if these employees leave the Service their only hope of retaining their pension rights from past service will be by re-employment with some other public authority. Those are the two points I should like the Parliamentary Secretary to consider, and I sincerely hope that I shall receive a sympathetic reply.
§ 10.13 p.m.
§ Mr. Brian Harrison (Maldon)
I am grateful to the hon. Member for Oldbury and Halesowen (Mr. Moyle) for raising this matter, and as we want to hear a reply from my hon. Friend the Parliamentary Secretary I will be as brief as possible. There are, however, three points I wish to bring to my hon. Friend's notice.
First, I hope that the Ministry will arrive at a decision about these farms as soon as possible. Probably I should declare an interest in that I am on the management committee of a mental hospital which, thank goodness, is not an office of profit under the Crown. I hope that the uncertainty under which the staffs, and particularly farm managers, foremen and the like are suffering, not only about their jobs but about their homes, will be disposed of as soon as possible and that we will know the Minister's decision about these individual cases as quickly as we can.
Secondly, I appeal to the Minister that the capital acquired from sales of land— 722 and there will be sales, because not all the land will be retained with the prospect of future development by the hospital—will be used for the improvement of the mental hospital service. There is ample scope for capital development in this sphere of the hospital service.
Thirdly, I should like to draw the Minister's attention to what I think is one of the chief reasons why some of the farms have not ben financially successful. No matter what Mr. Guillebaud says in his Report which I have been studying over the weekend, there is no doubt at all that hospital management committees have suffered from the fact that they could not use the farm profits for the benefit of the farm and of the hospital generally and that those profits ultimately went into general revenue, not to the benefit of the patients in the hospitals. I would ask my hon. Friend, if she can, to give some assurance that the Minister will arrive at a decision about individual farms as quickly as possible. I would particularly ask that the case of Severalls Mental Hospital near Colchester should be settled, because the uncertainty there is seriously affecting the position of the staff. I do not wish to take any more time because we are looking forward to my hon. Friend's reply. I hope she will give us some indication of what will happen to the staff.
§ 10.16 p.m.
§ Mr. Albert Roberts (Normanton)
This is not a political matter, and, when all is said and done, it is, I believe, a question of interpretation, but I think it is wrong for the Minister to hide behind a facade of an Act, saying he has no power to act in respect of some of these farmlands. As a member of a hospital board having to deal with mental defectives, I look upon this as a very important matter.
At this time of full employment it is possible to send high-grade patients into factories or into brickyards, and that helps considerably with the problem of keeping the patients occupied beneficially, apart from specific schemes of occupational therapy. What alarms me is the thought that if there should be any recession at all in industry the first persons who would become redundant would be the high-grade mental patients. It means we have to find more room in which to keep those unfortunate people exercised, to keep them in some kind of employment. Many 723 mental hospitals are situated on what used to be private ground. I feel that to send some committee to a hospital to recommend that it should sell slices of its land or otherwise dispose of them is to act very unfairly towards the management committee of the hospital. There are some mentally defective patients who cannot be taken on public highways but who, nevertheless, have to be exercised, and they cannot be exercised in an area of only one or two acres.
There is another matter, and that is the position of the staffs, and that includes their recreation. Much has been said about the difficulties of recruiting nurses for mental patients. Only recently it was suggested that playing fields should be provided, and now we are told that the lands have to be sold. In most cases the argument is strong for retaining the farmlands, especially those adjacent to the hospitals themselves. The argument is in most cases strong for retaining them for the purpose of occupational therapy. I am not so much concerned with whether the lands are making a profit or not. After all, they are and can be used in the treatment of the patients, and we shall make a mistake, I am sure, and one of the first magnitude, if we dispose of those farms which have served hospitals well for many generations.
Before the Minister does anything drastic about the matter, I appeal to him to cause inquiries to be made into it, and reports provided for hon. Members to consider. Do not let us go about glibly saying we have no power to carry on the farms, when we know that they are beneficial in the treatment of the people who, unfortunately, have to be housed in our mental hospitals. I trust that the Minister will accept some of the points which have been put by my hon. Friend the Member for Oldbury and Halesowen (Mr. Moyle) and the hon. Member for Maldon (Mr. B. Harrison) and will realise that this is a non-political matter which is causing great concern throughout the country.
§ 10.20 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to the hon. Member for Oldbury and Halesowen (Mr. Moyle) for initiating the debate. This is a subject of great importance, and I hope 724 that I shall be able to clear up some of the misapprehensions about it. As I have to cut my remarks a little shorter than I had expected and as I have a great deal to get through I hope that I shall be forgiven for speaking rather rapidly.
The basis on which farming at mental hospitals has been conducted has always been accepted as being, first, the necessity for a green belt to provide seclusion and privacy, and, secondly, the desirability of providing outdoor occupation for suitable patients. As long as it fulfils those requirements there is no question of cutting down that type of farming or size of the land. I hope that that meets the point made by the hon. Member for Normanton (Mr. A. Roberts). The third basis was the value of the farm and garden produce in the dietary of patients, particularly where large-scale supplies of milk and vegetables were not always available.
This problem does not stem only from the tenure of the present Government, because grave doubts on the matter were considered by the Labour Government which, when it took over these farms in 1948, realised very quickly that it was quite apparent that the practice of farming had in many cases developed into large-scale farming for its own sake. Therefore, it was the party to which the hon. Member for Oldbury and Halesowen belongs, which initiated the first circular on the matter and pointed out to hospital authorities that the criteria for farming should fall into the three categories which I have mentioned and that they should not carry out farming activities for their own sake.
As that Government said very strongly in its circular of 1948, there was evidence in some places that farming had become the primary interest with committees and officers, who had devoted much time and attention to the maintenance of attested herds and to the breeding of prize pigs, while the therapeutic value of farm work to the patients had become of second importance.
Not very much action was taken following this warning. People who had prize farms tended to hang on to them, and, following very strong criticism by the Comptroller and Auditor-General, a Departmental Committee was set up in 1952 to investigate the whole of the farming activities of these hospitals. As a 725 result of its consideration of information supplied concerning farms at 190 hospitals, the Committee reached the conclusion that the criteria laid down for the retention of land in 1948 by the then Government's circular were not being observed in all cases. It concluded that very few patients were employed on some of these farms as a form of occupational therapy.
I should like to dispel the illusion that many of these farms are employing large numbers of patients. The figures are very revealing. Only 3.3 per cent. of male patients were employed on farming proper and 3.2 per cent,. in gardening, and only 0.3 per cent. of female patients were employed in farms and gardens combined. That is a much smaller proportion than some of the protagonists for maintaining the farms have made out. These are figures from hospitals which run farms and are not inflated by figures from hospitals where there are no farms.
The Committee considered that it was questionable whether the reasons which once led hospitals to provide their own milk supplies had sufficient weight to justify continuance of the practice. It considered that the keeping of pigs was considerably practised and should be limited to what was necessary to consume hospital swill, and that the rearing of cattle for beef produce and sheep for sale was not a justifiable activity for hospital authorities. The Committee further pointed out that the complexity of modern farming tended to make it less easy to use patients, and that there had been a steady increase in staff drawn from outside and not in the number of patients employed.
The policy now being more strenuously applied by the present Government has not changed in essence. We have followed up the circular previously issued by the Labour Government. Circular H.M. (54) 23 lays down the criteria for these farms as reasonable seclusion, suitable occupation for patients, adequate recreational space and sites for development and future building. The boards were asked to review farming activities in the light of these criteria. At the same time they were told that sufficient land for the appropriate occupation of patients should be kept, and that provided the criteria were satisfied it was reasonable to expand market gardening and poultry 726 keeping for outdoor occupational therapy while contracting or abandoning full-scale farming.
It was stated in the circular that the Minister had no authority to run farms except in so far as they were an essential part of the running of hospitals. May I put it this way? Under the 1946 Act we have no power to State-farm as such. Our power is confined to providing such land and therapy as is required for the hospital and the patients, but not to State-farm. The legal position has been reviewed and we are advised that the essence of it is that a hospital management committee may run a farm only in so far as it may be properly incidental to the management of its hospitals, and that any farming activities which have no real connection with the hospital either by way of providing occupation for inmates or providing produce for their consumption are ruled out.
The present position, therefore, is that at 31st October last decisions had been reached in respect of 126 farms. Of those, forty-seven were to cease, thirty-eight had to reduce their activities. Eighty-one further farms had been surveyed in respect of which decisions had not then been made. I assure the hon. Member for Maldon (Mr. B. Harrison) that there will be no unnecessary delay on our part. At that date two farms had been sold and other sales were in progress. A local authority can repurchase at the district valuer's rate any land so sold.
I hope hon. Members will forgive me if I miss some points which I had wished to make. In the last minute I want to deal with the staff question. There will, of course, be some redundancy of staff as farms are disposed of. For the general farm labourers there would be no difficulty in finding other employment but it will be more difficult for the senior staff. In the memorandum issued in 1951 on the discharge of staff following reductions of establishment, hospital authorities were asked to do what they could to retain experienced staff in the hospital service by bringing to the attention of staff under notice particulars of any suitable vacancies in other hospitals of which they might not otherwise be aware. That still applies. They are National Health Service staff and the general service procedure applies to them.
727 In so far as there is loss of employment, if they are farm workers and do not wish to change from that type of work and are unable to find a vacancy within the National Health Service, they will come under the National Health Service (Transfer of Officers and Compensation) Regulations. In general, loss of employment by farm workers as a result of the review of farming activities can be regarded as attributable to the passing of the National Health Service Act. This brings them under those Regulations.
It does not follow that compensation will be payable automatically, for each case is dealt with on its individual merits, on the number of years spent in hospital service, and the like. But something is done also in the Superannuation Regulations if the "eight years' approved ser- 728 vice" condition is not satisfied. In those cases an employee who loses his job because of the National Health Service Act may, instead of getting a return of contributions, get the accrued value of his superannuation rights.
Up to the time of the issue of that circular nine claims for compensation from redundant farmworkers were received and accepted. Since that date eight have been received and seven have been accepted.
§ The Question having been proposed at Ten o'clock and the Debate having continued for half an hour,Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at half-past Ten o'clock.