§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. R. Thompson.]
§ 4.2 p.m.
§ Mr. W. R. Williams (Manchester, Openshaw)
On Monday, 5th March, I asked the Minister of Health the following Question:how many patients were on the waiting list for orthopaedic treatment, at the nearest convenient date, in the Oldham Royal Infirmary; what delay occurs in admitting patients; and how this compares with other orthopaedic departments within the region.The hon. Lady the Parliamentary Secretary—whom I thank for coming here this afternoon to answer this debate—replied in answer to the first part of the Question that 527 were awaiting admission on 29th February on a joint waiting list with the General Hospital in Oldham. In regard to the question of delay, the Parliamentary Secretary said:Emergencies are admitted immediately and urgent cases in a few weeks. Men not needing treatment urgently wait up to three months and women up to two-and-a-half years.In regard to the third part of the Question, the comparison with other centres, the Parliamentary Secretary said, I presume that she meant in the region:At other centres the average wait is about three months."—[OFFICIAL REPORT, 5th March, 1956; Vol. 549, c. 1717.]So far as I can gather there is no different treatment there between men and women as was the case in Oldham Royal Infirmary; if there was, the hon. Lady did not say so.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
May I correct that? The lists may vary between men and 1736 women, but the average is about three months in other areas.
§ Mr. Williams
I shall have to ask the hon. Lady later to say whether the two-and-a-half years, or three years in the case of women, also applies in those cases.
I was prompted to put the Question to the Minister of Health because of complaints lodged with me, first by a constituent in Failsworth, which is adjacent to Oldham and, also, by a resident of Oldham regarding alleged inattention in the case of her son, who resides in Chadderton. I have had a word with both the hon. Members for Oldham and, so far as I can gather, they have no objection whatever to my raising the whole issue of the Royal Infirmary in the way I am raising it now.
I wish to deal briefly with the two cases. My constituent met with an accident at work on 7th October last year which resulted in a chipped bone at the base of her thumb. Eventually her doctor thought that she should receive treatment at the orthopaedic department at the Oldham Royal Infirmary. On making inquiries of that department, my constituent was informed that it would be some considerable time before her turn for admission came round. In fact, the hospital authorities went further and said that they were at that time, 14th February of this year, admitting patients whose names had been entered on the waiting list in March, 1953. That represents a waiting period of three years. So far as I am aware, my constituent is still out of work, and I know that she is suffering much pain. The people at the orthopaedic department could give no indication that she would be dealt with in any sense of urgency.
The second case relates to a man at Chadderton who apparently has been off work since October, 1955. His doctor sent him to the infirmary to see a Mr. Nish, who I understand is the chief consultant there, who said that his was a case of a slipped disc. The man's mother tells me—I will quote her words, because I do not wish to exaggerate—He is just doubled up and is in awful agony. He has been waiting to go for an operation since 5th December last year. He just seems to lie there, no one bothering. His doctor gives him dope pills and he has gone through hell. After all this time he cannot 1737 lift his back up. He fought in the war and is a married man with one child.The mother apparently got in touch with the infirmary and received a letter to say that the ward was being decorated. I have not the time, nor do I intend to deal with that point, although I think it might have been related to the fact that there are 527 people on the waiting list with a waiting period of three months and three years, respectively, for men and women. The reply from the infirmary authorities said that the ward was being decorated but that they would have the man in as soon as possible. In her agony, the mother states to me:Is it fair? Is my son receiving reasonable treatment? He has suffered five months of agony. He has been five months on sick benefit only. How long he will be, God knows.I think it fair to say that, as a result of my calling attention to these cases, the Minister acted with commendable speed. Consideration is being given to my constituent being treated in some other centre in the region, and I understand that the man from Chadderton was admitted to the Oldham Royal Infirmary on 8th March; so those cases have been cleared up in a reasonable manner. But they have caused considerable concern not only to myself but to a large number of people living in this corner of Lancashire. The fact that there are 527 people on the waiting list, with a three-year waiting period, seems to us a sad and even chaotic state of affairs. I should like to emphasise that this is especially the case as the area concerned is highly industrialised, and accidents such as strain, dislocation and stresses are daily occurrences.
People in Lancashire, as in every other part of the country, are very proud of the National Health Service, and I am certainly proud of it, and none of us wants to throw any mud at all in the face of the services which are given, but I am bound to say that disclosures such as these are inclined to undermine the confidence of men and women throughout the country in the efficacy of the health and hospital services. I must hasten to say that I have no complaints whatever against the resident staff, medical or nursing, or indeed against the administration staff as a whole, but I am of the opinion, as are many of us in the area, that the consulting staff, the resident 1738 staff—doctors and nurses—feel that the problem is getting on top of them; they can see no way of resolving it without a good deal of assistance from the Minister.
I want to give the hon. Lady as much time to answer as I can, but I want first to ask her two or three questions. First, what causes these serious delays in the Oldham district? Is it lack of staff? I understand that that is a general problem in connection with the health services all over the country—some lack of nursing staff and in some cases lack of orthopædic medical staff. Is that one of the reasons?
If it is. I should like to know a little more. Mr. Nish the Chief Consultant, gave a rather remarkable answer when the suggestion was made to him that another full-time consultant should be appointed. Apparently he did not think that was necessary and he was not prepared to entertain the suggestion, for this rather remarkable reason: that he was not fully occupied himself. It seems to me remarkable that, in an area where there is a three-year waiting list and 527 people are on the list, the consultant should be in a position to say that he does not want any assistance because he himself is not fully occupied. If the hon. Lady can deal with this now, I should like her to do so. If not, perhaps she will be good enough to write to me on it in due course.
If it is not a question of staffing, is it lack of accommodation, premises and beds? Here again, it seems to me that the Minister must accept a little responsibility if there is a shortage of accommodation, because information has reached me as recently as this morning that the Divisional Committee of the Medical Regional Board in that areas has for some time—in fact since last September—been negotiating for the purchase of a House. Several inquiries have been made of the Divisional Committee by the Ministry of Health, but so far no official sanction has been given for the purchase of this house.
The intention underlying its purchase is to help to relieve the waiting list of which I am complaining, for my informant tells me that at present medical staff are occupying nurses' quarters, owing to the shortage of medical accommodation. The Committee wants this 1739 accommodation for the nurses so that it can open two wards which have been closed for some time. It seems to me that the hon. Lady might like to have a look at that matter, because if the simple proposition of purchasing this property will release two wards it might well be a valuable and substantial contribution towards the solution of the problem.
Perhaps the reason is lack of equipment. But there is a fourth possibility, and I should like the hon. Lady to look at this, too. In addition to the foregoing, is there any lack of close liaison between residential staff and consultants, between X-ray departments and consultants, or between the pathological departments and the consultants?
I have heard from other centres that there is often a good deal of delay caused in the treatment of cases through this lack of close liaison between the various departments. I am not too sure whether that is so in the case of the Oldham Royal Infirmary. I make no allegations because I have no proof, but I think it would be worth the while of the Ministry and of the Minister to make some inquiries in the matter.
I should also like to know whether the beds are being allocated in too high a proportion to paying patients. I can only tell the hon. Lady what has been said to me. I am told that if a person can afford to pay there is no waiting time at all. My informant says:Instance after instance can be given of specialists saying that the waiting period is six, nine or twelve months, but if you want to pay 70 guineas plus the hospital fees the job will be done immediately.I am only putting that on record so that the Minister can look into the matter at her convenience.
The second point which I should like the Parliamentary Secretary to look at is why, if the delay in Oldham is considerably greater than in other centres, the regional board or the divisional committees have not taken some action to even out the delay by utilising the less pressed centres to deal with at least the urgent cases. I think that the regional board should be asked whether it is not part of its normal function to ensure a sort of equality of delay as between one centre and another.
1740 My third point, briefly, is why should there be differential treatment between men and women? The hon. Lady is no feminist, at least not in the narrow sense of the word, and I do not think that she is any the worse for that. However, I think that she should look into this matter in the interest of her own sex because the underlying assumption is that it does not matter if the woman in the home has an accident, she can wait three years, but the fellow who has a job has to be attended to in three months. I cannot accept that point of view and neither can the women of the country. But there is an additional reason. A large proportion of the women in Lancashire go out to earn their living in the same way as the men. It is part of the system in that part of the country. Why, therefore, should there be any distinction whatsoever between the two sexes?
Fourthly—and this is my last point—what are regarded by the regional board in this part of Lancashire as urgent cases? I was told by the Minister in reply to a question that emergency cases are taken straight away and that the waiting time for urgent cases is about three months. I just cannot understand the definition of "urgent" when I relate it to the case of the Chadderton man, the details of which I gave earlier in my speech. That man has not been able to bend his back. He has been in great pain, and has been unable to follow his occupation. Is his not an urgent case? Yet there has been five months delay in that case.
Will the Minister give serious consideration to this part of Lancashire, and, if more doctors are wanted, will she make quite sure that little dictators in the area do not prevent us getting them? If it is a question of the expansion of premises, will she make sure that bureaucratic red tape does not delay that expansion? Will she also consider a serious examination of what I call the balancing of the question of delay as between one centre and another in the same region?
I hope that I have not embarrassed the hon. Lady by putting to her in this debate anything of which I have not given her prior notice. I shall be obliged if what she cannot answer today she will let me have in the form of a letter.
§ 4.20 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to the hon. Member for Openshaw (Mr. W. R. Williams) for having raised this subject which is, I know, of great importance and of very particular concern to the people of Oldham. He saved himself in his last sentence, because there were one or two points which I was not aware were coming up; I shall be very pleased to investigate them and send him details later.
There have been several Questions put down about this matter, and I welcome the opportunity of explaining what we are trying to do and what progress has been made. There is a shortage of orthopaedic beds in Oldham, and I know the Regional Hospital Board is most anxious to improve the situation. It is not wholly a problem of accommodation. As the hon. Gentleman said, there are two wards at the Oldham and District General Hospital which are, unfortunately, closed because of lack of staff.
I will look into how far housing and nursing accommodation may be holding up progress; as I did not know this matter was to be raised, I have not the details here today. It is, of course, true that in most highly industrialised areas it is increasingly difficult to get additional staff anywhere, and, not least, in the nursing profession.
On the consultant side, it is true that an additional consultant was offered to this hospital by the Regional Board. On an analysis of the cases, it may have been quite genuinely felt by the consultant and the medical hospital committee that it was not staff they needed so much as beds, and I would not like the fact that a consultant was offered necessarily to be taken as condemnation of a refusal locally to accept additional consultant staff.
Everyone concerned agrees that the position needs very close attention. There has been some progress on the male side. Two years ago, the waiting time for men was as long as it now is for women. The opening of 15 orthopaedic beds in the General Hospital reduced the list very considerably.
It is not always easy to achieve a balance between the waiting times for 1742 men and women because of various factors which affect the problem. A hospital may be divided into male and female wards. It may have a twenty-bed ward on either side, but the demand of one sex on a particular service may be much greater than on another. It is not easy, in the segregation of the wards, to switch beds from one group to another without overcrowding a ward, which, of course, is not desirable.
I do, however, agree that this disparity seems a little too great. It should be examined with the aim of securing some reallocation of wards or beds so as at least to reduce the disparity between women's waiting time and that of men.
Five extra beds for women were opened at the Royal Infirmary in December, 1955, but there has not yet been time for that to be effective in what I hope will be some reduction in the list in this quarter's return. The Board is advertising and doing its best to recruit additional staff.
There has clearly been some uncertainty about the length of the waiting list, and possibly some misunderstanding when I answered the hon. Member's Questions on the 5th March. I should like to repeat that the figures are not for the Oldham Royal Infirmary alone but for that hospital and the General Hospital also. They have a common waiting list. The figures which he gave as at 29th February were quite correct, but they were for the joint waiting list of the two hospitals, namely 527 people on the list, 335 of them being women.
There is very little delay in dealing with out-patients. Urgencies are seen the same morning, and for other patients the waiting time is not more than three weeks. We are having some difficulty about inpatients. I repeat that urgent cases are always taken in without delay, even if we have to put up extra beds where we should otherwise not wish to do so.
§ Miss Hornsby-Smith
I think I can anticipate the hon. Member's point.
For other patients, waiting time varies, and it is worse for women than for men. Male cases upon the urgent list have to wait between two and three weeks, and female cases from four to five weeks. A man who is not considered to be in need of urgent treatment has to wait three 1743 months. It is true that in the case referred to by the hon. Member—and I think that we have identified the patient by process of elimination—the male patient was admitted on 6th March after having been placed upon the waiting list on the previous 5th December, so that he had been on the waiting list for three months.
I must emphasise here that the measure of urgency and priority is always and must remain a medical decision. With the best will in the world the Regional Hospital Board or the Ministry can investigate the position of a patient only at the hospital. It would be quite wrong if laymen brought pressure to bear and if, through their position in this House or in the Ministry, they were able to override a decision which, fundamentally, must remain a medical one. We may differ as to the question of urgency—many patients who do not find themselves upon the urgent waiting list would so differ—but it is a long-established principle that we must accept the view that the decision as to priority is a medical one.
The lady to whom the hon. Member referred was also not considered to be an urgent case. Since the hon. Member raised this question, and since the exchange of correspondence which he has had with my right hon. Friend, we have again gone into this matter. Her general practitioner did not regard hers as an urgent case, although I appreciate that there may be differing points of view about that. We have suggested that it should be put to her general practitioner that he might care to refer this patient to Rochdale, where there is a much shorter waiting list.
I have very little time left, but I want to deal with the point made most fairly by the hon. Member, that it is a matter of urgency that the Regional Board should review its waiting lists at hospitals. We have put this matter to the Board, and I believe that it is of the greatest importance that it should review the very 1744 wide disparity between the waiting list at Oldham and that at Rochdale where either they have more beds available or, alternatively, there must be a smaller demand for these hospitals.
We shall investigate the hon. Member's allegation about pay beds, because only a limited proportion of such beds is provided for in any hospital, and if the hon. Member's allegations can be substantiated upon investigation it would be a very grave reflection upon the consultant staff at the hospital. I would not wish to say anything more about it at the moment, beyond saying that we shall certainly investigate the use and number of pay beds there.
I understand that the doctor of the lady mentioned by the hon. Member has been approached, and I hope that he will agree that it is desirable to refer her to the other hospital. I believe that doctors sometimes prefer to keep to the consultants they know rather than send their patients to another hospital consultant, and many patients refuse to be transferred further afield. So far as we have been able to help these cases I hope that the hon. Member will feel that we have done our best, within our limits, to facilitate the matter—always bearing in mind that this must be a medical decision as far as priorities are concerned—and that we recognise that there is an extra long waiting list at Oldham. We have asked the regional board to see what it can do, within the region, to make the situation easier.
§ Mr. Williams
Will the Parliamentary Secretary also take note of my other point, about the purchase of this house, which will be a big factor in expediting matters?
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Four o'clock.