HC Deb 29 May 1956 vol 553 cc198-208

Motion made, and Question proposed, That this House do now adjourn.—[Mr. T. G. D. Galbraith.]

11.50 p.m.

Mr. T. L. Iremonger (Ilford, North)

Before turning to the main subject with which I want to deal tonight, I wish to make two points generally concerning the National Health Service. One concerns the old people in our population, and the other the appointment of members to, hospital management committees

Regarding the old people, I want to say, first, that I believe the Guillebaud's Committee's admittedly tentative conclusion about the changing structure of the population having an effect upon the demands on the Health Service to be mistaken, because although it may well be that marriage—and I am the last to dissent from this—keeps old people out of trouble as far as the National Health Service is concerned. and that therefore, as there will be more married people among the older population of the future, those older people will not make extra heavy demands, I think the Report overlooks an important development in medical science, namely that it is now possible to extend, to a measure not before deemed possible, the actual life of the body. The consequence may well be that we shall have a larger proportion of old people whose bodies have outgrown their minds. Consequently we shall have an increasing number of bedridden senile patients. I therefore suggest that we shall require a radically new approach to the provision of beds and staffing for bedridden senile patients who undoubtedly in future will make a disproportionate and irrelevant demand on general hospitals and on mental hospitals in particular.

Secondly, I hope that we may be assured that high in the Government's list of priorities in their scheme for the National Health Service is the maintenance and provision of geriatric units I should like an assurance that there will be more geriatric units, both independently and as parts of general hospitals, so that we may eventually achieve at least one geriatric unit to serve every catchment area in the country.

With regard to hospital management committees, I should like to quote from paragraph 717 of the Guillebaud Report: …we can only reiterate that…hospital authorities…and local health authorities should continue to give prominence to the need for co-operation in their constant endeavours to achieve a fully integrated National Health Service. That is all very fine, but it will not help a particular type of local authority in which I am specially interested—namely, the non-county borough. My own non-county borough comes in an area in which the local authority for the purposes of the Act is the Essex County Council—generally known as "Chelmsford "—which is a remote body, and the North-East Metropolitan Regional Hospital Board, which is even more remote; so remote indeed that no one has even given it a geographical nickname. No amount of co-operation between these two remote bodies will help the practical co-operation between the various parts of the Service required in my borough.

What we want is co-operation between the health committee of the borough council and the area health sub-committee, on the one hand, and the hospital management committees of the hospitals serving the borough on the other hand. All of that depends on the composition of the hospital management committees, and in my case that composition is determined by the "Chelmsford" nominations, as they are called, no account being taken of the wishes of the borough council. For example, Mr. A. is a member of a hospital management committee in my area, and Mr. B. is nominated at the end of Mr. A. 's term. But Chelmsford appoints Mr. A. again. Mr. A., everyone is agreed, had served with great efficiency on the management committee, but he happens to have left are area two years ago to live in retirement far away in another part of the country.

The Minister should be aware of these practical defects which do occur in National Health Service co-operation and are bedevilling the smooth working of the Service—defects which, as I have tried to point out, are particularly apparent in the case of the non-county borough.

I should like now to turn to the mental health service. I need refer only briefly to its importance or size. It accounts for 40 per cent. of our hospital beds, or 46 per cent. if one includes the mentally deficient as well. Today it is an immensely important part of the hospital system. No longer is it the "snakepit" or the asylum as in the past. Today it is a curative service—the figure of cures is about 75 per cent—and people who used to be regarded as incurably mad are normally able to have treatment which sends them out cured. The curative nature of the work is the greatest part, but it is still the Cinderella of the National Health Service, and its treatment in the Guillebaud Report is inadequate to the point of insult.

I should like to raise with my hon. Friend the Parliamentary Secretary a number of points, all of which involve expenditure, and I will in fact be giving her a shopping list.

First of all, we must have a huge capital building programme for mental hospitals. Conditions of buildings are bad enough in comparatively modern hospitals such as Claybury and Goodmayes, in my own area, but they are quite shocking at, for example, Lancaster Moor in the north of England where the hospital was put up in the 'seventies. It is particularly important that we should try to improve the physical, actual buildings of these hospitals, because if the mental health service is to be a proper curative service it must have the confidence and co-operation of the public. It must break down the fear which the public traditionally has of mental hospitals from the days when they were lunatic asylums. We shall, however, never break down that fear so long as the worst type of hospital buildings exist in any part of the country. The Minister is to be congratulated in this context on the mental health exhibition, which should do much to educate the public out of its horror of those places it used to dread, places to which people would not have their relatives go.

Supplementary to that, I think there should be more encouragement to those hospital management committees who are trying to make the best of old buildings. For example, much can be done by the imaginative use of decorations, but too often there is not enough money to carry out what is necessary. The Minister must have regard to these needs when allocating funds to regional hospital boards and say what it is that the allocation is for, so that the management committees, when they send in their estimates, get what they want from the board.

I want to refer next to the enormous development in domiciliary psychiatric out-patient treatment which is going to be a major factor in the future development of our mental health service. I hope that the Minister will beware of the Committee's grave oversight in omitting mention of this from the Guillebaud Report.

Fourthly, I want to ask the Minister to give urgent consideration to the lack of provision made for the care of mentally ill children. There are only two institutions in the country for such cases, and this is a special problem which is inadequately catered for and is causing grave anxiety to responsible people in the mental health service.

I want to say a word about the staffing of the mental health service. I think it is of vital importance that the pay and status of medical superintendents of mental hospitals should be improved. In the long run the quality of an institution depends upon the medical superintendent, his quality and calibre, and at the moment. I am told, the incentives are not enough to attract and hold the men we want.

With regard to the lower ranges of staff in mental hospitals, I ask the Minister not to be too dogmatic in his decisions on the question of in- or out-accommodation for staff. In many cases it may be desirable to provide funds for building accommodation for nurses to live in. I have particularly in mind Claybury Hospital in my own constituency, which is in a comparatively isolated situation. The authorities at this hospital find it particularly difficult to accommodate the staff —which they are able to get for a first-class hospital. There is one sister who is retiring after thirty years, and who occupies the same room measuring 11 ft. by 8ft. 6 ins. which she occupied as a student nurse.

If it were possible to build a proper hostel for the accommodation of nurses in the grounds of the hospital, it would solve at one blow the problems which are being experienced there, because the most hopeful source of recruitment for nurses in the mental hospital service at the moment is from aliens and Commonwealth citizens. There are special problems attaching to those people, which make it important that they should be accommodated in the hospital. They cannot be sent out to seek accommodation as other types of staff are able to do.

Before I leave the question of the staff of mental hospitals, I must record a modest tribute to these people. Going round these terrible places has been to me a most inspiring and, strangely enough, hopeful experience. No praise is too high for the cheerfulness, patience, the astonishing compassion and imagination of these people for whom the best praise would be that they are fully worthy of the great Christian tradition of this nation.

I want now to turn to the question of mental deficiency. The Guillebaud Report makes no attempt to cope with the tragic and cruel inadequacy of the provision for mentally deficient children. There are 15,000 in the country, and they are born at the rate of 3,000 or 4,000 a year. In Essex alone there are 500 who have been waiting for two years and more for places in institutions.

When I read letters from constituents month after month and year after year, always from the same people and always with hope to begin with, and gradually becoming hopeless, I find that I cannot answer them satisfactorily. I ask the Minister to recognise that the waiting that we are causing these parents brings to them distress which is unbearable. I myself feel that the responsibility is an intolerable burden on my conscience. I implore the Minister to provide the funds for the buildings and to take steps to see that we recruit adequate staff to keep them going.

What I have asked for involves spending money. I would say two things to the Minister. First. I welcome the "Mental Million" for mental hospital building. But this million is not enough. Please make it £6 million. If the Minister asks me where the money is to come from, I will tell him. I think the right hon. Gentleman ought to revise his whole thought on this matter. I would commend to his attention paragraph 283 of the Committee's Report which says: There must be a clear and ungrudging appreciation of the fact that if more money is expended in one direction it must mean (unless there is an increase in the total resources placed at the disposal of the Service) that less is available to be spent in other directions. We want to face that and to accept it, and to think again about the whole question of financing the Welfare State and to ask ourselves whether it is not fundamentally wrong to apply slump principles to a surfeit and boom economy. We are at our wits' end to restrict spending on luxuries. We are limiting hire purchase, imposing Purchase Tax, and putting up the Bank Rate, but we still subsidise the National Health Service to the tune of £400 million a year. At the same time we say that we cannot help, because it would cost too much, the utterly defenceless people who are mentally crippled. It would cost us £6 million a year.

I ask the Minister to admit frankly that this is really quite crazy, because, of course, we can get this £6 million if we want it, and it would be thoroughly sound anti-inflationary policy to do so. The Parliamentary Secretary should ask which is the more important; that everybody should pay half the price for a bottle of aspirins or that we should fulfil our duty to care for those who cannot help themselves. I think that there is only one answer, and I ask my hon. Friend to put it to her right hon. Friend the Minister as to whether it is not really time that we took the only proper and logical step and raised this £6 million a year, which we so desperately need for this Service, by doubling the prescription charges in the National Health Service.

12.7 a.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

My hon. Friend the Member for Ilford, North (Mr. Iremonger) has raised a vast number of questions, and I know he will appreciate that it may not be possible for me to cope with them all in 12 minutes, but I will try to answer as many of his points as I can in the time.

May I first of all emphasise that there is no question in the Ministry as to the priority of the services for old people, and in announcing his three main priorities my right hon. Friend very recently named them as mental health, old people, and the hospital building programme. So far as concerns the hospital provision for old people, we have recently conducted a national survey of all the available sources, to which the Guillebaud Report referred. Although over half of the hospital management committees have beds specifically for chronic sick—and there are, in all, 55,000, which is 1.2 per thousand of the population, and a furter 1,300 in respect of whom we have contractual arrangements with voluntary homes—and while it is also true that the need varies very considerably from area to area, there being some areas, including my hon. Friend's area of Ilford, where there is a shortage of beds for chronic sick—nevertheless the need is not so much for more beds as for better use and better turnover of the existing beds.

I agree with him wholeheartedly, and indeed it has been laid down very firmly as the policy of the Ministry, that we should do everything to encourage old people to stay in their own homes as long as possible by the provision of the local authority services and by the provision of additional domiciliary geriatric services. To this end there has been a very considerable expansion of the services provided by local health authorities. One of the most important is the domestic help service, under which the local authorities who were employing about 11,000 people at the end of 1948 had just on 36,000—over three times as many—in 1955, and well over half of the domestic help service goes to old people. In the same way, the home nursing service has risen in number over the same period from 7,700 to 9,800 in round figures, and, again, more than half of the work of the home nurses is for the elderly and old folk.

The local health authorities also provide health visitors who are available to take part in the services designed for old people, and to this provision is added domiciliary visits by geriatric physicians. There has been a very considerable increase in this necessary service, which not only aids the better classification of old people awaiting admission to hospital —which is a point which my right hon. Friend has very much at heart—but enables a clearer decision to be made as to whether old people need to go in, whether their disability is such that they will be permanently in hospital or whether they are capable of being rehabilitated after in-patient geriatric treatment.

I can assure my hon. Friend that a very substantial increase has been made in the development of hospital geriatric units. Since 1948, over 70 such units have been established in hospitals in England and Wales, and these units have done outstanding work in treating and rehabilitating many thousands of cases. It is clear that in recent years the development of the geriatric unit has revolutionised the treatment of the elderly chronic sick. I have myself seen an old lady of 92, who had broken a limb at the age of 88, had been in hospital for eighteen months, had been taught to walk again and, having come out, had broken another limb when she was 91, but who cheerfully told me, holding two parallel bars and learning to walk yet again, that she was going to be out by her 94th birthday. Such a thing could hardly have happened ten years ago.

A chronic sick survey was carried out for the North-East Metropolitan Area—the Essex side—towards the end of last year. In that part of the region outside the administrative County of London, 3,375 beds for the chronic sick were provided by the hospital management committees, and a further 420 under contractual arrangements. That means a provision of 1.15 per thousand of population.

The geographical distribution of beds for the chronic sick within the region shows a haphazard pattern in relation to the distribution of the population. I appreciate that one of the points which is causing most concern to my hon. Friend is the fact that only 22 beds—all for women—are allocated by the Ilford and Barking Hospital Management Committee and, although cases of real urgency are admitted to general beds in this group, it has been necessary to refer many cases to other groups in the region. More beds for the chronic sick in this area are clearly needed to prevent the blocking of general medical beds by chronic cases.

The chronic sick problem in this part of the region is considerably helped by the outstanding geriatric service provided at Langthorne Hospital, Leytonstone. This hospital, with 886 chronic sick beds, a turnover of three patients per bed per annum, and no waiting list, provides an excellent domiciliary service and outpatient facilities for old people. That is a pattern which we should like to see developed elsewhere.

In Ilford there is the difficulty of the relationship between the county administration of health and welfare services from Chelmsford and the council of the large non-county borough serving a population of 180,000. For health service purposes the county is divided into 11 areas, each with a varying degree of delegated powers. There is the difficulty of the relationship between the area health sub-committee covering Ilford and the health committee of the borough council and its medical officer of health. A similar difficulty arises between the hospital management committee for the Ilford and Barking area and the borough council's health committee. It is useful to have such problems as these ventilated by means of an Adjournment debate.

The Guillebaud Report recommended that medical officers of health should be closely associated with the other branches of the National Health Service. The question of admission of patients to hospitals is always a medical decision. In the first place, cases are put forward by their general practitioners of old persons requiring hospital treatment, and the decision is then for the medical staffs at the hospitals. Where the medical officer of health has a mounting list of such cases reported to him by his home nurses or health visitors he will be in a better position—with more direct contact with hospital boards and the medical officers at the hospitals—to draw attention to the deficiencies which he finds.

Many suggestions of closer co-operation were made in the Guillebaud Report, and my hon. Friend will appreciate that these have been referred to the bodies concerned and are a matter of discussion and consideration at the moment. I obviously cannot give any more precise details about them. My hon. Friend suggested that all local authorities should be represented on their hospital management committees. It is difficult to make hard and fast rules about this problem, because in some vast cities like Liverpool there are three or more hospital management committees. In other areas there is one committee covering in some cases eight or nine local authority areas. If every local authority area is to have one or two members, there would be complete unbalance over the whole range of the committees. The fact is that the majority of the hospital management committees have some members who also happen to be members of the local authority though not nominated as local authority members. Although this matter was investigated by the Guillebaud Committee, it was not recommended that members should be nominated directly from county health or other authorities.

I can assure my hon. Friend that on the mental health side we recognise the size of the problem. Over the last five years it has been the policy to give deliberate priority to the mental hospitals. Not only have we provided the "Mental Million" but the hospitals are giving a large slice of the new building programme of some £17 million over the next few years. Up to 31st March this year the regional hospital boards had provided for 8,700 new beds-3,300 mental and 5,400 mental deficiency. Apart from further beds being provided out of the boards' allocations, there are another 6,800 beds coming forward which will be covered by the centrally financed programme. That is a very substantial increase in hospital beds.

My hon. Friend raised the question of nurses' quarters. That is a problem which must be settled locally. On the one hand there are strong and understandable opinions that the strain of mental nursing is such that qualified and trained staff should have the opportunity to live outside. That is a choice which must be retained or else in many cases we should not be able to obtain the necessary staff. There are also a large number of mental nursing staff who are married and work part-time. Their services are invaluable. I appreciate the difficulty about foreigners who may not have homes in this country and there is also the problem of the remote hospitals. That is a matter which can be decided only from area to area.

The position in the North-East Metropolitan area is reasonably good. In two of the mental hospitals, including Goodmayes, there is surplus accommodation for female nurses, because of the shortage of available staff. There is lack of accommodation at Claybury, but the board has a scheme in mind to improve the position.

There are in the country six special wards for mentally sick children, but of course the major problem is mental deficiency. Of the 6,900 on the waiting list, 3,320 are children under sixteen. On 5th March this year the waiting list in Essex was 173, and, as I said in answer to a Question on that date, the average waiting time is approximatley two-and-ahalf years. I do not pretend that this is satisfactory. But a large proportion of our new beds for mental deficiency hospitals will be available for children. There are 108 additional beds for children nearly ready at South Ockendon and I hope that a further 80 beds will be provided as part of the 1957–58 programme.

In Ilford there are two occupation centres for mental defectives; one for juniors, where there are 55 children on the register, although the centre has a capacity for 70, and a centre for senior boys where there are 59 on the register. I am grateful to my hon. Friend for raising these questions. He can rest assured that mental health has a real priority in the Ministry and although I cannot comment on his financial suggestions, we are doing all in our power within the financial limits imposed on us to give a "fair crack of the whip" to the mental health side.

Question put and agreed to.

Adjourned accordingly at nineteen minutes past Twelve o'clock.

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