§ 3.35 p.m.
§ Mr. A. Woodburn (Clackmannan and East Stirlingshire)
Today, we are discussing physical and mental health in Scotland. Last week, we discussed industrial health. These things are not separable for health, like peace, is really indivisible. All these things are very closely connected. There is no question, 423 so far as industry is concerned, that great losses can be made for this country by the failure of physical health. It is just as much an economic as a health matter to see that our people are free from disease.
The National Health Service deals only with those who are in need of treatment. That is only a very limited sphere of health. It leaves out the main basic science of creating conditions under which people can live healthily and avoid disease. That is really the starting-point for health. Fortunately, the Secretary of State in himself co-ordinates all these activities and, today, we can discuss health in its widest aspects. We shall go far astray if we try to separate it into compartments. To get down to definite points in this great sphere is important. It is better if we can preserve ourselves from attack, just as in war it is better than fighting after invasion has taken place.
We can rejoice at the great triumphs with which we have driven off dangerous diseases like smallpox, plague and certain fevers, such as diphtheria, and that we are making considerable progress in combating other diseases. Our modern menaces to health are three great diseases: tuberculosis, lung and other cancer and coronary thrombosis. Generally speaking, disease seems to arise where living conditions are bad, where the resistance of the individual is lowered. and, thirdly, where he has not developed or been born with immunity. Professor Crewe once said that the best way to avoid tuberculosis was to choose parents who were immune, or never to come in contact with the germ. Unfortunately, that is not possible for everyone.
§ Mr. Woodburn
Yes, some people are born immune and some never come into contact with the disease and, therefore, they may avoid it.
All these factors come out most clearly in our most feared disease, tuberculosis. I say that tuberculosis is our most feared disease because, curiously enough, people do not seem to fear lung cancer. In fact, they seem deliberately to defy it and seem prepared to risk it with the greatest 424 frivolity. That is not fear. As a society, I should say that our greatest danger from disease is the cult we have of trying to avoid civil expenditure on civil needs. Wherever the question of doing anything for the civilian population arises everyone wants to study what is called "economy."
The amount of grudging reluctance by which expenditure is made on preventive medicine and such things really shocks me. I am glad to say that only applies to the less intelligent hon. Members of this House and to the less intelligent members of the population. Sometimes, of course, those are the most noisy and, therefore, they get most attention in the Press. The greatest economy in the long run, in my view, is to expand our health services according to our means and not to cut them down according to our meanness. That, I think, is a good principle on which to start.
Tuberculosis, we are told, as. I think, is generally accepted, is spread very largely and more easily by poor diet, poor housing, slum factories, and overwork. These, in the main, account for its spread. Charles Kingsley, in "Alton Locke," told about the tailor's den in East London where the girls, crowded together in a small room making beautiful dresses, were coughing from tuberculosis and spreading its germs over the dresses which went to decorate and beautify a girl in the West End whose father thought that she was immune from this disease because she lived far from the slums. We can shut people into the slums, as we have discovered, but we cannot necessarily shut the germs into the slums. Therefore, if we are to be healthy we must see that the whole population is healthy and that the germs are not allowed to exist.
For nearly a hundred years people knowingly cultivated tuberculosis. We created and allowed to exist conditions which bred tuberculosis in all parts of the country, for the people and their Government did not think it was necessary to interfere with the exploitation of the poor and the driving of the poor into the slums, but allowed them to dwell in conditions which bred the disease, and let it spread and allowed it to be cultivated for nearly a hundred years.
In the last forty years we have started on the reverse development to try to get 425 rid of the disease which we allowed so to develop in the previous hundred years, and we have been paying a heavy price for the causation and neglect of that disease in the earlier years.
Even now, foolish economisers are threatening a return to those conditions. For instance, only yesterday the Joint Under Secretary of State, replying to my hon. Friend the Member for Gorbals (Mrs. Cullen), pointed out with some glee that a large number of children in Glasgow were now no longer geting school meals. That is opening the road back to the development of tuberculosis. One of the reasons for the introduction of school meals—and the right hon. Gentleman the Member for Kelvingrove (Mr. Walter Elliot)has an honourable record in this—was to try to provide the children with strength, through good nourishment, to make it possible for them to resist the disease.
We suffered between the wars because children by the time they reached the age of 5 had already contracted diseases which penalised them for the rest of their lives. So I ask the Government, when they are talking of trying to save money in one way, whether they are watching the possibility that by that saving they will in the long run lose far more money and, what is incomparably worse, lose lives, through opening the way for this disease once more to creep through our country.
In 1948, we must never forget, Scotland was shocked to learn that tuberculosis in our country was rising at an alarming rate, and we knew that something drastic had to be done. I should like to think that some of the steps the Labour Government took then played some part in stopping it, but I cannot be too certain. What is certain is that in the nine years since 1948 the trend has been reversed and that quite phenomenal progress has been made in Scotland, so that the death ratio is down from 66 to 14. In the First World War, the ratio was 107. Therefore" I think it is true to say that it appears to be reasonable to conclude that tuberculosis is on the run, and now seems to be the time for a concentrated drive to make it only an unpleasant memory.
Tuberculosis can be driven out, and my own view, in which I am backed by 426 medical friends who have considerable knowledge of the subject, is that if we really made a job of it we could wipe out tuberculosis in the next nine years. It might mean rather ruthless separation of contacts, but, after all, tuberculosis separates people in the long run, and it is much better to separate to recover health than to suffer the final separation through allowing the disease to develop. If we can get agreement to separate contacts and apply it profitably it would seem that we could wipe out tuberculosis in about nine years.
I am very glad to see that the Department of Health has had considerable achievements in the development of the mass surveys during the last year. I would quote from a letter I have from one of the most authoritative sources for the supervision of this disease. It says:The energy and imagination which inspired the Glasgow mass radiography campaign have won admiration throughout the world.We ought to add our appreciation of the results of that campaign and of the energy with which it was carried through.
It was not, however, the first campaign. These campaigns have been going for some time, and there is a question about that I would ask the Secretary of State. I am a little disappointed that there does not seem to be any systematic, scientific appraisement going on by which the Secretary of State could be advised about these developments. According to the Joint Under-Secretary of State yesterday, the Committee on Tuberculosis, which was set up in 1948, was disbanded in 1951. It was a scientific committee which was supposed to watch this process and advise the Secretary of State. Who advises him now?
I take it that the Chief Medical Officer of the Department of Health, of course, does his normal duty in this matter, but I think it is a bit much to ask the Department of Health to be the chief guide to the Secretary of State in tackling this disease. I should like to think that the Scottish Medical Research Association and the Minister's scientific advisers have a special committee to make an appraisal of what has been done and is being done and to advise the Secretary of State on the conduct of this campaign so that we can make a real job of it. Who watches, appraises and directs the campaign?
427 Can the right hon. Gentleman tell us, also, what is to happen now that the Glasgow campaign is finished? What is to be the follow up? What, in the main, the campaign has done has been to give us information. It is what we do on the basis of that information that will bring results. I should like to see somebody making a collective analysis of the lessons and giving the Secretary of State guidance, and in Scotland we have some of the leading people in the study of tuberculosis, and they, I am quite sure, would be willing to serve the Secretary of State in this business.
I pass from surveys in general to one in particular. One of the most phenomenal developments has been that in the Western Isles. In 1948, when Scotland was facing this problem the Western Isles were the blackest spot in Britain. In Lewis we proposed to build a big new tuberculosis hospital. Surveys were started there in 1949 and 18 per cent. of the school children had either already contracted or were showing signs of tuberculosis—18 per cent.
The population of the Western Isles was thought to be specially susceptible to tuberculosis, as the right hon. Gentleman suggested the Poles who came to Scotland might be. This is interesting: it was 18 per cent. in 1949. Last year, that figure was down to 1.5 per cent. The hospital was approved in 1948, but its construction was held up because of the coming in of the National Health Service and various other things. The surprising thing is that that hospital is now unnecessary. There has been a most remarkable change in the Western Isles.
What brought about this improvement? It was one of the first places to which we introduced B.C.G., which was given to school children, and mothers brought along their youngest children also to have B.C.G. The mothers began to co-operate in the most remarkable way. B.C.G. was not the whole answer to the problem, though it may have had a share. There was also a psychological feature in that all the mothers in the Western Isles were made aware of the need to fight the disease. That may have contributed to the success of the campaign.
One of the medical people concerned thought that one of the great contributions to its success was better housing. We are all agreed that one of the greatest 428 eliminators of disease has been the provision of room for people to live. When the Secretary of State for Scotland is considering his rent policy I hope that he will not again think of it from the mean point of view, but rather from the point of view of housing as one of the greatest factors in public health. I hope that he will realise that no one should be driven from a house simply because he or she cannot pay the rent. That point must be watched if we are to ensure that we do not return to the bad days of overcrowding.
An important aspect which is not often noticed is that whilst the incidence of tuberculosis has decreased with the provision of more and better houses it has also decreased with the reduction in the size of families. The bigger families probably caused overcrowding and the sharing of little food, whilst smaller families may have meant that mothers have been able to look after them and feed them better. School meals have also contributed to the decrease in the incidence of the disease. The survey that I have mentioned certainly played a great part in bringing the matter to the consciousness of the mothers.
Out of 5,000 children vaccinated with B.C.G. in the Western Isles, only one has developed tuberculosis. British Medical Council figures show that B.C.G. has provided immunity as far as one can judge, in 55 per cent. of cases. I should like to know what is being done to find out what lessons are to be learned from experience in the Western Isles. The area is small enough to enable an investigation to be made and to discover whether the factor which has actually brought about this improvement can be pin-pointed.
One shocking feature has been that girls of between 18 and 25 formed a far bigger proportion of tuberculosis cases than any other class. The number still seems very great and we can only speculate about the cause. Some people blame Christian Dior fashions for making girls slim. Now. Marilyn Monroe is getting the credit for improvement in the tuberculosis figures by reversing the process and getting the girls to concentrate on their figures. When their figure improves our figures improve, in relation to tuberculosis.
429 One must ask whether this has anything to do with the improvement or not. I think that girls are less likely to catch cold and get into trouble with tuberculosis if they are fairly well "upholstered." The general question of nourishment is involved. If this slimming campaign can be counteracted we are advised by the medical profession that it will improve matters considerably.
There used to be a musical comedy which contained a good song that might he taught to our girls:If a pullet is plump she's tenderIf she's scraggy no teeth can rend her'Tis so even with a wifeIf she's fat one blesses lifeBut if she's skin and boneMan prays to live aloneIf a pullet is plump she's tender.If that kind of propaganda was made in the schools we might have an improvement in our tuberculosis figures as well as in the girls' figures. Is it true that slimming is still a danger and, if so, can anything be done to counteract it?
A minor associate subject is pneumoconiosis. I am sure that every hon. Member receives letters from people who, according to professors in various universities and surgical schools, suffer from pneumoconiosis, but who do not suffer from the disease according to medical tribunals. Is it not time that the medical profession made up its mind what pneumoconiosis is? The fact that tribunals differ in this way seems to me a reflection on the whole medical profession. The profession should be asked to make up its mind about the nature of the disease. The disease was not known in my constituency until recently, but now it is developing. I hope that the Secretary of State will have an inquiry into the subject to see whether there can be some improvement in diagnosis.
I mentioned immunity as one of the defences against tuberculosis, and that can be natural or induced. Some doctors think it beneficial to expose their own children to every kind of "bug" so that they may develop immunity. One cause of perturbation in Scotland now is that young, prospective mothers have become alarmed because of reports that if they have not had German measles their children might contract poliomyelitis. This is causing them a great deal of worry. I see that a doctor received a lot of publicity in the Press because he was expos- 430 ing his own little girls to the risk in the hope that they would contract German measles with a view to protecting them later. Something should be done publicly to reassure young expectant mothers. They are sufficiently worried without having to bear this extra worry.
Scotland is not escaping the deadly growth of lung cancer, but even the Secretary of State cannot prevent smokers consciously inviting the disease. As far as I can judge from acquaintance with many of them, cigarette smokers will invite the disease whatever the right hon Gentleman does. In this case, the wages of medical sin in all probably will be death, but if these people ask for it we cannot do anything about it. The Secretary of State, however can do something to stop youngsters starting to smoke. This education should be given in the schools. A campaign similar to that in Edinburgh, showing a film of the effects of lung cancer, is something that might be done There would be less inclination to bravado in smoking if young people were shown some of the results.
Before the war a film used to be taken round and shown to young children in France to demonstrate the result of another dreadful disease, and to warn them of its consequences. I do not know whether that film was effective or not, hut something of the kind should he done in the schools in an effort to prevent youngsters starting to smoke. Lung cancer has now become such a commercial menace to the profits of the cigarette manufacturers that there is now a great deal of commercial backing for efforts to find a cure for cancer. The result may be that we shall make great progress.
I should like to pay tribute to the society which has been spending such a long time in organising cancer research. It has done a great job. The ramifications of the research are quite remarkable. The society's report is a document of heroic backroom work which will probably go unrecognised until, some day, a cure is found. I should like also to pay tribute, as is done in the Scottish War Memorial, to the minor contributors to the efforts made in fighting this disease, namely, mice. If anyone finds a cure for cancer, a monument ought to be erected to the humble mouse. Burns paid tribute to the mouse two centuries ago. If a cure for cancer is discovered, the 431 mouse will have played a tremendous part in that discovery.
Another false economy in our health services is made in connection with the teaching hospitals. I do not want to say a great deal about it, but the conditions under which our doctors are being taught and trained are a disgrace to this generation. I know that capital expenditure on hospitals is handicapped, but in Scotland teaching hospitals are almost an industry and our reputation goes all over the world with our doctors. Some of them have been visiting Sweden recently and have been seeing the conditions under which doctors are taught there with modern appliances.
Sweden is a small country, just as Scotland is, so I ask the Secretary of State to tell us what steps will be taken to introduce the latest scientific aids to teaching in the Royal Infirmary, Edinburgh, and the Royal Infirmary, Glasgow. I understand that conditions in Aberdeen are a little in advance of them both. Unless our teaching hospitals are improved a great handicap will be placed both on the students and on the lecturers.
For instance, in the Royal Infirmary, Edinburgh, patients who are waiting for treatment have to sit on a bare board. They might be waiting to go into prison. If they are ill when they go in, they are likely to be more ill when they come out. So, if patients have to wait to go into a lecture theatre, the least we can do is to give them comfortable seats, since that does not involve a great deal of capital expenditure.
The hospitals whose resources were poverty stricken under charitable bequests, must be put into a position to do their job thoroughly. I understand that the medical profession in Scotland has made an investigation into what is required, and that its report will be sent to the Secretary of State. I should like to urge, in advance of it, that this report will be taken seriously. I ask the Government to get rid of the idea that there is any real saving in skimping on our medical profession.
From my own experience, I would be the last person to say that good lectures depend on good rooms, when I think of some of the places in which I have spoken. I remember that the first lectures I gave were in a hall lit and heated by 432 an oil lamp, where I could hardly see the students for smoke. So I would not like to say that the quality of the lecture room determines the quality of the lecture. Certainly, some of the Edinburgh University lecture rooms would not give any indication of the wonderful lectures given in them.
If, however, a lecture room has 200 people stuffed into it, and the ventilation is such that it poisons those who are there for four hours a day, they will not do their best work. Something should be done, and done soon. I believe there are plans, but I want to hear from the Secretary of State what he is going to do.
Now I come to one or two points about the National Health Service. I make one more protest about the prescription charge. The silliest thing ever done in the name of economy was to put a prescription charge, and therefore a handicap, on people getting proper treatment for disease. Simply because doctors, in some cases, have not been scrupulous in their prescriptions, it seems to me the maddest kind of justice to punish the patient. We ought to start at the right end.
The Secretary of State has appointed a committee to report on prescriptions. This seems to be composed mainly of doctors. It has always been a doubtful proposition whether vegetarians were the best people to judge the advantages of butchers' meat, or whether butchers were the best judges of vegetarianism. The question here is whether doctors are the best people to judge prescriptions. I have always believed, and said, that experts should be on tap, not on top. What we want in a committee is men of sound judgment with expert advice given to them. In any case, what is the investigation to do? Is it to investigate the extravagance of doctors and what they are prescribing? Is it to find out whether they are not doing their jobs properly? What does the right hon. Gentleman expect to get from this investigation? We would like to have details, because nobody is sure what was meant by the bald announcement to the House.
I now come to a point about dentists. I understand that when people go to a dentist they assume that he will treat them under the National Health Scheme, but that in some cases they receive a bill as a private patient. This is a difficult 433 point. Must every patient, when he goes to a dentist, state that he has come as a National Health patient? Or is he entitled to assume that if the dentist belongs to the Health Service he will be treated under that Service? If the patient does not make a bargain beforehand, is the dentist entitled to send him a bill afterwards as a private patient? This is a complaint which the Secretary of State might look at, because patients feel irritated if they suddenly receive a bill for what they thought was work done under the Scheme.
Will the right hon. Gentleman also look into the question of sight testing? This was introduced as a supplementary service, but was originally meant to become a hospital or clinic service. There might be a possibility of economy here if this proposed development was carried through, and sight testing became a service given in a health centre or in a hospital, and was no longer regarded as a supplementary service, because it is a little open to abuse.
Another point is that practitioners in hospitals feel aggrieved that the promise of the Health Service to allow them to have association with hospitals is not being developed as it might be. It is difficult for some of the smaller hospitals sometimes to get registrars, because the amount they can offer is not sufficient to induce anybody of real quality to apply. In some fairly substantial mining areas it is important to have an outstandingly efficient person in charge of the hospital.
There seems to be little development of group practices. I agree, however, that the doctors have showed themselves reluctant to co-operate and, as a result, many are working themselves to death in this empire-building for more patients. Many doctors who are over-worked ought to have far fewer numbers on their registers. This could be achieved by organised group practices or by a night service to eliminate the necessity for doctors working through the night as well as through the day. A doctor cannot possibly do his best work if he is trying to run an individual practice on a 24-hour basis.
I hope, therefore, that the Secretary of State will make an investigation sometime into the working of the National Health Service in these respects, to see whether it can be improved. I am sure 434 that everybody is for the avoidance of waste, but not for cuts which impair the Service. Sometimes, we are alarmed at the mind of the Government, which seems to work in the wrong direction; that is to say, the Government start with the cuts, without finding out whether they will impair the service.
The prescription charge should be abolished as soon as possible, because it is silly. I understand that in some cases it does not work, and that even the Government are not insisting on it Therefore, they would do far better to deal with it from the right end, that is from the point of view of the doctors. When the Service was introduced the doctors claimed that the Government must never interfere between the doctor and his right to prescribe what was necessary for the patient. That is a good rule if the doctors behave conscientiously, but it is a bad rule if it means that the State interferes by putting a financial handicap on the patient in getting the medicine he needs.
It is a retrograde step to put on a means test before a child can get food. It is a retrograde step to put on a means test before somebody can get medicine or something which is necessary for his health. Our business is to encourage people to look after their health, to encourage them to get well. It has been proved already that because of the money we have spent on the Health Service we are beginning to save on hospital accommodation. The necessity for beds is declining steadily, so it is a great economy to eliminate disease. I hope, therefore, that the Government will develop a better sense of economy.
We must keep Scotland in the forefront of medical practice and teaching. It has a great reputation. Its doctors have gone all over the world and have been accepted with gratitude from people whom they have helped. People come from all over the world to Scotland and it has developed a great reputation for postgraduate teaching. If this Government or any other Government lets that reputation down by unconsidered meanness, and not doing the job that they ought to do as the custodian of our health services, then they will deserve the condemnation of Scotland's future generations. Money spent well on health is never wasted it is the wisest of economies.
§ 4.11 p.m.
§ The Secretary of State for Scotland (Mr. John Maclay)
The right hon. Gentleman the Member for East Stirling-shire (Mr. Woodburn)opened the debate with an interesting and constructive speech in the course of which he made a number of suggestions to which very close attention will be paid. During my own remarks I shall be surveying rather widely the whole situation in Scotland and picking up a fair number of the points that the right hon. Gentleman raised. I know that he will understand that on one or two of the more detailed points he raised it will be easier for my hon. Friend the Joint Under-Secretary to reply to them at the end of the debate.
We are always discovering things about the right hon. Gentleman, those of us who have known him for many years, but I did not realise that he was an expert on fashions—that is a very interesting discovery—and that he is the repository of interesting quotations relating to fashions and wives. I only warn him to be careful of those quotations, because some people might take umbrage.
There was one remark which the right hon. Gentleman made which I do not think he would expect me to allow to pass without comment. That was where he attempted to draw rather serious conclusions from the question of school meals. The fact is that at present the standard of nutrition of school children is higher than it has ever been before. There is no evidence that any changes in the price of meals in the past has affected the standard of nutrition. Clearly, I and any responsible person would watch that very closely. I feel that the right hon. Gentleman rather exaggerated the position.
§ Mr. Woodburn
The road back is a very easy one. I hope that he never approved of it. There was a case between the wars where children were not allowed to get boots until malnutrition was proved. They had to be suffering from malnutrition before they could get boots. If that kind of means test comes in again it will be rather dreadful. I think that we are entitled to give warning about it.
§ Mr. Maclay
I do not know of the pre-war example of which the right hon. Gentleman is speaking. But, of course, I recognise very strongly that good nutrition is the best thing to prevent illness. 436 In all our thinking on these matters we have in view the same considerations as have the right hon. Gentleman and his hon. Friends.
I will go on to give a general survey—and it will be fairly full, because I think that it is my duty to give it—of the general health of the people of Scotland during the past year. The Report of the Department of Health is. in general, good. There has been a decline in both the general death rate and the infantile mortality rate and a further improvement in the death rate from tuberculosis.
I would mention, in passing, that the figure for infantile mortality this year is 28.6 per 1,000 compared with 68 per 1,000 in 1939. We are still behind other countries, but we are catching up on them. These figures are an important advance. There have been no serious outbreaks of infectious or contagious disease. The expectation of life has reached a figure of over 67 years as compared with 40 years a century ago. I cannot yet, however, record any significant progress in dealing with the two major causes of death—diseases of the heart and circulatory system, and cancer.
The vaccination of children against poliomyelitis began in May, 1956, and the first phase proceeded smoothly. The safety precautions required in preparing the vaccine caused some delays and some irregularity in the preparation of the vaccine, but vaccination has now been resumed and I expect that before the end of August all the children registered in Scotland will have been vaccinated.
Vaccine will then be made available to children born in 1955 and 1956 and also to those children born in the previous age group between 1947 and 1954 whose parents did not register their names for vaccination last year. That is the position as it stands at present. The Medical Research Council is watching with great care the reports which are coming in from all over the country. Nearly 400,000 vaccinations have so far been given in Great Britain, and there is no evidence that they have been accompanied by any risk.
The right hon. Gentleman devoted a part of his speech to tuberculosis. The two-year campaign against tuberculosis is now well under way, and I think that it 437 might be helpful if I gave a short review of the progress made. Some of the figures have been given. They are the latest available and it might be useful to recall them. The campaign opened in March this year with the community survey in the City of Glasgow. This effort proved more successful than we had dared to hope and, in the event, 714,915 people were X-rayed during a period of five weeks. The provisional results of the survey in Glasgow are these: 13,855 people were referred to chest clinics for further examination; 2,136 cases of active tuberculosis, that is, about 3 per 1,000 of the number X-rayed were discovered; and 1,074 people who were found to require hospital treatment have been admitted to hospital.
The remarkable publicity given, by the Press, the B.B.C. and the cinema, and the wholehearted support of the churches and the voluntary organisations, has meant that not only Glasgow but Scotland as a whole has been made aware as never before of the problem and the facilities available to solve it. This in itself is a most important result, because Glasgow is by no means the whole problem there is still much to do in the rest of the country. Six further campaigns have been held in other areas and, there also, the response of the public has been outstanding. A further 160,000 people have been X-rayed in these surveys and we propose to continue the drive this autumn in Lanarkshire and Midlothian, then in 1958 in Edinburgh and many other areas in Scotland, finishing in Dundee.
I hope very much that at the end of this great campaign we shall have gone a long way towards eliminating tuberculosis from our list of major health problems. All this has thrown an immense burden on the efforts of the Public Health Department, X-ray units, clinics, and hospitals, both during and after the campaign. We should like to go on record with our gratitude to all those for the way in which they have risen and are rising to the occasion.
§ Mr. Thomas Fraser (Hamilton)
I wonder whether the right hon. Gentleman would seek to find out, as the total figures are being built up, how many people altogether will be X-rayed in these campaigns. I ask that for this reason. I know that a fair number of my constituents in 438 Central Lanarkshire went into Glasgow and were X-rayed when the campaign there was being carried through. Some of those people have told me personally that they will, of course, offer themselves for X-ray when the campaign comes to Lanarkshire. I am not suggesting that there will be hundred and thousands of people having these X-rays twice, but it may he that there will be quite a substantial number.
§ Mr. Maclay
I note the hon. Gentleman's point. It reminds me of the habit at one time in certain parts of Scotland of people going forward to be "saved" several times a week because it was rather an emotional experience. It is an interesting point, but I think that it may be difficult to get the figures straight.
§ Mr. Fraser
If, for example, we had 10,000 people from Lanarkshire working in Glasgow who offered themselves for X-ray in Glasgow and they were included in the Glasgow figures as part of the population of Glasgow which had offered itself for X-ray, the percentage given for Glasgow would be unreal. If these people, later, also offered themselves for X-ray in their own county, the figures would become even more unreal. It may not be an easy thing to do, but I would ask the right hon. Gentleman to try to give us more precise and understandable figures at the end of the day.
§ Mr. William Ross (Kilmarnock)
Is the right hon. Gentleman aware that the Medical Officer of Health for Kilmarnock took the trouble to ascertain who did not belong to Kilmarnock? The Glasgow authorities may well have done the same, and, therefore, it may be possible to say exactly what the real percentage is.
§ Mr. Maclay
These statistics are being worked on and on a future occasion we will show how far and how accurately they can be developed. The great thing is the remarkable number of people who have turned up for X-ray. In view of our satisfaction at what has happened, I do not think we are too much worried at the moment about detailed statistics.
The right hon. Gentleman asked what the follow-up would be. I am answering without careful reference to details. Some of the lessons of the Glasgow survey are being studied immediately and reports are 439 being prepared covering not only the method of doing it but some of the results. I think, however, that the right hon. Gentleman was on a wider issue. The position technically is that the Scottish Health Services Council is the advisory body to the Secretary of State on tuberculosis. Regional boards are advised by their chest physicians. The line of attack on the problem is now fairly clear, but if new difficulties arose the Council would be asked to advise on methods of tackling them.
§ Mr. Woodburn
Does not the Scottish Health Services Council deal rather with administration and hospital government matters and not so much with the scientific appraisal of disease? This seems to be much more a matter for the right hon. Gentleman's scientific committee or a special committee to investigate the disease and advise him. I should have thought that the Scottish Health Services Council was not the proper body for a job of this sort.
§ Mr. Maclay
I should like to examine that point a little more carefully. I think I am right in saying that it would be an appropriate body to give advice. However, I have noted the right hon. Gentleman's point and will study it in due course.
§ Dr. Dickson Mabon
Could the right hon. Gentleman make a comment about the very large number of people who are labelled as being under continued observation and assessment? In Glasgow, there are 3,600, an enormous figure.
§ Mr. Maclay
I have looked into that matter, but I felt that my speech would be so long that I ought not to go into too many details. I will ask my hon. Friend the Joint Under-Secretary to deal with the point later, for I think that will be better for the run of the debate.
I turn now from tuberculosis, in which very important progress is being made, to cancer, where the situation is not so satisfactory. It is one of the subjects on which the most intensive research is being concentrated. In the meantime, much is being done to improve the facilities available for treatment. The new radio-therapeutic unit at the Western General Hospital, Edinburgh, built at a cost of 440 about £380,000, was officially opened this month and is in full operation. It has over 100 beds and is equipped with the most modern apparatus, including an electronic machine producing a high voltage beam.
For the information of those who are interested—I know there are one or two hon. Members who are very interested—it is described as a 4 million volt linear accelerator. This will be of great value in treatment, as a training school for specialists, and in providing facilities for research into the problems of cancer. These highly specialised facilities need not be duplicated up and down the country, but we hope that the new unit, together with the facilities which will be provided in Glasgow, will make available in Scotland the most modern treatment facilities for all who need them.
In Glasgow, the original plan was to have a centre complementary to the Edinburgh one, using a different technique of treatment, but the rapid advance of medical science has made it desirable to revise the plan. The regional board has now decided that the Western Region should have two centres for advanced treatment, one associated with the Western Infirmary and one with the Royal Infirmary. One centre will be based on a cobalt unit and the other on a linear accelerator. The planning of these units will now go ahead urgently, and I hope that building will begin some time next year.
One of the deficiencies in the present service has been that the specialists are hampered by the lack of comprehensive information about the incidence of the disease and the relative value of particular treatment. On the advice of the Standing Cancer Committee of the Health Services Council, hospital authorities will shortly be given guidance on the steps they should take to collect information in standard form on the case history of each cancer patient.
Hon. Members will also have in mind the statement made in Parliament on 27th June on the subject of smoking and cancer of the lung, a subject upon which the right hon. Gentleman touched. That statement was sent immediately to the Scottish health authorities, who were asked to bring the opinion of the Medical Research Council to the notice of the 441 public. Copies have also been sent to all education authorities with a request that the risks of smoking should be stressed in health instruction. The Scottish Council for Health Education has also been asked to assist in this matter.
The other major cause of death to which I have referred is that of disease of the heart and circulatory system. It is well known that there has in recent years been a substantial increase in coronary heart disease, This trend is common to many countries, and much research is in progress. In Scotland, apart from the research work done in the ordinary course of treating patients, specialised research is continuing in Edinburgh, Glasgow and Dundee, with the support of the Scottish Hospital Endowments Research Trust.
I now turn to diseases of the mind rather than diseases of the body. There is a wide range for me to cover in my speech. I have tried to pick out the things which seem to be most important this year.
Progress in mental health is, I am glad to say, more dramatic and encouraging. Many of our mental hospital buildings are already nearly a century old, and modernisation is necessary to enable patients to have the kind of privacy and amenity to which they reasonably feel they are entitled. Much is already being done in this direction by way of both capital and revenue expenditure.
On the revenue side, to encourage these developments, I have this year made a special allocation of £60,000 over and above the ordinary allocation for expansion to regional hospital boards to meet the running costs of improvements to mental hospitals. On the capital side, one of the most important needs for which we shall make provision is for self-contained treatment units, sometimes called admission units, for short-term patients, and these will be attached to existing hospitals.
In the field of mental deficiency, I have received two valuable Reports, one on the Welfare of the Mentally Handicapped and the other on Mental Deficiency in Scotland. The first came from the Advisory Council on the Welfare of Handicapped Persons and the other from the Scottish Health Services Council. I have commended both of these Reports to local authorities and to hospital authorities. 442 The shortage of beds remarked on in the second of the Reports will, to some extent, be met by the substantial programme of buildings now being undertaken. This will provide over 1,000 additional beds for mental defectives. Over a period of four or five years we should get an increase of about 20 per cent. in the number of beds.
It would not be in order for me to discuss now the revision of the Scottish legislation relating to lunacy and mental deficiency, but perhaps I might indicate briefly the present position and how I have in mind to proceed. In December. 1955, my predecessor placed before Parliament proposals for the amendment of the law based on the recommendations of Lord Russell's Committee.
The recent Report of the Royal Commission on the law in England and Wales reviews the whole field comprehensively. Although it takes account, of course, of English conditions only, we in Scotland ought to consider the Report very carefully. The Russell Report dealt with a limited number of important issues. The English Report has dealt with these and many other matters. I am glad to say, however, that there is no significant divergence between these two Reports on important matters such as compulsory admission without a judicial order and the necessary safeguards for the rights of patients who have been compulsorily admitted.
In view of the many important issues arising from recommendations of the Royal Commission and the Russell Report, I am now arranging to obtain the views of the Scottish Health Services Council, local authorities and other public bodies concerned on the action which should be taken in Scotland. These consultations will take some time, but I hope when they are completed to be able to embark on a comprehensive revision of the Scottish law which, as hon. Members will agree, is many years overdue.
I assure the Committee that we are still very concerned with the problem of old people who are ill or in need of the care and attention provided in old people's homes. The number of hospital beds for the chronic sick has risen since 1953 by well over 1,000. We have been able to use beds which were previously required for infectious diseases and tuberculosis, and I expect that this change of 443 function will continue and be extended considerably.
The whole solution, of course, does not lie in increasing the number of beds. We must try rather to reduce the number of people who are in the category of being chronically ill, and there is good reason to believe that by the use of up-to-date methods of treatment it will he possible to restore to their own homes a much greater number of old people until now regarded as incurable.
I turn now to a matter which is not one of law or policy but, in the main, depends on health education in a new sense and on a greater sense of public and individual responsibility. In last year's debate, several hon. Members represented that the Government should take positive action to try to reduce the number of fatal and non-fatal accidents occurring in the home. The hon. Member for Coatbridge and Airdrie (Mrs. Mann)has said much about this subject in the past. Since last year interest has grown and there is a more general awareness that accidents in the home far outnumber deaths from accidents on the roads which excite so much concern.
I have given the following figures before, outside the House, but I will repeat them, because they are very striking. In Scotland, in the five years from 1952 to 1956, nearly twice as many people died from accidents at home as from road accidents—5,389 at home and 2,866 on the roads. I decided, therefore, to invite local health authorities, as the people who could most effectively take action, to deal with this problem as an integral part of their responsibilities for the prevention of illness.
The circular issued in April summarised the problem and suggested methods for dealing with it locally—by co-operation for example, with local voluntary organisations. by using health visitors, and by setting up home safety committees. There is plenty of room here, however, for experimenting and pioneer work, and I am sure that local authorities and their officers will respond to the challenge which the figures I have given offer. I have asked for reports on the action taken to be included in the reports made by my medical officers of health. The first results will not be available, therefore, until next year, but I hope that they will show that effective action can be 444 taken towards reducing the toll of home accidents. They are undoubtedly one of the most serious causes of death and disability, and they must be tackled as a major problem of public health.
I come now to the organisation of the Service and the Scottish Health Services Council. The Scottish Health Services Council has continued its valuable work of examining and advising on particular problems in the Service. During the last year, it has produced two reports—one on mental deficiency and one on medical superintendents in hospitals—which have been recently published. I referred to the report on mental deficiency when I dealt with mental health. The report on medical superintendents sets out the Council's view of the future of medical administration in Scottish hospitals where our practice has always differed from practice in England. This Report is now being considered, and I am sure that it will be of great assistance in determining future lines of development. The Council is now considering two other subjects—the organisation of the maternity services and the organisation of the laboratory services.
The Committee set up under the chairmanship of Lord McNair to consider the shortage of candidates for training as dentists reported in October, 1956. I hope to announce soon the steps I propose to take, in view of the report, to establish machinery to advise on a comprehensive national programme of dental health education. In the meantime, I can say that in Scotland the intake of dental students improved considerably last year and that in the three Scottish dental schools all 140 available places for new students were filled. The intake of new students for the coming academic year is equally promising.
With the full agreement of the medical profession, I have recently appointed a Scottish Committee on Prescribing Costs under the chairmanship of Mr. J. B. Douglas, the Committee to which the right hon Member for East Stirlingshire referred. In view of the continuous upward trend of the cost of this service, I felt that it was desirable that there should be a full examination of all the factors which influence prescribing costs. I think that the right hon. Gentleman must have heard the terms of reference, but I will repeat them, because he raised the point 445 specifically. The Committee is to inquire into prescribing practice in the general medical services and hospital specialist services of schools in Scotland, with particular reference to the factors governing costs, and to make recommendations. It is a wide remit, and we wait with great interest to see what will come out of the inquiry.
The right hon. Gentleman commented on the composition of the Committee. It is well balanced. The chairman is not a medical man, but he is a man of great experience and ability. The Committee consists of three general practitioners, three consultants, two other doctors, two lay members and a pharmacist.
§ Mr. Woodburn
I have read the terms of reference. It is difficult to know exactly what the Committee is to do. Is it to inquire into the type of medicine being prescribed, or into any question of economy in the cost, into substitution of cheaper medicines for luxurious and extravagant ones? Is the Committee to consider getting rid of expensive proprietary medicines which are unnecessary? What is the Committee to try to do? Is it to try to improve the Service, or to cut down the cost?
§ Mr. Maclay
Obviously both. The Committee will try to improve the Service. The right hon. Gentleman has referred to factors which might well come within the Committee's study. The Committee is to see that the Service gets the best possible value for money and that the Service is improved.
§ Dr. Dickson Mabon
Will it not be in the interests of the general public for the Committee to include one or two lay members, what might be termed "consumers' interest". to give the impression that it is not merely a technical committee devoid of any social implications?
§ Mr. Maclay
There are two lay members. I do not have the names, but the chairman also is a lay member and has wide experience of other than health matters.
I cannot conclude my review without giving hon. Members some information about the hospital building programme. There is no need to recall the difficulties of the hospital boards in the years after the war when the Health Service came into operation—the effects of the war, the post-war shortage of materials and the 446 backlog of maintenance and repair and upgrading that remained to be undertaken. The total amount, including the amount for this year, which has been spent on the Scottish hospitals since the inception of the National Health Service, on capital account for buildings, equipment and plant, is nearly £21½ million. The hospital building programme, as we now see it, falls into three main phases. In the first period, after 1947, capital had to be devoted mainly to works of improvement and adaptation at various hospitals all over Scotland. In the second phase, in which we now are, about half the capital available is devoted still to smaller works, but the other half goes to major projects costing £250,000 and upwards which are designed to provide additional beds and new specialised facilities.
The third phase will begin from about 1960, and this we are now planning. I hope that we shall then be able to devote about three-quarters of the capital available to major works and to concentrate our resources largely on the modernisation of the main teaching hospitals, the development of out-patient departments at the main general hospitals and, thirdly—I mentioned this earlier—new admission units at some of the mental hospitals.
The major works already under construction and now being planned include large extensions to mental deficiency institutions; a new neurosurgical unit at the Western General Hospital, Edinburgh, which will have one of the most modern theatres in the world; a new hospital for Shetland; a new hospital in Kirkcaldy, and new maternity hospitals at Bellshill and Glasgow. The programme will provide 161 new beds for cancer treatment, over a thousand new beds for mental defectives, 260 new beds for mental treatment and 205 new beds for maternity.
In last year's debate, there was a certain amount of anxiety expressed about whether we were providing sufficient money for Scottish teaching hospitals to keep themselves up to date. That anxiety has been expressed again today. I should say that about £2¼ million of Exchequer money has already been spent on building works in the main hospitals in which teaching is undertaken. This is exclusive of the substantial amounts which the boards of management in the hospitals themselves have spent from 447 endowment funds. As hon. Members know, plans are now being laid for a new teaching hospital at Dundee. I am also hopeful that we shall be able to undertake in the phase beginning in 1960 the first stages of reconstruction at one or two other important teaching hospitals.
In the present state of the national economy, our resources for hospital building must remain limited and we have to divide this limited capital over many different projects designed to maintain and modernise our existing hospitals. The allocation to the capital building programme in the current year was £2½ million, an increase of £300,000 over last year. Next year I hope it will be increased again. While this increase is not as much as we should all like if we could afford it, I believe that we are making a very significant contribution to the further development of the hospital service.
The last main topic to which I wish to refer is medical research, on which so much of our progress depends. The Committee would like me to say something of the activities of the two main Scottish bodies with which my Department co-operates closely. They are the Advisory Committee on Medical Research and the Scottish Hospital Endowments Research Trust. Both are very active in examining and encouraging promising lines of inquiry which are put to them by research workers who require financial support.
The Trust has decided to establish one of the largest research units we have ever had in Scotland to do fundamental work in virology under the wing of the University of Glasgow. This will be the only institution in the United Kingdom devoted exclusively to virology. For the benefit of those who are no more expert than I in the use of technical terms, "virology" means exactly what it would sound as though it means, namely, the study of the habits of viruses. The Trust is providing £225,000 towards the cost of the building which will be staffed by the Medical Research Council and the University.
The legislature and the administration cannot ensure successful and productive research. The most we can do is to provide the conditions which will secure that no gifted individual loses the opportunity to make his contribution to 448 research and that no favourable clinical opportunity for research is lost. With this in mind, and with the agreement of the Medical Research Council and the universities, I have sent a memorandum to hospital authorities asking them to do all they can to facilitate research work and suggesting to them means by which they can help.
I conclude with a word about the people engaged in the Service. I should like first to acknowledge the devoted work of those members of the Health Service authorities who give their time freely to organising and administering the various services. We owe a great deal to those who undertake such duties. Finally, and above all, I should like to pay tribute to the staff of the Service—the doctors, the nurses, the technicians and all the other workers—whose day-to-day work is to care for the patients. I can pay a personal tribute to their work. It is exacting, and I think hon. Members would support me in letting these people know how very much we in this Committee appreciate the work they do.
§ 4.45 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
Where there have been improvements in the general health of our people I welcome them, as have my right hon. Friend the Member for East Stirlingshire (Mr. Woodburn)and the Secretary of State for Scotland. I am sure that all hon. Members on this side of the Committee would wish to join with the Secretary of State in his appreciation of the fine and great work of all those engaged in the National Health Service in Scotland.
I wish this afternoon to devote my speech to two matters which I have raised on previous occasions. The first is the shortage of radiographers, which I understand is to be found not only in Scotland but in the whole of the United Kingdom. This shortage was brought to my notice by one of my constituents who is a senior radiographer in one of our Scottish teaching hospitals. I took the matter up with the Secretary of State and received a reply from him in which he said:It is true that there is at present a shortage of trained staff but it is hoped that the additional training facilities now available, through the increase in the number of schools, 449 will assist in this problem. The loss arising from persons going overseas is not confined to this group but exists in many other professions and industries.That sentence dealing with the loss from persons going overseas and comparing it with the loss in other professions shows an attitude of complacency on a matter which is of vital importance to the smooth and efficient running of almost the whole of our National Health Service.
Yesterday, I had a Question on the Order Paper which was answered by the Joint Under-Secretary of State for Scotland, who told us that there was a 5 per cent. shortage in Scotland. He said that it was "troublesome". That is a strange adjective to use about such a serious matter. One might refer to a child as "troublesome" when it is a little annoying, but to use the expression about a 5 per cent. shortage of radiographers seems to me a strange choice of words. It showed what I consider to be gross complacency on the part of the Joint-Under-Secretary of State.
The hon. Gentleman also told me yesterday that, because of the new training school opened in Dundee, it was hoped that this shortage would be overcome. Bit training facilities, taking the whole of the United Kingdom, have increased since the end of the war. My information is that there is no shortage of recruits to take the training to become radiographers, either in Scotland or in the whole of the United Kingdom. But there is a 5 per cent. shortage in the Scottish hospitals and a 16 per cent. shortage in the English and Welsh hospitals. Why do we have these shortages if it is the case that there is no shortage of pupils coming forward to train as radiographers?
I have tried to make a careful examination of this matter and, so far as I can discover, the reason why we are having these shortages is the particularly low rates of salaries paid to radiographers in the National Health Service. The Society of Radiographers has been deeply concerned about the shortage for many years.
§ Mrs. Jean Mann (Coatbridge and Airdrie)
I have an intimate knowledge of this question. If there is no lack of recruits, how does that square with the fact that salaries are so poor? If salaries are so poor, one would imagine that there would be a lack of recruits.
§ Miss Herbison
I was just going on to deal with that matter.
The Society of Radiographers is very concerned about this matter and made a survey in 1955 of the radiographers who had left the Service. It gave me the following figures. About 32 per cent. of those who left during the few years before the survey did so because of marriage. There is always a large number of young women in this service. About 23 per cent. gave health reasons for leaving, while 45 per cent. gave other reasons. The chief reason in this last category was the low rate of salary. It seems that the people concerned had not realised until they got into the Service how low the rates of salary were compared with what could be obtained elsewhere.
Hon. Members may be interested to know what the rates of salary are. The minimum basic grade is £420, going up by various increments to £485 for a radiographer who has no other duties. A senior radiographer, a man with at least four years' experience and additional responsibilities, begins at £485, and the highest salary he can get is £570. The superintendent radiographer, with at least five years' experience who is in charge of three to seven assistants, begins at £585, and his highest salary is £750. The superintendent radiographer, who is in charge of eight or more assistants—and this is the top grade—starts at £675, and the highest rate he can reach is £850. That is the very top figure.
§ Miss Herbison
They apply to the United Kingdom also, because they are decided by the Whitley Council for this branch of the National Health Service.
What academic qualifications must intending radiographers have before they are accepted for training? That is of the greatest importance when we complain about low rates of salary. In Scotland they must have reached the higher leaving certificate at least and have passes in mathematics, English and science subjects or any three other subjects. Young men and young women whom we expect to be attracted to this important branch of the National Health Service must, in other words, have stayed at school until about 17 years of 451 age and must have made at least four passes, if we include the two science subjects, or five passes on the lower standard.
It is not surprising that we find difficulty in keeping them when they must have these qualifications which take them elsewhere. Where did the 45 per cent. who left go? Some went abroad, but quite a number stayed in this country. They left the hospital service to go into industry, some of them doing work for which they had been trained and others just disregarding that valuable training and going in for other work because they were able to get higher rates of payment.
Let us look at the training. It is a two-year training, and the trainees must pass examinations approved by the Ministry of Health and, I take it, also by the Department of Health for Scotland. I understand that radiographers are divided into two categories, those who work in the diagnostic field and those who do radiotherapy. In the diagnostic field, the radiographer produces X-ray films at a doctor's request. He has a very important, indeed, vital job in diagnosis. The radiographer who spends his time in radio-therapy is responsible for treatment by radiation according to the radio-therapists prescription. What work could be more important than that? I stress the importance and the responsibility of the work done by these men and women in whichever category they work.
We see no sign of the shortage of radiographers growing less, and it could lead to a reduction in important diagnostic facilities and radio therapeutic facilities in our hospitals. Because I feel so strongly in this matter, I want to know—this is not a matter for smiling or laughing——
§ Mr. Maclay
I am sorry. I happened to be referring to something else to one of my hon. Friends. It had nothing to do with the speech being made by the hon. Lady. I was not laughing at what the hon. Lady was saying.
§ Miss Herbison
I am surprised that the Secretary of State for Scotland should be referring to something else when this important matter was being dealt with by me.
A deputation from the Society of Radiographers was met this morning by the 452 Parliamentary Secretary to the Ministry of Health. I hope that the Joint Under-Secretary of State will be able to tell us whether he or his right hon. Friend will meet a deputation of the radiographers from Scotland. Since it will be some time before the Joint Under-Secretary will be replying to the debate, I hope he will be able to have conversations and by this evening be able to tell us that the Secretary of State and himself will leave behind this complacent attitude. I hope he will tell us what specific action they intend to take to end the shortage of radiographers.
The Secretary of State, when speaking of the T.B. X-ray campaign in Glasgow, said that we ought to record our gratitude to all who took part in it. Who played a bigger part in it than the radiographer? One of the very best ways of recording our gratitude to these people is for the Secretary of State to use his influence to make their salary conditions much better than they are at present.
§ Miss Herbison
I made inquiries about that also, and I discovered that some of these people have to pay £50 a year or more in fees to be trained as radiographers. I want to give the fairest possible picture, so let me add that in the North of England, I understand, some of these people are given a little payment while they are training, but in the majority of places fees are extracted during training and no payment at all is made during these two years. I also understand that some education authorities give grants to help, but my hon. Friend has informed me that in the case of one of her own family no grant for this type of training was forthcoming. I am very glad that my hon. Friend reminded me of that.
I now turn to the second question. I find that on page 39 of this Report a statement is made about pneumoconiosis centres. This, again, is a question which I have raised on a number of occasions in the House. In 1951, the first industrial chest unit was opened in Bangour, and one of the happiest jobs which I performed as Joint Under-Secretary of State for Scotland was the opening of that unit. 453 On 25th March, 1952, I asked the Secretary of State—this can be found in column 22 of HANSARD for that date—if he would ensure that other industrial chest units would be opened in each regional hospital area which covered mining areas in Scotland. The right hon. Gentleman told me in reply that the unit at Bangour was only in its experimental stage, that, of course, he was bound by the advice he received from medical quarters in Scotland and that the regional hospital Board had the final decision. I am paraphrasing the Question and Answer.
On 8th November, 1955—column 1639 of HANSARD—I put almost the same Question to the Secretary of State and again received almost the same reply. I asked a supplementary question, and the following is the reply I received from the then Secretary of State, the right hon. Member for Moray and Nairn (Mr. J. Stuart):I agree that we must do all that we can in that direction, but specialised units are not the only method favoured by medical opinion to which I must pay some attention, but, in conjunction with the regional hospital board, I will certainly consider whether any further action should he taken."—[OFFICIAL REPORT, 5th November, 1955; Vol. 545, c. 1639.]I have often criticised the right hon. Member for Moray and Nairn, but I want to praise him today because it seems that he honoured that promise which he gave and that he had discussions with the regional boards.
I was delighted to find in this Report that three special centres were going to be opened in the South-Eastern Regional Hospital Board and the Western Regional Hospital Board areas. It is a long time since the Report was prepared, and I should like to know whether any of the centres have yet been opened, and also if one of them is going to be situated in the Law Hospital which is the hospital that really caters for the majority of the mining population in Lanarkshire. I hope that the Law Hospital, which has proved its worth so much since it was opened as an emergency hospital, will be given one of those centres to be used in the treatment of pneumoconiotics.
On page 39 of the Report, we are told about special investigations which were carried out by the Medical Research Council's unit at Cardiff. Those of us interested in the matter follow very carefully all the pronouncements that are 454 made on the subject, but I am surprised to see that our Department of Health did not incorporate in this short paragraph on industrial chest diseases something about the wonderful work done at the Bangour unit in the treatment of those suffering from pneumoconiosis. I agree very much with what is said at the end of the paragraph. The Bangour Unit has helped those men suffering from pneumoconiosis to make better use of their lungs than they could do before they went to the hospital and also in adopting a different attitude towards their disease.
As the Bangour unit was not mentioned in the Report, I think that it would be quite wrong for this debate to pass without showing our appreciation of the work done by the specialist from Edinburgh, by the resident doctor and by the nurses who are doing such valuable work for those suffering from this dread disease. I hope that on these two matters—there are others I should like to have raised, but I know that many of my hon. Friends wish to speak in the debate—the Joint Under-Secretary of State will be able to give the answers.
§ 5.6 p.m.
§ Mr. Walter Elliot (Glasgow, Kelvingrove)
We are reviewing this afternoon the real industrial capital of the nation. Of course, we are all anxious that a strip mill should be erected in Scotland and gratified at seeing the order books full on the Clyde. But we are now reviewing the people who make those things tick over and work. Without an adequate supply of healthy men and women, all the plant in the world would be of no avail. We are reviewing, both in general and in detail, the conditions under which our industrial workers and our population in general are living, and also the improvements which we hope to be able to bring about.
First, I wish to refer to the figure mentioned by my right hon. Friend the Secretary of State of the prolongation of the length of life. It is now sixty-seven years, a higher figure than ever before. People are a little inclined to think that this is made up of aged people kept alive longer artificially by some kind of pepping up or by injections of some kind or another, which, of course, is a totally wrong conception. The expectation of life in the advanced years has hardly gone up since the Romans. 455 The Roman Senate would have had about the same expectation of life as we here in Parliament have. It may have gone up by a year or eighteen months, but little more.
Where we are prolonging life is in the vigorous years, the twenties and the thirties. That is where it is taking place. People reaching the years of 65, 66, 67, and so on, are also, let us hope, healthier and fitter than they were in years gone by. The fear is sometimes expressed of the great number of aged people with which the nation is faced compared with the number of young people. That is to some extent an illusion because there is a broader base of youth and strength on which to carry it.
The burden of the old people is not carried by children of from 5 to 15 years of age. That is where the heavy death rate took place in the early years of the nineteenth century. The burden is borne by the vigorous people of the adult working period, and these are the people who are increasing in number. The burden of the old people is not as great as is feared, or as appears statistically. What is more, the older people—owing to the greater use of the science of geriatrics, which is really a long name for keeping older people fit—are themselves much more able to continue in a condition of reasonable activity and for much longer, than they would have been if crippled by rheumatism, pneumoconiosis, or some of the many diseases of which we have been speaking.
This prolongation of life then means that we have a larger fit population than we ever had before in proportion to the whole population, a larger proportion of fit people than there were in the early days of the nineteenth century. When the expectation of life was so very short, it was the huge infantile mortality, and also the heavy wastage in the earlier "fit" years, which represented an enormous and complete wastage.
The chief example of that is the disease of tuberculosis, which has been referred to several times this afternoon. We in Scotland can claim some credit for a much of the advance which has been made in the treatment of tuberculosis. The whole of the treatment of tuberculosis was enormously improved by our 456 own Scotsman, Sir Robert Philip—by the great advance which he pioneered in chest clinics and elsewhere. His is one of the key names in the treatment of tuberculosis and I am very glad that the City of Edinburgh is honouring him at the end of the week with a memorial plaque.
It is well worth our while in Scotland to remember that one of the great advances in the practical treatment of tuberculosis, as reflected in these extraordinary figures which we are able to show, is the result of the work of one of our own men; who studied in our own schools and with our own facilities, and who was able to make advances which have since been copied all over the world.
The figures are most interesting and surprising. The hon. Member for Greenock (Dr. Dickson Mabon)elicited some interesting figures yesterday, when he asked for the figures for 1948 as compared with those of today. No doubt the hon. Member will be referring to them in winding up the debate—and as one ex-President of the Union to another ex-President of the Union, I wish the hon. Member good luck and good fortune in this important task which he has been given.
When I looked at those figures, it occurred to me that they dealt only with the respiratory disease. Accordingly, I looked up the non-pulmonary figures also and they show the same striking fall. In 1948, as the hon. Member for Greenock has ascertained, the deaths from pulmonary tuberculosis in Scotland numbered 3,415; the deaths from non-pulmonary tuberculosis were 486, making a total of 3,901 actual deaths. In the year 1956, only 714 pepole died of pulmonary tuberculosis, and only 85 of non-pulmonary tuberculosis—a total of 799. The figures have gone down from just under 4,000, to 800, between 1948 and the present day. That is remarkable.
§ Mr. Woodburn
The right hon. Gentleman has done a service in calling attention to that. It shows the indivisibility of health from the progress that Scotland has made in eliminating tuberculosis from cattle. It is now almost entirely free of the disease. Large parts of Scotland 457 are free of tuberculosis, whereas in the old days, I understand, tuberculosis in cattle was the main cause of non-pulmonary tuberculosis.
§ Mr. Elliot
The right hon. Gentleman is perfectly correct. That reflects a striking advance in what has been called the cleaning up of the herds. Again, it is worth while to remember that our fellow countryman Sir Robert Philip was one of the very first to start a tuberculosis-free herd in connection with his clinic; and that he rammed home the fact that it was a preventable disease in both animals and human beings and that the one reflected upon the other.
Here is this figure of a drop from 4,000 to 800 deaths a year between 1948 and the present day. Tuberculosis, as I have said, is particularly a disease of the young and the at. These are the people who are being saved. That itself represents an enormous credit item in the real balance sheet of the nation, which is what we are discusssing this afternoon.
The figures, of course, leave still a great deal to be desired. The Glasgow and other surveys were very interesting. The Glasgow X-ray survey reached a figure of 75 per cent. and the Perth survey a figure of 67 per cent. The total of new cases detected was 2,297 in Glasgow, Perth, West Lothian, Ayr and Kilmarnock. Incidentally, the interesting point has been mentioned that there is a danger of some people being counted twice over. I do not think that it is a real danger. Glasgow has, in fact, already broken down the figures.
The Secretary of State was asked whether he could give the breakdown of those figures. It so happens that I ascertained these figures beforehand. The Glasgow figures indicate that 1,980 of the cases detected were from people resident in the area, and 156 from people resident outside the area; so that the figures have been actually kept and it will be possible to analyse them and make sure that nobody is counted twice, although, of course, another inspection is all to the good.
These figures, however, still show a considerable number of undetected cases of tuberculosis in Scotland. Here we had 2,297 new cases detected in an examination of something like 800,000 people. It is true that that 800,000 was in the 458 most heavily infected area. The West of Scotland is the area with the highest notifications. Glasgow is the second highest area and West Lothian, which was also examined, is the third highest. Naturally, the campaign was concentrated on the areas where there were the greatest numbers of notifications.
We can multiply that figure of 2,297 proportionately by the population of Scotland, but even discounting very heavily the fact that we would not expect as high a figure as that for the whole of Scotland, it is of the order of some 10,000—or, even if we halve it, 5,000—cases.
If there were 5,000 cases of smallpox walking about Scotland we would all throw up our hands in horror. But tuberculosis is also an infectious disease. It is well worth remembering that here is a very big source of infection still rife in Scotland. Although it may well be possible to clear up the disease in a short period of years, it certainly will need all the strength and effort that we can devote to it. It can, however, be done and that is the first lesson that we can draw from the examination of the figures and the review of them that the Secretary of State and other hon. Members have given this afternoon.
We have heard also of the cancer figures. I do not intend to go into them at any length, because a great deal of work is being done in that direction. I was interested to find in my right hon. Friend's statement about the new units which were being set up that at long last the rather unsatisfactory position in the West of Scotland has been cleared up and a decision has been reached concerning the radio-therapeutic treatment, about which I and, no doubt, other hon. Members also have had a good many complaints.
I understand that my right hon. Friend is setting up one unit in connection with the Western Infirmary and another in connection with the Royal Infirmary. He said that one was a lineal accelerator and the other a cobalt unit. That is extremely interesting. I hope that we will now be able to get ahead with these things.
Although it is true, as my right hon. Friend said, that the progress of medical science has been so great that it had been necessary to postpone and postpone again the setting up of these units, as we 459 all know in our engineering and other industries there comes a moment when one has to set one's teeth and decide to go into production. There are, no doubt, a great many improvements to be made, but they will need to be made some other time. And so my right hon. Friend is going into production on these important adjuncts to the treatment of malignant disease.
We have not, of course, come to the satisfactory solution of the cause of malignant disease. We are still very much at sea about the causes of it, but a great deal of work is going on.
I am not so sure about the other field of medicine dealing with the coronary diseases; we are rather at a loss where to start: we are still very much at sea about the causes of these. Some people say that they are due to the higher standard of living which we enjoy in the West. It is certainly true that they are associated with a higher standard of living and not with a lower standard of living.
§ Mr. Elliot
That may be so, but it would be a bad thing for many of us in the House if we put too much emphasis on a slightly increased waistline. After all, Caesar said:Let me have men about me that are fat;Sleek-headed men and such as sleep o' nights;Yond' Cassius has a lean and hungry look;He thinks too much: such men are dangerous.
§ Mr. Elliot
It was an occupational hazard rather than an ordinary health risk. As the hon. Member for Greenock, a medical friend of mine if I may so call him, is well aware, the fat metabolism is closely connected with this problem. It is thought by some people that an increase in the fat intake is one of the things which is responsible for this large and undoubtedly disquieting rise in these coronary conditions, the conditions of the small arteries which nourish the heart.
§ Mr. Emrys Hughes
If the hon. Member means a higher standard of living in the West of Scotland, does he not think that too much whisky may have something to do with this condition?
§ Mr. Elliot
I did not refer to the higher standard of living in the West of Scotland. This is a condition which affects whisky-drinking countries, wine-drinking countries and milk-drinking countries. There is far more fat in a glass of milk than in a tumbler of whisky. I was not speaking of the West of Scotland but of the Western World.
The fact is, oddly enough, that this is a disease which affects the Western World. An hon. Member opposite travelled with me to Nigeria, and he will recall that when we inspected the great hospital at Ibadan we found that they had no statistics at all about coronary disease, because nobody in Nigeria seems to have coronary disease. That was not due to a lack of anxiety, because some of them lived very anxious lives indeed. As for the comment about whisky, they brew a very potent kind of beer there which is not subject to any licensing laws and which sometimes leads to a very high intake of total alcohol.
I merely say that this is a question mark. Indeed, this field of medicine is still full of question marks. The right hon. Member for East Stirlingshire (Mr. Woodburn)was good enough to refer to some remarks I made about Poles as being a possible cause of that astonishing hump which took place in the Scottish tuberculosis statistics and which was not paralleled anywhere else. It was not due to industrialism because it was not paralleled in South Wales, and was, in fact, unique to Scotland. I myself followed it a little. For instance, I tried to obtain the tuberculosis statistics of Polish soldiers. There are very few cases in which we can obtain a comparative analysis of two sets of people of completely different races living not merely under the same dietetic conditions, but also under the same clothing conditions. The statistics showed a significantly larger number of tuberculosis cases by comparison with those among Scottish soldiers. It was one of those promising hares which one starts hoping that it will appeal to somebody else, but it did not appeal to anybody else and we went no further with it.
This brings me to the last point I want to make, which is a point of some importance. The right hon. Gentleman mentioned mental health; but he did not go very far into it. Nor does the Report 461 go very far into it. It simply mentioned, casually, thatthe number of beds in mental hospitals account for well over a third of all beds in the hospital services in Scotland.That reference will be found on page 35. In other words, one third of the hospital population is accounted for by patients under treatment for mental conditions.
As far as one can see, very little research, and certainly no research comparable with that in other fields of medicine, is proceeding in this direction. A certain amount of work, but not very much, is being done. The reason for this lack of work is partly physical. As we know, the great mental hospitals are segregated away from the big centres of population. They are built far away or on the outskirts. The mere physical difficulty of getting the students and the doctors to come and go between the mental hospitals and the other hospitals is a considerable factor. The staff as well as the inmates in mental hospitals live rather secluded lives. The every-day contact between people, when they come and go, meeting each other in canteen or club or in the innumerable activities of students and doctors, is almost lacking for those working in mental institutions by comparison with those working in the other great hospitals. That physical segregation is an important feature.
Secondly, very little fundamental research is taking place in this respect. I am not sure that it is not one of the fields in which we could make a break-through and make a start on reducing these figures. They concern in some cases the physically strongest and fittest people, for instance the schizophrenics. Many young and active people are struck down by mental illness. If we really turned our attention to it we might be able to make a great advance. The initiative will have to come from here; it will not come from the medical profession. It will not come even from the Medical Research Council.
§ Mr. Woodburn
I think the right hon. Gentleman has raised a very important point. When I initiated the Research Advisory Council my idea was that it should allocate to research workers certain problems, as we do in engineering science, in diseases of potatoes, for instance, or in the Institute with which the right hon. Gentleman is associated, 462 dealing with animal nutrition. If it is left merely to those who wish to apply for grants for research which they are doing, some of the big problems which he has mentioned might be omitted. It would be helpful where possible to say, "This is a problems which must be investigated". If the research workers could be found one could then deliberately set them the task of doing this research instead of leaving it to the movement of the human spirit and to whether somebody wants to undertake the investigation.
§ Mr. Elliot
One has to be a little careful about the direction of research, but I think we can put ideas into people's heads. This is an instance where those who start the work should be people from outside the ordinary range. We ought to have people whose lives depend on the practical application of psychology, people such as ourselves; we are all practising psychologists. Similarly, the lives of commanders of armies in the field depend on what is called morale which is simply applied psychology. A good serjeant-major could tell most psychiatrists a great deal about psychology which they have never heard in their lives, and a good minister of religion could also do much in this respect. After all, the Church has spent two thousand years in this work. There might easily be a considerable number of problems thrown up, well worth investigation by the more detailed work which a good working term could apply.
It has been said for a long time that war is too important a matter to be left to the generals. I think it might be said that psychology is too important a matter to be left to the psychiatrists. The time is ripe for this examination, because of the very important Report of the Committee presided over by Lord Percy.
We have the Russell Report for Scotland and also the Percy Report for England. Some of the recommendations involve legislation, but a great many of them do not. It is perfectly in order to discuss those on this occasion. Certainly, the research aspects do not involve legislation, and it would be well worth while spending a little time on them, because both the Percy Report and the previous Reports, including the Piercy Report on 463 rehabilitation, indicated that the local authorities would have to come back into this field. The whole question of rehabilitation raised by the Piercy Report goes outside the scope of the hospital boards, or at least a great deal of it, and a great deal of the recommendations of the Percy Committee also falls outside the actual field of administration of the hospital boards.
Incidentally, in passing, I am not at all sure that the hospital boards themselves do not require a bit of examination too, and bringing into the general run of the administrative machinery of this country. There are things being done about the Bruntsfield Hospital in Edinburgh, on which I do not wish to enlarge, but which it seems to me would be none the worse for a healthy breath of public opinion, expressed in the way in which we are all accustomed to have public opinion expressed, namely, an indication by the voter that he or she will not vote for us at the next election. We all know the stimulating effect which that has in making one look into the justice or injustice of the case.
I say that we are in fact practical psychologists, and that a great deal of our work is applied psychology. The psychiatrist knows little about psychology, compared with a number of people who are practising this art every day, and whose success or failure depends upon it.
The sort of opinion that Freud expounded about the Oedipus complex makes me ill. The Oedipus complex, he says, is at bottom an example of a man really wanting to kill his father and marry his mother. Oedipus spent his whole life in trying to avoid this fate, which came upon him by accident. The real point of the play is that it is a very good prehistoric "Whodunit," a detective story in which a man is detecting himself, one of the most astonishing situations in all detective stories, as anybody who reads good detective stories, as I do, knows quite well. This is a detective story, and not a psychological story at all.
I think that a great deal of Freud was pure, sheer unadulterated self-deception.
§ Mr. Elliot
I do not wish to use extreme words about Freud, and therefore 464 I will only use these very moderate remarks which I have made. If, however, we go to Jung, I think that here we have a man who did know something about psychology. As for Freud, I say, "Do not let anybody in this Committee try to kid me about Freud." I think that a great deal of Freud's views on psychology has been purely injurious.
§ Mr. Emrys Hughes
Surely, on reflection, the right hon. Gentleman will not dismiss Freud so easily as that?
§ Mr. Elliot
I would not dismiss him so easily. I would say some rather harsh things about Freud if I had the time, and I would make some bitter criticisms. I think I have let him off very lightly. These are the most moderate indications of a general attitude, which I would be very unwilling to enlarge upon. With Jung it is a different matter, but Freud—I will get on with the rest of my remarks.
We want a certain amount of objective work, as well as subjective work—objective work upon mental conditions which so far have been very difficult to interpret. The encephalograph work is not easy to interpret and a great deal of the data is such that people cannot so far understand it. There is a great deal of other work which has to be done, work for instance on the sugar metabolism of the brain, about which very little is known, even in the normal case. As I have remarked in previous debates on mental health, there is again the whole phenomenon of sleep in the case of the normal person. Very little is known about it, and practically nothing is known about that astonishing phenomenon from which we all suffer from time to time—the sudden onset of a most overpowering desire to sleep, which carries one away in spite of all our most vehement and vigorous efforts to the contrary. There are also all the different things that happen from slight modifications in the blood stream, the application of certain drugs, mescalin, and so on, which produce very interesting results. There is also the old-fashioned administration of whisky, which the hon. Member for South Ayrshire (Mr. Emrys Hughes)mentioned, which also occasionally produces some very remarkable results.
The right hon. Member for East Stirlingshire challenged us all in his 465 vivid approach to this whole subject. I will only respond by reminding him of the story of the man who was boasting in front of the fire at his club, and who said, "I have been everywhere, known everybody and seen everything." A wee man sitting at the back of the club said, "Have you ever had delirium tremens?" He said, "No." "Well," said the little man, "you have seen naught." This, of course, is an example of a kind of mental illness—a kind of lunacy. It can be induced, and it can be got rid of. There is a great deal about these conditions which is not known, let alone the deep questions of psychology which, indeed. I have no wish to discuss now.
Therefore, I say that the advance on the physical front is encouraging. Certain diseases are now being rooted out altogether, and these are good things to do, because they are increasing the area of strength and health in the national pattern, and not merely prolonging existence for its own sake. In certain other fields, very little has yet been done, more particularly in the field of mental health. One-third of all the hospital beds in Scotland receive no mention in this Report comparable to what is given to the other two-thirds. Even in the encouraging and interesting remarks of my right hon. Friend, they did not receive the same weight of attention, and certainly not the same encouraging hope for the future, as did the rest of his remarks.
I hope it will be possible for the Joint Under-Secretary to say something about these things when he winds up, and I close, because many other hon. Members wish to speak, by saying that when one doctor gets talking to another—the hon. Member for Greenock is to wind up for the Opposition—he is apt to say everything that he can think of. The hon. Member for Greenock is not only medically qualified, but several times in debating teams has succeeded with very encouraging results for himself and for the Union of Glasgow University, of which he was a distinguished President. We wish him well in his winding-up, and we hope that he will be able to continue on this extremely interesting note, which his right hon. Friend the Member for East Stirlingshire started and which my right hon. Friend the Secretary of State carried on so well.
§ 5.40 p.m.
§ Mr. Thomas Hubbard (Kirkcaldy Burghs)
We have listened with great interest to the right hon. Gentleman the Member for Kelvingrove (Mr. Walter Elliot). He is always very interesting on health matters—just as he was a very interesting companion in Nigeria—and we are all delighted to hear from him. Nevertheless, this is not a debate between doctor and doctor. Indeed, if there is any failing in this type of debate it is that there is not enough ordinary language used as between doctors and potential patients. It is all very well for colleagues who have been students in university unions and the like to use that terminology, but the person most affected is the patient, and I sometimes wish that doctors would use language that patients can understand.
In this connection I should like to compliment one speaker at the recent doctors' conference at Newcastle-upon-Tyne. He asked for the use of language that patients could understand. He spoke of the importance of the patient knowing what was wrong with him, and being told what was wrong with him in ordinary everyday language. He spoke of the need for patients to know their troubles so that they might live with them and not fear them.
If I were to make any suggestion at all to the medical profession it would be that its members should do a good deal more of that. I do not know the doctor personally—Dr. John H. Hunter, of London—but I do know that he suggested that half an hour's conversation between doctor and patient was sometimes worth a very great deal of medicine. I appreciate that it is necessary that doctors should have a language that is more or less international, but we should not completely disregard the patient. It will help a doctor if the patient really knows what is wrong with him.
The Report of the Scottish Health Department is a very interesting document, and one which would. I think, be a best seller if there was not so much medical terminology used in it which ordinary people cannot understand. Be that as it may, I found it fascinating. It records great successes with many killer diseases, but it is also a record of great failure in others. In total, it is a tremendous compliment to the National Health Service.
467 The subject of tuberculosis has, quite rightly, been very much explored this afternoon, and I do not intend to pursue it at great length. What I would say is that it is very noticeable that the diseases in which the incidence of the disease itself and the incidence of death is being reduced are, in the main, diseases which are notifiable. I think the reason is that the notifiable diseases offer opportunities for early diagnosis. That is one of the main factors in the success of the battle against tuberculosis. Mass radiography has disclosed the disease in the remedial stage. Previously, people did not know that they had it until it was almost too late to do anything.
In addition, there has been great progress in research work into the treatment of tuberculosis, and here I should like to recount an incident that happened to me in the Burgh of Buckhaven when the mass radiography mobile van was there. I was invited to say a few words of encouragement, and the Deputy Medical Officer of Health gave an explanation of the procedure and purpose, and outlined the advantages to be gained. But Provost Goodwillie of Buckhaven said, "Perhaps the best thing that I could do would he to be the first to go through the mobile X-ray unit and set an example." I followed him.
Later I was a little disturbed. The Deputy Medical Officer had explained that if an examination of the picture left any doubt, the person concerned would get a postcard asking him to come back for a further check. I got a postcard, and I was very surprised that the first man I saw was Provost Goodwillie of Buckhaven. We were both very relieved to learn that there had been something wrong with the apparatus. The relief was almost worth the visit. No praise can be too high for those engaged in that splendid work.
It is not merely the reduction in the death rate from tuberculosis that is so encouraging, but the fact that so many of those who have been victims have been able to return to work and natural life. That is of tremendous importance. I can think of nothing worse than a sufferer thinking he had no place in society.
I wish the picture of coronary heart complaints was as good. Unfortunately, coronary thrombosis is not a notifiable 468 disease, so its incidence is not known. We can get the figures of those who die from it, but because we have not got the history of those suffering from it, we are not able to deal with it quite as rapidly and effectively as we might otherwise be able to do. An attempt was made a few years ago to get the disease, if not compulsorily, at least voluntarily notifiable. A scheme was started by the County Medical Officer of Fife and one of his medical colleagues from Kilmarnock. I have no report as to how they got on, but such a scheme could not really be effective unless it covered the greater part of Scotland, or at least the industrial parts.
I am quite sure that it would be a tremendous advantage to research into coronary thrombosis if those carrying it out could get information about the sufferers, what treatment they received and how it worked. For instance, it would be very useful and helpful if the Secretary of State could get figures of those taking an anti-coagulant, and the methods of use. At one time, it was used only for those receiving treatment in hospital, but I understand that some victims of this disease are being given an anti-coagulant even though they are not in-patients.
Is it too early to expect any information as to the conclusion of this research? I hope that at some time in the future we shall be able to look at the reduced coronary thrombosis figures with the same pleasure as that with which we now regard the reduced incidence of tuberculosis. That cannot be done without a great effort. We need a departure from previous approaches—something, perhaps, on the lines of the approach to tuberculosis.
We have had sufficient evidence, I think, that smoking has a relationship to lung cancer. The importance of spreading that information has been very much emphasised but, unfortunately, the information that has been collected has been sent to the local authorities with the request that they should make it widely known. At a time when local authorities are being told to spend less money, the Government are asking them to spend money on this campaign.
Information about this is absolutely essential. I am, myself, a heavy smoker, and it would be helpful to me—and, I am sure, to other hon. Members who are heavy smokers—not merely to be told 469 that smoking is a contributory factor to lung cancer, but to know to what extent air pollution contributes to it. I should have been delighted if the Secretary of State had told us a little more of the attempts he is making to give us clean air.
It is within our knowledge that the incidence of lung cancer is higher in Dundee and Glasgow—industrial cities—than it is in Edinburgh and Aberdeen, that are not so highly industrialised. We know that lung cancer is much more in evidence in all industrial areas than it is in country districts. Agricultural workers suffer less than anyone from lung cancer. Therefore, I believe there is proof that there is a relationship between lung cancer and air pollution.
I suggest that the Secretary of State should look further into this question and tell us what he is doing to reduce the amount of air pollution. That is not an unknown science. It is known in the engineering world. Attempts to get rid of air pollution were even made in this House hundreds of years ago. Gadgets have been made to deal with fumes from motor cars. Recommendations have been made, but no further steps have been taken.
I am satisfied that the bulk of the people today, while they have a certain fear of lung cancer, would be much happier if the medical profession and the Secretary of State would investigate the connection between lung cancer and air pollution as compared with smoking. I might even stop smoking if I did not comfort myself with the belief that air pollution has a lot to do with lung cancer, and I am sure that there are many people like me. At any rate, I have lived a fairly long time smoking. I should not like to worry myself too much about stopping it, in case I killed myself by worrying.
There are other forms of cancer to consider. It is difficult to get an early diagnosis and, therefore, the disease progresses too far before it is dealt with by the medical profession. An early diagnosis is very important. However, we cannot deny that we are making tremendous strides in the treatment of cancer other than lung cancer, and the medical profession has done a great job. It is well known that the medical profession in this country is very modest. The last 470 thing that people in that profession wish to do is to sing their praises or to hear anybody else doing it.
The other day I came across a case to which I should like to refer in order to emphasise what can be done for cancer. I have the full authority of the victim to use the information to the fullest extent. The victim was a young, strong, healthy man living in St. Monance in Fife. His name is David Gerrard. Here is a man whose great courage must have been of great assistance to him. He went into hospital a young and healthy man, not knowing what was wrong with him, and never expecting to be there as a patient for five years. There was no question of early diagnosis. Ultimately it was disclosed that he had a tumour on the spine, and by the great skill of the surgeon—I believe he was a doctor at the Royal Infirmary, Edinburgh—the cancer was removed from that man's spine. It was deemed to have been a miracle operation.
It is perhaps a tribute to the medical profession that very little was said about the operation. The man, unfortunately and inevitably, was paralysed from the waist downwards. In fact, Mr. Gerrard has no feeling whatever in any region below his chest, except for one place. He has an ingrowing toenail on his right foot and, to quote Mr. Gerrard, it gives him hell. He requires chiropody, but he cannot have it because he is no longer in hospital. He spent five years in hospital and had many operations. If he could prove that he is in need he might get it through National Assistance. Communications have passed between this man and the Joint Under-Secretary of State.
Here is a man who had a miraculous cure, but when he came out of hospital and went to live at home he found that he required a special bed, and he had to pay for this himself. He sleeps on sixteen pillows and he has to pay for these himself. He required parallel bars to try to rehabilitate himself, and he had to pay for those. He even had to pay Purchase Tax. Had he opted to remain in hospital, had he not learned to live with his disease and tried to be happy with it, it would not have cost him anything. I am not attaching any blame to the Secretary of State. It is a weakness in the scheme. But it is regrettable in a case like this, 471 when a real attempt is being made at rehabilitation and when the victim displays such courage, that he should find himself with recurrent expense of this nature.
This man has been visited by many people, including eminent surgeons, from all over the world because of the nature of the disease and the cure. There have 'been eminent surgeons even from America. They express themselves as being surprised and shocked that this man should have to pay for certain services but, as I informed Mr. Gerrard, they need not be shocked for if that man had had the bad luck to be living in America he would have been dead. He is alive only because of the National Health Service in this country. Nobody in America except the most wealthy could afford hospital treatment for five years and the care and attention which Mr. Gerrard is forever praising.
It is a horrible thought, however, that while a man in hospital is allowed to get everything that he requires under the National Health Service when, as a result of a great effort, he returns home he has to pay a great deal of the costs of the articles which he requires. Mr. Gerrard is a living testimony to the National Health Service. He is a happy man. He has learned to live with his troubles. He has no complaints to make of any sort, except that he now has to pay for the treatment that he is getting at home.
I should like to refer to a matter which was mentioned by the Secretary of State, namely the aged and chronic sick. Far too many hospital beds are being used by that type of patient. One way to prevent aged people becoming chronic sick is to see that they get the right kind of food. There are more old people in hospital today than there have ever been since the end of the war. There is a lack of hospital beds, and there are many of these chronic sick occupying beds which were intended for remedial cases. That need not have happened, and I hope that the Under-Secetary will pay particular attention to this matter.
There have been improvements in the number of beds for the aged chronic sick, but they have in no way compared with the number of chronic sick people requiring hospital care. We know that in 472 great measure this is because these people have to eat filler foods and not proteins. But no matter how good a hospital may be, there is no place like home for these old folks. Every one of them who must have institutional care is a tragedy. Every old person who has led an active life, as these people have, would like to finish his days at his own fireside, but these old people require hospital care, just nursing care, in the main.
It so happens that we in Kirkcaldy and Fife are victims in this respect. I have fought a long battle with the Under-Secretary on this question of beds for the aged chronic sick. Recently, he gave me figures which show that the County of Fife has the lowest number of beds for this purpose in all Scotland. According to the figures I have, Fife County Council has only 47 such beds per 100,000 of the population, whereas in the North-East, for instance, there are 155 and in the Eastern area there are 165. This is doubly bad, because Fife County is an industrial area, a mining area, where there is already a shortage of beds. It is true that the new Victoria Hospital at Kirkcaldy, when it is open, will be of some assistance, but it is rather awful to think that when a hospital bed is required for remedial purposes, it cannot be used because the Department has failed to meet the needs of the aged chronic sick.
It is rather shocking also to think that some old people who require nursing care and must remain at home, despite the Health Service and the wonderful domiciliary nursing service we have got in Fife—I pay the greatest tribute to it—suffer in the last days of their lives bruised bodies because they cannot have proper care. This is the charge which the Secretary of State cannot evade. It is something which we ought not to tolerate. The local authorities, both county and burgh, have attempted to do something to remedy the problem, and they have asked to meet the Secretary of State to discuss the matter objectively. He has referred them to the regional hospital board. The regional hospital board is far too remote from old people and their needs. As I have said, they are a section of the community whose needs we must not disregard. Is it not a tragedy that many old people are today in mental institutions, which are the only places 473 where they can get beds? They are not there because they have become mentally defective but because they might do something dangerous to themselves, and they are receiving no nursing care at home.
There is still something needed in the service of the old. During the day, through the services of the National Health scheme and the work of local authorities and welfare departments, the valuable work of which I in no way wish to decry, something is done; but the very time when these aged people require comfort and somebody with them is during the long night hours. Some system must be devised whereby sufficient outside help is provided to see that they do not spend long and lonely nights.
The situation of old people at night is often tragic, and it is perhaps, something about which people who live near could do more. No matter how good the Health Service may be, there is always the personal touch, the good neighbour system, which should be added to it. I cannot stress too strongly that something should be done for the aged chronic sick to give them greater comforts at home, to keep them in their homes as long as possible, and to see that they are happy while there. When they must go away for nursing care, they should not have to occupy beds which ought to be used for remedial purposes. This is a task which could be dealt with and which would not be too expensive.
I have tried to offer helpful criticism. Good health is not something for this side of the Committee or the other; it is something for everyone, and its promotion is a common task. Each of us looks at that task from his own standpoint. No matter what the cost, we owe an obligation to society to ensure that we have a healthy country and a healthy people.
When we speak in terms of the money cost of the National Health Service, of course it is tremendous. The rise in the figures is alarming. However, when we put those things side by side with the benefits, when we consider the number of people alive today who would have been dead but for the National Health Service, the people who have been relieved of pain who would have continued in pain, the people now recovered, rehabilitated and back at work who would have remained incapacitated and a charge on the com- 474 munity, but for the National Health Service, when we consider the production of those who are able to return to industry, and the increase in hospitalisations, we realise that the money cost of the National Health Service is far outweighed by its real value to the whole community.
Whenever I see any sign of a retrograde move in the Service, it makes me very unhappy. The National Health Service is, after all, the envy of the whole world, and whenever inroads are made into it, when prescription charges are introduced, when suggestions are made that people should pay for medicine, or anything at all is done which might make even one person go without something he ought to have, that is a backward step. We in the House of Commons, having seen what we have of the work of this great experiment, should ensure that there are no backward steps. I compliment the Secretary of State on the Report this year and look for a better one next year.
§ 6.5 p.m.
§ Mr. John Mackie (Galloway)
I am glad to have the opportunity of addressing the Committee for a few minutes, and I am glad particularly to have the opportunity of following the hon. Member for Kirkcaldy Burghs (Mr. Hubbard)who has made such an interesting and, if I may say so, such a feeling speech, particularly in his concluding sentences. I am glad that the hon. Gentleman, when he began, said that this should not be a debate reserved only for the medical profession. He had in mind, of course, the very illuminating speech of my right hon. Friend the Member for Kelvingrove (Mr. Walter Elliot), and also the treat which the Committee will have later in the evening when the hon. Member for Greenock (Dr. Dickson Mabon), whom I congratulate on having found his way to the Opposition Front Bench this afternoon, comes to reply. We shall have had contributions from those two medical men, but, after all, I hope that the day is far distant when debates in the House of Commons are reserved merely for specialists in certain subjects when those subjects are debated. This great assembly is essentially an assembly of amateurs, as I am sure the right hon. Gentleman the Member for East Stirlingshire (Mr. Woodburn)will agree.
475 We are very grateful to the right hon. Member for East Stirlingshire, incidentally, for having given us the opportunity of discussing the Health Report for Scotland today. I listened with very great interest to a great deal of his speech. He will realise that a certain engagement I had elsewhere made it impossible for me to be present the whole time, but I did hear a great deal of what he said. He presented his case in an admirable way. I noticed that the hon. Member for South Ayrshire (Mr. Emrys Hughes)nodded in agreement when his hon. Friend the Member for Kirkcaldy said that health is not a subject which could possibly be debated in a party sense. It concerns us all. As my right hon. Friend the Member for Kelvingrove said, we are discussing the political capital of the people of Scotland——
§ Mr. Mackie
The physical health of the people—I am sorry.
The right hon. Member for East Stirlingshire devoted a considerable part of his speech, as one would expect, to the subject of tuberculosis. I am glad to gather from him that he is enthusiastic about the way in which that terrible complaint is being tackled in Scotland and about the way that its development and growth, thanks to medical skill and science, has been materially diminished. I was not quite so happy, however, when I heard him strike what sounded like a gloomy note—I hope I heard him accurately, and I shall be glad to give way if I misunderstood—when he appeared to suggest that the Government, by their policy, have been responsible for many children particularly in the City of Glasgow, going without school meals, which, so he said, was making possible an increase in the disease amongst the juvenile population of Scotland. That is a point with which I hope my hon. Friend the Joint Under-Secretary will deal when he replies. This is no party matter and we cannot afford to sit back and do nothing about it. I am referring, of course, to the question of school meals in Scotland generally and not particularly in the City of Glasgow.
§ The Joint Under-Secretary of State for Scotland (Mr. J. Nixon Browne)
My right hon. Friend the Secretary of State answered the right hon. Gentleman in his opening speech.
§ Mr. Mackie
That was when, unfortunately, I had to be absent. The right hon. Member for East Stirlingshire was gloomy about it. He gave us the picture from Charles Kingsley's lesser known work "Alton Locke" of the dressmakers of the East End of London coughing themselves to death with that terrible scourge of humanity and of the fine dresses that they were making for the debutantes and others in the West End of London by which the disease was passed on to those more fortunate and richer sections of the community. That is a terrible thought.
The right hon. Gentleman spoke about the days of laissez faire when we were exploiting the community. He will remember that that was largely in the days of Liberal Governments, when the party to which I belong was in a small minority. When Mr. Disraeli won what, in those days, was considered to be a sweeping victory—although it was by a majority of only 72, or 8 more than my party has at the moment—he was jeered at for his measures of social reform by the Left wing of the Opposition in those days.
§ Mr. Mackie
The hon. Member may shake his head as much as he likes, but if he goes to his history book "The Life of Disraeli," by Monypenny and Buckle, he will find that I have spoken the truth.
§ Mr. Emrys Hughes
The hon. Member is accusing the Left wing. Surely, it did not arrive here until 1892.
§ Mr. Mackie
I said the Left wing of those days. I regard the Left wing as having been started by Oliver Cromwell. I remind the hon. Member that that first very drastic Left wing experiment lasted only eleven years, after which the country was glad to fall back upon the previous regime. That, however, is only by way of parenthesis.
I was about to make one or two remarks on the Report concerning cancer and the alarm that we have all felt in recent weeks about the statistics published by the medical profession on the relationship of lung cancer to smoking. The right hon. Member for East Stirling-shire said that some people will go on willingly committing suicide and that 477 neither this nor any other Government could do much about it. That, of course, is the plain fact. None the less, everybody should be seriously alarmed by the figures which have been given on this important matter.
The hon. Member for Kirkcaldy Burghs asked about the relationship of air pollution to lung cancer and in doing so raised a valuable point. I do not know whether my hon. Friend the Joint Under-Secretary will be able to say anything about it this evening; I should think it unlikely. In any event, that is a point which any Government would do well to keep in mind.
There is one question which I should like to ask about this terrible disease. about which we know very little even now. As my right hon. Friend the Member for Kelvingrove said, cancer research is only in its infancy. The inquiry into the relationship between smoking and lung cancer was not charged with making recommendations, but it would be interesting to know the figures for lip and tongue cancer amongst smokers.
As a boy, I well remember the clay pipe being smoked, particularly by agricultural labourers, and the amount of lip and tongue cancer that was generally supposed to be connected with it. I am not at all certain that cigarette smoking also has not been productive of a good deal of cancer of the lip and tongue.
I read with interest the paragraph in the Report concerning dental health. In whatever other way the Report may be encouraging, it is certainly far from encouraging concerning dental health. To have the teeth in good condition is about as important a matter as anything else in the general health of the people. It is not with boastfulness, but with gratitude, that I say that I shall be sixty years of age if I live until 8th January next year and I still have all my teeth.
§ Mr. Mackie
I hope so. I hope that the hon. Member has not yet had his wisdom teeth extracted.
Too often in the past—it may still be the case—it has been a matter for pride among some sections of the community 478 to have all their teeth extracted early in life, sometimes at one go. It was said, "Why be bothered with continual face ache and toothache? Why not have a clean sweep all at once and get a set of dentures?" That is not the right attitude to adopt.
I am glad that the Report calls attention to the neglect on the part of parents in this direction. They are not imbuing their children with the necessity of keeping their teeth in good condition. The particular reason given in the Report for the bad state of teeth in so many children is the excessive eating of sweets. I have often heard that said in the past, and I suppose we must accept it as fact. I certainly would not be one to prevent the children's pleasure in that way—far from it—but more care should be taken. It might be advantageous to have some form of instruction in the schools and to impress upon the parents as well as the children the necessity of taking proper care of their teeth.
§ Mr. Emrys Hughes
The hon. Member is giving an interesting story of how he keeps his own teeth and I should like to know how he does it.
§ Mr. Mackie
By taking care always of my teeth and making regular visits to my dentist; but, as he has often told me, there are some people whose teeth are naturally weak. I happen to be among the smaller section of the community which is blessed with good teeth.
I have read the Report carefully, but can find no reference to the prevalent and dreadful disease of rheumatism. I am surprised and alarmed that nothing is said about it. We know quite well that it is not one of the diminishing diseases in the same way as the infectious diseases, of which so much is made in the Report. I happen to be a sufferer sometimes, and very much oftener than I like, from a certain branch of the rheumatic disease, and one for which the sufferer does not receive much sympathy and which is not rheumatism proper. I mean gout. The hon. Member for South Ayrshire laughs, but let him have it once and he will know that it is no laughing matter. After all, the Emperor Septimus Severus, when he was visiting the Roman Wall between Tyne and Solway, which we call Hadrian's Wall, suffered so badly from the gout that he had to be carried in a litter from Rome.
§ Mr. Mackie
I should be glad to know what it is because no medical man has been able to give me a cure or anything better than a palliative. The hon. Gentleman may have his own views about it, but I do not think he will get medical men to agree with him that he can prescribe a complete cure. The hon. Gentleman nods his head. He is perfectly entitled to his views, as all of us are, even though they may be erroneous.
I mention that only in passing, being a sufferer myself from that complaint. I am much more concerned with rheumatism proper as it affects very many people in Scotland and, indeed, throughout the world. I am sorry that nothing is said in the Report about it, because I cannot believe that this disease is at all on the decrease. Both the right hon. Member for East Stirlingshire and the hon. Member for Kirkcaldy Burghs mentioned coronary thrombosis, and let us not forget that rheumatism is very closely allied with heart trouble, as well the hon. Gentleman knows.
A great deal has been said about coronary thrombosis—heart failure it used to be called when I was a young man, or a seizure ending fatally. Now it has a more high-sounding name, which the hon. Gentleman rather dislikes, as he dislikes high-sounding medical terms in general. He said it ought to be made a notifiable disease. While I am all for preventing any disease or arresting its growth, I think that it would be rather difficult to make this a notifiable disease because it is not known that people have got it until they drop down dead.
§ Mr. Hubbard
Does the hon. Gentleman not agree that when a doctor diagnoses coronary thrombosis he ought to notify it? After all, he cannot notify measles unless he knows someone has got it.
§ Mr. Mackie
I am much obliged to the hon. Gentleman. I quite agree. He means that when people have heart attacks, seizures, or whatever we call them, and survive them and undergo treatment from their medical advisers, their medical advisers should notify the illness from which they are suffering. I agree with the hon. Gentleman that it 480 would be a good thing if possible to do something about making it notifiable.
§ Mr. Mackie
The hon. Gentleman is pleased to joke, but it really is not a laughing matter.
I have mentioned the two matters which I wanted to mention because, as I ventured to think, they had not been mentioned before in this debate. I was about to say, when I was interrupted, that generally the Report is encouraging. I think we would all agree about that. It is most heartening indeed that there has been this tremendous advance against infectious diseases, leading almost to their disappearance in Scotland. For that we are all thankful.
However, this Report should not make us inclined to rest upon our oars, so to speak, and we must continue to do everything we can for the good health of the people of Scotland. I feel sure that those who are at present in control—I say this without any reflection on their predecessors in office—of our destinies at the Scottish Office, and particularly in the Department of Health, have that task very much at heart, and I look forward with great interest to the reply of the Joint Under-Secretary of State. I hope that I am here to hear it.
§ 6.25 p.m.
§ Mrs. Jean Mann (Coatbridge and Airdrie)
I do not think anyone will blame you, Mr. Williams, if listening to this Scottish debate on Health you should feel a little apprehensive lest there should be a sort of competition in "Let me tell you about my operation." I have listened very carefully to the last two speeches. The hon. Member for Galloway (Mr. Mackie)told us about the state of his teeth. We all know the hon. Gentleman's teeth are perfectly good. We have nasty recollections of how often he got his teeth into us when he was on this side of the Chamber and we were on the benches opposite.
§ Mr. Mackie
As the hon. Lady has been kind enough to refer to me, she will permit me to observe that I know she is far too good a Parliamentarian herself to resent that in any way.
§ Mrs. Mann
Yes, indeed. I am talking metaphorically.
481 A challenge has been issued in this Committee and I am going to accept it—a challenge on smoking. My hon. Friend the Member for Kirkcaldy Burghs (Mr. Hubbard)knows, as we all know perfectly well, that the reports about smoking and cancer are accurate, that they have been made by men trained in analytical research. My hon. Friend used the defence mechanism, which has been used on both sides of the Committee, saying that it is the smoky atmosphere which causes lung cancer and that it can be said that the incidence of lung cancer is very much greater in smoke-laden towns than it is in the rural areas. My hon. Friend went on to say, "If you will prove otherwise I will give up smoking."
§ Mrs. Mann
I was just going to say that even after the case is proven my hon. Friend will not give up smoking.
The hon. Member for Galloway asked his hon. Friend to probe further into the matter. His hon. Friend need not do anything of the kind. The first reports were issued nearly three years ago. They are known as the Doll and Hill Reports. While it is true that the incidence of lung cancer is much heavier in the smoke-laden areas than in the rural areas, it is also true, as shown by examinations made by the doctors, that even in the smoke-laden areas there were eighteen times more deaths among those who smoked within the smoke-laden areas than amongst those who did not smoke in those areas.
§ Mr. Hubbard
Will the evidence of the effects of smoking on lung cancer stop my hon. Friend herself from smoking?
§ Mrs. Mann
I am coming to that. I will make no pledges. All I can say is that I have given up smoking time and time again.
The evidence is all there for my hon. Friend. It is absolutely conclusive, and no man should have any doubt what-ever. The warning is there, but my hon Friend will not give up smoking. Like myself, he may give it up time and again, 482 but the reason why he will not give it up altogether is that nicotine is a drug. He is a drug addict, like me. That should be emphasised to our children. They should be told that if they start smoking they start on a drug-taking habit which they will find more and more difficult to break according to their intake of the drug. That is a very simple instruction which has been given by my sons to their sons. I might say in proof that these sons of mine tell me that although they stopped smoking when the first Doll and Hill Report was issued almost three years ago they still feel that strong inclination to light up. It comes to them even three years afterwards. Let us warn our children and our grandchildren that cigarette smoking is drug taking.
Secondly, we ought to stop the habit of passing the cigarettes round. It ought to be an offence to pass a cigarette to another. By doing so, one is not only helping people to drug themselves, but one is helping to speed them to cancer. I know that it is very friendly and sociable to pass cigarettes round. It encourages people to get together. It breaks down reserve, and I shall be very sorry to see the custom go. I know young women do not want to start smoking, but young men pass them a cigarette. These girls have said to me, "It looks so snobbish and so unsociable to say I do not smoke'." A young man feels snubbed when a cigarette is refused. Therefore, in order to make sociability smooth, the girls accept the cigarettes.
I wish that these generous people—and they are generous in passing a cigarette case round—would feel, as I do, that this drug that got me should not go any further. I would never pass my cigarette case round, and I hope that its contents will get less and less until I do not even carry one about with me at all. I did not mean to speak on this subject, but it has been running through the debate, and perhaps it is a very good thing that it has.
I want to talk about the greatest single cause of death in Britain and that is accidents in the home. It is two years since the Joint Under-Secretary of State for Scotland told me that he would take active steps to do something about it. I am very appreciative tonight of the positive steps that he has taken. Indeed, I 483 think that the memorandum which he issued to local authorities did not receive the publicity that it deserved. It is an exceedingly good document. In it the hon. Gentleman advises local authorities to set up their own home safety committees and he tells them that they can get money to help them to do so. It does not provide for complete notification of accidents, but the memorandum is helpful in that the hon. Gentleman suggests that the registrar should communicate figures to the medical officers of health and that the hospitals should also take note of their accident cases.
What a revolutionary change has occurred. Only a few years ago one of the Joint Under-Secretary's predecessors sent out a letter to the local authorities telling them that the setting up of a home safety committee should be left to voluntary labour. Now this memorandum deals with Exchequer grants that are available, financial assistance for local home safety committees and other actions which the Minister suggests should be taken. The document goes a very long way indeed. The hon. Gentleman has gone as far as he can. He has passed the ball now to the others. One wonders just how far the others will respond, to help mothers in the home.
I may be wrong, but I have the impression that anything that affects the home and the mothers is last in the queue in the House of Commons. The mothers are not an organised pressure group. A report on moral and Christian hygiene, issued a few days ago, shows that there is more malnutrition among mothers and young children, where there are three or more in the family, than there is among old-age pensioners. We all know also about the treatment meted out to widows, and they are not organised into a pressure group.
Although I have praised the Report of the Department fo Health for Scotland, I cannot feel that we can be altogether content with it. Why is it that we have the "Mind that Child" propaganda in schools only in connection with children leaving school and crossing the road? The hour after the child has left school and has arrived at its own fireside is that in which most home accidents take place. The tea-hour at home is the most dangerous. Why not have "Mind that 484 Child" propaganda in school in relation to the toddler, the little brother who pulls the pot off the cooker or the teapot off the table at tea-time, and the little sister who catches her nightdress in the flames of the unguarded fire? If school children were taught a few simple lessons on home safety we should greatly reduce what is now a terrible death rate.
I am grateful that accidents in the home have been singled out for comment three or four times in the Report. This is very different from the practice two or three years ago when there was no mention at all in the Report of deaths as a result of accidents in the home. The present Report states that:In 1955, 192 infants lost their lives by accidents, mostly by reason of some form of suffocation—either from inhalation and ingestion of food or accidental mechanical suffocation in bed. On the other hand, the total number of deaths in infants from tuberculosis and all other infectious diseases (excluding pneumonia)was only 35.In my opinion the next move must come from the local authorities. Guidance to those local authorities must come from the medical officer of health. Doctors choose their vocations. There are those who want to be consultants, there are those who want to be physicians, there are those who want to go into general practice. There are also those who say that they want good hours from ten to five and will therefore study for their D.P.H., and at five o'clock the door is locked. That is true of some of them, but not of all. We owe a great deal to the fine medical officers of health, particularly in Glasgow and Edinburgh, who take more than a nine to five o'clock view of the noble profession they serve.
I can think of two. One in Edinburgh, who, faced with an abnormal increase in the figures for infant suffocation, immediately started a publicity campaign to bring them down. I hope he is meeting with the success he deserves. There are those like Dr. Nesbit of Kilmarnock and Dr. Tough of Glasgow and Dr. Wallace of Edinburgh who have been beacon lights in this campaign.
I hope that the publicity of Dr. Seiler will draw the attention of the young mother to the danger of leaving the feeding bottle propped up on the pillow, and to the danger of not nursing a baby for twenty minutes after the feed has finished. It may be that in this age of hurry the 485 mother has too much to do, and that such accidents may be due to the advent of the mother going out to work. We cannot say what is the cause, but we know of doctors who draw attention to it and who set up home safety committees.
There is another medical officer who, when the rate of accidents in his local authority went up to the highest in Scotland, did nothing about it. Indeed, he seemed to think it rather reprehensible and that we should not say anything about it. That is an entirely wrong attitude, and that local authority certainly requires a home safety committee.
I hope, therefore, that the work begun will go on, and that we shall have education in the schools. As well as giving instruction to health visitors, the home helps should be instructed, because if an examination is made of home accidents it will be found that the greatest number is due to fails by elderly people, and it is the home helps who are in touch with the elderly people in their homes. I am also astonished that every time I ask a question about the incidence of deaths from falls, the official reply always gives institutions and homes, so there must be a high incidence of falls in institutions. The other day I asked what was the percentage and so far I have not had it, but it would be interesting to know, because I have always had a horrid suspicion and hatred of the highly polished hospital floor.
I am wondering if that contributes to the number of falls and to the death rate from them in institutions. Why should there be a death rate from falls inside a hospital or institution? Many of us who, on visiting or other days, go into the ward, have the greatest possible difficulty in keeping our feet, although we are fit and well. How can it be easy for people who are ill, or who are rising for the first time, to take a short walk down the ward? It must contribute tremendously to their discomfort. I must seriously ask as a housewife, "What is the value of very high polish?" Personally, I do not know. When this is done in my home in my absence, as it often is. I take steps to stop it, particularly where there are rugs and there is an added danger of sliding.
I want now to express concern about the infant mortality rate which I think is still too high. Indeed, it is 3 per cent. 486 higher than it was in Welwyn Garden City ten years ago, so we cannot rest content until we get it down. I am also perturbed about the lack of accommodation in Lanarkshire, in Bellshill Maternity Hospital especially, which has had a lot of unwelcome publicity of late. I am sorry if either the matron or staff feel that this publicity cast any reflection on them. It could not have done to anybody who knows the conditions revealed in the letter which I hold in my hand from the Secretary of State, from St. Andrew's House. Anyone who knows the difficulties under which they are working can have nothing but sympathy and praise for their valiant efforts.
Although this one letter to me reveals an amazing state of affairs, may I say that I have had many letters in which the patients expressed gratitude for what was done for them in that maternity hospital. It has a long and noble record of service, but it is labouring under particularly difficult conditions at the moment—eleven confinements in a theatre equipped for five. Just think what it must mean to the women and the doctors in that theatre.
If the new hospital could be ready next year, I would not feel so concerned, but I am told by the Secretary of State that it is likely to be completed in 1960 or 1961, so something ought to be done now. Four years is too far away. and, as far as I know, in my constituency the babies are coming along in orderly progression. There is a great love of children in my constituency and we have an exceptionally high birth rate. So I do not think we can be complacent until 1960 or 1961. A good deal of the theatre equipment could be bought in advance, and, as regards the situation revealed in May about linen, there is no excuse for being short of linen. Even the merest teen-ager in my constituency starts with her bottom drawer in anticipation, in hope deferred, as all maiden ladies do, even though the man never comes along. If these hospitals are not coming along until 1961 they could start a linen chest now and provide the theatre equipment, and they could, perhaps, find some place in Lanarkshire which would take some of the surplus cases.
My final word is again one of congratulation. It is in regard to the specialist service in Scotland. We have heard much about paying for beds and about 487 people having to engage a specialist privately in order to get a bed quickly. How exaggerated that is. What a great degree of exaggeration there is when one reads that during the year there were 34,963 visits by specialists to patients' homes compared with 32,242 in 1955. I have seen specialists come into homes. I have heard doctors phone for them. When a general practitioner is in the slightest doubt, all he has to do is to pick up the phone and call for a specialist. If the speacialist finds that what appeared to be a stomach pain is really a threatening appendix he can phone to the hospital for the theatre to be made ready immediately. An ambulance is brought and the patient is taken to hospital. I have seen that procedure carried out day in and day out by general practitioners.
This is a great service indeed, and I am very scornful when I read that someone had to pay a specialist an extra fee in order to get a private bed. I think that that serves such people right. If the patient had asked the doctor to call a specialist, he would very soon have done so and if the case were urgent within an hour that patient would have been on the way to hospital. There is no case of paying a fee; none whatever. Patients in Glasgow can have a doctor and a specialist without the payment of any fees. The State medical service gives the specialist a domiciliary fee which is, I think, four guineas. The specialists fee is paid in the same way as the doctors salary is paid. Therefore, I hope that note will be taken of what I have said about this nonsensical, exaggerated talk of a patient having to call in a specialist in order to get a bed. I think that these are very great services indeed. I do not think that we boost them enough. The Scots are always inclined to be critical and I hope that tonight I have not been too critical.
§ 6.55 p.m.
§ Mr. Patrick Maitland (Lanark)
I should like to take up one point made by the hon. Lady the Member for Coat-bridge and Airdrie (Mrs. Mann)about the shortage of maternity accommodation at Bellshill. I wonder if the Joint Under-Secretary would take note of what I am saying. At least up till a year ago there were empty wards in Hairmyres Hospital which is also in Lanarkshire. That is a hospital which in the past has 488 concentrated on T.B. cases. There are, I believe, actually empty wards in that hospital and it might well be that as a temporary measure provision could be made there for maternity cases.
The hon. Lady and also the hon. Gentleman the Member for Kirkcaldy Burghs (Mr. Hubbard)confessed to great difficulty about giving up smoking. The hon. Lady mentioned that she had tried to give it up over and over again. I was reminded of my misspent youth, now too far away. I think that it might be worth while mentioning to them and others the resort to which I was driven having tried to give up smoking so many times, having given it up and then having fallen again when offered a cigarette at a party. I waited until my holiday and then turned from cigarettes to a pipe, as, no doubt, the hon. Lady could do. I then bought herbal tobacco which I gradually mixed with ordinary tobacco. The herbal tobacco tastes dreadful—rather like burnt grass or the tea leaves one smoked at school. I proceeded to mix more and more of the herbal tobacco with ordinary tobacco until I felt that it was not worth smoking at all—the pipe dropped away altogether and I was freed of that scourge.
I hope that my words will carry to the hon. Member for Kirkcaldy Burghs, whom we were glad to hear talking so robustly today and whom we hope will be with us for many years. He also alluded to the problem of the chronic sick to which I should like to make brief reference.
One of the problems of the chronic sick is the lack of assistance in the sort of family units in which people live nowadays. That is what makes it necessary for them so often to be cared for in institutions. I should like to draw particular attention to the very valuable contribution made in this regard outside the Health Service by the most devoted work of the Sisters of the Society of St. Vincent de Paul, who conduct the Roman Catholic Hospital of Saint Mary's, Lanark. Theirs is completely devoted and voluntary service, and they care for a considerable number of the chronic sick. When speaking on this subject I think that it is well to bear in mind that there is activity outside the National Health Service by these very devoted sisters and nurses, highly qualified, whose work is so often taken for granted.
489 When the hon. Member for Kirkcaldy Burghs announced that he was going to talk the language of sound common sense. I was somewhat relieved, after the discourse which we had had from my right hon. Friend the Member for Kelvingrove (Mr. Walter Elliot), one of the most famous if not also notorious sons of Lanark since William Wallace. I hoped that in addition to telling us his views about Freud and Jung, he would also give us his views on Groddck, and his theory of the "IT" and the "UNC".
The hon Lady the Member for Lanarkshire, North (Miss Herbison)made reference to Law Hospital. I should like to endorse what she said about it, with particular reference to the mining disease, pneumoconiosis. While I am speaking of local hospitals, do we not often take for granted the entirely voluntary service of the members of hospital hoards who devote so much time and trouble to what must be tiresome work? They get no physical reward and they are open to criticism and are frequently the targets of misunderstanding. I am thinking, among others, of the board which deals with Hairmyres Hospital. On one occasion an ill-considered word of mine arising out of a misunderstanding caused concern in that quarter, but I am glad that the matter was later rectified.
The right hon. Member for East Stirlingshire (Mr. Woodburn), in the overall global picture with which he opened the debate in his traditional style, a style we all appreciate—I do at any rate—alluded to T.B. Surely the progress Scotland has made in housing has a very important bearing—among other factors—on the progress which the nation has made in T.B. Carrying to their logical conclusion the thoughts implicit in some of the words of my hon. Friend the Member for Galloway (Mr. Mackie), who said that if one's teeth were all right one was sound in wind and limb, I should like to add, apropos of housing, that we cannot rest content until the lavatory accommodation of our people is not a source of disease and a cause of the spreading of, particularly, diseases of the colon.
On that subject, one is sometimes a little anxious at the provisions for sewage disposal. I have in mind the Crossford 490 scheme which will be coming before the Secretary of State in his quasi-judicial capacity, and about which he cannot, therefore, make any comment. If in planning a sewage disposal scheme one has a choice between a system which works by gravity and a system which makes use of pumping machinery, surely the preference will be for gravity because, at least, it will not go wrong?
My main remarks will be addressed to a totally different aspect of our affairs, one which is normally thought to be unmentionable, which is certainly very disagreeable, but which we have to face. I allude to venereal disease. There was no reference to this by the Secretary of State, and there is only very brief reference to it in the Report. It was alluded to indirectly, I thought, by the right hon. Member for East Stirlingshire.
The incidence of these cases is interesting in that Scotland is not as badly off as England and Wales. In England and Wales 95,000 or 100,000 cases are notified in the course of a year, which represents about two per thousand of population. In Scotland the total registered at December, 1955, was 4,500. That is out of a population of 5 million, and it represents about one per thousand of population; so the comparison is favourable to Scotland.
Moreover, at the end of 1955, so this year's Report shows, there was actually a reduction in the number of cases on the register in Scotland—by the end of the year—of 263, out of 4,800, representing roughly 5 per cent. That reduction in a year seems to be highly commendable and something which is certainly worthy of note in the Report. But there is no need whatsoever for complacency in this regard. Of the 4,800 on the register in Scotland in January, 1955, about 2,500 were males, and of those more than half defaulted either during the period of treatment or before treatment and the final test had been concluded. That is very serious. Is it a matter which we can just leave to be dug out of the columns of statistics? is it not worthy of comment in the body of the Report?
I do not know what can be done. One of the problems of this range of diseases is that it is exceedingly difficult to persuade people to admit that they suffer from them, and, therefore, to expose themselves to treatment. But at least, once treatment has begun, one 491 would have thought that it would be possible by way of propaganda, if we do not use the word "persuasion", to drive home to the victims of these terrible diseases that, having got that far, it is worth while being properly cured.
I now come to age distribution. I am quoting from a different set of statistics, though they come from the same Report. I suppose the totals relate to slightly different periods. Out of nearly 5,000 cases of males, 1,600 related to men over 35, which is about 40 per cent.; 1,900 related to men between 25 and 34, which is rather more than 30 per cent.; and 1,400 related to young men between 15 and 24. In other words nearly 30 per cent. of these cases begin between 15 and 24.
However, let us consider the statistics for the women, which are even more alarming. Of 1,160 cases of women set out in the tables attached to the Report, 330 relate to women over 35 and practically the same number to women between 25 and 34, but 467 cases, more than 45 per cent. relate to women between 15 and 24. Thus, nearly half the venereal disease cases notified by women begin between the ages of 15 and 24.
Surely this is a matter about which some educational programme in the schools should be possible. Just as the church has rightly concentrated our gaze on heaven but scares the wits out of us about hell, so I believe the emotion of fear is the one on which we can most hopefully play. Boys and girls in schools should have dinned into them by every possible means, particularly by such visual aids as films alluded to by the right hon. Member for East Stirlingshire, the hideous consequences and dangers of these diseases. If it is dinned into children at school, it may conceivably last some of them during the period which is shown by the statistics to be of the greatest danger and which we know from our knowledge of life to be the age between 15 and 24.
I am reminded in that connection of a storey told me the other day by a former Member of Parliament, Sir Richard Acland. I cannot imagine that there is any reason why it should he kept secret. He was describing the school where he now teaches. One of his jobs is to take charge of the current affairs sessions in that school. He said that he had never 492 had such a success with the lads as when he scared the life out of them about cancer. In a current affairs session he described the House of Commons statement on cancer and smoking. He said that he got them really frightened and thought that that was worth while. Is not it possible to consider ways and means of frightening our young people about venereal disease?
It would be helpful, if we are to consider the subject in future, to have slightly more complete figures in the Scottish Report. The Report of the Ministry of Health for England and Wales distinguishes congenital from acquired syphilis. That distinction is not brought out in the figures for Scotland and it would be helpful if it was. The Scottish Report dismisses this subject in a paragraph. I hope that next year it will be recognised to be worth a good deal more than that.
There has been an illusion to the problems of mental illness. How readily we take for granted the work which is done in institutions like the Birkwood Home at Lesmahagow, the home at Larbert and St. Charles' Homes at Carstairs where patients are looked after by devoted sisters of another Roman Catholic order.
On behalf of myself and one or two of my constituents, I want to express heartfelt gratitude to the Scottish Office and to the Joint Under-Secretary who has the care of these matters and to his staff all the way down the line who have been so ready so quickly to look thoroughly into cases of urgency. Only a few weeks ago I received a letter which practically sent me into tears. I was able to speak to an official of the Scottish Office who was attending the Scottish Grand Committee and within half an hour of my getting the letter a note was teleprinted to Edinburgh and within two or three days critical action had been taken about a very urgent and tragic case.
I am sure that the parents would approve of my saying that I am tremendously grateful and that I hope that the Scottish Office, the Secretary of State, the Joint Under-Secretary and all the staff will realise how tremendously we appreciate this attention to a harrowing and difficult case which was given so promptly without any thought of the fatigue of the officials and others engaged in this work.
493 In considering this subject, let us not forget that, although we have a great State Service, there are also people who make the wheels go round by their voluntary devotion. I refer not only to doctors in the Health Service, who slog, some times more than anyone can ever require an employee to slog, but also to the nurses, the voluntary people who serve on hospital boards, the nuns and sisters in Roman Catholic hospitals about whom nobody ever seems to bother. I should again like to thank the nameless, anonymous members of the Secretary of State's own staff from the top right down to the lowest.
§ 7.15 p.m.
§ Mr. William Hamilton (Fife, West)
I am glad that the hon. Member for Lanark (Mr. Patrick Maitland)referred to the voluntary work now being done in the Health Service. It was felt when the Health Service was introduced that it would destroy the incentive to do voluntary work. That was one of the arguments produced by those who opposed the introduction of the Service. The facts have scarcely borne out that contention, and I, too, pay a sincere tribute to the invaluable work which those people are doing.
I make one possibly trifling criticism about the physical form of the Report. I have in my hand the Report for 1955 and that for 1956. The latter has been stripped of its back. I could scarcely believe my eyes when I got my copy from the Vote Office. I went for another thinking that the back had been torn off. I hope that this is not a precursor of an economy campaign in the Health Service.
I want first to raise a matter concerning the County of Fife. An X-ray consultant is desperately needed in Fife at the moment. We had a part-time consultant who left, and apparently the Department will not agree to a replacement. My information is that the Department is trying to get Fife to agree to share a consultant with Dundee. But I understand that the consultant at Dundee admits that it is impossible for him to undertake the two jobs together.
General practitioners in Fife are greatly concerned about the position. I have said before that in developing 494 mining areas on the periphery of the regions we are getting a little tired of seeing the best of the medical profession creamed off and staying in Edinburgh at the expense of areas which are more important to the national economy than Edinburgh is. My hon. Friend the Member for Edinburgh. Leith (Mr. Hoy)may question that statement, but I maintain that the developing mining areas which are important to the national economy should have some of the medical ability now being concentrated to an unfair degree in Edinburgh. I hope that the Joint Under-Secretary, if he cannot reply about that matter tonight, will send a reply in writing—and it had better be favourable, or we shall take other steps to see what can be done about it.
The right hon. Gentleman the Member for Kelvingrove (Mr. Walter Elliot)and the hon. Member for Lanark referred to mental health. In the United Kingdom in the last twelve months there has been a great campaign to focus attention on what is an extremely serious problem in the United Kingdom as a whole. We have had a massive report which, on the whole, has been well received. In Scotland we are tending to be pushed out of the picture in this respect. I have looked through the last four or five annual Reports on Health in Scotland, and I have found that extremely scanty information on this aspect of the Health Service is given.
I understand that position is to be improved and that we shall get more statistics on this matter, possibly in next year's Report. In the last four or five years, not more than two or three pages have been devoted to mental health in Reports averaging 150 pages. With one-third of the hospital beds taken up with mental illness—as the hon. Member for Kelvingrove observed—to dismiss mental health in two or three pages in a report of that size is to treat it with less than the importance it merits.
Such information as one gets does not make pleasant reading. The Reports for 1953, 1954 and 1955 all refer to shortage of accommodation. It is true that this Report gives us a little more hope, particularly now that we seem to be mastering the problem of tuberculosis. Reference is made, I think in a hopeful strain, to the prospect of utilising some 495 beds for mental illnesses of one kind and another which were formerly used for tuberculosis patients. I should like more information about what extent beds which have been used for T.B. cases are now being used for cases of mental illness.
As is stated in the Annual Report of the General Board of Control, the accommodation problem is still very far from being solved as regards mental health. But even assuming it was solved, the staffing difficulties remain quite acute. The total number of admissions to mental hospitals has more than doubled sinuce 1945 and the end of the war. I wonder whether the numbers of staff has kept up with that increase; if not, it means that an additional burden is being thrown upon the existing staff.
The right hon. Member for Kelvingrove—he practically runs the Scottish Office, because what he says is law in the Scottish Office, or very nearly—made reference to the lack of research and drive in tackling this vitally important question. We see from the Report that some research is being done into the treatment of people suffering from mental illness. The stigma which used to attach to mental illness is disappearing. To use an Irishism, people are "less backward in coming forward" when there is evidence of this disease. I join with the right hon. Gentleman in hoping that the Scottish Office will not fail to press on with this extremely important work.
I wish to say a word about the problem of mental defectives, and here there is a seamy side to the picture. I should like to thank the hon. Gentleman for the copy of the Report of the Welfare Needs of Mentally Handicapped Persons which he sent to me. The Report contains some extremely disturbing revelations. For instance, we find that the ascertainment of the total number of mentally defective children in Scotland is incomplete. We do not know how many mentally defective children there are in Scotland.
The Committee was given evidence from representatives of the Central Youth Employment Executive which indicated that 40 per cent. of the disabled young persons with whom the Executive's officers dealt were mentally handicapped. That is a colossal figure. The number of adult mental defectives also is unknown. I 496 join with the Committee in urging the Government to impress on local authorities, health authorities and education authorities, the importance of ascertaining the numbers of mentally defective children and adults.
More publicity should be given to the provisions available for the cure of the mentally ill. There is also the necessity for more special schools for mentally defective children. A shortage of these schools means that mentally defective children must attend the ordinary schools. Anybody who has had experience of teaching, or who has mixed with school children, knows that there is no more cruel being in the world than a healthy school child. If they have a mentally defective child among them, they ridicule that child and behave in a most cruel manner. The parents of such a child, and the child, go through absolute hell under those circumstances.
The hon. Member for Galloway (Mr. Mackie)referred in an amusing manner to the problem of dentistry. The Report makes mention of the McNair Committee Report, published last October, on the long-term prospects of recruiting in the profession. While it is true that both the intake of new students and the output of qualified dentists have shown signs of increasing in the last two or three years, there is no ground for complacency. The McNair Committee said replenishment was not the most important problem; in the United Kingdom Report it says that half the dentists on the dentists' register are already over middle-age and that the testing time for dentistry will come in the next ten years when, presumably, most of those people will have retired.
The shortage of dentists in Scotland is acute. It is a national problem. According to the McNair Committee, the estimated need in Scotland for the school dental service is between 280 and 360. At the end of 1956 there were only 169. In other words, judged by the lowest estimate of the Committee, we are more than 100 dentists short. If I may revert for a moment to the local position, the 1956 Report of the Fife County Council comments on the loss of three dentists and states that despite continual advertisements for dentists, it could not fill any of these vacancies.
497 One of the reasons for this problem is the comparative indifference of most people to the importance of dental health. Examining their ratio between the population figure and the number of dentists, we find these revealing figures which are given in the McNair Report. In Canada, the proportion is one dentist per 2,790 of the population. In Sweden, it is one per 2,271; in Norway, one per 2,000; in the United States one per 1,667, and in Great Britain one per 3,273. The Scottish figure is not given in the Report, but I have taken the population figure for Scotland for December, 1956, which appears in the Digest of Scottish Statistics as 5,147,000. I have taken the number of dentists as 1,400, which is given in the latest Report, and that works about at one dentist per 3,676. In other words, Scotland is "at the bottom of the league." We must overcome that by embarking upon a great educational campaign to show the importance of dental health to the individual and to the community. We also need a recruitment campaign for this vital and honourable profession.
I emphasise the point made by the McNair Committee of bringing women and girls to take up the profession of dentistry. From the figures in the Report, it is clear that women dentists and students are not nearly as numerous here as they are in other countries. The Report gives comparisons with Norway, Sweden, Denmark and Finland, where the percentage of women dentists is anything from 30 to 75. The only facts that we have for this country suggest that our figure is not more than 10 per cent., which is somewhat disturbing.
There are great advantages in having women dentists—or perhaps I should call them lady dentists. The McNair Report states that when it was suggested to school girls that they should take up this profession one of the objections was that they had not the physical strength. That is an entirely erroneous idea. A dentist very often needs a gentle touch, not a touch like the kick of a mule. One of the advantages of women is that they have more charm and guile than men. They have also a gift for handling children. Two of my children are going to the dentist's, and I think the method of handling them is just as important as 498 what happens to their teeth. The psychological aspect matters.
The gifts that women have are great assets in the nursing profession, and would be so in dentistry. I would remind my hon. Friend the Member for Greenock (Dr. Dickson Mabon)who, I understand, is to wind up the debate for the Opposition, that nothing would encourage visits to a dentist more than to have a sweet young blonde working for us there. From that point of view, it is desirable in the interests of the community and its dental health to have more female dentists.
The Government must soon give us the results of their examination of the recommendations of the McNair Report. I could go on at length commenting upon it. There is nothing to get alarmed about. There are black patches and white patches and also rather spotty patches in it. The battle for health is like weeding the garden; it must be waged continuously on many fronts. It goes on and on, and once we have finished one patch we have to turn to another.
On this side of the Committee we have always regarded the National Health Service as a social service, and we are glad that Government supporters recognise it as such. We hope that they will do nothing more to undermine that essential feature of it. My hon. Friend the Member for Hamilton (Mr. T. Fraser)was in America some while ago. I have had an interesting talk with him about the American attitude to what they call our "socialised medicine," their term of denigration. They have their socialised Army, Navy and Air Force, but they do not think of them in the same way as they think of our socialised medical service. We are proud of our socialised medical service, which is the main cause of the healthy report that we have before us today. We shall certainly give to any Government in power the backing that they ought to have if they regard this Service as a social service.
§ 7.35 p.m.
§ Mr. J. C. George (Glasgow, Pollok)
I listened with great pleasure to the recitation by right hon. Gentlemen on both sides of the Committee, and by other hon. Gentlemen later, of this great saga of success in the medical field. When one reads the reports of what has 499 happened in recent years, it is a mystifying tale of tremendous success. In the days when education was not widespread, anyone who had performed these great changes and brought about these successes would have been termed a miracle worker. We have seen diphtheria, tuberculosis and other diseases go in recent years, and as the years go along we shall no doubt see further progress made in lifting from the bodies of men and women the toll of disease. It was right that my right hon. Friend the Secretary of State for Scotland should pay tribute, as he did in a most dignified way, to all who are engaged in the health service of the country.
One class of helper in this field has not received from my right hon. Friend or from any other hon. Member who has contributed to the debate, the commendation which they merit for the great work they are doing. I refer to the old people's welfare committees of Scotland. They are a great and growing body of voluntary workers who, in their own districts, dedicate part of their lives to relieving the loneliness of old people and thus preventing illness among them. We must not under-estimate the benefits to the health of the nation that can accrue from such work. I have seen it in operation in my own area for years and have seen the benefits that have come from it. There is no more rewarding task for a man or woman than to give service among the old people. The work is growing, the benefits are growing; the work is spreading, and the benefits are spreading.
In most areas spasmodic work was done for the old people, with a party here or a concert there. Later, a combination of all these organisations was brought about. Now there is one over-all committee, which makes things possible which otherwise were impossible. I have seen clubs grow up and an ever-widening range of things for the old people to do to combat the great loneliness to which they are subject in these days of abundant opportunities for entertainment.
Perhaps some of our old people's welfare committees concentrate too much on serving those who are fit to come out and enjoy what is provided for them in the clubs which are islands of rest in the sea of speed in which we move today. It is a great joy to see old people meeting. 500 I remember what pleasure it gave me to see two women meet for the first time in 30 years, weeping for the joy which it gave them. The old people can now meet week after week and break their former schedules of monotony and depression which come from spending long days alone in their own homes.
A great deal of help can be given to the medical profession by reducing the demands that the aged make upon their services. It is easy to give money if one can afford to do so, and it is good to give it, but it is ever so much better to give work and time. In our small area we have managed to find between 40 and 50 visitors, each of whom will take charge of two or three old people, visit them once or twice a month and spend an hour or two with them. I remember how touched I was when one visitor reported that when he knocked on the door of one of the houses and was admitted the woman said that it was the first time in two years that anyone had crossed her threshold.
There is loneliness in our midst which does not need Government help to be overcome. It could be overcome by a spreading of that community spirit which is doing great work today. Let us acknowledge that work and say how grateful we are for it. Perhaps that will give it the impetus to carry on and to spread—and it is remarkable how things are carried on. In the area from which I came, we started a very ambitious scheme which needed a lot of money. We appealed to the people in the town and in the county. We got a ready response, but to keep such a place going year after year is difficult.
We were able to organise that scheme—including chiropody, meals on wheels and all the rest, contained in a lovely house in its own grounds—only because we got great and ready assistance from the town council and amazing help from the trade unions. The trade unions got their members to make contributions of up to 6d. a week, which gave an assured income of £700 a year to keep the place going. Voluntary work can play a great part in cutting down the need for medical attention, because we know that the physical and mental effects of loneliness can make people prematurely in need of the doctor's attention.
We have heard of the progress being made in the care of the chronic sick. 501 The hon. Member for Kirkcaldy Burghs (Mr. Hubbard)said that a thousand more beds have been provided for these people. The care of the aged sick is a tremendous problem, far too many young lives are sacrificed to keep old people alive. The burden of attending a bed-ridden or house bound old mother or father over the years takes a tremendous toll of the young, and an interesting experiment has been carried out in two London hospitals where they talk about "six weeks in and six weeks out."
We know that there are not enough beds, and that many of the beds are occupied for far too long by chronic cases, but here in London an attempt is being made to relieve the burden of the nightly labour and lack of sleep which the aged require from the young. Such an experiment might well be tried out in Scotland. Describing this scheme, an article in the Lancet said:Caring for an aged invalid, who can easily become a neurotic tyrant,"—We know that from our experience. The idea that all old people are nice, kindly folk is wrong:is a fruitful source of domestic strain. This has serious social implications which demand more attention than they now receive. At present, the cost of strengthening the old and weak is far too often a weakening of the young and strong.We know how true that is. Into these two hospitals are brought the old people who have been a burden on the young. They stay there for six weeks, and are then sent home for six weeks. Here is what one young woman, looking after her mother, said of the scheme:The temporary stay procedure has made a difference to me between existing and living.I wonder if that could be looked at in Scotland.
There are many ways in which we can still help with this problem, which is not growing less, and we must try to ease it as much as possible by voluntary help. We know that these old people like to stay at their own firesides. I would like the local authorities to build special houses for the old people, and to make a study of the things that can help to make life easy for the aged in the house.
I remember watching a lecture on television one night showing all the aids devised to make life easier, and safer, for old people in a home of their own. 502 We should concentrate our study on that and encourage local authorities to build little colonies with a warden to look after them. We tried it in one district, where we wanted to have a local authority employee going round each day to see how the old people were, going for their prescriptions, and the like. Whatever the scheme may be, we could build specially-designed houses provided with all the means of making life easy, with a warden in charge, or we could try some other method of keeping these people together, which would be not only more acceptable to them but far cheaper for the country as a whole.
This problem merits a great deal of attention, but my right hon. Friend—and I say this with no disrespect to him—devoted to it only 1.5 minutes of his speech. I am sure that such a proportion does not represent the percentage attention they have in his mind.
We know that the numbers of aged people will increase over the years and that, as that happens, the burden on the remaining workers will increase annually. But must we accept as inevitable the present natural process of growing older and weaker? Is there not here a wide range for research into staying the oncome of age? This is not as fantastic as it may seem. A fortnight ago I walked into the office of a commercial oncern—pretty hard-headed people. I was astonished to be taken into a room where an eminent scientist, whose name is well known in this country—his inventions represented a very great part of plastic advance in recent years—and a first-class economist, lately highly placed in the Treasury, were working together, collecting and collating all the work that had ever been done in this question of de-aging. That was being done, not as a stunt or a gimmick, but to see if this problem, which is insiduously growing greater every year, cannot be helped by restudying the ways in which we grow old and, perhaps, to check the process.
Not much success has so far been achieved, but there are eminent scientists who believe that something can be done to stay the onset of old age. I know of one person who tried to get a grant from the Nuffield Foundation in order to carry on work in this direction. To solve the problem will be a great and costly task, but I wonder if there is not a great deal of research in which the Government 503 could participate. Can we do anything to avoid that burden reaching the magnitude that it will otherwise assume in the years ahead? I should like that to be looked into. At the worst, a failure would not burden the country very much.
I listened with great interest as the hon. Lady the Member for Lanarkshire, North (Miss Herbison)pleaded the case of radiographers. I, too, have had some conversations in recent months with radiographers. The information that I received was slightly different from that which the hon. Lady had, and different, indeed, from the information that the Minister gave in reply to a Parliamentary Question.
One of my constituents, a lady with years of experience in this work, wrote to me and said:I would like to draw your attention to the deplorable shortage of radiographers in this country. Many hospitals are extremely understaffed in their radiographic departments. Some have had to seriously curtail their services. This necessitates long waiting lists…We have heard that there is a 5 per cent. shortage and that a 5 per cent. shortage can be troublesome, but is it true that some hospitals have seriously curtailed their services and that there are long waiting lists for certain types of X-ray examination? These are serious charges in these days of the National Health Service, when one would imagine that the new and growing department of radiography would get urgent and complete attention.
My constituent goes on to say that the chief trouble in this occupation today is the lack of recruits. The hon. Lady mentioned the fact that plenty of people were coming into the profession, but that is not my information. I am told that there is a shortage of recruits to the profession and that there are three complaints—salary, poor working conditions and radiation hazards which, I think, have perhaps been magnified by the Press in recent months. Those are three factors contributing to the shortage of radiographers and, perhaps, to the failure of the X-ray system.
Dealing with the salaries which were enumerated by the hon. Lady, the complaint is that the increments and the final salary are too small. The increments are £15 a year, and at the top of the grade after nine years there are two increments 504 of £25 and a ridiculous final salary of £750 to £850. But those final salaries are paid to the superintendents, and my information is that there are too few superintendents and that among the superintendents there are too few radiographers.
Let us consider the radiographers employed at a hospital and how they are graded. Let us take a large teaching hospital with a staff of sixteen. There is one superintendent grade and that superintendent cannot rise above a salary of £850. There are three seniors who cannot rise above £570; and there are twelve on the basic salary who cannot rise in that hospital above the basic salary of £485. These salaries of £570 and £485 are no more than those which are paid to bus conductors, and they are not at all satisfied.
We must look into this problem of the remuneration of radiographers. I suggest that they should be made more senior appointments. In the Army we made some men majors automatically. Why should not radiographers become superintendents grade I after ten years of service? Look at the problem which is caused. The conditions of employment, my correspondent tells me, are needlessly bad in some cases. I do not want to over-emphasise the point, but I am told that the X-ray department is apt to be pushed into an odd corner, sometimes in a basement which is badly lit and ill-ventilated, with very little space for the work to be carried out properly. Indeed. I have seen these conditions myself. If that is the position, could we have some assurance that this important branch of the hospital service will be looked into and, if possible, improved as speedily as possible?
Turning to this question of radiation danger, the Protection Council has recommended that four weeks holiday should be given. Four weeks holiday is given to those engaged in this occupation, who are in hazard all the year through, when we give six weeks holiday to civil servants who are in no danger from radiation. If radiographers are absorbing radiation, is this not an occupation which should be specially considered for longer holidays than normal? I leave that for the Minister to look into.
Indeed, I need not pose the problem at all, because, as the Minister knows, 505 a Code of Practice for the protection of these persons has been issued this week which recommends that the amount of absorption in the future should be reduced to one-third of what has been the tolerance level in the past. It shows that those who have been complaining and have been afraid of the radiation hazard have perhaps had good cause. At any rate, here we have an occupation which is different from all other occupations in that it has this hazard of radiation. All these factors show that radiographers deserve some special consideration, and I hope the Joint Under-Secretary will give us some hope that such consideration will be forthcoming.
My last point relates to the Report, which I think is, admirable. I read all these reports with tremendous interest, and J. feel that by the joint effort of both parties we have brought the health of this nation up to a level fit for the twentieth century. But in the Report there are always one or two aspects which cause us concern, and I should like say a word on the use of drugs.
I used to make glass bottles, and it used to amaze me how, year after year, from the fast-moving machines the aspirin bottles, the narcotic and sedative bottles came pouring out by the million. I used to wonder how all these bottles were sold. But each year that passed the demand grew bigger, and we in Scotland have good cause to consider this problem seriously in view of the statistics given in the Report. According to the Report, deaths from suicides and accidents from the use of sedatives and narcotics in Scotland were 18 in 1948. and in 1955 they rose to 77. That is just one aspect of the problem, but it is a tremendously, serious aspect.
Phenobarbitone prescriptions are rising each year from 5.8 per cent. of the total prescriptions in 1947 to 10.9 per cent. of the total prescriptions in 1955. Over 2.2 million prescriptions were given out for narcotics and sedatives of one kind or another in Scotland. This tendency is not peculiar to Scotland. It was costing us 30s. per head of the population in 1955. It is growing all over the world, and it may be that it arises from the speed with which we live and the changing conditions of modern life; have we become nervy, edgy and neurotic? Here is another field for wide research.
§ 7.57 p.m.
§ Mr. James H. Hoy (Edinburgh, Leith)
The speech to which we have just listened does the hon. Member for Pollok (Mr. George)much greater credit than the speech which he delivered on a previous occasion, and it certainly was a tribute to the National Health Service that even he, whom politically we have not regarded as being very progressive, should have said that the Service has brought the health of the nation up to a twentieth century level.
It is a very good thing that at least once a year we should debate the National Health Service, because it was introduced in very difficult times and amidst great opposition. Its success is measured, I think, by the Report of the Guillebaud Committee which said that there has been an ever-increasing efficiency and economy of service since 1948 and that the whole record of the Service was one of real achievement. That is a great credit to us and to the country as a whole.
One of the most recent developments is the agreement which has just been made with Sweden which will provide a complete interchange of Health Service facilities to the nationals of each country, so that either Britons in Sweden or Swedes in Britain will be able to enjoy the benefits of the Health Service without extra cost. So often in the past there was that cheap and nasty criticism by those with cheap and nasty minds that one of the great costs incurred by the Health Service arose from the fact that foreigners visiting this country could enjoy its benefits. How one can enjoy ill health, I have never been able to understand, but, apparently, that was the suggestion. I think that it was just one of the sticks which was used to beat the Health Service. If people would only bend their energies to getting these agreements and interchanges of Services, they would do not only themselves but the world more good.
I do not want to get into an argument with my hon. Friend the Member for Fife, West (Mr. Hamilton), but I think that he went a little too far when he suggested that Fife was more important than Edinburgh. I will go this far with him and say that if there is a lack of doctors in Fife, then Fife, like any other part of Scotland, is entitled to its fair share of the country's medical skill. I must disagree with my hon. Friend also 507 in his references to criticism from America about our socialised Service. I regard it as a very good thing indeed that others should discuss our National Health Service, no matter what adjective they might apply to it. I have known many Americans who have come to the Theological College in the City of Edinburgh and who have had the benefit of the Health Service of our country. They have been very grateful, and have publicly paid tribute to our Health Service, and their one desire has been to have a similar service available to them when they return to the United States of America. I spent some time last year in the same hospital as my hon. Friend the Member for the Kirkcaldy Burghs (Mr. Hubbard). On two occasions, at that time, we had with us American visitors who, unfortunately, were taken seriously ill, and the tribute they paid to the treatment in the Edinburgh Royal Infirmary and to the National Health Service was very impressive.
The Guillebaud Committee made a recommendation that the regional boards should be allowed to undertake building work in excess of the old £10,000 limit without the prior consent of the Department. The Committee felt that this limitation was, in fact, retarding progress. The Report tells us that it has now been agreed that regional boards should undertake work without prior agreement up to a figure of, I think, £30,000. Will the Secretary of State tell us whether this release has, in fact, meant a speeding up of this type of work? Perhaps he could give us a few figures to show what advantage has been taken of it.
My hon. Friend the Member for Motherwell (Mr. Lawson), a few days ago raised certain questions in the House about the ambulance service in Scotland. We pride ourselves in Scotland that our ambulance services are better than those which obtain in England and Wales, and I do not think that any hon. Member from either an English or a Welsh constituency would disagree with us about that. My hon. Friend made a complaint, however, about the manning of ambulances.
In past years, the Public Accounts Committee has been somewhat critical of what it regarded as a fairly substantial wastage within the ambulance service. 508 The last Report shows that there has been a decline in the mileage covered and in the number of patients carried by the ambulance service. I am convinced that we could get the service spoken of by my hon. Friend the Member for Motherwell without any further increase in cost if, in fact, the ambulance service were economically used. That has been borne out in repeated meetings of the Public Accounts Committee when that Committee has had the Secretary of the Department of Health for Scotland before it. I should like to know what further steps the Scottish Office is taking to deal with the problem.
Edinburgh is, of course, very willing indeed to play its part in the two years T.B. campaign which is to be organised in Scotland. I know that the town clerk of Edinburgh has been in communication with the Scottish Office, because the Corporation of the City of Edinburgh feels that it is not getting the co-operation to which it is entitled. The town clerk has sent a letter to the Scottish Office and to Members of Parliament for Edinburgh constituencies raising this complaint. It might be as well if I recall what happened.
The Health Committee of the Corporation of Edinburgh agreed, with enthusiasm, to take part in this campaign. At its first meeting, the Committee thought that, for Edinburgh, it might be a campaign of eight weeks' duration, from 10th February to 5th April, and it was advised that ten mobile units would be available to assist. That seemed all right for the moment, but then the Edinburgh Committee considered the very successful campaign carried out in the City of Glasgow and came to the conclusion that a shorter but more intensive campaign ought to be undertaken, perhaps one lasting for five weeks.
The Health Committee of Edinburgh understands that when the Glasgow survey was undertaken twenty-six units were made available from the Ministry of Health in England for the purpose. The Edinburgh Committee felt that it might have greater assistance than the ten mentioned in the original intimation, but I am told by the town clerk that, so far as he is aware, the Ministry of Health has not yet agreed to release 509 further units. If Edinburgh is to undertake this work, it is important that these units should be made available.
§ Mr. Maclay
So that the hon. Gentleman knows about it, perhaps I should say that I am working on this matter now.
§ Mr. Hoy
We shall be glad to hear the result of the right hon. Gentleman's investigations. If we could have even a more extensive campaign, certainly a more intensive campaign, for, perhaps, five weeks, it would, in my view, be a much better effort than a longer one, dragged out for eight weeks or so at really the worst time of the year, from the beginning of February until April.
The Scottish Office, in its letter, mentioned community participation. The Secretary of State need have no doubt on that score because in Edinburgh, prior to anything taking place in Glasgow, we had a campaign in the Pilton ward of West Edinburgh, and in my constituency, in a ward in Central Leith, where one of the representatives is the wife of my right hon. Friend the Member for East Stirlingshire (Mr. Woodburn), a very successful campaign was carried out. The local people are very willing to take part in any other campaign.
I am sorry that the hon. Member for Pollok having delivered his speech, has now departed. I was very interested to hear him talk of services for old people. Arising out of the campaign undertaken in Central. Leith, there has sprung up a service to old people second to none in the country. The committee has kept itself in being and, ever since, has provided, from Monday to Friday, a lunchtime service to at least eighty old-age pensioners. They pay for it, but all the work is undertaken voluntarily. The hall is provided free by the Co-operative Society in Leith, and it is open for these few hours in the middle of every day. For 5s. a week, each old-age pensioner can have a three-course luncheon daily from Monday to Friday. This is a piece of real social service.
It would not be amiss if I were to mention the lady at the top of this service, a Miss Sinclair, who since the war, sometimes under adverse circumstances, has organised the service in a voluntary capacity and raised the money, asking 510 the Government for no assistance, to provide this social service for the old people in Leith. Every day without fail, she and her committee of voluntary workers provide this luncheon service for the old-age pensioners in my constituency. The Secretary of State need have no fear on the score of enthusiasm, but I think that Edinburgh is entitled to a little more consideration. If the right hon. Gentleman can provide these things, Edinburgh will certainly play its part.
I know that we have to get the best conditions for all who are engaged in the Health Service generally—doctors, nurses and others who perform the day to day jobs within hospitals. Neither do I forget the voluntary workers, who do such admirable service. One way in which we might try to do a little more is to make the interiors of the hospitals up to date and provide them with modern conditions.
A great deal of this work—I speak from personal knowledge—has been done in the Royal Infirmary in Edinburgh. On the first of my three visits to hospital. which, I regret, were extensive, I went under the old conditions into drab and dreary wards. On my two succeeding visits, they had been completely modernised and brightened and provided with modern equipment. I had the pleasure of greeting the Joint Under-Secretary on one of his tours, and I think he will agree that there was a complete transformation within the hospital. Improvements of this nature reflect themselves not only upon the patient, but upon the nursing staff, the doctors and all who work in the hospitals. Surely, it must be the duty of everyone of us to make these conditions available for those who have been stricken with ill health.
Our health services are second to none. We ought to be proud of them. I am certain that most of us are. Anything we can do to help them to become even better, we should certainly do.
§ 8.13 p.m.
§ Mr. George Lawson (Motherwell)
I would caution my hon. Friend the Member for Edinburgh, Leith (Mr. Hoy), who spoke of the ambulance service, that while I agree that we should certainly ensure that we get the best possible 511 service for the money—that is to say, it should be run in the most economical manner—we ought not to make economies at the expense of the service. I am sometimes rather afraid that that is what is happening.
For example, in the endeavour to reduce mileage, I have on more than one occasion heard of rather more people being—perhaps I should not use the word "canned"—put into the ambulance than should be the case and of people having to wait while the ambulance man collects a number of people to get a full load for his round. Some people have spent much too long waiting either in the ambulance or in hospital to be collected. In the concern to reduce mileage, we should keep the interests of the patients very much to the fore. Subject to this reservation about providing a proper service for the people, I am in agreement with my hon. Friend in his views about necessary economies in the ambulance service.
The first of the other two points which I raised in my Questions to the Minister was that of the one-man crew. It is now known that over most of Scotland there is no such person as an ambulance attendant. The exceptions might be taken as Edinburgh, Glasgow, Greenock and Paisley. I understand, however, that in Aberdeen, Dundee and Perth there is not such a person as an ambulance attendant. The rule—not the exception—is that the ambulance is manned by one person, the driver.
If it is not yet possible to have ambulance attendants throughout the country, we ought certainly to have them in cities such as Aberdeen and in our larger burghs. I should like to know, for example, why it is not possible to operate the kind of service that is afforded in Glasgow and Edinburgh. It is only of recent years that it has operated in Edinburgh, because when I lived there this two-man system did not exist.
I agree that if we are pressed for money, we can operate the one-man ambulance to collect what is known as the walking patient, but in addition to this service, Glasgow and Edinburgh and, I presume, Greenock and Paisley have the service which is used for stretcher cases and for accidents, when the driver necessarily requires assistance. In such cases, 512 Edinburgh and Glasgow have the two-man crew, including the ambulance attendant. It does not, however, appear to be the practice in Aberdeen, Dundee or Perth or anywhere other than in the four towns and cities I have mentioned. It seems to me that we could do much better than this. We ought certainly to have an adequate number of ambulance attendants throughout the country to ensure that when an attendant is required, he will be available.
We should be able to ensure that when it is known that assistance will be required, the driver does not have to go round knocking on doors or seeking assistance from bystanders when somebody has been injured or is incapable of getting into the ambulance unaided.
The second point raised in my Question yesterday concerns trained crews. I was given the Answer, which I knew was largely the position, that practically all drivers directly employed by the ambulance service are trained in first-aid. I understand that there is an inducement of 6s. extra if they acquire first-aid qualifications. From the Answer given me yesterday we can see that most of them, almost all of them, all but 25 out of nearly 500, are first-aid trained.
I understand, however, that there is a practice at the holiday period of bringing men into the service who are not so qualified, who are not first-aid trained. I would suggest that something be done about that, to see that the men brought in even at holiday times have first-aid qualifications. Many people requiring an ambulance also require first-aid attention and we ought to make it a condition of employment with the ambulance service—I am talking now of the direct service—that the men should be first-aid trained or should very quickly become first-aid trained.
My complaint is not with the direct service. My complaint is that a very large part of the ambulance service in Scotland is, as it were, contracted out. A local garage may get a contract for providing this service. It may have one ambulance, or two or three ambulances, but it has no ambulance attendants. It has ambulance drivers who may or may not—and the chances are that they will not—be ambulance drivers who have first-aid qualifications. The contract may go to 513 an undertaker or to a garage proprietor. A mechanic may be called from under a car to man the ambulance. He may be an excellent fellow. I am not criticising the men. I am talking about qualifications. These chaps do excellently what they do, and there is no question of criticising them. Nevertheless, as I say, a mechanic may be brought out from under a car and sent in the ambulance to handle the victim of an accident, and he may have no first-aid qualifications at all, and he may be, and normally is, the only person on the ambulance.
I cited yesterday an accident at Blackford in Perthshire in which two persons were killed and two were injured, and the ambulance which, I am informed, came from Auchterarder, came with only one man in it. I am not blaming the man or criticising him, but the fact is that there was only one man in the ambulance crew. Of course, the police were there and they gave assistance, but it is not good enough to send out an ambulance with only one man in its crew to deal with an accident like that. The ambulance service has to deal with accidents throughout the countryside. That is, perhaps, where most of the serious accidents occur. Yet we send out one-man ambulances, and very often the man will have no first-aid qualifications.
I am not at this stage trying to suggest how we might remedy the matter, but it would seem to me not to be impossible or difficult to write into the contract with a firm undertaking to provide ambulance service a condition that the men who handle the ambulance must have, or must in a specified time acquire, first-aid qualifications. It is really just too bad that we operate the service on its present basis.
I recently witnessed an accident at Notting Hill Gate, and I waited until the ambulance came, and I watched how the ambulance men handled the victim of the accident, who was an old fellow who had been knocked down. I was deeply impressed by the gentleness and the skill with which the ambulance men straightened out his limbs and disposed him in such a way that he should make only the minimum movement and then got him into their ambulance. Skilled action like that is not happening in Scotland—or, rather, it is happening, but very often does not happen, and it ought 514 to be our business to see that the unskilled work is not continued.
I put it to the Government that, whatever we do about our ambulance service, these are two matters we must keep in mind and that we should right these difficulties, though I am not prepared to say at this stage just how. I would, however, make this one further suggestion, that the Government consider eliminating as far as possible this contracting-out service and bring the service more and more under the direct control of Glasgow, and base many more of the ambulances upon hospitals and not upon garages.
§ 8.25 p.m.
§ Dr. J. Dickson Mabon (Greenock)
I I am very grateful to my right hon. and hon. Friends for the very great honour of being invited to wind up the debate for our side of the Committee tonight. I have not doubt that I shall not reach the level of performance which they think possible and expect, but I shall do my best, nevertheless. This is my second maiden speech in this Chamber, and I hope that hon. and right hon. Members opposite and my hon. and right hon. Friends, too, will not be impatient with me if I tend here and there to hesitate in making my speech.
The suggestion made by my hon. Friend the Member for Motherwell (Mr. Lawson)is, in my view, a very sound one. The National Health Service in Scotland has a great advantage over the National Health Service in England on two counts, and one is in the difference of the basis of the English and Scottish ambulance services. Our ambulance services are organised on a different basis from that on which the English service is. I think that it is on a more advantageous basis, but we ought to make sure that our system works as well as possible, and I think that the comments made by my hon. Friend are worth the Government's attention.
The plea about radiographers made by my hon. Friend the Member for Lanarkshire, North (Miss Herbison)—a plea which was reinforced rather unexpectedly, though we are very pleased about it, the hon. Member for Glasgow, Pollok (Mr. George)—was a reasonable one, which the Government would do well to think about.
515 In his Answer to the hon. Member for Lanarkshire, North on this matter yesterday the Joint Under-Secretary of State used a rather curious expression of logic. I am not going to trouble about "troublesome" but I will trouble the hon. Gentleman with this curious phrase which rather upset us on this side. He said:In any case, the shortage in Scotland is 5 per cent., whereas in England it is 16 per cent."—[OFFICIAL REPORT, 23rd July, 1957; Vol. 574, c. 200.]In other words, "The position in Scotland is bad, the position in England is worse, so what are we worrying about?" We may reach the stage at which we shall say, "There are not so many dying of lung cancer in Scotland as in England and therefore there is no point in trying to cure it. When the position is better in England we can worry about Scotland." The reverse logic is oft-times rather unfair, and we constantly compare the English position with ours, and so I do not blame the hon. Gentleman for falling into the trap of that comparison, but I would point out to him that it is a trap in which he must not allow himself to stay.
My hon. Friend the Member for Coat-bridge and Airdrie (Mrs. Mann)very wisely and properly brought up again the matter of home accidents.
Even though the Secretary of State for Scotland, in the course of his speech, gave an excellent commentary on this matter and the Report refers to it three or four times, we hope that my hon. Friend's efforts and the efforts of those associated with her will bear even more fruit in the coming year. The figures given by the Secretary of State are really quite graphic in showing how these accidents make the greatest claim on human life of all the matters that are surveyed in the Report.
I do not want to make this summing up appear to be a compendium, but I will say to my hon. Friend the Member for Kirkcaldy Burghs (Mr. Hubbard)that I hope that I shall adopt the plain language that he requested of all medical men and that I shall treat the Committee with all the confidence one would expect of a good doctor. My hon. Friend is perfectly right in his complaint that doctors do not tell people enough, but to a large extent this is because doctors do 516 not have enough confidence in the human beings who are their patients, although my hon. Friend is a noble exception. As I know from experience, he is a man with whom one can be perfectly blunt, but all of us are not made of the same tough, courageous texture. The doctor has to conceal opinions from those whose nature is very different from that of my hon. Friend. I complain, nevertheless, that in one sentence my hon. Friend, as a man complaining about the lack of plain language, should be able to use terms like "coronary thrombosis" and "anti-coagulants" without pausing for breath.
I can deal with only three major matters in the Report, and I say that with a certain amount of hope, because I may not quite manage it. My right hon. Friend the Member for East Stirlingshire (Mr. Woodburn)introduced the debate very well, and the standard was sustained by the Secretary of State—if I can afford to be patronising to both right hon. Gentlemen—in unfolding for us the post-war history of the treatment of tuberculosis in Scotland. It is not always acknowledged, and it is worthy of acknowledgment, that my right hon. Friend the Member for East Stirling-shire fought in the Cabinet for more houses for Scotland, by virtue of her awkward position in relation to tuberculosis. He set up an inquiry which has since reported on the position. My predecessor in the representation of Greenock, Hector McNeil, was responsible for introducing the Swiss sanatoria scheme.
These things were done at a time when the statistics of the incidence of tuberculosis were very bad. While I am glad that the right hon. Member for Kelvin-grove (Mr. Walter Elliot)mentioned the name of Sir Robert Phillips in relation to the new approach to tuberculosis, I want to stress that we must not forget that the introduction of the "wonder drugs" has a bearing on the great difference between the figures of tuberculosis incidence between the 1940s and the early 1950s and the figures today. We should not allow the debate to go by without acknowledging the work of the men responsible for discovering streptomycin, para-aminosalicylic acid, known by the initials P.A.S., and another drug, with a longer name abbreviated to I.N.H. These 517 are the three drugs that are responsible more than any other agency for the improvement in the tuberculosis figures.
Medical science has provided the drugs. Medical science has provided the key and it is Parliament's job to turn that key in the lock. The turning has been the community survey campaigns. We are glad that the Government have carried out these campaigns and that they are intent on stamping out tuberculosis in Scotland.
It is a remarkable situation when one considers all the people who are involved in this work. The appreciation which the Secretary of State recorded was very comprehensive and we all wholeheartedly agreed with it, but I should like to mention other workers as well. I know canvassers who work very hard for the political parties—my own more than those of other parties, of course. I discovered to my amazement that those who knocked at doors to canvass votes for those of us who are now Members of the House of Commons—and for those who are not here, also—knocked at the doors again to ask people to come out and be X-rayed. That is the kind of spirit that we want to see in a campaign of this kind. The figure of 883,000 X-rayed in the course of the campaign was first class. But then, of course, on this side of the Committee we are the watch dogs of the conduct of this campaign, and we have certain fair criticisms to make.
First, we are not getting all the information we need. If the Under-Secretary of State will look at the Answer he gave yesterday he will find that there are certain matters we want to look at. His Answer yesterday revealed that 1,124 people found to be suffering from active pulmonary tuberculosis are now under treatment by their G.P.s and that 1,173 are under treatment in hospital. In other words, by the contacts we have found that we are treating more than half of them at home.
I do not know if hon. Gentlemen can recall the time when I attempted to raise on the Adjournment the question of the dangers of treating tuberculosis at home. May I say that I did not dream this out of my little head? There are quite a number of medical men, far older than I am and with substantially more experience, who now and then write to me on these medical matters. On the basis 518 of reports sent to me, therefore, I raised that subject on the Adjournment.
I called for the Department and the Ministers to realise that there was concern in medical circles about the domiciliary treatment of patients. Why? First, because of the underlying suspicion we have that maybe the Department is doing this because it wants to save money. It is not wrong of us to think that. It may be a nasty, wicked little thought, but there it is. A patient being treated at home with any of these wonder drugs who breaks his regime of treatment can well render himself not only without a cure but even incurable, as regards those drugs, so, as a consequence, we have to spend more money trying to cure him.
Therefore, the fewer people we treat at home, the more confident we are of knowing that more will be treated on a sustained regime in hospital. When I say that people break their regime of taking drugs at home, that is no reflection on the general practitioner. A doctor cannot be expected to be in constant attendance on a patient, and give him the same treatment as would be given in hospital. There is the possibility that the patient may, through ignorance or laziness, fail to take the drugs. On this point it is worth stressing that the figures available show that we have now reached the stage where, of all the active cases we have found by X-ray, we are treating more than half at home. The other—the smaller half, if one can use that contradiction—is being treated in hospital.
Another matter which may be fairly criticised is that of the facilities available for these people. We are now beginning to get—and hon. Members on all sides of the Committee will get more and more of this type of correspondence—letters from people complaining about not getting this and that. The Department should make an effort to make it clear to us all, Parliamentarians and citizens, exactly what people are given when they are asked to give up their jobs and go into hospital or to stay at home and be treated there, when it is discovered that they have active pulmonary tuberculosis.
What allowances are they able to get? Which ones do they get automatically? Which ones can they apply for in difficult circumstances? What are the social 519 obligations on the local authority to rehouse them? What are the provisions? It is not only we in this Committtee who should know; the ordinary citizens also should know because, if they are confident of getting a fair crack of the whip from the community, they will come forward in even greater numbers. We do not want any people to be mistreated at this early stage in the campaign in case it should endanger enthusiasm later.
One case came to me recently not from my Division but from that of my hon. Friend the Member for Glasgow, Govan (Mr. Rankin)and I took up the matter with him. I have no doubt that, since I have since recaptured the letter, following our exchange yesterday, my hon. Friend will deal with the matter through the Joint Under-Secretary of State. It was about a carrier, that is, a man who is classified as suffering from active pulmonary tuberculosis, but not so active that he is a danger to himself, although he is dangerous to everybody else.
Carriers remind me of Typhoid Mary. She was a unique character. If I remember rightly, she was a cook. If I am wrong, maybe the right hon. Gentleman the Member for Glasgow, Kelvingrove will help me. The reference is Dible and Davies' Textbook of Pathology. Tyhpoid Mary was a cook in an American lumber camp in which, on seven separate occasions, there were 200 cases of typhoid. This Typhoid Mary was a buxom woman, not the least a victim of typhoid, but she was a carrier.
We are reaching a stage when we are going to discover in Scotland more and more of these so-called carriers. The case to which I have referred is that of a man who was asked to give up his work because he was a danger to his workmates. He had tuberculosis but it was caseated and confined itself, so it did not affect him, yet he was infecting his workmates. He was asked to give up his job, and he did so. He lost a good deal of income by doing it. He did not get any National Assistance because his wife was working, but the whole home had to sacrifice quite a bit of money. At the same time he was not allowed to be re-housed by the Glasgow Corporation because of an argument about the precise definition of his condition.
520 That reminds me of the earlier argument about pneumoconiosis. Apparently this case depends on whether a man should have a positive or a negative sputum. If it is a negative sputum he does not get re-housed, which is daft when one considers the fact that he is being asked to go home and have treatment so as to prevent his infecting others. The logic of that baffles me. I do not know whether I am reflecting on the Glasgow Corporation, which I should not like to do, or on any of the officials, which I should dearly like to do, but there it is. Whoever is responsible, I think that it is worth while considering.
I should like to make the point, and I hope that I shall not be misunderstood in this matter, that frankly, although we pride ourselves in such places as Port Glasgow, and the Secretary of State may pride himself, on the fact that 82 per cent. turned up at the community survey campaign there—it may be it was because the right hon. Gentleman opened it himself, I do not know—it is the 18 per cent. about which we should like to know. Not the 82 per cent.; but the 18 per cent. who did not turn up. I suspect that a large number of the 18 per cent. were the older people in Port Glasgow, and no doubt this applies to the other burghs. These older folks may say to themselves, "Now we have got to this stage of life, a wee bit of tuberculosis will not make much difference and we will not turn up." In fact it is these people nursing grandchildren at the fireside who are probably carriers. It is these old men and old women who must come forward and present themselves for the sake of the welfare of their grandchildren in their teens and so on. If these people would come forward we should feel more confident that these community survey campaigns would be the great success which they surely deserve to be.
I now turn to the question of mental health. Since I am a very inexperienced Member of the House of Commons, I have to tread rather warily in case I get into procedural trouble. The hon. Member for Fife, West (Mr. Hamilton)has spent some time in dealing with the aspects of treatment of mental health. It is regarding the proposals contained in the Russell Report and the consequences of that on which I should like to speak. May I remind the Committee that yesterday's Answer which my hon. Friend the 521 Member for Maryhill (Mr. Hannan)received from the Under-Secretary represents one stage forward in this lengthy programme of inquiry. We are now told that organisations in Scotland who are commenting on the Russell Report concerning mental health and mental deficiency law reform are now being asked to make comments on the Royal Commission set up for England and Wales to deal with this matter but only in respect of England and Wales.
I should like to go over the history of this so as to clear all our minds, no doubt including my own, of the exact procession of events. In 1938 the Royal Commission was set up under Lord Russell. In 1946 it reported. At that time, as I understand it, it was decided to wait until the National Health Service was introduced. In 1948 the National Health Service was introduced. There were three major developments in the matter which affect the law and which have become quite clear to us.
The first is that outpatients' attendances for psychiatry have trebled; in some hospitals they have even gone higher, but they have trebled as a whole. More people are coming forward voluntarily for mental treatment. We now have a possibility which was completely remote in 1946 of a domiciliary psychiatric service of a reasonable proportion.
The second important thing is that, because of advances in drugs, we can deal with patients on a short-term basis. These advances include insulin, shock therapy, and other forms of treatment developed in the last ten to fifteen year. The old Royal Commission was called the Royal Commission on Scottish Lunacy. The word "lunacy" follows us along as an echo from the past; it is out of date compared with our understanding of mental treatment now.
The third development has been that long-stay patients are no longer "dangerous lunatics", with the locking of doors and such things. Tranquillisers, the prescribing of which outside might be regarded by some as a shocking abuse, are a wonderful advantage to those in mental hospitals. People are no longer violent in such numbers as before because of the wonderful effect of the new drugs.
522 With this revolution in treatment we ought to have a revolution in the law. When we look at the Russell Report—I make no reflection on the members of the Committee; they were acting within the context of their time and understanding—it seems to be completely out of tune with modern requirements.
On page 65 of the Department's Report there is a reference to the Royal Commission. The Department seems to be confused by all this—I say it deliberately—confused by the evolution of the Russell Report, by its being stifled, by its being brought out again in 1955 and by its being sent out to organisations for their comments, and by the sudden appearance in 1957 of the last Royal Commission's Report. As a result, the Department has become more confused in writing the Report. At the bottom of the page it states that the Command Paper is No. 6913. That is actually Treaty series No. 31, Norway, an agreement between the United Kingdom and the Norwegian Governments concerning air communications. I will not be malicious, but I cannot see the connection.
I make the point not simply to prove that I have read the Report but also because it is worth remembering that we now have four rather large documents to consider before we can discuss mental health in Scotland. Yet in respect of England there was a wonderful debate in the House on the basis of an excellent Report, and legislation is awaited for England Wales which will be in advance of that in many other countries, whereas Scotland looks back to the 1857 laws and a Report now twelve years out of date. We do not want another year of inquiries with memoranda pouring in. We want an independent committee to deal with the whole matter and draw the whole position together in a year. Then we might be able to bring the Scottish law abreast of the reforms which will take place in England.
The Secretary of State mentioned the Scottish Hospital Endowments Research Trust. The legislation providing for the setting up of the Trust some years ago was one of the best pieces of legislation that the House has passed. The Trust has done excellent work, as one can see from the Report dealing with its research. I would, however, draw attention to the 523 paragraph in the Report which deals with finance, which says:It became apparent at an early stage that there exists in Scotland at the present time no shortage either of talented research workers or of deserving and promising research projects and accordingly entirely suitable projects might require to be rejected for no reason other than the insufficiency of the trust resources.There have been many research projects, very worthy in themselves, which the Trust, with a limited income of about £90,000 a year, could not tackle. I do not blame the Trust, which is doing its very best. One would have thought that research which could not be sustained by a research trust would be carried on the Department's Vote, but the Department's record in research is not all that good. It is not very wise to imagine that we can hide behind the work of the Medical Research Council. The Council is doing all it can, but every Minister and every Member wants more research.
However, to initiate research is not easy if one does not have the money and the Government Departments can plead all sorts of reasons why they should not provide the money, and research workers are constantly being put off by the different agencies. There are five continuing research projects in Scotland. The Report referred vaguely to new projects under consideration. It referred to only one specific one, that concerning partial sightedness, but did not specify the others. I have put down a Question for next week which I hope will lead to our being given a list of the projects, as well as those turned down for financial reasons.
The research Vote of the Department is £33,000. I am sure that few hon. Members will begrudge doubling that. Many fine research projects are being sacrificed because of our inability to meet the demands of research workers. Research ought not to be simply clinical, that is research conducted by practitioners, doctors, technicians and so on. Research should also have a sociological character. We have had excellent reports from Sunderland and Salford about the social problems of old age.
I see no reason why we should not have a statistical inquiry into one aspect of that in Scotland, namely, nutrition in old age. My hon. Friend the Member for Coat-bridge and Airdrie in an excellent speech last year referred to nutrition which the 524 National Food Survey of 1954 had mentioned. There is no reference to the feeding of the Scottish people in this Report. That must be a tribute to her eloquence, for it was obviously an embarrassment to the Department that she should have mentioned the subject as she did.
We need a sociological survey into the problem of nutrition in old age. I remember saying in my own constituency that the Government were unwilling to raise old-age pensions, but that malnutrition could easily be referred to the National Assistance Board. I caused a gasp of horror with that, but I was giving the Government's case. Perhaps I did not do it very well. We can learn more about the nutritional standards of the Scottish people and certainly more about nutritional standards in old age.
Available information seems to show that there is a lack of enterprise in research in Scotland. A Scottish Department, with Scotland's fine traditions in medicine, should be streets ahead of anything which the Ministry of Health does. With those traditions, there is no reason why the Department should not be our proudest Department. At the moment there is a terrible muddle over the proposed reform in the treatment of mental health in Scotland, and something could be done there. Although we all welcome the T.B. community survey campaign, I think our criticism of the policies of administration are valid and meant to be helpful.
All in all, salvation is not so far away. The Minister is redeemable, and we hope that he can improve the record of his Department further. Nevertheless, we are all pleased that the Report of the Department has shown such a substantial advance on that of last year.
§ 8.55 p.m.
§ The Joint Under-Secretary of State for Scotland (Mr. J. Nixon Browne)
I am sure the Committee would wish me to start by congratulating the hon. Member for Greenock (Dr. Dickson Mabon)upon his first appearance at the Dispatch Box. I can assure the hon. Member that we would all bet him half a pint of aureomycin that it is not his last.
This has been the best of the three debates on this subject which I have had the honour to wind up, and by far the best. I hope that the speeches which 525 have been made will be studied by many people it the country who have not had the opportunity to hear them. My right hon. Friend dealt with a great many subjects and I shall not speak at length about anything to which he has already referred. If I do not answer all the questions raised by hon. Members, I will endeavour to write to them.
The hon. Member for Greenock spoke about tuberculosis suspects under observation at home, about which he had some fears. These are patients whose radiological examination indicates some abnormality, perhaps suspected early tuberculosis. This necessitates that they be kept under regular observation until the chest physician is satisfied either that there is no active T.B. or that treatment must be given. We are fully aware of the dangers referred to by the hon. Member, but here we are in the hands of the chest physician. I can assure hon. Members that both money and beds are available if they are needed in this great campaign.
The hon. Member mentioned problems about expenses which confront patients receiving treatment for tuberculosis. If they suffer from loss of income, they can get special allowances from public funds of 60s. for a single person and 87s. for a married couple. Information about these allowances is, or should be, widely available to tuberculosis patients. It is issued in leaflet form and I have no evidence of anyone having trouble in this regard. I should be glad if hon. Members who know of any case would send me the information. These benefits are available to anybody who has been advised by a chest physician to stay away from work. That is entirely a matter for the chest physician to decide with the individual patient.
The hon. Member for Leith (Mr. Hoy), who speaks with great knowledge of the subject, referred to the question of ambulances, and I will study what he said. I will also pay attention to what was said on the subject by the hon. Member for Motherwell (Mr. Lawson), especially with regard to first-aid qualifications of a single driver of contractor's ambulances. Thai is one of the points which is worrying the hon. Member, and which is worrying me, although I have not yet been able to investigate it.
526 My right hon. Friend the Member for Kelvingrove (Mr. Walter Elliot), the hon. Member for Greenock and the hon. Member for Fife, West (Mr. Hamilton)all referred to the question of mental health. My right hon. Friend the Secretary of State devoted a large part of his speech to that subject and I do not wish to add anything to what he said. I can assure the Committee that we are fully aware of the problems which arise in mental hospitals, and those of mental patients, and of the condition of the law on this matter. Perhaps the best way of indicating this is to say that last year when I went on my Ministerial tour—that is the tour which Under-Secretaries of whatever party make each year—I devoted almost the whole of my time to visiting mental hospitals. I view this as the problem number one of that section of the Scottish Office for which I am personally responsible to my right hon. Friend.
So far as the facts are concerned, my right hon. Friend gave four figures which show what the Department and he think about mental hospitals. They show 1,034 new beds projected for mental defectives, 260 for mental treatment, 205 for maternity and 161 for cancer. I must admit that we are concentrating on action in mental health and we shall try—I accept the implied rebuke—in next year's Report to be a little more forthcoming. I believe that we are on the threshold of advance in every phase of the treatment of mental illness such as has not been seen in this country in this century. We are only beginning to look forward to an entirely new horizon for the unfortunate people, most of whom, although mentally ill, are curable.
The hon. Member for Fife, West asked about the use of former tuberculosis beds for mental illness. Of course, he is quite right. One good example is Ochil Hills Sanatorium in Stirlingshire which is now to be used for mental patients with tuberculosis, thus releasing beds in mental hospitals for ordinary mental patients. We expect also to use some former T.B. beds for old people who need not remain in mental hospitals.
The hon. Lady the Member for Lanarkshire, North (Miss Herbison)and my hon. Friend the Member for Pollok (Mr. George)spoke about radiographers. My right hon. Friend and I have, of 527 course, received letters from hon. Members—nine to be exact—about the shortage of radiographers. It was rather surprising to me that I had to sign four or five letters, I think it was, on the same day in reply to different hon. Members on the same subject. I make no complaint whatever if any organisation wants to bring pressure upon the authorities in this matter. That is the right thing to do, and I hope it will continue; but I hope that hon. Members will realise that the letters they received were the result of organised pressure. It was not the first that my Department had heard of the matter, and we had already been looking into it. We had arranged for the regional hospital boards to make a survey of the situation, which showed a deficiency of 5 per cent. on the establishment at the end of 1956. The deficiency was evenly divided betwen diagnostic and therapeutic radiographers.
We are not complacent; of course we are not. We will investigate sympathetically all the points that have been raised. Why should we not? We want radiographers. We do not want people not to become radiographers or to irritate anybody at all, but there is no question of services in Scotland having been withdrawn either from hospital specialists or from general medical practitioners. The hon. Lady blamed the shortage on the salaries and said that recruits were not coming forward. My hon. Friend the Member for Pollok also blamed the working conditions. I realise that he is right.
The salaries paid to radiographers are, broadly, comparable with those paid to other medical auxiliaries such as physiotherapists and occupational therapists and the same educational qualifications, broadly speaking are required of all those groups. This matter, therefore, goes wider than was suggested. Salaries are a matter for the Whitley Council and are a question in which my right hon. Friend does not normally intervene. My hon. Friend the Parliamentary Secretary to the Ministry of Health saw the Society of Radiographers today. If the Society seeks to see a Scottish Minister we should, of course, agree, but to my knowledge no such request has been received. The last salary increase was awarded to radiographers on 5th November, 1956. follow- 528 ing a reference by the Whitley Council to the Industrial Court.
Though there may be difficulties with radiographers, I should not like the Committee to go away thinking that we were not optimistic about the whole position of medical auxiliaries in Scotland. In other branches, we have fairly well related the supply to the demand. We could do with more almoners, who do such excellent work in the hospitals, and we are expecting help through the establishment of a professional course by the University of Edinburgh.
What is interesting is that this is the first university course of its kind in Britain. We, in Scotland, may be proud. Our favourable position—and it is a favourable position—in more or less all of these services is largely due to the initiative of our hospitals in the past in providing training facilities. In Scotland, the number of medical auxiliaries of all types, and they are an important section of our hospital service, has increased in the last few years from 2,000 to 2,300—a rise of 15 per cent.
I turn to more individual points. The hon. Member for Kirkcaldy Burghs (Mr, Hubbard), and my hon. Friend the Member for Galloway (Mr. Mackie), and the hon. Lady the Member for Coatbridge and Airdrie (Mrs. Mann)all talked about smoking and lung cancer, and I was asked about atmospheric pollution. My right hon. Friend has dealt with this, but I think that I should draw the attention of the Committee to the statement by the Medical Research Council on tobacco smoking and cancer of the lung. In page 3, it deals quite clearly, for the benefit of the hon. Member for Kirkcaldy Burghs and his conscience, with the position of atmospheric pollution. It says:On balance, it seems likely that atmospheric pollution plays some part in causing the disease, but a relatively minor one in comparison with cigarette smoking.In referring to the Report on cancer of the lung, the hon. Lady spoke about "passing the cigarette case." She was talking about an illness which today is causing—and I hope that the hon. Member for Greenock will not take me up on this—one in eighteen male deaths in England and one in twenty-one in Scotland. So I agree with her. In fact, I had the thought that to pass the cigarette case today is perhaps more dangerous than lighting a third cigarette from one match was in the First World War.
529 The hon. Member for Kirkcaldy Burghs and, again, my hon. Friend the Member for Pollok talked about the aged and chronic sick. The hon. Member opposite said that it was a challenge that we could not disregard. My right hon. Friend has already mentioned our concern with this growing problem of old people. He dealt with it shortly because I wanted to deal with it at greater length. The success which medicine has achieved in its attack on acute illness, coupled, as my right hon. Friend the Member for Kelvingrove said, with the increasing proportion of old people in the population, has created one of the most difficult problems facing the National Health Service—that of dealing with the chronic conditions of old age.
Our aim, our main aim, in all this must be to prevent old people from becoming bedridden in hospital and to secure a measure of recovery sufficient to enable them to return to their own homes, or to an old persons' home. This is what the old people themselves want, and, from the hospitals' point of view, it is important to keep as many beds as possible available for old people for curative treatment, and, of course, for urgent cases. It is part of our policy to provide geriatric units for assessment and treatment, linked to our general hospitals.
This work of restoring old people to health and activity is already being carried out by geriatric units at Stobhill Hospital, Glasgow, and at Maryfield Hospital. Dundee. The latest figures from Maryfield will, I know, interest the Committee. They show that some 53 per cent, of old people admitted—and we all know what it used to be like when an old person was admitted to hospital—were sufficiently restored to return home or to be discharged to residential accommodation. As several speakers have said, when old people are discharged to their own homes, they can receive very valuable assistance from the home helps service, and I am very glad to be able to tell, hon. Members that this year for the first time every—and I repeat every—Scottish local health authority is operating a home help service scheme of this kind. It is best, of course, for old people to live in their own homes——
§ Mr. William Hannan (Glasgow, Maryhill)
If I may interrupt the hon. 530 Member, he said that for the first time every local authority now has a home help service. Does that statement amend the statement in the health Report that the only area without a home help scheme happens to be that of one of the Joint Under-Secretaries, namely, in Dumfries?
§ Mr. Browne
I was saying that it is best for old people to live in their own homes, but we realise, as my hon. Friend the Member for Pollok pointed out, that those who live alone—they are, perhaps, 4 per cent. of the old people—present the greatest problem to the domiciliary services of local authorities and the voluntary organisations. It is a problem which we as citizens and as a nation have to tackle. But we must not forget the other point made by my hon. Friend, the problem of the relatives with whom most old people live and who spend so much of their lives caring for them.
My hon. Friend referred to the six weeks in and six weeks out plan in London. I can tell him that arrangements are gradually being developed, the object of which is as much to give a short-term relief to relatives or to let them get a holiday or even a good night's rest as it is to help the old persons concerned.
§ Mr. Hubbard
Would the hon. Gentleman say something about the care of old people during those lonely, long night vigils that they have alone? Does the hon. Gentleman intend to do anything about that at all? The home help service is all right in the day-time, but many of these old people need some help at night.
§ Mr. Browne
Without a little notice, I do not think I would like to say more than that I know many voluntary organisations are taking action in that respect, and of course, neighbours do what they can.
I was about to say something about the six weeks in and six weeks out scheme and how we want it to give relief to the relatives as well as to the old people. Arrangements for temporary admission of old people to hospitals are now operating on a limited scale in Aberdeen, Dundee and Glasgow. This is very important because we all understand that relatives are sometimes nervous about taking an old person back home from hospital it case they do not succeed in getting him admitted again if the need arises. Under 531 these new arrangements when the elderly person returns home, the relatives are told that he or she will be taken to hospital later again if the relatives find that they need another period of relief.
An important aspect of the home care of old people—here I agree with my hon. Friend the Member for Pollok—is the fine service rendered by the voluntary agencies. I think we should mention them in the House. I am thinking of organisations like the Old People's Welfare Committees, the King George VI Memorial Foundation, the Townswomen's Guild, the W.V.S., the Cooperative Women's Guild, the Red Cross and the many local organisations of the church as well as the old-age organisations some of which take up a slightly political aspect.
Among the services that these organisations provide is the meals-on-wheels service which is such a great benefit and which is one way—to meet one of the points made by the hon. Member for Kirkcaldy Burghs—of ensuring that they get the right food. With these various agencies, the Government, the local authorities and other voluntary bodies, all at work, my right hon. Friend and his Department have to try to ensure that each knows what the others do and that they can all co-operate one with the other. This is one of the objects of a memorandum about which we are now consulting with local authority associations and other bodies concerned. The memorandum attempts—it is a difficult task—to sum up the present experience of the problems of co-ordination and to indicate a working division of responsibility between the various interests concerned.
§ Mr. Willis
What happened to the committees which were supposed to be set up a year or two ago, which were mentioned in the Annual Report about a couple of years ago? They were supposed to be meeting to perform this work. Has there been nothing from them?
§ Mr. Browne
I think that it is on the work of these committees that we are now able to write a memorandum and talk about it with everybody concerned. It takes a terribly long time; I appreciate that.
532 The right hon. Member for East Stirling-shire spoke of the necessity for research on pneumoconiosis. The hon. Lady the Member for Lanarkshire, North paid a tribute to Bangour. I acknowledge and endorse that tribute. The position as regards pneumoconiosis is, I think, satisfactory. In March, 1956, after discussions with the N.C.B. and the miners' unions, we decided to review the existing arrangements in the hospital service in Scotland for the diagnosis and treatment of pneumoconiosis, and to consult the Advisory Committee on Medical Research on the extent to which special provision should be made for research in Scotland. The Advisory Committee reported in. I think, August, 1956.
In February, 1957, we put before the Board and the Unions proposals based on the recommendations of the Advisory Committee. These, briefly, were three. First of all, one main clinic, with special provision, including beds, for occupational chest diseases including pneumoconiosis, should be established in each of the three main mining areas, Ayrshire, Lanarkshire, the Lothians and Fife. Incidentally, the hon. Lady the Member for Lanarkshire, North asking about the Lanark centre, asked that it should be at Law. I am afraid that the answer is "No". The western region centre is to be at Belvidere in Glasgow because it is more central for the other coalfields in the West; if it were at Law, it would serve only Lanarkshire conveniently. For strategic reasons, therefore, we must put it in Glasgow.
The second proposal is that, after the main clinic, there should be a number of smaller, satellite clinics established in these areas, to serve the main clinics. The principal function of the smaller clinics is the first radiological identification of the disease and subsequent follow-up of patients referred to the central units for further investigation and treatment. Lastly, it is said that the best plan for pneumoconiosis research in Scotland would be to give encouragement to promising lines of inquiry at any of our major teaching hospitals where the research worker is in close contact with his other specialist colleagues.
For the main clinics, we shall use premises which are already functioning and which already deal to some extent with the problem of pneumoconiosis. 533 The regional boards are now considering how best to implement the proposals of the Advisory Committee to improve arrangements for this very important speciality. The first research programme under this arrangement has started at Maryfield Hospital, Dundee, with financial assistance from the National Coal Board and the Department. Its task will be to make a special study of the functioning of the lungs in various pathological conditions, including pneumoconiosis.
My hon. Friend the Member for Pollok referred to the increased use of barbiturates and tranquillisers mentioned on page 34 of the Department's Annual Report. The increasing use of barbiturates has given cause for concern. In /954, and again in 1956, the Prescribers' Notes issued to doctors by the Ministry of Health and my right hon. Friend's Department emphasised the need for caution in their use.
Tranquillisers are relatively new drugs which have been used to some extent in substitution for barbiturates. They have not been in use long enough to indicate whether they are habit-forming or dangerous in their side effects, but it is probable that indiscriminate use of them would raise problems. In March, 1957, in the Prescribers' Notes, doctors were urged to use them with care and not to prescribe them where a simple sedative would meet the patient's need equally well. The scale on which barbiturates and transquillisers are being increasingly used will, no doubt, be one of the subjects examined by the Committee on Prescribing Practice and Costs that my right hon. Friend has just set up.
From all points of view—and we have discussed some of them today—our Health Service is an enormous and ever-growing organisation. Every day brings new problems and new opportunities. Let me deal briefly with some of them. We are beginning to realise that in fulfilling the great managerial responsibility of the day-to-day administration of our hospitals, we still have very much to learn. About 70 per cent. of the cost of the hospital service goes in wages and salaries. We must, rightly, have a large, efficient and well-paid staff at all levels, but are we sure that we are not wasting our valuable resources in manpower and in money? In some ways, I think, we are.
534 We could make greater use, for example, of machines and so save the work of scarce and costly hands. Many hospitals still do not have all the ordinary domestic aids that the average housewife now regards as essential for her daily work. We need more domestic machinery and to teach the staff how to use it.
The average industrialist knows as a matter of course the cost of each separate department in his enterprise. Industry could not function efficiently without such information. Hospitals are not strictly comparable with industry, but large sections of hospital administration do have similar problems. I am quite sure that no industry could run efficiently on the kind of information that is at present available about the running of our hospitals. What is needed are comprehensive and uniform costing systems, and valuable pioneering work is already being undertaken.
It is only when we have the right information that we can compare the management of some activity in one hospital fairly with that in another hospital, or one hospital or group of hospitals can learn from another. It is only by intelligent costing and all that goes with good management that we can stretch our limited resources to meet the expansions which we all know are needed and which we all want to see.
Let me give one example of a saving of money without loss of efficiency. The Western Region called in outside experts to advise on the laundry service of a hundred of its laundries and took the advice which was given. Over five years, the region spent £190,000 on new buildings and machinery. The result is that 53 of the 100 laundries will be closed and the saving resulting from the capital expenditure of £190,000 will be in the region of £100,000 annually.
§ Mr. Browne
We would give more money if it was to be well spent like that.
Let me give an example of where we want to spend more money. Many hon. Members, including my right hon. Friend the Member for Kelvinerove, have spoken of research in mental health. It is carried on at the main teaching hospitals and at Crichton Royal, but much more research is needed into nearly all aspects of mental health. We must be active in promoting 535 it. I say from this Box that if any young doctor wishes to undertake research into this wide and interesting field and applies for financial assistance, he is unlikely to be disappointed if his project is worth while.
Having examined, praised and criticised our Health Service, let us look in the last few minutes at the National Health Service as those across the sea see it. To a far greater extent than any other nation have we as citizens mobilised our resources to fight disease and to ensure that the best attention should be available for all our citizens irrespective of means. Alone, for example, among the nations of the world can our citizens visit their doctors without paying any charge at all. Taken as a whole, our National Health Service is the envy of the world.
But it is an incredibly expensive war that we are waging, and we are all in it; as taxpayers, ratepayers, stamp payers, patients, we are all in it. It is our duty to ourselves to be sure that our money is spent where it is needed most and on those who need it most. Any waste or unnecessary expense, however small it may be, means that someone somewhere has to be denied help which he could otherwise receive. We are, as I say, all in it. We may differ about some of the means, but we do not differ about the end, which is further to improve and strengthen the National Health Service that we as a nation run for ourselves.
§ Question put and agreed to.
§ The CHAIRMAN then proceeded, pursuant to the Order of the House this day, forthwith to put severally the Questions:
§ That the total amounts of the Votes outstanding in the several Classes of the Civil Estimates, including a Revised Estimate and Supplementary Estimates, and the total amounts of the Votes outstanding in the Estimates for Revenue Departments, including a Supplementary Estimate, and the Ministry of Defence Estimate, and in the Navy, the Army, and the Air Estimates, be granted for the Services defined in those Classes and Estimates.