HC Deb 25 March 1957 vol 567 cc927-38

Motion made, and Question proposed,That this House do now adjourn.—[Mr. E. Wakefield.]

9.59 p.m.

Mr. James H. Hoy (Leith)

I desire to raise in the House tonight the serious position which has arisen over the appointment of a consultant physician to the two women's hospitals in Edinburgh, namely, the Bruntsfield Hospital for Women and Children and the Elsie Inglis Maternity Memorial Hospital.

This question was first raised by my hon. Friend the Member for Edinbugh, East (Mr. Willis)—

It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed,That this House do now adjourn—[Mr. E. Wakefield.]

Mr. Hoy

— with the Secretary of State for Scotland in December of last year. Immediately after the Christmas Recess my hon. Friend and myself sought an interview with the Secretary of State, and it is only fair, at the beginning of this short debate, to pay tribute to my hon. Friend the Member for Edinbugh, East for the work that he has done in connection with this appointment.

There are in all Scotland only two hospitals where women can be assured of seeing women consultants, and these are the Elsie Inglis and Bruntsfield Hospitals, in Edinburgh. They are both memorial hospitals commemorating two pioneer medical women, Dr. Sophia Jex Blake and Dr. Elsie Inglis. They were established by money subscribed for the purpose of providing medical care for women by women doctors, and the house belonging to Dr. Blake, which is now Bruntsfield Hospital, was gifted for that purpose. It started with 17 beds and now has 81. It is an extremely busy little hospital, serving a very useful function in the City of Edinburgh, and has played a valuable part in the development of medical history in that city.

Miss Margaret Herbison (Lanarkshire, North)

And outside it.

Mr. Hoy

And, as my hon. Friend reminds me, outside as well.

The nucleus of the fund which enabled the Elsie Inglis Hospital to be built came from funds subscribed for the Scottish women's hospitals, which gave such magnificent service during the war of 1914–1918. I ought to say that as a maternity hospital it is the second largest in the City of Edinburgh and deals with about 1,700 cases annually.

With the inception of the National Health Service, in 1948, these hospitals, along with the Deaconess Church of Scotland Hospital and the Longmore Hospital, were placed under the Southern Hospital Group Board of Management. Until now the purpose and the spirit of the trusts upon which both these hospitals were founded have been observed and respected.

Arising from the present situation, by a coincidence the physician consultant to the women's hospitals is about to retire. On this occasion it is right to pay a tribute to Dr. Margaret Martin, who has rendered such yeoman service as the physician consultant in these hospitals. At the Deaconess Church of Scotland and Longmore Hospital the present physician is leaving to take up, I understand, an appointment elsewhere. It was felt that these two consultants ought to be replaced, one dealing with the women's hospital and the other with the Deaconess Church of Scotland and the Longmore Hospitals, as obtains at present.

However, the South-Eastern Regional Hospital Board, despite the recommendation of the Board of Management of the Southern Hospitals Board, decided to amalgamate the two posts. This decision provoked a storm of protest not only in the City of Edinburgh but throughout Scotland. At present, Scottish hon. Members are receiving a tremendous number of protests. Hon. Members often say that they receive hundreds of letters. We are sometimes inclined slightly to exaggerate our case, but I have in my hand at least 90 postcards of protest from my constituents. I see that the Joint Under-Secretary has a bundle in his hand, too. We are not exaggerating when we say that hon. Members have already received thousands of protests.

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

There are many more still to come.

Mr. Hoy

As my hon. Friend says, there are many more still to come.

Within a few days of the announcement, more than 27,000 people in the city, without any organisation at all, signed a petition protesting against the decision and asking the Secretary of State to reverse it. It was not an appeal issued to all and sundry, and it was not done with great organisation, but the response from most responsible sections of the community was amazing.

The protest was supported by the Edinburgh Medical Committee, which represents all the general practitioners in the city. Its reason for supporting the appeal was that it considered that a hospital staffed by women consultants was essential if the best was to be got out of the group in Edinburgh, and it said that there was a necessity to have available in the region at least one woman consultant-physician for patients who wished to consult a woman specialist. The Act will fail in its operation if it does not give the people the service they desire. When it is realised that within the group there are already 31 male consultants while there is only one woman consultant, it can be appreciated how strong the case is.

We also had the support of the Edinburgh Executive Council, a body of lay and medical persons, which also unanimously supported the views of the Medical Committee. We had the support of the Medical Women's Federation of Great Britain, an organisation with more than 2,200 members. We had the support of women's organisations which are held in great respect, such as the Soroptomist Clubs of Edinburgh and Leith. We had the Edinburgh Association of University Women, Co-operative Women's Guilds and the Edinburgh Branch of the National Council of Women, all protesting against the decision which has been supported by the Secretary of State for Scotland. If we consider the individual signatories——

Mr. Willis

I am sure that my hon. Friend will not forget that the Consultant and Specialist Committee itself was against the proposal.

Mr. Hoy

No. I wanted to leave that for a special category.

I want, next, to deal with some of the individual signatories to the protest to show how widespread is the feeling against the proposal. We had the Lord Provost of the City of Edinburgh and the Lady Provost, dignitaries of the Presbyterian Church of Scotland, the Roman Catholic Church and the Scottish Episcopal Church, and, along with the Lord and Lady Provost, magistrates and councillors of the City of Edinburgh.

This is very striking; we had also the signatures of 256 medical practitioners in Edinburgh. The Secretary of State cannot ignore that. We had also the names of 54 representatives of the legal profession and of 407 nurses to this petition. We are always paying tribute in this House to the nursing profession, not only in Scotland but elsewhere. In fact, we had representatives from every walk of public life in the city.

As my hon. Friend the Member for Edinburgh, East said. let us consider the opinion of the Consultant and Specialist Committee of the South-Eastern Region. The Committee has indicated its support direct to the regional hospital boards. Its reasons are: first, the volume of work is too great to be done efficiently for only one consultant to be appointed; secondly, the need for at least one woman consultant physician within that region.

It is a travesty of justice, that, despite the unanimity of this opposition to the proposed change, the Secretary of State upheld the decision of the South-Eastern Region Hospital Board and supported the paltry excuse it gave that here was an opportunity to combine these two posts and then it would be able to pay a larger salary. That was the main argument in Section 5 of the reply which the right hon. Gentleman sent to the protesters. The Secretary of State for Scotland is sheltering behind the decision of the regional hospital board and refusing to accept his responsibility under the National Health Service (Scotland) Act.

I could quote many instances of people protesting against this decision, but I want to quote only two more. One was the summing up in an article in the British Medical Journal,last month in a letter signed by four distinguished members of the profession in Edinburgh. It was signed by two. One was Dr. T. R. R. Todd, an eminent Edinburgh physician whom I know in a professional capacity since I spent four months in his ward. I am grateful for his medical knowledge and skill, and that of Dr. Halliday Croom, and Mr. W. A. D. Adamson the surgeon. One other signatory to the letter was that world famous surgeon, Professor Norman Dott. They said: It would appear from this wide and forceful public reaction that where we have a regional hospital board out of touch with medical and lay opinion, and under-estimating the valuable part played by smaller hospitals in the medical service. Surely no State bureaucracy should assert its authority against the expressed wishes of the people by whom the National Health Service is financed and for whom the National Health Service exists. That sums up in a nutshell the case for the Secretary of State giving way on this issue.

If it does not, may I be allowed to quote the opinion of a distinguished member of the legal profession, Miss Margaret Kidd, Q. C., who, as hon. Members know, has not any association with the political party to which I belong. The opinions I am expressing are those of every Scottish hon. Member of the House, from whichever side. Miss Kidd concluded a letter she wrote to the Scotsmanlast week by saying: To appoint a man consultant to these hospitals must appear to every honest person an outrageous breach of trust. I think that that is very true.

I hope that in the short time at my disposal I have been able to express the opinion of the people of Edinburgh and the overwhelming opinion of the people of Scotland. These hospitals were a trust set up by the women of Scotland and those who supported them, and have been administered so far with great respect to that trust. They have established the need for a woman consultant physician in Edinburgh. The Secretary of State will be betraying this trust if he allows the Board to depart from that.

I hope that the Joint Under-Secretary will not regard this as any personal criticism of himself, but I would much rather that the Secretary of State had appeared at the Dispatch Box tonight, because this was a decision made by him and only he can overturn it. I even challenge the Lord Advocate, as the case I have submitted tonight is not only sound in fact but obviously very sound in principle. It is one against which the Scottish Office cannot place a comparable case. I hope that before the debate ends. the Joint Under-Secretary will at least give us this promise—this the smallest he can give us—that he will take the whole case back for reconsideration.

10.16 p.m.

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

The hon. Member for Leith (Mr. Hoy) has certainly done a service to Scotland tonight in raising this very important matter. As he told the House, in the autumn of last year the South-Eastern Regional Hospital Board had before it these two consultant vacancies in the Southern Hospitals Group. The first was for a post of three half-days for adult work at the Bruntsfield Hospital and the Elsie Inglis Hospital and the second vacancy was for a post of four half-days at the Deaconess of the Church of Scotland Hospital and the Longmore Hospital.

The Regional Hospital Board decided that those two part-time posts should be combined and proposed to advertise the vacancy in the ordinary way as open to applications of either sex. Before reaching that decision, it consulted the board of management which had represented that the two posts should be kept separate and that the post at the Bruntsfield and Elsie Inglis Hospitals should be advertised and restricted to women applicants. That decision was followed by representations to the Secretary of State by the board of management and a number of other bodies, which the hon. Member has mentioned, as well as by hon. Members of this House and a large number of private individuals. Because of the special interest of the board of management, the Secretary of State arranged for its views to be heard. Following that. and after consulting with the regional hospital board, and after considering all the representations received, the Secretary of State wrote to the board of management on 25th February saying that he did not think those representations provided any ground that would justify his interfering with the discretion exercised by the regional board under the powers delegated to it by statute.

Mr. Willis

A shocking decision.

Mr. J. N. Browne

My first function this evening is to make clear the respective positions of the Secretary of State and the regional hospital board in a case of this kind. The National Health Service (Scotland) Act, 1947, places a duty on the Secretary of State to provide hospital and specialist services throughout Scotland to such extent as he considers necessary to meet all reasonable requirements. This duty was delegated to regional hospital boards by Regulations made in 1948.

The terms of the Regulations are to the effect that the regional hospital board shall exercise on behalf of the Secretary of State the functions of the Secretary of State relating to hospitals and specialist services. It is therefore the duty of the regional board to plan these specialist services in its region, to decide where posts will be established and how they will be organised. It advertises vacancies and is itself responsible for making appointments in accordance with the standard procedure laid down by Regulation.

Where does the Secretary of State stand in all this? It is clear that he cannot intervene in the day-to-day exercise of the functions which he has delegated to the board. Every Secretary of State since the National Health Service began has respected the duty and the right of the regional boards to exercise their own discretion in the performance of their delegated functions.

This does not mean, of course, that the Secretary of State stands aside entirely. His Department is frequently consulted by regional boards about their specialist services. He himself can advise and recommend, and in the ultimate he can direct. But to override the decision of a responsible body exercising its statutory functions as it thinks best is a serious matter. The Secretary of State would have to ask himself whether the regional board has taken a decision which is reasonable or one which is so completely at variance with the facts of the situation that it cannot be defended on any reasonable grounds. This is the question which the Secretary of State has had to ask himself in this particular case.

Let us consider the main representations which have been made. The board of management represented that a woman candidate might not be successful in open competition. If this should happen, then there would be a break with tradition at the Bruntsfield and Elsie Inglis Hospitals, and women in the South-Eastern Region would be deprived of the services of any woman physician of consultant rank. Such women physicians would then be available only in the Western Region. There are none now in the Eastern, North-Eastern or Northern Regions.

The board of management took the view that if there were a woman available who could be regarded as suitable for appointment, she should be appointed even if she might not be succesful in a competition open to either sex. The board, therefore, proposed that the two posts should be kept separate and that the post at Bruntsfield and Elsie Inglis Hospitals should be advertised as restricted to women applicants only.

The main burden of the representations from the various women's organisations is the desire of many women to be treated in a women's hospital by women consultants. The regional hospital board is fully seized of the value of special hospitals for women and there is no suggestion of restricting their functions or frustrating their development. The board also knows that there is a demand for the services of a woman physician in Edinburgh.

It is clear, however, that the regional board finds this the crux of the matter. The demand for the services of a woman consultant physician is there, but it is limited. The bulk of the work is at the Bruntsfield Hospital, where there are only nineteen medical beds; and in 1956 there were only eight or nine new medical outpatients on the average each week. The services of the medical consultant are required at the Elsie Inglis Hospital from time to time. Though this is a matter on which I know the strongest and most sincere opinions can be held——

Mr. Hoy

The hon. Member is getting his figures wrong. The consultant physicians say that new patients for the year 1956 were 416, out-patients' attendances were 2,292 and patients admitted, although the wards were closed for four weeks, were 253.

Mr. Browne

I assure the hon. Gentleman that my figures are correct, as he will see if he looks at HANSARD.

I said that this is a matter on which the most sincere opinions can be held. It is well to get the facts in their true perspective, however. Apart from consultations there are, in Bruntsfield, only nineteen medical beds compared with 1,001 medical beds in Edinburgh. There are eighty-one beds in Bruntsfield in all, and the other sixty-two beds are not affected by the decisions of the regional hospital board. They are still staffed by a woman surgeon and a woman gynaecologist. All the sixty-eight beds in the Elsie Inglis Hospital are staffed by women. These facts have not always been clearly brought out in the representations which have been made.

Other representations which have been made are, first, that it is a break with tradition, but at any one time the regional hospital board must deal with the facts as it finds them. The appointment has not yet been made and it might still be a woman.

Willis: Never.

Mr. Browne

If a man is appointed his successor might be a woman.

This has also been called a breach of faith. As for the legal position, the National Health Service Act did no more than vest the hospitals in the Secretary of State. There is no statutory obligation to carry out the intentions of the original founders of these or any other hospitals, though of course this is done where it is reasonable and at all possible.

On the question of salary the regional board and the board of management have assessed the services at these women's hospitals as requiring a post remunerated on the basis of five half days out of eleven. This post is less than half time. The salary would be, in round figures, £1,100 to £1,600. This certainly would be very unlikely to attract anyone who was already a consultant. Indeed the starting salary of £1,100 is no higher than that of a senior registrar, so that the post would have a very limited appeal.

The regional board found itself driven to the conclusion that in the present circumstances the Bruntsfield and Elsie Inglis post alone would not attract a wide enough range of applicants of satisfactory quality from which to choose. It must always have regard to its obligation to obtain for the consultant service the highest level of ability and experience it can get in the interest of the patient including those at the Deaconess and Longmore hospitals. They took the opportunity therefore of combining the Bruntsfield post with the other vacant post in the same hospital group.

The salary for this combined post would be £2,100 to £3,100 on a whole time basis or about £1,800 to about £2,600 on a maximum part time basis. The Regional Hospital Board considered that a post of this broad scope and of this salary would, if open to either sex, attract a consultant of the highest calibre.

It was represented also that the regional boards were prejudiced against women consultants. I have found no evidence of this. That particular regional board recently appointed a woman consultant surgeon in the same hospital group after open competition to which in that case neither the board of management nor anyone else took exception.

In the present case the regional board has asked me to emphasise that should a woman candidate prove herself worthy in open competition she will be appointed to the post with its fullest confidence.

I maintain that the Secretary of State's decision was the right one and the only possible one. I am however grateful to the hon. Member for raising the matter and for giving me an opportunity to explain both the regional board's actions and the Secretary of State's position.

10.28 p.m.

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

This is a most unsatisfactory answer. The hon. Gentleman, in the arguments which he has advanced, has not said one word about the wishes of the doctors in Edinburgh or about the body of skilled and technical opinion which is against this decision; or about the women in Edinburgh who want a woman consultant. This is an arbitrary decision by a regional hospital board. There is only one democratic way which can be effective for the people who are supposed to be served by this board. The only democratic manner is through the Secretary of State.

In a case like this, where we know the universal wish of the patients and of the citizens of Edinburgh, where we know the considered opinion of the vast bulk of medical opinion, the hon. Gentleman was not able to quote one single medical body which approved of his decision. In such a case as that it was surely obligatory, if there was to be any democratic control of the National Health Service, for the Secretary of State to have advised the regional board along the lines which most people wanted.

Letters appeared last week in medical journals on the matter. I do not know whether the hon. Gentleman has seen them. This is not a matter of a few disgruntled women, for women all over Scotland have come to these hospitals because they wanted to be treated by a woman consultant physician. That may be right or wrong. Some women do not like being treated by male doctors and some men do not like being dealt with by women doctors——

The Question having been proposed at Ten o'clock and the debate having continued for half an hour,Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.