CANCER, WALES (TREATMENT AND RESEARCH)

HC Deb 27 March 1957 vol 567 cc1300-10

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

10.41 p.m.

Mr. George Thomas (Cardiff, West)

On 4th March, I asked the Minister of Health the number of vacant beds in tuberculosis sanatoria in Wales. He gave me a most heartening reply in column 11 of HANSARD for that date, as follows: — Mr. Vosper: 658, of which 384 are empty as there are no suitable patients awaiting admission to them. The Welsh Regional Hospital Board is considering alternative uses for some of its tuberculosis hospitals.—[OFFICIAL REPORT, 4th March, 1957; Vol. 566, c. 11.] This is momentous news for a country that has been plagued with tuberculosis. Great tribute is due to those people in the medical profession who have brought about this happy result. They have almost worked miracles in the field of tuberculosis, and they deserve our highest tribute and our heartfelt gratitude.

It is clear from the Minister's reply on 4th March that it is now possible to use at least one large hospital in Wales for other purposes. I am conscious that there are many good and competing causes for the service of this hospital. There are the chronic bronchitis sufferers, people suffering from other chest diseases, and the chronic sick, both young and old. These are all good causes, but I wish tonight to deal with the ever-growing cancer casualties of our community.

The Minister of Health has given me some startling replies in recent days. On 18th March he told me, in column 3 of HANSARD, that in Wales the death rate from cancer of the lung increased from 207 per million of the population in 1950 to 329 per million of the population in 1955, an increase of 59 per cent., I believe that by 1956 the figure is probably over 60 per cent., and I hope that the Parliamentary Secretary may be able to give us the figure when he replies.

This disease of cancer is grasping from our circle more people every year. In Wales alone, 500 more people die every year from cancer now than was the case in 1950. It is not part of my case that the figures for Wales are proportionately worse than they are for England. My submission is that this is a major problem, and it is high time that we had an opportunity to discuss it here in the House.

In this matter, the House is indebted to the hon. Member for Watford (Mr. Farey-Jones) for the part he has played. On 11th February, when the House turned its attention to Welsh affairs, the hon. Member took part in the debate and said: If Welsh Members will take the trouble to look at the increase in the figures for cancer in Wales they will be appalled, and yet at the moment there are no Welsh hospitals, in Cardiff or anywhere else, with adequate facilities, or with research departments, to deal with this dread disease. That is a problem which as Welshmen we have to tackle. This is a disease which is feared, and about which people are inclined to be secret, so nobody bothers to do anything about it."—[OFFICIAL REPORT, 11th February, 1957; Vol. 564, c. 989.] Those were disturbing words, and hon. Members on both sides have been addressing Questions to the Minister of Health on this subject ever since.

The hon. Member for Watford is playing a leading part at the present time, I know, with the voluntary organisations which are seeking to raise the necessary funds to ensure adequate research into the causes and cure of cancer. I admire the work of these people, and I should like to express my regard for what the hon. Member is doing. But I think it monstrous that in Great Britain in 1957 we should have to have flag days and charity appeals in order to conduct our research into the causes and cure of this dreadful disease.

I was ashamed when the Minister of Health told me, as reported in column 7 on 18th March, that The total expenditures from all sources by the Medical Research Council "— in 1955–56 was £2,480,656 and that the expenditure on cancer research was £327,000. He added: In addition to expenditure by the Medical Research Council further substantial sums are spent on medical research in general and on cancer research from private and also from public funds."—[OFFICIAL REPORT, 18th March, 1957; Vol. 566, c. 7.] But the figures from the Medical Research Council seem to me totally inadequate to meet this grave challenge to our people. This is the front line in civil defence in the protection of our British people, and we spend more on preparing for a mythical war of the future than on meeting this cruel enemy that is here today.

This is my main emphasis tonight—that parsimony prevents progress. I want to see a hospital in Wales specialising in the treatment of cancer sufferers. When publicity was given to this proposal in the Western Mail recently, some of our most eminent consultants in the Principality wrote to the Press disagreeing with the proposal. The Western Mail has served as a useful public forum, and I am very grateful to the editor for the way in which this subject has been treated. I give the utmost consideration to the contributions of these eminent men, but I have had the opportunity during the past few days, along with some hon. Members opposite, of discussing this question with some of Britain's leading cancer authorities.

In the columns of the Western Mail one distinguished consultant said: Cancer is best treated in general hospitals by those surgeons and others whose work is in the special region of the body in which the disease occurs. He added: It should be clearly understood that with the complexity of modern surgery there can be no such thing as a cancer specialist. This is a substantial argument from people of standing. It is a point of view. But I submit to the House that it is not the only point of view which eminent people in this worthy profession are holding at the present time. There are today eminent cancer specialists associated with our cancer hospitals. There are already hospitals devoted almost entirely to the care of cancer patients.

Mr. L. M. Lever (Manchester, Ardwick)

Christie Cancer Hospital, Manchester.

Mr. Thomas

I am grateful to my hon. Friend. I had not proposed to name any of the hospitals, for obvious reasons, but I am grateful to my hon. Friend for his intervention. There is a hospital in Glasgow with 100 beds devoted to cancer patients. There is a hospital in Manchester with 260 beds devoted to cancer patients, and there are two London hospitals devoted to cancer patients. Is it psychologically right in Glasgow, Manchester and London, but wrong in the Principality of Wales?

I know that people dread the name of cancer. They dislike going to a cancer hospital. They disliked going to the tuberculosis sanatoria, but we are wiping out tuberculosis—I am not suggesting that the problem is settled by any means, although victory is in sight. If for psychological reasons the name "cancer" is to be left out, so be it, but let us have the facilities. I do not care whether the hospital is in Cardiff, Swansea, North Wales or Mid-Wales, but the Principality needs it.

I will illustrate what is happening in Cardiff. We have one wing of a hospital devoted to X-ray therapy. Eminent consultants with whom I have spoken have asked why there cannot be under one roof a chemo-therapy wing, an endo-chemo-therapy wing, an X-ray therapy wing and a research unit. That would mean that equipment would be centralised and the learned gentlemen who are concentrating on this complaint would meet in the common room to share and pool their ideas.

There is a hoodoo about cancer. It has been surrounded with such mystery that people take their lives for the very fear of it. That is where the present system has brought us. Even the medical profession itself must face the fact that there is an ever-mounting death rate from cancer in this country. In the past five years in England and Wales the increase has been no less than 6,000 deaths per year extra compared with five years ago.

I am told by doctors in South Wales that there is practically no research into this disease in Wales. There is treatment, but no research. I ask the Parliamentary Secretary tonight what plans there are for the establishment of a research unit into this terrible disease in the Principality. I want to see a greater urgency.

My last point is this: it seems that nobody really knows the scope of the prob- lem and how many cancer patients there are in the Principality. Is there a register? I want to know, and people in Wales want to know. Does the Minister realise how many beds are wanted?

My four points, summarised, are: firstly, we ought to be ashamed of the niggardly amount spent in our name on cancer research; secondly, we need to over-ride vested interests where necessary and increase the provision of hospital beds for cancer patients, as in Glasgow, Manchester and London; thirdly, we must have more money so that a cancer research unit can be established; fourthly, there must be a register of those who suffer from this complaint. The only register we have today is the list of deaths published by the Registrar-General.

I have tried to be careful in what I have said to the House, because I realised that this is a delicate subject, but it is one upon which public people have a responsibility to speak.

10.55 p.m.

Mr. Farey-Jones (Watford)

I am very happy indeed to follow the hon. Member for Cardiff, West (Mr. G. Thomas), and I am very grateful to him for his kind remarks. I shall try to compress into three minutes what I would like to say on a subject on which I could address the House for a very long time. I regard the hon. Member's contribution as the first shots at the beginning of a campaign which hon. Members from both sides of the House will continue to fire until the Government form a national cancer policy, because without a national cancer policy, without a complete revolution in our ways of approaching this problem, we have no hope of dealing with it other than in a hopelessly piecemeal way.

It is incredible that in a National Health Service today costing the country £690 million we are this year spending about £300,000—the cost of one school-on cancer. In London, the Chester Beatty Cancer Research Institute is carrying on, as a result of a medical charity of £60,000, in 1957, which is 20 per cent, of our national subsidy for this scourge.

In fairness to the Minister, all I need do is to thank the hon. Member for Cardiff, West (Mr. G. Thomas) for being the first to raise this matter and then give some absolutely official figures which will bring hon. Members up short when they realise what is happening in regard to cancer. These official figures were produced especially for me by the medical fraternity.

In 1927, deaths in this country from all causes were 484,609; the deaths from cancer in that year were 54,078. In 1937, deaths from all causes were 509,574; deaths from cancer had gone up to 66,991. In 1955, deaths from all causes were 518,000; deaths from cancer had gone up to 91,000. Think this out. In 1927, male deaths from cancer were 10.2 per cent., or one in nine. In 1937, they were 12.4 per cent., or one in eight. In 1955 they were 18 per cent., or one in every five. What do these figures imply?

I must give the Minister time to reply, but I have one interesting set of figures from which I will quote three special items. In 1957, for every eleven women dying before they are out of their 50's four are dying of cancer. For every four men dying before they are out of their 50's one dies of cancer. In the year just ended, and certainly in 1957—and worse in 1958—nearly 100,000 people die of cancer in England and Wales each year. This is an important point: of this number, nearly 30,000 are still in what should be the productive years of their life, that is, between 15 and 59.

I need not say more. There is one personal request I would make to the Minister. In 1958, we shall have here in London the International Cancer Congress, the first time it has been held in Great Britain for 25 or more years, I think. I hope that the Minister's Department will underwrite that congress and that the Government will give every facility to the specialists who will come here from all over the world. I hope that as a result of this beginning of our effort the Minister will indicate—as I am sure he is ready and probably only too happy to do—that this dreadful scourge, which is being driven underground from fear and secrecy, will be brought out into the open, and that he will tell us his policy.

11.0 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)

This debate has wandered rather far from the original title which the hon. Member for Cardiff, West (Mr. G. Thomas) chose. I should like to begin by expressing gratitude to him for the courtesy he has shown to me in giving me more than adequate notice of the points he intended to raise. I did not really need such adequate notice. I had seen the cuttings from the Western Mail and his Questions as well. I was fairly well acquainted with the way in which the campaign—if I may call it that—was developing.

My hon. Friend the Member for Watford (Mr. Farey-Jones), in his moving remarks, went into a rather wider sphere. Perhaps he will forgive me if I bring the debate back to the more local question affecting Wales, though I must say that I very much appreciate what he said.

The hon. Member for Cardiff, West quoted certain figures for England and for Wales which show that there has been no marked difference in the growth of the cancer figures in the two countries. There have been certain fluctuations, but they are not unusual or unexpected in this disease. The increasing rates reflect, as I think hon. Members now know, partly better diagnosis, the increasing age of the population and the diminishing death rates from other diseases which have been overcome by modern treatment. They do not necessarily point to inadequate facilities.

It would not be right for me tonight to embark on a full academic discussion from the medical aspect on whether we should or should not have a separate series of cancer hospitals, but I must remind the House that the organisation of the cancer services in the National Health Service was outlined in a Memorandum sent out in 1949 by the Ministry of Health and based on the advice of the Standing Advisory Committee on Cancer and Radiotherapy. The policy laid down then embodied the one main principle that cancer should not be treated as a specialty in itself. A complete cancer service should be provided in each region based on general hospitals.

I am fully aware of the work done by the hospitals which the hon. Member mentioned, and by the hospital in London, all of which have changed their names, for very sensible reasons; but that does not alter the fact that the present, more modern policy is to base a cancer service in each region on general hospitals. We must remember that, however important it is to diagnose and treat cancer, it is equally important to diagnose and treat many other conditions. It is really only in a general hospital that both these objectives can be attained. In a general hospital a patient can receive the more general attention which is needed, and cancer would not then be treated in isolation but in a true relationship to other conditions and illnesses.

Frankly, the claim made in favour of cancer hospitals, that certain special ancillary services could be provided, such as laboratory facilities, medical photography and so on, does not stand examination, because all of these can be provided at a major general centre and they are equally applicable to other forms of medical and surgical work. If I may sum up the changed policy, it is that concentration of this particular disease in one hospital is bad for morale. We must bear that in mind.

I have rather a lot of ground to cover and I must leave that aspect and go on to what is being done to treat cancer in Wales. There are two main forms of treatment, surgery and radiotherapy. Diagnosis is the first step. I am advised that there is no delay in Wales in providing the facilities necessary for the diagnosis of cancer. Investigation of suspected cases receives urgent consideration and is dealt with promptly. I do not think the hon. Member mentioned this, but there are now thirteen cancer consultative clinics in Wales, situated at outlying hospitals and all visited by a radiotherapist from the main centre. That, surely, is the right way to approach this matter. Once the disease is diagnosed the policy is to provide admission to hospital urgently.

It cannot be said that general hospital facilities in Wales are entirely adequate, but, whoever suffers from that inadequacy, it is not the cancer patient. Most are under treatment within three weeks, many in a few days. Although there are no hospital beds reserved specifically for cancer patients, there are 17,000 beds, apart from mental beds, and the cancer patient would receive very high priority.

Although I have given arguments against specialised hospitals, this does not mean that there is not partial specialisation. For example, radio-therapy in North Wales is carried out through the Liverpool and Manchester Regional Hospital Board. That in South Wales is based on the Radio-therapy Centre at Whitchurch, near Cardiff, and Cardiff Royal Infirmary, with a sub-centre at Swansea.

The Whitchurch Centre was opened in June, 1956, and is still awaiting delivery of two cobalt units for treatment by radiation from radio-active material. The centre will then provide a service as good as any in the country. The centre is now fitted with two 300 K.V. deep X-ray sets. Over four thousand M.Gs. of radium is held and radio-active isotopes are being used soon.

There is no waiting list, and patients can be admitted immediately from clinics or other hospitals as the occasion arises.

It is true that there is no specific cancer research unit in Wales. Frankly, this is not a matter which can, or should, be approached on a narrow geographical or nationalistic basis. From the point of view of the patients, it is not relevant where research is carried out.

Research is being carried out, not only by the Medical Research Council, or directly sponsored by the British Empire Cancer Campaign, but by hospitals all over the country, not necessarily specialised under the sub-heading, as it were, of cancer research. There is quite a lot of active work in this field taking place in Wales. In the Welsh National School of Medicine research is being carried out by the Pathology Department into certain specified aspects of cancer. There is another special investigation being carried out under the auspices of the British Empire Cancer Campaign into the differences in cancer rates in North Wales. There is a further project now under consideration for a special investigation at Sully Hospital into cancer of the lung.

Lastly, but by no means least, cobalt units for Whitchurch are being specially designated by manufacturers in conjunction with radiologists there, and their construction alone is a piece of original research which will add to our knowledge of this form of treatment.

I have not been able to cover all the points, but I would like now to come to the question of the establishment of a register. It has not yet been found possible to effect a reasonably good scheme of cancer registration in South Wales, but a start has been made on such a scheme, and the appointment of an officer to undertake the work has been approved by the Welsh Board of Health. In North Wales, cancer registration is working satisfactorily, and I think we can say, although we shall have to watch the position, that the situation is better than it was.

In one of his quotations, from the Western Mail, the hon. Gentleman the Member for Cardiff, West referred to domiciliary visits by a consultant. His words were that he regarded as "haphazard a system which allows anyone to suffer and die from cancer without a domiciliary visit by a consultant". It is open to any general practitioner to call for such a visit to any of his patients who would benefit by it, but it is a fundamental principle of medical practice which we would not want to change to suggest that the consultant should in any way replace the family doctor in regular attendance on a patient—and I do not think the hon. Member wanted to suggest that.

In dealing with the matter of the redundant tuberculosis beds, we have to remember that the majority of these hospitals are miles away from the centres of population, are isolated, and inaccessible to consultant staff. They are equipped to deal only with tuberculosis and are not provided with operating theatres or pathology laboratories, so are not really suitable for surgical treatment of cancer. But the Welsh Regional Board is now giving full consideration to how to use the redundant beds, probably by increasing the turnover of existing beds in general hospitals, thus speeding up treatment for those conditions not receiving the same priority as cancer.

I have tried to cover a few of the points which the hon. Member raised——

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

Adjourned at eleven minutes past Eleven o'clock.