§ Motion made, and Question proposed, That this House do now adjourn.—[Colonel J. H. Harrison.]
§ 9.58 p.m.
§ Mr. James Callaghan (Cardiff, South-East)
It is many years since I troubled the House at ten o'clock with an Adjournment speech, and I am grateful for the facility given to me now. A matter came to my notice in Cardiff some months ago about which I have had correspondence with the Home Office. It is a question in which, I think, an issue of public importance arises, so I bring it to public debate now.
One of the beneficial effects of the setting up of the National Dock Labour Board has been the great interest it has taken in the extension in the docks of welfare and medical facilities which, before the Board's advent, were, in some cases, primitive in the extreme. In 24 of our major ports it has set up medical centres, staffed by qualified nursing sisters, with proper accommodation and good facilities, in which they handle about 230,000 accidents a year which occur in and around the docks. Although, for the most part, it is dock workers who are treated, the centres, like all hospitals, open their compassion to anyone who is injured, and about a quarter of the total number of injuries dealt with by these centres every year are not to dock workers at all.
In Cardiff, we have a first-class port medical centre, staffed by three State registered nurses. They have done wonderful work, as I have seen during the visits I have made to the centre, and to that work I should like to pay tribute. There is one facility——
§ 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.—[Colonel J. H. Harrison.]
§ Mr. Callaghan
There is one facility which the port medical centres are denied. They may not have in their possession supplies of morphine for use in severe 1284 injuries, because it has been the longstanding practice of the Home Office that morphine may be administered only under the direct supervision or control of a doctor. The National Dock Labour Board itself made representations, to the Home Office in 1950, so the Home Office tell me. The Board was refused a supply of morphine. In 1953, it made further representations and was again refused.
There were two reasons given for the refusal, according to the Home Office. The first reason was that the Government have undertaken—let me say at once that I agree with the undertaking—that the use of morphine should be under strict supervision and control. The second reason given is thatconsultation with the medical profession in the past has shown that a weighty volume of medical opinion supports this principle.As to the first, I agree. There must be rigid control over the use of these drugs. However, I hope that it will not be suggested by the Home Office that there are not, at these port medical centres, adequate facilities for supervision. They are, in my view, among the best medical centres in any industrial establishment in the country.
As to the second reason, that a weighty volume of medical opinion has been opposed to what the Board ask, I do not know how long ago this weighty volume of opinion was tested. I have tried myself to test it during the last few months, and I simply do not believe the Home Office reason.
I wrote to the local branch of the British Medical Association, in Cardiff, and asked what its view was. I did not receive a reply, so, obviously, the local branch of the B.M.A. did not feel very strongly about it one way or another. I then went to Dr. Macrae, the Secretary of the British Medical Association. Dr. Macrae wrote me a very full letter in which he told me that the British Medical Association itself had made representations to the Home Office in 1955 and in 1957, asking that supplies of morphine should be made available on a wider basis.
Admittedly, the B.M.A. did not raise the matter of port medical facilities; it was talking about other industrial places where there were medical centres, and asked that morphine should be made available in those circumstances. The 1285 Royal College of Nursing took the same view. Indeed, the Royal College of Nursing joined in the deputation which went with the British Medical Association to see the Home Office official.
Althoagh I have made diligent inquiries, I have not been able to find this weighty volume of medical opinion on which the Home Office retied in turning down the request. I thought that, if I could not find it, I would ask the Home Secretary where it came from. I put a Question to the Home Secretary on 20th March, in which I asked:what is the weighty volume of medical opinion which has led him to deny the use an emergency supply of morphineto port medical centres? The Home Secretary gave me a reply which was, as usual, skilful, but, I am bound to say, evasive. This is an experience which, no doubt, has been shared by other hon. members when they have asked Questions on the subject. He did not give me a reply to the Question I put. He said:It is in general considered desirable thatthese drugsshould be administered by or under the direct supervision of a qualified medical practitioner."—(OFFICIAL REPORT, 20th March, 1958; Vol. 584, c. 160–1.]It was not the Question I asked him, and I did not get a reply to the Question I asked. I asked what was the weighty volume of medical opinion upon which he relied. I merely had a general statement in reply.
The Home Secretary has, so far, brought forward no medical opinion, whether weighty or otherwise, which supports his view that, under properly controlled conditions, such as are found in the port medical centres, which are proper clinics, a supply of morphine should not be available. Thus, the burden of proof lies on the Joint Under-Secretary tonight, if he can, to tell us upon what medical opinion he relies in reaching that decision.
The matter came to a head in October, as far as I was concerned, when a singularly harrowing accident took place in Cardiff Docks. The second mate of a timber vessel discharging overside had his leg caught in a noose in a wire hawser. A crane out of sight from the hold tightened up the noose across his leg and his leg was torn off his body. The man's screams were harrowing to everyone within a reasonable distance. The 1286 nursing sisters came rushing to the scene, because the great advantage of port medical centres is that they are right in the middle of the docks.
The nurses could do nothing about it they had not a supply of morphine. They could do nothing to relieve that man's agony. They had to get him out of the ship, take him ashore, and put him in an ambulance which had to travel over three miles of bumpy dock road to get to the hospital. where a supply of morphine could be injected. There were three State registered nurses on the spot all the time.
There was great indignation in Cardiff about this incident, which I shared. I believe that this man was the victim of inhumanity that has been caused by bureaucracy. I am convinced that no body of medical opinion would fail to agree that a State registered nurse, operating from a port medical centre in a dock where accidents are happening every day, many of them, fortunately, light, others very serious indeed, should not have the power, in an emergency, to be able to use morphine to relieve a man's pain. Indeed, it goes further. The Medical Officer of the National Dock Labour Board has said that in his view the use of morphine in such circumstances would not merely relieve pain; it might be the means of saving a man's life.
In these circumstances, I make my appeal to the Under-Secretary. I know that there are a lot of barnacles clinging to these regulations, but it is the job of Ministers to brush the barnacles off now and again. I am sorry to say that the Home Office is my unfavourite Depart ment. This will probably lead the Under-Secretary into a passionate defence of his officials, but I believe that the Home Office is one Department where the Ministers themselves must, because of the nature of the work of the Home Office, take control of the officials. I believe that the Secretary of State himself and the Under-Secretary together are able to do this job. It is vitally necessary in these circumstances. The Under-Secretary himself is the son of a doctor. He must know much of what I am talking about. He, with his family connections, must have views about this matter.
I believe that the hon. and gallant Member for Croydon, North-East (Vice Admiral Hughes Hallett) wishes to catch 1287 your eye if he can, Mr. Deputy-Speaker, and, therefore, I do not propose to detain the House for long, except to say that common humanity, in my view, demands that this need should be met. It could be met quite simply. All that has to be done is to keep the supply of morphine in the hands of the medical officer, but give one emergency shot and put it in the satchel that State registered nurses have hanging up for an emergency so that they can slip it on their shoulder and run out. Nobody will get very far on one shot, but it could make all the difference in an emergency between agony and, maybe, death and the saving of a man's life and a great deal of pain and suffering.
I am told that I will not get anywhere with my appeal. All those whom I have consulted have told me that the Home Office is far too strong and that nothing will be done. I do not believe it. I have great confidence in the Under-Secretary for one thing, but, secondly, I do not believe that, when a bad case is publicly exposed in this forum, it can for ever sustain the light of reason, justice and humanity.
Whatever reply I get this evening from the Under-Secretary, unless it is satisfactory, I shall go on probing this matter, because it applies not only to Cardiff but to every port which has these medical centres. This is a matter in which the House, if it were fully seized of the position, would ask the Under-Secretary to request his officials in the Home Office to think again.
§ 10.10 p.m.
Vice-Admiral John Hughes Hallett (Croydon, North-East)
I am grateful for the opportunity to support the plea put forward by the hon. Member for Cardiff, South-East (Mr. Callaghan). The hon. Member confined himself to a narrow point, namely, the supply of morphine to the medical centres at docks administered by the National Dock Labour Board. I do not wish tonight to press the matter beyond what seems to me to he a reasonable proposition.
I would, however, say that this question was raised, indirectly at least, in a rather more general form in connection with an Amendment which I moved at the request of the British Medical Association during the Committee stage of the Opticians Bill. That Amendment was 1288 intended to prohibit the supply of dangerous drugs to ophthalmic opticians. One of the objections to it was that, had the Amendment been carried, it would have prevented ophthalmic opticians from being able to use pain-killing drugs in cases when people came to them after, say, an accident in which a splinter had entered an eye, or something of that nature. That was one of the reasons which led to the Amendment being withdrawn.
It certainly appears, therefore, that this is an example of a body of trained people who, although unqualified in medicine, are none the less allowed to administer drugs to ease pain after an accident. It seems hard to defend the anomaly whereby trained nurses who are employed standing by at publicly-controlled medical centres to deal with accidents should be forbidden to administer morphia. In contrast, as the House knows, certain first-aid workers, often, I should have said, with a good deal less experience of accident cases, are permitted to do this very thing.
I also invite my hon. and learned Friend the Joint Under-Secretary to contrast the rather rigid attitude of the Home Office on this matter with the practice of the Armed Forces in time of war. Even as a midshipman, at the age of 16, I was entrusted with a supply of morphia with the idea that it could be given to men who might be seriously wounded; so, also, were thousands of officers in both world wars. I successfully resisted the temptation either to take the stuff myself, to give it to anybody else or to sell it. If there were any cases of abuse, they must have been very few. I have never heard of one myself. I never recall a case being reported where this wartime concesson was abused in any way.
I hope, therefore, that if my hon. and learned Friend cannot give a satisfactory answer tonight—although, perhaps, he will—at least my right hon. Friend the Home Secretary, with his reputation for humanity and kindness, may be moved to look into this matter again.
§ 10.13 p.m.
§ The Joint Under-Secretary of State for the Home Department (Mr. David Renton)
The hon. Member for Cardiff, South-East (Mr. Callaghan) has raised a most important matter which must arouse the sympathy of us all. It is obvious that 1289 when people have sustained grievous physical injury causing them great pain, drugs should, whenever possible, be available and be administered to alleviate that pain unless—and I must stress this—there are important overriding reasons which make it better not to have it that way.
One most important factor which must not be overlooked is that, although morphine does good by alleviating pain, it does harm by masking symptoms which might be important in diagnosis. If, as a result of concealing symptoms, a wrong diagnosis is made, the wrong treatment may be given. Then the person who will suffer is the victim of the accident. This is one reason why we have to tread warily in this matter and why it has been generally accepted by the medical profession, in spite of what the hon. Member said, that wherever possible a doctor should be present when morphine is administered.
Another reason for caution is that this country is comparatively free from the problem of drug addiction. The reason we are comparatively free is the strictness and efficiency of our system of control of drugs. That system is based on the general principle that nobody shall be in possession of a dangerous drug unless authorised by the law in a general way, as medical practitioners are, or specially authorised by the Secretary of State for a particular purpose.
If I may give two examples which I think it may be appropriate to mention, the master of a ship which has no doctor on board is specially authorised in that way and so are certified midwives. Certified midwives have a strictly limited authority for the administration of drugs of this kind, but apart from those exceptions—and there are one or two others which I shall mention—not even fully qualified nurses are allowed to administer any dangerous drugs except under supervision and in the presence of a doctor or dentist.
This is quite a big subject and my time is limited, but the House will realise that our dangerous drugs legislation gives effect to international conventions which this county has ratified and which require the exercise of that stringent control over the supply, possession and use of dangerous drugs which I have mentioned. Within the framework of that legislation, however, special arrangements have been 1290 made for the administration of morphine in particular types of cases. Generally, those special arrangements relate to circumstances where accidents happen and where it would be impracticable or unreasonable to insist upon the presence of a doctor for the administration of the drug.
The hon. Member for Cardiff, South-East mentioned coal mines. That is an example with which I am personally very familiar. Special authority has been given to certain first-aid men in the mines, and the mines concerned are all listed in a very long printed order made by the Secretary of State. Those first-aid men are allowed to be in possession of and to administer dangerous drugs, including morphine, but, of course, even in those cases there are stringent conditions to ensure safe custody so that there is no leakage for the purpose of addiction or illicit traffic. Another example which springs to mind is that of mountain rescue parties.
What the hon. Member for Cardiff, South-East suggests is that special arrangements of that kind should be extended to the docks generally, or I suppose he would fall back on the alternative of certain docks, including Cardiff docks. We are aware that the National Dock Labour Board would like this exception to be made.
I happen to know Cardiff docks; they are very long and sprawling and quite a long way from the town. I know a good many other docks, too. Docks vary a good deal as to their proximity to the nearest town or hospital from which doctors could be summoned. At the moment we have no evidence that the circumstances of docks in general are such as to justify a broad exception to the general principle. I cannot, therefore, tonight give the hon. Member the answer which he seeks, but I can and will now give him some measure of comfort.
I am arranging for the matter which he has raised to be urgently considered, first in relation to docks generally and, secondly, in relation to Cardiff docks in particular. I can assure him that in making those inquiries we shall give the fullest weight to humanitarian considerations and the desire of all of us to minimise suffering. It will, of course, be necessary to consult other Departments as 1291 well as various authorities and professional bodies who are concerned. If any extensive exception is to be made, we may well find that there will be fairly complicated administrative arrangements as to licensing and inspection to be made, and we should have to put up with these complicated provisions if we were to make this special arrangement. It is also right that I should remind the House of our obligations under international conventions and the need to guarantee beyond doubt safe custody of the drugs.
§ Mr. Callaghan
According to my information, there are 26 ports where these centres exist and there are 67 State-registered nurses employed throughout the ports of Britain; so I do not think that it would be a very big exercise, even if they had to be scheduled, and even if some form of inspection had to be made. I am very grateful to the Under-Secretary for what he has said so far.
§ Mr. Renton
I am sure that the hon. Gentleman will appreciate that examining the physical characteristics of the docks is not the only part of the exercise. It is also part of the exercise, as I mentioned, to consult the other Departments which are concerned, including, of course, the Ministry of Health, and we would naturally wish also to consult the professional bodies.
I can assure the House that, in consultation with his colleagues directly concerned in this matter, my right hon. Friend will give the fullest weight to the case which has been advanced by the hon. Member for Cardiff, South-East and so 1292 vividly supported by my hon. and gallant Friend the Member for Croydon, North-East (Vice-Admiral Hughes Hallett). With great respect to my hon. and gallant Friend, I must say that, although I would have been proud to serve under him, even when he was a midshipman, I am very glad that I did not have that suffering which might have tempted him, at the age of 16, to prod me with morphia.
§ Vice-Admiral Hughes Hallett
The morphia supplied in the Services was in the form of a tablet which was sucked. I am not quite clear why that form of morphia cannot be supplied to these only partially trained people, because it was quite effective.
§ Mr. Renton
I am grateful to my hon. and gallant Friend. That is perhaps another factor which should be borne in mind. The form of the administration of the drug which the hon. Member for Cardiff, South-East has in mind is by needle.
That is as far as I can go tonight. I can assure the House that not only has very careful consideration been given to the matter in the Home Office, from the most humanitarian point of view, but we will also bear in mind what has been said tonight, and we will do our best to reach an arrangement which is satisfactory. However, at the same time, we should be neglecting our public duty if we ignored the need for the safeguards which I have mentioned.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-four minutes past Ten o'clock.