HC Deb 18 December 1958 vol 597 cc1376-88

3.10 p.m.

Mr. Victor Yates (Birmingham, Ladywood)

I am grateful for the opportunity to raise once again the question of the urgent need for additional hospital services in the City of Birmingham. I am sorry that I have not been able to report more progress in this matter, because the Parliamentary Secretary knows quite well that in the last five years I have consistently raised this question. The fact that there are many thousands of people in and adjoining the City of Birmingham who are suffering unnecessary pain while awaiting operations and facing considerable inconvenience and dangers is, I feel, some reflection upon the Government and the Minister of Health.

I want to raise three aspects of the matter. I know that my right hon. Friend the Member for West Bromwich (Mr. Dugdale) is anxious to say a few words in this debate, but in so far as the Minister can give us hope of relieving the pressure in the three sections to which I propose to refer it will, I am sure, be of assistance not only to West Bromwich but to other adjoining areas.

I have raised the question about patients in the City of Birmingham many times in the past. I have asked Question after Question about the Selly Oak Hospital, Birmingham. I know quite a lot about this hospital because I live very close to it and, unfortunately, I have had continuously to accompany a relative over the past twenty years to its out-patients' department. Therefore, I do not need any evidence beyond my own personal experience.

Selly Oak Hospital was built under the old Poor Law system. It was never intended for the treatment of casualties or outpatients. Therefore, it never had an outpatients' department. The present outpatients' department of the hospital consists of two old wards one above the other. The fact that during the first nine months of this year 63,568 attendances were made to the out-patients' department and that 30,368 people attended the casualty department will give the House some idea of the enormous strain being imposed upon a hospital that was not originally equipped with an out-patients' department or a casualty department. Any relief that can be given to Selly Oak Hospital will bring a compensating relief to other hospitals.

The Birmingham General Hospital is dealing with more than 2,000 casualty cases a week. The accidents hospital is dealing with casualties from all over the Midlands, and here we have a hospital which was never built for its present purpose urgently in need of an out-patients' department. Nearly 100,000 people attended either as out-patients or casualties in the course of nine months. One lady recently wrote to me saying that she had attended the hospital as an outpatient for many years. She said: I wear a caliper and I have had one or two minor falls climbing those steps. I marvel that some of the dear old souls of 70 etc. do not have many a serious fall. This proves the need for an adequate outpatients' department.

I do not wish to enter into recrimination. The Minister knows perfectly well that there has been delay. There should be no further delay because my information is that the hospital management committee and the regional hospital board have given all that they have been asked to give. They have given information and have submitted to all the requests from the Ministry. It now only remains for the Minister to say that the project is now approved and that there is no further administrative obstacle to the provision of this urgent need.

The second hospital to which I wish to refer is the Little Bromwich Hospital, Birmingham. The hospital was originally an infectious diseases hospital, with only a very small operating theatre. It was never intended to be used as a general hospital, but as the infectious diseases have declined it has really taken on the rôle of a general hospital. It is quite incapable of catering for all the cases which need operations.

The Minister gave some figures and he knows that the number of operations performed at the hospital in 1953 was 469. During the eleven months of this year that number rose to 1,098, which means that the doctors and nurses working in this small operating theatre are working in difficult conditions and are faced with a waiting list of some 100 patients. I have seen the operating theatre and the inconvenience and difficulty under which the staff has to work. The greatest tragedy of all is that the hospital cannot deal with surgical emergencies or casualties. It cannot possibly relieve the tremendous strain being placed on other hospitals.

There are many cases of hernia, of people in considerable pain and of working men waiting to be restored to good health and who cannot be attended to because the hospital just cannot perform any more operations than it is performing at the present time.

The Minister has said that plans to deal with the situation were seen in January of this year. I think that there has been an almost unforgivable delay. Even if the regional hospital board is guilty of delay due to difficulties which I know, of course, that it has experienced, that does not excuse either the Minister or the Ministry for allowing the delay to continue.

Every time that I raise the matter with the Minister he tells me, "We are pressing on with this as fast as we possibly can." All we want the Minister to do is to approve an additional operating theatre. The management committee and the regional hospital board are agreed on the subject, and surely the Minister himself ought now to agree.

The third hospital I wish to mention is the Birmingham Dental Hospital. The Minister knows that some twelve months ago I raised the question of this hospital on the Adjournment. I hardly think that I need explain to the Minister or to the House the need for a new dental hospital. I would refer the Minister to a letter in the Manchester Guardian of yesterday and ask him to examine carefully what it says. It is a long letter from a Mr. Frederick Ballard, who, evidently, has considerable knowledge of the dental service. His letter refers to the care of children's teeth, and the first paragraph of it states: Unless more serious and realistic thought is given to the provision of preventive dental services, we are likely to run into the most absurd and costly failure ever experienced in this field. The facts are patent and grim. Most distressing and critical is the increasing incidence of dental caries in young mothers and pre-school children. School entrants have more decayed and missing deciduous teeth today than ever before. While statistical accuracy is wellnigh unobtainable, it has been stated officially that the reparative needs of the whole child population of Great Britain is met only to about one-third. That is true, and it is true of Birmingham.

A year ago the Minister told me that he would come to Birmingham and would accept my offer to escort him, but he has not yet come. I extend the invitation to him again even now, before he tells me this afternoon that the Ministry are to approve of a new dental hospital being started immediately. I think that he will see, if he goes to look at this hospital, a most disgraceful and disgusting state of affairs that one could find in any hospital anywhere.

I should like to say that the dentists at this hospital, and the doctors and nurses of the two other hospitals that I have mentioned, are among some of the finest in the whole service. I pay great tribute to their patience and endurance, because, as the Minister knows no addition can be made to this hospital or any improvements at all. It is quite beyond improving, and, in any case, owing to a street widening scheme, it will have to go.

Today, I am informed that on 1st December, the number of people on the waiting list for treatment at this hospital was 1,449, and, in 1957, the Parliamentary Secretary, who is to reply to The debate today, told me that he and his right hon. Friend would ever be mindful— not to let this most important matter take anything like a back seat in our calculations."—[OFFICIAL REPORT, 11th December, 1957; Vol. 579, c. 1400.] A back seat, indeed. I come to him one whole year later, because, a week ago, he could not tell me that the Ministry is willing to approve the final plans for this hospital.

My information is—and I can assure the Minister that it is on good authority—that during this year, after I raised this matter, there have been many meetings between his Ministry, the regional hospital board and the University Grants Committee, and that on 2nd June, 1958, what was thought to be a final meeting took place, at which it was understood that all was approved, and that all they had to do was to wait for Treasury sanction. On 19th September, the regional hospital board received a letter which contained these words: We"— that is, the Ministry of Health— and the University Grants Committee are prepared to accept your answers on the points left outstanding. What impression could we get except that all was now approved? On 19th September, they asked for the sketch plans, which were sent on 11th October.

My anxiety and that of the regional hospital board and of all the dentists in the city, is that this new dental school will take two and a half years to build, unless the Minister and the Treasury give their sanction very quickly, within the next week or so. In fact, it wilt delay the building of that hospital by one year. I am told that the University Grants Committee and all concerned are agreed that the intake of students to this hospital will be 80, instead of 40 as at present. These dental students are needed, because dentists are needed, not only in Birmingham but all over the country, and this is a contribution to the whole country which we are asking to be allowed to make.

There are far more students who apply than can possibly be accommodated. At present, 40 are taken, and the authorities want to take 80. They want them to be allowed to do their first year at the medical school to study physiology, and anatomy so that they can go the following year into the dental school. All that we are asking is that the Minister and the Treasury shall give their sanction and enable them to do so immediately.

That is my case this afternoon, on these three important and vital aspects affecting the health of the men, women and children in the City of Birmingham. I say to the Minister that I would be delighted if he would tell me this afternoon that he would go to look at these three aspects of the situation in Birmingham. I should be glad if he would go with me, and I ask him again, because I am convinced that he need spend only 15 minutes at the dental hospital and 15 minutes at the other two hospitals to see all that is necessary to convince him of this vital and urgent need for the City of Birmingham.

I ask him, whatever he says to me, to give me an assurance this afternoon, and certainly before Christmas, that will give to all the doctors, nurses and other people at this hospital who are trying to battle against almost insuperable difficulties, hope for the future. I ask him that he should not expect me to apply for yet another Adjournment debate—after all, I have had two. Let me have something definite. I do not mind how the hon. Gentleman knocks me about. He can be rough with me, though he is a very courteous man, and always gives me a most courteous answer, but I do not mind, even if he is rough, if he will give me the answer "Yes," which will give some hope to Birmingham. I therefore appeal to him to do his best to assist Birmingham to overcome these difficult problems.

3.26 p.m.

Mr. John Dugdale (West Bromwich)

My hon. Friend the Member for Birmingham, Ladywood (Mr. V. Yates) has made an overwhelming case for the Minister trying to do something, not only for Birmingham, but, as he has said, for the adjoining areas, because the situation in Birmingham is reflected in many other areas. The West Bromwich Hospital District, about which I want to speak, includes not only West Bromwich itself, but Oldbury—and I see that my hon. Friend the Member for Oldbury and Halesowen (Mr. Moyle) is here—Wednesbury, Smethwick, Tipton and part of Handsworth, which is a very large area.

I will make my remarks practically in telegraphic form, because I do not want to take a very long time. I want to deal first with cases of tonsils and adenoids. There are 670 children waiting for operation in this area, and some of them have waited for as long as ten years. That seems to be a very serious matter. I know that a great deal more is now being done as a result of very strong pressure by the regional hospital board, and I myself have put a Question on the matter recently. I understand that the Board is now to be able to do something to overcome this terrible long waiting list.

Next, I turn to the chronic sick. According to the circular H.M.86 of 1957, the Ministry says that there should be 1.2 beds per thousand of the population. On that basis, there should be 270 beds for West Bromwich, but there are in this district, not 270, but only 75 beds. Even that very small number of beds has been achieved by "stealing" 24 beds from from post-operative cases, so that some people who have recovered from operations have to leave earlier than would otherwise have been the case, because the beds have been taken, and quite rightly taken, for the chronic sick.

I want now to turn to the mental hospitals and refer to Birmingham itself. All Saints' Hospital takes people from the adjoining areas, and it is now unable to take all the people who want to go there. It is unable, in particular, to take women voluntary patients, and can take only very few men. The result, as I think the Minister will agree, is most unfortunate. Mental patients who cannot be taken in voluntarily, have to be signed in on a three-day order as compulsory patients, with all that that implies. They go into the hospital under an order and, at the end of three days, they may be kept on voluntarily if they are unsuitable to be discharged. I feel that to be a most serious state of affairs.

There is one other point to which I want to refer, and it is an individual case. I do so because it shows the appalling difficulty there is in finding accommodation. A certain Mr. Callaghan, of 24, Brindley Road, West Bromwich, an iron moulder, had very serious ear trouble, and went to see an ear specialist, originally, on 13th August. The ear specialist was a Mr. Dunn. He was told that operation was necessary and that he would get a bed within one week at the Birmingham Ear, Nose and Throat Hospital. At the end of the week there was no bed.

On 17th September, over a month later, when he was having very great difficulty in breathing, he saw a specialist privately. The specialist said that he could be admitted as a private patient after five days to the Birmingham Ear, Nose and Throat Hospital, but if he wanted to come as a public patient the specialist could do nothing about it at all, because there were just not enough beds for the public patients. Mr. Callaghan had therefore to go as a private patient since he was seriously ill and had been advised to go into hospital at once. He had to pay a sum of £36 in all. I cannot think that is a satisfactory state of affairs. It seems most unsatisfactory.

These are the points, which I have put as shortly as I could, to illustrate the very great difficulties there are in this area. Apparently the Minister has not fully realised them as yet. Pressure has induced him to take action in the case of the long waiting-lists for tonsil operations, but not in other cases. I beg him to come down to Birmingham, and indeed to West Bromwich as well, to see for himself exactly what the situation is, and then to act and act quickly. I do not expect an answer from him this afternoon, as he may not have time to give it, but the best answer is action, and that is the answer we want.

3.32 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)

In view of the lateness of the hour and the shortness of the time, I will eschew the customary courtesies and will endeavour to give both the hon. Gentleman and the right hon. Gentleman the best reply I can in the briefest time.

Before I refer to the three schemes to which the hon. Member for Birmingham, Ladywood (Mr. V. Yates) devoted most of his speech, I would speak in general about the activities of the Birmingham Regional Hospital Board. We must not be too limited or parochial in our attitude; the board caters for a population of 4½ million people and is responsible for 220 hospitals. It is obvious that in its arrangements for hospital provision in Birmingham the board has to look at the whole picture, and although it may sometimes appear that particular local aspects are not getting the attention they deserve, the region has to be looked at as a whole. We need a sense of perspective here, and should realise that activity in one sector probably serves a need in another sector as well.

We ought not to underrate the achievements in Birmingham since the start of the National Health Service. Since 1948, £2½ million has been spent on various capital works at different hospitals, excluding mental hospitals, in Birmingham itself, and many sizeable schemes have been completed. I am not fully satisfied and am not in the least complacent about this. Of course, we need new out-patient departments, operating-theatre suites and other units; emphatically we do. Our hospital building programme is being expanded to provide such additions and improvements, many I agree overdue.

It would be relevant to refer to the announcement made by my right hon. and learned Friend only yesterday, in reply to a Question about the future capital expenditure in England and Wales on the hospital programme. He announced that this capital expenditure was to rise from £22 million in 1959–60 to £25½ million in 1960–61. Birmingham hospitals have had, and will continue to get, a good share of this available extra money. I have had a look at the figures, to break them down for the purposes of this debate and to see what this increment would mean for Birmingham. It means, apart from major schemes and centrally-financed items, an increase of about 15 per cent. in Birmingham's 1960–61 allocation over its 1959–60 allocation.

Since 1949 the board has provided 300 more general hospital beds in Birmingham. In the same period—I think this is very important—nursing staff has increased by 800, which is roughly 25 per cent. In the same period, there has been a very substantial increase in senior medical staff, that is to say consultants and senior medical hospital officers. In the Selly Oak and Dudley Road groups, this increase has been equivalent to 27 whole-time staff, or over 30 per cent.

Hospital improvement is not only to be measured in terms of the number of beds available, but by improved capacity to treat more patients, whether as inpatients or out-patients, than in 1949. I join in the tribute of the hon. Member to the nursing and medical staff, who have been working under considerable difficulties. We have certainly had very much more efficient use of beds. With additional nursing and medical staff there has not been any decline in quality of treatment.

Waiting lists are a perpetual source of worry and frustration, and it is true that there have been long lists for admission to certain hospital departments, but no urgent case waits long and emergencies are dealt with immediately. What strikes me in considering these waiting lists is that the waiting list at the non-teaching general hospitals in Birmingham has fallen by 40 per cent. between 1949 and September last, the latest date for which I have figures. I think that is a very creditable achievement. We should like to see it better. We shall never be satisfied in this respect, but it shows that the graph is going the right way. Certainly deficiencies exist, but the problem is being energetically tackled and we can already see some results.

Before I say a word or two about the three principal schemes which the hon. Member had in mind, I should point out that while it is the duty of my right hon. and learned Friend to encourage necessary new development, it is also his duty with the help of the regional board, to see that available money is wisely spent. This inevitably involves very close scrutiny of development schemes to ensure that those developments are properly related to the needs of the area concerned and to other hospital facilities nearby and that they are soundly planned and within available financial resources.

It is interesting to note that in this debate we have heard an hon. Member and a right hon. Member quite properly, pressing the claims of the areas of their constituencies for additional development. Both those areas come under the regional hospital board, who have the difficult task of holding a proper balance in the use of the available resources between the two. I should be in trouble with one or other if we found that too much was going to one or the other.

The points I have made are relevant in considering the case for an out-patients department planned for Selly Oak. I know the condition and age of that hospital, but it is being planned as a main centre for out-patients consultation in south-west Birmingham, at a cost of £350,000. As I explained to the hon. Member in reply to a Question on 8th December, it was necessary for the regional board to consider this scheme in relation to other hospital provision in Birmingham, including two other major schemes under consideration. This involved much local consultation at a time when, as I explained to the hon. Member, headquarters medical staff was severely depleted.

I wish to pay tribute to the assiduity of the board in trying to overcome this handicap and trying to get through its work at a time when it is short of staff. I happen to know that many of the discussions relating to these matters have been held on Sundays, and one was on Whit Sunday. I make that point because I do not want it to be thought that any grass has grown under those feet while this matter has been under consideration. In the event, the board has sent us within the past week its observations on the points raised by us earlier in the year. These cover a number of subjects, but we shall consider them with all speed, because both the board and ourselves are most anxious to press on.

The Little Bromwich case was a matter of the new operating theatres. I certainly appreciate the tremendous strain under which the hospital staff there are operating. The regional board's original scheme was, however, for an advanced experimental design of theatre which had to be abandoned because it was too costly. Sketch plans of the revised design were submitted in January, 1958, but these appeared to us unnecessarily costly. I am happy to say that the differences have now been resolved and that the Board—I am sure that the hon. Member will be glad to hear this—is now authorised to prepare working drawings. This is not a replacement of existing services, but part of a plan to expand an old infectious diseases hospital into an acute illness general hospital.

Since our Adjournment debate on the Birmingham Dental Hospital a year ago, agreement has been reached on the size of student entry. In the light of that decision, plans were discussed, as the hon. Member said, with the board of governors on 2nd June last. The matter was not quite settled at that stage. Modifications resulted and were incorporated in fresh plans, which reached the Department on 13th October. These are now being studied to determine with the University Grants Committee the share of the cost which is a proper university responsibility.

Here again, I assure the hon. Member that we accept the urgency and we shall proceed with all possible speed. This is a £1 million scheme and one of the reasons which involved additional delay was that in seeking to accept the findings of the McNair Report and to step up the facilities for the training of dentists, we have in the event greatly enlarged the proposed capacity to train students in this hospital. That is one of the points with which the hon. Member was concerned.

The hon. Member mentioned also the question of waiting lists. It is, however, fair to point out that we are dealing here with a teaching hospital whose main function is to train students, not to provide general dental care, although I freely admit that it is making a valuable, irreplaceable contribution on that front in Birmingham.

The hon. Member chided me with not having visited Birmingham after his courteous invitation last year. On the whole, however, I have done the hon. Member rather well. It is true that I did not go myself. My right hon. and learned Friend went and I should have thought that the hon. Member would feel that it was the sorcerer and not the apprentice who made the visit.

Mr. Yates

The Minister wrote and told me that he could not come. Although he was, in fact, in the area, he did not come to the dental hospital.

Mr. Thompson

I have a copy of the letter with me. It is expecting a little too much that specific individual hospitals can all be visited when a Minister visits a region. My right hon. and learned Friend did go, however, and he is in no doubt of the situation concerning the dental hospital.

I hope that the hon. Member will acquit me of discourtesy if I reply in only a few words very quickly, to the points which he rapidly made. The waiting lists in respect of tonsils and adenoids are being reviewed urgently. The regional board has applied for authority to appoint an additional anaesthetist. As the right hon. Member for West Bromwich knows from a written reply, two extra operating sessions per week are to be provided. This should give some relief.

The right hon. Gentleman correctly stated the figures in respect of the chronic sick. The regional hospital board has recently set up a regional advisory committee on geriatric services and the geriatrician to the West Bromwich and District Hospital Management Committee is a member of this committee. One of the matters for its consideration is geriatric services in the West Bromwich area, including the proposal to provide new accommodation for chronic sick at Hallam Hospital.

The hon. Member raised with me the case of one of his constituents who had been denied entry to a hospital. I ask him to let me have the details. I will most gladly look into it.

I must conclude, because I shall incur your displeasure, Mr. Deputy-Speaker, if I proceed further. Apart from the three major schemes in which the hon. Member for Ladywood was interested, my right hon. and learned Friend's statement yesterday indicated that the board of governors are being authorised to proceed with the planning of a new radiotherapy centre to serve all Birmingham, and the regional hospital board, in addition to the further rebuilding of the Coventry and Warwickshire Hospital, which I agree is outside the area which we are discussing today, are being authorised to proceed with further development of the Good Hope Hospital, Sutton Coldfield, which I am sure will help to relieve pressure on the Birmingham General Hospital.

When we consider the full implications of the statement made yesterday, together with the assurance which I have been able to give to the right hon. and hon. Members today, I hope that we can honestly say that progress is being made. that all these matters are very much in our minds, that the necessary financial assistance is forthcoming and that we are pressing on with them with a sense of due urgency.