HC Deb 24 June 1958 vol 590 cc384-92

Motion made, and Question proposed, That this House do now adjourn.—[Sir G. Wills.]

10.21 p.m.

Mr. Arthur Pearson (Pontypridd)

I sought this opportunity to raise the matter of the insufficiency of the medical staffing at the Graig Hospital, Pontypridd, because of a widely-held view that the time is overdue for this hospital to have a full-time medical staff. The hospital management committee, too, has held such a view for some time past, and repeated representations have been made to the Welsh Regional Hospital Board—all to no avail.

Like most hospitals of its vintage, the Graig Hospital is a barrack-like building. On the other hand, since the National Health Service Act, 1946, I am conscious that much good work accomplished has been directly due to the quality of the people serving the hospital. All honour to those who have done so much.

In the main, the hospital is for chronic sick, and caters for a thickly-populated industrial area. The hospital load itself is, no doubt, coloured by the consequent social and environmental factors. There are 283 or more beds, of which 180 are classified for the chronic sick, 64 for general medicine, and the rest for other illnesses. However, the position of the chronic sick is so desperate that the beds are most probably filled with that type of patient. One is pressingly aware of the urgency of this problem, because of an ageing population and because present-day social trends make it increasingly difficult for people who are seriously ill over a long period to be cared for in their own homes.

At present, in this hospital of at least 283 beds, two local, busy and, I may say, very respected general practitioners are giving eight sessions each week, Which amounts to about 28 hours. When I raised the matter at Question Time on 20th May, the Parliamentary Secretary informed me that an additional consultant had been appointed. I must point out, however, that such a consultant is to give only one session of three hours per week. To me, that has just a flavour of paint and unreality. With this totally inadequate concession, the Welsh Hospital Board propose to defer consideration of any further appointment pending experience of the effect of this increase in staff, and the result of the general review of hospitals for the chronic sick now in progress—in that area, I take it, or in the whole of Wales.

I submit that the effect of this appointment is easily assessed, as it means only three hours a week of the consultant's time. Clearly, therefore, it will not fulfil the medical needs of the hospital.

On the question of the general review of the services for the chronic sick and, possibly, the acceptance of the urgent need for complete revision of these services, what hope does the Parliamentary Secretary hold out that money will be made available for a full-time medical staff and at least of a consultant geriatrician at an early date? The point at issue is that of an adequate medical staff to investigate the condition of each sick person, with ancillary staff to ensure whatever degree of rehabilitation is possible.

So many of the chronic sick at Graig Hospital are the silent people who have not spoken yet. They are grateful for the kindness and the skill shown but would appreciate further arrangements for a periodic medical check-up. My concern is to improve the facilities, and though one might be critical, this does not involve failing to give credit where it is properly due. Is not the present part-time medical staff too hard-pressed to give the detailed attention needed? Is the care of the chronic sick in this area the Cinderella of the National Health Service Act, 1946? Certainly the medical staffing has been niggardly, and its improvement is essential. For the patients and their near ones there is the need that they should feel that behind the sick is the fullest medical provision possible.

Much of the value of hospital treatment like that at the Graig Hospital, if it meets the needs and aspirations of the family and friends, is of great value to the morale of a large industrial area like this. Proper geriatric treatment is sadly lacking, though I am glad to admit that nursing and food are first-class.

I want to put a question on the wide variation in the standards of medical staffing between this and similar types of hospitals. What variation in the nature and amount of work done is there between that in the Graig Hospital, with over 283 beds, with only a part-time medical staff, and, say, St. David's Hospital, Cardiff, where there are only 194 beds for the chronic sick, with three full time medical officers, that can warrant the denial much longer of a full-time medical staff in the Graig Hospital?

A more vigorous interest is developing in the hospital care of the chronic sick in the area concerned. Relatives and friends want the reassurance which is so helpful in giving a sense of satisfaction. I believe they are entitled to have it. I am very disappointed that the Welsh Regional Hospital Board has given such faint indications, judging by the staffing standards, of fulfilling the Ministry's aims in the geriatric services and the care of the chronic sick as set out in the memorandum of 7th October, 1957. Much firmer lines of advance should be forthcoming for this hospital.

I trust that the Parliamentary Secretary can give me real hope that something will soon be done in the matters that I have brought to the notice of the House. I feel from the depth of my heart that it is a sore and pitiless prospect if there cannot be provided for a hospital of this nature containing over 283 beds a full-time medical staff.

10.30 p.m.

Mr. Iorwerth Thomas (Rhondda, West)

My hon. Friend the Member for Pontypridd (Mr. Pearson) has presented a very strong case to the Minister for his very serious consideration. It requires no eloquent plea in the wake of what my hon. Friend has said, as the facts speak for themselves. If only the House could appreciate the psychology that has been centred around this hospital for many years prior to the introduction of the Health Service. There has been a very strong prejudice against the hospital owing to its antecedents.

The local hospital management committee has been very much aware of this fact and has concentrated a great deal of its efforts in attempting to break down that prejudice which has been lodged in the minds of the people in the valleys who avoid the hospital. The committee has succeeded to a very large extent in overcoming the reluctance on the part of people to go to the hospital because of its past reputation.

The hospital management committee should give far more serious consideration and weight to the knowledge of the people on the spot and should attempt to meet what in my opinion, particularly in the light of what my hon. Friend has said, is a very modest request.

One of the weaknesses of the present administration of the hospital—and I speak with the greatest respect for the two medical practitioners who have been elected to work at the hospital—is that it cannot work very successfully. Here we have two general practitioners in a very largely industrialised area in South Wales who from general reports about which we read are so much involved in their general practice that they have little time for leisure.

If that is the case—and that is the conclusion one must come to having read so many reports about the arduous responsibilities of general practitioners—these two doctors can give the attention required from them at the hospital at the expense of their general practice. They are therefore faced with a dual loyalty, a loyalty to their general practice and a loyalty to the hospital. Quite frankly, their first priority must always be their general practice, because that depends on them giving their patients the best attention possible. Therefore, there is a weakness in preserving the present administration. With all the best intentions in the world, these two doctors cannot give a very satisfactory service to this hospital if they are deeply involved in their own practices. For that reason, like my hon. Friend I am of the opinion that the present situation should be altered.

I do not know what motives or influences bear upon the regional hospital board in this matter. I hope that it is not on grounds of economy that it is refusing to grant this modest request. Unless the situation is altered the prejudice which still exists will harden. I have had letters from some of my constituents who are patients and complain that they do not receive the medical attention and treatment to which they are entitled. I hope that the Minister will give serious consideration to the point. We want to encourage the people in our valleys to show a greater willingness to enter the hospital when the necessary facilities are available. I trust, therefore, that the Minister will do something to prevail upon the hospital board to alter its attitude.

10.37 p.m.

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

I am obliged to the hon. Member for Pontypridd (Mr. Pearson) for the agreeable manner in which he has raised this matter, which is of great importance not only in his constituency but also in the surrounding area.

The Graig Hospital at Pontypridd is, as he has said, a former public assistance institution, with 276 staffed hospital beds. Of these hospital beds, 160 are allocated for long-stay chronic sick—and the bur-then of the hon. Member's argument, and also of his hon. Friend the Member for Rhondda, West (Mr. Iorwerth Thomas) was that the elderly people were not being sufficiently provided for—64 for general medicine, 13 for skin diseases and nine for mental cases. There is also a separate block with 30 beds for children, which is now little used. The average occupancy during 1957 was as low as seven, and consideration is now being given to putting these beds to other uses. The building is an old one and is seriously in need of modernisation. Perhaps it would be a crumb of comfort to the hon. Member and his hon. Friends if I say that the Welsh Regional Hospital Board, in its forward planning, has earmarked £50,000 of capital development money for this purpose.

Most of the argument this evening turns on the staffing problem—whether the hospital, in relation to the calls made upon it and the comparable services elsewhere, is adequately staffed. The present medical staffing consists of two consultant physicians—one recently appointed to cover the field of geriatrics as well as general medicine—and two general practitioner clinical assistants. The consultants between them devote two half-day sessions a week to the Graig Hospital, and the clinical assistants eight sessions. In addition, members of the specialist medical staff of the group visit the hospital as required.

It is true that as long ago as 1954 the hospital management committee put forward a proposal for the appointment of a whole-time medical officer of senior status, relating the proposal particularly to the needs of the chronic sick. Meanwhile, approval had been given to the appointment of an additional consultant physician for the group; and the regional hospital board's consultant adviser, following a survey of the needs of the group, recommended, as the hon. Member knows, that the committee's proposal should be deferred until experience had been gained of the results of this consultant appointment.

In making appointments of this character, the regional hospital board naturally has to consider the needs of Wales as a whole, and it was not until this year that it found itself financially able to fill the Pontypridd and Rhondda post.

Reference has been made to the organisation of geriatric services as a whole—

Mr. Pearson

Will the hon. Gentleman give some attention to the difference in the staffing between the hospital I named—St. David's Hospital, Cardiff—and the Graig Hospital, where there are three full-time appointments for a much smaller number of beds?

Mr. Thompson

Indeed I will, but if we compare those two particular hospitals we are not comparing like with like. The Graig Hospital, as I have shown and as the hon. Member well understands, is largely for the chronic sick, but St. David's, Cardiff, has 262 beds for the chronic sick and general medicine and 258 for other specialties, which means that only about half of its effort is devoted to the chronic sick. Therefore, a comparison between one and the other is not strictly valid.

However, as I was about to say, following a nation-wide survey of the services for the aged chronic sick, a circular was sent last year to hospital authorities and to local health authorities—this was the circular to which the hon. Member referred—suggesting that they might act in concert in setting up comprehensive geriatric services covering domiciliary as well as hospital facilities for their respective areas.

In pursuance of that suggestion, the Welsh Regional Hospital Board, through a special sub-committee set up for the purpose, is preparing plans on which it intends to consult local health authorities and others with a view to the launching of services of this kind. I make a point of this, because I would not wish it to be thought that the needs of the elderly chronic sick in this area have in any sense gone by default.

The consultant physician recently appointed for Pontypridd and Rhondda has a record of special interest and successful work in this field elsewhere, and his advent opened up the prospect of an early start in this work in this area. With this prospect before it, the regional hospital board has, wisely I think, decided to await a report from him, when he is in a position to make one, before taking any steps to this end. Among the matters thus in abeyance is that of additional medical staff. By this is meant not only staff for the Graig Hospital, but for a geriatric service in general for the locality.

It is only fair to say that the newcomer took up his post only seven weeks ago. It would surely be unreasonable to expect him or the regional hospital board, after so brief an interval, to make any pronouncement until a little more time has elapsed.

Mr. Pearson

How long is that "little more time"?

Mr. Thompson

If the hon. Member will give me more time, I hope to come to that.

The hon. Member made a point of comparison with other hospitals. If medical staffing is to be judged by comparison with other establishments, there is a difficulty in that no hospitals are to be found in South Wales, I am informed, closely comparable with the Graig.

Its function, as the hon. Gentleman pointed out, is preponderantly the care of the chronic sick, and 160 out of its 276 beds are devoted to this purpose. It does not cater, as other hospitals do, for other specialties over a wide range, and it has no out-patients' department. For a fair comparison one has to look further afield, to West Wales and North Wales, where there are three hospitals, each catering for up to 150 chronic sick patients and nothing else. Their present medical staffing is roughly half that at the Graig.

Therefore, we should not make too much of the point that the Graig is worse off in its medical staffing as compared with hospitals doing the same kind of work. But I fully accept that the criterion of comparison is not necessarily the last word, especially in view of the developments to be desired in geriatric services, and the Welsh Regional Hospital Board has by no means closed its mind to the hospital management committee's proposal.

I cannot help thinking that the reasonable conclusion is that this question, which may be more far-reaching than the hospital management committee has supposed, should not be hastily decided but should be held open a little longer for the benefit of the specialist advice which the board may expect to receive when the consultant has had time to assess the needs of the hospital and the area.

The hon. Member made a point about the attitude of the hospital management committee to this and its earlier feelings in the matter. I am bound to say that the Committee's attitude lias not been wholly consistent. As recently as 3rd April last, it informed the regional hospital board that it would be content to await the outcome of the board's further consideration, adding that its medical staff committee might have something else to say. Shortly afterwards the medical staff committee also decided to wait and see. With this decision before it, the hospital management committee early this month resolved unanimously, so I am informed, to press for the immediate appointment of a full-time doctor for the Graig.

One can well understand that every hospital management committee worth its salt wants the best possible deal it can secure for the hospitals under its control. That is absolutely human and understandable, but my whole point in this debate is that the committee concerned cannot and should not consider its problems in isolation from the needs of the other hospital services which are necessary in the area, I say to the committee, through the hon. Member who has raised this point with great fairness and moderation, "Give this experiment a chance to work out. Let us have the benefit of the recommendation which will be placed before the board."

The hon. Gentleman has asked me how long will that be. I cannot say precisely—perhaps six months or perhaps as much as a year. But let us get the benefit of what this appointment has set out to do. As I said earlier on, the mind of the Welsh Regional Board is by no means closed to the hospital management committee's proposal, but I think it will be able to arrive at a fair and more appropriate conclusion if it has the benefit of the results of this experimental appointment behind it.

Question put and agreed to.

Adjourned accordingly at eleven minutes to Eleven o'clock.