HC Deb 17 December 1959 vol 615 cc1724-38

3.28 p.m.

Mrs. Alice Cullen (Glasgow, Gorbals)

I am very glad to have this opportunity of raising what I regard as a very serious matter, namely, the shortage of maternity beds in Glasgow. As everyone knows, Glasgow has immense problems of over-crowding and slum clearance. One would have thought that, because of those problems, Glasgow would have had better accommodation for maternity cases. The fact is that bad housing is matched by a serious shortage of maternity accommodation. Perhaps Glasgow is the worst area in Scotland. Mothers have been discharged from hospital on the same day as their babies have been born, not because of medical advice but simply because of shortage of accommodation.

On 8th December, I asked the Secretary of State for Scotland how many mothers had been discharged from the Royal Maternity Hospital on the same day as their babies were born during November. The reply given indicated that 12 mothers were so discharged in that month. Information in my possession is that on 17th November 10 mothers were discharged from hospital on the same day as their babies were born. Some were discharged at their own request and others were asked if they had someone to look after them at home and if there were a bathroom in the home. Relatives were invited to come to the hospital to take them home. When they got there they found those women had been transferred from the labour ward to beds in the corridor because of lack of accommodation in the wards. They were left there for practically three hours awaiting ambulances.

As a mother, a grandmother and a great-grandmother, this practice is all wrong and very harmful. Sooner or later, it is bound to have repercussions. The Royal Samaritan Hospital, in Glasgow, can usually trace the trouble from which patients suffer to not having greater care after confinements. I can understand a mother being anxious to leave hospital if she has left a child at home, but is not this the type of patient we are most anxious to see slay in hospital for three or four days for a well-earned rest before going home to cope with her household tasks? The Royal Maternity Hospital is 125 years old. There are wards in general hospitals for maternity cases, but they are not enough.

In reply to a Question by my hon. Friend the Member for Glasgow, Maryhill (Mr. Hannan), the Secretary of State for Scotland said that within sixteen to eighteen months 90 beds will be available and another 110 units at York-hill will come into use in 1964. That will be 200 additional beds in five years. Under present conditions that is most unsatisfacary. Thousands of babies will be born between now and 1964. There are many private maternity homes in the City of Glasgow which were originally large dwelling-houses. Why cannot the Government acquire such large dwellings as may be unoccupied and, as a matter of urgency convert them into maternity homes?

Assuming that there was ample accommodation and a patient asked to go home on the day her baby was born, do we think that the doctor would agree? I do not. If she persisted, I am sure that the doctor would want her to sign a paper exonerating the hospital from further responsibility. This is a most serious matter. I trust that the right hon. Gentleman will recognise how serious it is. I am a former member of a hospital board, and no one has a greater admiration for the efficiency and skill of surgeons, doctors and nurses than I have. My complaint is only one of many, however, and the blame rests entirely with the Government because of their inability to provide the accommodation so urgently needed to cope with the very serious problem which exists in the City of Glasgow.

May I refer to a letter which I received no later than yesterday? It reveals a horrible state of affairs. The woman concerned was sent home after 24 hours in the maternity hospital. According to the letter, she had to wait four hours for an ambulance. On the way to her home, the ambulance called at the Royal Infirmary, which is quite a distance from the maternity hospital, and picked up an elderly couple. From there it travelled to the Western Infirmary, still some distance away, and picked up an elderly gentleman. All this was done before the woman was taken home to her own house on the first day of the birth of her baby. She was put into the ambulance by a nurse wearing a mask, but three elderly people were picked up by the ambulance and, although the young baby was still there, they were not wearing masks.

While this lady was at home, she never had a visit from a doctor although it was known when she was discharged from hospital that not all of the afterbirth had been taken away. A nurse called daily but left her for good on the eighth day. The next day, the woman was taken seriously ill. Her husband tried to contact his own doctor, who was out making his calls, and then had to contact the hospital from which she had been discharged. A doctor arrived immediately and, when he had seen her, he ordered the woman to he taken to hospital suffering from childbed fever. She had to have a piece of the afterbirth removed. This woman could have been dead in 12 hours, never mind eight days. In my opinion and justifiably, she feels that she has been disgracefully treated. I intend to pass the letter to the Joint Under-Secretary of State.

We are nearing the end of 1959. Will the Joint Under-Secretary of State convey to the Secretary of State for Scotland my sincere wish that he will make it his New Year's resolution to explore every possible avenue to provide more maternity accommodation in 1960, and not 1964?

3.38 p.m.

Mr. William Hannan (Glasgow, Maryhill)

I, too, am delighted that this opportunity has been afforded us, and particularly that it has been afforded to my hon. Friend the Member for Glasgow, Gorbals (Mrs. Cullen), to introduce this topic into the House. It is particularly appropriate at this time, since in the near future we shall be celebrating the Nativity, that we should talk on this subject and should think very hard whether all that can be done is, in fact, being done by way of the assistance which we can give to women who are about to go through this great trial and great joy. I am bound to say that an examination which I have made of the history of the provision of maternity accommodation in Glasgow seems to suggest ineptitude and maladministration on the part of the Government.

If that charge and those words are too harsh, let the Joint Under-Secretary of State tell us where the fault lies, because these conditions in Glasgow must not continue very much longer. It is indicative of the kind of society in which we live that, despite the introduction of radar, jet planes, atomic energy, and automation, and all the other facilities to make life easier by way of travel and comfort, we contrive in the City of Glasgow to provide only 50 per cent. of the beds necessary for mothers in this category, whereas in the City of Aberdeen the figure is 90 per cent., in Dundee 80 per cent., in Edinburgh 80 per cent., and the average for Scotland is 70 per cent.

No doubt the Joint Under-Secretary of State will have some reasons to give. I hope that they are very good reasons. He should not try to bemuse people with the glitter of transient things instead of getting down to the fundamental provision of good social services. I understand that it is six years since Glasgow Corporation approached the Department of Health and the Western Regional Hospital Board about the need for more maternity beds in the City. Just prior to the 1955 General Election the Government, with a great flourish of trumpets, announced a hospitals building programme. The hon. Gentleman is very well acquainted with the gentleman who announced that programme. I do not want to suborn him from his filial loyalties, but it was the present Lord Strathclyde, who has been recently lauding the North of Scotland Hydro-Electricity Board. The present incumbent of the Under-Secretaryship has the opportunity to do something about this badly needed service in Glasgow.

In the 1955 Report it was said that the hospital boards, now having advance information, would be able to plan ahead. It was said that an increase of£300,000 was to be provided for hospital building. When the election had been won, my hon. Friend the Member for Fife, West (Mr. W. Hamilton) received a reply from the Secretary of State saying that he could assure us that: Regional hospital boards are making the fullest efforts, consistent with the maintenance of services to patients, to restrain expenditure on hospital running costs."—[OFFICIAL. REPORT, 21st February, 1956; Vol. 549, c. 17.] It is part of the charge which we want to lay at the Government's door that it is their overall economic policy of restrictions, particularly since 1957 and 1958, that has led to the present dreadful situation in Glasgow. In a Written Answer on 12th December, 1956, the Secretary of State, in reply to the former Member for Glasgow, Scotstoun, Sir J. Hutchison, said: In 1958–59 it is proposed to start three further schemes…"—[OFFICIAL REPORT, 12th December, 1956; Vol. 562, c. 68.] That was for maternity accommodation. The third-named scheme was a new maternity hospital in Glasgow. Despite the fact that since 1955 Glasgow Corporation had been pressing the Western Regional Hospital Board and the Government about accommodation, three years afterwards the announcement was made that it was to start in 1958–59.

In reply to a question by the former Member for Coatbridge and Airdrie, Mrs. Mann, the Joint Under-Secretary of State, now Lord Craigton, said: There may be some adjustment of the starting dates of the major hospital building projects planned for start in 1958–59, but the programme announced in reply to my hon. Friend the Member for Scotstoun (Sir J. Hutchison) on 12th December last, still stands."—[OFFICIAL REPORT, 29th October, 1957: Vol. 575, c. 6.] It does not bring much satisfaction to know that a programme still stands. What we are interested in is the start of the programme and its completion. So we go on through Questions in July, 1958, and the Secretary of State told me on 25th November, 1958, that the planning of this hospital was well under way. That was November, 1958, but in previous replies it was supposed to have been started in 1958–59. The actual reply was: The planning of this hospital is well under way, and I can assure the hon. Member that construction will start as soon as the preparatory work has been completed."—[OFFICIAL REPORT, 25th November, 1958; Vol. 596, c. 203.] That preparatory work started last week—last week. The Government can now claim that they have kept their pledge, but only by about fourteen days, and even then it is not building construction work but only site clearance. The Secretary of State was not aware, when replying to me on 28th July that the hospital would start in 1959–60, that the start of the hospital had been delayed for a further year.

In reply to a debate on the Supplementary Estimates for the National Health Service, Scotland, in March of this year, the Joint Under-Secretary of State, the hon. Member for Dumfries (Mr. N. Macpherson), replying in the absence of the other two Ministers, made a most remarkable speech. Instead of handing out the excuses and evasions that had up till then been employed, his speech gave the real reasons for the present disgraceful situation. He said: A year ago, when the£was under pressure and expenditure had to be severely restricted as part of the Government's measures to protect the£, we set the hospitals in Scotland the task of saving about£400,000 on their annual expenditure. That was to he their contribution to stability. That saving has been very largely achieved by careful economy, as the result of reductions in demand and appropriate action, notably in tuberculosis treatment in hospital…My right hon. Friend and I are grateful to the hospital authorities for their excellent co-operation with us."—[OFFICIAL REPORT, 12th March, 1959: Vol. 601. c. 1539.] Co-operation indeed! It was coersion. The Government told the regional hospital boards just what they were to spend. And to say that economies had been achieved at the expense of some of the frightful conditions that my hon. Friend has mentioned is certainly not to the credit of the present Government.

This position exists in face of the valuable report published by the Scottish Health Services Council on the maternity services. Breaking down the conditions in Scotland, the report made various salient points. Referring to the 70 per cent. distribution of institutional confinements, the Council made a comparison between one local authority and another and gave the figures I have already quoted.

In addition, it made a comparison in respect of the regions themselves, and said: Only the Western Region, at 65 per cent. is below the national figure of 70 per cent. (Glasgow as low as 57.6 per cent. if only National Health Service accommodation is counted); the three smaller regions are all above 74 per cent… Paragraph 82 is very pertinent to my hon. Friend's remarks: As to overcrowding and length of stay in hospital, the average length of stay in obstetric units in the Western Region is again markedly shorter than in the other Regions, and it is obvious that there is very little margin for the occasional emergencies… This group of experts evidently thought it unwise and undesirable for mothers to leave hospital before the end of ten days, yet we now have cases quoted of mothers being discharged from hospital on the same day.

It is really a shocking state of affairs. Some of the newspapers were inclined to think that that adjective was too strong, because when I used it in the debate we had the week before last, they put it in inverted commas. I will now go further and say that the state of affairs is appalling. It is a great criticism of present-day conditions that we should be providing all the glitter of a false society while leaving the fundamentals of a decent civilised life in abeyance. The Council gave two main reasons: first, that the mothers were not strong enough to be discharged from hospital, and secondly, that there was a shortage of domiciliary midwives. We went to make it clear that we make no charge against the medical people, the surgeons and nurses involved. We say that there is pressure on them, that there is lack of accommodation and, if I may apply the term to this noble profession, the turnover is the important thing to the people in the hospitals—to get these mothers in and out as quickly as possible.

One of the arguments that the Joint Under-Secretary may advance is that there is a danger of infection. But it is the overcrowding, as I understand it, which itself causes the danger of the spread of infection. The obstetricians are extremely annoyed about the early discharges.

As I say, the vital and central factor in this matter is the shocking shortage of maternity beds. The local authority met the Western Regional Hospital Board and the Department of Health on 28th March, 1958 and put its case for an increase of 250 to 300 beds but got no satisfaction. On 26th March, this year, the local authority again asked for a meeting and met the Western Regional Hospital Board. The corporation was informed that the Board proposed to provide 81 beds in existing hospitals within 18 months. But to do something in 18 months' time will not be of any use; neither is 1964. By 1964 many of the teen-agers and children at school today will themselves be married, because that is one of the features of our society today. The Government must shake themselves together and do something about this problem.

Dr. J. Dickson Mabon (Greenock) rose—

3.53 p.m.

The Joint Under-Secretary of State for Scotland (Mr. T. G. D. Galbraith)

I am very sorry to have to keep out the hon. Member for Greenock (Dr. Dickson Mabon), but he will realise that we are working to a timetable and this debate is intended to finish in seven minutes' time.

The hon. Lady the Member for Glasgow, Gorbals (Mrs. Cullen), in initiating the debate, spoke mainly about mothers being discharged from the Royal Maternity Hospital, in Glasgow, on the day on which they were confined. This is one aspect of the general problem of the development of the maternity services in Glasgow to which the hon. Member for Glasgow, Maryhill (Mr. Hannan) has also drawn attention.

I was very glad when the hon. Member for Maryhill and, I think, the hon. Lady indicated that they were complaining about the shortages of beds for maternity cases in Glasgow and that neither of them were making any reflection on the quality of the care given by the doctors and nurses who serve in this hospital.

I should like to congratulate the hon. Lady on the very feeling way in which she has presented her case. Childbirth is a matter of intense interest to every one of us, and the hon. Lady's Question on this subject, combined with this debate, has, naturally, aroused considerable publicity in Scotland. I therefore welcome the opportunity which this debate provides of giving the facts and allaying any fears which may have been aroused unintentionally.

I should like to begin with the hon. Lady's main point about the mothers who were discharged on the day of delivery. As the hon. Lady probably knows, important building alterations are being carried out at the Royal Maternity Hospital. This has increased the pressure on beds to the extent that the staff sometimes have had to discharge mothers to their homes on the day of delivery.

Dr. Dickson Mabon

Why?

Mr. Galbraith

If the hon. Gentleman will contain himself he will hear why. In these cases the mothers had normal confinements and had been admitted to hospital only because their homes were unsuitable for confinement and not because of medical need. The reason why they were discharged early was to enable other expectant mothers whose condition urgently required hospital confinement to be admitted.

The hon. Lady mentioned 10 discharges on one day. There must have been some exaggeration. I have checked the numbers with the hospital and the maximum number discharged on any one day in November was three. Three were discharged on the day to which the hon. Lady referred, 17th November. The remainder of the 12 mothers were discharged on various other days during November and the maximum number on any other day was two. This does not alter the position concerning the individual mothers, but it shows that there was not a sudden or wholesale discharge of mothers from the hospital on any one day.

The House will realise that no one would wish to resort to the practice of very early discharge except under extreme pressure of beds. The hon. Lady said that the remedy for this state of affairs was more beds and the hon. Member for Maryhill made the same point. Later in the debate, I hope to be able to give an account of what the regional hospital board is doing to improve the supply of beds.

Meanwhile, however, I would like to make it quite clear that the doctors at the Royal Maternity Hospital are most careful to ascertain that the patients concerned are fit to go home and that proper arrangements are made for the medical and nursing care of the mothers after their discharge. I cannot emphasise this point too clearly.

Dr. Dickson Mahon

Is not the hon. Gentleman tending to misrepresent, perhaps unintentionally, the position of the doctors? My experience of the doctors at that hospital—and I know some of them now serving there—is that none of them would agree to the discharge of these patients save under administrative pressure, not because of medical opinion. I have never yet heard an obstetrician express the opinion that he should discharge a woman from hospital on the same day as her child is delivered. That is nonsense.

Mr. Galbraith

If, tomorrow, the hon. Member reads the OFFICIAL REPORT, he will be able to appreciate exactly what I said.

Of the 12 cases to which I have referred, 6 were from the district of Glasgow, in which the domiciliary midwifery services are provided by the district nursing staff of the Royal Maternity Hospital. These patients, therefore, were visited in accordance with the normal practice twice daily after discharge by the district midwife from the hospital and the doctor from the hospital visited them as required, usually once a day. The other patients were discharged to the care of their own family doctors only after those doctors had confirmed that they would be willing to take over the care of the mothers when they were discharged, with the assistance of the domiciliary service provided by Glasgow Corporation. Therefore, all of these mothers had a high degree of medical care.

The reason why some mothers are discharged early after their confinement—this answers the point made by the hon. Member for Greenock in his intervention—is because the hospital is trying to extend the service it provides so as to meet the urgent need of mothers in Glasgow whose home conditions are not suitable for confinement. This, of course, is in addition to those who, on medical grounds, require hospital attention. What happens is that after confinement has taken place and when it is normal, the doctors have to balance the needs of one mother against the needs of another mother with a suspected complication who arrives and must be admitted to the hospital.

Mr. Hannan rose—

Mr. Galbraith

The hon. Member has made a long speech and we are short of time. I must finish in a minute and a half and I shall press on.

In future, however, all patients who have to be discharged early from the Royal Maternity Hospital will be offered a bed at the Ross Maternity Hospital for the remainder of their lying-in period. This practice has usually been followed in the past, but I am not able to say categorically that it was done in every case in November. I hope that the information I have given will show the hon. Lady that the hospital staff does not arrange these discharges thoughtlessly, or without taking every step open to them to ensure that the patient is as well cared for as is possible.

Mrs. Cullen

Would the hon. Gentleman say something about the case which I mentioned to him yesterday?

Mr. Galbraith

The hon. Lady mentioned a case today, but I do not know whether it is the case of a Mrs. O'Neil.

Mrs. Cullen

That is right.

Mr. Galbraith

If I am right in that assumption, I have been able to make a fairly full inquiry about it. I think that it would be unfair both to the hospital and to the ambulance service to let the matter rest on the description given by the hon. Lady's correspondent. I must point out, however—and I hope the hon. Lady will not take it amiss—that it is very difficult to answer at short notice the kind of question of fact such as the hon. Lady raised. It is very much better for all concerned that, if possible. the facts should be agreed beforehand, as otherwise our debates tend to be rather valueless.

So far as I am able to ascertain, Mrs. O'Neil was admitted to the Royal Maternity Hospital on the last day of September, having arrived unexpectedly in an advanced state of labour. Because of her condition, she could not have been sent to another hospital, and next day the Royal Maternity Hospital found it necessary to discharge her, due to pressure on beds.

The ambulance to take her home was sent for at four o'clock, but, because of other calls on the ambulance service at that time, the ambulance did not arrive at the hospital until 5.30. All the time, I would point out, Mrs. O'Neil was in bed. All mothers are kept in bed until they are taken to the ambulance, and, therefore, any delay does not affect the mother, though I agree that it might affect relatives who were waiting to collect them. Two patients, one of whom was Mrs. O'Neil, from the Royal Maternity Hospital were then put in the ambulance, and another was collected at the Western Infirmary on the way to these patient's homes. All three patients, however, had been delivered to their homes by five minutes to seven. On her arrival at her home, Mrs. O'Neil was looked after in her home by the district staff.

Mrs. O'Neil's convalescence proceeded normally for ten days. On the eleventh day, however, she had to be admitted to Robroyston Hospital with a complication. She was discharged from that hospital fit and well on 20th October. The hon. Lady will appreciate that it is not for me to make professional assessments in these matters, but I am advised that it is unlikely that there is any connection between the complication which arose on the eleventh day after the confinement and the patient's early discharge from hospital, or the length of time spent in the ambulance on her way home.

Dr. Dickson Mabon

Who said so?

Mr. Galbraith

That is the advice I have been given.

I should like very quickly now to deal with the general points raised by the hon. Member for Maryhill, who referred to the general situation. In recent years, there has been an increase of 100 beds, but until the Montgomery Committee reported in 1959 there was no authoritative assessment of the number of beds required in Glasgow. On the basis of the formula suggested by the Montgomery Committee's Report, it appears that there is now a gap of 146 beds. The moment the regional board received this Report, it looked into the matter and considered what could he done, and, on present plans, within eighteen months the number will be raised to 792 beds, and, through the building of the York-hill Maternity Hospital, to 902.

I am glad to be able to say—

Dr. Dickson Mahon

That will be five years. What happens then?

Mr. Galbraith

The work has already started. The hon. Gentleman seems to doubt that. Work has already started on the site on building the foundations, which is the first step, but the amount of new building involved means that it will take three or four years until the number of beds has been brought up to standard.

Dr. Dickson Mabon

What happens afterwards?

Mr. Galbraith

I must press on. I cannot deal with that now.

One very important aspect of this matter is the procedure for selecting patients for admission to hospital. There are already available in Glasgow enough beds to make it possible to take all the cases likely to require entry to hospital on medical grounds. These include all first births and fourth and subsequent births and other cases in which admission is required because of abnormality or other medical difficulties. The existing number of available beds is also sufficient to provide for cases which require ante-natal care in hospital.

In addition, there is also available within the existing provision a certain number of beds for patients for whom admission is desirable on social grounds only, and by this I mean that their home conditions are not suitable for confinement. To some extent, therefore, the present problem in Glasgow is one of regulating admission in such a way as to admit those cases which require admission on medical and on social grounds.

The present arrangements, I think, could be improved. My Department has just had very useful discussions with the regional hospital board and Glasgow Corporation, and I have asked the hospital board to pursue the problem urgently with the consultant obstetricians. The Corporation has said that through the medical officer of health it is prepared to select the urgent cases from amongst those who seek admission on social rather than on medical grounds. If such an arrangement were made I think it would have the result that, till the number of beds can be increased by new building, the best use would be made of the resources which we have on the basis both of social and medical need.

I want to assure the House that my right hon. Friend the Secretary of State is very much concerned about Glasgow's maternity services. He shares fully the desire of all concerned, and which has been expressed very feelingly today, to have an adequate number of beds to provide the kind of service which Glasgow needs. I hope that the plans which are now in hand, and which I have described, will substantially achieve all these objects within the next two or three years. This will very largely be controlled by the speed at which building can go ahead, and not by the availability of money. The money is there. The regional hospital board will be doing what it can in the meantime to use to best advantage the substantial resources which are already available.

Lastly, I hope that what I have said today by way of providing a general background will also have shown that there is no justification for suggesting—and I do not think that the hon. Gentleman or the hon. Lady did suggest it, but I have a feeling that, perhaps, it did get out in the Press that there was the suggestion—that the Royal Maternity Hospital is in any way agreeing to practices less than the highest standard of medical care.

Mr. Hannan

I reiterate that, but will the hon. Gentleman direct his attention to this point? Is it true that 1,000 beds are available in the West Regional Area because of the decline in tuberculosis? Will he do something about that?

Mr. Galbraith

The hon. Gentleman must put a Question on the Order Paper. I certainly should not like either to confirm or deny that offhand.

What I should like to say is that the hospital is not indulging in any practices which do not represent the highest standard of medical care. The staff is a most devoted one. It has a high sense of service, and it is trying to do the very best it can for all the mothers concerned. It is working in conditions of great difficulty and strain, but given the job which it has to do, I am sure that Glasgow, and particularly the mothers of Glasgow, have good reason to be extremely grateful to the staff for the efficient and humane way in which it carries out its duties.

Mrs. Cullen

Would the hon. Gentleman say that it is right for a young couple and for three old people to be put into the same ambulance together, when the young mother has a child, and without their having on masks? If they went visiting the mother with the child in a maternity hospital they would be required to put on masks. Here were three people put into the same ambulance with the mother. I am prepared to say that there is not one hon. Member on that side of the House who would allow his wife to leave hospital on the first day—

Mr. Speaker

I cannot allow the hon. Lady to make a second speech, except by leave of the House, which, in these circumstances, I venture to think, she might not get.