HOSPITALS, NORTH-EAST COAST (WAITING LISTS)

HC Deb 23 February 1959 vol 600 cc879-914

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

6.54 p.m.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

It is an unexpected pleasure to have the opportunity, at a fairly early hour, of discussing the very important matter of hospital waiting lists. I hope that this will mean that there will be an opportunity for other hon. Members who are concerned in this matter to take part in the discussion.

I wish to draw the attention of the Parliamentary Secretary to the Ministry of Health to the problem of hospital waiting lists in the North-East of England, that is, the area covered by the Newcastle Regional Hospital Board. There may be hon. Members from other parts of the country who wish to raise similar matters, because the problem with which I am concerned especially in the North-East, applies with almost equal force in other parts of the country. If I refer specifically to Newcastle and the immediately contiguous areas, it is because I am aware of the problem there and am particularly anxious about it, as indeed, is the general public in that region.

There are, in effect, two separate problems. There is, first, the problem of the waiting list for consultant appointment before the patient may get on to a hospital waiting list at all. That waiting period may be very considerable. Secondly, there is the problem of the waiting list for hospital bed accommodation.

The problem of the waiting time for consultant appointments was very strongly raised by the Northumberland Health Executive Council some time ago, and it gave rise to a good deal of Press discussion in the North-East. It was mentioned at a meeting of that Executive Council that there were complaints from general practitioners in the area. The Executive Council wrote to the hospital concerned confirming these complaints and pointing out that it was argued that a waiting period of from five to six weeks was involved before a patient could be seen by a consultant and an opinion given to the general practitioner. This was not raised by one doctor, but by many.

That complaint sent to a major hospital in the North-East gave rise to very considerable discussion. It was pointed out by the hospital concerned that the waiting periods vary very much from one field of treatment to another, but that in some fields the waiting period is broadly of that order.

I have spent some time checking up, both in the teaching hospitals and in the Newcastle Regional Hospital Board hospitals. There is a very wide range of waiting periods for consultation appointments. Some are as long as five and six weeks and some may be even longer. I have had many complaints from patients, who argue that this is tending to mean that the only way to get a bed in hospital reasonably quickly is by securing a private consultation first and paying for the consultation, so that at least the first hurdle is cleared in that way.

I want to tell the Parliamentary Secretary of the serious view that many of us take of the fact that it is publicly felt in the North-East that the only reliable way, or one of the most reliable ways, to secure an early consultation is by paying for it. I am not saying that that is necessarily correct. I know that there are provisions at most hospitals—certainly, I know that there are at several—by which the doctor is recommended to adopt certain procedures. If he is satisfied that an early consultation is required for his patient, there are certain procedures to make sure that a patient does not have to wait. In the general run of cases, I am satisfied that any urgent case is seen and admitted to hospital reasonably quickly. We are rightly proud of the treatment provided for urgent cases.

Problems, however, arise in the definition of an urgent case. A general practitioner may not recognise how serious the case is, and it is not then put forward as being urgent. Again, a general practitioner may say that, in his view, the condition is not sufficiently urgent to warrant his recommending it for immediate consultation. Or he may say to a patient, "If you want to satisfy yourself about this, and avoid the waiting list, you had better let me arrange a private consultation." I hear so much about this now that I get the impression that this method of private consultation is on the increase, and is being encouraged by the fact that a patient may be on the waiting list for consultation for five or six weeks, or even longer.

Before I speak about hospital beds, I want the hon. Gentleman to direct his attention to reducing the consultation waiting period. If we can make wider provision for consultant and specialist services in such an areas as North-East England, it may lead to a considerable reduction in the waiting period and, as a consequence, some reduction in the number of people who try the short cut of a private consultation. I am sure that the hon. Gentleman will agree that it is highly undesirable that such a method should be used as a short cut to earlier consultation—so by-passing others in the queue!

Some consultants may not be altogether pleased about a reduction in the list It would be human enough for them to feel that a certain length of waiting list for consultation is not a bad thing, as it keeps the road open for a certain amount of private work. I hope that that attitude is not often adopted. I am quite sure that many of our more senior consultants would not take that view, but there may be some such element in the business. I therefore particularly urge that, because of the undoubted waiting lists there are for consultation, a real effort be made to try to improve the staffing position in the North-East.

I want now to refer to the comments made on staffing by the Newcastle Regional Hospital Board in its annual report for the year ended 31st March, 957. The Board says that specialist recruitment was very rapid in the early years after the introduction of the National Health Service. When the Health Service started on 5th July, 1948, the region employed only 164 specialists, but by 31st March, 1951, that figure had increased to 292—almost doubling the number of specialists employed. The numbers continued to rise until, on 31st March, 1953, 370 specialists were employed.

After that, the speed of advance slackened considerably. There were only two new appointments in 1954–55, in the following year there were 10, and in the year after that there were nine. This, of course, was when the Ministry itself was restricting, by a very strict examination of any proposals put to it, the number of new appointments. It was then no longer possible for appointments to be made without the direct approval of the Ministry.

That had the effect of very seriously curtailing growth, in spite of the fact that the needs were very great and that in relation to its population, the region had, and has, a low number of beds— and, to some extent because of that, an even greater need for specialist attention than exists, perhaps, in other regions. This region has suffered from the economic blizzards of the past. It has not yet completely emerged from them. Although the growth of specialist appointments was dramatic and very valuable in the early years, that growth has been so much slowed down as to lose a lot of its value.

For that reason, I most seriously ask the Parliamentary Secretary to consider the special claim of this region's specialist appointments, and to make sure that where a good case can be made out for new appointments in order to bring down the waiting list—and I believe that a good case can be made out in very many of these cases—no hesitation will be shown in approving the proposals. I hope that we may get that definite undertaking this evening.

From the waiting period for specialist consultations, I turn to the waiting period for hospital beds. Again, I want to emphasise that this waiting period follows the period during which the patient has awaited a consultation. That period may be as long as five or six weeks, although, of course, I do not suggest that five or six weeks is an average figure. In many cases, the patient waits for a very much shorter time, but it is quite possible that those on the hospital waiting list for beds have already had to wait a considerable time before even reaching that list at all.

The rather anxious fact that we face in the North-East—and I think that it is common in other parts of the country, also—is that the total waiting list at the latest date I have available shows an increase over the year before, which, in turn, showed some increase on the previous year. In other words, the healthy situation that existed for some years of reductions in the waiting list has been reversed. Over the last two years, at any rate, we have had a throw-back—a moderate but real increase in the numbers on the list for hospital admission.

To give the full position, on 31st December, 1949, there were some 24,000 patients on the waiting list for hospital beds. That figure rose the next year to nearly 28,000. That was a period when new services were being opened up and, of course, it is to be expected that large numbers of new cases would come forward. The Minister, in answer to a Question that I asked not long ago, twitted me with the fact that in the early years of the National Health Service there were increases in the waiting list. Therefore, he asked, why should I complain that there had been much more moderate increase in the last year or two. The reason is the very obvious one, that when we were opening up the National Health Service and making available a new provision which had not been available in the past it was not surprising that large numbers came forward to take advantage of this new service.

As I say, in the Newcastle region—and I am quoting the Newcastle Regional Hospital Board—there was an increase in the first year up to 1950, but in 1951 the figures declined slightly and in 1952 they remained fairly stable; actually they went up a little, and in 1953 they remained almost identical. In 1954 and 1955 there were reductions, and then after 1955 there were two years of increase. I suggest that those two years of increase are related in part to the Government's own action in refusing permission for the effective expansion of the specialist services in the area. I would not say that the difficulty in making the expansion, which was undoubtedly still needed in the area, was necessarily the sole cause, but it was certainly a contributory cause.

I am well aware that one can be easily led to false conclusions by quoting just the crude figures for hospital waiting lists. But if one examines some of these figures one finds that in areas where there are no services of a particular character available there are no waiting lists, for the simple reason that there is no point in people being on the waiting list. Of course, there are certain special problems which inevitably create waiting lists. However advanced our services might be, there would be bound to be waiting lists for plastic surgery, for example, because of the nature of the problem. A series of operations is performed and there must be a certain period between one operation and another. There are those factors which we fully understand and, therefore, one does not want to rest the whole of one's case upon broad figures.

But when one examines the problem of waiting lists for hospital beds in the Newcastle region one sees that the problem seems to be concentrated in the City of Newcastle and the immediate surrounding area, and on Tees-side. This is perhaps natural on Tees-side, where there is an increasing population, and it may be that the services are not yet adequate to provide for the growing population. However, it is noticeable that in Newcastle itself there has been a serious increase in the numbers on the hospital waiting lists, rising from 4,300 in 1953 to 4,700. It becomes all the more serious if one quotes the 1951 figure of about 3,500. It will be seen, therefore, that there has been a concentration of the problem in Newcastle itself.

In addition, if one considers just where the heaviest lists are, and where the increase has been most noticeable, we meet certain problems. I am not saying that this is necessarily true of other parts of the country, but in the Newcastle region as a whole there is no doubt that general surgery is proving one of the most difficult and urgent problems. There we have had a very considerable increase in the lists, and it is one which everybody recognises must be tackled as quickly as possible. There are also alarming increases in gynaecology cases, although I would add that the situation is recognised, and efforts, which I hope will prove successful, are being made to bring into use fresh hospital beds which will make a considerable inroad into the problem.

There are other difficulties. I have already mentioned plastic surgery. Even after allowing for the problems which are inevitably connected with plastic surgery, there is a serious increase in the waiting list. I would mention in this connection that we have built up a service in the area; we have some extremely able specialists whose names are well known and who, no doubt, attract a great deal of attention in connection with important industrial cases, for this is not just a question of beautification; there are urgent industrial cases resulting from accidents, and so on. Perhaps just as serious is the increase in the waiting list for orthopaedic treatment.

These are matters which affect many working people and it is of considerable concern that we have increases in this type of case. Quite clearly, it is bound to affect the work that people are able to do while waiting for the treatment that they need. It does not necessarily mean that they are off work altogether while waiting for a hospital bed, but in all probability they are having to take less important and less skilled work. In addition, there is always the problem of family welfare. Some of the most difficult welfare problems emerge where housewives are concerned. Difficulties arise in the family when the mother is unable to carry on, or tries desperately to carry on but is not able to do so because she needs attention.

It may be that some of the people on the waiting lists are not regarded, and perhaps properly so, as requiring such urgent attention as others who are brought in more quickly. But what I am trying to emphasise is that, urgent or not, from a strictly medical point of view there is a very real economic and welfare problem and it should be our object to treat these people as quickly as possible. Everyone with whom I have discussed this problem agrees that although many of these cases may not be urgent in the earlier stages, they may well become urgent if allowed to remain on the lists for too long.

Perhaps one of the most anxious problems indicated by all the figures which I have by me is that the greatest increase in the region appears to be in that long period of waiting time over twelve months. That is the one which is most emphasised, and which has shown the greatest growth since 1953 in the Newcastle area, and that is another reason why we should be particularly anxious about it.

I do not want to paint an unfair picture of the problem. I have said that I have picked out the cases which appear to us to be most urgent. It is also fair to say that there has been a quite dramatic drop in the waiting lists for ear, nose and throat cases in the region. A great deal of extra work has been done there to reduce the lists, and the same thing is true of the ophthalmic side, especially amongst children, which is very encouraging, especially the way in which admissions have been improved and we have overcome the difficulties there.

I have to say, however, that in spite of these improvements—and I pay tribute to those who have helped to achieve them —they are overborne by the size of the increases in the other fields which I have mentioned, so that there is a considerable net increase in the waiting lists, even after taking account of these quite valuable reductions in the waiting lists in other specialties in other directions.

What is to be done? What action can be taken? I have already suggested one line of action which I believe is open to the Minister, after consultation with the proper hospital authorities, namely, a review of the establishments, to see what is the most urgent need by way of additional appointments. Of course, one understands that appointments of specialists by themselves may not solve the problem. In some cases, but not necessarily in all others, the need, as in this area, is for extra hospital beds. I am not one of those who say that additional hospital beds are everywhere required. By no means. The real need is to get a more modern use of, and more useful, beds, but not necessarily, over the whole of the field, to increase their overall number.

In the North of England, we are still relatively very short of beds in comparison with the size of our population. We are much worse off than most parts of the rest of the country. For that reason there is, for us at any rate, still a real need for additional beds. For example, the Newcastle Regional Hospital Board's report states that, in our region, we have 95 beds per 1,000 of the population, as against a national average of 11.6, and we note that the proportion is much higher in the South. There is no good reason why the proportion should be so much greater in the South. It is reasonable to suggest that there still needs to be a review of the availability of beds in the northern parts of the country.

I suggest that if we are to tackle this problem, we need both a review of the staffing situation and of specialist appointments, and we need, in certain fields, though not necessarily in all, a special examination of the beds available. I hope that both of these will receive the special attention of the Minister because of the urgency, in my view, of the problem that arises at present.

The figures I have quoted so far have not included the almost special and distinct problem of the psychiatric cases. Indeed, we have waiting lists here which mean very little, because it is well known that there is great difficulty in getting cases admitted to hospital, because of the shortage of accommodaiton, so that the waiting lists are, or may be, quite unreal. The same thing, in my view, is true about geriatric cases and about old people. It is true that any list that one has prepared of numbers of old people waiting would also be quite unreal. I do not want to leave out these two problems, especially that of the old people.

Some parts of the country have managed to secure more beds for treatment, have managed to build up on the basis of those beds active treatment, and have brought into use the concept of the day units and the like, but in the majority of cases that is not so. It is certainly not so in Newcastle, where we still suffer from a real shortage of hospital accommodation for old people, as well as other forms of accommodation for them. The tragedy is that all too often old persons can only be found a bed, particularly in the winter months, too late to be able to do very much of value for them.

This is a very distressing fact. It means that too many of the beds are blocked by long-staying cases, and this suggests that, for us in Newcastle, though it is not necessarily true everywhere, there is an urgent need for more bed accommodation, to enable some active treatment to be provided for the hospitals to get to work on the cases that come before them before they become so chronic as to be— I will not say incapable of treatment— but very much more difficult to treat.

Therefore, I believe that we have a very special claim on the attention of the Ministry. What is wanted is a real sign of vigour on the part of the Minister to show how determined and eager he is to see this problem solved, to see that, in Newcastle as well as elsewhere, there is an adequate number of beds and that the form of treatment shown to be so successful in a number of cases, in Newcastle with active treatment and in Oxford with day units, should be introduced.

My criticism of the Ministry is that for too long it has been unwilling to exert the kind of leadership and pressure that I believe is required. It is the job of the Minister to keep on as good terms as possible with the Treasury. That is perhaps an understandable desire, though difficult to reconcile with a developing service, but we do not feel that there is in the Ministry of Health any kind of sense of urgency. We feel that the Minister should see that people waiting for consultation and the long waiting lists of people wanting hospital beds means an economic loss to the country, which should be a matter of very real concern both to the Minister and to the members of the Cabinet as well.

I therefore appeal to the Parliamentary Secretary to say something more than that the Ministry is prepared to look into this problem, because I am sure that the Parliamentary Secretary himself will do so. I have had some correspondence with the Minister about the matter, and I am sure that, in the effluxion of time, there will be a reply. But I want much more than that. I want the Minister to say that he agrees that this is a supremely urgent problem and that he will not be satisfied until a very considerable reduction is made in the waiting lists.

I want the Minister to say that he recognises the importance of this problem and that he recognises the welfare and human aspect of it as well. I want him to say that he fully realises—I am sure the hon. Lady the Member for Tyne-mouth (Dame Irene Ward) will emphasise this if she has the opportunity—that, in the North-East of England, our ratio of beds is much lower than it is in other parts of the country and that, although there have been considerable advances in specialist appointments, about which we can be rightly proud, the advance has come almost to a full stop during the last few years. These things must be put right if we are to tackle the problem effectively.

7.31 p.m.

Dame Irene Ward (Tynemouth)

I apologise to the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) who has raised this very important matter on the Adjournment tonight. I congratulate him on his luck in being able to speak so wonderfuly early in the evening, and I am very sorry that I did not hear the earlier part of his speech. Although he and I differ basically in our political philosophy, we, together with all Members for the North-East Coast, keep a very close eye on the fortunes of that part of our country in whatever direction they may run.

For very many years, we have suffered in many ways as a result of prolonged and hard unemployment in the 'thirties, and we have much leeway to make up. We are always very glad of an opportunity to remind Ministers, when they are dealing with Government policy and looking at national affairs, as they must, in their wider aspect, that the North-East Coast has a great deal of leeway to make up before it can be said to be in a position to share equally in the general ups and downs of the work of any Government Department. Tonight, of course, I speak particularly of matters which are the particular concern of the Ministry of Health.

It is a wonderful thing when, on an occasion like this, we can put the arguments for the North-East Coast. I am delighted to have the opportunity of supporting the hon. Member for Newcastle-upon-Tyne, East in asking my hon. Friend to convey to his right hon. Friend that there has been, and rightly so, a great deal of criticism about the long waiting lists at hospitals in the North-East. It is usually very difficult—at least, I always find it so—to establish a channel of communication to the Minister to convey representations which start, so to speak, from the organisation which has been built up and which has the basic knowledge. Tonight, if I understand matters aright, we have the advantage that the Northumberland Executive Committee has drawn to the attention of the Newcastle Regional Hospital Board the difficulties of our situation. I have not the slightest doubt that the Newcastle Regional Hospital Board, which has done a really magnificent job in always trying to emphasise the needs of the North-East Coast to the Ministry, will have been in touch, through the proper channels, with my right hon. Friend. We want to know now what action is to be taken.

Last Thursday, I think it was, I put to my right hon. Friend the Prime Minis- ter a Question on a very important subject. I asked him always to bear in mind when considering the national interest the need for everyone to do everything he possibly can to cut costs, to make what we have to offer the best, which it generally is, and the most efficient, at the best price in the markets of the world There is, however, no doubt that, if people have to wait a very long time either when they go to make appointments at hospitals or when they wait for hospital beds, the delay irritates them very much indeed, especially when they feel that, if there were more beds available and there was a generally accelerated organisation, we should be able to move ahead much faster than we are at the moment in producing what the country needs in the national interest.

It is a pity that when speeches are sometimes made on a certain subject Ministers do not sit in so that they may immediately point out that as regards their Departments they are prevented from giving 100 per cent. service through lack of money for capital expenditure, for increased facilities, or whatever it may be. This, however, very rarely happens in Parliamentary life. One has to make one's representations to one Minister or another, and very seldom is one able to mate the two. I particularly wanted to say that as the general policy and aim of the Government and, I think, of every Member of the House of Commons is to increase our productive capacity and competitive efficiency in the world, it is most unfortunate that we do not at the same time ensure that no man or woman has to delay returning to ordinary life after illness because we have not the hospital beds available or the facilities for reducing waiting time when people have to visit out-patient departments. This is a very important aspect of the case, and I want to know what is to be done about it.

Everyone takes great pride in the general improvement in the health of the nation. I sometimes feel that it is a great pity that the Ministers concerned in the Ministry of Health, when they find the Treasury or any other Minister arguing against them because they want a little more money, do not try to put in the balance the value in national efficiency of the improved health of the nation. We are always talking about the amount of money which is spent on the National Health Service. We are always talking about it going up by leaps and bounds every year. I suppose it would be difficult for a Minister to do so in the House—I should like to know what goes on sometimes in the Cabinet—but why is it that the Minister himself cannot announce that in very many ways the money which is spent on the National Health Service has proved a great boon to the whole nation?

One has only to go to the schools today and look at the magnificent state of health of most of the children, the gloss on their hair, the brightness of their eyes and the sturdiness of their limbs and bodies. It is an absolutely magnificent result for science, medicine, the National Health Service and all that this country has done to secure the healthiest possible nation.

Dr. Edith Summerskill (Warrington)

I agree with every word uttered by the hon. Lady, but will she tell me whether she voted with her colleagues against the Second Reading of the National Health Service Bill?

Dame Irene Ward

I had no idea that the right hon. Lady loved me so much that she did not realise that I was not a Member of the House at that time. She and I worked together very closely during the war, and I am always delighted to have had the co-operaton that we have had, but it cuts me to the quick to find that she did not realise that I was not a Member of the House when the National Health Service finally came into operation. However, I did my share as a member of the Tory Reform Committee before the 1945 General Election in laying the foundations for the introduction of the National Health Service.

Dr. Summerskill

Might I put an amended question to the hon. Lady? If she had been a Member of the House at that time, would she have voted with her Conservative colleagues against the Second Reading of the Bill?

Dame Irene Ward

The right hon. Lady well knows that there was an Amendment moved by the Conservative Party. The conflict between the Socialist Government and the Conservative Opposition was not on the introduction of the National Health Service. I do not think it serves any good purpose when for political reasons the Socialist Party trots out this old lie until it nearly drives one mad. If the facts and the debate are studied properly it will be seen—I remember this though I was not a Member of the House at the time, but I have had to answer questions in my part of the world —that the Amendment moved to the Second Reading of the Bill gave a welcome on behalf of the Conservative Opposition to the introduction of the National Health Service.

Dr. Summerskill

As the hon. Lady has mentioned the word "lie", which is not a Parliamentary term, I am sure, and has explained away the vote on Second Reading, can she tell us why the Conservative Party voted against the Third Reading of the Bill?

Dame Irene Ward

If I remember correctly, it was because the Bill did not embody what the Conservative Opposition thought was important to it. I am not in the medical profession and so the right hon. Lady has an advantage over me, but if I remember rightly, while the Conservative Government were in power one or two alterations had to be made to the Bill or to the administrative framework of the Service. What the Conservative Opposition said at that time proved to be correct.

Mr. Speaker

We are getting rather far from matters for which present Ministers are responsible.

Dame Irene Ward

Yes, Mr. Speaker, and I will put my remarks in order. However, perhaps you will allow me just to say to the right hon. Lady, who raised the matter, that one of the reasons why we have such long waiting lists on the North-East Coast is that we were never given sufficient money to catch up on the deficiencies in the Service. I would not have mentioned this, because I am only too glad that the hon. Member for Newcastle-upon-Tyne, East has brought up the whole question, but as the right hon. Lady was trying to catch me and the Conservative Party out I would like to put on record that I think it was a great pity that when we were so short of hospital beds in relation to our population on the North-East Coast and when the Socialist Minister of Health and his Parliamentary Secretary were planning a hospital service which has been of such benefit to the whole community—with the co-operation of the Conservative Party—they did not think a little more about the needs of the North-East Coast. When the capital expenditure was allocated, they left the North-East Coast and the Newcastle Regional Hospital Board very much behind in the number of beds and in many other aspects of the medical service compared with the rest of the country. I should like that question to be answered seriously at some time.

The right hon. Lady, who at that time represented Fulham, had the great benefit of the King Edward Hospital Fund which helps enormously when things are needed in this part of the world, but the Newcastle Regional Hospital Board is unable to get anything from it. That is all the more reason why tonight we must argue our case so that we can get a little more money to deal with the deficiencies which undoubtedly exist on the North-East Coast. I ask my hon. Friend the Parliamentary Secretary, who was not concerned with the battles which went on with the Socialist Government, to do a little better for the Newcastle Regional Hospital Board than the Socialist Government did.

On the North-East Coast we are expanding in all sorts of industrial developments. We are a very inventive part of the world and have going forward tremendous developments which will enormously help the general economy of the country. It is important that our people should have the best possible facilities for keeping themselves fit and healthy and in every way ready to meet the challenge of life. It is tremendously important that we should not have long waiting lists.

The Newcastle Regional Hospital Board has done extremely well. It has been fighting a rearguard action in respect of our deficiencies. We have had a lot of help from the Minister of Health. A lot of additional money has been given to our regional hospital board, and I hope the right hon. Lady will bear that in mind. It has come from the Conservative Minister of Health. We are making progress, but I still think that we have a very long way to go. When anything as important to us as the Newcastle Regional Hospital Board has had repre- sentations made to it through the Northumberland Executive Council, it is up to those of us who represent the North-East Coast to impress on my hon. Friend that we feel very strongly that we have a genuine grievance. Our people are very hard workers, and we want to make sure that they are fit to meet all the problems of everyday life. Will my hon. Friend say what the Government intend to do about our situation?

I will not take the matter any further, although I have always understood that on an Adjournment debate one could raise almost any subject. However, I will not treat my hon. Friend to a lengthy speech on what we want on the North-East Coast. We want a great deal. In the meantime, we should be glad to know what help we can expect in reducing these long waiting lists and in meeting the criticism which the Northumberland Executive very rightly put to the Newcastle Regional Hospital Board and which the Board put to my right hon. Friend.

Mr. Blenkinsop

May I make a point of correction? In fact, the Northumberland Health Executive sent its note only to the board of governors of the teaching hospital, although, of course, the general argument applies to the teaching hospital and to the Newcastle Regional Hospital Board.

Dame Irene Ward

I thank the hon. Member.

7.51 p.m.

Mr. Joseph Slater (Sedgefield)

It is always a pleasure for hon. Members from the North-East to listen to the hon. Lady the Member for Tynemouth (Dame Irene Ward). At times she discusses productivity, and I have often wondered whether she has yet concluded what is meant by increased production and productivity. Tonight she has talked about productivity and what the Government have done for the National Health Service, of which we are so justly proud.

What the hon. Lady has not told us is why there have been so many changes in the Government and why since the party opposite came into power we have had five Ministers of Health. One concludes that some of the Ministers have not been as efficient in their control of the National Health Service as were our Ministers after the Labour Party took office in 1945. Incidentally, local authorities who were largely responsible for the development of health services before 1945 did a very good job.

We of the North-East feel that we are not getting a fair crack of the whip. We believe that the Minister does not allocate sufficient money to meet our needs. We criticise the regional hospital board in the belief that the board is not doing all that it might, but our criticism is mainly directed against the Government, and we shall continue to agitate for an increase in financial support from the Government, hoping that the Minister will bring the necessary pressure to bear on his colleagues.

The Minister has told me that two hospitals are to be built in my constituency, one at Billingham and the other at Newton Aycliffe, the new town. However, I have not been given any likely date of commencement. Can the Parliamentary Secretary, in the context of this debate on waiting lists, tell us when work on either of those hospitals will be begun? At one time, a scheme was on the stocks for a new hospital in County Durham, but nothing has come of that.

People in the North-East will be gratified to know that the House is now united in its demand for adequate facilities for the people of the North-East. As the hon. Lady the Member for Tynemouth indicated, the National Health Service has done a magnificent job since it was brought into being and hon. Members opposite have greatly changed their attitude since the days when they were in Opposition.

I hope that the Parliamentary Secretary will report to his right hon. Friend on the facts presented by my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) and on the attitude of other hon. Members from the North-East, for we are not satisfied with the progress being made in hospital extensions, new hospitals, and other forms of hospital accommodation. If the service is to progress as we all hope, the Minister must reconsider his attitude to financial provision for the North-East. He may be the fifth Minister of his party to have responsibility for this important service, but I hope that before he leaves office and hands over responsibility to us, he will have done something for the North-East.

7.55 p.m.

Mr. Charles Grey (Durham)

I must apologise to the House for not being able to be present when my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) opened the debate. I must also apologise to the hon. Lady the Member for Tynemouth (Dame Irene Ward) for having arrived in the Chamber only while she was speaking, thus being unable to follow the purport of her speech.

I rise to say how much we owe to my hon. Friend the Member for Newcastle-upon-Tyne, East for having raised this very important topic. It is an issue which has been near and dear to our hearts for a long time. Indeed, it has now become a grievous matter. When there are 5,000 people who have been waiting for hospital beds for more than twelve months, there is obviously something wrong with a system that allows this. I agree with my hon. Friend the Member for Sedgefield (Mr. Slater) that more money should be given to the Newcastle Regional Hospital Board so that it can conquer the problem of these devilishly long waiting lists.

Many men would undoubtedly be available for employment if they could have the chance of being admitted to hospital to have the necessary treatment. I do not know how serious many of the cases are, nor whether their condition deteriorates as time goes on, but I am certain that men who are left to wait for twelve months for a hospital bed must think that there is not anyone who cares and therefore must feel themselves the odd men out, and also must have an impression that no one cares a tinker's cuss for them.

That is an attitude which should not be permitted. In all the regions services should be such that waiting lists would be curtailed and kept to an absolute minimum. Of course, the answer to the problem is the building of more hospitals. It is said that that cannot be done, but there are building workers out of work. It is a bad form of economy, a bad form of social advancement, that, on the one hand, we should be short of hospitals and, on the other, that we should have out of work the men needed to build the hospitals.

That is undoubtedly the long-term solution, but in the short term it might be advisable to study the private bed system. I have had the figures given to me by the Parliamentary Secretary, although I do not have them with me at the moment. It might not be as serious as we think, but I hope the Parliamentary Secretary will give us some assurance that if it is not to be abolished, the private bed system will be reduced so as to make way for those people who have been waiting for beds for many months. I beg him to look into the matter and to give people in the North-East some encouragement, and also to give those who have fallen sick every opportunity to regain their health and vigour.

8.0 p.m.

Mr. J. A. Sparks (Acton)

I congratulate my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) on introducing this subject. I can assure him that much of what he and his colleagues have said about the North-East applies to many other parts of the country, not least to London and its environs. In considering this matter we must realise that the present form of the National Health Service—especially the hospital service—is quite inadequate to meet the needs of a growing population, especially one the average age of which is rapidly increasing. Unless the Government tackle this question so as to meet modern needs we shall always be having the sort of complaints that have been raised tonight.

We must also remember that the Government's policy has been responsible for reducing much of the expenditure of regional hospital boards in the past few years. Many extensions and developments which hospital boards would otherwise have carried out have had to be halted or suspended for the time being. That has created a growing problem of waiting lists in most hospitals.

We must also consider the question of the out-patients' service at some hospitals. Some people may consider that it does not matter if out-patients have to wait for hours before being treated in hospital. I know that they are very grateful to receive hospital treatment, but much remains to be done to cut down unnecessary waiting and delay in many of our great hospitals. One of the reasons why I was attracted to this debate was that I recently heard about an elderly lady who was called to attend at a private house to certify a patient who was mentally unstable so that the patient could be taken away. This happened at night, and when the lady left the house she fell over some bricks which had been moved from their previous position, against the gateway, into the centre of the path. In falling, she injured her ankle.

The lady was sent by her doctor to the out-patients' department of the local hospital for an X-ray, but the hospital authorities refused to to take an X-ray photograph because some formality had not been gone through. She was, therefore, sent back home and was later again taken to hospital for an X-ray examination. She was collected by ambulance at about 9.15 a.m. and she did not get back until 2 o'clock. The whole process took five hours.

That sort of thing is not good enough. I wonder how many similar cases have occurred. We have all had complaints about the appalling delays at outpatients' departments, which have meant that out-patients have had to wait for long periods. The system needs to be reorganised. Much more could be done by co-operation between the hospital boards and the local county health authorities. The pressure on hospitals could be relieved by the establishment of more local health centres, serviced by specialists who could attend at outpatients' departments and could visit smaller buildings, where the problem of administration would not be so great as in very large hospitals.

My hon. Friend made a passing reference to the geriatric clinics—presumably those to be organised and run mainly by the county health authorities. If there were closer co-operation between the regional hospital boards and the county health authorities a series of geriatric clinics could be set up mainly to advise elderly people. This would relieve some of the pressure on the hospitals. Often the patients would not have so far to go, and interviews and appointments could be more easily arranged. It would be necessary for the Health Service to have additional staff in the way of health visitors. Much could be done by decentralising. Many of the cases which now have to go to hospital for treatment could be dealt with at local health centres and geriatric clinics.

The Minister will probably say that we want more doctors if this is to be done, but if he will study the Willink Report, which was published recently, he will see that it predicts that by 1961 we shall have a surplus of 10 per cent. of qualified medical men and women ready to engage in practice. If that Report is substantially correct it would seem that there is room for an expansion in the consultant service by way of more and better geriatric clinics and the establishment of more local health centres to which minor cases could be sent for consultation and treatment. So, through the geriatric clinics and the local health centres, the patients could, as it were, gravitate to the hospital when their complaint was such that only hospital treatment was adequate.

With the increase in the number of aged members of the population, inevitably greater demands will be made on the National Health Service because older people need more medical attention, advice and treatment than younger people do. Some people argue that additional specialist hospitals are needed and in some areas there are annexes to general hospitals where elderly people receive attention, especially the chronic sick. It is also argued that it is a bad thing to segregate aged patients and that they should be mixed with other patients in the general wards of hospitals. There is much to be said for both points of view. But if we are to reduce the waiting lists and provide better treatment and accommodation, we must provide more buildings in which specialist treatment can be undertaken.

I hope that the Ministry will investigate the possibility of meeting this urgent need to provide adequate facilities for the whole country. It will mean spending more money on the Health Service, but the health of the people is of paramount importance and the time has come when the question of reorganisation should be examined. If the hon. Gentleman and his right hon. Friend will put up a fight for a better Health Service, and for the provision of increasing facilities for treatment, they will earn the gratitude of the House and the country.

The Parliamentary Secretary should urge his right hon. Friend to see that there is closer co-operation between regional hospital boards, hospital management committees and the county health committees, so that more duties and responsibilities may be undertaken by the county health committees. It is a matter which affects many regions and it is only in this House that we can ensure that anything of a lasting value is achieved.

8.15 p.m.

Dr. Edith Summerskill (Warrington)

Every hon. Member of this House is familiar with the Questions which appear on the Order Paper, put down by hon. Members from both sides of the House, on the subject of hospital waiting lists. Today there was a Question on the Order Paper about waiting lists in the Birmingham area. My hon. Friends who represent constituencies in the North-East region have put down similar Questions time after time. On Monday afternoons we have asked the Minister of Health and his Parliamentary Secretary what they propose to do about this problem We have received evasive Answers: we have received sympathy; we have been told that they understand the problem and that they will expedite measures to relieve it—yet nothing has been done.

Weeks and months have passed, and out of courtesy to Mr. Speaker and to other hon. Members we have not followed up these Questions with more and more supplementary questions. This debate provides me with an opportunity to ask the Parliamentary Secretary to give details about what is meant by the kind of replies which we have received to our Questions. On looking through the information contained in the Answers to those Questions I am shocked at the evasion of the Minister and his Parliamentary Secretary on this point.

Tonight we have discussed the problem in the north-east region and it is interesting to realise that conditions there are a reflection of the conditions which exist in other regions. It is important to break down these waiting lists to discover what categories of patients need treatment. Apparently some patients who are awaiting treatment are suffering from complaints which call for the attention of a general surgeon. Others are suffering from ear, nose and throat complaints, and I am glad to know that attention is being given to the problem that arises there. There are also women suffering from gynaecological complaints or from some orthopaedic condition.

The interesting fact is that on those occasions when I have asked the Minister or the Parliamentary Secretary for figures relating to the Midlands or the North I have been presented with precisely the same picture. I was told on one occasion, in relation to a waiting list of many thousands, that I must realise that many of the people were suffering from a chronic condition, the implication being that it did not matter that they had to wait. I wish to ask the Parliamentary Secretary what he feels about this and why such answers should be given to me.

Let us be practical and realistic. When one refers to the chronic surgical condition of a waiting patient, and it is implied that hon. Members must not be overwhelmed by the long lists of such patients awaiting treatment, as a doctor one thinks of a man with a hernia or a woman with a prolapsed womb. I regard it as absolutely inhuman to say that a worker suffering from these conditions should be expected to go on working. A man with hernia is supposed to carry on, standing about for hours probably in a job which involves a great deal of strain. A woman with prolapse is also expected to carry on. "It is a chronic condition", say the authorities." They look all right", they say, and so these people have to stand for many hours doing their jobs, although their condition is such that the job necessitates weariness and exhaustion. More rest is called for, but is not available.

These are known as chronic conditions. Therefore, when many thousands of people are waiting in one area the Opposition are regarded as a little difficult when we press for an answer why action has not been taken about them. Any patient who has his condition diagnosed, whether as acute or chronic, must suffer mental stress until he is receiving treatment and his operation is over. It is not easy for a man and woman worker to plan their household arrangements during the period of the operation, and this involves again a mental stress. When I hear about these long waiting lists of many thousands I do not divide them into two categories and say that some are very urgent and that we need not worry too much about the others.

If the Parliamentary Secretary will look at the Question on the Order Paper today, in the name of one of my hon. Friends from Birmingham, to which I have referred, he will see something which has been mentioned in some of our speeches tonight, which is that admission to a hospital can be expedited by payment of a fee. I have observed this, particularly in the northern area. Indeed, when I was in Bolton last week a question was put to me by a woman in the audience whether I knew that it was accepted in that area that a private fee should be paid in order to expedite admission to a local hospital.

That is being said too often. I hope that the Parliamentary Secretary is making detailed notes of these points. Perhaps he might attend to me just for one moment. He has had months to do his homework on this question because he has been asked about it time after time, and he should not have to come here to study his notes while questions are being put to him. He should be familiar with the subject, have concentrated upon it, and he should have come to the debate tonight feeling a certain shame that he has been called here to answer something which he should have been prepared to answer many times. He should be familiar with his notes and not have to be studying them at the last moment on a human problem which should affect his heart as well as his mind.

I ask him for a detailed answer, whether the payment of a fee for admission is widespread and whether he will say that this is an abuse of the National Health Service. He must have answered the Question which was on the Order Paper. He has probably given a Written Answer. We should like to hear what the Answer to Question 22 today was, because it is on this very problem.

My hon. Friends and the hon. Lady the Member for Tynemouth (Dame Irene Ward) have said that in the northern area the number of beds per thousand of the population is smaller than in the South. Is that allegation correct and, if so, why is the North not treated as fairly as the South.

I want to ask another question, to which I hope the Parliamentary Secretary will answer specifically. If there is a shortage of surgeons in the North for general surgery and of gynæcologists, why is it? Is it because of an actual shortage of surgeons, or of a shortage of operating facilities? By answering those questions the hon. Gentleman will be able to answer the question about waiting lists in other parts of the country where general surgery, ear, nose and throat treatment and gynaecology have been particularly mentioned in regard to waiting lists.

On the subject of establishment, we should like to hear just how hospital establishments are planned. How is it that hon. Members come here and allege that there is a difference in areas? Why is there what appears to be a rather haphazard approach to this question? Furthermore, when I suggested to the Minister many months ago that he should consider a more flexible arrangement where there was a large waiting list of surgical patients at one hospital, and that such patients might be transferred to a hospital where there was not such a large waiting list, the Parliamentary Secretary told me that he would consider the problem and let me know. Perhaps he will let me know tonight whether that flexible arrangement is or is not practicable.

In the London area, waiting lists are not so large. The people of the North are more patient and long-suffering than people in the South, and their patience and long-suffering seem to be a little disregarded. They should sometimes have more consideration, having regard to the industrial conditions and more severe climatic conditions of the North. From the morbidity and mortality statistics of chest diseases, for instance, we find that the North suffers infinitely more than the South and yet it is necessary for this debate to be held and for the Minister to come here to explain why the north-east region has to suffer in this way, although it makes such an important contribution to the country's production.

I hope that the Parliamentary Secretary will reply to these points, which are of a practical nature. If they were examined and action taken, the problem could be solved. I hope that as a result of the debate hon. Members will feel that some of their problems have been answered and that in future it will not be necessary to put so many Questions to the Minister and the Parliamentary Secretary.

8.28 p.m.

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

We have had a useful debate concerning hospital problems and, in particular, the waiting list problem of the Newcastle area. I wish to say at the outset that the Newcastle Regional Hospital Board is not in a particularly unusual position as regards the length of its waking lists. In fact, it is above the average —I was glad that several hon. Members agreed about this—in its attempts to deal with the problem.

I think that that is particularly commendable because, as my hon. Friend the Member for Tynemouth (Dame Irene Ward) observed, at the start of the National Health Service scheme the Board inherited rather poor hospital facilities, poorer in many respects than those in other areas. I can confirm that the record of the Board in this matter has been good. Nothing that has been said in this debate should be taken as in any way impugning that.

The total number of patients waiting in the area related to hospital facilities available is virtually identical with the national average. That does not mean that we are complacent about it at all, but it does mean that this area is not actually worse off, as has been suggested.

Mr. Sparks

Now that the hon. Gentleman has mentioned it, is there any way in which he can convey to us what is the national average?

Mr. Thompson

If the hon. Member will refer to some of the Questions and Answers which form the background of this debate, he will find that it has been given. If not, I shall be glad to let him have it.

Dr. Summerskill

Surely the hon. Gentleman can give the national average when apparently he is hingeing the whole of his reply to the debate on it?

Mr. Thompson

It has been stated in Parliament, but perhaps before the end of the debate I may refresh my memory on it. As the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) rightly observed, the figures themselves can be misleading in suggesting that the hospital service is deficient. I do not say that they are necessarily misleading, but they can be.

Mr. Blenkinsop

I pointed out that they could be misleading both ways. They can suggest that there is not a problem when there certainly is, as well as suggesting what the hon. Gentleman has indicated.

Mr. Thompson

I do not think there is anything between us on that. The point is that we cannot entirely rely on the figures. Some duplication of entries is unavoidable, as I am sure the hon. Member will recognise. Then there is the difficulty in all regions of keeping the lists up to date. The reason for waiting lists is not always a lack of beds. The hon. Member referred to plastic surgery patients whose treatment is often staged over a long period during which, although they are in receipt of treatment, they may be on the waiting list. Some forms of treatment cannot be given until the physical condition of the patient improves. Minor indispositions which patients may have while on the waiting list can prevent them from being admit-led for an operation when their turn arrives. All these considerations have to be taken into account.

What we are concerned with mainly this evening is, where genuine shortcomings exist, what types of remedial action are open to us. In referring to remedial action, I am excluding for the moment administrative measures. I want to take the matter a stage beyond that.

There are two courses open. The first is to increase the consultant establishment and the second is to improve and increase the buildings in which treatment can be given, which is another way of saying to provide more hospital beds. As the hon. Member said, the Newcastle Regional Hospital Board increased its number of specialists from 164 to 409 between 1948 and 1957. That was a very considerable increase. I agree with him that it has tapered off in the latter part of the period, but my right hon. and learned Friend is always prepared to look at proposals emanating from the Regional Board in this connection and to give them most careful consideration.

On the question of new buildings there is a great deal to be said. The Newcastle region entered the National Health Service relatively handicapped, as my hon. Friend the Member for Tynemouth explained, because its hospital facilities were limited and sometimes below acceptable standards. Allowance has been made for this factor when distributing capital money. This Regional Board has always had more than its share, if that share is reckoned on a strict population basis. Hon. Members from the area will be glad to know that.

Including the two new centrally financed schemes announced on 17th December, nine building schemes to the value of £11 million have been contained in the centrally financed programme, including one scheme at the Newcastle teaching hospital. A sum of £8½ million has already been spent on capital works in the region since the start of the National Health Service, and the total waiting list has been reduced from 32,000, its peak figure, in 1953, to about 27,300 at the end of 1958. I agree with the hon. Member for Newcastle-upon-Tyne, East that there has been some fluctuation in these figures, but, on the whole, I feel that this is marginal and is under control, and as these new facilities come into operation I feel that the picture will progressively improve.

In the regional board waiting list three areas are mainly affected—Newcastle, Middlesbrough and Cumberland. I recognise the particular situation of Newcastle, because with one-tenth of the population it has one-fifth of the total waiting list. This is partly due to the concentration in Newcastle of all regional plastic surgery work, but Newcastle has had five of the area's ten major centrally financed schemes.

Mr. Blenkinsop

There are plastic surgery units outside Newcastle.

Mr. Thompson

I feel obliged to include Middlesbrough and Cumberland, because we are discussing the Regional Board area. They will both benefit soon from brand new hospitals. Cumberland will benefit from that at Hensingham, now being built on the West Coast, while the Tees-side area is to have a new hospital north of the river. I am glad to give this information to the hon. Member for Sedgefield (Mr. Slater), because this is one of the schemes about which he asked me. If he would like to know a little more about the progress of the scheme I can tell him that the Board has been asked to complete the planning for it by 1960–61.

The other hospital to which he referred is Aycliffe, and here I cannot give him the same encouraging reply because, as he well knows, Aycliffe is a new town and at present the population is very small. That does not mean that it will not grow, but he will agree with me that on the basis of population alone there are more urgent problems to be dealt with, although we shall not overlook Aycliffe.

The effect of the new building will be felt over a wide area, with the result that pressure at East Cumberland, particularly in Carlisle, will be relieved by the absence of patients from the West, and similarly the Middlesbrough waiting list should shorten when patients from the industrial area to the north have their own hospital.

May I turn to the waiting list of the teaching hospital? There was some reference to that in the debate. The problem here is mostly confined to Newcastle itself and surrounding areas. As I suggested earlier, it is difficult to know precisely how much the waiting list contains duplications. The teaching hospital is constantly engaged in improving its facilities, and the House may know that work is soon to start on a new boilerhouse and plans are being prepared for a new out-patients' department, which might rejoice the hon. Member for Acton (Mr. Sparks). Although he is not a Member for that area, he referred to it in his speech. In addition to this, an annual capital budget of about £75,000 is being used to enlarge wards, provide additional operating facilities, and so on.

May I say something about the specialties which are particularly involved. General surgery affects the largest number of patients, approximately one-third of the whole regional total. It has been the policy of the regional board to provide additional operating theatres, which answers one of the questions which I have been asked. New theatres are to be opened shortly at South Shields General, Bensham General, near Gateshead, and Darlington Memorial Hospitals. Ashington Hospital, north of Newcastle, already has a new theatre. Work is now to start on another at Sunderland. The picture in relation to operating theatres is quite an encouraging one.

Many patients on the list are suffering from relatively minor ailments, but all medically urgent cases—and doctors and consultants must surely be the judge of urgency—are dealt with immediately. The list at the teaching hospital decreased by more than 10 per cent. in 1958, the whole of the decrease being among those who had been on that portion of the waiting list which is four months and longer. The board of governors is now engaged on providing additional operating facilities.

The next in importance of the specialties, from the point of view of length of time of waiting, is orthopaedic surgery. An additional specialist has recently been appointed in East Cumberland and by reorganisation, 25 extra beds provided at Cumberland Infirmary. Tees-side, which is the next most important area, will in a few months commence to use a new orthopaedic and accident wing at Middlesbrough General Hospital, which will certainly have the effect of relieving the position. With this general end in view, it is proposed within the next twelve months to appoint an additional consultant at Darlington.

Gynaecology is the next problem and is the biggest problem in the Newcastle area. The hon. Member and I have had correspondence about this. The urgency of this situation is fully recognised by the Regional Board, which is paying special attention to it at this time and hopes to provide additional accommodation.

Neurosurgery and urology are almost exclusively a Newcastle problem, and new units for both are to be provided by the Regional Hospital Board. The urology unit will be completed late next year and the neurosurgery unit, which is a centrally financed scheme, is to be started within the next few months.

Dr. Summerskill

The Parliamentary Secretary said that gynaecology is the greatest problem. What did he say will be done immediately?

Mr. Thompson

I think that the right hon. Lady confused the last point I made with the one immediately before it. The one immediately before it referred to gynaecology, and my comment was that the urgency of the situation was appreciated by the regional board, which hoped to be able to provide additional accommodation soon—

Dr. Summerskill

Really, this is not good enough. The hon. Gentleman admits here that the gynaecological waiting list is one of the greatest problems, but he simply says, "We hope to do something about it." He has said that before on many occasions, when Questions have been asked about out-patients. Surely, this is the opportunity—on the Adjournment debate—to tell the House specifically whether the intention is to appoint more surgeons, and to deal with the subject in a special way. Is the intention to send cases elsewhere? If so, will the Parliamentary Secretary specify the hospitals to which the cases will be sent? How does he intend to deal with the situation? We have not come here tonight just to be told again that something is to be done.

Mr. Thompson

I have been giving the right hon. Lady a quite detailed account of the various measures being taken to deal with waiting lists in the Newcastle Regional Hospital Board's area. I said that the gynaecological speciality was being investigated as a matter of urgency by the Board. It is the Board that has the first responsibility in this. It has the problem immediately on its doorstep, and the first measures must come from it. We will give it all the support we can in carrying those through, but the first measures, the proposals, must come from the Board.

Mr. Blenkinsop

This is very important. I am rather disappointed with what I have just heard. I understood that, in fact, the board was opening some 24 new beds in, perhaps, a week or two. If that is not absolutely decided now, I am disappointed. I hope that what the hon. Gentleman now says does not mean that the board has gone back on what I believed it was to do. I understood that the small Walker Accident Hospital was to be converted in order to deal with this class of case.

Mr. Thompson

I have no reason to suppose that the board has gone back on anything, but I should like to see it formally announced before I say more here.

The hon. Member for Durham (Mr. Grey) laid particular stress on pay beds, and this subject was mentioned by other hon. Members. I can assure the hon. Member that there is no substance in the argument that waiting lists could be re- duced if all pay beds were transferred to the use of National Health Service patients. On average, pay-beds are now 70 per cent. occupied. In any case, half the patients are National Health Service patients, admitted as urgent cases, or for some special medical reason. If there were no pay-beds, private treatment patients would, no doubt, have to receive equivalent treatment under the National Health Service, and the effect of bringing them on to the waiting list would be to leave the list where it is now.

What, I think the hon. Member wants me to clear up is whether the average of 30 per cent. of unoccupied pay beds could be drawn into the system so as to relieve it in any way. I should like to express the position in real figures, and not as a percentage. The total number of beds involved in this little block is between sixty and seventy, for a population of 3 million—for whom over 27,500 National Health Service beds are available. The addition of this small number of beds to the pool would, clearly, make no practical difference to waiting lists, particularly as most of these beds are in small, scattered groups. But, of course, it would mean a worsening of facilities for emergency cases since it is most important that a small reserve of not permanently occupied beds should exist to be available for sudden admissions if the rest of the hospital is full. That is a very important function which I would not wish to see negatived by any change in policy.

Mr. Grey

Of course, we are all anxious that there should be a few beds in reserve for emergency cases, but I do not agree with the argument that 50 or 60 beds should be kept available. It means that fifty or sixty people out of a population of 3 million could use those beds, and that is very important.

Mr. Thompson

We must probably agree to differ about that. My point is that if we added these sixty or seventy beds to the pool we would lose that valuable emergency capacity, and we must weigh that against doing what the hon. Gentleman would like us to do.

Mr. Slater

Is not the hon. Gentleman missing the point that priority is given to people who are in a position to pay, as against some of the more important cases who are in need of attention but who are not able to pay?

Mr. Thompson

I would not accept that over the country as a whole the existence of pay beds means that National Health Service patients who are in urgent need of a hospital bed are denied it.

May I now say a word about outpatients. The complaint is that teaching hospital patients must wait six or more weeks before getting an out-patient appointment. The complaint came from general practitioners in the Northumberland area and has been discussed in great detail by the board of governors and the executive council. I believe this was one of the points in the speech of my hon. Friend the Member for Tynemouth. I am very glad to give her and other hon. Members who referred to this matter a fairly detailed account of what has happened.

A meeting has now been held between the Northumberland Executive Council and the teaching hospital about this complaint from general practitioners about the delay experienced by their patients in getting out-patient appointments. It was explained to the executive council that some of the difficulties arose from temporary causes. For instance, there had been a shortage of registrars. This has now been put right and, as a result, the exceptional delay in surgery clinics has been reduced. To some extent, however, there is a long-term problem in that general practitioners have a preference for sending patients to the teaching hospital which, as a result, has an abnormally heavy out-patient load.

The executive council accepted this point and has undertaken to point it out to the doctors. My information is that the meeting ended on a very friendly note, and there is no reason to suppose that the general practitioners in the area are unduly concerned about this now that the matter has been made clearer to them. The teaching hospital, for its part, has undertaken to continue with its work of reviewing out-patient arrangements and dealing with other difficulties. The teaching hospital is most anxious to make it clear that whatever delays there may be they do not affect urgent cases. This point was explained to the executive council which was asked to remind doctors of the importance of telling hospital authorities whenever there is some degree of urgency which ought to affect the speed of making an appoint- ment. I take the view that this matter must be solved locally by good cooperation between the board and the executive council. In the meantime, the board is increasing the out-patient facilities, and the number of out-patient clinics held annually has risen in the last five years by 400.

The board of governors emphatically reject the complaint—and this is in reply to the question I was asked—that consultants will arrange National Health Service in-patient treatment for their private patients without putting them on the normal waiting list. The Board says, and it is very definite on this point, that it has no evidence of this, and that it is very distressed at such an allegation being levelled against its consultants. Certainly patients can see consultants privately without difficulty, but if they then require admission as National Health Service patients they will take their places in the regular queue.

The hon. Member for Newcastle-upon-Tyne, East made some reference towards the end of his speech to the question of some special kind of survey, and, indeed, he referred to it in a Question some little time ago. I am frankly doubtful if such a survey would throw up anything new, because, as I told the hon. Gentleman in reply to his Question, it is not necessary to stimulate boards in this way to extend and improve their services. Certainly nothing that I know of would justify singling out Newcastle for such an inquiry.

It is true that an inquiry on these lines was carried out in Cardiff in 1954, and I see that the hon. Member has his copy of the report, as I have mine. It is an interesting document, and I refreshed my memory of some of the details of the main conclusions and recommendations before coming to this debate. I think some of the conclusions probably have a national and not merely a local application. Of course, it is open to the regional board or to the board of governors to make this kind of inquiry on its own if it wants to, and, having regard to the fact that this is a progressive body, I think that if the board felt that there was value in it, it would have done it before now.

In conclusion, I should like to make the point that the capital allocation of moneys for the hospital services, firstly, in the country as a whole, and, secondly, in the Newcastle area, is certainly not diminishing but rather the reverse under the present Administration. In 1957–58, we had £20 million of capital moneys available for hospital development; in 1958–59, £22 million and in 1960–61, a total of £25½ million has already been announced. Newcastle's share of this in 1959–60 and in 1960–61 will be approximately £2 million, and, when we think of these considerable sums of money and the fact—

Mr. Grey

Can the hon. Gentleman say how that compares with other regions in the country?

Mr. Thompson

If the hon. Gentleman would like me to break down the figures for the country as a whole for him, I will certainly do so, or he may wish to put down a Question about them, but, in the earlier part of my speech, I pointed out—and I think he probably may have overlooked it—that we have taken into account the fact that Newcastle started off these hospital facilities relatively handicapped and in making our allocations to that region we have allowed for that situation. I think that that really answers the hon. Gentleman's point.

Mr. Grey

I will put down a Question about it. There is the question whether we are being given a proper share or whether it is being left to us to do something about it.

Dame Irene Ward

It would be interesting if my hon. Friend could give us the figures, but am I not right in saying that the last report of the Newcastle Regional Hospital Board for the first time for a number of years did not refer to the fact that it was behind in capital allocation? In other words, is not it fair to say that the Newcastle Regional Hospital Board thought that some effort had been made? For my part, of course, I am never satisfied.

Mr. Thompson

That is a very commendable attitude for any constituency Member, and hon. Members who have spoken for this part of the world during our debate this evening have shown that they have caught that healthy contagion from my hon. Friend.

I hope that what I have said will indicate that very great progress is being made in this region. It is not being starved of money. The many projects to which I have referred, which are going on now, will have the effect soon, I am confident, of providing the better and more comprehensive service which is what we all desire to see.

Mr. Blenkinsop

I hope that the hon. Gentleman will consider the other points which have been made during the debate. I understand that he could not answer them all now. Particularly, I want him to consider looking at the whole waiting list problem and trying to give, let us say, a new sense of urgency and drive, not only in relation to what can be done in the hospitals themselves, but also along the lines suggested by my hon. Friend the Member for Acton (Mr. Sparks), who spoke of what the general practitioner service, properly organised, might be able to do towards alleviating some of the hospital waiting list difficulties. I want the Minister to bear in mind also the position of the local health authority. We need a joint campaign in order to overcome the problem.

During the course of the debate, we have asked what is the national average for waiting lists to which the hon. Gentleman referred, and we have not had an answer. He told us that Newcastle is no worse off than other areas. So much the worse for the country as a whole.

Mr. Thompson

About 1 per of the population.

Question put and agreed to.

Adjourned accordingly at two minutes past Nine o'clock.