HC Deb 14 April 1960 vol 621 cc1505-21

1.30 p.m.

Miss Margaret Herbison (Lanarkshire, North)

I bring to the notice of the House the fact that neither the Secretary of State for Scotland nor the Joint Under-Secretary of State who is responsible for health is present for this important Adjournment debate.

The matter which I propose to raise is of the utmost importance to the health of more than half the population of Scotland. During the Crichel Down debate, the present Lord Chancellor, who was then Secretary of State for the Home Department, had this to say: The Minister is not bound to defend action of which he did not know, or of which is disapproves. But, of course, he remains constitutionally responsible to Parliament for the fact that something has gone wrong, and he alone can tell Parliament what has occurred and render an account of his stewardship." —[Official Report, 20th July, 1954; Vol. 530, c. 1286.] I hope to show today that something has gone seriously wrong in the West of Scotland, and I think that it is disgraceful that the Minister responsible is not here to answer for his stewardship. On 4th May, 1953, in answer to a Question, the right hon. Gentleman the Member for Woodford (Sir W. Churchill), who was then Prime Minister, said: All members of the Government are, of course, aware of their responsibilities both to Parliament and to their Departments. It is certainly customary for Ministers to give precedence to their Parliamentary business." —[Official Report, 4th May, 1953; Vol. 515. c. 29.] Thas is exactly what the Ministers responsible for this subject are not doing today. This is analogous to the case of an English or Welsh Member raising a similar subject on the Adjournment, and the Minister of Health and his Parliamentary Secretary saying, "We have a great many other engagements today", and asking the Minister of Agriculture if he or his Parliamentary Secretary would answer for them.

That is exactly what is happening here now, because the Joint Under-Secretary of State for Scotland, who is to reply, is really the Minister of Agriculture for Scotland and cannot possibly have the background to reply to a debate of this nature. Indeed, it might have been wiser for the civil servants of the Department of Health for Scotland to put the reply on a tape recorder and play it back on the Dispatch Box, or, if they had had the time, perhaps to have trained a parrot to give the reply.

I am not castigating the hon. Gentleman who is to reply, for this is not his responsibility. All he will be able to do is to read from a brief and give no answer at all to the debate. It is a grave discourtesy to the House. I will go so far as to say that it is a contempt of the House. It shows scandalous complacency and a "could not care less" attitude on the part of the Secretary of State and the Joint Under-Secretary of State who is responsible for health matters.

I am sorry that I have had to use some of my valuable time on this matter, but I felt that it was important for Scotland that this ought to be shown up. I want now to raise the urgent need for the provision of facilities for the assessment and treatment of rheumatic diseases and for research into these diseases, for the area in Scotland covered by the Western Regional Hospital Board.

I have already stated that this covers more than half the population of Scotland. The lack of such facilities was drawn to my attention in the first instance by a doctor in my own constituency. I wrote a long letter to the Secretary of State, and six weeks later received a reply. In the intervening period I put down three Questions to him. So far, I have had no satisfaction at all. In his letter the Secretary of State used these words: It is up to the regional boards to plan the hospital services in their area and to assess the relative priorities of various proposals for the improvement of the services. Since they have been appointed by the Secretary of State for that purpose, the central Department is not normally involved in detailed consideration of any but the largest projects. In his final paragraph, the Secretary of State said: In the light of what I have said earlier, I see no reason for intervening, though you may take it that I and the officers of my Department will take a close interest in future developments. I shall refer to other parts of the letter later.

The whole reply illustrates crass complacency on the part of the Scottish Ministers. The Secretary of State, if he does not know it, is the Minister of Health for Scotland, and the good health of our people is his responsibility. He has not the right to try and shuffle off that responsibility on to the shoulders of any regional hospital board in Scotland.

I have been trying to carry out some research myself in this matter. The first document to which I went was the latest Report of the Department of Health for Scotland. I found in it nothing about rheumatism. Not even was the word mentioned. It was treated as though rheumatism just did not exist in Scotland. I then went to the latest Report of the Minister of Health and there I found that seven pages were devoted to the subject of rheumatism.

That shows the attitude of the Minister of Health, as compared with that of the Secretary of State, to this disease that is so prevalent, particularly in the West of Scotland. I also studied the latest Report of the Registrar-General for Scotland. I found in that Report that the area covered by the Western Regional Hospital Board had three times the number of deaths from chronic rheumatic heart disease than the area covered by the Eastern Regional Hospital Board.

Now, the Joint Under-Secretary of State who is to reply may point out that far more people come under the Western Regional Hospital Board than under the Eastern Regional Board. That is true, but in the Eastern Region, in Edinburgh, there is a first-rate unit to deal with this matter.

We find in the Report that in the area covered by the Western Regional Board there were two and a half times the number of deaths from other forms of rheumatism and arthritis than in the area covered by the Eastern Regional Board. Again, according to this Report, in 1956 there were 217 deaths in Glasgow from chronic rheumatic heart disease as compared with 61 in Edinburgh. In Glasgow, there were 55 deaths from other forms of rheumatism, as against 23 in Edinburgh.

The statistics of the World Health Organisation's Technical Report—to which my hon. Friend the Member for Glasgow, Maryhill (Mr. Hannan) has given a great deal of study, and with which he will deal later—shows that, of 20 countries listed, Scotland has the highest percentage of deaths due to cardio-vascular diseases, of which almost half were due to rheumatic fever or chronic rheumatic disease. Does not that worry the Secretary of State, or does he just not know that that is what is happening in Scotland?

The latest Report of the Ministry of Pensions and National Service, published in 1958, shows that the number of days for which benefits was paid, over the whole of the United Kingdom, to people absent from work because of some form of rheumatic illness was 22,177,000. Hon. Members can imagine the suffering which those figures reveal. Would it not have been better for the Government to have used some of their resources—when they tell us that we have never had it so good —for research into and treatment of rheumatism?

Rheumatism may not be one of the greatest killer diseases, but it certainly causes dreadful suffering and pain to many thousands of people in Scotland. I suggest that it is a contributory cause of other deaths which are not listed as death from rheumatism. Indeed, it is conservatively estimated that one out of 200 of the population suffers some form of rheumatism.

The reply to my Question to the Minister on 8th March showed that in the whole of the area covered by the Western Regional Hospital Board there were only 30 beds devoted specifically to the treatment of rheumatism—30 out of hundreds of beds in the area. In the Minister's reply on 1st March we were told that research into the disease was going on at the Western Infirmary, Glasgow, although no details were given. On 8th March, I put another Question and I was told that a research unit established by the Medical Research Council undertook research into certain aspects of the disease.

The first Answer which I got from the Secretary of State was misleading and the Answer I got on 8th March from the Joint Under-Secretary was not much better and would have given anyone who did not care to do research on his own the impression that there were research facilities in the West of Scotland in connection with this disease.

What are the facts about this research unit in the Western Infirmary? I am informed that it is a chemotherapy unit staffed largely by doctors with scholarships from the Medical Research Council. It is almost a coincidence that since its inception the work of that unit has been research into the effect of drugs used in the treatment of acute rheumatism. That is an important subject, but it leaves the wide range of arthritis and chronic rheumatic diseases with not a vestige of research undertaken in the West of Scotland. I understand that not even those in charge of the unit in the Western Infirmary would dream of claiming that it was sufficient for research into arthritis and chronic rheumatic diseases.

I want again to quote from the letter which I mentioned earlier. Referring to the question of research facilities, the Secretary of State said: It is true that this matter had been discussed in various quarters since, I understand, 1957". He went on to say: In this case, I am informed that the Regional Board had no specific proposal from the Board of Management of the Glasgow Royal Infirmary until March, 1959". As early as April, 1957, the Western Regional Hospital Board was made aware that facilities available at that time would be disappearing from hospitals under the control of the Royal Infirmary —I do not want to go into details which can easily be found if required. From 1957, nothing was done to ensure that there would subsequently be adequate facilities. It was only when it was evident that the Western Regional Hospital Board was not prepared to initiate proposals on this matter that the Royal Infirmary, which, in 1957, had informed the Board of what was to happen, put forward its proposals.

It is no use the Secretary of State or the Western Regional Hospital Board hiding behind the fact that it was not until 1959 that specific proposals were made. The Board knew as early as 1957 that the then facilities, inadequate though they were, would be disappearing in two years, but during those two years the Board did nothing. The Board approved in principle the proposal put forward in July, 1959. If it approved it in principle, why am I now having to quote this letter from the Secretary of State saying that the Board has had second thoughts about the proposal? There is no time for delay in this matter.

The proposed unit at Belvidere Hospital would have provided 30 beds—I am reliably informed—and not the 20 beds mentioned in the letter. It would have been a unit which would have provided for a very large outpatient consultation and for research. One of the great advantages of the proposals made by the Royal Infirmary is that Belvidere is a fever hospital built on the pavilion principle. Infectious diseases are rapidly decreasing—and we are all very glad of that. If the pavilion type hospital in Belvidere had been used, then, if expansion were needed, another pavilion could have been taken over for the purpose. It would have been just a matter of duplication.

I know that there is a shortage of funds and that every regional hospital board is experiencing the parsimony of a Tory Government, but since there is a shortage of funds it is all the more important that money should be spent wisely. The Western Regional Hospital Board spent £90,000 on a unit for poliomyelitis. That unit has since treated only a handful of people. It should have been known to the Board that experiments with Salk vaccine were taking place in the United States of America, for the Board would then have known that there was no need to spend that £90,000.

We will now be left with a monument to a disease which all of us hope will disappear. It would have been much wiser for that money to have been used for research into the treatment of rheumatism. Are we to leave 200 to 300 beds in Belvidere Hospital for an epidemic which is almost certain never to occur? If, by some mischance, it did occur, there is nothing to prevent chronic rheumatic patients being sent home. This is a very foolish attitude about available premises.

The Rheumatic Research Unit in Edinburgh has done excellent work and the Empire Research Council in Rheumatism has now given it £600 a year for research into the incidence of rheumatic diseases, with particular reference to industry. If we had had a unit in the West of Scotland, we would have had at least a share of that money. As it is, either the heavy engineering and shipbuilding industries will be neglected in this research, or we shall witness the spectacle of a unit from the East of Scotland having to go to the West of Scotland to do a job for which we ought to have facilities.

The Secretary of State tells us that we ought to be careful. He says, moreover, that in planning research projects we should be careful that there is no duplication with work being done elsewhere. No consultant would dream of duplicating the work of another unit. The last thing that a consultant or those interested would want would be to make in Glasgow a mirror image of the unit in Edinburgh or in Manchester.

I have hurried through this, because some of my hon. Friends from the West of Scotland have done a lot of work on this subject.

On 1st March, I asked the Chancellor of the Exchequer which universities in Scotland had a Department of Rheumatology. His Answer was that not a single Scottish university had such a department. Not one university, although the incidence of the disease is so high. I then raised this matter with the Chancellor of the Exchequer in relation to England. What a different picture I found. Manchester University has a centre for the study of chronic rheumatism, with a chair financed by the Empire Rheumatism Council. If one considers the population of Glasgow and the conditions which lead to rheumatism, and compares the situation there with what one finds in Manchester, the Secretary of State should be thoughly ashamed that we are so far behind. What is he doing to try to interest Glasgow University to do what Manchester University has already achieved?

Let us consider another example. The Post-graduate Medical School of London University has a professorship—not just a department—of rheumatology in the Department of Medicine. Sheffield University, which is smaller than Glasgow University, has a lecturer in rheumatic diseases. Leeds University has two research fellowships in rheumatic studies.

That is the picture in England. What a bright picture it is compared with Scotland. But it is not surprising that the Scottish universities should be failing us. They receive no leadership from the Secretary of State for Scotland, who is the responsible Minister of Health for Scotland. I hope that if this Adjournment debate does nothing else it will make the Western Regional Hospital Board realise that its job is to get a move on and use Belvidere to provide a much-needed service for the people who are suffering so badly from this disease in Scotland.

1.53 p.m.

Mr. A. C. Manuel (Central Ayrshire)

I congratulate my hon. Friend the Member for Lanarkshire, North (Miss Herbison) on her initiative in making this debate possible. It is unfortunate that we have only 45 minutes in which to discuss this subject. Obviously, we cannot do justice to it, but I endorse all that my hon. Friend said about the need for more research into rheumatism in Scotland. It is scandalous that with the incidence of rheumatism as high as it is we have far fewer facilities in Scotland than are provided in the rest of the United Kingdom.

I do not wish to criticise the medical profession, but this disease still largely baffles the doctors. That being so, the need for research is paramount. If we are to arrest the damaging effects of this disease we must so arrange our facilities for providing treatment that treatment is provided in the early stages of the disease.

As I understand, certain local authorities in Britain have been listed by the Minister of Health, by regulation, where notification and treatment must take place. This notification, however, refers only to cases of acute rheumatism in the case of children under 16 years of age. It is remarkable that this listing by regulation started only in 1947, although there have been further extensions in 1953 and 1959. I have not the time to list the areas, but there are 14 local authority areas in England which are listed for this compulsory notification and treatment. We have no comparable regulations for any part of Scotland. We are completely apart in this respect, and the areas which we represent, and which are in most need of help and hospital facilities, have nothing comparable to England and Wales in connection with notification and treatment of rheumatism.

I understand that the incidence of this disease has been much lessened in recent years among young children. After reading Sir John Conybeare's "Textbook of Medicine", where he tells us that overcrowding and poverty are probably the most important factors in causing this disease, we can understand that good housing and full employment have reduced the incidence of rheumatism. I am appalled at the amount of productive time that is lost to industry and to workers in industry because of the ravages of this disease.

We have now reached a stage where compulsory notification should apply to the whole country in respect of young people. In addition, all our local authorities—and I want this to apply in particular to Scotland—ought now to be empowered to provide clinical and hospital treatment, and adequate facilities, as are provided for infectious diseases, tuberculosis, maternity cases, and the host of other services provided by the local health authorities. I am convinced that in Scotland the need is greater than in any other part of Britain.

Our climatic conditions and the dampness with which we have to cope lead to a high incidence of this disease. In Scotland, we lose far more man-hours than any other comparable area of the country. While we have compulsion up to the age of 16 in certain areas in England, we must not for a moment forget the many thousands of people in Scotland who are older, and who are subjected to damp and wet conditions because of the nature of their job and who attract rheumatism after that age. We must provide facilities for treatment to give those people some hope of being cured.

Other hon. Members wish to speak and perhaps I should not have spoken at all, because of the short time at my disposal, but it is commonplace in Scotland to find old people on the street crippled by this disease, and to many of us that is a heart-rending situation. Scotland is lagging behind England in the treatment of this disease. Our need is very great and I hope that this short debate will spotlight attention on our need. I hope that the Joint Under-Secretary of State for Scotland will talk to the other members of the Government who are responsible for Scottish health matters and make an authoritative statement, in view of what we have said about local authorities and other things, in connection with research and the need for action in Scotland to deal with this dread disease.

2.0 p.m.

Mr. William Hannan (Glasgow, Maryhill)

I am sure that the House will understand that in the time available one cannot develop all that one would like to say. I think that two or three of my hon. Friends wish to speak after me, and I will, therefore, only briefly support what my hon. Friend the Member for Lanarkshire, North (Miss Herbison) said about this important subject.

One aspect has not been mentioned, which is that rheumatism and arthritis take second place only to bronchitis as the illnesses mainly responsible for the absence from work of many industrial workers. I accept that research is being undertaken into the common cold and influenza. Of the rather more serious illnesses, rheumatism takes second place only to bronchitis, and it would repay many hon. Members, when they make attacks on the workers for absenteeism and strikes, to remember that if we could save the days lost by illness generally, and by this disease in particular, it would go a long way to helping us to pay our way better than we are doing at present.

It should also be remembered that a quarter of those attacked by rheumatic fever at some time, particularly younger people, have a return of the disease within five years. That is something to which the Secretary of State, and the Western Region Hospital Board—which covers, as has been said, half the population of Scotland—must pay increasing attention in the future. From current correspondence it appears that there is a strong analogy between what is needed in this case and what was wanted in dealing with cancer in the West of Scotland, when the right hon. Gentleman's predecessor, as a matter of urgency, had to kick some people into action to produce the necessary facilities. The very same conditions apply here.

Rheumatism can be substantially prevented by continued administration of penicillin and the sulphonamides, and this long-term treatment was strongly recommended by the Rheumatic Fever Committee of the Royal College of Surgeons in 1957. As we are now in 1960, some of us would like to know what attention the Secretary of State has paid to the recommendations of that committee. I could quote figures, did time permit, to show that the incidence of arthritis and rheumatics is taking precedence even over that of respiratory tuberculosis, particularly so in men. Surprisingly enough, there is a greater disparity in the case of women.

I am sorry not to have had more time to underline many of the points made by my hon. Friends the Members for Lanarkshire, North and Central Ayrshire (Mr. Manuel). Why have no areas been designated in Scotland? Why is there no compulsory notification of the disease, particularly for children under 16 years of age? There are areas listed for England and Wales, and an amending Order was made as late as 1959. We want to know what the Department's intentions are.

As some reference has been made to the reports of the World Health Organisation, I would refer the Joint Undersecretary to page 5 of its second report, which gives a table showing deaths from cardio-vascular diseases in persons under 35 years of age, belonging to 20 different nations. Norway leads, with a proportion of deaths from cardio-vascular disease in relation to all deaths of only 1.9 per cent.

Denmark comes next with 2.2 per cent. The figures range upwards through a number of countries to the three countries of the British Isles. In England and Wales it is 5.6 per cent. Northern Ireland has 6.1 per cent. Scotland comes tailing along with 6.4 per cent. Half of these deaths are due to rheumatic fever or chronic rheumatic heart disease.

The House would do better to get down to such fundamental problems rather than to spend so much time on matters that are not so important for the future well-being of the nation.

2.5 p.m.

The Joint Under-Secretary of State for Scotland (Mr. Gilmour Leburn)

I am sorry if the hon. Lady the Member for Lanarkshire, North (Miss Herbison) feels some slight by reason of the fact that I should be answering the debate—

Miss Herbison

I am not slighted.

Mr. Leburn

I am grateful to her for the fact that she makes no personal attack upon myself. I do not think that I should take up time discussing the matter—time being so short—but I think that notice will be taken of her remarks.

I am aware of the very close interest which the hon. Lady has taken in recent months in the arrangements for the treatment of and research into rheumatism in the West of Scotland. As she said, she has addressed three questions on the subject to my right hon. Friend the Secretary of State, and has also written to him.

In view of her concern, my hon. Friend the Joint Under-Secretary wrote to her at some length on 23rd March explaining the latest position in detail, and this debate this afternoon has given me a further opportunity of dealing with this matter. We should all be grateful to the hon. Lady for the publicity that she has given to this important topic.

The hon. Lady's speech has shown that she considers some further action should be taken by my right hon. Friend and his Department. In view of this, we must, I think, first of all get in proper perspective the responsibilities of hospital boards and their relationship with my right hon. Friend.

The Secretary of State appoints regional hospital boards to act as his agents in the planning and organisation of the hospital service in the five regions of Scotland. It is for them to decide, within the framework of the Secretary of State's broad policy, what priority should be attached to the various proposals for improvement in the service.

The Secretary of State appoints to these boards people of standing, both in the medical world and laymen and women, able to speak for a wide variety of interests. Having appointed them, it would be quite wrong—and I feel sure that, in principle, the hon. Lady would not disagree—if the Secretary of State were constantly telling them how to run the service in their regions, and interfering in their consideration of each and every project for development.

While the final responsibility for their actions—and, perhaps, even omissions— is the Secretary of State's, he must leave them a reasonably wide area of discretion in planning the regional service along with boards of management in their local knowledge of local needs.

Having said that, I must make it clear that my right hon. Friend and his Department are very much concerned about the suffering and incapacity resulting from this disease. We all sympathise with the many people whose lives are lived under the constant shadow of pain or disability; and we are all concerned to see that proper measures are taken to help them.

We in the Scottish Office are also aware of the effect of chronic rheumatism and arthritis upon our economic life. I have figures but, because of the time, I shall not quote them, to illustrate the number of days lost, and the number of fresh cases of rheumatism in Scotland each year. They have been quoted so I shall not repeat them.

I may say, first that this disease in its ordinary chronic forms is a crippling disease rather than a killing one. Rheumatic heart disease and rheumatic fever have traditionally been regarded as more dangerous forms of the disease. The Reports of the Registrar General, however, I am glad to say, show a welcome fall in deaths from these forms of the disease in recent years. The number of deaths from rheumatic fever fell from 57 in 1950 to 17 in 1958—a result which is a great tribute to medical skill and care.

Before I deal with the particular point raised by the hon. Lady and with the Western Regional Board's present activities in this field of rheumatism, perhaps I might say a general word about research into rheumatism in Scotland. Facilities far investigations of various kinds in this connection have existed for some time. If the hon. Lady cares to study another report of the Department of Health, the one published in 1954, she will find reference to the establishment by the Medical Research Council in that year of two units concerned with research into rheumatism. Of course, she has, in fact, mentioned them.

One was the establishment of a clinical chemotherapy unit at the Western Infirmary, Glasgow, to investigate the treatment of acute rheumatism and certain blood diseases. Research is still taking place in this unit, which has its own staff of doctors and research workers. It has 14 beds and laboratory and associated facilities.

The other unit, as the hon. Lady mentioned, was the one established at the Northern General Hospital, Edinburgh, through the generosity of the Nuffield Foundation. This unit concentrates entirely on rheumatic conditions and has comprehensive treatment facilities both for in-patients and out-patients. It carries out an extensive programme of research and is financed partly by the Secretary of State and partly by the Medical Research Council.

The House will, I think, be interested to know that it has recently been arranged that Dr. J. J. R. Duthie, head of this unit, who, incidentally, is also a university lecturer, is to direct a survey financed by the Empire Rheumatism Council into the incidence of rheumatic conditions among the working population.

In spite of all this, there is, of course, always room for more research into the various aspects of rheumatism. But it does not follow that it would be right —and I am sure that the hon. Lady realises this; in fact, she has really said so—merely to reproduce the Edinburgh unit somewhere in the West of Scotland. In fact, provision for research, unlike treatment, does not necessarily require additional building; sometimes all that may be required are interested and suitably qualified people to carry out the investigations.

I should like to say as firmly as I can that no doctor with a soundly planned programme of investigation or research—

Miss Herbison

Surely, if the units are to carry out any investigation they have got to have even a small number of beds at their disposal.

Mr. Leburn

That may be so, but, on the other hand, they can get the equipment and the finance from a number of various sources, into which I do not think I need go. In the last resort, they can, if necessary, get help from the Scottish Office or from the Department of Health itself. If any interested person wanting to do this sort of thing needs medical and scientific advice in the preparation of his programme we have an advisory committee on medical research to help him.

In speaking of research, I have gone beyond the Western Region, because research, unlike treatment, is not specifically devoted to the needs of any one region. The patients in one region benefit from the results of research in another, though they have, of course, to have treatment facilities of their own. On that point, I have no doubt that patients in Scotland greatly benefit from the research that is done in England, at Manchester, London, Sheffield and in the other centres.

May I now turn to provision for treatment in the Western Region? While it is valuable to have some units which specialise in the treatment of rheumatism, it is wrong to assume that adequate in-patient treatment can be provided only in beds specially set aside for that purpose. Like other medical conditions, it can be treated in medical wards of general hospitals.

In the Western Region, as in others, patients are accommodated in the medical wards of hospitals throughout the region. But, in addition, in Killearn Hospital, associated with the Western Infirmary in Glasgow, there are 30 beds specifically devoted to the treatment of rheumatism. There are also the beds in the research unit at the Western Infirmary itself which may be occupied from time to time by rheumatism patients.

The hon. Lady has expressed her concern about delay in providing a further special unit at Belvidere Hospital in Glasgow, and I should now like to make quite clear the position of my right hon. Friend and the regional board in relation to this proposal. The first point to emphasise is that, while officers of the Department of Health have known that this matter was being discussed, no proposal has, in fact, been made to the Department of Health.

Many projects do not come formally to the Department at all since they can be carried through within the regional board's delegated authority.

Mr. Manuel

The local authority, not the regional hospital board.

Mr. Leburn

I hope that the hon. Gentleman will allow me to finish.

When the large projects come to the Department it is often only after a long period of consideration at regional and board of management level—perhaps involving radical reshaping before they reach the Depart- ment. In view of the hon. Lady's interest in this proposal, the Department has, however, asked the regional board for a report on the whole matter. The information which I shall now give the House is based on information obtained from the board.

I understand that a proposal for some kind of rheumatic unit at Belvidere Hospital has been discussed in various quarters since 1957. The Empire Rheumatism Council has, I know, been interested in the proposal and has been involved in the discussions. As I have indicated, there are often fairly long, sometimes disappointingly long, periods of preliminary discussion of new projects.

In this case, I am informed that the regional board, although it had been involved in these discussions, had no specific proposal from the board of management of the Glasgow Royal Infirmary group, which includes Belvidere Hospital, until March, 1959.

Miss Herbison

Though it knew the need and had had the discussions, supposing that the Royal Infirmary had never at any time put forward specific proposals, would nothing have been done by the regional board? That is really what we are being told.

Mr. Leburn

Treatment of this disease is being given in very many hospitals. We are now coming back simply to the question of specialised beds.

This was for the provision of 20 beds at Belvidere for the treatment of rheumatic patients. The regional board approved this proposal in principle in July, 1959, and sketch plans were thereafter provided by the board of management in October. After this, I understand, the regional board decided to give some further consideration to the whole conception of this unit, in particular to its size, the facilities it should offer and the area it should serve.

Last month the regional board decided that instead of merely providing some additional beds at Belvidere it should examine the desirability of having a much more comprehensive regional centre for the treatment of rheumatism —not necessarily at Belvidere, where there are many demands for other types of accommodation. I will draw particular attention to what the hon. Lady has said about this hospital.

I would point out that a special subcommittee was set up and the senior administrative medical officer was asked to make inquiries about the size and function of comparable units in other parts of the country to see what kind of provision might be appropriate to the circumstances of the Glasgow area. To the extent that some aspects of the unit might be experimental, it would be necessary to avoid duplication of work going on elsewhere. I understand that the senior administrative medical officer has already been in consultation with the director of the Edinburgh unit and that the sub-committee is to meet on 28th April to consider the results of his inquiries.

I am bound to say that in view of these developments my right hon. Friend can see no reason for intervening further at this stage. The hon. Lady may take it, however, that he will keep in touch with developments and will be eager to see that a firm decision of some kind is come to on this matter in the very near future.