HC Deb 27 April 1960 vol 622 cc347-56

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

10.14 p.m.

Mr. George Thomas (Cardiff, West)

The need for a second plastic surgery unit in South Wales is at once pressing and urgent. I have resorted to the extreme measure of this Adjournment debate because I was shocked by the Minister's bland reply to my Question on this hospital a few weeks ago. I was told that the question of a second plastic surgery hospital unit in South Wales is a matter for long-term planning. I maintain that such a reply is totally unsatisfactory to the Welsh people. It reveals an unbelievable complacency which I am quite sure the hon. Lady the Parliamentary Secretary to the Ministry of Health would not like to maintain tonight.

The facts are these. There is only one plastic surgery hospital in-patient unit in South Wales to cater for all the teeming masses of our people. From Milford Haven in Pembrokeshire to Aberystwyth in Cardiganshire, people suffering from burns or who need plastic surgery hospital treatment have to be conveyed to Chepstow in Monmouthshire.

This is a hospital with 129 beds only, and they are in a hotch-potch of old buildings. I want to pay a sincere tribute to the dedicated service of Mr. Lewis, the consultant plastic surgeon, and the entire staff at Chepstow Hospital. I want to thank them for the splendid work they have done and are doing for the people of the Principality. Wales owes a deep debt of gratitude to these people, a debt which we can never properly repay but of which we are ever mindful.

The St. Lawrence Hospital is quite unable to cope with the needs of our people. I understand that the consultant has outpatient days in Swansea and in Cardiff and it may be in other places, but all surgical cases have to be conveyed to Chepstow. A crazier siting for a plastic surgery hospital for South Wales would be bard to think up.

A constituent of mine was telling me at the weekend that he had been in a very serious motor accident and had been taken to Cardiff Royal Infirmary for an emergency operation. Then he had to be conveyed for another emergency operation to Chepstow 20 miles away, but owing to his condition and the fact that those conveying him had to keep on stopping to attend to him it took six hours to get this seriously ill man from Cardiff to Chepstow. He was subsequently in the hospital for over four years.

Two or three years ago when miners in Trehafod in the Rhondda Valley suffered severe burns from an underground explosion, as my hon. Friend the Member for Rhondda, East (Mr. G. Elfed Davies) can well recall, they were taken to the Chepstow Hospital. The miners' union laid on a special bus to take their families and visitors to Chepstow. There is no bus today. People in that valley have to start at 10 o'clock in the morning and they do not return home until 8 o'clock at night. How they manage from West Wales, from the constituency of my hon. Friend the Member for Gower (Mr. I. Davies) or, the constituency of my hon. Friend the Member for Brecon and Radnor (Mr. Watkins), both of whom I see in their places, quite defeats me. It is bound to mean great cost in time and money, and for many patients it is bound to mean fewer visits from their families and friends.

It is an elementary fact that visiting plays an important part in maintaining the morale of patients. I know that those hon. Members in the House who are doctors will agree with this layman's generalisation, and because visiting plays an important part in the cure of sick people I remind the House that the Welsh are as clannish as any and the family tie is as strong in the Principality as in any part of the world. It is indefensible to make it so difficult for families to visit their loved ones who are seriously ill. Most burns patients are very ill and relatives often have to stand by. It is difficult to stand by when a member of the family is dangerously ill but is 60 miles or more away from home.

Tell me that this is a matter for long-term planning and I suggest that it is an insult to the people of Wales to say that there is no urgency about a problem of this sort. According to the last Report of the Welsh Regional Hospital Board, there is a waiting list of no. fewer than 1,070 plastic surgery cases seeking admission to St. Lawrence Hospital. There are another 95 dental plastic surgery cases. Because priority, quite understandably, is given to cases of burns and cancer, other cases have much longer to wait.

The delay for women patients is, I understand, rather low—six months to a year, but for men in South Wales the delay is five years. That is five years to brood over their disfigurement. The psychological effect of this delay cannot be measured. Because of the highly industrialised nature of South Wales this queue will get longer, not shorter. Our basic industries, coal, steel, and the transport of oil, are all industries that lead to a steady stream of cases needing plastic surgery.

What of our children? No fewer than 401 children in South Wales are awaiting admission for plastic surgery. These are cases of cleft palate, skin lesions, and hare lip. The waiting period is two years for children. Parents who are worried and depressed by their children's deformities find two years an eternity.

I am astonished that the Welsh Regional Hospital Board should advise the Minister—if it is the Board which has advised him—that there is no urgency about this problem, when children are waiting for three years for hare lips and cleft palates to be adjusted and men are waiting five years for plastic surgery. This is a black spot in the Health Service. We must speed up admissions and that can only be done in two ways.

We need more hospital beds, which means more hospitals. We need more consultant plastic surgeons. Dr. Duncan Davies, who is the Medical Superintendant of Morriston Hospital, which is in the Swansea area, is one of the foremost advocates of a further plastic surgery hospital for South Wales. I believe I am right in saying that the medical profession is overwhelmingly of the opinion that we need a second plastic surgery hospital in Wales.

I cannot for the life of me understand why, in the Report of Government activity in Wales, in the health section, there is not even a mention of plastic surgery. This reveals a surprising complacency on the part of the Welsh Regional Hospital Board which, no doubt, has given to the Minister a report to submit to the House.

I want to know what urgent steps— not long-term—are being taken to increase the number of beds available for plastic surgery in South Wales. Secondly, what steps are being taken to increase the number of consultant plastic surgeons? I am informed that the St. Lawrence Hospital, of which the Welsh people are inordinately proud, has the services of only two consultant plastic surgeons and one consultant dental plastic surgeon. How sadly that contrasts with the East Grinstead plastic surgery unit, which, I am informed, has about the same number of beds as the St. Lawrence Hospital, but where there are not two but six consultant plastic surgeons and five consultant plastic dental surgeons. South Wales has a right to feel that it is not having a fair deal from the Health Service in this matter.

Thirdly, will the Parliamentary Secretary tell us, as I trust she will, what plans the Minister has for such a hospital in West Wales? I believe that St. Lawrence Hospital should be brought to Cardiff and that there should be a second plastic surgery hospital situated in the Swansea area to deal with West Wales. That is an elementary fact which I would have thought the Ministry would be quick to acknowledge.

I recently wrote an article on this subject in the Welsh edition of the Empire News and I invited readers who supported my point of view to send me a card saying so. I have been overwhelmed with a deluge of postcards and letters and even petitions, petitions which have had the signatures of every worker in a factory. In a factory in Pontyclun the staff as well as the workers all penned their signatures urging the Ministry of Health to grant urgent consideration to this question.

This is not a minor issue for Wales. I regard it as the most important question which I have had the privilege of raising in an Adjournment debate, and I have had the privilege of initiating many Adjournment debates. This is a matter of life and death and of human suffering. This is a major issue and the Welsh Regional Hospital Board ought to rearrange its priorities.

I hope that the Parliamentary Secretary will announce financial support for a second plastic surgery unit in South Wales and that she will be able to give hope and encouragement to people who immensely value the National Health Service and who do not underestimate the difficulties which face the hon. Lady and her Ministry in the administration of this great social scheme. I am glad to have had the opportunity of raising a matter of the first importance.

10.29 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)

Before I try to answer the points raised by the hon. Member for Cardiff, West (Mr. G. Thomas) I should like to fill in a little of the background about the facilities available for plastic surgery. The unit comprises 124 beds, and not 129 as the hon. Member said—although I do not want to quarrel about that—at the St. Lawrence Hospital, Chepstow, which is administered by the Newport and East Monmouthshire Management Committee. For teaching purposes and in association with it is a token unit of eight beds at Llandough Hospital, Penarth, under the control of the Board of Governors of the United Cardiff Hospitals. These two units serve mainly the areas of South and West Wales, and also, in the case of St. Lawrence Hospital, the near-border areas of Hereford and Gloucestershire. The areas, which cannot be precisely delimited, have a population of approximately 2.1 million people. Plastic surgery facilities for patients in North Wales are available at Liverpool, and the occasional patient in mid-East Wales would possibly find it more convenient to travel to Birmingham.

St. Lawrence Hospital is situated in Chepstow, at the extreme eastern part of Monmouthshire. It is thus on the periphery of the area covered by the Welsh Hospital Board. Newport is 16 miles away; Cardiff is 28 miles away; Swansea is 73 miles away, and Pembrokeshire and Cardiganshire are more than 100 miles distant. It is true, therefore, that the distances involved in some cases are very great.

St. Lawrence is a brick-built, hutted hospital—not a hotchpotch, as the hon. Member said. I have not seen it personally, although I have been to Wales, but I have today seen photographs of the hospital and I am satisfied that it is typical of the emergency hospitals erected in wartime and later switched to peacetime use. That is the history of this hospital, because it was erected in the early part of the last war by the Ministry of Works and intended for the treatment of war casualties.

On completion, in 1942, it was loaned to the War Department and continued throughout the war as a military hospital. In September, 1949, it was taken over by the Welsh Hospital Board and entrusted to the Newport and East Monmouthshire Hospital Management Committee, to form the nucleus—50 beds then—of a plastic surgery unit. Further developments in 1951 and 1954 brought the number of beds to 124, and the range of functions was extended to include a burns unit. There are, in addition, 52 orthopaedic beds.

On the question of staffing, which the hon. Member referred to as being inadequate, I would point out that the medical and dental staff consists of two consultant plastic surgeons, a consultant anaesthetist, a consultant dental surgeon, a senior hospital medical officer, two senior registrars, two registrars and two senior house officers.

Before dealing with the specific criticisms made by the hon. Member I should like to make certain general observations. Plastic surgery is highly specialised and demands outstanding skill and experience. Before the war the number of surgeons engaged solely in this specialty was very small. Facilities were extended to meet the needs of war, in the way we all know, and this expansion and the near-miraculous achievements of the plastic surgeon have led to a greatly increased demand for civilian purposes. Today, plastic surgery includes the treatment of a number of congenital defects, such as cleft palate and congenital abnormalities of the face; deformity due to diseases such as lupus, syphilis or cancer; traumatic cases, especially those involving injury to the face, and burns.

It is not necessary, nor would it be practicable, to provide in this specialty, as in other forms of surgery, a fully developed service in the main towns. There is primary work, especially that associated with the treatment of burns and extensive superficial injuries, which must be undertaken in all hospital centres. Provision for a plastic surgery service is necessary only at a regional centre. The size of such a unit demands much consideration, but it would be uneconomic to provide a unit of less than 50 beds. Ideally, the figure should be more—of 100 or so beds, as it is at Chepstow.

The hon. Gentleman has pressed for the establishment of a second Welsh plastic surgery unit on three grounds, of which he was kind enough to notify me in advance. Those grounds are, first, that the location of the unit at Chepstow is too distant and inconvenient. Secondly, that the number of beds and the medical establishments are inadequate Thirdly, that waiting periods and the numbers waiting are excessive.

The hon. Gentleman suggests that a number of tuberculosis sanatoria no longer being required might be used, or at least that one of them could be transformed into a plastic surgery unit. The unit located at Chepstow is admittedly inconvenient, though this was dictated by necessity. The only buildings readily available in 1948 were in the hutted wartime hospital at Chepstow. The skilled medical personnel required were, as it happened, also available at that time owing to the closure of the unit at Gloucester, and not to have made use of the buildings then might well have lost the opportunity for the early setting up of the Welsh unit.

The present provision of beds assigned to plastic surgery at the St. Lawrence and Llandough Hospitals is 132 the equivalent of 0.064 beds per thousand of the population as against the average for England and Wales as a whole of 0.033 beds per thousand. Even allowing, as is reasonable, for a higher incidence of industrial injury in South Wales, the number of beds proportionately is not only higher in this specialty than the national average but higher also than for any other industrial area in the country.

I cannot accept the claim that the medical establishment is inadequate and unfair to the medical staff. The unit at East Grinstead is not comparable since the consultants devote a large proportion of their time to other hospitals. The medical establishment at St. Lawrence does not compare unfavourably with other similar centres.

On waiting, I would say to the hon. Gentleman that every emergency is accepted at once and cases of high priority within two weeks. Of the 1.567 cases admitted in 1959, 651 were classified as emergency admissions. Of these, 247, that is 38 per cent., were attributable to accidents in the home, and 118, that is 18 per cent. to industrial injuries. Those figures emphasise the greater need for safety in the home more even than in industry, and the duty that lies with us all to prevent such unnecessary suffering.

At 31st December, 1959, there were 1,405 cases recorded as awaiting admission to St. Lawrence, and 591 to Llandough Hospital. Of these, 579 were classified as non-urgent—253 men, 126 women and 210 children. For these nonurgent cases the delay before admission is, on average, six to nine months for women, and between two-and-a-half to three years for men—not five years as the hon. Gentleman suggested.

I have stressed that urgent cases are dealt with speedily. These figures can, however, be misleading. There are, for instance, cases where the surgeon plans a series of operations and must allow a period of time to elapse between them. Again, there are cases of congenital defect which should not be operated on immediately, and a planned delay of periods up to three years is necessary before undertaking operative treatment. In such cases the patient's name remains on the waiting list. This is a feature common to all hospitals. The hon. Gentleman referred to children waiting for three years for a cleft palate to be dealt with. I am advised that the age of three, on average, is about the right one to deal with that problem because the palate does not form earlier.

A factor which significantly influences the turnover of cases at St. Lawrence Hospital is that the average duration of stay per case, which is 25 days, is long, and is substantially above the average for England and Wales, which is 16.5 days. On these figures I think a study of bed usage would be interesting and possibly useful. But one reason for this apparent long stay is that the unit is dealing with a large proportion of trauma which elsewhere would be dealt with in a general acute hospital.

Major schemes of development of the hospital services now under way in South Wales, which include, apart from the new University Hospital of Wales in Cardiff, a surgical unit at Newport, a consultative centre and additional wards at Bridgend, new hospitals at Swansea and Carmarthen, will help to remedy this situation and enable the unit to devote its time to its own particular skills.

I could, perhaps, say here that Wales is receiving a very good share of the expenditure on hospital service in proportion to its population, and development on the scale which I have just mentioned will inevitably lead to the rationalisation of hospital services in the area.

One of the possibilities which will be considered when this comes about will be that of bringing the plastic surgery unit nearer to the main weight of population. This, however, is a fairly long-term project, five or more years ahead. I would stress that such a development is long-term and take this opportunity of saying to the staff who are doing such a wonderful job at Chepstow that there is no need for them to be disturbed by any fear of immediate changes. Indeed, I hope that the unit will continue to add to its splendid record of work, to which the hon. Gentleman paid tribute.

Much thought is being given to the future of the former tuberculosis hospitals now redundant. Consideration is being given to their change of use and a number, in fact, are now being used for the accommodation of the chronic sick. This is a cause which the hon. Gentleman has consistently advocated. In Wales, in most cases, neither by reason of location nor because of their construction do these hospitals lend themselves to acute hospital work.

Let me sum up. There is only one minute in which to do so. The plastic surgery unit at Chepstow does an excellent job as the hon. Gentleman recognises. While its location is admittedly not the best for some areas of the Principality, a service is available for all who need it, and, in fact, the number of beds is higher than in England and Wales as a whole. Only Oxford has a higher proportion of beds. In other words, Wales does better than any other area of England.

Waiting lists are to be deprecated at all times, but I have shown that for those who need urgent treatment there is no delay. The number of consultant plastic surgeons is adequate for the present service and compares favourably with other areas. With the very considerable developments which are under way or planned for the hospital service in Wales it will be possible, and it is the intention of the Regional Hospital Board and the Board of Governors to rationalise the service so that specialised services may be more readily available and the facilities for plastic surgery form part of the consideration now being given.

Mr. James Callaghan (Cardiff, South-East)

I am sorry that the hon. Lady has not explained why it is not possible to relocate this hospital. Why must we wait for such a long period before it can be brought nearer the centres of population which need its services? This is the urgent point to which my hon. Friend directed this very valuable Adjournment debate. Could we have an answer to that?

Miss Pitt

The hospital is available and it is providing a service for the whole of Southern Wales. Nobody goes without accommodation.

Mr. Callaghan

It is in the wrong place.

Miss Pitt

That I have admitted.

Mr. Callaghan

Bring it nearer.

Miss Pitt

I have said that, as part of the long-term planning, consideration will be given to that. The hon. Gentleman surely does not wish to close Chepstow. But so long as a service is available that is the answer for the time being. What I have to say now is that consideration will be given to developments in the service as part of the general planning which is now taking place in the development of the hospital service in Wales.

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at sixteen minutes to Eleven o'clock.