HC Deb 10 February 1960 vol 617 cc617-26

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

10.58 p.m.

Mr. T. W. Jones (Merioneth)

I believe it is generally recognised that one of the greatest Acts of Parliament passed so far this century is the National Health Act. All of us deplore the enforced absence from the House of the one who piloted that Act through the House, my right hon. Friend the Member for Ebbw Vale (Mr. Bevan). We all rejoice, however, to know of his great improvement during recent days.

This Act has brought untold blessings to millions of our fellow-citizens. Its main purpose was to secure for all our people, free of cost, the best that medical science has devised for various types of ailments. Until the passing of the Act, this had been the prerogative of the rich. It was their privilege to have the best that medical science could provide. It was the purse that decided what attention a patient would receive.

Under the provisions of the Act, there is no discrimination between the rich man in his castle and the poor man at his gate. Both are equally entitled to and can receive the same treatment. Neither was it intended to discriminate between the town inhabitant and the rural dweller. All citizens are entitled to the full benefits of the Act. The fact that a person lives in a sparsely populated or remote area should not deprive that person of a single medical facility provided by the State.

I would go as far as to say that for many reasons the rural inhabitant should be catered for more fully than even the town inhabitant. Even today a simple physical disability can prove to be a very costly affair for the rural inhabitant. I should like to give the Parliamentary Secretary to the Ministry of Health an illustration of this.

Children from the Corwen area in Merioneth who need an eye specialist's attention have to travel to Bala. It is true that Bala is only 12 miles away, but it means in most cases that many of the children, who naturally are accompanied by their mothers, have to be away from home for most of the day. The appointment is usually for 10.30 in the morning. I know of one instance, which can be multiplied, of a child and its mother from Carrog who had to catch the 8 a.m. train to keep the appointment and could not possibly be back home until 4 p.m. As there were other children in the family, the husband had to lose a day's wages to look after the children. And the irony of the situation is that the eye specialist has to pass through Corwen on her way to Bala. Should not facilities be provided at Corwen for this lady specialist to spend an hour or so there and thereby avoid this waste of time and this expense?

I shall now give one or two facts which can only be described as shocking and which call for immediate and practical attention. I want to refer the Parliamentary Secretary to the accommodation provided for outpatients at the Dolgellau Hospital. An after-care sister attached to the Gobowen Orthopaedic Hospital recently complained that her patients attending the Dolgellau Hospital had to change and undress in the corridors and waiting rooms and in full view of the other patients. This is not only undignified but shamefully indecent and should not be tolerated. The position is that about 140 persons visit the orthopaedic clinic once a month. There are only very small waiting rooms and a few cubicles there for these patients. Local councils have been pressing for a long time for an improvement, but without success.

The Dolgellau Hospital comes under the control of the Wrexham Powis and Mawddach Management Committee. I gather from a report which I read in the Liverpool Daily Post of 2nd February that this committee is making an effort to get at least a prefabricated building to provide changing rooms. The Welsh Regional Board has said that nothing can be done until 1962–63. Patients will therefore have to suffer the indignity that I mentioned for a further three years. Perhaps the board could be stung to shame and take action if the patients could be persuaded to take strike action and refuse to undress and strip in those conditions. I hope that the hon. Lady will take particular note of that complaint.

May I now refer to the position in the Corwen area? Hospital facilities in that area are appalling. The orthopaedic clinic was closed some time ago because the accommodation was unsuitable. The Wrexham Hospital Management Committee here, as at Dolgellau, would be prepared to provide suitable accommodation but it cannot get the necessary money to do so. In the meantime, patients have to attend clinics at Wrexham, Denbigh and Bala. The workers have to lose a day's wages because of the time spent in travelling.

That is how the free National Health Service is administered in Corwen. It is free right enough for the administrators, but it is not free for the workers who are entitled to its benefits.

I now propose to refer to a state of affairs which can only be described as a scandal. The Minister will be aware that the average of stillbirths and infant mortality in the Corwen area has risen sharply since 1954. Up to that year that area had the benefit of an ante-natal clinic. It is more than a coincidence that since the clinic was closed the stillbirth and infant mortality rates are higher than those of the County as a whole. In the first year after the closing of the clinic, out of sixty six births, seven babies died within a week of birth, and one within a fortnight. It was said that prematurity was the cause of death of five of those babies, and congenital malformation the cause of death of the other two. The lives of some of those children would have been saved if an ante-natal service had been available for the mothers.

If a child were murdered in the Corwen area, one can visualise the whole police force of Gwynedd, with the addition of Scotland Yard, being mobilised to track down the murderer. The Home Office, quite rightly, would not stop at any expense to bring that about. Is it less an act of murder in principle when unborn children are doomed to die because expectant mothers are denied the benefits of ante-natal services to which they are entitled? In a Christian country which recognises the sacredness of the individual human personality the excuse of insufficient attendances for closing the clinic is wholly unacceptable.

One may conclude that this is a reflection on the health department of the county council. This is far from being so. I am sure that the hon. Lady, as would every other Minister, would agree with me that there is no more active nor more advanced county council in the whole of the Principality than the Merioneth County Council. Each of its departments is 100 per cent. efficient and the council's principal officers are second to none.

The attitude of the county council can be summed up in the words of the ex-Prime Minister: "Give us the tools and we will finish the job." A more generous response from the Ministry and a less complacent attitude by the Welsh Regional Board towards the question of accommodation in Corwen would soon remedy the position.

Lastly, I would refer to the great but again unsuccessful agitation which has been carried on for a considerable time to establish a maternity unit at the hospital at Blaenau Ffestiniog. The local council has rather strong feelings about this, particularly having regard to the fact that when the hospital was transferred to the present management committee a considerable sum of money was handed over. Had the inhabitants of the area known at the time what would be likely to happen after the transfer, they would have voted in favour of spending the money in order to extend the existing hospital.

Hospital maternity cases have now to go thirty miles to the City of Bangor. The case for establishing a maternity unit at Blaenau Ffestiniog cannot be stated better than has already been done by the five medical practitioners in the town. This is what they stated in their memorandum: We, the general practitioners in Blaenau Ffestiniog have met to review the proposed maternity unit, in the light of the recent Cranbrook Report. We still feel, as we have stated in previous meetings, that there are strong grounds for providing accommodation for normal maternity cases in this area. Our points are made as follows:—

  1. (1) There is a large nucleus of population in the area, which is increasing, and there are no maternity beds available to this population within a 30 mile radius, approximately.
  2. (2) Blaenau's geographical position is unique, making this 30 miles journey hazardous at certain times of the year, and inconvenient for visiting at all times"—
thanks to the Transport Commission. (3) We have found that the journey home is detrimental to convalescence, especially at certain times of the year. (4) In view of the length of the journey, patients sometimes have to be sent away at the earliest signs of labour commencing, only to be returned home shortly because they have not really started in labour. This necessitates a double journey when very close to their date of delivery. (5) A large percentage of the births in Merioneth occur in this Northern area. (6) Of these births mentioned in the above paragraph, a high percentage of the mothers not being confined for the first time, could he confined in the Unit in Blaenau. (7) We feel strongly that in a community like Blaenau, it is still important from the patient's and the doctor's point of view, that attendance by the family doctor at a normal confinement is most desirable. In concluding, we all feel convinced that a small 2 or 3 bedded maternity unit incorporated in the present local hospital, should not be difficult to run, or expensive, and it would be fully utilised by the local practitioners. Also, the saving in ambulance services and services of the district midwife, would be considerable. I have taken the precaution to inform the hon. Lady the Parliamentary Secretary of the points that I was going to raise, and I hope that when she is replying she will be able to give me and the House very reassuring news indeed.

11.14 p.m.

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

The hon. Member for Merioneth (Mr. T. W. Jones) began his speech with a tribute to the National Health Service, which I was very glad to hear, and in particular he stressed that there was no discrimination—to use his own eloquent Welsh words—between the rich man in his castle and the poor man at the gate. Nor was it the intention, he went on to stress, that there should be any discrimination between town and rural dweller. With that I entirely agree, but there are some practical difficulties in bringing the Health Service to people in the country.

The Health Service as we now have it applies equally throughout the country. The standard of service is intended to apply equally throughout the country. But in some instances, I agree, the patient who receives the service may have longer to travel before being able to make use of that service. That is the special difficulty of the county the hon. Gentleman represents. Merioneth is mountainous and sparsely populated. The total population of the county is only 38,600. It means, therefore, that communications throughout the county are exceptionally difficult, especially in bad weather in winter.

Lest I may sound critical of the county, let me say at once that it is a most beautiful county, as I well know. But because it is mountainous and, therefore, beautiful, sparsely populated and not commercialised, giving pleasure to all of us who go there, it provides for those who live there these practical difficulties of making use of the service we wish them all to have.

I took the precaution of providing myself with a very large-scale map of the county to be sure of the area which the hon. Gentleman wished me to consider, as I have. I have also taken a little trouble to learn to pronounce Welsh names. If I err I hope I shall be forgiven.

There are three general practitioner hospitals in the county—what I would usually call cottage hospitals. They are at Ffestiniog, Dolgellau and Towyn, where the work is done by the local practitioners with regular sessions from visiting consultant staff. For the more important treatments, medical and surgical, patients are referred to the major hospitals within the respective group—Caernarvon and Anglesey Hospital, Bangor, in the north; the Wrexham hospitals to the east; and Aberystwyth General Hospital to the south. At Bar-mouth there is a small maternity home of eight beds. Bronygarth, Penryhndeudraeth, a former public assistance institution, is owned by Merioneth County Council and provides, in addition to 58 hospital patients, for 42 Part III cases.

The hon. Gentleman has indicated three main lines of criticism, and he was generous enough to notify me in advance what they would be. The first was the need for maternity beds at Blaenau Ffestiniog; the second, the need for additional out-patient facilities at Dolgellau Hospital; and, thirdly, the need for clinic facilities at Corwen. Dealing with them in order, the present maternity beds position is that at Bar-mouth Maternity Home there are eight beds, at Towyn Hospital, three beds, and at Dolgellau Maternity Home, three beds used under contractual arrangement.

In 1958 there were 572 births registered in the county, of which 504, or 88 per cent., took place in hospitals or maternity homes. This compares with the national figure for England and Wales of 64 per cent. in that year. Of the 504 births, 323 took place in institutions outside the county.

As part of its forward programme, the Welsh Hospital Board proposes to provide at Dolgellau Hospital a new maternity unit of approximately 20 beds. This would involve the closure of Barmouth Maternity Home and the termination of the contractual arrangement with the Dolgellau Maternity Home. These proposals while improving the standard of accommodation, have the added advantage of concentrating beds in association with the hospital. The net increase—nine beds—would bring the number of beds to that required by the Cranbrook Committee's standards.

The Welsh Hospital Board has not as yet contemplated a similar provision at Blaenau Festiniog. The main difficulty is that consultant attendance cannot be reproduced outside the main centres and the staffing of the small maternity unit also presents a problem and so far the board has not considered it to be practicable. These practical problems of consultant service, of consultants being able to give time to small areas and not dissipating their time and of staffing in districts where perhaps amenities are not too attractive, are very real in small areas.

The hon. Member mentioned the outpatient difficulties at Dolgelly. Present accommodation, it is agreed, is limited, although up to now the board has not been able to provide a high priority on the need for added space. There has been criticism of late, which the hon. Member mentioned again tonight, that on occasion patients are obliged to undress in the corridors. The present accommodation comprises a waiting room, two examination rooms and an eye clinic. In 1952–53 the sum of £3,800 was expended in providing male and female dressing rooms, but difficulty arises once a week from the large orthopaedic session and mainly because it is necessary to take in follow-up cases. That is when congestion arises. The board has undertaken in view of these representations to look into this matter again. Long term arrangements for consultant orthopaedic sessions will be reviewed when the new Aberystwyth Hospital extensions come into operation.

The ante-natal clinic at Corwen was closed in 1954 because of lack of support. In the year before closure, attendances for the year were thirteen only, made up of six cases, and at that time it was said that the local general practitioners preferred to provide antenatal services at their own surgeries, and we have no reason to think that this is not still the case. This is a development noted and commended by the Cranbrook Committee. Some expectant mothers from this area now attend the clinic at Bala, but even there attendances are low—seventy-eight per year, plus one post-natal case. The Edeyrnion rural district, the area served, has a population of only 4,070 and there were fifty-two births in 1958. This area the hon. Member referred to as having a still birthrate which, in his words, was a scandal, but in a small area with a birthrate of only fifty-two in 1958 one stillbirth makes the rate for that small area sound very much higher by comparison with the whole of the county or the whole of Wales. It is true that the still birthrate for the whole county is slightly above that for the whole of Wales, but in the area in 1958 there were no maternal deaths, which is something we can all feel pleased about.

There is the further point to be made on the maternity service, which I am not able to cover in detail tonight—maternity accommodation in general and the need for any additional provision forms part of the review which, in the light of the recommendations of the Cranbrook Committee, the Welsh Hospital Board is undertaking in full consultation with the local interests concerned, local health authorities, executive councils and local medical committees. The infant welfare clinic is held in the chapel vestry as a temporary measure. But, again, the attendances are low. There were 12 sessions in 1958, and 30 cases made a total of 111 attendances.

There has been a suggestion made that clinic premises should be provided for housing a chiropody service provided by the Merioneth Community Council. I understand that the health committee of the Merioneth County Council has recommended that a chiropody service should be provided, and this is to be considered by the county council next month, which, I think, will be welcome news to the hon. Member and his constituents.

The provision of hospital clinics and out-patient departments should, normally, be at hospitals, partly in order to conserve staff, equipment and premises, but chiefly because an out-patient department or clinic is of little value without the diagnostic—for instance, X-ray—and other support of a hospital. Local health authorities have power to provide clinics for several purposes, but when deciding on the extent of the clinic provision they will make, including the number of premises and their locations, councils need to take into account their limited financial resources, that is, the product of the rate, and the demand which exists for the services. If clinic premises are made available by the local health authority, the hospital service would be prepared to use such premises for work which can be carried on away from hospitals, for example, follow-up orthopaedic clinics.

The Welsh Hospital Board has in hand a substantial and expanding programme of capital works. It has to consider the needs of Wales as a whole and it must necessarily place its priorities in those places and in the areas where it considered the need is greatest. In the ten years up to 1958, the board spent over £8 million on capital development. In the current year, its outlay is about £1¾ million. In 1960–61, its outlay will be a little over £1¾ million, and for 1961–62 it is to be £2½ million.

In the areas of the hospital managements committees covering Merioneth, there are major schemes of development in hand or projected. Improvements and extensions at Caernarvon and Anglesey General Hospital, at a cost of £340,000, are almost complete. This scheme provides a new out-patient de- partment, X-ray department, a ward unit of 64 beds, and accommodation for medical staff. Also, there have been major improvements to the out-patient department at St. David's Hospital, Bangor, at a cost of £50,000.

Work is expected to start later this year on new hospital accommodation at Bronglaise Hospital, Aberystwyth. The scheme, at an estimated cost of £872,000, provides ward accommodation for 194 acute sick, a consultative centre, a twin operating theatre suite, casualty, physiotherapy and pathology departments. The project allows for rationalisation of services in the area, including the conversion of Aberystwyth General Hospital for chronic sick and infectious diseases. The net effect will be to add 30 beds.

There are other developments. The Welsh Hospital Board is considering the need to improve facilities in the Wrexham area, and plans for a further development at Oakwood Park Mental Deficiency Hospital to provide for 450 patients are in hand. I hope that what I have said in the short time available to me—I cannot go into these developments further—will show the hon. Member that his concern for Merioneth is shared by the Welsh Hospital Board. It is aware of the difficulties to which he has referred and, indeed, of some of the problems particularly of Merioneth. In the broad field of the hospital service, much is being done in North Wales by way of major hospital development; the Board is going some way to meet local difficulties, and consideration is being given to what further can be done.

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 twenty-nine minutes past Eleven o'clock.