Motion made, and Question proposed,
That this House takes note of the Report on Developments and Government Action in Wales and Monmouthshire for 1959 (Command Paper No. 961).—[Mr. H. Brooke.]
§ 4.3 p.m.
§ Mr. Arthur Pearson (Pontypridd)
It will be known to most of those interested that the task of opening this debate today falls somewhat fortuitously on me, and is not due to any special knowledge I have of the National Health Service. It seems somewhat appropriate that the first part of our debate today should be on, hospitals. We can thoroughly prepare the hospital services for any casualties that might arise from the hotter atmosphere that will be engendered in the later debate on the Welsh Broadcasting Council. I beseech you, Mr. Speaker, not to think that I am inciting my hon. and right hon. Friends in any way. Be assured that the Celtic temperament is cool under provocation—although on this matter I fear that you may not agree.
For the first time the day given to the consideration of Welsh affairs in the House has been supplemented by the establishment of the Welsh Grand Committee, whereby we have been provided with useful additional scope for surveying in greater detail matters within the Report on Developments and Government Action in Wales and Monmouthshire. In the three sittings of the Welsh Grand Committee we have debated matters covering employment and industrial development, rural Wales and education. This new procedure has given us opportunities for greater concentration upon the various aspects of matter affecting Wales, and it has met a need.
Our thoughts today are upon the advancement of health, referred to in Chapter V of the Report. This is the purpose of the National Health Service, which is a real part of our national life. It is knit up with numerous activities in the general medical services, the hospital service and the prevention of illness. Within this framework there is a greater power and opportunity to spread the benefits of medicine and direct them to the best purpose.
264 This pattern, this great power and this opportunity to bestow a more effective health coverage on the people, owes much to the weight of character, the splendour of talents and the unceasing devotion of our late Parliamentary colleague, Aneurin Bevan. The National Health Service will ever be his true memorial. I am sure that as we proceed with this debate every heart will be filled with concern for the grief of his widow at his passing and the calamity which we all feel as a result of the absence of a distinguished voice that is stilled.
A change has taken place in what we mean by health. We desire not only clinical study and treatment, but planning and work for health as a positive aim. Education in the arts and sciences goes forward in a thousand and one ways, but with it must be allied a knowledge of right living and the learning of citizenship, because health and welfare are indivisible. All the services are vital, be they hospital, mental health, local authority, general practitioner, pharmaceutical, dental, nursing, eye, social insurance, housing, water and sanitation.
There is always the urgency of establishing the right priorities, so that all considerations should be properly balanced. It is dawning upon us, perhaps too slowly, that the best and cheapest of all health measures is prevention—absolute, or by treatment in the early stages. The next is prompt and adequate treatment in the home for all the cases that lend themselves to it.
The annual reports of the Welsh Regional Hospital Board have drawn our attention to the pattern of hospital development since 1948. I hope that the House will think it appropriate for me to refer to the retirement of Sir Frederick Alban, who was chairman of that board from its inception. He did a valuable piece of work—inspiring the whole service during a deeply formative period—which has earned for him a secure and lofty place in the annals of the hospital service in Wales.
Those who had the responsibility of handling and shaping development, amidst all sorts of difficulties, share the pride of many achievements, though much remains unfinished. On too many occasions, restrictions of priority and money won victory for the Government's old friend, "Make do and mend." Is 265 it not true in hospital expenditure that putting up new hospitals provides a great saving on the maintenance side, and gives deeper satisfaction altogether? Patching up old ones is rarely satisfactory.
I am glad to note that the 'hospital building programme in Wales is showing some tangible evidence of progress, yet how plain it is to see the real need for a thorough reconciliation of health policy, health expenditure and national expenditure in both the ordering and the administration of the service. The House knows how great is the difficulty of assessing and allocating the proper shares within the total resources and liabilities of the State. It is common knowledge to us.
Too often, when the Treasury faces financial troubles it is hospital expansion and the build-up of the health services that is the victim. We are at such a period at this moment, as is seen by the recent increase in the Bank Rate to 6 per cent. The consequent fuss at Cabinet level filled us with fears of what was to happen to the steady fulfilment of the needs of the hospital service. It was, indeed, a great relief when the Minister of Health announced that it was not expected that the hospital capital programme for next year would be affected.
After next year, no one knows. During the passage of the Finance Bill, there were ominous noises from the Government back benches indicating that Ministries dealing with social services are in deadly struggle against cuts, but I trust that the gains to society from the regained health of the individual, as well as the happiness won, will be kept to the forefront. Not even the Treasury has tried to assess the relative value to the community of a sick mother quickly returned in good health to her working husband and children.
The care and treatment of those suffering from mental disorders is an important part of a good system of health services. Most of us are conscious of the need to repair the omissions of the past, and to press for high priority to he given to that task. The new Mental Health Act reflects some welcome forward concepts, so that it is noted with interest that the Welsh Regional Hospital Board is taking steps towards the 266 reorientation of mental health away from institutional care and towards care in the community. But will the new mental health provisions for community care remain a dead letter?
How many of the local health authorities in Wales can at present adequately meet the added costs without a drastic change in their financial resources? In an editorial article in The Times of 12th July strong doubts were expressed about the effectiveness of the Minister's intention to have the whole of the Mental Health Act working by November next. That article said:Unfortunately, his intentions, though admirable, are unlikely to be enough. The spirit of this legislation has been justly acclaimed, but it is by no means clear whether, when the Act officially comes into effect, it will in fact be operating in full or even nearly so. Particularly is it doubtful in the case of sections six to ten, which are the main ones to come into force this week.That is, the week of 12th July.
The article continues:They deal with services to be provided by local health authorities, and since the whole bias of the statute is in the direction of 'community' rather than 'institutional' care they are crucial…In May the Minister, reporting that he had received proposals for providing such services from almost all the authorities, explained that they showed an intention to develop them at a reasonable rate with the ultimate object of meeting all these.That sounded promising, hut what do the 'intentions' amount to? There is still no sign that the Government have ensured that there will be adequate numbers of trained staff, such as psychiatric social workers, mental welfare officers, and health visitors available to cope with the increased responsibilities—either now or in the immediate future. Nor is there any evidence that local authorities by and large have carefully ascertained what the precise needs are going to be. Many hospital psychiatrists are saying that this is a wonderful opportunity for them to concentrate on acute patients and achieve a quick turnover in cases, but very few local authorities seem to be in a position to say how they will tackle the outflow of chronic and other cases that would result. What sort of care will they need? How many will live at home, how many in hostels? How many will be capable of doing work? That the authorities have by and large accepted the principle that something must be done is easier to believe than that they know exactly what it is.The article adds:Until we have the assurance of Mr. Walker-Smith that all the authorities know exactly what is expected of them and are doing it 'community care' will remain an unrealised ideal.267 Whatever is the substance in the comment of The Times, some enlightenment as to the position in Wales will be welcome, as we on this side of the House are not prepared to see the new mental health provisions for community care remain an unrealised ideal. To state such is not unrestrained enthusiasm; it is plain commonsense.
Ready support will be forthcoming for immediate priority being given to the training of children up to 16 years of age, and the extension of facilities for the training of adults. Along with this goes forward, I hope, the training and recruitment of the staff for the development of advisory services for those living in their own homes. Can the House be informed of the number of training centres required to meet the needs in this field?
The House will expect a lively implementation of the new ideas in mental health work providing for the early return of patients to the community and the rehabilitation of patients who, until recently, have been regarded as permanent inhabitants of mental hospitals. Has the Welsh Regional Hospital Board a sub-committee planning this part of the service in close touch with the local health authorities and hospital management committees? Is there a true way for improvement by way of industrial therapy towards rehabilitation? Some local authorities, I know, have made good headway in this respect. Two or three of them are in Wales.
What impact will the new ideas have on the "severe overcrowding" of mental hospitals which was referred to in the 1958 medical services report for Wales? What is the present regional average overcrowding? Are forward planning proposals adequate to needs in this important aspect? There are no prominent signs of surging ahead in this vital field so as to provide first-class working conditions for doctors and nurses with up-to-date amenities and the pleasant therapeutic atmosphere for the patients.
I should like to see the provision of many more psychiatric out-patient clinics. That is the way to save later trouble and expense, for it has been shown that with early modern treatment a high proportion of those with 268 mental disorders quickly recover and return to society as useful citizen. Of course, the patient's family in this respect cannot be forgotten and in-patient hospital treatment, if considered preferable for the sake either of the family and other sick person, should be available.
I greatly doubt whether enough is being done to overcome the chronic shortage of mental deficiency beds. Admittedly, some improvement has taken place, but it is very sad to think of the helpless, bedridden low-grade children who have to wait years for a bed. There are unfortunate reactions on a family in such circumstances through worry, anxiety and health, when a helpless, low-grade child has to remain at home being nursed, perhaps, among three or four other children. May we have information about the waiting list position of this category of patient? I hope that we shall do our utmost in the direction of alleviation of the patient, the parents and the family.
I cannot pass over the existence of very heavy waiting lists for various speciality attention throughout the Principality. There must be something amiss when patients have to wait from one to three years for operational treatment. For instance, the ear, nose and throat speciality waiting list is extremely formidable. Adults have to wait up to three years and children waiting for tonsils operations have to wait for eighteen months to two years. Hundreds, nay thousands, have to suffer these very long delays before operations. Surely it is plain that consultant E.N.T. surgeon staffing needs to be strengthened. Concern is bound to be voiced about such an unsatisfactory situation. I charge those responsible and the Minister of Health with complacency on this important aspect of their work.
It may be suggested that there is a great deal of "dead wood" in the lists, but that does not explain the lengthy time which large numbers of patients 'have to wait. I therefore call for an assurance that additional consultant sessions in the hospital group areas which are suffering worst shall be established. In addition, energetic steps should be taken to institute E.N.T. departments in appropriate hospitals. I press for an adequate explanation of why 269 there is delay to the extent I have mentioned.
In the ophthalmology speciality the position is far from satisfactory. In hospitals outside Cardiff the city council has provided consultant sessions from Cardiff Royal Infirmary, which already has a tremendous burden in trying to cope with the waiting list in the Cardiff area. The waiting period in this speciality is from ten months to one year for an in-patient and up to fifteen months for an out-patient.
The same picture exists in the neurology speciality, where there is a waiting time of two years. I am compelled to make adverse comment on the general surgery speciality, where hundreds of cases have to wait from one to two years. There follows deep concern that defects of discipline and duty among some consultants—full time and part time—contribute to this very unsatisfactory state of affairs in the hospital service. How many consultant sessions are missed by consultants? What records are kept of such failures? Do the consultants get paid for a missed operation session? What steps are being taken to obtain reasons for missing a session? Is the matter allowed to pass without any comment or action whatsoever?
In this problem of waiting time, I understand, hospital management committees have made representations to higher authority with a view to having the position remedied. What is the reason for so little being done about it? They want more time to be allocated by consultants. Such a picture as this sets our teeth on edge at the apparent complacency which is being shown. What is the answer of the Minister or the Parliamentary Secretary to these criticisms? They have been brought to light only by the rooting away of "weeds" which, entirely without profit, suck the fertility of the service for greater good and more effective work.
Our voices need to be raised for greater provision for temporary admission of chronic sick patients to nursing homes so that their relatives might have a much needed rest. There is a scheme in operation, but I know of cases where great difficulty has been found in obtaining alleviation in this way. Likewise, a great field for good lies in convalescent rehabilitation and spa treatment for 270 patients. Is it too much to ask and demand a duplicate of the Park Nursing Home, Llandindrod Wells, for the Welsh Region? Will the Minister institute inquiries about the possibility of rendering financial help to Porthcawl Rest, for many years a valuable convalescent home and entirely run by voluntary contributions? I know that at present the governors are facing great financial difficulties in carrying on. It would be a tragedy if that convalescent home closed.
The importance of the geriatric service for the care and rehabilitative treatment of the elderly sick presses itself upon our attention. A close working link between the Regional Hospital Board and the local health authority is imperative for any marked impact on this somewhat sad side of the problem of the aged. Are we sure that a charge of being niggardly cannot be sustained? Many assert that the care of the chronic sick has been the Cinderella of the National Health Service. A sustained improvement is called for and an assurance passed on to the patients and relatives that behind the geriatric service is the fullest medical provision possible.
In provisions to meet responsibility for the chronic sick and elderly, I attach much importance to the local authorities who, in their health capacity, provide home nursing and domestic help, and other services, and who, in their welfare capacity, are doing a most heartening humane work in providing up-to-date residential accommodation. Good home nursing and domestic help are powerful aids to the aged in time of need. Let us be generous in maintaining as high a standard as possible in this sphere.
In surveying the needs of the sick, I cannot leave out the general practitioner service. I understand that if a hospital has not a bed empty and available, admission is refused and it then becomes the general practitioner's task to search elsewhere for help for his patients—a process which must be time-absorbing and tedious. How far do bed-finding bureaux exist in the Welsh Region? I know that there are some. Such bureaux need good and persistent staff, backed, as a final resort, by a medical referee with power to insist on the admission of the case somewhere in the area if the best service is to be made available. This type of help for the general practitioner would be of very great value. My 271 submission on this side of my remarks is that when faced with chronic infirmity—for men and women in the prime years of life as well as the old—the way is open for a big gain in the happiness and betterment of the people.
Anxiety about the recruitment of trained nurses is being repeatedly expressed. The provincial Press, the national Press and the local Press are continually referring to the needs of hospital management committees in respect of this weakness. Recently issued regulations covering the conditions of hospitals as training schools for admission to the general part of the Register of Nurses will, I fear, make it more difficult to combat the acute shortage of trained nursing staff. As from 1st January, 1964, general training schools will be approved only at hospitals with more than 300 beds with an average daily occupancy of 240.
For Wales, as I see it, these new conditions will mean a reduction in the number of training schools. Apart from the large hospitals on the coastal fringe of South Wales, East Glamorgan hospital will be the only training school in the valley regions, and probably extending the whole of the way northwards, including North Wales, excepting the possibility that there may be grouping of hospitals, say, in Bangor, for this purpose, and a training school at Wrexham.
Under the same regulations a minimum educational qualification for entry with effect from 1st July, 1962, will mean that the entry to nursing is confined to grammar school girls who have gained the General Certificate of Education. Am I right about that? I know that certain other students may also be admitted holding qualifications acceptable to the council, but does not this mean virtually—I hope I am wrong—debarring the secondary modern school girl from training? Experience shows that quite a number of girls in this category have made first-class nurses and have qualified quite as well as have those from the grammar schools. The effect of that might well be that the numbers who enter and pass out will be less than now, with resulting difficulties in staffing hospitals in Wales.
The recruitment of vital staff to various hospitals is often made difficult because applicants make it a condition that they will accept the post provided 272 that they can have themselves and their families properly housed. That is quite common. A solution of this stubborn problem for the hospitals, especially in the periphery, is urgently needed if good standard staff are to be engaged. There is a limit to any hospital management committee going repeatedly to the local housing authority for favours. Why not allow the hospital boards, in a wider sense than now, to build houses for the residential medical staff and other key personnel? It is an unnecessarily restrictive policy to withhold from hospital authorities the power to provide houses for their staff where it is deemed essential.
I have but touched the fringes of the complicated mosaic-like ramifications of the National Health Service in Wales and Monmouthshire. I am sure that my hon. Friends will touch on other important matters. Whatever hard things it has been necessary to say, I salute this great service, bless its purpose and its work and express thanks and appreciation to the men and women in every phase of its activities who serve the common weal so nobly. They are the health guardians of today, for whom boundless good will spins the great wheel of co-operative thought, action and skill to help to neutralise pain and to improve the general health of the community in the Principality.
§ 4.39 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
I join with the hon. Member for Pontypridd (Mr. A. Pearson) in welcoming this opportunity, when we are discussing Welsh affairs, of concentrating a fair amount of our time on the National Health Service in Wales, because there is a very satisfactory record of progress to relate. In saying that, I assure the hon. Gentleman and the House that there is no complacency. We know that there is more to be done, and it is being done, as I hope to show in the course of my contribution.
Hon. Gentlemen are aware that my right hon. and learned Friend the Minister's functions in Wales, except some limited ones relating to supplies, audit and superannuation, are delegated to the Welsh Board of Health. This is in accordance with current Government 273 policy to delegate administrative responsibility to Wales and to the Welsh people.
The medical and professional staff of the Board has been strengthened to equip it to deal with the developments in health and welfare services. In view of the considerable extensions of local authority welfare services, the House will be glad to learn of the appointment to the staff of the Board of a qualified social worker.
The Welsh Regional Hospital Board has a membership of 32, of whom 22 are lay members and 10 are professional—.that is, doctors, dentists, nurses, and so on. The policy has always been integration of service, and we are anxious to make this integration even closer and encourage co-operation between statutory bodies, local authorities, and voluntary organisations.
It is perhaps appropriate for me to give the House, first, some information about some of the main items of the local health authority service. I start with maternal and child care. I shall not take up time by giving figures, but comparative statistics for 1948 and 1959 show that there has been a considerable improvement during this period. The maternal mortality rate is now comparable to that of England and Wales. though in infant deaths the rates are higher than in England and Wales. Improvement in these rates has been accomplished more slowly in Wales than in England and Wales as a whole.
I can record developments in this part of the Health Service. Premature baby units have been established in maternity hospitals, and local health authorities have made special transport arrangements for these infants. In certain areas the authorities have taken the clinic facilities to the mothers and children by operating mobile clinics. During 1959, eight new clinics were brought into use, and work is expected to start in 1960–61 on the provision of 14 clinics, 12 of them in newly constructed premises. The figures of attendances of mothers at the clinics, which from 1950 tended to decline, are now increasing.
The hospital confinement rate in Wales is not far short of the 70 per cent. which was recommended by the Cranbrook Committee, but a review of hospital services is in hand in the light of the recom 274 mendations of that Committee. Although the average rate of hospital confinements is relatively satisfactory, there are areas where more beds are needed—for example, Cardiff, Newport, and Merioneth. The current hospital building plans have been designed to relieve these shortages.
The hon. Gentleman said that good home nursing could be a powerful help in the care of the sick, particularly the elderly. I agree entirely. There have been improvements in domiciliary services. There has been a great increase in the care of the elderly by the amount of time devoted to these cases by health visitors. On home nursing itself, which has expanded rapidly, the service is being increasingly devoted to the needs of the elderly.
Poliomyelitis deserves special mention in this debate, because the figures for Wales are rather better than those for England and Wales, but there are still many adults who have not come forward for vaccination, despite the fact that the vaccine is available to general practitioners and that local health authorities are running lunch hour and evening clinics and are taking the service to factories and works. The response from expectant mothers is particularly disappointing, especially as the vaccine provides a measure of protection for the unborn child. In the two years 1958 and 1959, 87,142 babies were born in Wales, but only 17,654 expectant mothers were vaccinated.
The Report says, in paragraph 262:The most significant development in the health field in 1959 was the passing of the Mental Health Act…The Minister issued a direction in August, 1959, that local health authorities should make arrangements for the prevention of mental disorder and care and after-care of persons suffering from mental disorder. This was followed in October by a further direction requiring authorities to submit to him by 1st April, 1960, their proposals for making these arrangements. Thirteen schemes have received the Minister's formal approval and a further three will be dealt with immediately on the expiry of the statutory period for objections, leaving one scheme only still to be submitted—from Glamorgan.
In their proposals authorities have set out their intentions to provide 275 training centres for the mentally subnormal, hostels for those in need of such accommodation but not requiring admission to hospital, home training and visiting, as well as day centres and social clubs. Of the proposals already put into effect I mention only the new training centres opened at Hafodyrynys, Monmouthshire, in October, 1959; at Barry, Glamorgan, in April, 1960; and at Swansea in March, 1960, bringing the total number of centres in Wales up to 16, providing 1,057 places.
A further centre is under construction at Ystrad Mynach, Glamorgan. [Laughter.] Hon. Members can correct my pronunciation later. I have tried very hard. Approval has been given to the erection of a centre at Malpas, Newport, at an estimated cost of £82,000. Approval has been given also to the acceptance of a tender for the erection of a hostel for mentally disordered girls at Bridgend, costing £29,000. Further schemes are planned to start this year for training centres at Ammanford, Wrexham, Bridgend and Merthyr Tydfil, and for two further hostels in Glamorgan.
From this extension of facilities will come a further improvement in the proportion of persons capable of receiving training who are attending training centres. At the end of the year 459 mentally disordered children were receiving training at a centre out of 779 suitable to do so. For adults the figures were 441 and 1,079 respectively.
Generally, authorities have not been deterred by the difficulty at this stage of assessing the future community care needs of their areas and have prepared schemes that will allow them to develop their services according to the demands arising.
The Anglesey County Council, in conjunction with the Nuffield Provincial Trust, has embarked upon a survey of the mental health requirements of a rural area, and the results are awaited with interest by rural authorities everywhere. There is great promise in Wales of a speedy development of this important new service.
The hon. Member for Pontypridd asked me specifically whether this service will remain a dead letter. He quoted from the leader in The Times. 276 The fears of the hon. Gentleman are not justified. I am happy to inform him and the House that consultations with local authorities began more than twelve months ago. Local authorities have been very co-operative. A good start has been made, as I hope that the figures and details I have just given indicate. Obviously, though this will develop progressively, progress so far has exceeded expectations, and I am confident that a good service will eventually emerge.
In another aspect of local authority welfare services—namely, old people's homes—again, there has been improvement. The number of beds, expressed as a percentage of the population, is slightly higher for Wales than for England and Wales as a whole, although the proportion of the over-65s is rather lower in Wales than it is for England and Wales. I was surprised to learn that. I thought that the Welsh people stayed in the valleys, but it is a fact that there are more beds and proportionately less people to be cared for in this age group.
Welsh local authorities are now providing accommodation for 2,615 people in 91 small homes, which is the ideal way, we believe, of caring for old people. Seven of these homes are in new buildings, specially designed for the purpose, the remainder being provided by the adaptation of existing premises. Five new buildings are under construction providing accommodation for 188 people and a new home is being adapted for 24 people. The building of two homes for 95 more will start shortly.
Plans are also in hand for nine more homes in Caernarvonshire, Abergele, Maesteg, Pontypridd, Tredegar, Blaina, Pembrokeshire, Cardiff and Newport. The demand for residential accommodation has made it necessary to keep in use a number of former institutions, including some shared between welfare and hospital services, but in nine instances it has now been possible to discontinue these arrangements. Twenty-three former institutions remain in Wales, providing accommodation for 1,520 people.
Most of the institutions used exclusively for Part III residents have been modernised to bring the accommodation more into line with present conceptions. In the others, early cessation of use is 277 expected as major building schemes are developed and planned. Capital expenditure on old people's homes is currently running at the rate of £540,000 per annum compared with £105,000 in 1949–50.
The figures for the family practitioner services, which the hon. Gentleman mentioned, show a welcome increase in the number of doctors practising in Wales, with a corresponding reduction in the average number that each doctor provides with medical services. There has also been an increase in the number of doctors working in partnership, from 601 doctors in 1952–53 per cent.—to 915 in 1959–71 per cent.
The number of dentists in Wales has decreased from 522 in 1951 to 420 in 1960. The shortage of dentists is one which affects both Wales and England, but it is slightly more acute in Wales, where there is one dentist to 5,476 people compared with 4,200 for England and Wales. In view of the pressing need for more dental surgeons, first priority will be given to the dental school and hospital which will form part of the new Medical Teaching Centre for Wales. it is hoped that by 1964, in the first yearly intake, 50 dental students will begin their clinical training. In spite of the small number of dentists, the number of courses of treatment completed and emergency cases has increased steadily each year.
On the question of hospital services, perhaps I might refer to one or two minor points which the hon. Gentleman mentioned. As to training centres, this was a recommendation of the General Nursing Council, and as the hon. Gentleman correctly stated the new condition is to apply from 1st January, 1964. There is nothing to prevent some of the smaller hospitals combining to achieve the total of 300 beds which will qualify under the new regulations and, in addition, the General Nursing Council has assured my right hon. and learned Friend that it will consider sympathetically the position of existing schools which have special difficulties in complying by that date. The Council has made clear that that consideration includes geographical difficulties which may be met by some schools in Wales.
The Regulations provide that girls from a certain date will need a minimum standard of education which is to be 278 equivalent to two passes at O level of the General Certificate of Education, but, in addition, the Regulations provide that equivalent education can be counted for the admission of girls. Perhaps I may repeat to the hon. Gentleman, who was so concerned, a comment I made when I was putting the Regulations before the House. Among the papers given to me was one of the test examination papers. I did all the questions myself and I found that with my council school background I could answer them. I was glad about that, because I felt that it would not stop any good girl from entering the nursing profession.
§ Mr. S. O. Davies (Merthyr Tydvil)
Could we be told what two subjects at ordinary level are considered absolutely necessary for this examination?
§ Miss Pitt
English and one other—I cannot remember the other. [HON. MEMBERS: "Welsh."] Welsh in certain cases, by all means.
The hon. Member asked me, too, about houses for staff. There is nothing to prevent the regional boards buying houses. There is the power which would enable them to buy houses for staff where there is need and that has been done in some cases in the Welsh areas, but I would stress that that need would have to be balanced against other pressing needs of the service because it is all part of the current capital allocation.
§ Miss Pitt
The power is there if the hon. Gentleman wishes to pursue a particular case. The hon. Gentleman said that the hospital services programme was showing tangible evidence of progress. I am glad to have that tribute from him. In fact, the numbers of beds allocated have increased from 1949 to 1959 by 6.6 per cent. compared with 1.5 per cent. for England and Wales. Patients treated have shown a marked increase in the same period—45.4 per cent.—and waiting lists, which the hon. Gentleman specifically asked me to comment on, have been reduced by 25.5 per cent. in the same period compared with a reduction of 4.4 per cent. for England and Wales, so there has been a quite striking reduction in the waiting lists in Wales. The picture is one of steady increase in 279 beds and considerable improvement in the use of beds—eight patients per bed in 1959 compared with 6.1 in 1949. This turnover obviously shows a better use of the beds.
The substantial new building programme in Wales will soon begin to have its effect and show further improvements. I want to stress that this will be all over Wales and not in just the main centres. There is, however, room for still further improvement in Wales in the use made of existing beds, and the attention of the Regional Hospital Board has been drawn to the great importance of using existing resources to the fullest effect for the relief of waiting lists and the reduction of waiting time. Great emphasis has been laid on the development of outpatient services and this is also a feature of the new building programme.
The expansion of the consultant services continues and a comprehensive service is now provided. There are still deficiencies to be made good, particularly in psychiatry and geriatrics, but progress here is governed mainly by the supply of suitably qualified and experienced people. One striking point about the consultant services is that there has been a considerable increase in domiciliary work. This is especially marked in psychiatry were domiciliary visits have increased by no less than 344 per cent. comparing 1949 with 1959.
The hon. Gentleman stressed that point and said that the use of psychiatry in the early stages was most valuable in keeping people in their own homes, and he referred to preventive treatment and adequate treatment in the home. I agree with him and I am glad to learn of this considerable improvement. We all realise the value of early consultation which means a tremendous improvement in the results which can be obtained.
The major building programme now in hand will see the provision in the next few years of modern, fully-equipped acute hospitals in each major population centre in Wales. Those areas for which plans have yet to be announced are north-east Wales and the northern part of Monmouthshire. The Hospital Board is at present considering the siting of new hospitals for these areas. The increasing capital allocation for hospital building in Wales has not only made it possible to start many more schemes both large 280 and small, but also to enable a number of the major schemes to be speeded up.
The Aberystwyth and Bridgend schemes were originally planned to be developed in stages and are now being completed under one contract. The second stage of the new Swansea hospital and the last stage of Glangwili Hospital are now both twice the size originally contemplated.
The architectural competition for the design of a new University Hospital of Wales, which was launched in 1959 jointly by the United Cardiff Hospitals and the Welsh National School of Medicine, which attracted forty entries, has now been decided. The design, which has attracted a great deal of attention, provides for a hospital of 650 beds, a medical school, a dental 'hospital and school, out-patients and casualty departments and ancillary accommodation.
A particular feature is the complete integration of the teaching departments and the hospital units and it will provide for Wales a University Hospital of which 'it may be justly proud. I am very happy to give the House this piece of information. The Minister has agreed, in principle, that this hospital may be built under one contract instead of in stages, as was first envisaged, provided, of course, that this does not delay the building.
The features of the mental 'hospital service are the great increase in voluntary and informal admissions and the reduced average length of stay. These factors have contributed to the reduction of pressure on the hospitals. Development of outpatient services and more early treatment 'have also contributed to this greatly improved state of affairs. Welsh mental hospitals have been well to the fore in the developments in treatment and care which have made possible the new look in mental health.
In particular, the Welsh Hospital Board is to be congratulated on its foresight in devoting such a substantially higher than average proportion of its capital resources over the years to the modernisation and improvement of its mental hospitals.
The problem of the mentally subnormal was one of the most acute facing the Welsh Hospital Service in 1948. There 281 was an acute shortage of beds and waiting lists were formidable. A substantial building programme has produced in the past five years, 200 beds at Cwmbran; 187 at Conway; 150 at Ely Hospital, Cardiff; 40 at Hensol Castle, near Cardiff and 33 at Caersws. The completion of the hospitals at Cwmbran and Conway will provide another 550 beds and this, together with the development of the local authority community services, promises early relief for those remaining families in Wales subjected to the strain and stress of the care of a mentally subnormal person. Waiting lists in Wales have already been reduced by 19 per cent. since 1956 compared with the England and Wales figure of 5 per cent.
A survey of hospital facilities available for the chronic sick was carried out by the Department in 1954 and showed that bed provision is 0.9 beds per thousand of the population, very much bellow the existing average for England and Wales which was then 1.27 beds per thousand. Since then, additional beds have been made available, bringing the rate up to 1.14 per thousand of the population. Building schemes now in hand, or planned, will further increase facilities by providing geriatric units at acute hospitals, or, more indirectly, by allowing for the diversion of beds from other specialties.
The provision of additional hospital beds is not, however, the complete answer in the case of a socio-medical service whose needs are bound up with the question or the provision of housing and domiciliary services, and the provision of residential accommodation in homes for the aged. The aim of the geriatric service is to provide early care and rehabilitative treatment for 'the elderly sick. This is best achieved by close co-operation between the hospital and local authority services, as we have indicated. The Welsh Hospital Board has reached the conclusion that one of the ways of furthering this highly desirable measure of co-operation is by the joint appointment by the Board and local authorities of consultant geriatricians. As the Report shows, some appointments here have already been made. In fact, the figure is now three, though the Report shows two, and others are in hand.
282 I have tried to set out the position fairly, showing the improvements, and there are many, and not attempting to conceal need where it exists. There is much to be done. In this debate no doubt hon. Members will draw our attention to the various local deficiencies with which they are familiar. Everything cannot be done at once, but the general picture is one of substantial progress in all health matters with a steadily increasing tempo—more and better hospital beds, more consultants, doctors and nurses and rapidly improving domiciliary and community services and a substantial effort in the case of the elderly which will soon begin to have a marked effect and a constantly improving statistical health pattern.
My first visit to any hospital since my new appointment as Parliamentary Secretary was made in South Wales last October. In such a visit one tries to do so much and I made a point of talking with every patient in every bed that I could see. The result is that I have some kaleidoscopic impressions but the topmost impression was the progress and the drive going on and, above all, the devoted service of those who were helping to operate every branch of the National Health Service.
Sometimes in these old hospitals—there is one in the constituency of the hon. Member for Pontypridd—the physical nature of the buildings was not good, but the care was extraordinarily high. I loved going round the wards and talking to the old people. One old gentleman—well in his eighties, confined to his bed but still interested—I discovered was keen on horse racing. We discussed form together. He asked, "Are you married?" to which I replied, "No, are you offering for me?" His answer was, "Ah, and I might think about it at that."
There was also the old man who insisted on singing the hymn to me that he sang to matron every Sunday morning. These may be isolated instances, but this is what the Health Service really is—people. I was glad to find this very high standard of care and to know that it was being given. I hope, with all hon. Members from Wales, that that progress will continue and expand as I am sure it will. Wales can show a very proud record in health matters, and I am glad 283 to have been able to give details of some of it today.
§ 5.9 p.m.
§ Mr. Leo Abse (Pontypool)
If charm and a valiant effort to master the Welsh language were necessary attributes to persuading us that all was well in the Health Service in Wales the Parliamentary Secretary would, indeed, have succeeded. But the cold facts present a very different picture. Although all of us salute those within the Health Service who give themselves to the care of the sick and aged, we should be failing in our duty if we showed any diffidence in criticising all those aspects of the Health Service where, in our view, some very serious gaps are revealed.
The Parliamentary Secretary referred to the infant mortality situation in Wales. Anyone Who, as a parent, has been touched by the hazards of prematurity and toxaemia, must be aware of the fearful anxiety that arises from childbirth. To lose a new-born babe after months of expectancy is a bitterly cruel blow. I was brought up to believe that life was man's greatest blessing, and there is surely no greater sin than to treat the boon of life as if it were some trivial gift. But who can dispute that the persistent and regularly grim infantile mortality rates of Wales are being accepted, as they have been today, with an extraordinary degree of complacency?
I do not see in the infant mortality rates in Wales—if I may adopt the phrase of the Parliamentary Secretary—a satisfactory record of progress. Naturally, I think first of my own constituency. This year we have grim figures indeed. Pontypool and Blaenavon had an infant mortality rate in 1959 almost three times the English figure. The Monmouthshire figure has gone up from 25.8 in 1958 to 27.2 in 1959. There are constituencies with conditions clearly calling for the closest attention, and they exist both in industrial and rural areas.
My hon. Friend the Member for Merthyr Tydvil (Mr. S. 0. Davies) has often spoken of the position in his own constituency where we find there is a perinatal rate—that is to say, a rate based upon the deaths under one week, plus stillbirths—per thousand live births 284 of 56, whereas the perinatal rate for England is 34.6. That is a measure of the seriousness of the situation. I am sure that my hon. Friend the Member for Carmarthen (Lady Megan Lloyd George) is full of disquiet at the position which exists in Caernarvonshire which has an infantile mortality rate of 35. Of course, the figures have improved over the years nationally, and we expect them to do so in Wales. They have improved at a greater pace in countries outside England and Wales, as we know from the recent figures applicable to Scandinavia and the Netherlands.
The question that we in Wales are asking is: why is it that after years and years, the gap between the English national average and the Welsh national average of perinatal deaths, instead of closing, is widening? Those are the statistics. How can one dare to have complacency in the face of a situation like this? What we need to do is to translate these percentages and to realise how many deaths have resulted. The fact is that if the English figures had been achieved in Wales in the post-war years 6,000 children and 150 women would be alive today, and we are entitled to ask why they are not alive.
When we put the question to the consultants, to the Regional Hospital Board or to anyone in Wales we get diverse answers. One is told, as we have been told by the Regional Hospital Board, that these figures are probably due not to medical reasons but to social and economic reasons. I have heard it said that there are congenital reasons. A very distinguished professor of obstetrics in Cardiff, Professor Duncan, recently said:Women who are having babies now are women who were born during the time of the depression. With a thing like reproduction, we are dealing with a previous generation and this time lag is very important.Let me tell the Minister and the Parliamentary Secretary that we in Wales are not prepared to allow the sins of Tory Governments in the 1930s to be visited on the babes of Wales in the 1960s.
We are confident that there is a method by which we can genuinely find out the reasons for the persistence of this rate which is chronic. We ask the Government to make some effort to discover what are the real reasons. We require 285 —indeed, we do not ask; we demand—that fund; shall be put at the disposal of the National Health Service in Wales to enable pilot experiments to be undertaken, so that we can inquire in the grim areas of Carmarthenshire or Merthyr and there have a survey by teams of investigators, doctors, social workers and sociologists who could tell us where the fault lies. We are not content to allow the situation to remain as it is. We are asking that, at least, surveys should be carried out to give us some of the answers to these questions about which there is confusion and complexity in the minds of leading consultants in Wales.
If we do not know all the answers, we certainly know some of them from the Cranbrook Report. That Report made it clear thatThe practice of obstetrics requires special skill and experience. There is not enough domiciliary maternity work available to enable every general practitioner to obtain and maintain the necessary standard of skill.The expert evidence given to the Cranbrook Committee urged that only a general practitioner in group practice should undertake midwifery, and that if he did so his general medical list should perhaps be limited to 1,500. There are in Monmouthshire and Newport at this moment 50 doctors with lists of almost 3,500. Doctors with lists of this size cannot possibly give obstetric care. Those in medical circles in Wales, although surrounded by a conspiracy of silence because they do not want to criticise their own colleagues, know that it is impossible with lists of that size for adequate obstetric and antenatal care to be given to the mothers of Wales.
We are asking that the obstetric lists should be reviewed immediately. The sooner the lists are cut down and confined to doctors who satisfy a proper criterion of skill, the safer the mothers will be. A general practitioner not on the obstetric list who provides maternity medical services to a patient on his list is paid five guineas instead of seven guineas. I say with a full sense of responsibility, knowing as we do these large lists which exist in Wales and the fantastic number of doctors who have managed by some method or another to be on the obstetric list, that babes are being murdered in Wales at two guineas a head.
286 If we have a special problem with the infant mortality rate, and if we have a legacy from the 1930s there, we also have a legacy from the 1930s so far as old age is concerned. We have special problems of the aged sick. The Parliamentary Secretary quoted some statistics which surprised her. But if we ignore South-East Wales, in every other area of the Principality Wales has a higher proportion of old folk above 65 than any other region in the kingdom. I would have expected, therefore, that the Regional Hospital Board would have met this challenge—a challenge which affects 300,000 people in Wales.
I would have thought that the Boucher Survey of Services to Chronic Sick and Elderly, published in 1957, would have jerked the Board out of its complacency. I direct the Parliamentary Secretary's attention to that Report. There, hospital statistics reveal that Wales was almost the worst region in Britain, having the lowest but one number of beds per 1,000 population over 65, having almost the lowest bed turnover and providing the lowest number of consultant sessions to the old folk of any region in the Kingdom. Now in 1960, in Wales, our number of geriatric beds remains well below even the national average figure of mid 1954.
We need hundreds more beds, and even more, in my view, we need more geriatric consultants. We have no consultant geriatrician in Cardiff, East Monmouthshire, Newport, West Wales, Mid-Wales and Mid-Glamorgan. At the moment, there are the three who have been mentioned, but there are none throughout Wales; yet we all remember the words of the Boucher Report, which said:Where a trained geriatric consultant was in charge, and particularly where he had reasonably adequate medical assistants and ancillary staff, the bed turnover was remarkably good.We are doing by omission what Hitler did by commission. We are killing the aged. If the turnover of beds is not "remarkably good", but bad, as the figures show that it is in Wales, it means that the turnover is not from hospital to home, but from life to eternity.
If we have special difficulties with the young and the aged, I say that of all the features that could be said to be worst in Wales. it is the present position of 287 psychiatry in our country. The Government, the Welsh Regional Hospital Board and the National School of Medicine must all bear responsibility, in my view, for the fact that the mentally sick in Wales are being deprived of the full opportunities that contemporary psychiatry can offer.
Again, let us look at the statistics. Whereas in England overcrowding in mental hospitals is 8 per cent., in Wales, where we have one-third or one-half of the beds in the whole service in mental hospitals, overcrowding is 14 per cent. It is even 25 per cent. in some places in North Wales, and we need more than 1,000 beds to reach the standard that has been laid down officially. Why is it that in London, in the north-west Metropolitan area or the south-east Metropolitan area, overcrowding has ended? Why is it that, in the face of this need, over the last ten years the Regional Hospital Board has spent less than the national average of its capital expenditure on mental hospitals? Why is it that, although at this moment in Wales, 11,000 of the psychiatric beds are occupied by mental patients, not one of the fifteen consultant advisers to the Regional Hospital Board, who determine so much of its policy, is a consultant psychiatrist? Why has the Department failed miserably to create an adequate number of consultant psychiatric posts? To bring us on a population basis to parity to England, another ten consultant posts should be created immediately and another eleven S.H.M.O. posts.
If the Parliamentary Secretary believes that there is a need, when we are dealing with mental defectives, to get at the problem quickly, I would ask her to look at the position regarding child psychiatry in Wales. There is not one fully qualified child psychiatrist in the Health Service available in the whole of Monmouthshire. There is not one in Mid-Wales, and there is not one even in the capital city. One of the greatest Welshmen of this century was Dr. Ernest Jones, the man who brought to the whole of the Western world from Sigmund Freud, the greatest Jew of this century, in Vienna, the whole science of psychoanalysis. It is a miserable commentary on Wales that it can do so little to pay 288 homage to that great man that, even inside the university itself, there is no chair of psychiatry.
We know how the Regional Hospital Board values the effect that a chair of psychiatry would have on its medical school. In 1949, the Board says that it made representations to the University of Wales for the establishment of a chair in psychiatry. In June, 1950, ten years ago, the Board was informed that the University was in favour of establishing a chair. In January, 1951, the Board again asked the University. It asked again in September, 1954. It is still asking, and it is still waiting.
The position is, and the people of Wales ought to know it, that—at a time when they are talking of a National Health Week or a National Health Year or Mental Health Year in this country—in Wales, more than the public, it is, above all, the Welsh National School of Medicine that needs educating. It is a sin against 11,000 patients in our mental hospitals in Wales that the establishment of the school—so many of whom we recall hated the introduction of the National Health Service—fail to give any adequate psychiatric training to its students. The medical graduates of Wales are psychiatrically illiterate, and it really is not good enough.
The Welsh nation should know that the advances that are being made by way of drugs, electro-therapy and psycho-therapy in the field of mental illness means no longer that a sojourn in a mental hospital is a sentence of life imprisonment. They should know that Government parsimony and sordid medical intrigue is preventing bringing back to rationality many of those in Wales now lost in their bizarre private world.
The Parliamentary Secretary spoke with some optimism about the effect of the new Mental Health Act in Wales. The Mental Health Act in Wales will be a complete farce. The after-care services are quite inadequate, even in the very shadow of the medical school at Whitchurch Mental Hospital, there is not one qualified psychiatric social worker to aid the discharged. We have only to look at the numbers of the psychiatric social workers we have in Wales to realise how impoverished is the whole mental care service. Until the University s 289 of Wales has a chair and department of psychiatry where students and postgraduates can take a diploma in psychiatric medicine, until it has a department of social administration, there is absolutely no hope of attracting or training an adequate supply of psychiatric social workers to aid the discharged patient to re-orientate himself to the outside world.
Meantime, we shall continue to have the terrible casualties we have in Mid-Wales. I doubt whether the grim figures which we have in the Mid-Wales Mental Hospital can be repeated up and down the country. This year, more than two out of three patients admitted are discharged patients who have once again broken down. That is the type of comment we have to make on the position regarding after-care in the whole of central Wales.
I should like now to speak of something the effects of which all of us see in our own constituencies. It is the position regarding industrial injuries. My right hon. Friend the Member for Llanelly (Mr. J. Griffiths), at a meeting of the Grand Committee recently, drew attention to the figures of industrial injuries in Wales. vis-à-vis any other part of the country. He quoted a figure this year of 8,500 men and women who were idle because of industrial injuries, while in London and Middlesex, which has three times the population of Wales, there were half the number of industrial injuries. That figure is not an eccentric figure, if one looks at the figures month after month, because we see that in April last Wales had 7,600 cases, while London and Middlesex, with three times the population of Wales had 2,600.
It is not an eccentric thing to do to compare Wales with London and Middlesex, but let us compare it with Scotland, which has approximately twice the population of Wales. Whereas the figure for industrial injuries in Wales is about 8,000, in Scotland it is 8,700, which reveals the price that our people have to pay for their dependence upon heavy industry. We do not need the reminder of Six Bells to know haw severe are the effects of industrial injuries in Wales. We are therefore entitled to ask the Government what they are doing about industrial rehabilitation. All we have got is one industrial rehabilitation unit 290 serviced by a part-time doctor who belongs to general practice. Is it not right that, at least, we should have what Scotland has got? In Edinburgh, there is a residential unit, and in this country there are others at Leicester and Egham. Is not that the least that we should have in Wales, in view of these severe figures?
What we really require in Wales is something far more comprehensive, a system of rehabilitation and assessment centres located near general hospitals. We need rehabilitation units which would include occupational workshops as part of the hospital service, apart from industrial workshops which would be part of the industrial rehabilitation services of the Ministry of Labour. Adjacent establishments of this kind would make it easy to allocate rehabilitees to the type of therapeutic activity most suitable for them and to provide specialist services, in particular, psychiatric services, which would be readily available for the rehabilitees.
In my professional life, I sometimes see the industrially injured 12 or 18 months after their accidents. There is nothing more terrible than to see the mental deterioration which comes upon men when they know they are of no use. In my experience, there is nothing more sad than to see how family relationships are poisoned as a man begins to feel that he is useless. I urge that more consideration should be given now to the needs of physical medicine in Wales so that, at least, a serious attempt can be made to match our effort to the pressing, clamorous needs of the industrially injured of our country.
The Parliamentary Secretary referred to the new hospital in Wales, the hospital which is to be erected as the medical teaching centre at Cardiff. She spoke of it with pride, saying that it was attracting a great deal of attention. It has indeed. It has attracted attention from every young architect in Wales who has been horrified by the plans which have been produced. I am not surprised. We have already suffered from some of the effects of architectural establishment in Wales. We have the monstrous beehive desecrating the civic centre of Cardiff which houses the Welsh College of Technology. When the most important assessor of the committee is responsible for that desecration, I am not surprised at the result which has come about.
291 This is not a personal predilection of mine. I direct the Parliamentary Secretary's attention to last month's issue of the Architects' Journal and I ask her to read what is said about the hospital building there. The fact is that the hospital is just what one could expect from this miscegenation; out of the architectural-medical establishment of Wales, we have produced an architectural abortion. The Architects' Journal, speaking of the assessors, says that theyhave done little /o further hospital planningin this pedestrian scheme, adding that no newtrends in hospital planning are evident in the winning designs".The Journal goes on to say, speaking of the elevations, that theyshow an absence of architectural character and a lack of cohesion among the various buildings.We are spending £8 million. I should have thought that the hon. Member for Cardiff, North (Mr. Box) would, at least, want a beautiful building in his constituency. More important even than the æsthetic aspect of the matter, there is grave disquiet that this school is becoming a glorified cottage hospital. Most of us here are concerned with the peripheral needs of Wales. We are not concerned with puffing up the egos of the part-time consultants of Cathedral Road who want more and more beds in the hospital. We are concerned that the hospital should be properly serviced with adequate research laboratories and adequate research staff. Anyone examining objectively the present plans of the hospital cannot but come to the conclusion that there has been a battle for beds but there has been little battle to ensure that we build a hospital which will be worthy of the 1970s instead of the outmoded medical traditions of the 1950s.
I have spoken harshly, but we are dealing here with human life, and I do not think that I have exaggerated the case. Each one of us has a duty to see that there is no complacency in the service. There is a division between hon. Members on that side and on this. We on this side believe in public expenditure even if it must result in increased taxation, and we are not afraid to say so. In Wales, where we have, 292 largely, a Socialist society, we appeal to the Government to be prepared to spend more money so that we can have a better-equipped hospital service throughout Wales, so that we can have considerably more consultants and bring ourselves up to parity with England. We have suffered enough from the Tory legacy of the 1930s and we want to march forward genuinely into the 1960s.
§ 5.35 p.m.
§ Mr. Raymond Gower (Barry)
Many of us on this side, I think, will feel that it is quite proper to view the shortcomings of the National Health Service with great concern, and I would certainly support the hon. Member for Pontypool (Mr. Abse) in searching out and finding a remedy for the defects which have emerged in it. I really cannot accept, however, that any good purpose is served by speaking in such exaggerated terms as he did, comparing our attitude towards the aged with the attitude of Hitler. I cannot conceive of anything more unrealistic or more unfair to the many people who have devoted great energy and earnest attention to this problem. It is quite unwarranted to make any such comparison.
Again, I do not doubt that the hon. Member has powerful views on the important subjects to which he addressed himself, but it was most unworthy of him to speak about the Welsh National School of Medicine in such improper terms, protected by the immunity which we enjoy in this place, and to suggest that the authorities of that medical school need educating because there may, perhaps, be some defects in one aspect of our medical services. A case could equally well be made to show that in other directions the Welsh National School of Medicine has been a pioneer. Indeed, some of the services we have in Wales are, perhaps, ahead of what people in other parts of the United Kingdom are doing. While I would agree with the hon. Member that we should make criticisms and that we should direct them to the best of our ability, I think that he served no good purpose in speaking in such exaggerated and, sometimes, I felt, unworthy terms.
§ Mr. Abse
Does the hon. Member dispute that there is no psychiatric education given to the medical students of Wales? Does he not think that it would be more worthy of him that he should give greater consideration to the mentally sick of Wales rather than to the consultants of Wales? Does he not think that he should put greater emphasis upon the needs of the old instead of trying to protect the medical establishment of Wales?
§ Mr. Gower
I am referring to the hon. Gentleman's suggestion that our attitude towards the elderly is comparable with the attitude of Hitler. It is not at all comparable. He should know perfectly well that people are living longer in this country than ever before. Indeed, this is one of the great problems which face most modern communities. People are living longer, and it is to the credit of all those who have done so much not only in hospitals but to improve the standard of living in many countries of the world that this problem has now come to assume great importance.
§ Mr. Abse
Has the hon. Member read the Boucher Report? Does he dispute that, if one has consultant geriatricians, one can achieve a quick turnover and that, without consultant geriatricians, there is no turnover? If one has no turnover, does not that mean that, by omission, people die? Am I not justified in speaking in anger when that is the result?
§ Mr. Gower
I have agreed that, in some respects, there are important defects, and, further, I have said that the hon. Gentleman is right to do his best to draw attention to them. What I said was that, at the same time, I deprecated and denounced the manner in which, in some respects, the hon. Gentleman did it.
I wish to stress one point with which, perhaps, the hon. Gentleman will agree. I have no desire to protect any medical establishment—medical men are well capable of defending themselves—but it is a fact that in other fields the school of medicine to which the hon. Gentleman referred has been a pioneer and that in many branches of health in Wales it can be said that we are considerably ahead of some other parts of the country.
That comes, I admit, from our peculiar industrial position. I agree with the hon Gentleman that there are special problems in an area so dependent on very heavy industry in which people are likely to contract certain diseases. As a result of that position we have a larger number of industrial disabled. I support what the hon. Gentleman said about the great need for tackling this problem. It is also because we have this special problem that our advance in the treatment of pneumoconiosis and similar diseases is probably rather further advanced than in other parts of the United Kingdom. Therefore, we may say that our progress in some directions, or lack of progress in other respects, is connected with the nature of our economy and our industry.
At the same time, it is also true that our defects in the past were probably due to the fact that voluntary effort in Wales, in the formative years of the last century, did not, perhaps, in some aspects achieve so much as the voluntary effort in some other parts of the United Kingdom.
§ Mr. Gower
I did not differentiate between particular regions of Wales. I said that in some cases it may well be that voluntary effort in parts of England achieved a greater advance than in parts of Wales. There is nothing to be ashamed of in making such a statement. 295 I do not think that my part of the country is always right. The hon. Gentleman is trying to express a quite ludicrous argument.
For that reason, there is the fact that the leeway which the Welsh Regional Hospital Board and the National Health Service in Wales had to make up was correspondingly greater than that in England.
§ Mr. Abse indicated assent.
§ Mr. Gower
The hon. Gentleman agrees. I am not trying to establish any strange theory. I think that it is one based on the facts.
It is natural, of course, that we should tend to judge the quality of hospital and general medical services by our experience of them either as individuals or as Members of Parliament, or even in both capacities. Our experience in Wales will certainly tend to differ—and this is true of elsewhere—according to the area in which we live or the constituency which we represent. As I said before, I agree with the hon. Gentleman that in assessing the virtues and achievements of our services it is very important—and I think my hon. Friend the Parliamentary Secretary will accept this—that we should not overlook any defects and shortcomings.
Superficially, of course—and more than superficially, as my hon. Friend pointed out—the achievement of the Health Service in Wales, now in its twelfth year, has been impressive. At the end of 1958, as my hon. Friend reminded us—that is now about eighteen months ago—and as we learned from the Report on Developments and Government Action in Wales for last year, there was something like 214,000 in-patients Who had been treated in Welsh hospitals during the year. This represented a 43 per cent. increase over 1949. Beds available for use in 1959–28,000 or so—represented an increase of 4,000 over 1949, and the number on the waiting lists, to which my hon. Friend referred and which in 1949 totalled 37,000, had fallen by 11,000 to 26,000 in January last year.
As my hon. Friend also mentioned, in the same ten-year period out-patient attendances in Wales had risen from 936,000 to 1,800,000 or so. The Welsh Digest of Statistics, in its fifth issue pub 296 lished in May last year, showed that while the total number of doctors on the list in Wales had risen—again as my hon. Friend pointed out—from 1,093 to 2,091 and the average number of paients had fallen, our figure generally was not nearly so good as that in other parts of the United Kingdom.
If I cannot quote with equal precision the present figures it is because the part of this year's Report on Developments and Government Action dealing with health is not so adequate. In all seriousness, it is one of the worst parts of the Report, the least adequate and the most poorly documented. Indeed, it is not nearly so good as the part devoted to health in last year's Report.
§ The Rev. Llywelyn Williams (Abertillery)
Cannot the hon. Gentleman make the obvious deduction that the previous Report was dealing with the whole ten-year period? The last Report dealt only with the year immediately preceding.
§ Mr. Gower
That may well be the main reason, but, even allowing for that, I think that the part of this year's Report dealing with health is otherwise still one of the least satisfactory parts of it. It contains less information, and there are one or two notable omissions with which I will deal later.
I should like my hon. Friend the Parliamentary Secretary to compare the section dealing with health with some of the other sections of the Report. While acknowledging the gradual improvement which has occurred in hospital waiting lists, I should like to express, as did, I believe, the hon. Member for Pontypridd (Mr. A. Pearson), some concern at the cases of delay in certain instances. I have had such cases brought to my notice, cases where the family doctor has emphasised the need for early treatment or for early operation.
On occasion, as, doubtless, other Members have done, I have had to bring such a case to the attention either of the local hospital committee or, indeed, to my right hon. Friend the Minister of Health. I confess that I have been most impressed by the manner in which such cases have been taken up by the hospital authority or by my right hon. Friend. But the point that I want to make is that in some of the cases brought to my notice it seemed to me that it should not 297 have been necessary for them to have been so brought to me and that, indeed, it was obvious from the facts placed before me that the persons concerned should have been in hospital receiving the treatment thought necessary by their doctors.
These, of course, are the more urgent cases. While I recognise that in some cases delay is almost inevitable, I hope that very great care will be taken not to have urgent cases included among those which have to go on the waiting list. I hope too, that when my right hon. Friend replies to the debate he will be able to give us fuller information about the extent of progress made in the actual waiting list during the last eighteen months or so. I am not quite sure whether my hon. Friend the Parliamentary Secretary gave the latest figures --if she did, I apologise—but—recognize, as do other hon. Members, the limit of the availability of beds and, in some cases, the shortage of trained nurses.
I now turn to hospital building. I am certain that the House was impressed by the figures given and by the extent and quality of some of the new buildings. It is certainly encouraging to note that there is to be a major scheme for Caernarvon and Anglesey General Hospital at Bangor involving sixty-four beds, operating theatres and an outpatients' department. It was very gratifying to note what my hon. Friend told us about the new hospital at Singleton Park, Swansea, and the manner in which it has been pushed ahead, and the new hospital at Cwmbran in the constituency of the hon. Member for Pontypool (Mr. Abse), with 200 beds and the necessary services. These things are encouraging. I have also been impressed by the references in the Report to the improvements carried out at various hospitals, such as those at Wrexham, Neath and in my own constituency at Barry.
However, I have an impression that the problem of building new hospitals or of building extensions is being tackled with greater energy than the problem of using beds which are now becoming available in hospitals because of the changing pattern of disease. There is, for example, the decline in tuberculosis. I realise that tuberculosis and similar hospitals are not always sited in the best positions for use to be made of them for 298 general purposes, but some of them are and I hope that their facilities will be used and that steps will be taken soon to make the fullest use of them.
There is another notable omission from the Report. I think that the hon. Member for Abertillery (The Rev. Ll. Williams) is interested in this matter. The Report tells us little or nothing about the recent progress of dentistry in Wales. In the previous Report a year ago our attention was drawn to the shortage of dentists in Wales, which was then much more severe than the shortage in England. In January, 1959, the ratio of dentists to patients was 1:4,000 in England and 1: 6,000 in Wales. Moreover, 40 per cent. of the Welsh dentists at that time were over 60 years of age against 28 per cent. in England. I believe my hon. Friend gave us a figure for this year in this connection and that it represented a very slight deterioration even in that situation. Consequently, the position regarding dentists in Wales is one of the most serious problems that we have to face. I sincerely hope that my right hon. Friend will consider the matter very carefully indeed, and perhaps he will be able to say something about it when he speaks later.
There is one other remark that I should like to make about dentists and dentistry. This may have a United Kingdom application as well as being of importance in Wales. Arising out of the recommendation of the Royal Commission on Doctors' and Dentists' Remuneration, a decision will have to be made about the basis upon which dentists are to be remunerated. Undoubtedly, some notice may properly be taken of average performance and average time schedules. In the case of dentistry there may be very serious dangers indeed in pressing these considerations too far. Much of the work of modern dentists is essentially operative in character, resulting in continuous strain through long periods of the day. Dentists who work comparatively slowly may nevertheless perform invaluable work. Their work must be almost indispensable in the case of Wales, where we are so desperately short of dentists. Therefore, I hope that in this matter the question of time schedules and average performance will not be pressed too far.
299 I hope, too, that my detailed criticism will not hide my conviction that our health services in Wales are improving and performing a most valuable function. As my hon. Friend said, they are staffed by many devoted and able people. I am glad to hear the news about the Welsh teaching hospital. I am glad to have the assurance that it will be possible for it to be built in one phase—sooner perhaps than we contemplated.
Serious notice should be taken of the criticisms about the proposed plans made by the hon. Member for Pontypool. I do not know to what extent architects ever agree about the virtue of a new plan. Having a father and a brother who are architects, I read the architectural journals and have noted from time to time that most new plans are criticised by other architects. Nevertheless, it is true, as the hon. Member said, that the plan has come in for very great criticism, and I hope that serious attention will be paid to what he has said.
I hope, also, that nothing that has been said today will destroy our conviction or damage the feeling in the House that the National Health Service in Wales can be made, with perhaps a short-term improvement rather than a long-term improvement, an admirable instrument for improving the health of our people.
§ 5.56 p.m.
§ Mr. Ifor Davies (Gower)
During his speech the hon. Member for Barry (Mr. Gower) referred to voluntary workers in relation to health matters. I am second to none in my admiration for voluntary workers in all respects, and I think I can say on behalf of my hon. Friends that we are also second to none in our admiration for the National Health Service.
I join with what was said by my hon. Friend the Member for Pontypridd (Mr. A. Pearson), in his excellent opening speech, when he referred to this as the first "Welsh day" in the House this year to the fact that the National Health Service will stand as a great memorial to the memory of my late right hon. Friend the Member for Ebbw Vale, Aneurin Bevan.
The hon. Member for Barry mentioned the changed pattern of diseases and referred to tuberculosis. Despite the important matters which we have been discussing, I feel that the most dramatic 300 and most arresting statement in the Report is contained in nine words on page 52:The incidence of tuberculosis is still on the decline.It is noteworthy that "decline", in English, means "reduction". But the Welsh reference to "decline" meant "wastage". I remember when, twenty years ago, the right hon. and learned Member for Montgomery (Mr. C. Davies) produced a remarkable report which came into being as a result of the abhorrence in Wales of this wasteful disease.
These words in the Report are like sweet music in the ears of ex-T.B. patients like myself and I take the opportunity today to pay a tribute to the great work done by the pioneers of the Welsh National Memorial Association, who, over a period of fifty years, have led the work of fighting this disease. I pay tribute, too, to the chest physician at Swansea, Dr. T. W. Davies, and my general practitioner, Dr. Morgan Owen, to whom I am personally indebted. Indeed, the close co-operation between general practitioners and the chest physicians has been of very great significance in the fight against tuberculosis.
Despite the fact that we welcome the comments in the Report about the decline in the incidence of tuberculosis, I would remind the hon. Member for Barry and the House of what appears on page 117 of the Welsh Regional Hospital Report. There, we find the statement that the danger still persists. Its words are:Tuberculosis still presents a problem necessitating a continued attack for the foreseeable future. Although there is a decline in mortality, there is as yet no convincing evidence that the incidence of the disease will diminish at the same rate.This means that there must be no relaxation in the attack on this disease. There must be far greater efforts to combat it.
But what is happening? What has happened, in Swansea, within the last few days? I should like the Parliamentary Secretary to tell us why the static miniature radiography unit in Swansea, the first to be established in Wales nine years ago—although two or three others have been established since—was closed on Saturday last. Who is responsible 301 for this tragic blunder on the part of somebody in authority?
I know who was against closing it. In a statement which he made last week, the medical office of health referred to it as a most serious retrograde step. The management board of the Glantower Hospital also opposed it. The local author ties opposed it. Last, but not least, the latest Report of the Regional Hospital Board anticipated that something would happen. On page 121, the Report states:This static unit is of great service to general practitioners and it will be a disservice to the public to close it and replace it at the Singleton Park Hospital.That is the new hospital. The Report continues:The unit at this hospital centre will deal almost entirely with the hospital population and the people of Swansea and district".and the valleys which I representand the general practitioners will be deprived of the present service. It is highly probable that a number of persons will be reluctant to go two or three miles for an X-ray and"—this is the important matter—general practitioners will not be so inclined as at present to refer individuals with slight symptoms to a unit so far from the patient's home.In the face of all these protests, why was the unit closed? What are the reasons for the closure? Cases can now be dealt with, so we are told, at the new hospital. I have visited this hospital and I pay tribute to its excellence. The action which has been taken, however, ignores the needs of the general practitioner and also the voluntary aspect. For example, in the unit in Swansea, 20,000 films were taken last year. If we take into account the people who will now be transferred to the new hospital, it is obvious that somebody is ignoring the fact that the general practitioners have referred between 5,000 and 6,000 people to this unit. Indeed, as many as between 4,000 and 5,000 people have visited it voluntarily.
For years, we have been attempting by propaganda and education to get people voluntarily to have X-rays, especially people with early symptoms of the disease. Because of fear and suspicion, however, they have refused to be X-rayed. In Swansea last year, between 4.000 and 5,000 people visited the unit. People will not do this when they have 302 to go out of their way and travel three or four miles outside the town. Somebody has ignored these considerations. The general practitioners have persuaded 5,000 or 6,000 patients to call in because they knew that they had early symptoms of the disease and it was easy to suggest to these people that they might visit the unit whilst doing their shopping in the town. In future, we shall lose those people.
What has caused the decline in the incidence of tuberculosis? One reason has been the introduction of mass radiography in 1944. It is noteworthy, however, that on page 143 of the Report of the Regional Hospital Board, we read:The proportion of new cases discovered by mass radiography is considerably increased in those places where static miniature radiography facilities exist.There is a remarkable table on page 154 of the Report to which I draw attention. Dealing with the position in Swansea, it shows that of a total of 643 cases referred by the mass radiography service for further observation, 57 confirmed pulmonary tuberculosis cases were traced. Fifty-seven out of a total of 126 new cases diagnosed at the clinic—in other words, 45.24 per cent. of the mass radiography cases confirmed as having pulmonary tuberculosis helped by the existence of this miniature unit and its co-operation with the local chest clinic.
The significant link between general practitioners and the static miniature radiography unit is shown clearly in Table V, on page 149 of the Report. It gives some remarkable figures. We see that 7,693 cases, or the equivalent of one-quarter of the total number of cases dealt with at the static unit, were referred by general practitioners. Of this number, 56 were cases of confirmed pulmonary tuberculosis, representing one-half of the total cases referred from all sources. This is a clear indication of the significant link of general practitioners with the service. The yield of cases referred by general practitioners to static units is the remarkably high figure of 7.28 per 1,000, the highest of any source whatever. This national figure corresponds to the yield in Swansea.
Another reason for the need of static miniature units in convenient centres of population is the remarkable increase in the incidence of non-tuberculous chest 303 conditions in Wales, which show no sign of declining. On page 116 of its Report, the Welsh Regional Hospital Board uses the word "staggering" and gives the amazing figure that 89 per cent. of the non-pulmonary cases examined in the chest clinics were non-tuberculous. They included heart disease, bronchitis, emphysema, pneumoconiosis, malignant growths and infection of the upper respiratory tract. In all, over 40 different non-tuberculous chest diseases and more than 60 non-respiratory diseases have been diagnosed.
A serious and significant fact has been the steady increase in the number of cases of lung cancer. This means that it is imperative and urgent that the existing chest services Should be adequately developed to meet this menace that is draining the economy and the health of the nation. These facts, I suggest, should also destroy any illusions that the work of chest clinics is decreasing merely because of the decline in the incidence of tuberculosis. There is a school of thought which argues that now, because of the decrease of the incidence of tuberculosis, the work of chest clinics is coming to an end. On the contrary, the work of chest clinics is increasing because of the increase in these other chest diseases. This is added reason why the chest clinic in Swansea should not be unnecessarily burdened with cases of slight symptoms which could quite adequately be dealt with at the static unit in the centre of the town.
I appeal to the Minister for Welsh Affairs, who, I am glad to see, is in his place, to investigate and to reopen this unit as soon as possible, for it is an area where industrialism is increasing and will require more and not fewer facilities for dealing with the control of chest diseases. It is also essential that political expediency and economic excuses, which, I believe, ware put forward for the closing of this unit, must never be allowed to interfere with the provision of facilities for early diagnosis; otherwise, the final victory over these chest diseases will be delayed indefinitely. Indeed, early diagnosis is the secret of success, and prevention is always better than cure. Hence the importance of static miniature radiography units.
304 In conclusion, I turn for a few moments to re-emphasise the appeal which has already been made in the House for an additional plastic surgery unit to be placed in a more favourable geographical position in Wales. I welcome very much the reply given yesterday by the Parliamentary Secretary to a Question, a reply in which she stated that she was prepared to look again at this point. I shall not repeat the arguments which were put forward in the House on 26th April when this was last discussed, but I would re-emphasise—this is not a criticism of the excellent work done at the Chepstow Hospital—that it does not make sense that in the industrial area of West Wales people who are, for example, in Swansea, should have to travel 73 miles to Chepstow or, who are farther afield, in Cardiganshire or Pembrokeshire, Should have to go 100 miles. I myself have seen people in local industry having to be visited in Chepstow, and the mothers of children who are seriously ill having to stay with them because of the distance involved.
There is every case for an additional plastic surgery unit in West Wales. I put forward the suggestion that we have already in Swansea, at the Morriston Hospital, an excellent opportunity of establishing this unit. I plead with the Minister to give great attention to the request which is being made from many quarters in West Wales for this very desirable additional surgery unit.
I hope that these two important matters will receive the attention of the Government and that action, which always speaks louder than words, will be forthcoming.
§ 6.13 p.m.
§ Mr. Donald Box (Cardiff, North)
In the recent debate in the House on the pollution of beaches great stress was laid on the fact that dirty beaches are not only unpleasant but are also an ever present danger to health as well. Though, at the end of that debate, one was left with the impression that already bad conditions were the exception rather than the rule, there is no doubt whatsoever that the intensive Press publicity has had the effect not only of stirring the national conscience but even of waking up one or two local authorities to the realities of the situation.
305 It was with this recent debate in mind that I was interested to read the paragraphs on infectious diseases and food poisoning in the Report before us today. As a result, I could not help wondering whether, in our deliberations, we should, perhaps, have sponsored a clean food campaign in priority to cleaner beaches. As the Annual Report of the Ministry of Health for 1959 is not published till later this year, the Report we are debating today contains details of only two outbreaks of food poisoning in Wales in 1959.
There were others of less significance, no doubt, but the impression is that the general decline in the number of food poisoning cases in Wales in recent years—they were down by as much as 16 per cent. in 1958—is a clear indication that the decision to remove the primary administrative responsibility for food hygiene in Wales from the Ministry of Food to the Welsh Board of Health in 1955 was a very sound one indeed.
In both cases reported here it was not possible to say what had caused the trouble. In each instance, the Report states:it was possible to pinpoint shortcomings in hygiene which could well have contributed to the spread of disease, and the correction of which would make for safety in future.It is—I hope that hon. Members on both sides will agree with me—this safety in the future factor which interests me most, for, despite our excellent record in Wales, there must be many minor cases where the symptoms are insufficient to be recorded as food poisoning, or where the resultant infectious disease is so long in developing it is difficult to identify its origin. This safety in future is of especial importance at present to our tourist industry in Wales, which is gradually expanding year by year.
What tremendous further impetus it would get if we could claim pride in spotless conditions in all the hotels and restaurants and licensed establishments throughout the Principality. But can we claim this? I do not think that we can. We are all, I fear, too familiar with the half-washed glass, the chipped cup and the unsterilised spoon and fork. How many caterers would really welcome a surprise inspection of their kitchens while meals are being prepared? Some would, of course, because they take pride in the cleanliness of their establishments, 306 but there are others where the motto is, "What the eye does not see…". In this respect, I look forward to the adoption by more and more catering establishments in Wales of the American system where, I understand, an increasing number of restaurants are being fitted with glass-walled kitchens in the centre of the diningrooms. In this way the preparation of food is constantly under the observation of the customer and a high standard of food hygiene is the inevitable result.
The Welsh Board of Health is doing a great deal to promote food cleanliness by enforcing the regulations relating to hygiene, unfit food, the control of food-borne disease, slaughterhouse inspection, and the hygiene of milk distribution. The duty of enforcing these hygiene and sanitary provisions, however, is placed upon the local authorities, and the food regulations enable the courts to impose heavy penalties for bad handling of food. In addition, the Welsh Board of Health carries on a constant campaign of food hygiene educational publicity through the medium of Press and television advertising, leaflets, posters, booklets and films; but however assiduously this campaign is pursued, and, indeed, however effective it may be, the real solution to this problem can be obtained only by the full impact of public opinion, for food must not only be clean but safe.
Food which looks clean and does not taste or smell bad may, nevertheless, be dangerous. There are germs everywhere, in the air we breathe, on everything we touch, and, in particular, in and about our bodies. Most of them are harmless; some of them are even beneficial; but there are others which cause food to deteriorate, and a few which are downright dangerous. Cuts and sores particularly may be a source of infection and a person may be a carrier of these germs although unaffected by them himself. If they are transmitted to food they can cause an outbreak of food poisoning such as those to which the Report refers.
Flies and insects may sometimes be to blame, but invariably a human being is ultimately responsible. Whatever steps are taken by the Board and its representatives, a great deal depends on the personal hygiene of the person who is handling the food. It is no good installing hot water supplies if they pare never 307 used. Food handlers should scrub their hands with the care and particularity of doctors, and it is up to public opinion to see that they do.
The Board is doing its share and we must do the rest. Although these conditions apply to most parts of Great Britain, I should like to see Wales give a lead to the rest of the country in being clean food conscious. The Report shows how the public health laboratories at Cardiff, Newport, Swansea, Carmarthen, Aberystwyth, and Conway are playing their part in fighting food poisoning and disease. The rest is up to us, for only public opinion can and will ensure that the hygiene of our hospitality in Wales lives up to the charms of our beautiful countryside.
§ 6.22 p.m.
§ Mr. Tudor Watkins (Brecon and Radnor)
I was enjoying the speech of the hon. Member for Cardiff, North (Mr. Box) so much that I was making a brief note to welcome his contribution and that of my hon. Friend the Member for Gower (Mr. I. Davies) and I was not ready to get up when you, with your kind face, looked my way, Mr. Speaker.
I very much agreed with the hon. Member for Barry (Mr. Gower) when in the course of his speech he referred to his notes, but when he discarded them I could not agree with what he said. The hon. Member referred to omissions in the Report on Developments and Government Action of references to the medical and health services in Wales. Except for two brief paragraphs dealing with two services there is no reference to the Executive Councils in Wales. They are important bodies which deal with general practitioners, opticians, dentists and chemists. There was a very good report on their work in 1958, and I ask the Minister for Welsh Affairs to see that paragraphs are published in next year's Report dealing with the excellent work of these bodies.
The hon. Member for Barry said that the report on the Health Service had been cut by half. It is important that we should have as much information as possible. There is an Association of Executive Councils. If a doctor came to Wales from England or Scotland and read this Report he would ask, "Who is administrating these services in Wales? Have 308 you no Executive Councils?" I hope that the Parliamentary Secretary to the Ministry of Health will look into this matter and pursue it through the usual channels. I have to declare an interest, because I was a chairman of an Executive Council. These councils do valiant work and they have so many sub-committees that the number would frighten even a county council.
I am glad to find that the Welsh Joint Prescription Pricing Service has been selected from among all the services in the country as the one in which a pilot scheme is to be studied in future as to pricing of drugs following upon the recommendations of the Hinchcliffe Committee. This is a great tribute to the work that has been done by this service in Wales. More publicity should have been given to the work that has been done by doctors in Breconshire. I know that one must not advertise doctors and I shall not do so, but there are doctors in Breconshire who have issued an excellent report on economical prescribing. The Welsh Board of Health has sent the report to all regional medical officers in England and Wales. I hope that even Conservative organisations in Wales will make that known throughout the land. It is far more vital work than some of the things that Conservatives are doing these days.
A number of interesting subjects could have been dealt with in the Report. We might have had information about the average cost in Wales of specific services—the general practitioners, dentists, chemists and so on, so that we could make comparisons with the cost of these services in England and Scotland. I should like to pay tribute to the services of Sir Frederick Alban as chairman of the Welsh Hospital Board. The Labour Government did well in forgetting politics and appointing him as chairman. He did magnificent work when he was in charge of the Welsh National Memorial Association.
There is a tendency these days to pay tribute to people when they have given up work or have died but there is a man in charge as vice-chairman of the Regional Hospital Board in Cardiff to whom I should like to pay tribute—Alderman Tom Evans. The announcement was made yesterday that he had been appointed president of one of the sessions of the Royal National Eistedfodd 309 in Cardiff, and that is a greater tribute than being appointed to the chairmanship of the B.B.C. in Wales. I should like to pay tribute to those who have worked in the National Health Service in Wales and particularly to Alderman Tom Evans as chairman of the Finance Committee.
As to the newly-appointed chairman of the Welsh Hospital Board, I would say that there is a tendency nowadays to appoint people who have been of great service to the Conservative and Unionist Association and apparently he was selected because he was chairman of that body in Wales. He was not a member of a regional hospital board and he had no previous knowledge of management committees. Nevertheless, I wish him success. I hope that officials will not spend too much time preparing briefs for conferences instead of getting on with other work because of the chairman's lack of knowledge. I do not often make criticisms of this kind but I make them on this occasion because I know what I am talking about.
The hon. Member for Gower referred to the progress made in the treatment of tuberculosis but I hope that in future it will not be left to the man in the street to be told suddenly that a hospital for the treatment of tuberculosis is to be closed. I refer particularly to the Pontywal Sanatorium and the Adelina Patti Hospital known as "Craig-y-Nos". Let there be forward planning by the regional hospital boards. They should not be spurred by the Ministry of Health to close hospitals on economy grounds. Now the regional hospital board in these cases has seen the advisability of continuing to use the Pontywal and Adelina Patti hospitals, the one for chronic sick and the other for the treatment of chest diseases and tuberculosis. I am sure that people generally are pleased with that decision.
When a small unit is closed in a rural district it is not generally realised that those who become redundant as a result are a greater proportion of the community than would be the case in a large industrial centre. It is important to keep these places going and this means forward planning. There are blank spaces in the report of the Welsh Hospital Board where it ought to be dealing with what is to happen in the future. 310 Let the Board fill these blank spaces by the time we receive the next report.
I should now like to say a few words about bronchitis. The report of the senior administrative medical officer, Dr. T. Stenner Evans, says that 10 per cent. of all sickness claims under the National Insurance scheme in England and Wales are in respect of bronchitis from Wales. Therefore, the disease is very prevalent in Wales. This compares with 5 per cent. in respect of asthma and 36 per cent. in respect of silicosis. Greater consideration should be given to this aspect.
There is another aspect of T.B. with which I am concerned. There is a tendency towards empire building on the part of some consultants. They treat T.B. patients as out patients instead of sending them to a recognised place for treatment where there is better provision. A well-known doctor in Mid-Wales tells me that it is much more difficult to deal with a patient who has been treated with antibiotics at home than it is to deal with a patient who had gone direct to a T.B. sanatorium.
A new kind of disease appears to have come into existence. It is called farmers' lung. It is brought about by mouldy hay dust. I think that there has been one fatality from it in Montgomeryshire during the last two months. I hope that consideration will be given to this disease so that when farmers get it they can obtain ready admission to hospital for treatment. When I was concerned with National Insurance whenever a miner was reported to be suffering from bronchitis I always referred him to the regional medical officer to ascertain whether he was suffering from anything else. I understand that it is not easy to cure this disease called farmers' lung.
My hon. Friend the Member for Pontypool (Mr. Abse) said a great deal about infant mortality. I do not think he exaggerated the case. If he used strong language it should not have upset the hon. Member for Barry so much. He stated the facts. I should like the Parliamentary Secretary to look at the situation in some of the counties. In Brecon the average is 41, the same as the average for Wales. It is greater than that of England. What is the reason 311 for this? In one of the reports of the Regional Hospital Board it is stated:There are important factors involved. They are not medical, but they are either educational or socially economic.The educational aspect can be dealt with by various means, but "socially economic" is a very strange phrase. Does it mean bad housing or that local authorities in rural parts of Wales cannot build houses because they have no subsidies? What is the reason for it? I hope that it is not the reason about which I am rather frightened. Is it because there is a greater fall out of Strontium 90 in the mountainous parts of Wales? How many deaths are due to leukaemia? I understand that there have been far more deaths than there should have been in the last two years because of the fallout of Strontium 90. What research is being done into this matter?
There are 102 sampling places for medical research, 42 of them in South Wales, but only four in the mountainous districts. If the fallout of Strontium 90 is heavier where there is greater rainfall, the sampling centres ought to be equally divided between the industrial and rural areas. Information on this subject should be available in the Report to allay public fears.
I was glad to hear what the Parliamentary Secretary had to say about the mental health service. This is very important. I hope that there will be greater discussions with local authorities to bring about co-ordination. A great deal is being done by the Welsh Board of Health, but I am not certain that sufficient is being done with regard to the provision of training centres for children. Too many mentally handicapped children are going out of Wales for treatment. There ought to be training centres for them in Wales.
What is being done for young persons? A formidable list of centres was given by the Parliamentary Secretary but they were not divided into subheads so that I could distinguish them. Local authorities ought to pay greater attention to rehabilitation. Excellent work is being done with regard to rehabilitation. I have seen the workshop in the mental hospital in my constituency, but once the patients leave the hospital what is done about their after care? Surely there are many boys who could be use- 312 fully employed by doing clerical work in county council departments. The answer of the authorities is, "Look at the superannuation Act. We cannot employ them". I would not mind seeing the regulations broken if boys can be rehabilitated. There is a reluctance on the part of local authorities and other people to employ people who have attended a mental hospital for voluntary treatment.
I was glad to hear what the Parliamentary Secretary had to say about the building programme. There is a shortage of doctors in T.B. hospitals, despite the fact that they are running down. From where is the future staff to come? There is a deficiency in hospital staffs all round. I asked the Minister of Health the other day whether something could be done to increase the salaries of matrons in some of the rural hospitals. Two hospitals in my constituency, one at Builth Wells and the other at Llandrindod Wells, recently advertised for a matron. Each hospital received only one application.
I suggest that the salaries of those who venture to come back to rural Wales should be increased or that not so much should be charged for board and lodging. An allowance is made to teachers who do exceptional work. Such an allowance should be made to a matron of a small hospital, because proportionately she has greater manual work to do than the matron who is supervising a large hospital.
I cannot leave this aspect of the matter without paying tribute to the men and women and young girls who venture into the hospital service and do domestic work. Much credit is due to them. I find from the Report that 30 per cent. of their time is spent in sweeping and polishing floors, 25 per cent. in washing up, 15 per cent. in washing and scrubbing and 10 per cent. in dusting and polishing furniture. This is not a very good advertisement. The work should be more amenable. I am glad to see that mechanisation is being introduced to ease this drudgery. I pay tribute to those who are doing this work.
I shall not dwell a great deal on the question of queue jumping for beds. If I were to elaborate on it a great many people would write to me and tell me of their own cases. Far too much of it is 313 done. I do not wish to be pointed in my criticism, but the Ministry should look at the question of part-time consultants jumping the queue in order to get more private consultations in the future.
Another thing which annoys me is the fees charged by doctors when asked to give their opinion in a court or for a certificate. A trade union or a lawyer acting on behalf of an injured person or someone with a disability, asks for a report from a hospital and sometimes requests the doctor to attend the court. They are then charged enormous fees for attendance—the charge being made in the knowledge that the union has, perhaps, plenty of money, or that the lawyer can get it in some other way. There should be a uniform charge for fees for doctors from hospitals, and also for consultants, for certificates and attendance at court.
I declare my own interest in this matter. Unfortunately, I have a complaint which needs constant consultant attention from time to time. If it had not been for the great work both by the general practitioners and the consultants I would not be able to speak here today. I want to pay tribute to them and to thank them and the National Health Service for the excellent work they are doing. I am sure that I am voicing that sentiment on behalf of a great number of people. As an ex-member of the Executive Council of Breconshire and of the Hospital Management Committee for Brecon and Radnor, I wondered where I would find the time for this work. I found it, however, because the work was of interest to me, and I want to pay tribute to those on the Hospital Management Committee, on the Regional Hospital Board and on the Executive Council, for the terrific amount of voluntary service still being given under the National Health Service.
I remember that when the National Health Service was proposed in 1946 there were criticisms from hospital governors, and I remember at one meeting answering twenty-three questions. For once I did not lose my temper. One reverend gentleman said that when the National Health Service came in, voluntary service would go out. I asked the late Aneurin Bevan what I should reply. He said, "No, that will not happen." He was quite right. Voluntary service is as noble 314 today as it has ever been, and I hope that it will continue.
I congratulate the Parliamentary Secretary on the able report which she gave. I hope that she will bear in mind the severe criticisms that have been levelled at the National Health Service today, and that an opportunity will be given in future reports for more information to be supplied in order to allay some of the fears that have been expressed.
§ 6.44 p.m.
§ Mr. Hugh Rees (Swansea, West)
The hon. Member for Brecon and Radnor (Mr. Watkins) was right in the praise which he gave to the late chairman and deputy-chairman of the Regional Hospital Board, but he was a little unfair in his criticism of the present chairman. He omitted to mention the very valuable public services which Sir Godfrey Llewellyn gave at the time of the Empire Games, which brought such benefit to Wales. That was a considerable administrative achievement and if Sir Godfrey brings that skill to the regional hospital hoard, it will be very beneficial.
The hon. Member for Gower (Mr. I. Davies) referred to the closure of the radiography unit in my constituency. Technically and geographically it is about 100 yards outside my constituency, but it is nevertheless in Swansea. He referred to the reason for that closure as being economic, but I understand that it was to ensure greater efficiency.
The building which housed the unit was in an area which in the future will be demolished and redeveloped. In any event, therefore, the unit would have had to be moved at that stage. It has now been moved to the hospital out-patients' department, a brand new building which has been open only a few weeks and which is later to be extended to hold a further 500 new beds.
I understand that the medical profession—and I am close to it because members of my family are doctors—considers that there will be greater efficiency and that doctors will be able Ito see a greater number of patients. If that is true, then I am happy. I do not wish to disagree with the hon. Member, for I believe that his sentiments were right in wishing this unit to continue its good work. The disease of tuberculosis is a scourge which must be wiped out completely.
§ Mr. I. Davies
The hon. Member said that he was in close touch with the medical profession. I quoted examples of members of the medical profession who are against the removal of this unit. The whole issue is not that the building containing the unit did not need to be pulled down but that the unit should still be kept in the town. Members of the Regional Hospital Board and the local medical officer of health—indeed all the authorities—are against the move. The unit, really to be effective, should be in the area where there is the most population, that is, in a convenient and suitable spot for people to call in. That is why criticism has been made of the decision removing it to what I admit is the beautiful new hospital. It is now too far away for voluntary patients merely to walk in or for general practitioners to encourage their patients to make a visit.
§ Mr. Rees
I do not wish to be unkind to the medical officer of health, but he is losing control of this unit and it is being taken over by the hospital. I am not sure that that is quite a good thing. I am not too happy that his criticism of the closure is as important as perhaps it may seem on the face of it. The important thing is that, as long as the service continues and develops, other diseases than tuberculosis can be detected by this means, and there will be specialists on hand to give advice at the same time as the radiography unit detects the disease. I will go this far to meet the hon. Member—that I understand that part of the medical opinion of Swansea and South Wales is strongly in favour of the move.
Some people have criticised the Report for its brevity and because it does not cover certain subjects. That may be so, but I welcome it because it is a Report of action and progress in a year in which a lot has been done in Wales. Perhaps we are, sometimes, a greedy nation and are never too happy and seem always to be wanting more and more improvements. Let us admit, however, that the Report tells a story of some progress and development in our hospital and medical services.
Wales has had its full share per head of the population—indeed, greater than its full share—of hospital development. In my own constituency there is a new 316 hospital which was originally planned in several stages. The out-patients' department, as I have stated, has already been opened. The Report says that the hospital is to have 250 beds, but this figure has now been increased and it is to have 500 beds. That is not a Report to be ashamed of.
My only concern is that so long as the hospital as it stands is in three sections—the Morriston Hospital on one side of town, another section in the centre of the town and the outpatients' department two miles down the road—administrative difficulties will be great. If the development of the later stage can be hurried so that the old hospital in the centre of the town can be transferred in toto to the new building, this will be greatly appreciated in Swansea and South Wales.
The difficulties in Swansea are those found in all the older types of hospital throughout the Principality. Tribute has already been paid to the work of the staffs of the hospitals and I am sure that no hon. Member would suggest that the Welsh hospital service was not living up to its standard and the promise which it has always put forward.
The reallocation of hospital services is an important subject and has been mentioned by several hon. Members. Tuberculosis hospitals and sanitoria are not fully occupied and plans need to be made for the future use of those hospitals when they are used even less than now. I wonder whether there is not a case for creating another plastic surgery unit similar to that at Chepstow and nearer to industrial South Wales and Glamorganshire.
I know that statistics can be provided to show that numerically we are better served in Wales than in many other parts of Great Britain, but, as the hon. Member for Gower pointed out, a 73-mile journey for someone who has suffered an industrial accident is too far. That sort of situation arises on only a limited number of occasions, but when it does, speed in getting the patient into hospital is most important. There is a small unit at Llandough Hospital which is nearer to the heart of the industrial areas and I hope that, in the not too distant future, the suggestion which was made by the hon. Member for Cardiff, West (Mr. G. Thomas) yesterday and which 317 the Parliamentary Secretary promised to consider will be implemented and plastic surgery units will be extended in the South Wales area.
There has been much talk of the extent of rehabilitation. As the hon. Member for Pontypool (Mr. Abse) said, there is now only one unit in Wales, in Cardiff, catering for one hundred people on a non-residential basis. He did not go into the subject deeply enough, but perhaps that was because he was limiting his time and devoting his speech to other matters. The rehabilitation service in respect of industrial injuries is administered by the Ministry of Labour while for medical cases—broken bones and so on—it is administered by the physiotherapy departments of hospitals which come under the Ministry of Health. Is there not a case for amalgamating all forms of rehabilitation units under the supervision and administration of the Ministry of Health? We are dealing with people who have a disease, or a disability, or who have suffered an accident, and the Ministry of Health is best able to cater for them.
The hon. Member for Pontypool spoke of establishing more residential centres. I am not sure that that is the answer. The difficulty with a residential unit is that if the unit at Cardiff, say, became a residential unit, men going to it from Swansea, Carmarthenshire, Cardiganshire or parts of North Wales would have to leave their families and live in Cardiff until they were rehabilitated either to go back to their old jobs, or to take new jobs. A series of small units near general hospitals in local industrial areas, which men could attend as out-patients from day to day, would be preferable. Such an arrangement is feasible and I myself attended the Cardiff Royal Infirmary for two years after having an accident—I cannot say that it was an industrial accident, but perhaps it was commercial. Many people would be able to carry on some form of occupation to supplement their National Insurance benefit and in that way some hardship would be alleviated.
I want the units to be established around the local hospitals and for the services to be amalgamated under the Ministry of Health because men who go to the units for rehabilitation after breaking a bone, or undergoing an amputation, or something of that nature 318 —not necessarily the result of an industrial accident—may have to be trained in a new craft and may have to be sent to some other form of unit. In addition, when the units are separate, the medical staff has to be duplicated and there is a strong case for having all the medical staff on a full-time basis so that both mentally and physically the man concerned is kept in his own environment and in conditions which will help his return to normal life.
If the units cannot be brought close together, several hospitals will be needed in Glamorganshire and Carmarthenshire for this work. I am not so conversant with North Wales and I am sure that the hon. Member for Brecon and Radnor (Mr. Watkins) would not want me to go down the leafy lanes of Breconshire with him. However, there are hospitals throughout the Principality which would be suitable for this purpose and which are near to industrial areas where, with the introduction of high speed machinery, more accidents are likely to result, whether we like it or not. The more that people are employed on industrial jobs, the greater will be the number of accidents. We must do some thing to improve these services, amalgamate them and bring them nearer together so that they are not broken up and so that when a man goes to such a unit there is not so great a disturbance in his home life and his social, industrial, or commercial life.
The hospital service in Wales has done a great job. The figures show that there are more general practitioners per head of the population in Wales than there are in England, or in England and Wales together. The Report shows that 46 per cent. of the population of England and Wales are on the lists of doctors with fewer than 2,500 patients on their lists, while in Wales alone the figure is 61 per cent. As one goes up the scale, to doctors with lists of 2,500 or more—3,000 and 3,000 or more—we are still better off than other parts of the country.
§ Mr. Abse
Has the hon. Gentleman examined the figures of the numbers of consultants in Wales and in England? If he does, he will find that in Wales we are scores down on a population basis. I know that he is anxious that we should have parity, but I urge him to direct his attention to that fact, 319 because without consultant services we can never achieve parity of personnel with England.
§ Mr. Rees
I follow the hon. Gentleman's argument, but he did not allow me to finish developing mine. Apart from road accidents, all medical treatment begins with the general practitioner, and if we have a situation in which more people have a chance of getting more personal service from their general practitioner, then we can probably do much to limit the effect of disease. As the hon. Member for Gower said, prevention is better than cure and much work in preventive medicine has been done in Wales. I do not dispute the figures about consultants, but it is more important that we should have sufficient general practitioners and then, later, have the specialists who know more and more about less and less. I think that we will find that in that way our medical service will improve.
The Report is heartening, encouraging, and one of which we ought not to be ashamed. No one has suggested that there is any complacency on this side of the House—apart from hon. Members opposite, and that is understandable. We want to go to greater things and to develop the service even more, but, at the same time, let us be fair and frank and admit that last year was a year of achievement.
§ 7.0 p.m.
§ The Rev. Llywelyn Williams (Abertillery)
We have listened to a very thoughtful and well-reasoned speech by the hon. Member for Swansea, West (Mr. Rees). Indeed, I think it is fair to say that the debate has not suffered from a lack of thoughtful and well-reasoned speeches. In that sense this has been a beneficial day for those of us who represent Wales, and I am sure we all join in the hope that the people in the Principality, whose services we have been so easily able to praise and eulogise, will become aware of what has been said and will be inspired to greater efforts and even better results in the future.
I thought that the debate was opened perfectly by my hon. Friend the Member for Pontypridd (Mr. A. Pearson). His speech was so much like his own 320 gracious personality. It was calm, deliberate and sincere. He gave a fine lead in what I am certain has been a useful debate. I associate myself with what he said about two of our great benefactors in Wales, two people whom we are proud to claim as Welshmen: first, our late lamented colleague Mr. Aneurin Bevan who was, as I think everyone will admit, the great architect of our National Health Service, and, secondly, Sir Frederick Alban, whom I regard as one of the finest public administrators in the Principality.
When my hon. Friend the Member for Gower (Mr. I. Davies) was speaking, my mind went back to the terrific impact made on me as a young man by the Report of the Commission under the chairmanship of the right hon. and learned Gentleman the Member for Montgomery (Mr. C. Davies) which revealed an agonising analysis of the frightening tuberculosis figures for Wales. I remember the shock of seeing five Welsh counties at the head of the table which showed the ravages of this insidious disease. My mind went back to the days I spent in the birthplace of my hon. Friend the Member for Caernarvon (Mr. G. Roberts). I was a minister of religion in Bethesda. Caernarvonshire, and, on reflection, I seem to think that almost every family in the church had at one time or another lost one member of the family through tuberculosis. I officiated at funerals in the latter years of the thirties and the majority of the people whom I buried died from this dread disease.
One became almost fatalistic about the disease. My hon. Friend the Member for Gower said that the word used in the vernacular in South Wales was "decline". The word used in North Wales was "decay". It seemed so terribly inevitable that at regular intervals people would die because of this shocking disease. It is now excitingly wonderful to see how the mortality statistics have gone down year by year.
There are many reasons for that. One is the tremendous strides made in what I call chemo-therapy; the tremendous effects brought about by our antibiotic drugs, the sulphonamides, and so on. The other reason is the early diagnosis of the disease, through mass radiography, referred to by my hon. Friend the Member for Gower. 321 But, whatever the reason, I am certain we all rejoice that the disease which at one time was the scourge of our country is now slowly but surely disappearing from our midst.
We in Wales claim, and I hope rightly, that we have rendered great service not only to our own country but to the United Kingdom in the sphere of medicine and health. I shall never forget how, in the midst of sadness, I noted with pride that of the six signatures on the daily bulletins issued as the late King George VI was dying, three were those of distinguished Welshmen. I am referring to Sir Daniel Davies, Sir Clement Price-Thomas, a native of the township in which I live, and Lord Evans as he now is, Sir Horace Evans as he was then. When it is remembered that the population of Wales is only one-twentieth of that of England, it is a remarkable tribute to a small country that those three distinguished people, who came from humble homes, achieved such eminence as to be ranked amongst the greatest and the best specialists available during the crisis.
I remember reading with great pleasure a Ministry of Health Report issued only three years ago. In the introduction to the Report reference was made to the three pioneers in thoracic surgery. First, Dr. Morriston Davies, the first person in Great Britain to reveal the possibilities of surgery in the lungs; secondly, Dr. Tudor Edwards; and, thirdly, Sir Clement Price-Thomas. Whoever drew up the Report saw fit to refer to those three great pioneers in thoracic surgery. It can, therefore, be understood why we in Wales are possibly more than usually concerned about health and health matters.
In referring to the problem of tuberculosis, diminished though it is, thank God, my hon. Friend the Member for Gower said that there was no room for complacency. He referred to the Report of the Welsh Regional Hospital Board where the chief consultant in tuberculosis to the Board said that even though the mortality rate in tuberculosis was decreasing, nevertheless the incidence of tuberculosis amongst the Welsh people was not decreasing correspondingly, and that there were some people who were still reluctant to receive the treatment which has proved so wonderfully beneficial to thousands of our people. The 322 professor who wrote this admirable chapter in the Report—Professor Frederick Heaf—says that he is still far from satisfied with chest conditions in Wales generally. In conclusion, he says:It is for this reason, during this period of transition that I suggest that the whole position should be considered by a specially appointed committee of chest and general physicians who should be able to guide the Board to provide the services that are required.In the non-tubercular disease, such as carcinoma of the lungs, the figures for Wales are alarmingly higher than those for England. Although the population of Wales is only 5 or 6 per cent. of that of England, statistics from the Ministry of National Insurance show that more than 10 per cent. of those who claim sickness benefit on the ground of bronchitis come from Wales. I am very perturbed at the mortality figure for carcinoma of the lungs, or lung cancer. The figure for Swansea is 32 per cent. higher than the national average; for Cardiff it is 26 per cent. higher, and for Newport it is 17 per cent. higher. As my hon. Friend the Member for Bedwellty (Mr. Finch) has informed us on many occasions, the figure for silicosis—another dread disease in Wales—is out of all proportion to the population percentage. No fewer than 36 per cent. of those who die from silicosis in England and Wales come from Wales.
In Wales the proportion of notifications of tuberculosis per 100,000 of the population is 70.2, whereas in England it is 57.6. Deaths from tuberculosis per 100,000 of population in Wales number 11.6, while in England they number 8.7. I regret to say that the figures for Scotland are even worse. A proper examination of this position should be conducted in view of the disparity in these sets of figures.
I now turn to the question of the dental condition of the people of Wales, which is very much worse than it is in England, although I agree that there are two regions in England which have a poorer pro rata representation of dentists to population than Wales has. For some inexplicable reason the Midland Region and the North Midland Region have the worst proportions. with one dentist for every 5,900 people. But in Wales, according to the most recent Ministry of Health Report, which came out last 323 week, the proportion is as low as one dentist for every 5,500 people. So we are still very near the bottom of the list, and we are very concerned at the situation.
I should have to use some pretty strong words to describe the school dentist situation. If my two grammar school children had depended upon the frequency of the visits of the school dentist they would not have anything like such lovely teeth as their father has. We feel compelled to send them to a dentist who is not employed by the school dental health service. He is a very fine dentist in every sense, and we are proud to send our children to him. This is a parlous situation and it apparently arises because we have no dental school in Wales, as my hon. Friend the Member for Pontypool (Mr. Abse) said, in his grippingly dramatic speech.
We look forward to the future with eagerness, knowing that when the new university hospital medical teaching school is set up it will have affiliated to it a dental school and hospital. Lot us hope that when that great day comes and we have this new teaching hospital we shall see, in time, a corresponding improvement in the health of the teeth of our children and of all the people in Wales. Very little conservation work is done on the teeth of our people. We are at the very bottom of the list in this respect. I quote from Table F of the latest Report of the Ministry of Health, which gives the figures for 1959. We are at the bottom of the list in relation to the number of permanent teeth filled to every one extracted, but at the top of the list in regard to the percentage of cases which include the provision of both upper and lower dentures. I do not want to see a nation of people with false teeth. I want to see people with their own teeth when they are well into their old age. Wales has a higher percentage of people with artificial teeth than any other region in England.
There is no room for complacency here. The hon. Member for Swansea, West referred to the fact that we are better off than England in respect of general practitioners who have lists of over 3,000 patients. I suggest that it is a shockingly bad thing wherever it occurs. We are not so bad in this respect. In Wales the figure is 16 per 324 cent., while in England it is 28 per cent. But the figure for Monmouthshire and Newport is 24 per cent., and that area has longer waiting lists than any other part of the Principality. That explains why we are to build a completely new general hospital in Neirlle Hall, Abergavenny, and why we are contemplating the building of a new hospital to replace, phase by phase, the existing Royal Gwent Hospital at Newport. The shortage of beds in Monmouthshire and Newport is more acute than anywhere else in the Principality.
We were all very glad last week to hear the Minister of Health say:It is not expected that the hospital capital programme already announced for next year in England and Wales will be affected."—[OFFICIAL REPORT, 11th July, 1960; Vol. 626, c. 972.]His reference was to the other Government cuts.
That was very good news, because we believe that we have a terrific backlog to make up in Wales. We have a lot of work to do there to make up for the deficiencies of the past. I certainly rejoice in the tremendous developments at Glangwili, Carmarthen and Singleton, Swansea. Bangor has had a very big scheme, while a completely new mental deficiency hospital is being built at Llanfrechfa Grange, Cwmbran. One is glad to be able to refer to things like that. They all reveal that we are on the high road of progress and moving in the right direction, and that, in the future, we can expect to have some wonderful hospitals in the Principality, as in other parts of the United Kingdom.
I should like to make one appeal here. I cannot claim to speak about architecture—I know nothing about architectural susceptibilities—but when I have visited modern hospitals on the Continent and in other parts of the world I have found that the trend is now towards smaller wards—three-bed wards. For goodness' sake, in these new hospitals, let us not have these fantastically large wards with about thirty or forty patients.
At any given time, in surgical wards as big at that, someone is about to die, and as one who has been in that type of surgical ward I can say quite sincerely that it has a very deleterious influence on the general atmosphere. Let us have 325 smaller wards. For one thing, in a smaller ward there is much less noise, and noise, I insist, is one of the curses of modern civilisation and must not be tolerated in any modern hospital.
I am fortified in that statement by the recommendations of a sub-committee of the Central Health Services Council, whose Report has just appeared. The sub-committee was set up by the Minister to consider the whole programme of inpatients, day and night, with a view to obviating early awakening and unnecessary noise. For years we have heard about this utterly pointless awakening of poor people—for whom sleep is surely priority No. 1—at 5.30 in the morning, or even earlier; twisting the whole day contrariwise, and making it impossible for people, who for years have been awakened at reasonable times, to fall into a natural routine of living.
I ask the Parliamentary Secretary to see her Minister about this. Do not let us have this matter pigeon-holed again. This is a serious recommendation by the people who are advising the Minister and the Ministry on a very serious matter. Anybody who has been to a hospital will know that' it is almost callously cruel to awaken people at this very early hour for, seemingly, no good purpose at all.
I do not apologise for referring to noise, because so many patients have told me how they have been disturbed by unnecessary noise in the wards. When people are very ill and in hospital, they are completely dependent on others. They cannot speak for themselves. I have known people who could stand up for their rights as well as the next man, but, in hospital, they are completely dependent on those who are looking after their welfare, and dare not say anything lest the nurse or the sister should take revenge on them for being nosey parkers.
Many of these people have told me, "You know, Mr. Williams, that wireless is driving me crazy." It is a fact that very often in a general surgical ward the ambulant patients, who may have suffered injuries hut whose general health is all right, switch the blaring loudspeaker full on. Let hon. Members think of the effect of that on a poor fellow who has cancer, or on one who has had some very serious abdominal operation. I can assure the Minister that this is a recommendation that he should take up very seriously.
326 I want now to refer to nursing and to medical staffing problems. It seems that there is no difficulty at all with the general hospitals, but that there is still difficulty with regard to tuberculosis sanatoria and mental hospitals. In theory, the nurses have what is called a 44-hour week, but I have taken up with the Minister cases of nurses who have complained to me that they have had to work for much longer than that.
That is no incentive of recruiting. These girls tell their friends how much longer than the fixed statutory limit they have to work in hospitals. The Parliamentary Secretary, being a lady, should look into this question of the hours these nurses have to work—and I am certain that there is no overtime payment made to them for working more than the 44-hour statutory period.
One of my hon. Friends has referred to the fact that the number of patients attending out-patient departments is less now than it was a year ago but that the number of attendances is higher. I have had fairly considerable experience of out-patient departments, and I should like to know whether the waiting period is less now than it was because, in all conscience, some years ago it was a pretty grim prospect. One almost had to take sandwiches with one, and nothing is more heartbreaking than to sit there in an insalubrious environment seeing everyone else, like oneself, as miserable as sin and waiting for hours and hours.
My hon. Friend the Member for Pontypridd put his finger on one possible explanation of this fantastic waiting period in the out-patient departments, when he suggested that it was the result of tardiness and dilatoriness on the part of some consultants, who often do not turn up at the right time and sometimes do not turn up at all.
A further matter was brought to my notice only this week, when I was travelling down the valley to Newport. A gentleman told me that he had been going down to the Royal Gwent Hospital, Newport, for many months, and was likely to have to continue to do so for months ahead. He told me that he had to go down there four times a week and that, at a moderate estimate, he had to pay 11s. or 12s. a week on bus fares. He told me that he was not 327 in receipt of National Assistance benefit, and that this expense was a terrific drain on what now is a very meagre pittance, a matter of £4 or £5 Industrial Injuries benefit. To take away that amount in expenses from such a person for treatment is a serious deprivation and an act of injustice. I appeal to the Minister to see whether something can be done in these hard cases.
I wish to make cursory reference to what I thought the most dramatic moment in the whole debate when my hon. Friend the Member for Pontypool referred to the frightening disparity in the figures of maternity deaths and perinatal deaths in Wales compared with England. I put my position very simply. I am not one who would expect Wales to be better treated than any other part of the United Kingdom, but until I am given a satisfactory explanation why Wales so continuously lags behind England in this respect, I shall join with my hon. Friend in agitating for a change in affairs.
The figures for 1954, 1955, 1956, 1957 and 1958 show that the disparity does not change one iota. We are not happy about this because, as my hon. Friend said, in a sense these are lives which have been taken from our community. There may be explanations which are beyond my comprehension. I do not know exactly what the Welsh Regional Hospital Board meant when it referred to the perinatal mortality and saidthe most important factors are not principally medical, but may be rather educational…Where in thunder does "educational" come in?and socio-economic.The Ministry should give us some illumination on this worrying problem. There is no sense whatever in having this continuous disparity.
I now come to an aspect of the Health Service which one is almost tempted to put higher than any other. We are living in a cockeyed world, a tortured civilisation, and the inevitable repercussions are to be seen in mental disorder. I speak with the utmost sincerity when I say that the line between those who have received treatment for mental disorder `nd those of us who have not is a very thin line. A little extra push of 328 adverse circumstances and we would be where they are. There is no stigma attached to it now, no approbium. In all our references we should regard mental disorder exactly as we regard physical illness.
I was proud to be the only Welshman who served on the Standing Committee which considered the Mental Health Bill and I join with my hon. Friends in saying that it is a great Act of Parliament. Nothing more progressive and forward-looking, nothing more creative has gone through this House than the Mental Health Act, but one question mark is still unresolved. It may be that I am a suspicious kind of person, but thought that the reply of the Parliamentary Secretary to my hon. Friend the Member for Pontypridd half-hearted. Will the Minister answer much more positively and affirmatively? He is in charge of local government. Will he tell us that local health authorities in Britain will be able to carry out the wonderful provisions of the Mental Health Act?
Will the block grant impede the fulfilment of what local authorities can do to change the whole orientation from institutional care with all the institutional neurosis which very often is part of institutional care? Will he help local authorities in after-care and after-treatment? I gave an address on the Mental Health Act in one of the wards of my constituency the other day. I spoke for about an hour on this great theme and at the end of my address someone said, "Yes, it is a wonderful piece of legislation, but how is it going to be carried out?" We are very concerned about that.
I wish to end my speech by talking about the problem of aged people. I cannot think of anything more important in the present context of Wales than the condition of our old people. God knows that financially they are having a desperate time. This is outside the scope of this debate so I cannot speak on it at length, but there are some very worrying figures about the condition of old people. There are one million people in Britain living completely alone and the number is increasing at a tremendous rate from year to year. In the twenty years before 1951 there was a rise of 450,000 people living alone. It is a frightening problem.
I read an article the other day in the Observer by Dr. Marcus Abrahams, who 329 quoted from a report of the World Health Organisation. It showed that the group in which the highest suicide rate is to be found in Great Britain is that formed by men over 70. We could be absolutely sure that a large percentage of them have been living alone. The young are well looked after because, whatever happens to a youngster, there is either a parent or a school to care for him, but these people suffer and no one knows anything about it until, in desperation, some of them commit suicide. The problem of the aged in Great Britain is very serious, because we are an aging population.
I believe that some wonderful things are being done. Local authorities have a fine record in the provision of residential homes. I have been to some of them and found a lovely atmosphere there. I agree with the Parliamentary Secretary that the smaller the residential home, the better it is. We do not want a huge home which is something like the old workhouse, but a home which, as mud, as possible, can preserve the atmosphere of the person's own home. That, however, is the last resort. The best thing is to try to help these people in their own homes by health visiting and home visiting.
In that connection I make my final appeal. It is an appeal for more and more co-ordination in the Health Service of Wales and of the United Kingdom, for a better link up between our hospital service, the general practitioner service, local health authorities and ourselves. As people who live in these communities, we should do a sight more than we are doing for our fellow men and women. We should be a bit more neighbourly and sympathetic and prepared to visit people to try to help them.
We must have this liaison between the various branches of the Health Service in Britain. I was disappointed to read about the tardiness of local authorities in operating the provisions made by the Government for a chiropody service. Only four local authorities in Wales are operating a scheme to help old people who suffer from what is a crippling, frustrating and circumscribing ailment. I was terribly disappointed that in the Principality only four local authorities are operating a scheme to help these people in their troubles.
330 I have tried to cover the ground as well as I could. It has been a very interesting debate. If I close on one note it will be a final appeal for better liaison and co-ordination between the different branches of the Health Service.
§ 7.41 p.m.
§ The Minister for Housing and Local Government and Minister for Welsh Affairs (Mr. Henry Brooke)
I hope that the hon. Member for Abertillery (The Rev. Ll. Williams) will allow me to take this, my first, opportunity of expressing my sympathy in the House with him over the recent colliery disaster in his constituency, and to say that though an event like that passes out of the newspapers after a time none of us here is likely to forget the sorrow which it leaves behind it among his people.
We are very glad indeed that it fell to the hon. Member to wind up the debate today. None of us has had far from our minds, during its interesting course, the figure of Mr. Aneurin Bevan. I was not able to be at the memorial service on the mountainside the other day—my noble Friend Lord Brecon represented the Government there—but I saw a photograph of it in the Western Mail, and it was a vivid reminder of Mr. Bevan's link with the mining valleys and their pit heaps, the background from which he and many other great Welshmen came.
Aneurin Bevan never forgot the environment in which he grew up as a boy. He came to perform great services for the Heath Service, which we have been discussing this evening. There were those who agreed with him and those who disagreed with him, but this debate would be taking a very different course if the National Health Service had not come into operation in this form in 1948.
No doubt history will judge whether Parliament made a good decision in this epoch-making Session by setting up the Welsh Grand Committee. It has enabled us to have four separate debates on particular aspects of Welsh affairs. In a sense, I missed the old "Welsh day", when we ranged so widely and the Minister had to claim three-quarters of an hour to wind up the debate. It may even be that 'by this system we are leaving out for twelve months an aspect and set of problems to which Parliament 331 ought to have been giving attention. Nevertheless, I feel quite certain that the experiment has been worth making. We shall all have to decide, a year hence, whether we wish to go back to the old habit of having a free-for-all discussion on "Welsh day" in the Chamber, or whether it is desirable to identify "Welsh day" with one particular chapter in the Annual Report and all that is linked with it.
At any rate, by common consent, we have had an extremely interesting debate. We have ranged widely. The House will not expect me to answer every point which has been raised, but all these points will be noted by the Welsh Board of Health. The Board has been the subject, in 1959, of further devolution of administrative responsibilities from London to Cardiff, and I am sure that that is right. It is in line with the policy which the Government are pursuing and by which, last year, the functions relating to welfare foods and port health administration were transferred from London to the Welsh Board of Health. The Welsh Hospital Board has further developed. There are more women members on that Board, which I am sure is a good thing, and there is a better geographical distribution of the membership.
The matter which has been to the fore in this debate has been the infant mortality rate in Wales. Hon. Members on both sides of the House have referred to that, and rightly so. It is still above the rate in England. It has fallen from 70 per 1,000 thirty years ago, and 39 per 1,000 at the time when the National Health Service was introduced, to 26 per 1,000 last year, a considerable fall, but still too high.
Even if the hon. Member for Pontypool (Mr. Abse) doubts it, I am convinced that there must be truth in the view that it is in part because the women in Wales who are now aged 21 to 35 were born in the period when unemployment was far too heavy and poverty too prevalent in the mining towns, where so large a part of the Welsh population was concentrated. My noble Friend Lord Brecon and I have been working to get the whole of the Principality on to a sound economic basis, with no pockets of worklessness, even in Anglesey or Caernarvonshire soon, I hope, and with 332 a wider diversity of industries as a protection against the knock-out of a whole community in the event of a slump in one industry.
The first outward evidence of that improved economic health can be seen in the unemployment figures, but the Government are building for the future here. If we can achieve a high and steady level of employment generally throughout Wales, we shall be laying the foundations not only of a happier, but of a healthier Wales for years to come, and we shall surely be helping the mind as well as the body, because the fear of the return of unemployment has eaten deeply into the minds of thousands of people in Wales. If we can drive out that mental horror we shall be strengthening the mind as well as the body of the Welsh nation of the future.
Nothing gives me greater pleasure, when I go about Wales, than to see the children, clearly getting plenty of food and in the main with a background of happiness in their homes. The House will see that I am not at all complacent about the infant mortality rate, but the hon. Member for Pontypool suggested that no adequate inquiries were being made. The National Birthday Trust Inquiry, as I think he must realise, covers Wales as well as England; it is a general inquiry and its findings are awaited. When we have the report of the inquiry we shall be in a very much better position to see the whole picture for Wales as well as for England.
The hon. Member also spoke about psychiatry. He said that the medical graduates of Wales were, psychiatrically speaking, illiterate. He made a lot of other somewhat discourteous remarks about the medical world in Wales, which I certainly do not intend to repeat. He must have it out with them. I know that he felt that it was his duty to speak what he thought in the House, but he appeared to me to be washing a certain amount of Welsh dirty medical linen in public. His words are on record. I must leave them to be read. We shall see whether those people in the medical service, in the hospital service, and elsewhere in Wales, will accept that the state of affairs is as unworthy as he suggested that it was.
With regard to psychiatric appointments, the consultant establishment in Wales has been increased from 16 to 26 333 since 1949. Further additions are planned, but the supply of consultant psychiatrists is not easy. I agree with the hon. Gentleman that a chair of psychiatry is needed in the University of Wales. Certainly, my hope is that there will be such a chair before long.
The hon. Gentleman spoke also of the need for more geriatric beds. The present building plans in Wales will very substantially help in that direction over the next few years. Geriatric units are to be provided in the main acute hospitals—in Newport, Cardiff, Bridgend, Swansea, Carmarthen, Pontypridd, Bangor, Aberystwyth and Wrexham. Consultant geriatricians have been appointed at Caernarvon, Merthyr, and Swansea. It is significant that when a post in Cardiff was advertised no applications were received. That shows that it is not altogether easy to add to these appointments. Additional appointments are contemplated in the next year or so in Wrexham, Newport, Pontypridd, Clwyd and Deeside, but the timing of these appointments must depend on the availability of suitable applicants.
The hon. Gentleman spoke of the architecture of the new hospital. As Minister of Housing and Local Government, I find that people's architectural tastes differ. It is not the whole architectural profession or the whole body of people with architectural taste, either in Wales or England, who would necessarily agree with everything that is said in the Architects' Journal. I doubt whether any selected design for this hospital would have given complete satisfaction.
My hon. Friend the Member for Barry (Mr. Gower) in his interesting speech, called attention to the fact that the chapter dealing with this year in the Annual Report is less full and informative than was the same chapter last year. That is absolutely true. Last year, a special chapter was inserted because it was the tenth anniversary of the National Health Service in Wales. I do not know whether I am right, but what I have been seeking to do in the editing of the Annual Report on Welsh affairs is to try to single out one subject after another for a special periodical chapter. I hope that in the last three or four years the Report has become more interesting to read and more informative generally, but, as I have said on previous "Welsh 334 days", I am always happy to receive suggestions from hon. Members on both sides as to ways in which we could increase its value.
My hon. Friend referred to hospital waiting lists. We can proudly say that the percentage reduction in the waiting lists in Wales has been substantially larger than the percentage reduction in England. Again, we are not at the end there. There is a great deal more to be done. My hon. Friend spoke of the shortage of dentists. That is undoubtedly one of the very serious features of the whole situation in Wales. That is why it is so extremely important that we should make rapid progress with the new dental school and hospital. I know that it is the intention of my right hon. and learned Friend to see that that is done.
The position with dentists contrasts so markedly with the position with doctors. In 1949, there were 1,021 general practitioners in Wales. In 1959, there were 1,293. It is that fact which has brought the average doctor's list down over that period from 2,464 to 2,011. All that movement is in the right direction, but I do not deny for one moment that the dental situation in Wales is very unsatisfactory and needs to be rectified.
Reference was made by several hon. Gentlemen to the need for further consultant appointments. I do not demur to that, but I must point out that there has been a 50 per cent. increase in the number of consultant appointments in the last 10 years. I am advised that the figure in 1949 was 242. The figure in 1959 was 368. In that time, alongside the dramatic reduction in tuberculosis and the waiting list for tuberculosis beds, there has been an increase of 45 per cent. in the total number of in-patients treated in hospitals in Wales and Monmouthshire.
I do not mention these facts to suggest that everything is well and that there is no more to be done. I do so because it is desirable to get all this in perspective. During the course of a debate whose proceedings will be widely read in Wales, hon. Gentlemen on both sides, naturally, draw attention to individual facets where they think that there is a shortcoming. That is what our debates are for. It is important, also, that those of us who have to look at the whole picture should set the various shortcomings against the 335 general pattern of progress which has been made so that we keep all of it in perspective.
§ Mr. A. Pearson
Does the right hon. Gentleman intend to say something about the missed sessions of consultants?
§ Mr. Brooke
I very much doubt whether I am qualified to say anything on that subject. I will certainly bring it to the attention of my right hon. and learned Friend the Minister of Health. My hon. Friend the Parliamentary Secretary to the Ministry of Health has heard it. The Minister for Welsh Affairs has many duties and interests, but this is not a matter which has ever been drawn to his attention before. I certainly will consider further what the hon. Member for Pontypridd (Mr. A. Pearson) said in his very interesting speech on that and other subjects.
The hon. Member for Gower (Mr. I. Davies) asked why the mass radiography unit had been closed. My hon. Friend the Member for Swansea, West (Mr. Rees), in a speech which was very rightly described as a thoughtful one, gave the answer, or, at any rate, part of the answer, This unit was the responsibility of the Hospital Board, but located in a health authority building. It has been the general policy to try to place these units so that they are fully employed and also to place them in situations where the most effective use in detecting disease can be obtained. I quite agree that the new hospital is not quite so central, but I am not sure how many people, when they are walking casually along the street, go in and have themselves photographed. I think that it happens much more naturally when they are sent by the doctor, or when they are attending as an out-patient at a hospital.
In this hospital the unit will be receiving patients sent along by general practitioners. In addition, an acute hospital such as this is will offer the facilities to the large number of out-patients who will come to the hospital. Then the hospital will be able to carry out more work with the same staff, which it is well equipped to do. Experience will show that there is not a falling off in attendances and that more use can be made of the unit. At any rate, I would appeal to everyone to give the new scheme a chance.
§ Mr. I. Davies
The right hon. Gentleman said that he was not sure of the number of people who volunteer. I quoted figures of 4,000 to 5,000 people who had volunteered. My criticism is also confirmed by the Welsh Regional Hospital Board itself.
§ Mr. Brooke
All that I am saying to the hon. Gentleman is that we should now give the new scheme a chance. If what I have said or my hon. Friend has said is wrong, I should be the first to admit it, because I seek to be frank on these matters.
My hon. Friend the Member for Cardiff, North (Mr. Box) said that clean food was more important than clean beaches. Clean beaches are important, but all the evidence I have on these environmental health matters is that one will safeguard one's own fitness much more by taking care about the food one eats than by taking care where one bathes. We had a debate about this not long ago and I did not deny that there was health risk in bathing on polluted beaches. I can think of some beaches in South Wales where I hope that a new sewerage treatment works will make a great difference. The risk of disease is much greater from polluted or diseased food than it is from bathing in the sea anywhere I know around those coasts.
The hon. Member for Brecon and Radnor (Mr. Watkins) referred to Strontium 90. I would express the hope that the fears that have spread in Wales about Strontium 90 should now be stilled. Experts have published a great deal of factual material about this. It is known that deposits of Strontium 90 are falling and that the amount of Strontium 90 in milk is falling. I believe that it will do only harm to Wales and Welsh farmers, and do no good to anyone, if continued fears about Strontium 90 in Wales are expressed.
The hon. Member was another who complained that the chapter in the Report was not full enough and did not deal with the work of the executive councils and the like. I say again that we have to be selective in the Report, otherwise it would swell to gargantuan proportions. If there have been omissions this year, we will try to make up for them another year.
337 The hon. Member for Swansea, West also suggested uniting the rehabilitation services. These services, if I remember rightly, were further referred to by the hon. Member for Abertillery. These are wide questions. They go far beyond the confines of Wales. They are very different services. Some of them are industrial, some medical, some educational and social in their general form. I cannot say more than that I have taken note of what was said today and I entirely agree about their importance.
The hon. Member for Abertillery was fearful lest very large hospital wards were to be constructed in the new hospitals That is not so. Even where the wards are large they will be divided up into sections so that people will no longer have the experience, which I have had, of being ill in a very large ward where some other people may be dying. Quite frankly, unless I were very seriously ill I would much rather be in a large ward for the interest of it than in a small ward where, I think, life can be extremely dull. I assure the hon. Member that these matters are not overlooked in the planning of the new hospitals.
The hon. Member referred to the maternity mortality rate. I do not know whether it was by a slip of the tongue. The maternity mortality rate is comparable with that in England. There is little difference between the two. It is in the infant mortality rate that there is still a large discrepancy. He also asked whether local authorities would be able to carry out their duties under the Mental Health Act. Frankly, it is up to them. I put my faith in the Welsh local authorities. They have been producing their schemes. The schemes, so far as one has seen them up to date, look good and there is no reason at all why we should not look forward with confidence to speedy development of the mental health service in Wales.
If I may sound a critical note for a moment, it sometimes troubles me that six out of the 17 local welfare authorities in Wales have not yet taken power to provide welfare services for the deaf and dumb, and five of the local authorities have not taken similar power to provide services for cripples, epileptics and spastics. The Welsh Hospital Board is 338 endeavouring to encourage action on these lines and I hope that hon. Members who have constituencies concerned may be able to stimulate the local authorities to take action.
§ The Rev. LI. Williams
The right hon. Gentleman said that my figure was not correct. I am quoting from the Welsh Hospital Board's Report. It states:In Wales the number of deaths under one year the perinatal mortality rate and the maternity mortality rate is appreciably higher than the rate for England and Wales.My figures are quite correct.
§ Mr. Brooke
I am quoting figures provided for me by the Welsh Board of Health, which show that the maternity mortality rate in Wales has been barely different at all from the rate in England. I will look into the matter, and if I am wrong I will certainly let the hon. Gentleman know.
I apologise to hon. Members if they have raised points which I have missed. I have endeavoured, as I hope the House will agree, to make an honourable effort to pick up most of the questions raised in the debate. I should like to go back for a moment to the improvement in the tuberculosis figures. We owe that partly to research, partly to the work of the surgeons, and partly to the general advance in the standard of living. It is a tremendous improvement when one thinks back to the tuberculosis scourge in Wales not so very long ago. What we should do is to express gratitude in all directions for the courses and factors which have transformed the situation.
I have spoken today with a sense of deep responsibility about the health services in Wales. I recognise as clearly as anybody how much more there is to be done, but I ask all hon. Members, when they express criticism as to particular defects and shortcomings, not to do so in terms which may be distressing to those who are at work in the National Health Service throughout Wales, whether in the domiciliary health service the general practitioner service or the hospital service.
There is a great deal to be proud of in Wales. The Principality has not only produced brilliant doctors, physicians and surgeons. It has also shown a remarkable advance over the years in the general provision of health services for the people. Let us be proud of that. 339 Let us keep that in our minds and be tireless, one and all, in seeking to make what is already good better still.
§ Question put and agreed to.
That this House takes note of the Report on Developments and Government Action in Wales and Monmouthshire for 1959 (Command Paper No. 961).