HC Deb 04 March 1960 vol 618 cc1671-82

Motion made, and Question proposed, That this House do new adjourn.—[Mr. Chichester-Clark.]

4.14 p.m.

Mr. John Rankin (Glasgow, Govan)

I beg to draw the attention of the House to the urgent need of investigating the cause of migraine, and to provide a specific therapy. Over a number of years much has been said and written about this illness, and I have listened to, and read, many human stories associated with its misery.

Here I have one from a lady in Warwickshire. Mr. Eamonn Andrews looking at her, having read her story, might well attach to it that famous designation. "This is your Life". At the going down of the sun and in the morning, from the age of 30 until her present age of 60 she has been attacked by migraine.

In the midst of the simple joys of family life, on picnics, at Dudley Zoo, and on visits to relatives, she has been suddenly prostrated and left a sick, shivering, shaky human bundle, suffering a headache which the chief of a great hospital in the West End of London has described to me as more violent than that which precedes a cerebral hœmorrhage. Yet more dreadful than her own suffering is the knowledge that her children may grow up to relive the agony through which she has passed.

But, said the Minister of Health on 22nd July, 1954, to those afflicted in this or similar ways, "Cheer up; there is a good deal of work going on, mostly under the Medical Research Council". The reply of the present occupant of that high office to me on 8th February last was: … a good deal of research is in progress with a view to throwing light on the cause and treatment of the various forms of headache …".—[OFFICIAL REPORT, 8th February. 1960; Vol. 617. c. 21.] For six years, and long before that time, the good work, so we are informed, has been proceeding, yet nothing appears to be happening.

Therefore, I would tell the Parliamentary Secretary to the Ministry of Health, clearly and without ambiguity, first, that insufficient steps are being taken to disseminate the results of this research to doctors and hospitals within the National Health Service. I tell her, also, that there are general practitioners who know nothing about it; and hospitals which are in the same state of ignorance.

I say, further, that before the busy doctor in general practice can apply treatment to any particular case he must have a diagnosis and a directive which require the help of the hospital consultant. Then the therapy may be applied. In Scotland, particularly, this liaison between the hospital and the general practitioner is terribly lacking. Despite the knowledge and comfort of a separate Health Act, the Secretary of State for Scotland waits meekly on the doormat of his English colleague to hear what he proposes, rather than exercise the independence which we in Scotland are supposed to possess in such abundant measure.

Will the hon. Lady tell me exactly what assessment is being made of treatment results? The only specialist I know of in the whole of the United Kingdom who is attempting any work of this nature is Dr. Hay, of Birmingham Eye Hospital. If research of the nature suggested by the Minister is proceeding, it must be costing somebody something. Will the hon. Lady therefore tell us what sum is being spent by her Department in furthering research into the cause of migraine? It would be sidestepping the problem to answer that this expenditure and work are bound up with general neurological research. Migraine is a specific illness, exhibiting certain common significant symptoms. In my view, and in the view of all those who have advised me, it requires a specific research unit.

I have been told that when useful results are known they will he disseminated in the normal way through medical journals. But useful results are known. They have been disseminated in the usual ways. They are known at the Migraine Clinic, at Putney. From there they have been disseminated. They can be applied at hospitals and by general practitioners, so says the Minister in charge of the National Health Service. While they can he applied in all these places, they cannot he applied at Putney, the place from which they have sprung. Yet people are being cured at Putney by private benevolence. Not by public munificence.

Mr. Norman Punt, a Harley Street specialist and consultant on the staff of several London hospitals; Dr. Mons, another Harley Street specialist and consultant at St. Marylebone Hospital, the Portman Clinic and the German Hospital; Dr. Sweetnam, at Stoke-on-Trent—all confirm the successful nature of the work at Putney Clinic. In addition, a growing band of general practitioners, as they learn of Putney and its successful treatment of chronic cases—the type which, for the most part, come to Putney—seek to apply its methods.

Yet the right hon. and learned Gentleman says to this specialist clinic, "Thou shalt not enter the magic circle of the National Health Service". I ask, why? If the Minister thinks that something is wrong or lacking at Putney, will he institute forthwith an inquiry into the work being done there? It must he noted that the particular therapy carried out by Dr. Leyton at this hospital has never yet been carried out by a research team to assay its particular value in practice. Until that is done, however, we have no way of officially disputing either what Dr. Leyton claims for Putney, or crediting to him what he says is being done. I hope that the hon. Lady will make it clear to her right hon. and learned Friend that until this step is taken he is falling short of his duty.

If the right hon. and learned Gentleman decides to institute an inquiry, and if as a result he finds no fault with its outcome, will he then tell us that he proposes to incorporate the Putney Clinic within the National Health Service? If he does so, he may encourage the Secretary of State for Scotland to take a similar course for my own country. Can the hon. Lady tell us, further, that the Minister will do his best to promote the specific treatment of migraine at consultant level in all National Health Service hospitals?

Lastly, will the Minister encourage university courses in migraine, in the medical schools, so that doctors will enter general practice with a greater knowledge of its history, cause and treatment than they presently possess?

4.25 p.m.

Mr. Reader Harris (Heston and Isleworth)

I support everything the hon. Member for Glasgow, Govan (Mr. Rankin) has said. He has put it very clearly indeed.

I have previously spoken in debates on migraine and asked Questions on the subject, and the more answers to which I listen from the Minister, both in debates and to Questions, the more mystified I become on the subject. I am a poor, simple, honest lawyer, and in medical affairs I am a complete layman, but it seems to me, as a layman, an extraordinary state of affairs that hospitals—and teaching hospitals at that—will wash their hands of a patient and say, "We cannot do anything for you. Go to the Putney Migraine Clinic and see whether they can do something for you there." The hon. Member referred to the Putney Migraine Clinic as private benevolence. That is right. There is no Government subsidy towards its running costs. It has an honorary consultant. Dr. Neville Leyton, of Harley Street.

Every time the matter of the treatment given at the Putney Migraine Clinic has been raised, the Minister has said, "Dr. Leyton has published his work and it is up to any doctor to give that treatment to his patients if they so require." That does not seem to me to be quite the answer. Surely, there are textbooks on how to remove an appendix, but one does not expect a general practitioner to remove somebody's appendix, for it is a job for a specialist.

I should have thought that the right and proper thing to do was to get some clinics going under the aegis of the National Health Service where specialist treatment could be given, either Dr. Leyton's treatment or somebody else's specialist treatment which might come to light as a result of the investigation which has been asked for. Incidentally, it is a request which I heartily endorse.

I do not know whether it is professional jealousy which is preventing the matter from being looked into or not. I hope there is no professional jealousy which is preventing progress. I sincerely hope that the Minister will try to look at the matter more sympathetically. Incidentally, I believe that the Putney Migraine Clinic is housed in premises owned by the National Health Service. Although a room is given to the clinic, apparently the National Health Service washes its hands of what goes on inside the room.

Could we not extend the business a little further? Let us have the inquiry first, and then let us set up some specialist clinics to give, specialist treatment on the lines of that given at the Putney Migraine Clinic. We should then be making real progress in bringing relief to some sufferers.

4.28 p.m.

The Parliamentary 3ecretary to the Ministry of Health (Miss Edith Pitt)

The hon. Member for Glasgow, Govan (Mr. Rankin)—

Mr. Rankin

On a point of order, Mr. Speaker. I wonder whether the hon. Lady realises that we shall be going on a little later this afternoon than usual?

Miss Pitt

Yes, Sir. I carefully inquired about the time before the Adjournment debate started. We shall finish at a quarter to five, so that if I am to take the time which it is usual for the Minister to take I must rise now. Otherwise, I shall have to curtail the reply which I wish to make.

4.29 p.m.

Dr. Edith Summerskill (Warrington)

May I ask whether the hon. Lady must have sixteen minutes in which to reply? Is it possible for me to have two minutes?

Miss Pitt

The right hon. Lady may have her two minutes.

Dr. Summerskill

My hon. Friend the Member for Glasgow, Govan (Mr. Rankin) was right to ask for this Adjournment debate, because the last answer the Minister made on this subject in the House seemed to me to be a curious understatement. He told my hon. Friend that migraine was, after all, a severe headache. That must rouse the ire of any hon. Member interested in this complaint. It happens that today, as I walked through the Lobby to the Chamber, I was told of two hon. Members who are sufferers from this complaint.

To say that it is a severe headache is a gross understatement. In fact, this complaint is a paroxysmal nervous disturbance, and the most constant feature is a headache. But, when it is fully developed, this condition is most disabling. It is associated with nausea and vomiting, and it can last from childhood to past middle-age. I am not asking the Parliamentary Secretary to promote the interests of any organisation. I am asking her again to discuss the matter with her right hon. Friend and to consult some of the written authorities, and they will find that it is not definitely declared that this is merely a functional complaint. In fact, it may be due to some refractory disablement. It may be due to all kinds of things. The fact is that the authorities do not know.

If we do not know, my hon. Friends and hon. Members opposite are quite right to ask that they should be reassured that everything is being done to investigate the matter; and not only reassured—perhaps they have been reassured for many years—but told precisely what the authorities, the research doctors and others investigating the matter, have already informed the Minister on this subject. I think we should be told specifically what is the latest information and the sources of that information, and if there is some document which the hon. Lady possesses which there is not time to read now, perhaps she will include it in the OFFICIAL REPORT.

4.32 p.m.

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

First, let me say that this debate enables me to make my first speech in this House in a debate on a subject on which, like many hon. Members, I have a little experience. Almost all of us have, it may be within the family circle, knowledge of someone who suffers from migraine, and are aware not only of the distress caused to the observer but the extreme pain suffered by a person so unfortunate as to be the victim of migraine. It is a distressing condition; sometimes it is temporarily disabling and it is characterised by a headache which is often very severe.

The condition is known to be associated with temporary changes in the cerebral blood vessels, but the cause of the change is unknown. It cannot be said that any treatment consciously aimed at the fundamental cause of the trouble is known at present. The features vary from patient to patient and each case requires individual consideration. Once the general pattern in an individual patient is known, various forms of treatment can be used to relieve it. Since a severe headache is the common feature, research has continued to concentrate on headaches generally in the hope of isolating the migraine part rather than the other way round.

There has been considerable research into the nature of the blood vessels which may be affected, into the sensory pathways concerned with head pains and into the visual disturbances also often characteristic of migraine. I am advised by the Medical Research Council that this is a most promising line of investigation. Clinical aspects of migraine have been extensively studied, and a number of drugs have been tested clinically at such hospitals as the National Hospital for Nervous Diseases at Queen Square, and the King's College Hospital, but none has been found to be significantly better than the currently accepted remedies.

In the previous Adjournment debate, which I have read and re-read, figures were quoted. Hon. Members then said that the estimated figures were between 150,000 and 200,000 people who had to take one to three days off work a week because of migraine. It was also said then, I think by my hon. Friend the Member for Heston and Isleworth (Mr. R. Harris), that there were about 5 million people affected by this complaint. One of the reports issued by the Putney Clinic, which has been referred to today, mentions that 3 per cent. to 4 per cent. of the population are suffering from periodic headache.

I must tell the House that completely reliable statistics on the prevalence of migraine do not exist. Probably the best measurement of prevalence we have is the study published in 1958 by the General Register Office of 106 general practices with 171 doctors covering a population of 382,829. Of these, 2.7 per 1,000 men and 7.6 per 1,000 women—5.3 per 1,000 together—consulted their doctor for migraine. For headache the rates were during the year 4.2, 7.4 and 5.9 per 1,000 respectively. If we add these together we get about 1.1 per cent., which is very different from the 3 per cent. to 4 per cent. already mentioned. This would give a total of less than half a million who consulted their general practitioners for any form of headache and it may be compared with 8.1 per cent. who have consulted their practitioners for the common cold and 6.2 per cent. for bronchitis.

There is no desire, in quoting these figures, to play down the importance of migraine or to understate the size of the problem. Still less have I any intention of overlooking the individual sufferer, for whom, of course, all of us have the greatest sympathy, but since rather larger estimates have been made we should try to get the problem in proportion. Broadly, the Minister is required by the National Health Service Act to provide the physical facilities for hospital treatment and to see that the medical services and services of specialists are available in hospitals. He has a general responsibility for the adequacy of the general medical service. He is not empowered or required to prescribe what treatments doctors should give nor to assess the value of various treatments or advise doctors on their respective merits. He has, moreover, no direct responsibility for general medical education and training, which are matters for the General Medical Council, the universities and the medical profession itself.

It is the Minister's concern that there should be adequate facilities for treating migraine. He is satisfied that there is no shortage of competent practitioners to assess the different forms of treatment for this condition and to decide what methods should be applied in any particular case. The published work of all those closely concerned in this field is available to doctors. If they are satisfied that the results favour a particular course they would undoubtedly follow it. It is not the responsibility of the Minister to persuade them to do so. The Minister has certain general powers to conduct research, and so have hospital authorities, but the Government body primarily responsible for organisation, research and advising on research matters is the Medical Research Council.

Following the Adjournment debate on 4th June, 1959, the Medical Research Council was asked to advise whether any special action was necessary in the light of current developments of research into migraine. It has advised—having consulted a wide field of expert opinion—that on the published evidence regarding the work done it did not feel that it could usefully promote the study of fresh lines of treatment. I think that the House would agree that the Minister would feel bound to accept advice; from this source.

The practitioner referred to by both hon. Members is we [I-known and has published in professional journals accounts of his work. In 1955, he published a book, "Migraine and Periodic Headache—A Modern Approach to Successful Treatment".] I should stress that the Minister offers no, criticism of him or of his work any more than he is prepared to publicise them. Judged by the results that he claims, he is doing good work. The problem is that he does not seem to have persuaded the majority of doctors that what he is doing should be copied by them. The clinic and, it may be fair to say, the practitioner, have been at pains since 1954 to publish the work done there, the nature of the methods and the degree of success claimed, not only in professional journals but in the lay Press.

The clinic has recently issued the "Tenth Annual Report of the Committee of the Clinic, January, 1960". This has been circulated widely amongst Members of Parliament. The Report expresses a direct challenge to the Minister to arrange an inquiry into the clinic, and says that he does not do so because he dare not. That has been repeated today. The suggestion is that there should be a tribunal of inquiry with an independent chairman, a representative of the clinic, and a representative of the Minister or of the Medical Research Council.

It might, indeed, be desirable, from the clinic's point of view, that there should be an independent objective investigation of its work which could be publicised in the normal way, but emphatically it is not the task of the Minister to conduct it, or take part in it, or to publicise the results. I can say to hon. Members that to the best of my knowledge the Ministry of Health his never conducted such an inquiry into claims of this character.

Mr. Marcus Lipton (Brixton)

What is the objection to it?

Miss Pitt

Much of the difficulty and misunderstanding which seems to have arisen and lent colour to the thought that the Minister is opposed to the clinic, or the work it does, which is certainly not the case, arise from the point that the clinic feels that it could or should turn only to the Minister to secure results which it appears that it and its supporters alone desire. A great deal of importance seems to be attached to the promise alleged to have been given by my right hon. Friend, now the Secretary of State for the Colonies, in 1954, that he would undertake the kind of investigation that the clinic has in mind.

What actually happened was that, in reply to a supplementary question from the hon. Member for Sowerby (Mr. Houghton): Is he also aware of the work of the migraine clinic at the Putney Health Centre? Is there anything there that his advisers should study and explain? my right hon. Friend said: I should be very glad to look at the particular experiment to which the hon. Gentleman refers, but there is a good deal of work going on, mostly under the Medical Research Council."—[OFFICIAL REPORT, 22nd July. 1954; Vol. 530, c. 1535.] This comment was not intended to be in any way an undertaking to make any sort if investigation with a view to assessing the claims of the clinic. It was merely the expression of an intention to inform himself of a development to which his attention had been drawn. There has been no change in the situation between then and now. It was not, and it is not, a task for the Minister, and this was stated clearly in the debate in June last year. I must repeat it now.

The hon. Member for Govan mentioned also that treatment is not given by the National Health Service. This rests on the assumption that the only treatment which has validity is that given by the Putney Clinic. He went on to say that general practitioners and hospitals are in ignorance of the treatment which is available. It is certainly not true that there are no treatment facilities for migraine in the National Health Service, whether through the hospital or the family doctor services. As I explained, different treatments affect different patients. The fact that hospitals and general practitioners refer patients to the clinic indicates only that in those cases there has not been success and that the doctors concerned are willing to try the clinic's approach. It would be quite wrong to imply that all other treatments are failures. The point is that treatment is available everywhere so far as the doctors are prepared to give treatment. The hon. Member referred to Scotland. As he is a Scottish Member, I made inquiries and am informed that there is no reason to think that Scotland lags behind what is available in England.

The challenge in the Putney Clinic's report to make an investigation does not concern my right hon. and learned Friend, nor the rather extraordinary suggestion that he dare not make one. The challenge is sent to the wrong address. No doctor is waiting for the Minister to investigate or give guidance before acting on the lines proposed by the clinic. If they are waiting at all, it is for the clinic itself, which, it would seem, does not advance its no doubt admirable cause by knocking on the wrong door.

I have not said everything I wanted to say, but I allowed an intervention. In conclusion, may I say that I am grateful to the hon. Gentleman for raising this subject on the Adjournment. So, I am sure, should be those people who suffer from, or have a relative suffering from, migraine. I repeat to the hon. Gentleman that the practitioners and hospitals in the National Health Service can provide facilities.

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

Adjourned at a quarter to Five o'clock.