§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Sharples.]
§ 10.1 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
I wish to take this opportunity to discuss the question of poliomyelitis vaccination, because I feel keenly about the success of the National Health Service and all its endeavours. I want it to succeed. It is in that constructive spirit that I wish to draw the attention of the Minister to the maladroit way in which his Department dealt with the arrangements for poliomyelitis vaccination in February of this year. I am not criticising the intention or the results. I think all hon. Members would pay tribute to the excellent work done by the medical profession and all who have contributed to the excellent results which have been achieved. I am not criticising what has been done but the way in which it has been done—"It's not what you do, it's the way that you do it."
I submit that this excellent piece of work has been done in the wrong way. At Question Time on 1st February, the Minister, in response to Questions from hon. Members on this side of the House, announced that it was proposed to extend the scheme of poliomyelitis vaccination to all citizens up to the age of 40, and this was generally welcomed. The immediate result was that wide publicity was given to the statement, on television, in radio programmes and in the Press. The impression was left among people in this country that a service had been instituted as from 1st February and would be immediately available.
I realise that I cannot blame the Minister for the power of publicity in this day and age, but nevertheless a statement by him on such an important subject inevitably attracted a large body of public understanding and support, and naturally there were repercussions in the constituencies. We must always realise that the National Health Service is nation-wide. It affects every village and hamlet in the British Isles and an announcement made in London has to be administered in the far corners of the country. In this case it meant that, the decision having been taken and the policy decided, the 1469 arrangements had to be carried out by county medical departments.
May I take as an example what happened in Middlesex and in my own constituency? The position was that the Minister made his announcement on 1st February. The area medical officer of health received his first intimation that it was proposed that there should be an extension by 4th February, but it was not until 24th February that the memorandum was issued by the county medical officer to his local area officers to say that the county council had decided to implement the scheme and that it was quite in order to go ahead.
In the meantime, each area medical officer was inundated by requests from general practitioners. I could name half a dozen in my constituency who are keen on this kind of preventive medicine and who communicated with the local medical officer of health requesting that the service should be extended and that they should be permitted to jab people.
In my area the general public started to worry the general practitioners and also, because in that area we are particularly occupationally health conscious, it meant that the personnel of local factories began to worry the local area officer of health. Telephone calls were received from a number of factories. We have pioneered part of this work, in close contact with the Middlesex Hospital, for the extension of preventive measures in connection with occupational health, and as a result there were many inquiries going to the local area officer.
I submit that, because it was done in this way, there was unnecessary work at local level and unnecessary frustrations and administrative difficulties which ought not to have occurred. My plea is that in all such cases the administrative arrangements to deliver the service should be made prior to the public announcement. That is the burden of my remarks this evening.
Even more important than the harm done in relations with the public is loss of good will between the Ministry and the medical profession. If the first that the local area officer hears about this is over the radio, he naturally feels a little put out. He feels some resentment and says, "No one has told me. Here is a State scheme which I have to operate and I have not been informed about it previously." Were this an isolated case 1470 of Ministry mishandling in its relations with the profession, I think that perhaps a question which I put to the Minister perviously this month might have settled the problem.
Since its inception this particular aspect of the Ministry has been singularly unfortunate. The whole arrangements for polio vaccination have from the outset caused difficulties within the profession.
The British Medical Journal of 28th January, 1956, in a leading article headed "Another Ministry Blunder", said:… we were most unfortunately kept completely ignorant of the details of the Ministry of Health's scheme and so were not in a position to Rive them to our readers.This rather blistering article goes on to say:It is deplorable that the Ministry should fail to give facts of such importance to the medical Press to enable it to report them, with informed comment, to the medical profession at least at the same times as the national papers report them to the public.In the same issue there is a strong letter from a general practitioner in which he says:I wish to protest most strongly at the manner in which news of polio vaccination was given to the medical profession; namely at a Press conference, through the B.BC. and in the morning papers.This was four years ago, at the outset of the experiment. In April of that year, in the British Medical Journal there was another leading article attacking the Ministry on the way it handled the situation. On 20th October, 1956, there was yet another leading article attacking the right hon. Lady, who was at that time Parliamentary Secretary, which was indicative of the bad relations then existing between the medical profession and the Ministry of Health.
I should like briefly to make two other points in connection with polio arrangements. The hon. Lady will know of the frustration which the medical profession has felt during the last two years about the way in which payment is made to the general practitioner. If I understand the Minister's comment on 1st October correctly, doctors have given some 30 million injections of vaccine. It is a remarkable achievement, but in fact payment is all deducted from their pay at the end of the year. It is taken out of the central pool and they do this extra service for no additional payment.
1471 A further unsatisfactory aspect of this matter is that, because of the arrangement, the doctor who sends in the form gets paid, but not necessarily the doctor who makes the jab. I do not wish to pursue this at very great length because the Minister is still investigating a specific case and will give me the answer in due course. It seems that the doctor employed by the local health authority has to give a number of jabs in a number of sessions to people in a factory, and then he finds that the factory doctor, who is already paid for his services elsewhere, is receiving the cash because he sent in the cards for those injections. It is things like this which have led to the slight friction which occurs from time to time between the Ministry and the medical profession.
Although this concerns only one section of the Ministry's activity, it indicates that there is something radically wrong with the way in which the Ministry has been handling professional arrangements. Again, going back four years, it was more the way in which the Ministry handled the doctors' pay claim —the "brush-off" they were given— which led to exasperation than the actual decision on the claim.
I hope that the Parliamentary Secretary will not just reply to the immediate issue raised, but that she will seek to influence her right hon. and learned Friend the Minister to have a complete overhaul of this section of his Department to secure greater coordination between the excellent work done in the Ministry and that done in the medical profession.
This will be vital in the coming months, because we shall be entering a period of closer relations between the profession and the Ministry. I believe that preliminary talks have started which will be of great significance to the National Health Service and for which a sense of great confidence is essential. We must avoid the kind of position made manifest in the British Medical Association's Council meeting in January. I am coming forward four years now. At that meeting, Mr. Lawrence Abel wondered whether it was any good going to the Minister of Health, because he was not in the Cabinet. That is an indication of the 1472 lack of confidence which I think hon. Members on both sides of the House very much want to remove.
As I have said before, the time is ripe for sweeping advances in the National Health Service, not only for dealing with those suffering from very severe illness, but in preventive medicine. I believe the Government's poliomyelitis vaccination programme has made a worthy contribution in this matter, and it is therefore exasperating to find the effort marred by inept relations. I do not want to scratch old sores or reveal vaccination scars on any part of the body politic by going back four years, but I have to put this to the Minister if we are to get some change in the relationship between the Ministry and the profession.
At present, there is more cordial feeling between doctors and the Ministry than there has been for some time. There are the preliminary discussions on the Pilkington Report which, because of that, have got off to a good start. I am well aware of the sensitivity of the profession inside the State medical service and I want the Minister to improve his organisation of public relations to ensure that there is no more disgruntlement but a further phase of solid progress in the nation's health.
§ 10.15 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
The hon. Member for Willesden, West (Mr. Pavitt) began his speech with a generous tribute to the National Health Service, for which I should like to thank him. May I also take this early opportunity to thank him for his kindness in sending me a note of what he proposed to raise tonight so that I might be able to answer him.
Perhaps I should begin by filling in a little of the background to the arrangements for poliomyelitis vaccination, which began in 1956 in this country and under which a system of priorities has been operating. Initially, only some children and certain groups of hospital staff were offered vaccination. Later, in progressive stages, the offer was extended to all children, then to young people up to the age of 26 and, finally, earlier this year, to all persons up to the age of 40. At each stage certain special groups, for example, other Health Service employees who were at special risk and expectant mothers, were included.
1473 These successive extensions have been made on the basis of advice given by the Joint Committee on Poliomyelitis Vaccine under the chairmanship of Lord Cohen of Birkenhead, in the light of the facilities available, including the supply of vaccine, and after consultation with the local health authority associations and the medical profession, upon whose efforts we rely to carry this very extensive programme into operation.
Broadly, the arrangements are these: the Minister is required, under the National Health Service Act, to approve any extension into a new field of a local health authority's arrangements for vaccination or immunisation. As the poliomyelitis vaccination programme has developed, he has from time to time given the necessary authority for its extension to those groups of the population which it has been possible to cover and has supplied the necessary vaccine free of cost to the authorities.
Local health authorities are then responsible for the arrangements for putting into operation the vaccination programme in their localities. The work of inoculation may be done by local authority doctors or by family doctors cooperating in these arrangements. General practitioners come into the picture because, in their arrangements for vaccination and immunisation generally, local-health authorities are required, under the National Health Service Act, to give every family doctor in their areas an opportunity to participate in their programmes.
I think that the House will agree that extensions to the poliomyelitis vaccination programme are of major public interest and importance and should not be regarded as minor administrative adjustments which are only of local concern. The Government certainly feel that the House, which, from the beginning, has shown great interest in the progress and success of this endeavour to give protection against a distressing disease, should be informed directly and as soon as possible of any impending major variations from previous arrangements.
On recent occasions the first announcements of the extensions to the programme have, therefore, been made in answer to Parliamentary Questions. Thanks to the Press, the radio and television services, these answers have received wide publicity and people 1474 affected have thereby received early intimation that they would be able, if they wished, to be vaccinated.
The hon. Member said that he thought that those arrangements had been mishandled, and I should, therefore, like to explain briefly how they have worked. The first announcement that poliomyelitis vaccination would be available for children born in the years 1947-54 and for some hospital staff was made by Press notice at the same time as the circular was sent out to local authorities on 19th January, 1956. Consultations with local health authority associations and the British Medical Association were carried out confidentially in advance of the public announcement so that synchronisation was easy.
The first extension was in May, 1957, when the scheme was extended to children born in the years 1955–56. This step was announced by the Minister in the House on 15th May, the day after a circular was sent to local authorities. Again, consultations with local health authority associations and the British Medical Association had been carried out confidentially in advance of the announcement.
The second extension was in November, 1957, when the scheme was extended to children born in 1943–46, to expectant mothers and certain Health Service employees. Public interest in the programme, combined with apprehension about the supply position, was at such a high pitch that it was thought desirable for an encouraging statement to be made publicly at the earliest possible moment. The Press notice was, therefore, issued on 11th September that this extension would be made "before the summer of 1958." Consultations with local health authority associations and the British Medical Association were then needed before the circulars could be issued on 19th November, 1957, well in advance of the time suggested in the September Press notice.
The third extension to persons born between 1933 and 1942, and to some Health Service employees, and the provision of third doses for those earlier immunised, was forecast in the Minister's Answer to a Parliamentary Question on 21st July, 1958, when he said that he hoped to make a start on this extension 1475 by the autumn. Once again, this statement was made at the earliest possible moment, because public interest in the programme was at a very high pitch. Consultations with local health authority associations and the British Medical Association were then needed, and the circular was issued on 2nd September.
The fourth extension of immunisation for persons up to 40 years of age and certain other small groups was announced in reply to a Parliamentary Question on 1st February this year, as the hon. Gentleman said, and, at the same time, a circular was sent to local health authorities. As public interest was not at such a high pitch, and advance notice of making the extension had been given in the Conservative Party election manifesto, it was again possible for consultations to be carried out confidentially before the public announcement was made, so that the announcement and the circulars could be simultaneous.
In general, and ideally, no public announcement would be made until final preparations for giving vaccination are completed. We have succeeded, save on two occasions in special circumstances which I have already mentioned, in eliminating the interval between public announcement and the issuing of circulars to local health authorities and executive councils by completing consultations with the associations beforehand. The remaining interval between the issue of circulars and a state of readiness in clinics and doctors' surgeries cannot be eliminated, because it is impracticable to release instructions confidentially to 146 local health authorities and thousands of individual doctors. The hon. Gentleman will appreciate that all confidentiality would be lost if that were done.
In the last extension, the Parliamentary Question and Answer and the information given to the Press attracted, as the hon. Gentleman said, a wide volume of interest, and by this means notice of impending extensions of the programme was given to local health authorities and doctors and to those members of the public who became eligible, so that all concerned were, as nearly as possible at the same time, given clear information as to what was intended.
The hon. Gentleman has been critical of this procedure, but I would say, 1476 in reply, that the Government see considerable advantage, from a publicity point of view, in making the first announcement of any changes in this programme a central, national one through Parliament and the Press. Indeed, I think the House might well have been critical had we not followed the usual practice of making the first announcement to Parliament when Parliament is in session, save perhaps if any urgent situation had arisen.
We have, in fact, provided general practitioners with full information, at every stage of the vaccination programme, about the groups to be covered, the vaccine available—Salk or British— and the vaccination procedures to be followed, to enable them to give appropriate advice to their patients. We have consulted the British Medical Association fully about the part which general practitioners can play in the programme, and about our further plans as disclosed from time to time in draft circulars.
I am quite sure that the House, and the hon. Gentleman in particular, will join with me in expressing pleasure at the considerable progress that has been made with poliomyelitis vaccination in this country. This has been made possible only by the hard work of local health authorities and family doctors, and by their very ready co-operation and response to this careful central planning of a national programme.
Perhaps, at this stage, I might refer to the hon. Gentleman's comment on what he calls the fee paid. He said that he did not agree that it should be deducted from the central pool of doctors' remuneration. The history of this goes back to 1949, when it was agreed that the fee for vaccination records—agreed, incidentally, between local health authorities and the British Medical Association—should be 5s. As the hon. Gentleman will appreciate, this was in the days before poliomyelitis vaccine. That was the fee for any kind of vaccination.
Since doctors are paid on an average figure, estimated to cover the net remuneration from all sources, it follows that any net income they receive from other sources—such as hospitals, local health authorities, other Government Departments and private practice—has to be deducted from the central pool. That is the situation at present.
1477 I wish to make one other brief point here. It refers to the hon. Gentleman's comment on factory doctors who may help with this service. We are aware of the one case where he has expressed concern. Inquiries are still being pursued and my right hon. and learned Friend will write to him, as he promised.
I welcome the opportunity the hon. Gentleman has given to me by choosing this subject for the debate, to pay this tribute, which he has already expressed, to those on whom the main burden has fallen. By the end of 1959, about 33 million injections of poliomyelitis vaccine had been made by the doctors of Great Britain. This is a tremendous achievement in such a short time, and those who have given these injections, as well as those who have been responsible administratively for organising the arrangements in the localities, have every reason to be well satisfied with the results of their efforts.
The summer of 1959 was one of the warmest and sunniest of the century. Previous experience has suggested that, in such summers, polio figures tend to go high. That so few cases were recorded during the year therefore 1478 prompts the question of the extent to which anti-polio vaccination could claim the credit for this satisfactory outcome. One hesitates to claim too much credit, but since 1947, when polio first assumed, annually, widespread epidemic proportions in this country, we have had both bad years and relatively good years. But it is noteworthy that 1958, when vaccination against polio was well under way, should have been one of the good years and that 1959, by which year three out of four children under 15 had received at least two doses of vaccine, should have been even better.
I think that this is encouraging and I join with the hon. Gentleman in the very generous tribute he paid to all those who have helped to bring about this measure of progress. I hope that in discussing that part of the system which has caused him concern he feels a little more satisfied that we have done our utmost to maintain good relations and to show our appreciation of the considerable help we have enjoyed from the doctors who operate the practical part of the job.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock.