§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Finlay.]
§ 10.22 p.m.
§ Mr. W. Griffiths (Manchester, Exchange)
The matters to which I wish to refer tonight arose in the following way. During March this year, a series of articles appeared in the Manchester Evening Chronicle and the writers of those articles included a hospital board member, a family doctor, an obstetrician and a casualty specialist. The writers made charges about serious shortcomings in the operation of the National Health Service in Manchester. Tonight, I shall confine myself to only two of the matters aired in the articles, and perhaps the most convenient thing to do would be to quote from the article with which I am particularly concerned.
This was an article written not by a layman but by a Manchester family doctor. He began by saying:Jumping the queue in the waiting list for a hospital bed has become a racket. It pricks my own conscience.He went on to say:How is the jump-the-queue trick done? A patient is sent, quite properly, to a hospital to see a consultant. Eventually an appointment is obtained. The patient needs hospital treatment and goes on the waiting list for a bed. It may be months before that bed becomes available.The same patient goes to the family doctor, who knows what is going to happen and what the delay is likely to be. He's in a cleft stick, so he says: ' If you won't mind paying the fee I'll send you to see a consultant privately'. The doctor sends a note to say that the patient is suffering from a certain complaint, and will the consultant do what he can? Within a week that patient is in a hospital bed—a hospital bed provided by the Health Service.That is the first point.
I apologise for these long quotations, but it is essential to make them to put my case. The second matter concerned the way consultants operate in outpatient clinics. The writer here spoke of sending his patient to see a consultant and he said:I know who the consultants are. I know the value of the work of the particular man I want—call him Mr. Blank. I send my patient to the hospital to see Mr. Blank, because it is Mr. Blank's opinion I want, no one elses's.1630I am sick and tired of getting hospital reports back signed by a hospital registrar per and pro the consultant. It is not the registrar's opinion I want. It is the consultant's. The patient should have the right to get that opinion. That is what the consultant is paid for.When I read this, I appreciated that it was a matter of concern to myself, to any other public representative and to the people of Manchester. What do these charges amount to? First, it seems that there is a short-cut to the hospital ward via a consultant's private room. Secondly, it would seem that for some reason a patient referred to an out-patient department through the consultant's clinic often does not see the consultant to whom he is sent.
I thought that these were serious matters which should be brought to the Minister's attention. I therefore tabled a series of probing Questions and sent the articles to the Minister in March. I want to make it absolutely clear that I am not making a wholesale attack upon consultants, many of whom I know personally to be dedicated and hardworking men and women. I was therefore a little shocked at the Parliamentary Secretary's Answer. When I asked for information about the number of patients admitted to three of the teaching hospitals in Manchester after having had private consultations with the consultants attached to that hospital, the hon. Lady said,I regret that this information could not be made available without a disproportionate amount of work by the hospital authorities." —[OFFICIAL REPORT, 9th May, 1960; Vol. 623, c. 14.]Had I let the matter rest there, that would have been an end of it, but I did not. I said that I thought that that was unsatisfactory, since a little work might do something to remove the smears that lay on the consultants and the expressed dissatisfaction of the patients. The hon. Lady went on to give some reasons why it was difficult to extract the information that I was seeking. However, I hope to indicate how I think that a test could be made to verify the accuracy or otherwise of these charges.
The hon. Lady and the Minister have been extremely kind to me and other hon. Members in the past in obtaining most exhaustive statistics over a wide field. When she refuses to find the 1631 statistical answer to a matter of this kind, it possibly lays her and her Department open to the charge that she has something to conceal by not producing the information, as statistics are so readily available in other spheres.
It is not as though the allegations about queue-jumping were unheard of. Recently the Minister set up an inquiry in Shropshire, which I understand is sitting now, to probe into allegations about queue-jumping or even worse matters in the Shrewsbury area. Therefore, to set up such an inquiry the Minister must have been convinced that prima facie there was a case that should be probed in another part of the country.
As a result of the publicity given to these matters and the articles, I received many disturbing letters from all over the country. I should like to read some extracts. The first is from a general practitioner, who states:The queue-jumping about which you complain in Manchester"—in fact, it was not my complaint but that of a general practitioner—is also prevalent in Sheffield and Rotherham, and a three or five guinea fee paid privately to a specialist would appear to invariably succeed in achieving earlier admission to hospital. The practice is so universal that I would not like my patients to suffer as a result of a lack of co-operation from local consultants through a lone crusade on my part… I should be glad to give evidence at any subsequent inquiry.There has been much publicity of a similar kind. There was a letter a week or two ago, which was signed and gave the address of the sender, among the readers' letters in the Sunday Express. The writer told the story of a friend expecting her second baby who was told by the doctor that there was no chance of her obtaining a National Health Service bed at the local maternity hospital through the normal channels. There was, however, one way round the difficulty. The hospital's senior gynaecologist agreed to accept her as a private patient and assured her that he would have no difficulty in obtaining a bed for her under the National Health Service.
Only yesterday in Manchester, in the presence of two doctors and a leading citizen of the city, I was told by a lady that last week her husband was admitted to a bed in a north Manchester hospital the morning after paying six guineas for a private consultation. He was a sick 1632 man, he certainly needed hospitalisation, but his condition, I am advised, was one which, perhaps, would not have succeeded through the normal channels in getting him into a bed as quickly as happened on this occasion. The lady said that her husband had used similar channels to go into hospital on an earlier occasion for a hernia operation, for which there were long waiting lists at most hospitals, but he paid a private fee and was admitted to hospital. She said, quite simply and straightforwardly, "I thought everybody did it."
I come now to the other matter concerning the difficulty that many people experience in seeing a consultant at the out-patient department, which to many of us seems to be a considerable difficulty and widespread. I do not need letters or stories from other people, because I have a personal experience. Some years ago, I injured my thumb and I went, as many other hon. Members no doubt have done, to the Westminster Hospital. I was X-rayed. I returned and was told by a young houseman that he was happy to tell me that in his opinion there was no fracture, but he thought there was an old arthritic condition around the joint. I am a layman, but I thought it highly improbable that such a condition was present and I said that I would like to see the consultant.
The young man knew that I was a Member of the House. He said to me, " Possibly, you can see him, but you will have to wait a very long time, and you might not see him. But, if you like, I can arrange for you to see him privately." I was astonished, but I said "Can you really?" He said, "Yes." I replied, " All right. Then let us do so." There and then, from the hospital, he telephoned the private consulting rooms in Harley Street and made the appointment and said that he would send the plates along. He did. So the whole resources of the National Health Service in the public sector were placed behind a purely private transaction. The only means of obtaining that private transaction were through the hospital, where that consultant held a highly-paid appointment. That was a personal experience.
People in Manchester may say, as I am sure they have done, "It is true?" Let me refer to one or two letters which 1633 have come to me, so that hon. Members may judge whether it be true. Here is a letter from a lady in Manchester, who was referred to a consultant in May, 1958. She names the consultant and the hospital and she states:At his clinic, I saw a doctor and two months later was admitted (a varicose condition).She certainly did not have long to wait. She continues:Not until after the operation did I discover, as a result of ward gossip, that the doctor whom I had seen at the clinic and once in the ward was not Mr. … but his registrar. Incidentally, I never saw Mr. … at all. Doubtless I could have found that out by asking questions at the beginning, but having seen twice at Manchester Royal Infirmary the consultant to whom I had been referred, it never struck me that the same would not obtain at other Manchester hospitals. At two post-operative clinics I saw the same registrar and (again from clinic gossip) heard that Mr. … never attended his own clinic.Speaking of the last occasion, the lady states:Furthermore, as to times of attendance, the registrar never appeared before 3 p.m., clinic appointments starting at 2 p.m., very much to the annoyance of the outpatients, many of whom, like myself, had urgent domestic ties. After waiting for 1¾ hours, I left without seeing Dr. … (I was due for final discharge anyway) and later wrote complaining of the arrangements to the hospital secretary, from whom I had an apologetic but unhelpful reply.Another letter from Blackley, Manchester, says:It has been my experience four times over the last few years to be referred to various registrars, although my doctor has given me notes to see consultants under the Health Service. Over the years I have not had the slightest difficulty in seeing consultants provided I paid a private fee.Another letter is from a gentleman in Levenshulme, Manchester, and states:Between 1950 and 1957 I paid three visits to Manchester Royal Infirmary, and then I saw D. A. privately at his rooms. He had been suggested to me by my doctor in an effort to explain certain symptoms. He promptly diagnosed a form of sclerosis and obviously since then I have paid many visits to the Infirmary. I have yet to be seen by Dr. A at the Infirmary clinic, though I have seen him on three occasions privately at his rooms almost 'by return of post.'".Another man writes from Cheshire:About two or three years ago my wife was seriously ill, and our own doctor was away but he had a locum working for him. This locum sent my wife to a consultant at Manchester Royal Infirmary, who, I believe, 1634 although I would not be certain, was a Professor X. My wife kept the appointment and said she had to go for another visit in one month's time. The second appointment was kept and, of course, I was anxious to know the findings, but all I could find out was that my wife had to go for a third appointment in another month's time.The letter says that he discovered that she was seeing a young man, who may have been highly qualified and was charming, but who certainly was not the consultant to whom his wife had been sent. He took his wife away and they have not been back since.
All these people speak highly of the kindness and good treatment they have had from people at the hospital. There are very many other instances I could give, but there is not sufficient time. I have a feeling, in any case, that we shall be coming back to this subject in the weeks ahead.
What is the trouble? Have we too few consultants, or do those that we have give preference to private fee-payers in the out-patient departments? I have been told that those selected to be seen by the consultants are often people who have seen the consultants in their rooms, or people to whom they have paid domiciliary visits as a result of recommendations from certain general practitioners. Or is it just that they do not turn up on time at the clinics, as one lady says? Is that the answer? Or is this inherent, as I suspect, in the part-time system? It is really impossible to try to run the economics of private enterprise hand in hand with a public, full-time service.
At the clinics, the patients should at the very least be told who is seeing them and looking at their bodies. Why not have an occasional spot check on selected wards to verify how the people in its beds on that day were admitted? Another suggestion is for a check on simple surgical cases, such as hernia or varicose veins, admitted last year to one single hospital, and to compare the waiting time of those admitted after private consultation with the time that people who went through the normal channels of the out-patient department had to wait.
I leave the matter there. In closing, I would just say once again that in the weeks ahead we shall be returning to this National Health Service question, 1635 certainly as it affects the Manchester region, because there are many other matters which cause great concern and which we think should be brought to the attention of the Minister.
§ 10.40 p.m.
§ Dr. Edith Summerskill (Warrington)
I wish to say only a very few words in support of what my hon. Friend the Member for Manchester, Exchange (Mr. W. Griffiths) has said. I am quite sure that the House is grateful to him for raising this matter. We are all jealous of the reputation of the National Health Service, and only in this way can we ventilate these problems.
I want to raise two points. Rumblings of discontent from registrars have reached me because so many of them feel frustrated because they have not reached consultant status. Indeed, it has been impossible to promote them to that status because there are not sufficient vacancies. They feel that they are called upon too often to deputise for the consultants.
Furthermore, there have been complaints that young men and women who are doing pre-registration jobs in the hospitals have also been asked to do too much of the work which should fall to the registrars. The difficulty is to know how these grievances can be remedied. It seems that these complaints can only come to our ears either through the patients themselves, as my hon. Friend said, or through individuals who are themselves in medical circles.
I should like the Parliamentary Secretary to tell me through what channel these complaints, which are real, can reach the ears of authority.
§ 10.43 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
The hon. Member for Manchester, Exchange (Mr. W. Griffiths) has raised in this debate tonight several matters which I think are of wider interest than the heading which he gave to his Adjournment debate, which was "Manchester Hospitals." I think that they will be of interest to the country as a whole as well as to the citizens of Manchester, and I am glad to have the opportunity of replying to some of the points which have arisen tonight and in earlier Parliamentary Questions.
1636 I will do my best to reply, though I think that the hon. Gentleman will be the first to appreciate that I cannot comment on the individual letters which he has read out since I had no prior knowledge of them.
First, may I say a brief word about Manchester in particular and Manchester's needs? As a centre for medical and dental teaching, as the focus for clinical advice and hospital administration in a region which extends from Windermere in the north to Crewe in the south, and as the centre of a conurbation with a population of over 2 million, Manchester deserves to have the attention to its hospital services which has been given by one of its Members this evening and which, I assure the hon. Gentleman, will continue to be given by the hospital boards, by my right hon. and learned Friend and myself.
The development of the services in Manchester has, of course, to be considered in relation to the needs of other parts of the country and to the amount of money that can be made available for this part of the sector of public investment. My right hon. and learned Friend is therefore anxious to see that the services as they exist are as efficient as possible and that patients referred to Manchester hospitals are given the best possible service. Here I would agree with the right hon. Lady the Member for Warrington (Dr. Summerskill) that we are jealous of the National Health Service in this country. We would wish it to maintain the good name which, in general, I think, it enjoys.
One very important consideration is, of course, the waiting time to which the hon. Gentleman referred, that is, the time that patients have to wait before being admitted to a hospital bed. In Manchester, as in other parts of the country, waiting lists—and waiting time—are often much longer than we would wish. Neither my right hon. and learned Friend nor the hospital boards view this with complacency. Since 1951 the total number of staffed beds in hospitals in Manchester has increased from 5,638 to 5,965, and schemes at present under consideration will add a further 300 or more.
Much of the capital work being done is in the nature of improvement or replacement of existing facilities and there is a matter of quality as well as of 1637 quantity. I think that the hon. Member will be interested to know that since the introduction of the National Health Service the total expenditure in Manchester on ordinary capital allocation, that is for the three hospital management committees and the teaching group, is about £2½ million. In addition, with the centrally financed programme in the reinstatement of the ward blocks of the Royal Infirmary and the large number of schemes which my right hon. and learned Friend has authorised centrally, some not yet started, the figure will be over £5 million.
I now turn to some of the criticisms concerning the running of the hospitals in Manchester made by the hon. Member. I ought to qualify the word "made" by saying that he voices the criticisms, because they have already been made in Manchester. They concern among other things the services of part-time consultants. It is, of course, well known that the National Health Service employs, and always has employed, both full-time and part-time consultants. It would be impossible to dispense with the services of part-time consultants or to require all those consultants to become full-time.
Many part-time hospital consultants work in other parts of the Health Service and others have appointments in universities or other public services. These part-time consultants make a most valuable contribution to the Health Service. They have, of course, the right under part-time contracts to take private patients and it is in connection with those patients that an abuse of the hospital administration has been alleged to exist.
It is alleged that these patients gain earlier admission to hospital than the patients who are seen by consultants under the ordinary National Health Service arrangements. This allegation has been made concerning a hospital controlled by the Board of Governors of the United Manchester Hospitals and I have asked the Board for its comments on it. The Board has assured me that patients recommended for admission to hospital after a private consultation who do not wish to go into a pay-bed are put on the ordinary waiting list and their cases are subject to the same considerations regarding urgency as those of other patients. Cases of real urgency are admitted immediately and other cases 1638 dealt with according to the medical needs of the patients.
This is not an argument which is susceptible of statistical assessment or proof. Perhaps the best proof is that the papers of patients who have been seen privately are not readily distinguishable from those of others. As I explained to the hon. Member on 9th May, any detailed information regarding comparative periods of waiting would involve the examination of thousands of individual case records. We would have to ask hospitals to put several staff on for several days to go through the admission tickets of all the patients, because they are not distinguished in any way. I have taken note of the hon. Member's suggestion that we might consider a spot check, and that I will certainly pursue for him.
When the hon. Member asks whether there is something to conceal I assure him that there is not. My right hon. and learned Friend does not think that he would be justified in asking the Board to undertake a complete examination over the year of all admission tickets, but if the hon. Member is prepared to give details of particular cases where he thinks preference has been given to a patient who has had a private consultation I shall be glad to have inquiries made.
I appreciate the hon. Gentleman's statement that he makes no wholesale attack on consultants, and I am anxious that any complaint against the National Health Service and those working in it should be cleared satisfactorily. I am sure that the hon. Gentleman will agree that allegations which are not supported by detailed evidence can be damaging to the service and disturbing for patients whose confidence in the service and in its medical staff it is so important to maintain.
The hon. Gentleman also complained about out-patient clinics and said that National Health Service patients of some general practitioners in Manchester were not seen by the consultants to whom they are referred but by a registrar or other deputy. There is nothing essentially wrong in this system of clinical organisation which, incidentally, provides the means by which registrars gain practical experience in the specialty of their choice which is necessary before they in turn can 1639 receive appointments as consultants. It is an accepted part of hospital staffing arrangements, but the delegation is done expressly by the consultant who retains his ultimate responsibility for the patient.
The hon. Gentleman referred to the fact that an inquiry is proceeding in the case of a Shrewsbury hospital under the Birmingham Hospital Board, but in that case we have been given information on which we can hold an inquiry, and if the hon. Gentleman is prepared to let me have those letters from which he quoted that would be helpful and would enable me to make further inquiries. I will certainly give the undertaking to treat them all in confidence if the hon. Gentleman is concerned about protecting the interests of those people who have written to him.
§ Miss Pitt
I referred earlier to the need for patients to have confidence in the hospital staff, and it is on that note that I close. I am as anxious as the hon. Gentleman is to dismiss these sweeping allegations which have appeared in Manchester newspapers and I appreciate the restraint with which he has put his case.
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at eight minutes to Eleven o'clock.