§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. E. Wakefield.]
§ 11.19 p.m.
§ Mr. Harold Finch (Bedwellty)
For some time now, I have been rather disturbed about the administration of the National Health Service in my constituency. I came to the conclusion that it would be advisable to refer to the case of Mr. Robinson because the facts would illustrate clearly what I have in mind when I speak about the working of the National Health Service in Monmouthshire.
Mr. Robinson, who lives in Oakdale in Monmouthshire, sustained an injury to his hand. The condition did not respond to treatment by the local doctor. The doctor thereupon advised Mr. Robinson that he should be examined by a specialist and made the necessary appointment. At the same time, Mr. Robinson was suffering from a hernia which could not be properly controlled by a truss. The specialist at Newport who examined him advised that an operation was essential, but he pointed out that there were no prospects, at any rate for some time, of Mr. Robinson being given a hospital bed in the County of Monmouth.
Mr. Robinson was over 70 years of age. He had been employed at the local colliery all his working life, and for many years he had been a colliery official. He had a little money, and he was in pain. He was suffering from the hernia and from the injury to his hand. The specialist pointed out to him that his only chance of an early bed was to go into a private nursing home. In the circumstances, Mr. Robinson agreed to that, and he was thereupon admitted to a private nursing home in Newport. He was operated upon. The operation was a success. He had excellent treatment. He does not require the refund of the money, about £77, which he had to pay for the treatment.
This is not an isolated case. I could give other cases of people requiring hospital treatment who are told that there are no beds vacant in the County 541 of Monmouth and that, in the circumstances, their only hope is to go into a private nursing home. People in the district are becoming very alarmed about the situation, and they are coming to the conclusion that almost anyone who wants hospital treatment must go into a private nursing home for it, if he has the money. The Old-Age Pensioners' Association for Wales has raised the matter and sent a protest to the Regional Hospital Board at Cardiff. This is not something new to the Regional Hospital Board, of course. For some years, it has been known that a hospital was required in Monmouthshire. There has been a huge waiting list for a long time. The chronic sick are in a very serious plight. There are scores and scores of disabled and chronic sick people who are unable to go into hospital.
As a result of Mr. Robinson's case, I took the matter up with the Minister some time ago, and he pointed out that steps were now being taken to deal with the situation. There was to be an extension of the Royal Gwent Hospital at Newport, and in the future hospital building programme a hospital was to be erected at Abergavenny in the north of Monmouthshire. No doubt, these developments will alleviate the position, but they will not cure it. The completion of the new steel works at Llanwern now in course of erection will create a big demand for beds in the Royal Gwent Hospital at Newport, and the Abergavenny hospital will be in the northern part of the county.
Quite apart from that aspect of the matter, this is a serious situation. There is a growing tendency on the part of medical men to advise people that there is no immediate chance of a bed in hospital, that they will have to wait some time, but, of course, if they are prepared to pay they can have private attention. It is becoming evident to the public that it is easy to be admitted into a private nursing home but it is very difficult to receive attention in hospital under the National Health Service. This is in a district where, before the National Health Service came in, there was a medical aid scheme between the persons employed at the colliery and their wives and the employers. If they required medical attention, if they required to consult a specialist or if they required hospital 542 treatment, they could get it under that scheme. Now, unfortunately, under the National Health Service, to which they contribute, many of them have to pay in addition for attention by a specialist.
I have taken this matter up with the Minister, and he has pointed out that steps have been taken to improve the situation as far as hospital treatment is involved. But it is not only a question of hospital treatment. I have a case of a young man, aged 25, who was in a rather serious condition. He consulted his doctor, and as it was thought he should be examined by a specialist. The doctor arranged it accordingly. The young man had to pay the specialist at Newport. The young man himself is in hospital, but his father alleges that the specialist asked for a fee of three guineas. The young man had been on sick benefit a long time and got £2 10s. a week. He paid the fee. Since then he has gone into hospital. He has not been charged in hospital, but he was charged three guineas for examination by the specialist. That is alleged by the father, and I have no reason at all to disbelieve it.
This is supposed to be a free medical service. In these circumstances, I ask the Parliamentary Secretary that an inquiry be held into the whole situation, for there are so many of these cases who have to go—if they have the money—to private nursing homes, when it is a question of fees having to be paid.
The Minister in his letter referred to the case of Robinson and said:Certainly Mr. Robinson was entitled to be referred to the National Health Service specialists if their services were required, but he preferred to seek treatment elsewhere in view of the possibility of having to wait".Mr. Robinson was over 70 years of age and in great pain. What did the Minister mean by "preferring to have attention" elsewhere? I can quite understand it if a person would rather go to a private nursing home or one hospital rather than another to have private treatment and has to pay a charge. There is no argument about that. But when a person's doctor says he requires attention, and he cannot get into a hospital, but can get examination at a private nursing home, what is he to do? Where is the preference? Where is the choice?
The position is getting worse. I know it is suggested that there should be new 543 building, but what is to happen meantime? One answer is to erect a new wing at the Royal Gwent Hospital, but in the meantime we have many cases requiring attention. The Government have been so long making up their mind through the Regional Hospital Board whether a new building is to be erected or not. We have had this position for some years, and it is getting worse. Many people have waited a long time for treatment and the position is such that it calls for an immediate inquiry.
I hope that the Parliamentary Secretary will be able to inquire into the position so that at a future date we may know what definite steps are to be taken to alleviate the situation, steps particularly arising out of the cases of Robinson and Grey.
§ 11.31 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
I shall detain the House for only a minute or two, as I am sure the hon. Lady the Parliamentary Secretary will need the rest of the Adjournment time to answer the very serious case put by my hon. Friend the Member for Bedwellty (Mr. Finch).
There are two points, I think, to which the hon. Lady should address herself. The first is the very serious shortage—on my hon. Friend's showing—of hospital beds in Monmouthshire, which really must be one of the worst shortages in the country and which present plans are not going to alleviate.
The second point concerns something about which we have heard time and time again in the House, how patients going to consultants and expecting to be treated as National Health Service patients are persuaded to accept private treatment. I wish to ask, first, whether the man who persuaded Mr. Robinson to go into a private nursing home was a consultant with access to National Health Service beds, and, if so, in what circumstances was the persuasion exercised.
I understand that Mr. Robinson's examination took place in hospital. If the consultant was a National Health Service consultant and accepted a fee of three guineas for an examination in hospital, then I think the case needs to be very thoroughly gone into by the hon. Lady and by the Ministry.
§ 11.33 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
The hon. Member for Bedwellty (Mr. Finch) based this case on the matter of his constituent, Mr. Robinson, but I think he agrees, and I certainly feel, that it widens into the broader issue to which the hon. Member for St. Pancras, North (Mr. K. Robinson) has just referred—the provision of hospital beds in the area.
In the case of Mr. Robinson, he was referred by his own doctor for consultant advice for the injured hand. I understand that during the examination the consultant discovered that he also had a hernia which needed attention. Following the correspondence which the hon. Gentleman had with my right hon. Friend, the Minister explained that as Mr. Robinson was treated as a private patient we have no means of assessing at this stage what treatment might have been provided under the National Health Service.
I may say that inquiries have been made of the consultant following the hon. Gentleman raising this case, but the consultant says that he cannot remember the details. As it was a private transaction, I do not feel that there is much more that I can add. The position is that Mr. Robinson was certainly entitled to use the National Health Service, and if his case had been a surgical emergency he would have been admitted to the hospital bed at once. If he had been assessed as an urgent case, then there would have been a waiting period of some three to four months in this area. If he had been assessed as a non-urgent case the waiting period would have been up to two years.
I conclude that Mr. Robinson was a non-urgent case, that the consultant explained to him that there would be delay in his getting a hospital bed, probably considerable delay, and that therefore Mr. Robinson chose to be treated privately.
§ Miss Pitt
As I say, I have no details of the particular case. On the limited information available to me, that is the conclusion I must reach. It cannot have been a case of extreme urgency as otherwise the bed would have been available. The real crux of this whole problem is 545 the shortage of surgical facilities in the area.
The hon. Gentleman mentioned the case of another constituent of his, Mr. Ivor Grey of Oakdale. I have no details of that case, of course. I am told that he is at St. Woolos Hospital. If the hon. Gentleman adds the address of his constituent, I am prepared to make inquiries into that instance.
The hon. Gentleman mentioned the facilities for the chronic sick in his area in the context that the Robinson case had caused some concern to people of his age, the pensioners. I have looked into it, and I think that the position is reasonable. The Hospital Management Committee in the area in which the hon. Gentleman is interested, because it largely caters for his constituency, is Rhymney and Sirhowey.
There are in that area 181 beds for geriatric cases, that is, beds for the aged and the aged chronic sick. That represents 1.16 beds per thousand of the population, and comparing that with the whole of Wales the figure is 1.1, so the local area is rather better than the rest of Wales. Compared with England and Wales, the figure is 1.29, so it is slightly less favourable than England and Wales, but I think that this number of beds normally suffices to deal with the geriatric load, particularly if they are in charge of a consultant geriatrician, and I would inform the hon. Gentleman that such an appointment has been approved for this hospital group.
Coming back to the shortage of surgical facilities, which is the crux of the situation and accounts in particular for the difficulties Mr. Robinson experienced, the position at the Royal Gwent Hospital—which is the one to which Robinson would probably have gone because it is the main one for surgery—is that no emergency is turned away even if it means putting beds in the middle of the ward. As an example of an urgent case I might quote a cancer case; the patient would be admitted within two to four weeks. In non-urgent cases, for example, hernia, haemorrhoids and varicose veins with no complications, males would be admitted within a period of two years, and females within four to five years.
When there are any complications, or the likelihood of complications develop- 546 ing, or interference with occupation, they are admitted in approximately three months. The general practitioners in the area are also aware that in the case of any change in the conditions, needing earlier admission, they can report to the Hospital Committee, and the hospital would re-evaluate the priority.
Surgical facilities are provided in the Newport and East Monmouthshire Group in these proportions. General survery—239 beds; ear, nose and throat—65 beds; opthalmology—24 beds; gynaecology—57 beds. I have included the figures for ear, nose and throat, opthalmology and gynaecology because they also make demands on the operating theatre time, which is one of the difficulties here.
The provision for surgery, 239 beds for a population of 247,000, represents a provision of 0.97 beds per thousand population, which compares with the provision of 0.79 for Wales and 0.76 far England and Wales.
Newport hospitals cater a lot for patients from the neighbouring North Monmouthshire area, but if the two groups are aggregated the provision, 0.83 beds per thousand population, still exceeds the national average. In spite of this, waiting lists in the Newport and East Monmouthshire Hospital Management Committee area have gone up. The total waiting list for 1958 was 1,519; for 1959 it was 1,705; and for 1960 it went up to 2,074.
These figures are disturbing not only for the level at which they now stand but also for their precipitous growth, a clear indication that hospital facilities, albeit exceeding national averages, are insufficient. I have asked for a scrutiny of these figures in order to arrive at the reasons for the sharp increase in the last twelve months, and for checks to make sure that there is no duplication.
Beds are not the only delaying factor. Operating theatre facilities are inadequate, and this adds to the problem. The situation disclosed by the latest figures is more serious than had been estimated, and while the long-term solution must lie in additional building, it is recognised that first-aid measures to relieve the situation quickly are imperative. For some months now the Welsh Hospital Board has been trying to bring into use vacant beds and a little-used operating theatre at Mount Pleasant 547 Hospital, Chepstow, which was initially provided for thoracic surgery but is happily no longer needed. So far the Board's endeavours have come to nothing, because despite prolonged effort it has failed completely to recruit the necessary nursing staff.
Having failed to recruit nurses the Board has turned its mind to the alternative approach of secondment from other hospitals, but it is not possible at short notice to say what can be done in this way. The Board, however, is hopeful that it will provide a temporary solution. If the nursing difficulty, which is the main one, can be overcome, it is thought that the further hurdle of medical staffing can also be surmounted. In addition, the adaptation and upgrading of a further ward in St. Woolos Hospital, Newport, will increase the number of beds for gynaecology and surgery. These should be available towards the end of the present year.
The Hospital Board is also going into the possibility of diverting patients from Newport to outlying hospitals such as Ebbw Vale, the County Hospital, Griffithstown, Abertillery and possibly even Cardiff. It is thought that Abertillery and the County Hospital, Griffithstown have spare capacity, but this, again, requires close investigation which it has not been possible to carry out in the time available. All these and other possibilities are being thoroughly pursued in the hope of giving some relief.
As for long-term measures, two major schemes for development at the Royal Gwent Hospital, Newport have been announced in the 1958 and 1959 lists. This does not offer an immediate advantage—the scheme is still in its infancy, in the planning stages, and it will prob- 548 ably take five years—but when this work is done 64 beds in existing accommodation at the Royal Gwent Hospital will be released for surgery, and there will also be 14 additional beds at Panteg. When the work is complete the additional beds and new operating theatres proposed should rapidly overtake the waiting lists.
I should explain that a special feature of the situation at Newport is the extreme pressure on the casualty department arising from the vast industrial developments in the neighbourhood, to which the hon. Member for Bedwellty referred, notably the construction of the Spencer Steelworks at Llanwern. Measures agreed here to give immediate help will consist of converting an unused radiotherapy room into a temporary minor operating theatre and a temporary hutment will be erected adjoining the casualty department. This should come into use very quickly. The Regional Hospital Board fully recognises the position, and the problem of this area.
I have already explained that the provision of hospital beds is higher than for Wales as a whole, or England and Wales, although this is qualified by the fact that cases from North Monmouthshire come into the area. Even allowing for that, however, the number of beds is greater than elsewhere. The fact remains that there is a problem: the lack of operating space and pressure caused by local industrial conditions are two of the factors. Nevertheless, I can assure the hon. Member that we know of this problem, as does the Welsh Regional Hospital Board, and every effort is being made to try to meet it.
§ Question put and agreed to.
§ Adjourned accordingly at a quarter to Twelve o'clock.