HC Deb 05 July 1962 vol 662 cc834-46

Motion made, and Question proposed, That this House do now adjourn.—[Mr. J. E. B. Hill.]

10.2 p.m.

Mr. Woodrow Wyatt (Bosworth)

I should like to raise tonight a few matters concerning the health services in my constituency. One has to do with maternity units, and another with the dental service, and I should like to start by dealing with the maternity unit side of the problem.

For years, the two major towns in my constituency, Coalville and Hinckley, have been agitating for maternity units. At one stage, it was agreed by the Minister and by all the relevant authorities—the regional hospital boards and so forth—that each town should have its maternity unit, and both towns were delighted. But they did not know, of course, that the bungling and inefficiency at Ministerial level would soon reverse the decision which had given them so much pleasure, because, in 1961, after years of struggling to get these maternity units and achieving the promise, yet another new plan was produced. The Minister decided that the human beings in my constituency ought not to be treated as such, but ought to be dealt with as numbers and grouped geographically, far Ministerial convenience.

As a result, expectant mothers in Coalville have to go 12 or 14 miles to Leicester for ante-natal treatment and confinement. Hinckley is seven miles from Nuneaton, and that looks all right to the planners in Curzon Street, or wherever the Ministry of Health is now, but from the point of view of giving human:, treatment, it is all wrong, because one cannot get from Hinckley to Nuneaton, even though it is only seven miles, without two bus changes, and, for many expectant mothers, it is three bus changes, according to the areas from which they come. The average time which it takes for all that is just over an hour. I am assured that in fact it takes half a day to go from Hinckley to Nuneaton for pre-natal or ante-natal treatment.

But that is not the worst of it. The nearest bus stop is a place called Coton Arches—a famous name in my constituency. From there they have a quarter of a mile walk up a hill with a 1-in-6 gradient to get to the hospital at the top. Naturally, by the time they get there the expectant mothers are exhausted, tired and irritable. They dread having to make this journey but the Ministry of Health is quite indifferent to that.

At Coalville, the other major town, the average time for the journey to the place which the Ministry has decided to dispatch them is 1¼ hours—to the General Hospital at Leicester. But such is the general difficulty of the bus services that anybody who has to undertake this visit to the General Hospital must expect to use most of the day—from about 10 a.m. to 5 p.m.—to get there and back. These journeys must be made at numerous times before confinement.

Then the time of confinement arrives and the mothers' husbands, relations and friends have to make the same journey to hospital. It is not a matter of seven miles as the crow flies; the journey must be thought of in terms of hours, or half a day, and so forth. Often it is just not possible to do the journey. The Minister appears to think that all the expectant mothers in my constituency drive their own motor cars and that this journey is therefore of no consequence. He also thinks that all the families have motor cars. I feel that the Government have been over-reading their own propaganda about an affluent society, because this time has not yet arrived.

Expectant mothers still have to negotiate extremely difficult bus stages across country. The Minister seems to know nothing of these difficulties, and to care even less about them. From Hinckley and Coalville we have been belabouring him for years. We all went to see him with a deputation last year and argued with him for 2½ hours, trying to put this human problem to him. He remained, and remains, bureaucratically adamant. He is quite content with his map and his numbers and, I suppose, his bits of string and his pins, which he swings to traverse the area and says, "That is all right. They are not very far away."

The people of Hinckley and Coalville are not content with this doctrinaire planning. People in the Hinckley area have just signed and produced a petition to try to move the stubborn stones that pass for hearts at the Ministry of Health. Fifteen thousand of the people of Hinckley have done so, which, even on a democratic, or, if one likes, a purely electoral basis, might make the Ministry pause to think whether it is on the right lines. That petition is just for one town in my constituency. The other town produced a similar petition the year before.

In all the time that I have been a Member of the House I have never known such strong feeling as there is on this issue. I know what the Minister will say, because he has said it before. He will say, "These mothers will get much better treatment in these big central units, and it is very important to concentrate all the specialist skill at a central unit. We must not dissipate our energies and resources." I can see the force of that argument but it does not work out in practice. That is the trouble with the planners at the Ministry. They do not understand the human problems involved, and they assume that because they have made their little sums everything will be all right at the other end.

The first thing that happens, however, is that the family doctor is unable to get to the central unit to look after the expectant mother with whom he has had a long-term association. He is unable to maintain that association, and the mother has to start going straight away to the central unit because the general practitioner knows that he will be unable to do so, and to see her at the proper times. That cannot be good medically, and it is certainly not good emotionally and psychologically.

Secondly, the big units are short of staff. It is not even certain that expectant mothers will get the best treatment if they go to these units. The general practitioner maternity units which could be set up and which were once promised for Hinckley and Coalville could be staffed in both towns, because local doctors are anxious to give their time to such units.

As the Ministry has been told, we have long lists of midwives and nurses who are now married and who are living in the locality. They, too, are anxious to give their services to maternity units but they cannot find time to go all the way to Leicester or Nuneaton to work at the central units. As I say, there is no difficulty of staffing and it is only the general bureaucratic indifference of the Ministry that prevents these local units from being set up.

It is not certain that one receives better treatment from the central units, although it looks as though one should on paper. That is all the Ministry cares about. It is likely, in many respects, that one may get worse treatment and, as I have said, there are emotional and psychological factors involved. Expectant mothers hate long journeys and hate being cut off from contact with their family doctors, especially at the precise moment of confinement. This is very much proved by their violent reaction to the Minister's bureaucratic insolence of allocating them to centres as though they were cattle rather than Englishwomen.

This all represents a sort of futuristic nightmare in which doctrinaire, Conservative planners treat people as so many dreary production units without reference to the feelings of the people concerned. This is proved by the growing number who go into private nursing homes nearer their homes rather than make these arduous and difficult journeys. The whole purpose of the National Health Service—which is already being run down fairly fast by the Government —is being defeated because expectant mothers are being forced by this treatment into saying that they will not use the service but will save their money so that they can be treated properly nearer their homes.

I cannot understand why, if it were once thought possible to have these units in Hinckley and Coalville, the Ministry should suddenly decide that it has become impossible. If it could be done once why cannot it be done now? Why does the Ministry continue in its determination to carry on in the way I have described with bits of paper, string, maps, and so on?

Since the Minister decided not to provide general practitioner maternity units, a committee of the Royal College of Obstetricians and Gynaecologists, a powerful and eminent group of people, has reported that precisely such maternity units should be provided and are specially suited to the conditions which exist in Hinckley and Coalville, both in size and location. But, of course, the Minister is not interested in that. "It is just another of those reports produced by interfering busybodies," he no doubt considers. The Minister probably regards it as a report which might disturb the smooth, tramlike operation of his plan which is not going to work in the long run, in any case.

I suppose that it is a forlorn hope, even at this late hour, that he may reconsider his inhuman decision. It was certainly not a human one, for it did not take the human factor into account. Had it done so these units would have been provided. The units could be provided simply and cheaply and, as I have said, adequate staff would be available. It would certainly not prevent the Minister from being able to keep alive his idea, quite a good one, of having central units where the specialist services could be concentrated.

I turn to the problem of dental services in my constituency. There is supposed to be a school dental service but, as part of the general deterioration of the National Health Service under the present Government, it has totally collapsed for half of my constituents. There is not a single school dentist in the whole of the Hinckley area and the only thing that can be obtained is emergency treatment, and then only with enormous difficulties and long distances to travel.

There is no conservation of teeth or six-monthly routine treatments, although everyone knows that this is vital for dental care, particularly with children. We have repeatedly drawn the attention of the Minister to this. This matter is not the hon. Lady's direct concern, but she and her right hon. Friend have not taken the slightest notice, because they do not care. I understand it has been agreed that she will reply on these points.

Although the Hinckley area of the Bosworth constituency pays an education rate like everybody else, it does not get that to which it is entitled. The result is the rapid decay of children's teeth is over half my constituency—and every doctor and medical officer of health will say the same. This is an appalling situation for the future, and it is something from which no recovery can ever be made because of the neglect of the Government to provide the school dental services which they think exist, but which in fact do not.

It would not be so bad if there were a sufficient number of ordinary dentists in my constituency, because then if the children could not be attended to at school they could visit a dentist in ordinary practice. But once again there are too few of them in my constituency. Every dentist is fully booked for six months ahead—at least he was until the other day. If someone in the Hinckley area wants an appointment with a dentist under the National Health Service, he is not able to get one for six months. This is obviously bad not only for children but for adults. One can, however, get an appointment if one is willing to become a private patient.

By its failure to provide sufficient dentists in my area, the Ministry is encouraging a kind of racket, a sort of blackmail, and really egging dentists on to say to a patient, "I should opt out of the Health Service if I were you", and promise him that if he becomes a private patient for more money he will see him. This is bad for the general morale of the dental service in the Hinckley area.

Lately the position has improved slightly because two Australian dentists have set up in practice. But even so we are nit anything like up to the standard of one dentist for every 3,500 people. We are nowhere near that. At the moment we have about one dentist for every 10,000 people. It is impossible to get dental appointments for newcomers to the town. This applies to both children and adults. Our new town clerk had to wait 18 months before he was able to see the dentist whom he had been clamouring to see. Is Hinckley the worst area in the country for dental services, or is it just average under the general decay of the dental service under the administration of this Government? Time and again we have asked about this, and nothing has been done to improve the situation.

Can the hon. Lady say whether the Government think that it is sensible to go on with so-called school dental services when they do not appear to operate at all? In the County of Leicestershire only two and a half dentists are operating the school dental services. I was puzzled about what half a dentist was doing, but he is accounted for by the fact that he is a part-time operator and gives only half his time to the job. It is ridiculous that we have two and a half dentists for the whole county. Are the Government going to attempt seriously to get more dentists for school dental services by putting up salaries and improving conditions, or do they propose to abandon this and say that these dentists should be added to the general dental service?

Again, why have the Government no kind of equalisation system for dentists, such as I believe operates for doctors? Even the present Government have realised that it is wrong to have more than three or four doctors to each person in a place like Eastbourne! After a time they say that that may be fashionable but nevertheless there are far too many doctors there and some should go elsewhere. But this does not appear to happen with regard to dentists. I should like to know why not, and why this could not be operated. If there ever was an under-dentisted—I do not know whether that is a real word—area, it certainly is Hinckley, unless the Minister tells me that it is an average area, in which case I cannot imagine what is happening to the teeth of the population generally.

No doubt we shall have the usual excuses about the difficulty of getting dentists, staff and doctors, and how hard it is because of the salaries, and so on. It really is not good enough. The plain truth is that the dental services seem to be on the way towards collapse, and the maternity unit provisions in my constituency are both inhuman and totally inadequate. I should now like to hear what the hon. Lady has to say about this.

10.21 p.m.

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

I should feel that the hon. Member for Bosworth (Mr. Wyatt) expressed more real concern about the services in his area if his speech had been less bitter and less biased. That is contrary to the thanks he expressed to my right hon. Friend after he had received the deputation which he mentioned.

Further, if the hon. Member had sent me a note in advance, as I asked him to do, of the points he had in mind, and as is customary in connection with Adjournment debates, I might have been able to be more specific and more helpful in my reply. As it is, he has taken twenty minutes of the time, leaving me only ten; he has raised a large number of points, a number of which are not the responsibility of my Department, and, therefore, I do not propose to try to touch on the school dental service. I shall begin with the general dental service.

The position in Hinckley and district, where there is a total population of about 41,000, has improved within the last few days. There are now 10 dentists in the area. In a letter to the hon. Member a few days ago I said that there were eight. I am happy to say that the position has improved in the last few days. It is expected that there will be 12 there in the near future.

The Coalville and Ashby-de-la-Zouche district has a total population of about 33,000. These towns are about five miles apart and between them have eight dentists. There are facilities in neighbouring major towns, such as Leicester. Hinckley and Coalville are 14 miles from Leicester, and the distance from Ashby is about 19 miles, and I am told that there are good transport facilities available by road and rail. There are 75 dentists in the Leicester city area serving a population of under 300,000 people. This is a ratio of one to 4,000 people. The number of persons per dentist in the Hinckley district is roughly 4,100 and in the Coalville and Ashby district 4,250, which compares with 4,570 for the country as a whole.

Mr. Wyatt

rose—

Miss Pitt

I will not give way. The hon. Member has taken too much time already.

As to the shortage of dentists, it is true that patients in Hinckley and Coalville may find difficulty in obtaining treatment or in doing so without some delay. This is a national problem. There is a shortage of dentists in most pants of the country. The degree of shortage in particular areas may vary considerably. But, as I have already mentioned, the ratio of dentists taking part in the general dental service to the population in Hinckley and Coalville is a little above the national average. In any event, we have no power to direct dentists to serve in particular areas, and even if we had a relative improvement in one area could be achieved only at the expense of another.

As to the numbers of dentists, the position nationally has improved somewhat over recent years. The number of dentists on the United Kingdom register increased from 15,052 at the end of 1949 to 16,007 at the end of 1956 and 16,619 at the end of 1961. The actual number of dentists taking part in the general dental service in England and Wales in 1961 was 10,450. Comparable figures are not available, since the records of dentists in the general dental service in earlier years contained some element of duplication, but on a basis which is comparable over the years, there was an increase in the number of dentists in the general dental service in England and Wales of about 800 between 1956 and 1961.

For the same period there has been an increase in the whole-time equivalent number of dentists taking part in local authority dental services from 1,126 to 1,179 or an increase of about 50. Despite this increase in the number of dentists and the still greater increase in the amount of treatment they have been able to provide, the shortage persists. The Government have made plans for expanding the training facilities for dentists with the ultimate object of achieving an annual output from the schools of about 800 qualified dentists who will practise in the United Kingdom. The present output is about 560. These plans entail the expansion of nine dental schools and the creation of a new one in Wales. Building has already begun on three of these and is expected to begin in the near future on two others.

I turn to the maternity services. It is quite true that the hon. Member has been pressing my right hon. Friend for some time now to provide maternity units at Hinckley and Coalville and that he brought deputations from the two towns, who put forward the views of the local people, which we know are strongly held, and which have been very forcefully put to my right hon. Friend. There is need for a better hospital maternity service for each area, but the right course is not to build new units there.

The general policy for the future of hospital maternity services has developed from the recommendations of the Cranbrook Committee, with its emphasis on specialist care where specialist care is needed and on the need for close physical association of specialist and general practitioner beds, and for the concept of the district general hospital. The argument for this is set out in the Hospital Plan, where it is said that the district hospital offers the most practical method of placing the full range of hospital facilities at the disposal of patients.

The policy is designed to secure the best possible hospital service for the mother and her baby, and far from expectant mothers being treated as numbers, our whole concern and the most important of our considerations is this point of providing the best possible service, and I am sure that the hon. Member's constituents will agree with that.

Mr. Wyatt

They do not.

Miss Pitt

The Hospital Plan says: A maternity unit will be a normal part of the district general hospital where full and continuous consultant cover will be at hand for all beds, including those which should be available to general practitioners for the care of their own patients undergoing normal confinements. This policy does mean, as my right hon. Friend has told the hon. Member, that to reach a modern, fully-equipped unit with consultant advice readily at hand may mean longer travelling for many, but he also said that he is sure that when the new units are built people will be glad to pay this price. The Hospital Plan does recognise that there are cases where a local unit which is many miles from the district general hospital should be retained.

The application of this policy to Hinckley is this. Hinckley is about five miles from Nuneaton in the Birmingham region, and Hinckley is in the Sheffield hospital region. At Nuneaton, there is a maternity unit at the George Eliot Hospital. This hospital is to be redeveloped, and the first phase of the work is to be a new and larger maternity unit, work on which is expected to start in two or three years' time. The right course, and the course which is being followed, is to provide the maternity beds, including the general practitioner maternity beds, for the Hinckley area in this new hospital. The right place for the general practitioner beds is at this specialist hospital, and not five miles away from it. The people of Hinckley may think that it is too difficult a journey and may be unwilling to go there, but it is not so very far for them or for their general practitioners to travel.

At Coalville, the position is rather different. The nearest consultant maternity beds are at Leicester, about 13 miles away. There is an admitted deficiency there, and the Hospital Plan contains proposals far increasing the number, but about five miles away at Ashby there is a 13-bed general practitioner maternity unit where provision is made for general practitioner maternity beds for Coalville. There is also at Loughborough, about 10 miles away but not very convenient, I agree, for Coalville people, a 12-bed general practitioner maternity unit. What is needed in this area is an improved service for the majority of hospital cases which require the care of consultants. These will be provided at Leicester. Thirteen miles away from Coalville in the opposite direction a new maternity unit is also, under the proposals of the Hospital Plan, to be built at Burton-on Trent.

The hon. Member referred to the Report of the Royal College of Obstetricians and Gynaecologists, and he has been in correspondence with my right hon. Friend on this matter. I have armed myself with the answers, but there will not be time to give them in detail.

A 25-bed unit is regarded as desirable and suitable in densely populated areas, but a unit of this size would not he necessary in less concentrated areas. It is on this point that the views of the College may be said to diverge from those of my right hon. Friend in regarding a small isolated maternity unit as a desirable provision. In general, the views of the Report support the view that we take. The College's Report lists the type of cases which would generally be regarded as unsuitable for confinement in a general practitioner maternity unit.

Analysis of it shows that it would involve the admission of the majority of cases of hospital confinements to specialist maternity units. This would leave so small a proportion of confinements to take place in general practitioner maternity units that, unless all confinements were taking place in hospitals—which, of course, is far from being the position—there would seldom be a sufficient aggregation of population away from a centre with a district general hospital to justify a separate maternity unit.

For neither Hinckley nor Coalville could anything like a 25-bed general prac- titioner maternity unit be justified. The College, in referring to "some distance" from the main hospital, does not define that distance. There will be a case for small units in some isolated places—the Hospital Plan envisages a distance of 15 to 20 miles—but neither Hinckley nor Coalville can be said to be sufficiently isolated.

I know that the hon. Member feels that there are dangers in planning too much for big centres and leaving out the feelings of the individual some distance from those big centres. But I am sure that to provide small units in all towns such as Hinckley and Coalville would dissipate our resources and would not be in the best interests of the patient. I am sure that if they do not already do so, the people will come to accept the soundness of the policy of the Hospital Plan.

Mr. Wyatt

May I ask the hon. Lady why she does not intend to answer about the school dental service and——

The Question having been proposed after Ten 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 twenty-eight minutes to Eleven o'clock.