HC Deb 15 February 1963 vol 671 cc1725-38

Motion made, and Question proposed, That this House do now adjourn.—[Mr. McLaren.]

4.1 p.m.

Mr. Laurence Pavitt (Willesden, West)

I wish to draw the attention of the House and of the country to the appalling impact of bronchitis on the health of the nation, and, at the same time, to prod the Minister of Health into action.

I am pleased to see the Parliamentary Secretary. He always looks a picture of ruddy health, as befits his Ministry, but I know that he will forgive me if I say that in spite of his countenance I wish that the Minister were present, and I hope that the hon. Gentleman will convey to his right hon. Friend what I have to say on this important subject. May I also ask him to convey to his right hon. Friend that this debate arises from dissatisfaction over a Question put to him in the usual way, as do so many of these debates?

We on this side of the House feel that we are unnecessarily brushed off in Answers that we receive from the Minister of Health, and the Answer which I received in reply to my Question on bronchitis was no exception to the rule. The right hon. Gentleman's form has changed considerably from the time when he was first made Minister, when we used to have good exchanges and we used to think that he was dealing fairly with Questions and giving Answers which, although we did not agree with them, gave the Questions the weight they deserved.

In reply to my Question on the occasion to which I have referred, I received the answer, "No, Sir". I have checked a number of replies, and found that on occasions I have not even had the "Sir", just a straightforward "No", and I hope that the hon. Gentleman will convey to his right hon. Friend that we would like him to return to his previous form and give us a little less of the brush-off and evasive answer.

The essence of the Answer that I had on bronchitis was that the Minister found no need to differentiate between the impact of bronchitis on the health of the nation and all the other terrible and disastrous diseases which hit us from time to time. When I asked for special action to counteract this impact, the Minister replied: I do not think that there would be any gain from this ".—[OFFICIAL REPORT, 17th December, 1962, Vol. 669, cc. 873–4.] What I am seeking to show is, first, the importance of this compared with all other illnesses which we face, and, secondly, that there is a large field in which the Minister can take action which could be effective. The size of the case warrants the Minister's special attention. It is not a matter of one death being preventable, but that literally thousands of deaths could be prevented by the right action.

My original Question included not only bronchitis, but lung cancer, but because of the shortness of time I want to concentrate on bronchitis, without in any way lessening the importance of the other aspect of the problem, that of lung cancer. Lung cancer has increased in ten years from 36 people dying every day to the present score of 61 every day, and nobody can lightly brush aside figures of that kind. In spite of the terrific impact of the increase in lung cancer, which has risen from 1,800 a year in 1935 to 22,000 a year, and is continuing to rise at the rate of 1,000 a year, even worse is that during the last ten years 75 to 80 people have died every day because of bronchitis. Apart from the other respiratory diseases of which bronchitis might be the commencing factor, but where the certified cause of death is something else, bronchitis is the major killer, and as such should be target No. 1 for the Minister's attention.

I submit that if there were 80 deaths from road accidents each day, or if there was a flood disaster or a fire in which 80 people died, the whole House and the country would be shocked. But we have got used to living with the problem of people dying from bronchitis, and the situation is too easily accepted. I charge the Minister of Health with being far too complacent about it.

In comparison with the rate of between 75 and 80 deaths per day from bronchitis, road deaths are now running at a rate of 16 per day. I have here a number of charts, which I hope the Parliamentary Secretary will accept from me after the debate. I am sorry that the OFFICIAL REPORT is unable to produce an illustrated edition, because these charts are very important to my case. They show in graphic form the incidence of bronchitis, lung cancer and road deaths, and it is easy to adduce from them the difference in attention which the Government pay to these matters. It is clear that the attention given to them bears no relation to their incidence.

Let us consider the question of hospital treatment of people with bronchitis. In 1960, there were 61,450 admissions. Only five years ago, in 1956, there were only 47,800 admissions. The average stay in hospital—and this has an impact on the whole hospital service—is 25 days. I can interpret this in the form not of national figures, but of figures applicable to a hospital in my constituency. Last year, the Central Middlesex Hospital had 720 admissions with bronchitis, and the average stay was three weeks. If we could eliminate this disease in my area we would have sufficient beds and facilities completely to get rid of the waiting lists in general surgery in gynaecology—two questions about which the Minister is very concerned, and on which he is seeking advice, in order to try to find solutions.

Now let us consider the question from the point of the general practitioner. In a recent survey it was shown that one in every four visits to a general practitioner is in connection with bronchitis. Of men between the ages of 40 and 64, no fewer than 17 per cent. suffer from bronchitis. In other words, one in five of the men of this age we meet suffers from bronchitis. In terms of the death rate per 100,000, this country has an appalling record. I have not time to give the complete list, but I draw the Minister's attention to the fact that for England and Wales the figure is 92.3 per 100,000; for Scotland, 70.8; for Northern Ireland, 54; for the United States, 3.1; and for France—swhich has an occupational health service—4.8. Roughly speaking, there is an average of three deaths in America, four in France as compared with 90 in England and Wales.

I now turn to the economic consequences. The Minister will be aware of these circumstances, because we have discussed them before. No less than 29 million days per year are lost because of bronchitis alone, out of 282 million days lost in respect of all health matters. In 1960, we lost 3,024,000 days in strikes. We cannot pick up a newspaper without reading something about the effect of strikes upon industry, and yet, although we lost 29 million days from bronchitis, which is ten days for every one day due to strikes, there are no headlines in the newspapers about this, and there is seemingly very little action on the part of the Minister to cope with it.

I ask the hon. Gentleman to check the figures of the Ministry of Health and the Registrar-General in connection with this problem. I ask him to treat bronchitis in 1963 as we treated tuberculosis in 1913. The hon. Gentleman will recall that there was a good deal of complacency about tuberculosis before the First World War. In the period from 1911 to 1920 there were 38,000 deaths a year. We then instituted measures placing a special responsibility on local health authorities, and we saw a decline in the figures, from 1921 to 1930, to 31,000 deaths a year. In each of the subsequent years there was a corresponding decline, until in 1950 we had got the figure down to 12,000.

This was before the discovery of antibiotics, which finally managed to help the medical profession entirely to defeat the disease. In 1961, there were only 3,000 deaths. I would point out that prior to the discovery of antibiotics, it was action by local authorities and other planned activities which brought down the average death rate from 38,000 to 12,000 per year. This could be done with bronchitis. Do we have to go through another twenty years of having deaths at the rate of 80 a day, waiting for a wonder drug to come along to solve our problems or, do we insist that the Minister takes some action to get local authorities and other agencies to work together in the matter?

I should like to see a special service for bronchitis. I realise that I am prohibited by our rules of order from talking about legislation, but surely it is possible to encourage local voluntary notification, to command a team which could include G.Ps, physicians at local hospitals, local health authority doctors and resettlement officers attached to the Ministry of Labour in order to have a combined operation to try to stem the impact of bronchitis on the nation.

There is already some co-ordination. The local health authority has to pay two-elevenths of the chest physician's salary in any case. It should not be beyond the ability of the Ministry to present a scheme which will bring all these forces together to play as one team in this way. We need a plan whereby we can redeploy all the resources now running down which were previously needed to combat T.B. A large number of beds have become vacant because of our defeat of T.B. and a number of chest clinics are now not required to the same extent for the same purpose.

I ask the Minister ruthlessly to take these resources and apply them in an endeavour to combat bronchitis. There is no difficulty in definition of what bronchitis is. Medically that is quite clear. It can be notified, and if there is early diagnosis action can be taken to prevent what is slight bronchitis from developing into chronic bronchitis.

The three main causes of bronchitis are known. They are atmospheric pollution, smoking, and the occupational hazards of dust and other irritants of that kind in work places which lead to chronic bronchitis becoming endemic. It is now known that people who cough are more likely to get lung cancer than those who do not. A cough is easily recognised. We accept it and say that it is a smoker's cough. If it is known and not accepted, then something can be done. People smoking 25 cigarettes a day have a mortality rate six times higher than non-smokers. Notification would enable the use of antibiotics in the early treatment of recurrent infection.

It would also enable the use of influenza vaccine in known susceptibles. Removal from polluted areas and the change of jobs where they are the main cause of the disease could be ensured. Co-operation with the resettlement officers and other agencies could make certain of stopping the growth of the trouble. We know that to a person in that situation bronchitis is a certain killer. So change the situation and save a life.

I charge the Minister with complacency on this issue. Because he has so many responsibilities—and I recognise them—he is prepared to accept this as just one of the many hazards which he has to face in trying to deal with the health of the country. My plea is that he should raise the matter above the ordinary case and give special consideration to it. He should make it a priority in his work. I ask the Parliamentary Secretary, to persuade his right hon. Friend, in the midst of all his other duties, to take just one complete day off to consult with Sir George Godber in the light of all the information which I know the Ministry has in order not only to assess the facts that are now known to the medical profession, known to the Ministry and known to Sir George Godber, but so that he as the responsible Minister—he is a Cabinet Minister—can persuade the Government to take the kind of action along the lines which I have suggested this afternoon.

4.15 p.m.

The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

I am grateful to the hon. Member for Willesden, West (Mr. Pavitt) for giving us the opportunity to discuss this important subject today. I have listened with close interest to the way in which he has developed his argument that action to prevent bronchitis might follow that taken in 1913 and which has led, of course, to the virtual eradication of tuberculosis. I feel, however, that there is no real parallel and it would be fruitless, I think, to pursue this particular approach. I want to say at once that we are not really comparing like with like. For reasons I will make clear, I completely reject the charge of complacency.

Tuberculosis of the lungs is an infectious disease. That was the reason for making it statutorily notifiable. Bronchitis, on the other hand, is not an infectious disease. Again, tuberculosis is normally either present or not this is a readily ascertainable fact. Bronchitis, on the other hand, has infinite gradations and for that reason could hardly be made notifiable.

Unhappily, we must recognise that diseases cannot be eradicated by legislation or by administrative action alone. In that sense, if T.B. has been conquered, it has been conquered in large measure by the development of new drugs. No new specific drug for bronchitis has yet been found. I may sum up these differences by saying therefore, that there is no analogy between bronchitis and tuberculosis in aetiology, cure or prevention.

However, the fact that I see difficulty in tackling the problem in the manner suggested by the hon. Gentleman does not mean that I have any wish to underestimate the seriousness of the incidence of this disease for the nation. On the contrary, all of us can agree that the prevention of bronchitis must be a major objective in the continuing war against ill health.

Bronchitis, as the hon. Gentleman said, is a killer. It causes widespread disability and much misery. It has been estimated that it accounts for about 29 million working days being lost each year, and in 1961 over 5 per cent. of all the deaths that occurred in England and Wales could be attributed to it.

It is true that mortality from the disease appears to be higher in Britain than in any other country, though it may not be true to the extent that the figures imply, because the diagnostic and classification habits of different countries vary and what may be labelled as bronchitis in this country, for example, may be labelled as heart disease in another.

Nevertheless, the fact is that bronchitis is regarded the world over as a peculiarly British disease and one which is unhappily linked with two British characteristics—the presence of air pollution and the widespread habit of smoking. It has long been associated with air pollution. Certainly it is much more prevalent in the heavily populated industrial areas than elsewhere.

If one takes the mortality ratio for bronchitis in England and Wales as a whole as being 100, then for the year 1959 it is significant that the comparable ratio for conurbations alone was 130 and for rural areas alone 66. The effects of air pollution are most virulent when the conditions are such as to produce smoke polluted fog, or what is more commonly termed smog. It is estimated that in the exceptional smog that enveloped London in December, 1952, there were some 4,000 more deaths, many among those already suffering from bronchitis, than would otherwise have occurred.

I think that it is useful to compare our experience in December, 1952, with that of the smog of December last year. Preliminary results of the investigation of last December's smog indicate that whereas the atmospheric levels of sulphur dioxide were roughly similar to those ex- perienced 10 years previously, the quantities of smoke were definitely lower. The associated mortality and sickness was certainly far less.

This was probably due to several factors working in combination, such as the shorter duration of the 1962 smog, the effects of action taken under the Clean Air Act, the lower amount of respiratory disease among the population, and the fact that by and large the public themselves are better informed about the dangers of smoke polluted fog.

Mr. Pavitt

But 340 people still died of bronchial trouble during that period.

Mr. Braille

I am in no way minimising the dangers I have no wish to minimise the dreadful toll which bronchitis still takes today of our population. Perhaps the hon. Member will permit me to develop my argument.

Smoking is undoubtedly a contributory factor to bronchitis and one which I hope is much more susceptible to control by the individual. The Royal College of Physicians, in its Report on smoking and health, said that chronic bronchitis is a common and distressing disease in Britain, and causes many deaths, especially in middle-aged and elderly men. Smokers, particularly cigarette smokers, are much more often affected than non-smokers. Moreover, while recognising the part played by other agents, many men and women who are disabled by chronic bronchitis might have remained well had they not smoked.

It has been estimated that heavy smokers are five times more likely to be admitted to hospital with bronchitis than non-smokers. Recent research has indicated that in English country towns and in the United States symptomatic bronchitis, by which I mean the detection of more than minor symptoms, is practically confined to smokers. It is true that in London smokers and non-smokers suffer from symptomatic bronchitis, but smokers suffer more.

What I am trying to show is that there is no short cut to the prevention of bronchitis and no specific which will confer immunity. The best ways of controlling and preventing this disease lie in the reduction of atmospheric pollution and smoking, especially cigarette smoking, and Government action at present is directed accordingly in those directions.

The provisions of the Clean Air Act prohibiting dark smoke and controlling emissions of grit and dust apply all over the country, not just in smoke control areas. They are enforced, as the hon. Member knows, by local authorities. By 1962 some 1,500,000 premises in the so-called "black" areas, by which I mean those major centres of population most heavily polluted, were covered by smoke control orders. My right hon. Friend the Minister of Housing and Local Government estimates that by the end of 1966 the number of premises covered in "black" areas will have more than doubled to about 3,700,000. The Government hope that local authorities will do their utmost to accelerate this rate of progress.

One sometimes encounters the argument that it is not so much visible smoke as oxides of sulphur which are harmful to health and that it would be better to concentrate on dealing with these instead of on the control of visible pollution under the Clean Air Act. This is quite wrong. What is more it is dangerous. I hope that no local authority in a polluted area will be deterred from making a smoke control order by arguments of this kind.

The truth about pollution by sulphur is that it has never been satisfactorily shown that sulphur dioxide, the commonest sulphur compound, is by itself harmful to health in the quantities in which it is found in the air. I understand that the air pollution research unit of the Medical Research Council suspects that sulphur oxides help to cause bronchitis when inhaled in conjunction with smoke.

But in the present state of scientific and technical knowledge it is not yet possible to prevent the emission of large quantities of sulphur oxide into the air. The major aim at present is, therefore, to reduce concentrations of sulphur oxides at ground level to a minimum by requiring under the Alkali Act and the Clean Air Act the use of chimneys high enough to ensure that gases are dispersed over a wide area and diluted before they reach ground level. The House will be glad to learn that my right hon. Friend the Minister of Housing and Local Government will shortly be issuing advice to local authorities on the exercise of their powers to control chimney heights under the Clean Air Act.

There is also, of course, scope for immediate preventive action when serious fog is expected. Hon. Members are aware of the announcements made on health precautions whenever serious fog is expected. Smog masks are also available under the National Health Service to persons needing them on medical grounds.

I turn now to smoking. I have referred to the established connection between smoking and bronchitis. There is a sinister aspect of this established association between smoking and chronic bronchitis which everyone concerned with the well-being and health of the young would do well to take every opportunity to stress. There is evidence that the foundations of chronic respiratory disease may be laid early in life. We know that the evidence against smoking in later life is very strong indeed and that it is a major factor in the incidence of respiratory disease. It is logical to assume that the same factors are at play in early life. There is a tremendous opportunity here, I suggest, for all those who are concerned with the education and training of young people.

The numbers who smoke cigarettes at an early age are depressing. In a recent investigation I understand that it was found that more than 20 per cent. of the boys and nearly 20 per cent. of girls at secondary schools admitted to smoking. While giving up smoking in middle life is helpful, injury has already been done; and we know how difficult it is for adult people to give up smoking even when they wish to do so. It is far better that the young should be helped to think over the facts for themselves and to reach their own commonsense decision never to develop the addiction of smoking.

Immediately following the publication of the report of the Royal College of Physicians, my right hon. Friend and my right hon. Friends the Minister of Education and Secretary of State for Scotland asked local authorities to make the conclusions of the report widely known and to bring home to the public the dangers to health of smoking, particularly of cigarettes. I hope, therefore, that parents and young people will realise in good time that smoking contributes not merely to the incidence of lung cancer but to bronchitis, which may start in mild fashion but which so often develops into a distressing, and even disabling disease.

I emphasise that the Government have not hesitated to emphasise the hazards involved. The hon. Gentleman asked me what action has been taken. We have made available free of charge to local authorities and other bodies a series of posters, some of which have been specially designed with children in mind. This work of health education will be continued. Indeed, it will be extended to include films and film strips. A new film for schools will soon be ready. I am very glad to say that local authorities are making very widespread use of these posters. In the last nine months 820,000 posters have been supplied. The services of mobile publicity units have also been made available by the Central Council for Health Education with Government assistance and are being. widely used. [Interruption.]

I do not know what the hon. Gentleman is murmuring from his seat. The fact of the matter is that passing Acts of Parliament will not solve this problem. This is essentially a problem of individual education with as much encouragement as can be given by the Government. Giving up smoking is primarily an effort of will on the part of the individual. The Royal College of Physicians' report suggested that experimental work should be done through anti-smoking clinics to find out how those who have difficulty in doing this could be helped. The answer to the hon. Gentleman is that local health authorities wishing to engage in this experimental work are given every encouragement to do so. So far, experimental anti-smoking clinics have been started by eight local authorities. There are two such clinics at London hospitals.

I suggest, however, that the effect of all the measures I have described is not likely to be fully realised for a long time to come. Out-of-date appliances and conditions and the ingrained habits of generations cannot be changed overnight. In some respects, let us frankly confess that, particularly when dealing with smoking by young people, they will be changed only with great difficulty. What we must do, however, is to keep up the pressure, to lose no opportunity to increase the effectiveness of the measures we have already taken, and to press on with study and research. I pay tribute to the hon. Gentleman for raising this matter this afternoon, because he has given us an opportunity to focus attention on the necessity for keeping up this pressure.

Research on the effects of sulphur pollution on health and on the means of controlling such pollution is well under way, although it would be quite wrong to suggest that as yet there are any signs of a major break-through. The effect of petrol and diesel fumes is being studied by the Medical Research Council's Air Pollution Research Units and by the Department of Scientific and Industrial Research. I may also mention that the Royal College of Physicians announced in its report on Smoking and Health that air pollution and health would be considered in a later report.

Moreover, I can assure the hon. Gentleman that the health aspects of air pollution are under continual study by my own Department so that the medical effects of the Clean Air campaign can be demonstrated as soon as possible. The Standing Medical Advisory Committee of the Central Health Services Council is also engaged on a study of bronchitis and in the course of this study may be expected to consider what further measures might be taken in the management and prevention of chronic bronchitis and allied conditions. My right hon. Friend looks forward to receiving this advice.

May I say in conclusion that there is no question of my right hon. Friend treating this matter with any degree of complacency. I am sorry that the hon. Gentleman got the impression from the Answer to his Question that the matter was being treated lightly. He will recall that my right hon. Friend said this in answer to a supplementary question: If I could legislate bronchitis and lung cancer away of course I would."—[OFFICIAL REPORT, 17th December. 1962; Vol. 669, c. 873.] Indeed, I have indicated this afternoon that we take this matter very seriously indeed. Although it is not possible, for the reasons I have given, to adopt all the suggestions the hon. Gentleman has made this afternoon, I hope that I have shown that a great deal is being done to combat the conditions which encourage this dread disease.

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 twenty-nine minutes to Five o'clock.