§ Motion made and Question proposed, That this House do now adjourn.—[Mr. I. Fraser.]
§ 10.6 p.m.
§ Mr. Cledwyn Hughes (Anglesey)Last Christmas Eve there was a serious bus accident in St. Helena, as a result of which 10 people were injured, six of them seriously and four moderately. Later the same night one of the injured persons died. Before I deal with the aftermath of the accident, perhaps it would help if I gave some details about the island and the medical services there.
The island is small, having an area of 47 square miles and a population of just under 5,000. It is one of the remotest of British Colonies, being 4,500 miles from this country and 1,140 miles from the nearest point on the African Continent. It is made the more remote because there is no airfield and ships call there only infrequently.
However, there are compensating factors. It is a very attractive island, with one of the best climates in the world, and the inhabitants are very pleasant people. They are of mixed European, African, Indian and Chinese descent, but they are English-speaking and they try and live as far as they can on a European standard.
The St. Helenians have great loyalty to this country, and we have a very special kind of responsibility towards them. This is because Britain was responsible for populating the island. It was of vital importance to us, before the Suez Canal was opened, as a watering and victualling station. Now it is unimportant, but since we created its community we have a special responsibility towards it.
I turn now to the medical services. Since August last there has only been one doctor on the island. He is Dr. John Noakes. There is provision in the establishment for two doctors, but when this accident occurred Dr. Noakes had been working on the island alone for over four months. The doctor who left in August had given six months' notice.
I hope that the Under-Secretary of State will be good enough to say what steps were taken by his Department to 530 fill this vacancy, of which it knew in February, 1962. My information is that insufficient steps were taken and that advertisements appeased in the medical journals only two or three times. Be that as it may, Dr. Noakes was left with a practice of nearly 5,000 people on this island, together with a 58-bed hospital to look after,
A general practitioner in this country has an average of 2,500 patients on his list and also has the hospital services, with consultants, and so on, behind him. To assist him on St. Helena, Dr. Noakes had a matron, Miss Grace Sim, the first St. Helenian to qualify as a State-registered nurse. Matron Sim is a first-class nurse and has been a tower of strength during the recent emergency. To give some idea of the hospital side of Dr. Noakes' work, in 1962 there were 755 in-patients at the hospital. Perhaps the Under-Secretary will be able to tell the House what qualified staff is in St. Helena at present, apart from Matron Sim.
Before I come to the accident itself, I want to deal briefly with the question of drugs. The House will recall that a United States aircraft from Ascension Island and a United States vessel took certain essential drugs and medical supplies to St. Helena immediately after the accident. In his Answer to my Question on 26th February, the Under-Secretary gave details of the drugs which were taken, and I am informed that they were largely drugs which should be in ample supply in St. Helena in case of emergency, for example, streptomycin and anti-tetanus serum.
Can the Under-Secretary say whether the drugs were in stock in Ascension Island, 700 miles away and, if so, how did they come to be in stock in Ascension Island, with a population of fewer than 300, and not available on St. Helena with a population of nearly 5,000?
On my return from St. Helena in the summer of 1958, I wrote a report for the Colonial Office, and in paragraph 30 these words appear:
There is a serious shortage of drugs in stock. Neither does the money provided enable this shortage to be remedied. … It is quite extraordinary that this shortage should be permitted to continue on a remote Island where the possibility of obtaining additional supplies presents obvious difficulties.531 Shortly before my visit, a man died from tetanus because of the lack at that time of anti-tetanus serum.Drugs on St. Helena have to be bought on a very tight budget. I do not know what this year's estimate is, but that for 1958, when I was there, was £1,200 for a population of 5,000. On this occasion, I am informed, the letter of order was sent by the medical officer for St. Helena, Dr. Noakes, to the Government of St. Helena, at the Castle, in Jamestown, but was put on one side because it was a holiday period, with the result that the next boat was missed. If this is true, it seems to be a very serious matter, because it is because the stocks were low when the accident occured that additional drugs had to be brought from Ascension Island.
I now come to the accident on Christ. mas Eve. It was this which presented Dr. Noakes and Matron Sim with a fearful problem which they tackled with success and great courage. Dr. Noakes had to attend to his normal work during the day with frequent calls at the hospital and to stay at the hospital all night keeping the injured people alive. One operation took him 12½ hours. He kept them alive by intravenous therapy and antibiotics. There being no anaesthetist on the island, he used a local anaesthetic. As there is no blood bank, he had to obtain blood donors from the street, and the House can imagine the difficulty of cross-matching blood in those circumstances. In all this he was helped by Matron Sim and assistant nurses and neither he nor Matron Sim had a wink of sleep day or night for more than seven days. This joint effort by a British doctor and a St. Helenian nurse is deserving of the highest praise.
I now turn to a matter upon which I should like the Under-Secretary's comment. After the accident occurred, the medical officer reported it to the Governor. The Governor called at the hospital on Christmas Day, but did not go to see the patients themselves. I understand that the medical officer told the Governor that he needed help, which, in any event, was perfectly obvious, but that the Governor did not report the accident for seven days. I believe that the cable reporting it arrived in the Colonial Office on 31st December. Will the Under-Secretary confirm whether that 532 is true? If it is, why did the Governor take seven days to report the accident and to ask for surgical assistance?
I want to pay this tribute to the Colonial Office: when the accident was reported, it lost no time in taking the necessary action. Dr. R. P. Boggon, of St. Thomas's Hospital, was flown to Ascension Island and then taken by sea to St. Helena and was there by 5th January, which I understand to be a record journey from this country to St. Helena. But he did not arrive until 13 days after the accident occurred. He was then able to relieve Dr. Noakes of some of the strain which he had been suffering.
I am not at all happy about the way in which St. Helena is being administered. I am not satisfied that suitable officials are sent there. It is a small place and it is not regarded as important. It is remote and, therefore, officials can act in a slack and incompetent way, because by the time news filters through to this country it is diluted and stale. If this is true, it is very serious, because St. Helena is nothing more nor less than a microcosm of Victorian imperialism at its worst.
It is common knowledge on the island that the wife of one of the senior British officials who heard of the accident during a Christmas Day party was heard to say, "I am sorry for the so and so's; they have lost a good cook". That is the worst possible attitude for a British official to take in this day and age. Very little is needed to make St. Helena a very happy community. I hope that some effort will now be made to improve matters. I should have thought that the Colonial Office would have wished to nurse St. Helena carefully, ready for the time in the not too far distant future when she will be the only responsibility left to the Colonial Office.
There are some other matters which I want to mention. I shall try to summarise them in very brief questions. First, £500 per annum is allowed for the purchase of food at the hospital regardless of the number of patients there. Why is this? Should not the budget be elastic to meet the requirements from week to week and month to month? Secondly, what provision has been made 533 to provide better housing in St. Helena? When t was there, hundreds of the inhabitants were living in the most appalling hovels. They wanted better houses, and I should be glad if the Under-Secretary will say what progress is being made in providing adequate housing conditions for the people. Thirdly, what are the employment prospects there? This is one island where unemployment is consistently high. Can the Under-Secretary say how much on average is paid out in poor relief, which is their equivalent to unemployment benefit in this country?
What is the present position with regard to assisting those who wish to emigrate to this country? The young St. Helenian wants to come to this country either to live or to obtain some suitable training, because the outlet which he used to have to South Africa has been closed to him by the policy of apartheid there. The St. Helenian is a proud and independent person and no longer looks to South Africa. Can the Under-Secretary say what assurance is given to the young St. Helenian to emigrate to this country and to those who are suitable for various types of training to come to this country to train for various callings and professions? Many difficult problems remain to be solved in this small island, and they can be solved with a little effort and good will on the part of the Colonial Office. I hope that the Under-Secretary and his right hon. Friend will take the necessary steps to help this island and its charming people to overcome their problems.
§ 10.20 p.m.
§ The Under-Secretary of State for the Colonies (Mr. Nigel Fisher)I am very grateful to the hon. Member for Anglesey (Mr. C. Hughes) for raising this matter in the House. We have all too little opportunity, I always think, to debate the problems of the smaller and more remote Colonial Territories, and especially those places like St. Helena, which are very difficult for hon. Members or Ministers to visit; I believe the hon. Gentleman is perhaps the only Member of this House who has ever been to St. Helena. I am conscious of the fact that his background knowledge about the island, obtained from his own personal experience, is rather preferable to mine, which is based simply on Colonial Office 534 files, which I am afraid are sometimes rather impersonal.
The islanders of St. Helena ought to be very grateful to the hon. Gentleman for the great interest he has consistently shown in their welfare since he visited the Colony. It is for this reason, particularly, that I take very seriously any criticisms that he has felt obliged to make tonight, because I know perfectly well that they are not actuated by any party political motives, or anything of that sort, but are actuated by his sincere anxiety for, and interest in, St. Helena.
Indeed, his report following his visit there in 1958 was of great value to the Colonial Office, and I am glad to say that we have since been able to take up some of the points he made in it, the most important of which have been the subsidising of the flax industry and the introduction of elected members to the Advisory Council.
This evening the hon. Gentleman has concentrated mainly on the serious motor accident on St. Helena on Christmas Eve, and on various criticisms that arose from it. The information that I have confirms that the senior medical officer, Dr. Noakes, the matron, Miss Sim, and the nursing staff, only two of whom are fully qualified over and above the doctor and the matron, did an extremely fine job under very difficult circumstances indeed.
Nine people were seriously injured in this accident. Many of them had multiple injuries, including fractures, one leg amputation, broken skulls, and so on. There is no doubt that the emergency placed a great strain on Dr. Noakes, and I think that the hon. Gentleman is right in saying that there should always be two doctors working on St. Helena. This is, of course, the normal practice, except for leave periods.
I am very much concerned indeed about the gap of six months between the departure of the second medical officer and the arrival of his successor. I understand that there were genuine difficulties in recruiting a replacement, and indeed there is almost always bound to be difficulty in recruiting people for these smaller and more remote territories. In this case there was an added delay because the candidate who was first elected unfortunately fell through at the last minute and the whole process had to begin all over again. As 535 the hon. Gentleman knows, the Department of Technical Co-operation advertised this post on several occasions in medical journals over a period of several months. and it was also advertised in South Africa.
The hon. Gentleman criticised the Governor for not notifying us in London of the need for an extra doctor to help cope with the emergency until a week after the accident happened. As the House knows, there is a convention, and a good one, in this House that Ministers should always defend Governors, and this, therefore, one would wish to do anyway. But quite apart from that, in this case I wish to defend the Governor simply on the facts, which I think speak for themselves, and they are these: the accident occurred on the night of Christmas Eve. The Governor visited the hospital on the morning of Christmas Day, the 25th, and discussed the whole situation with the Senior Medical Officer. As Dr. Noakes obviously had a great deal on his plate, so to speak, at that moment, the Governor told him that he would not interfere with his work, or his rest—if he had had no rest—by paying frequent visits to the hospital, but would be available at any time if his help was needed in any way, and that Dr. Noakes must not hesitate to keep in touch with him. No requests were made from the hospital except for extra drugs which were supplied by air drop. The Governor was ready to see the patients himself, but he did not do so because he understood that they were too ill to be seen by outside people. In the meantime the hospital was visited from time to time by the Government Secretary.
On the evening of the 29th the Governor himself went to the hospital again and came to the conclusion, without any request from Dr. Noakes, that a relief doctor was needed. That was not so much to help the injured, because that crisis had already been resolved; it was really to help Dr. Noakes, who had been under very great strain and was clearly in need of a rest. The Governor then first tried to get a doctor from Ascension Island, because that was obviously the easiest and quickest source of help. This is a sad story. Normally there are two medical officers on Ascension, but it so happened that one had just gone to the United States for the New Year. He had just left as the request 536 came in. It was then that the Governor approached us and, as the hon. Member kindly said, we got someone there rather quickly.
I hope that it will be clear to the House from what I have said that the relief doctor was called for as soon as it became apparent to the Governor that help was needed. I must point out that although the strain upon the senior medical officer had been great, the fact is that, much to his credit, he got through this crisis. I have heard no corn-plaint that any patient was deprived of necessary treatment—and certainly no one died as a result of lack of attention. So no irreparable damage was done. The damage consisted of the great strain that Dr. Noakes was under during that period.
I should like to take this opportunity—because it is only fair to the Governor to do so—of saying that I have been impressed not only from reading Colonial Office files but also from other sources of information that I have had from the island, by the fact that the Governor has had a great deal of success in establishing very good relations with the islanders, including both the flax exporters and the General Workers' Union. I want to pay that tribute to him.
The hon. Member also referred to the question of drugs. The senior medical officer had foreseen that supplies of drugs and dressings might need replenishing at about the end of the year, and had indented to us for them. They should have arrived on the pre-Christmas mail ship, but they did not. There is really no excuse for this. I think it is better to be frank with the House. I do not like Ministers to make excuses when there are no excuses to make. They were simply omitted from the assignment. I can only ask the House to accept my apologies for what might have been a very serious omission.
In fact, despite the extra demands resulting from the accident, there was never an actual shortage of drugs, because the Americans—to whom I have already expressed my gratitude in the House—arranged for an air-drop of essential supplies within twenty-four hours. We are greatly in their debt for this very prompt assistance, and also for flying out the relief doctor to Ascension and then bringing him on by boat to St. Helena.
537 I hope that that covers most of the points raised by the hon. Member arising from the accident.
I quite agree that there is some very bad housing, from what I have been told, especially in Jamestown, but the Government are trying to improve it. In 1960 they set up a Housing Committee—which was a new body—consisting of the superintendent of works, councillors from each district, and a social welfare officer. The Committee did a very good job and advised on housing problems. In the past ten years the Government have built 39 houses, mostly from colonial development and welfare funds and are at present building 18 detached cottages in Jamestown. As the hon. Member knows, the Government make loans to house-owners for repairs and, in some cases, make free grants of material and labour, or they issue material at cost price. They are trying, but the housing picture is not all that good.
I now turn to the question of employment. According to my latest information, about 180 men are now unemployed on St. Helena, which is the lowest for a long time, mainly due to the re-opening of three mills. That has been a great help. In addition, 30 per cent. of the men on relief are older people whom it would have been difficult to employ in any case, and about 10 per cent. are only temporarily stopped—being between jobs, as it were. Over the past five years about £275,000 of C.D. and W. money has been spent, and this year £58,000 of this money will be spent. That does not sound very much. But it is quite good per capita by any standards and means that C.D. and W. funds have been spent at the rate of £45 per head over the last five years and £100 per head per annum given in grant aid. I was rather encouraged by a letter from the Governor, who said that this was one of the occasions where C.D. and W. help was really noticeable. The projects had provided for the needs of the people. and there was no one who did not daily get some direct benefit from them. One likes to think that the money voted by this House is well spent.
The island is pretty well equipped for medical buildings and schools, and development money is being concentrated mainly on agriculture and public works, especially road building and so on. Over 538 the past five years £44,000 has been spent on public works. I must confess, I do not know whether the Treasury would consider this right, but the public works have been chosen as much for their employment potential as for the actual benefit in development terms for the island. There is now a new 10-mile road being built, and the 18 cottages which I mentioned, and there is a new scheme for a slipway at Ruperts Bay.
As an employment measure, and it is really only that, the Government guarantees the price of hemp at a level at which it is possible for the millers to continue to operate the mills and the guaranteed price level has recently been raised from £56 15s. to £68 F.O.B. St. Helena. A contract for sales below the guaranteed price made in 1962 led to the reopening of two mills, and a recent rise in the price of hemp has led to the opening of a third mill. In fact, the price of hemp is higher than it has been for several years, and this is a great help in relation to employment The statutory Poor Relief Board pays out about £3,500 a year. The Government grant—the rest comes from rates—has been increased since the hon. Member's visit there from £500 to £2,000 a year. That board makes payments according to need. Single people may receive up to 12s. 6d. a week front the board and widows £1 10s. 3d. according to the number of children of school age. There is also relief work for men who are employable but unemployed. They do three days a week for 30s. at 10s. a day. There are additional grants from charitable funds in the hands of the Government, and there are food subsidies in St. Helena, Customs duties have been abolished on everything except luxuries. Money is worth substantially more than in the United Kingdom.
Emigration was another point mentioned by the hon. Member. Many young women leave the island under a private domestic agency scheme, which as the hon. Member knows, is run by a St. Helenean. The Government sponsors a scheme for men who are found jobs in the hotel industry here and pay part of their passage money if they cannot raise it themselves. I understand that thirty-two men have come here under that scheme in the last three years, but only one this year. That is because 539 employment prospects in the island were better, and that is a good thing.
There has been recruitment of men in St. Helena to the Army here without the necessity to come for interviews. I believe that four have taken a preliminary test in St. Helena and are due to arrive here shortly.
I hope that I have covered all the main points the hon. Member put to me. I am sorry that this is not a complete answer to St. Helena's fundamental problem which arises from her changed position on the trade routes of the world. There have been some quite marked improvements in social and economic conditions on the island since the hon. Member's visit five years ago. I realise that there i5 still much more to be done, and I am not in the least complacent about the progress we have so far made. I appreciate very much the hon. Member's interest in this Colony. It does a tremendous amount of good. I know how much it is appreciated there, and it is good for me and my office. I think it wonderful that people should go to a Colony and continue to take an interest in it thereafter. I wish that applied to all hon. Members who visit Colonies. I am quite 540 sure that as long as I hold this office the hon. Member will keep me up to date and up to the mark about ways in which to help this island and its people.
§ Mr, A. G. Bottomley (Middlesbrough, East)While recognising the qualities of the Governor, particularly as underlined by the Minister, may I ask whether he does not agree that if, four days after the accident, the Governor saw the necessity for further medical assistance he ought to have seen it at the time?
§ Mr. FisherHe went to the hospital the very next morning and said to the doctor, "I don't want to bother you. You will obviously have a terrible job here. Let me know if there is anything I can do, let me know at once". No request came except for drugs and not until four days later—
§ 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 twenty-four minutes to Eleven o'clock.