§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. G. Campbell.]
§ 9.58 p.m.
§ Mr. Tom Driberg (Barking)
We have just a minute or two extra for our brief Adjournment debate, but I want to allow plenty of time for the reply by the Parliamentary Secretary, and I know that the hon. Member for Hornchurch (Mr. Lagden) is also hoping to catch your eye, Mr. Speaker. I shall, therefore, compress, so far as I can, the points which I wish to make.
The matter with which we are concerned —the conditions and treatment for aged patients at St. George's Hospital, Hornchuroh—arose late last summer, when a constituent of mine, Mr. C. E. Vidler, came to see me in great distress because his wife had died at this hospital in circumstances in which, as he contended, she should not have died. Lest it be thought that, in his natural grief, Mr. Vidler overstated his case against the hospital—I cannot, of course, vouch personally—
§ It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pym.]
§ Mr. Driberg
I cannot vouch personally for every detail of what he said —I must emphasise, as I said in a letter to the Minister on 2nd August, 1962, that Mr. Vidler may be regarded as a witness of more than average credibility on this kind of matter, for the simple and unusual reason that he is himself a qualified nurse. He served in the R.A.M.C. and worked at St. Bartholomew's Hospital for 31 years, retiring laden with testimonials and honour.
Mrs. Vidler, who was 80 years old, had a stroke some time before her death. Her husband managed to get her a bed at St. Bartholomew's. Then she had to be transferred to St. George's. On his first visit to her at St. George's, Mr. Vidler was struck by the contrast between the resources and amenities of Bart's—if I may so call it—which is, of course, a great teaching hospital, and the lack of them at St. George's. Worse than this, 1670 however, was what seemed to him the attitude which he says he found among some—not, of course, all—of the staff. As he put it, some of them seemed to assume that he would realise that St. George's was "simply a hospital to which old people were sent to die".
Mr. Vidler's wife had been making good progress at St. Bartholomew's with the help of trained physiotherapists. At St. George's her condition got steadily and rapidly worse and, rightly or wrongly, he formed the opinion that she was dying for want of proper geriatric attention and of proper care in her feeding. I cannot go into all the details. The Parliamentary Secretary will be familiar with them from my original letter and Mr. Vidler's numerous letters.
As I say, I was impressed and disturbed by Mr. Vidler's obvious sincerity and by the detailed and, to some extent at least, informed nature of his allegations; and I was confirmed in my view that this was a matter which had to be taken seriously by a letter, dated 13th August, from the Parliamentary Secretary. He wrote to me:From one or two recent complaints it seems that the service which this hospital is able to give to elderly patients may not he as good as it should be. You may like to know that our officers and the North East Metropolitan Regional Hospital Board are considering what can be done to improve matters. As the complaints about the treatment given to Mrs. Vidler ought to form part of the wider investigation it may be some time before I can let you have a full reply to the points raised in your letter; but I can say in spite of difficulties which I know exist in St. George's I am most anxious that it should provide the hest possible service. I am glad that you have brought this matter to my attention.Hon. Members will note that in this remarkably candid letter—much more candid than Ministerial letters sometimes are—the Parliamentary Secretary indicated that there was to be, apparently, a full-scale investigation of this hospital and its services. The matter had by this time attracted some attention in the local Press, and I received a number of letters from people who were or had been patients in St. George's Hospital, or their relatives, or, in two cases, former employees. Almost all these letters contained information tending to confirm what Mr. Vidler had told me. Some of them were expressed in very strong language.
1671 One lady who had visited an old man of 80 every week for two years, after he had had a major operation, said that she was "disgusted" by the treatment he had received. Unfortunately, she complained to somebody in authority and although she did not mention the patient's name, she said enough to enable him to be identified. She wrote to me:He was sent for into the office and questioned before several V.I.P.s, matron, secretary and others, and scared out of his life, he had to answer so many questions. They said that if he was not satisfied with the treatment he was getting, he could be moved to another hospital—well out of visiting distance.So, inevitably, in due course a reassuring letter was sent to the tiresome visitor telling her that she was quite wrong and that her old friend was as happy as he could possibly be.
I am sure that the Joint Parliamentary Secretary does not want to engage in any whitewashing exercise, but the main point that I wish to put to him tonight is this: I sent all these letters to the Minister on 27th September with a request that they should be passed on to those who were conducting the investigation into the hospital and asking particularly that ex-patients and relatives, such as the writers of some of these letters, should be interviewed personally.
As it happened, that letter of mine crossed with one to me from the Joint Parliamentary Secretary replying to some of Mr. Vidler's complaints and vigorously repudiating, as the hon. Gentleman was entitled to do, some of the language which Mr. Vidler had used publicly about the hospital. No doubt, if he so wishes, the hon. Gentleman will tonight repeat his explanation of the very real difficulties that, I do not deny, have existed in the staffing and management of the hospital.
In this letter, however, the hon. Gentleman also saidOur officers have now had full discussions with officers of the Regional Hospital Board and the Hospital Management Committee.Was this the full-scale investigation that had been promised? Was this all—" full discussions "at official level? Were there no personal interviews with actual ex-patients or relatives—with Miss Relton, for instance, who gave a most circumstantial and detailed account of 1672 conditions in the ward in which her mother had died, two days, as it happens, after Mrs. Vidler's death?
The hon. Gentleman may recall that Miss Relton alleged that the conditions in her mother's ward were deplorably squalid, that there were eight open sores on her mother's back, that the patients' lockers were, as she put it, "alive with ants and mice", and that on the very day before her mother died, she was told that there was "nothing to worry about" and was promised that she would be notified of any turn for the worse—a promise which was not kept.
On this and other specific cases, the Joint Parliamentary Secretary replied to me on 4th January—a lapse of more than three months, which, I hope and believe, indicates that some fairly searching inquiries were made. I am bound to say that in this case I did not find the hon. Gentleman's reply as convincing as Miss Relton's allegations, but it was again, within the limits of what was possible for the hon. Gentleman, an honest and candid reply. He wrote, first, on the general issue, that he had not been able to substantiate any of the serious complaints; but, he added:this does not mean that we are complacent about the situation at the hospital. The relatives who have made statements seem sincerely to believe them to be true just as the staff are sincere in their belief that they have done all they can for the care of the patients. The only certain thing that we can say about the cases you have brought to our attention is that the hospital has failed to assure the relatives that the patients were being properly looked after. This in itself is a serious situation.The hon. Gentleman went on to say that in cases such as this, where there is sometimes rapid deterioration in the condition of aged patients,the relatives as well as the patients need much more than the usual attention from nursing staff.He explained, very fairly, about the immense difficulties caused by the shortage of nursing staff at St. George's Hospital. He wrote:…the staff are carrying a very heavy load of particularly difficult nursing.They… have less time than they would like to give to worried and often distressed relatives.Then the Parliamentary Secretary came on to the particular case of Miss Relton. 1673 Here, as I say, I found his reply less convincing. He said:I am told that Miss Relton was frequently distressed during her visits"—That is quite natural, after all.—and could not believe that her mother was unlikely to recover. The burden of much of Miss Relton's complaints is that she was told insufficient about her mother's condition. In retrospect we must admit that, in so far as it is true, this may have been a mistaken act of kindness to save Miss Relton from further distress. The final deterioration in Mrs. Relton's condition was unfortunately so sudden that it is true that the sister was unable to keep her promise to let Miss Relton know about it. Miss Relton also quoted some remarks said to have been made to her by members of the hospital staff. It is, of course always difficult to investigate this sort of allegation. All I can say is that the Hospital Management Committee would not expect the remarks to have been made.A little later in this very long letter the hon. Gentleman says:It is in the nature of the kind of complaints which you have received about St. George's Hospital that to some extent their investigation should be inconclusive.But might the investigation not have been just a little less inconclusive if there had been personal interviews with such people as Miss Relton and Mr. Vidler? Perhaps the hon. Gentleman will make it quite clear tonight that, as I gather from his letters and his Answer in the House on 11th March, there were no personal interviews. If this is the case, I should like to know why not, and should like to have a really convincing reason.
How can an investigation be thorough and impartial, how can justice be seen to be done, when only one side of a case is heard? It may be said that the letters which I passed on were taken into account by the officials conducting the investigation. Would it not have been better if they had taken the trouble, as I asked in advance that they should, to see the writers of the letters, or some of them, so that they could judge for themselves of their credibility? This is the most unsatisfactory aspect of the whole case.
Much more satisfactory is the news contained in the hon. Gentleman's Answer on 11th March that the nursing staff of this hospital is to be increased and a whole-time geriatrician appointed. May I ask whether these desirable improvements have yet been effected? Of course there ought to be a whole-time geriatrician at such a hospital. Had there been one there before, last July, it 1674 may be—this is, of course, only speculation—that Mrs. Vidler would have lived for some months longer. At least, I hope that the widower may derive some slight consolation from the knowledge that the action that he has taken even though in his grief he may have used, now and then, language which was rather too strong—may ensure better treatment in future for other aged patients in this hospital.
Having spoken, necessarily, with some severity, I cannot end without saying that I realise fully that whatever has gone wrong at St. George's in the past is not primarily the fault of the nursing staff. Too few of them have had too much to do, too much of a kind of work that can be exceptionally trying and unpleasant, demanding a real sense of vocation in those who undertake it, for such very modest pay. Some of them may well not have had a special training in geriatric nursing. That is not their fault, either. But I should like to know to what extent the under-staffing of the hospital has been related to the general policy of the Minister and of the Treasury, which has tended to restrict recruitment of nurses.
I am most anxious that nothing should be said in this debate, and that nothing that I have had to say, in the fulfilment of my duty to my constituents, should in any way act as a damper on the recruitment of nurses, especially for this hospital. I do not think that it should do so, for a thorough shake-up such as the hospital must have had in the last few months should lead to considerable improvements for both patients and staff. To provide the best possible conditions, the best possible services and amenities, is the least we can do for our old people when they are sick and for the devoted young women who care for them.
§ 10.15 p.m.
§ Mr. Godfrey Lagden (Hornchurch)
I know that my hon. Friend the Joint Parliamentary Secretary will want as much time as possible to answer this debate, and I shall therefore briefly put three points. First, I am sure that he is aware that this hospital is in my constituency. Secondly, can he assure me that the accusations made by Mr. Vidler are without substance? Thirdly, can he tell me that any disguised or indirectly made accusations against the staff, many of 1675 whom are my constituents, are unfounded? From my personal observations in visiting this hospital, I find them a very devoted set of people.
§ 10.16 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I am grateful to the hon. Member for Barking (Mr. Driberg) for the opportunity he has given me to clear up any misunderstandings about conditions at St. George's Hospital, Hornchurch. There has been a great deal of publicity about this hospital which most unfortunately has left an impression of criticism of the staff which is unjustified and which they have not been able to counter. I hope that I shall be able once and for all to remove any misunderstanding on this score.
The hon. Member wrote to my right hon. Friend on 2nd August last reporting some complaints by Mr. Vidler about the treatment of his wife in St. George's before she died in the hospital on 5th July. Some short time before this officers of my Department had visited the hospital. They shared the Regional Hospital Board's view that the service which the hospital was able to give its elderly patients was not as good as it should be. This was something that I told the hon. Gentleman in the correspondence to which he has referred.
We were already considering with the Board what we should do to effect improvements. I therefore felt that even before we looked into the particular case of Mr. Vidler's complaints that I should explain this frankly, candidly and fully to the hon. Gentleman in order to reassure him that Mr. Vidler's complaints would not be dealt with in any routine fashion but would be given the most serious consideration.
My letter to the hon. Member had some unfortunate consequences. He released it to the Press, as he had a perfect right to do. But unfortunately it was reported in the same context as some further statements by Mr. Vidler which had formed no part of the complaint which the hon. Member had relayed to me.
The juxtaposition of my letter and the further statement by Mr. Vidler gave the impression that we at the Ministry and the Board already knew about the new 1676 allegations that Mr. Vidler was now making and were taking them seriously. I say quite firmly that this was not so. Part of Mr. Vidler's statement as reported in the Press—I quote from The Guardian of 27th August—went like this:The hospital is like a prison, the staff are like warders and the patients are treated like criminals. My wife did not receive the proper medical attention and care; she was neglected and her death was hastened by the lack of oxygen at the proper time.These are very serious allegations. They did not form at that stage any part of what the hon. Member had sent to me. If they had been, I would certainly have refuted them at once because our knowledge of the hospital would certainly have enabled me to deny emphatically that it was like a prison and that the patients were treated like criminals. On the contrary, while battling against admitted difficulties, the staff there bring great devotion to their task, as the hon. Gentleman and my hon. Friend have testified and as I am glad to confirm.
When we investigated the specific complaints contained in the hon. Member's letter, we found that there was a considerable conflict of evidence. Mrs. Vidler was admitted to St. Bartholomew's Hospital in January, last year—she was about 80 at the time—and she was transferred to St. George's Hospital on 7th March, where she stayed until her death. Mr. Vidler stated—and the hon. Member repeated it tonight—that while in St. Batholomew's she had been making good progress and, with assistance, was walking about and sitting up. He then said that at St. George's Hospital her condition steadily and rapidly worsened owing to lack of proper nursing care.
The medical report from St. Bartholomew's, however, stated that during her stay there she had remained out of touch and unresponsive and that there was no sign of improvement. While I have, and we must all have, every sympathy with Mr. Vidler in his sad loss and must make every allowance for the strain and stress which he must have experienced during the illness of his wife and after her death. I must accept the independent report of St. Batholomew's medical staff which refutes the statement he made on this point.
Mr. Vidler made no complaints to the nursing staff at St. George's, although, as a former nurse, he would find it easier 1677 than most to establish an easy relationship with nursing staff. The hospital staff were therefore rather surprised when Mr. Vidler wrote letters of complaint, and arrangements were made for him to talk with the matron and almoner. The talk took place on 23rd May.
Mr. Vidler stated that he realised that nothing could be done for his wife and that her condition was gradually deteriorating. In view of his later complaints that he was forced to bring food to his wife because she was starving—this is what appeared in the Press—I should mention that at this meeting matron agreed that he could feed his wife, making it clear that this was because he wished to do so and not because the hospital did not provide her with sufficient food. Matron thought, not unreasonably, that as a former nurse Mr. Vidler could be given this responsibility. Mr. Vidler left saying that he much appreciated what was being done for his wife. On the same day he wrote a warm letter of thanks to the matron and a letter of appreciation and apology to the Regional Hospital Board.
On 2nd June, Mr. Vidler sent 12 boxes of sweets to the nursing staff of the ward where his wife was being treated and a letter expressing his gratitude for the way in which his wife was being cared for. With Mr. Vidler's permission, these sweets were distributed to patients and Mr. Vidler wrote again to matron on 6th June reiterating in warm terms his gratitude for the care his wife was receiving. This makes it all the more difficult to understand the bitterness of Mr. Vidler's later complaints about the treatment which his wife had received up to that date, although I appreciate, as I have said, that he must have been under considerable strain and stress.
One of the specific points, however, refers to the time, somewhat later, just before his wife died, and we went into this very thoroughly. Mr. Vidler alleged that on 1st July he went to see his wife and was shocked to see her gasping for breath and obviously suffering great distress with nobody paying her any attention. He went on to say that he went to fetch the sister, who sent two orderlies to see his wife, and that after further representations sister said that she would telephone the doctor when the visitors had gone.
1678 The hospital's version of this event, however, is that Mr. Vidler told the sister that he did not think that his wife looked very well. Sister found that Mr. Vidler had been giving his wife liquid, which she thought the patient had had difficulty in swallowing, and she considered that her condition was such as to cause no immediate anxiety. Later, when Mr. Vidler was leaving, he again stated that he did not think that his wife looked very well. Sister immediately went to Mrs. Vidler again and found her suffering from cyanosis. She at once telephoned the doctor on duty and arranged for Mr. Vidler to be recalled before he left the hospital.
I have dwelt on this sad story and Mr. Vidler's complaints in some detail, because his statements have received a great deal of publicity and none has been given so far to the replies of the hospital staff, although I told the hon. Member for Barking about them when I sent him a full reply to his original letter.
Not surprisingly, the publicity given to Mr. Vidler's statements brought further letters from the public. The hon. Member received a number of further complaints about experiences in the hospital. We in the Ministry, on the other hand, received a number of letters commending the work of the hospital staff. We looked into the further complaints made by the hon. Member's correspondents, and again we could find no evidence of inadequate nursing of patients.
We have always been ready to concede that conditions at St. George's are not as good as we would wish. This is a hospital for old people, and the nursing of old people calls for particularly hard and heavy work. In all geriatric hospitals the average age of the patients is getting higher. At St. George's the average age is nearly 80, and a considerable number of patients are much older. An increasing number are incontinent, some doubly so, a number are inevitably somewhat confused in their minds, and quite a high proportion need help with feeding at every meal. I do not need to elaborate on the devotion that this calls for from the nurses. The hospital buildings are quite attractive but when they were built in the late thirties they were not of course intended for a hospital of this sort. The layout causes the nurses to have a great deal of running 1679 about, more than they would do in many other hospitals. As my hon. Friend said, he knows this hospital which is in his constituency. In addition, the hospital is understaffed, for Hornchurch is an area where there are plenty of competing jobs and efforts to recruit enough nurses have failed.
The hon. Gentleman quite rightly asked whether the shortage of funds was hampering the recruitment of nurses. It is true that we have recently had cause to remind regional hospital boards of the need to keep within their financial allocations but, this could not be relevant to the case of Mrs. Vidler who died last summer. The position is that despite efforts to recruit nurses there has been a staff shortage at this hospital arising from the nature of its work and the amount of competing employment in the area.
Inevitably with such a load the nurses have less time for the patient and sympathetic handling of relatives—this goes to the core of many of the complaints—which is an important function in a hospital like this. Although the hospital is doing good work in getting many sick old people back on their feet, it is a sad, though natural, feature that a number of the patients are coming to the end of their lives and we know that relatives in these circumstances are often distraught and frustrated at their own impotence to do anything for their loved ones.
It is a truism in any hospital that relatives as well as patients are themselves often in need of nursing attention. How very true this is in an old persons' hospital. At St. George's, to make the best use of staff, nursing time is concentrated when it is most needed for active treatment, and this is not during the hours when visitors are expected. There are, therefore, fewer staff on duty during visiting hours and these still have nursing duties for the more seriously ill patients. In these conditions relatives may not always get the careful attention which they ought to have to their inquiries.
This I think goes quite a considerable way to explain the complaints which the hon. Gentleman has received. Complaints about hospital staff are almost inevitably inconclusive. It is rarely possible 1680 to confirm or refute that a certain statement was made or that a nurse took up a certain attitude. I accept that the relatives who have complained are quite sincere in their beliefs, and I am sure that the nursing staff are just as convinced that they were doing their best for their patients. This is a failure of communication, and the first thing we must do to improve it is to increase the staff.
The Regional Hospital Board is at present advertising for a full time geriatrician for the Romford Group. We have not yet got one. He will be engaged for most of his time at St. George's, and he will be able to ensure that the efforts of the hospital are well directed. I am convinced that this appointment will bring great benefit. But shortage of nursing staff is proving very difficult. It is particularly unfortunate that the misleading publicity—I use that term deliberately—about the Vidler case has made matters worse. It is not surprising that people have not come forward to work or to send their daughters to work in a hospital which has been described as "like a prison", particularly when this comment appears in the same context as a letter from me to the hon. Gentleman explaining that we were not satisfied with the hospital—not, I hasten to add, dissatisfied with the staff who work there. In my letter to the hon. Gentleman giving a full reply to Mr. Vidler's complaints I explained this and expressed the hope that I could have his help in removing false impressions.
I am asked what was the nature of the inquiries? Our object has been twofold. First, to look into the difficulties at St. George's, which we had identified before the hon. Gentleman wrote to my right hon. Friend, and also to look into the specific complaints brought to my attention. Officials of my Department have visited the hospital with officials of the Regional Hospital Board and of the Hospital Management Committee. I have already explained the conclusions to which they came about the difficulties of the hospital. In looking at the specific complaints, we have had statements from the hospital staff involved and from the Hospital Management Committee and the Regional Hospital Board.
The hon. Gentleman expressed dissatisfaction with this method of dealing with 1681 complaints, and suggested that it is one-sided. I cannot accept this. Full statements were made by the people who were complaining, and we have had the reply of the staff involved, together with the evaluation of the senior officials of the Management Committee who know their staff. I cannot see that we could have done any better by doing what the hon. Gentleman has suggested from time to time that we should do, that is, interview the complainants. I think it will be obvious from what I have said that there were no grounds for thinking that there was any serious lapse on the part of any individuals, or any need for a formal inquiry.
Our objective throughout has been to find out what was wrong and to put it right. I am convinced that the Board and we have found out what was wrong, and we are now setting about putting it right by trying to recruit more nurses 1682 and by trying to secure the services of a full-time geriatrician. We have also made a number of other suggestions to the Board. But to achieve this object the most urgent thing is to raise the morale of the staff which has been badly lowered by the unfortunate publicity which has been given to them, and then to convince the local community that St. George's is doing devoted work for old people and that they can gain great satisfaction from sharing in this work. The work of a hospital like this sometimes appears to the staff to be thankless. We have a duty to see that it is not misrepresented, and that it receives the recognition that is its due.
§ The Question having been proposed at 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 half-past Ten o'clock.