§ 3.55 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
Although there are other aspects of the National Health Service which we on this side of the Committee are anxious to debate, we have chosen today to debate the hospital service for a number of reasons. First, hospitals account for well over half the total expenditure of the National Health Service, and it is no bad thing for an expenditure of £600 million or more a year to come under scrutiny by the Committee of Supply from time to time. Secondly, there are certain aspects of the hospital service which cause us and people outside the House of Commons considerable anxiety.
Perhaps the main reason why we have selected this subject for debate today in preference to others is the need to examine closely and in depth the Government's Hospital Plan. Therefore, I turn first to the capital development programme, especially in the light of the White Paper entitled A Hospital 643 Plan for England and Wales (Revision to 1973–74), published last month by the Minister of Health.
When the House debated the original Hospital Plan about two years ago, we welcomed it with certain reservations and we made a number of criticisms. Amongst those criticisms were that we said that it was a rushed job and that insufficient research and planning had gone into its preparation. That charge, far from being denied, was accepted by the right hon. Member for Wolverhampton, South-West (Mr. Powell), the then Minister, in his winding-up speech, and indeed he took credit for it. With that characteristically unorthodox approach to these matters that is noteworthy of the right hon. Gentleman, he told us that he thought is absolutely right to publish the plan first and to begin the planning afterwards. We said that the Hospital Plan was largely based on guesswork. As events have turned out, it appears that that was the understatement of this Parliament. All the indications now show that the Plan has run into serious trouble within its first two years.
I should say at this stage that we on this side do not regard a programme for the modernisation of our hospital system as a boon which is graciously bestowed upon the public by a generous Government. We prefer to regard it rather as a belated act of restitution for the long years of neglect—12 years, for example, in which the Government built four hospitals in England and Wales, 12 years in which this country fell behind almost every other country in the Western world in the building of new hospitals. In our view, it was about time that we got down to the job of modernising our network of out-of-date hospitals. It is in that spirit that we approach the right hon. Gentleman's proposals and that I intend to subject them to criticism.
I should begin by reminding the Committee of the original prospectus, which I am inclined to describe as a false one in the light of subsequent events. We were to have a ten-year plan covering the years 1961–1970. This was produced as a White Paper which listed projects to be started in two five-year periods, the quinquennia 1961–65 and 1966–70. The capital expenditure for 644 the ten-year period was estimated at £200 million for the first five years and £300 million for the second five years, it is understandable that the figure for the second five years would be the larger, because a programme of this size would inevitably take some time in getting under way. The Write Paper also set out in Appendix C the Government's estimate of the ultimate cost of the completed projects. They estimated it at a fairly precise figure of £707½ million.
The first mystery arose very early in the proceedings. During his winding up speech in the first debate, the Minister, the right hon. Member for Wolverhampton, South-West, produced, quite out of the blue and with no explanation, a new total figure of £800 million. Thus we had an increase of nearly £100 million only four months after the plan had originally been published.
There was, of course, a great deal of emphasis that this was a flexible plan, that it would be subject to annual revision and that at each annual revision the plan would be carried forward one further year. It was always to be a ten-year plan, ten years from the current year. The first revision of the plan was published in April 1963, and that covered not one but two years, because the first year of the Hospital Plan was practically over before the plan was published, since it started from 1961–62. This first revision, therefore, carried the plan on to 1972–73. I am sorry about all these figures and years, but it is very necessary to give them in order to show the picture accurately.
This first White Paper was not a very informative document, but it contained two points of interest. First, it announced something approaching a crash programme for additional maternity beds, which represented an admission on the part of the Government that there had been a serious under-provision in the original plan. But they hastily placed the blame very squarely on the shoulders of the Registrar-General for having made too low an estimate of the number of births which could be expected in the year 1975.
The second point of interest was that the ten-year cost had risen from £500 million to £600 million. I should explain 645 that we could expect some modest increase each year as we moved out of the first quinquennium into the second, but this could not be expected of its own account to be more than £20 million a year, so that we have an increase of £100 million, and not the £40 million or less which we might have expected. The 1963 revision also listed some new projects which were added to the plan to cover the extra two years which were then tacked on to the end of the original period.
I come to this year's revision, which carries the plan forward another year to 1973 and which is contained in a White Paper published by the Minister last month. This document is not merely uninformative. It is, I think, misleading to the point of dishonesty. It is obscure—and it is deliberately obscure; and it is deliberately obscure because it has something to conceal.
First, we notice that the ten-year cost has again risen, not £20 million as we might have expected but a further £150 million to £750 million. It will now be £300 million in the first five years and £450 million in the second five years. We are also told how much has been spent in the first three years of the original plan. If we add this expenditure, we reach a total figure of £867 million in only 13 years—in other words, it would represent a total of over £1,000 million for the 15 years for the completion of the original scheme against an estimate of £707 million.
The House might think that this was a fairly serious piece of under-estimating, to the tune of about 50 per cent. But this, I am afraid, is only part of the story, because in order to contain the expenditure on the Hospital Plan as it now stands even within the vastly increased figure, dozens and probably a hundred or more projects for new hospitals and major redevelopment schemes which were included in the original plan have had to be postponed to the mid-1970s or else eliminated altogether. The promised starts of many of those projects have been deferred four, five or even six years.
§ Mr. Robinson
They have indeed.
646 We are entitled to ask: what went wrong? It is not that building costs have risen in the last two years to any appreciable extent. I can only think that the explanation is that the right hon. Gentleman, or rather his predecessor, had no idea at all what it costs to build a new hospital today. After all, why should he? They built only four hospitals in 12 years, and for the most part those were not the type of hospital envisaged in the plan.
If the right hon. Member for Wolverhampton, South-West had not been in such a tearing hurry to produce this plan and to collect the sorely-needed political kudos for the Government and his party, he might have had time to find out how much a hospital was likely to cost. I cannot resist quoting one phrase which he used in the debate two years ago when he was describing his Department's function in preparing a plan of this kind. He described this function as giving to the planconsistency of policy as well as financial practicability"—[OFFICIAL REPORT, 4th June, 1962; Vol. 661, c. 152.]Almost from the moment that that remark was uttered the chickens began coming home to roost.
I want to ask one more question of the Minister, and then I hope that I shall almost have finished with figures. I should like to ask him what is the extent in monetary terms of the cuts in the ten-year plan which have become necessary to keep it within even this greatly increased financial commitment. I understand that the Minister does not propose to follow me in the debate, that the Secretary of State will speak next and that the Minister will wind up the debate. He will, therefore, have plenty of lime to prepare the answers to the questions which I am putting to him and to produce the evidence to rebut the charges which I am making and shall make. But I have noticed in earlier debates that Ministers winding up do not necessarily answer all the questions which have been asked from the Opposition benches. I have therefore made my own calculations for these figures, based on such evidence as I have been able to gather.
The position is this: now that more realistic costings are at last being made 647 by the Minister, each hospital authority has been given an annual allocation of money right to the end of the period, which is the amount which, all things being equal, they can expect to receive. The hospital authorities—the regional boards and the boards of governors-have also estimated the total expenditure year by year of the schemes which they were hoping to initiate—schemes which have been approved by the Minister, at any rate to the end of last year, and have been included in the ten-year plan. The difference between the two sets of figures represents the excess expenditure which has somehow had to be pruned away. As I have shown, the only way in which one can prune away expenditure of this kind is by cutting out whole major schemes in the programme and deferring them beyond the end of the current ten-year period, to the mid-seventies or beyond that, or by eliminating them altogether.
I have these figures for three regional hospital boards, and I have added them together. It appears that for these three the aggregate sum needed for the ten years in order to carry out what, after all, was the Minister's plan, would have been £177 million. They are now promised, over the ten-year period, £101 million—a deficiency of no less than £76 million. There are 15 regional boards in England and Wales, plus the boards of governors of the teaching hospitals, which I have left out of my calculations. My figures are, therefore, if anything, on the low side.
The three regional boards for which I have figures represent a competely random selection—I have no reason to believe that they are anything but typical.. My calculation, therefore, suggests that the total deficiency for England and Wales as a whole is likely to be about five times the figure I have quoted—about £380 million at least. If we add that to the extra money that the right hon. Gentleman and his predecessor have been forced to provide even for the truncated programme, we get a total deficiency in the original estimate of nearly £600 million—on an original figure of £700 million. In other words, due mainly to what we can only assume to be incompetent costing and estimating, and I put it as charitably 648 as I can, the Hospital Plan will cost very nearly double what we were told at the time.
In the light of what I have just disclosed, I should like the Committee to look again at the recent White Paper. Does it contain any mention of massive cuts of postponements? Not a hint—well, perhaps just a hint. There is one sentence that I should like to read to the Committee:An alteration of the timing of some schemes has followed because many of the schemes projected have now increased in scope and cost.The alteration of the timing of some schemes being about £380 million of schemes pushed off the end of the ten-year period—
§ Mr. Robinson
At the same time, with a change in priorities, Hospital Boards have been authorised to plan more schemes.I shall deal with that in a moment. I can assure the noble Lord that I shall not dodge anything.
The White Paper lists only those schemes due to start in the first five years of the ten-year period. It omits all reference to the schemes in the second ten years, which is where the main cuts have come. Nothing is said about them at all. Instead of an honest admission that the plan had had to be drastically cut, instead of explaining that the ten-year plan would now take something like twenty years to achieve and cost about twice as much, we have this elaborate attempt to conceal the truth. Where is this "straight talk" we hear so much about from the Prime Minister?
The smokescreen that this document throws up becomes still more intense when one looks at Appendix II, which is the appendix that purports to list new schemes included in the plan for the first time. They are, in fact, mainly developments that were included in the original plan, published two years ago, to start after 1970, or schemes for the 'seventies which replace schemes that should be starting now.
I should like to give the Committee an example. I simply take the last two regions listed in the White Paper—the Liverpool Board and the Welsh Board. 649 All that Liverpool gets in these additional schemes is the promise of two district hospitals starting after 1974, in place of two developments that were due to start in the period 1965–69, and which are now cancelled. There does not seem to be a great advantage to Liverpool there. Wales is even worse off. Wales simply gets a promise of a hospital at some unspecified date in the distant future to replace another scheme that should already have started but is now cancelled. Those are not additions; if anything, they are subtractions. This is a shocking document, and something of which the Minister should be ashamed.
Almost the only people who are not deceived by it are the hospital authorities themselves. They know what the facts are, and they know that once again their plans, into which they have put so much, have been frustrated—plans that were encouraged and endorsed by the Minister of Health. Hospital planning committees are disappointed and angry at this outcome. I should like at this stage to pay my tribute to the regional boards for the way in which they have met the challenge contained in the original plan, building up their technical and planning departments, and their architectural and design staffs to meet it. Now they are faced with the frustration of so much that they planned for and hoped for.
In addition, there are some rather tricky consequential problems arising out of this decision to postpone so many schemes; problems involving still more expenditure, or, alternatively, a steady lowering of standards in many existing hospitals. I should like to quote from the leading article of the Hospital, a very well-informed journal. It states:… the prolongation of rebuilding is likely to increase the demand for patching up. What might have been endurable until a new building was available in 1970 may well seem impossible if it has to last five years more.That, of course, is what will happen.
When the Hospital Plan was first decided on and the consequential policy decisions taken, many of us in the hospital world were rather worried about the way in which maintenance was being cut down in anticipation of the new hospitals. As this journal says, one was prepared to tolerate a certain amount, but if these massive postponements are 650 to take place, we simply cannot keep some of the hospitals maintained at the same low standard, deteriorating for some ten or twelve years more.
What does it all mean? It means, on present form, that substantially less will be accomplished in thirteen years than was promised in ten, and at a far greater cost. Nor is; there any evidence that this process of attenuation is yet finished—at least as long as the party opposite is in control of the hospital services. This is what happens when a Government which do not believe in planning—and if it is true of this Government it was doubly true of the right hon. Member for Wolverhampton, South-West—purport to plan. [An HON MEMBER: "Where is he?"] I mentioned to the right hon. Gentleman that I would have to refer to him on a number of occasions in this speech, and he told me that he quite understood but could not be present at this debate. I make no complaint about that, of course.
This is what happens when anti-planners purport to plan. It is an example of what, in another context, the Guardian called "playing at planning". I believe that it is also an example of what would happen to many of the other lavish promises—pre-election promises—of development, involving things like universities, schools and roads that we have heard so much about in the last few months, if this Government were returned to office at the General Election.
What should the right hon. Gentleman do now? Of course, he has not very much time left, but the least he can do is to publish without delay a new White Paper showing clearly what projects are still going ahead in the first and second quinquennia, with up-to-date estimated costs, and also showing what schemes in the original plan have been cancelled, or deferred—and for how long—and what schemes added. Then we should at least know where we stood. We are entitled to demand that for the Minister, and we are entitled to demand that he should do this without any delay at all.
The Committee is entitled to ask what a Labour Government would do in this situation. It is difficult to answer that question in precise terms without access to the voluminous mass of detailed information which only the Minister and his Department have in their possession, 651 but I am very prepared to answer the question in general terms. Obviously, schemes that are under way or immediately about to start would have to go on. Beyond that, and particularly for the whole of the second quinquennium, we should take a long and hard look at the entire programme in concert with the hospital authorities.
In doing so, we should want to ensure a number of things. First of all, we should want to ensure that we are getting the right type and size of hospitals in the right places. I very much doubt whether sufficient attention has yet been paid to population changes which are likely to take place in the future. For example, to what extent has the South-East Study been taken into account by the right hon. Gentleman's Department?
Secondly, we would want to ensure that we have our priorities right. That would involve a good deal more research than has already been done into needs. I believe, for example, that the plan still seriously underestimates the need for geriatric beds, just as the local authority health and welfare plan was deficient in plans for accommodation, and indeed in all services, for old people.
I believe that there is a need to reconsider the whole of the psychiatric planning content of the Plan. More and more evidence is coming forward that the previous Minister's estimate of the bed needs for the mentally ill was far too optimistic. This may be a disappointment, but it is the way the evidence is pointing. I understand that one regional hospital board has carried out a statistical survey for its whole region which indicates that it will probably need rather more psychiatric beds in 1975 than it has now, instead of a reduction of nearly half, which is the estimate on which the Hospital Plan is based. I also think that we may well need more accommodation for the sub-normal.
Thirdly, we should wish to ensure that we are getting proper value for the enormous expenditure of public money involved in the plan, and we would see whether we could not bring about further economies in building costs without lowering standards. I cannot see why hospital building must always be the most expensive kind of building and 652 pretty nearly the slowest. I do not believe it need be.
Lastly, we should certainly try to speed up the programme to the limit of the technical resources available in planning and construction. I believe that if that proved possible the financial resources would be forthcoming to meet an accelerated programme.
We should hope that the whole review operation could be carried out without any hiatus in the forward progress of new constructions, but since one would be shaping the whole future pattern of the hospital service, we should take every step necessary to ensure that no further avoidable blunders were made.
§ Mr. R. H. Turton (Thirsk and Malton)
The hon. Gentleman must realise that by having the review he will put back the whole programme and give uncertainty to every regional hospital board and hospital management committee.
§ Mr. Robinson
That is exactly what I have said we should hope to avoid doing. The plans which are going forward, and which are at the end of the planning stage, and the projects which are ready to start would start. One would carry on the review as far as possible while starts were continuing. All I am saying is that if it became necessary, in order to get the right answer, to have a hiatus in starts, we would not shy away from that, because we should be determined to get this right. There is nothing more important in the whole hospital service than this.
When we debated the plan originally two years ago a good deal of concern was expressed from this side of the House that relatively little attention had been paid to the whole question of hospital staffing. We all know that bricks and mortar, even if they contain the most elaborate and expensive equipment, cannot cure patients without the skill of doctors and nurses. We drew attention to the shortages of every kind of hospital staff and criticised the absence of any plans to remedy these shortages. As far as I can discover, the situation in general is no better now than it was then. It is not because we are in any way satisfied with the position about nurses, physiotherapists, radiographers and many other categories that I propose 653 to limit my remarks under this heading to one critical sector, the most vital sector of all—medical staffing.
It seems to me on the best statistical evidence that I can get that over the whole medical field we are hardly keeping our head above water. In other words, the number of doctors entering practice each year barely equals the annual wastage due to death, retirement and net emigration of doctors. But, even supposing that those two figures are in balance, we should still be failing to keep pace with the needs of a rising population. That is bad enough, but where hospitals are concerned, there are two additional factors which make the outlook pretty desperate.
The first is that there is already serious understaffing in almost all non-teaching hospitals. It is worse in the provinces and, in particular, in the hospitals in the north of England. One consequence is that we have intolerably long waiting lists in many hospitals. This medical under-staffing exists at both senior and junior levels. At this stage I want to inquire about the Platt Review. The Platt Working Party on Hospital Medical Staffing reported to the right hon. Gentleman's predecessor three and a half years ago. The Report called for an urgent review by hospital authorities of their medical staffing requirements. A review was put in hand, and I believe that the results, apart from one or two stragglers, were in the right hon. Gentleman's Department at least a year ago. I know that there were one or two teaching hospitals which were a bit slow. However, the Minister told one of my hon. Friends in a Parliamentary reply that this was not holding up the general review.
Why are we still waiting for the Minister's conclusions and recommendations? The Secretary of State for Scotland published his review four months ago. Why are we still waiting for the English review? Is it because the implications of it in terms of additional consultant posts and supporting medical staff are too alarming? Is the publication being deliberately delayed until the House rises for the Summer Recess or even perhaps until after the General Election? Perhaps the right hon. Gentleman will tell us, and perhaps he will deny, if he can, that there will be a demand for a very large increase in hospital doctors of all grades, a demand which cannot be met.
654 The second special factor which affects the hospitals is the difficult, thorny problem, which has been raised many times in the House, of those junior hospital posts which are filled by overseas doctors, mainly from India and Pakistan, doctors who are ostensibly undergoing postgraduate training. I believe that more than 40 per cent. of our junior posts are filled by such overseas doctors, and this must mean well over 60 per cent. of those posts in hospitals outside the Metropolitan area and the teaching hospitals.
I have never felt this to be a very satisfactory situation. Though, of course, we welcome these doctors in our hospitals, and we have by tradition for a long time offered postgraduate facilities for them, I believe it is wrong that we should have to rely on them as we do to staff the hospitals. There are in many cases language difficulties, and between patient and doctor language difficulties can often spell danger.
Another thing that worries me is that few of these doctors get any postgraduate training in any formal sense since they have to be used as pairs of hands. Instead of training, they get, of course, experience of a kind. Why do they come here? They come because when they return to their own country they tend to get preference for those senior hospital appointments which are available solely by reason of having undergone postgraduate instruction in Great Britain. My information is—I should like the right hon. Gentleman to confirm this; I should, in fact, prefer him to be able to deny it—that this may not happen very much longer, that: this supply may well dry up in the fairly near future, and quite suddenly. If so, it will be with incalculable effect on the staffing problems of many provincial hospitals.
Quite apart from the needs of general practice—and those needs are no less clamant than those of the hospitals—it is clear that these two special factors alone are likely to make demands on our medical manpower which we cannot possibly meet from current resources. I want to ask the Minister what he proposes to do about this. In the short term, there is simply no solution that I can envisage. Thanks to another failure in planning and a complete lack of foresight on the part of the party opposite, we shall simply have to face the shortage of doctors over 655 the next few years. It is a shortage that is bound to be acute and can, perhaps, be dangerous. I believe that we might do something to mitigate that shortage to some extent in the hospitals by a greater emphasis on whole-time staff and less on part-time staff. But this could have no more than a marginal effect in the short term. In the long term, we simply have to train more doctors and keep more of them in Britain in the National Health Service than we do at the moment.
What is the Government's answer to this?—one new medical school, which I understand is to be in Nottingham, although we have not yet had any official announcement, and to cram a few more desks into the existing crowded medical schools. That we regard as a totally inadequate answer to the problem. A Labour Government would start by establishing at least four new medical schools, but, of course, it will be ten years before the fruits of new medical schools will come in to swell the ranks of the doctors practising in the National Health Service.
I am conscious of the fact that my speech has been somewhat arid, considering the essential human nature of the subject that we are discussing, but it was necessary that these things should be said and the facts put on record, and that the Government's failures, which have been so painstakingly concealed, should be exposed. This is all the more essential since it is likely that after October a Government of a different complexion and a new Minister will inherit these daunting problems—problems which this Government have utterly failed to solve and in some cases have assisted in creating.
It is important that the public should know where the responsibility lies. After all, the party opposite have sought to extract the last ounce of party political capital out of their Hospital Plan and by means of T.V., and radio broadcasts, posters, and Press advertisements and with the right hon. Gentleman's handsome features staring at us over our breakfast tables. It is time that the public had a glimpse at least of the chaotic muddle that lies behind this political window dressing.
§ Mr. Percy Browne (Torrington)
I think that we might get the record 656 straight. The hon. Gentleman has talked a considerable amount of nonsense. I would refer him to the end of the second paragraph on page 13 of the Hospital Plan for England and Wales and read this sentence to him:Moreover, the present tentative estimates of the cost of the schemes in the programme may have to be modified considerably when the detailed schedules of accommodation come to be prepared.The hon. Gentleman did not mention that at all.
§ Mr. Robinson
If the hon. Member thinks that an increase from £700 million to £1,300 million is a modification, then clearly we have different ideas about the use of language. In that case, why was the total cost estimated so precisely at £707½ million?
I want to turn to the more human aspects of the hospital problem. I refer to the way that hospitals treat patients as persons, as individuals, and this is a field where there is much still to be desired. I have spoken many times about this problem both inside and outside the Committee, and so, to do him credit, has the right hon. Gentleman's predecessor. Indeed, I think that he was the first Tory Minister of Health to admit that there was a problem here at all.
This is a service for people. It is a service in which the interest of the patient ought to be paramount at all times. People who are ill are especially vulnerable and need to be treated with more and not less consideration on that account. There are too many failures here, and they are failures that arise not out of unkindness but from thoughtlessness, lack of imagination, and through inefficiency and bad organisation more often than not. They are things that are remediable, and no one can say that guidance has been lacking.
I am very willing to pay my tribute to a whole series of admirable Reports which have been circulated by the Minister to hospital authorities dealing with different aspects of this problem—Reports such as the Platt Report on Children in Hospitals, the Pattern of the In-Patients' Day, Communications between Doctors, Nurses and Patients, all excellent Reports. I should like to congratulate the various Committees that produced them. They have had some 657 attention, but it seems to me that just where the changes are most needed they have had the least effect and progress on the front as a whole has been painfully slow.
I have no time to elaborate the kind of practices and habits of mind which I myself and I am sure the Minister would like to see eliminated. I shall briefly list a few: There are the ward routines which pay little regard to the patients' convenience and comfort. There is the excessive and unnecessary waiting in out-patients' departments. There is the unnecessary restriction of visiting hours, which comes, I think, of regarding visitors as a hostile force. There is the acceptance of a rigid hierarchy in the hospitals, with the consultant at the top and the patient at the bottom. There is the routine withholding from the patient of information about his condition. There is, all too often, a sharp difference of attitude towards public and private patients. We still get too much early waking, although I am glad to think that more and more hospitals are waking their patients at a reasonably civilized hour. Lastly, I would mention the nonsensical ritual that precedes the consultant's ward rounds. One could add many more.
I doubt if this whole question of human relations in hospitals has been better dealt with than in a Penguin book, published a few weeks ago, called What's Wrong With Hospitals?, by Gerda Cohen, whom, I hasten to add, incidentally, I have never met. I hope that the Minister has read this book and, if he has not, that he will remedy the omission. It was a book which was provoked in the first place by personal experience as a patient, but it was certainly founded on very extensive research and study in a number of hospitals. I think that for doctors, nurses, administrators and members of hospital boards and committees it should be essential reading. It will infuriate some people perhaps, because it is broadly true and well-aimed. One doctor, in a Sunday paper, reviewing it somewhat unfavourably said that if he were a patient he would like a hospital to be efficient rather than kind. That in my view is an utterly false antithesis. I do not believe that we can have efficiency without kindness and understanding of the 658 patient's needs. This is not a frill; it is part of the therapeutic process.
This book, the emergence of the Patients' Association, and one or two other bodies of similar character, are more bits of evidence that the patient is at last beginning to have a voice, and although this is, in a sense, a criticism of the hospital service, it is a development that I warmly welcome.
I believe that there is still a great deal to be done and that the pressure must continue. Outdated attitudes towards patients—vestiges of the old poor law hospitals—have no place in the National Health Service as Aneurin Bevan conceived it, nor as we conceive it today. We shall find ways to get rid of them, ways that seem to have eluded this Government.
The National Health Service, for nearly 13 of its 16 years of existence has been under the control of a party which bitterly opposed its creation in the first place and has never become wholly reconciled to it. That, I think, is the explanation of much that is not right with the Service today, and that, in turn, may also be one reason at least why the Government's time is very nearly up.
§ 4.41 p.m.
§ The Secretary of State for Scotland (Mr. Michael Noble)
I am glad to have the opportunity of following the hon. Member for St. Pancras, North (Mr. K. Robinson). I thank him for his courtesy in suggesting that my right hon. Friend the Minister of Health would have more time than me to study the series of figures he gave and to deal with them in replying to the debate, because I have often in this Committee noticed how figures can be bandied from one side to the other without meeting in any very convenient or obviously sensible form.
The Committee will agree that it was clearly recognised in the original plans that they represented only the first instalment of long-term planning of the hospital services, and that, indeed, the programme would have to grow from year to year. Indeed, it was clear from the start that, after years when relatively few large schemes had been undertaken, hospital building could not be stepped up overnight to the level that was needed and the level that the Government were determined to achieve.
659 At this point, may I say that if the country has the misfortune later this year to be governed by a different Administration, at least hon. Members opposite will not find themselves in the position that my predecessors found themselves in in 1951 when there were no plans and no arrangements made for these purposes.
The fact of the matter is that, in bringing forward plans of this sort, staff have had to be recruited for the difficult and complex planning work that has had to be done. I shall be showing later in my speech what we are doing at the moment. As the programme has grown and we have carried forward the ten-year period, we have been able to plan for further increases, as shown by the figures quoted, even by the hon. Member.
Much has been made of the fact that a number of the schemes listed in the original plans have now been deferred. It has even been suggested that less work is now being done than the Government originally intended. The fact is that the total amount of building work being done has in no way been reduced. As building costs have risen, we have increased the allocation of funds to the programme to the full extent required to keep pace. It is true that there have been changes in the plans, as was anticipated when they were published. Some are the result of a reassessment of priorities. In some cases, reconsideration of how best to meet the changing hospital needs of an area has led to decisions to defer schemes or bring new ones into the programme, and this process will go on. Factors like the movement of population must be taken into account.
There have, of course, been real increases in the estimated cost of some of the schemes, and this, in most cases, is because the scope of particular schemes has been reconsidered. Where, for example, an out-patient department was proposed and estimated for in the original plan, a closer assessment of need in the process of detailed planning has sometimes shown that a bigger out-patient department would be preferable, or that it would at once be more useful and more economic to provide an out-patient department and an accident department together.
Again, as the Committee knows, there have been the most significant advances in 660 surgical technique in the last few years. Some of these new techniques make no special demand on theatre accommodation and call for only simple equipment. Others, however, call for elaborate supporting facilities and necessitate lengthy sessions in the theatre. Others, again, make possible new forms of treatment which have not been attempted before.
All this adds up to a need for more ancillary accommodation and for more theatres in total in the modern genera] hospital. These examples show, I think fairly, how schemes can change in content and increase in scope as they move through the normal stages of planning, and the earlier estimates of scale and cost have, therefore, to be revised.
This explains why it will not be possible within the time-scale of the original plans to start all the projects there listed. It is the necessary enlargement of some projects in the programme that has had the effect of deferring others. I think that the Committee generally will agree that, in this matter, we are pursuing the right course and that it would have been quite wrong to restrict the scope of particular schemes to the proposals which held the field in 1961 when the Hospital Plans were being prepared.
It is clearly essential that we should make the best possible use of the resources which can be made available for hospital building, both for the success of the plan itself and for the sake of the investment programme as a whole. Here, we are concerned to improve our administrative and planning procedures and are seeking to ensure that hospital authorities and architects concerned with hospital planning have the best guidance possible about functional requirements and about possible solutions to the many complex problems that hospital planning presents.
In recent years great changes have occurred in medical and nursing techniques, in methods of diagnosis and treatment and in morbidity. Thus, the needs of hospitals today are very different in many aspects, particularly in patient care and in diagnosis, from those provided in the past. I am certain that, however well we or hon. Members opposite plan, these sorts of changes will continue as long as medical science advances.
§ Dr. J. Dickson Mabon (Greenock)
The right hon. Gentleman is making a fair point, but he said at the beginning that building costs had risen and then that the programme had been revised because of changing scope and other reasons. My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) has suggested that building costs have not risen all that much. Can we have some concrete figures to show the proportions involved here?
§ Mr. Noble
The increase in real terms is of the order of £160 million.
Before the process of design of a particular hospital building can be begun, it is essential to establish clearly in the light of modern conditions the needs it will require to meet so far as they can reasonably be foreseen. The two Health Departments have, therefore, prepared codes of practice for the planning and design of hospital buildings so that all hospital planning is conducted on a common basis. The content and functioning of all the main parts of the hospital are now described in building notes and planning notes published by the Health Departments. These notes also set up a cost target system, which is a radical departure from the old conception of a hospital as a building which was first designed and then costed. Nowadays, we treat a hospital as a functional unit with requirements to be met within a building for which a target cost can be set.
Alongside these building and planning notes, equipment notes are being published to help the planners in deciding the amount and the cost of the equipment which is needed. These notes, in the main, are based on the best current practice known to us today, but this is clearly not enough, however satisfactory the standards may be to meet current needs. Over and above this, the Ministry of Health and the Scottish Home and Health Department are devoting considerable resources to research and development work in hospital building and engineering, with the object of producing better solutions to the problems of hospital design. Development projects based on a new approach to the design of hospital outpatient and accident departments, kitchens and dining rooms and hospital wards are being carried out at Liverpool, Kingston and Falkirk. The 662 Ministry of Health has a project at Greenwich for a complete district general hospital which will introduce some radical new ideas in hospital design.
If all the work is to be done within the period allotted to the hospital programme, it is essential that the building industry should make use of the best modern techniques of building and management. Of these techniques, perhaps the most potentially useful is industrialised building. The Ministry and my Department have organised upwards of 20 study groups, including hospital and private consultant architects, engineers and quantity surveyors. Each group is studying either a particular building or engineering component or a particular aspect of management. The object is ultimately to base hospital building on a range of standardised components, prefabricated so that site work is essentially a matter of assembly and finishing. In this way I hope that we can come to the end of the period when hospital building is always more expensive and slow than any other form of building, and we are—and have been—extremely active in this respect.
Sir Barnett Stress (Stoke-on-Trent, Central)
Would the right hon Gentleman give an assurance to the Committee, which he has given outside the House of Commons, that industrialised building techniques will in no case mean a lowering of standards?
§ Mr. Noble
Yes, I shall be very glad to give that assurance, because this is the "basic factor in the acceptance of industrialised building, not only in hospitals but every other form of building.
The reports of many of these groups will be published within the next few months, and it ought then to be possible to consider the bulk manufacture and supply of the ranges of components involved. "We are also making a considerable effort to achieve greater standardisation of equipment, particularly non-medical equipment, and the Ministry of Health and my Department have a series of groups at work on this. The groups are already examining furniture of various kinds, textiles, crockery, paint and so on.
Before I leave the Hospital Plan, I should like to place on record some of 663 the facts about the progress of the building programme. Sometimes when listening to the criticisms which are made, one almost gets the impression that nothing is happening. In fact, this year we are spending £66 million on hospital building. The picture is that from Wick in the north all the way down to West Cornwall a great variety of hospital projects is under way, and some of them have already been completed. Since 1951, the Government have spent more than £300 million on hospital building and there are now very few hospitals indeed at which there have not been some improvements in the last 13 years. [Interruption.] Not a great deal was done in the six years before. I am merely stating the facts.
§ Mr. Noble
In concentrating on major new schemes, as we all tend to do, we must not lose sight of the immense amount of building work done in our existing hospitals, to the very great benefit of patients and staff. The major new schemes are the most obvious feature in any hospital building programme. If they wish to see the kind of thing which has been achieved, hon. Members opposite might well pay a visit to Bellshill in Lanarkshire, or Yorkhill in Glasgow, where two great new maternity hospitals are now in use.
§ Miss Margaret Herbison (Lanarkshire, North)
While the right hon. Gentleman is giving such advice, would he also advise hon. Members to visit not only Bellshill but Stonehouse Hospital, in Lanarkshire?
§ Mr. Noble
I am certain that there are many hospitals which it would profit hon. Members to visit, both to see how well certain things are done in the new hospitals, and how much remains to be done. I am making no attempt to hide either; I am merely trying to balance the picture.
I come now to the maternity services. Improvement in the scale and quality of maternity accommodation is one of the main objectives of the hospital building programme. By new building and, where practicable, by conversion of existing buildings, we are overtaking the 664 deficiencies. Throughout the country, there is visible proof of our endeavours to improve these maternity services. The level of staffing in maternity hospitals and units has also improved steadily throughout the country. Improvements in pay and conditions of service over the last year should help to maintain and enhance recruitment.
My right hon. Friend has recently made a personal appeal to non-practising midwives to return to hospital or domicilary practice. We in Scotland are perhaps a little more fortunate in being better placed for staff: We have not felt to so great an extent the increase in the birth rate which has taken place in England, and I have therefore decided to leave the field open to my right hon. Friend at the moment, and I hope very much that his appeal will be successful.
The Montgomery Committee told us that in its estimation lying-in beds should be provided for 70 to 75 per cent. of the total births in Scotland. In 1962, the hospital confinement rate for Scotland as a whole was 77 per cent., and the provisional figure for 1963 is 79 per cent. My right hon. Friend has an immediate objective of a 70 per cent. hospital confinement rate and this has already been exceeded in some areas, including London.
§ Mr. John Robertson (Paisley)
Would the right hon. Gentleman explain these figures? Does the 1963 figure include the figure of 40 per cent. in my own constituency?
§ Mr. Noble
The figures I have given are on exactly the same basis as that suggested by the Montgomery Committee. I know that giving an overall average for Scotland of 79 per cent. conceals the fact that many individual areas are below it. but I think that the whole Committee will agree that the overall average is very satisfactory.
§ Dr. Mabon
I am sure that the right hon. Gentleman does not want to mislead us. Is it not the case that in the Western Regional Hospital Board area, which covers a large industrial part of Scotland, it will be many years before the Montgomery provisions about maternity beds can be implemented? Would he be kind enough to tell us when the Western Regional Hospital Board will be able to provide these maternity beds?
§ Mr. Noble
Without notice, I could not give the hon. Gentleman the exact date, but I will try to find out from the Western Regional Hospital Board and let the hon. Member know as soon as possible. I realise that there are problems, but I am not ashamed of the fact that in Scotland on average we are above the recommendations of the Montgomery Committee.
Though we have had less pressure than England from the rising birth rate, we have had to face a problem of a different kind. It is a feature of the social history of the two countries that the perinatal and infant mortality rates have consistently been less favourable in Scotland than in England, and it is therefore particularly satisfactory that we have been able to achieve the higher rates of hospital confinement now obtaining in Scotland.
Let me try to anticipate some of the criticisms that are likely to be made in certain quarters of our efforts in Scotland. I recognise that the Montgomery standards have not as yet been achieved in certain areas of the country, and that ante-natal provision is not yet on a desirable scale everywhere. We and the regional hospital boards are fully aware of these short-comings, and it is our intention to remedy them as quickly as we can. The revisions of the Hospital Plans for Scotland and for England and Wales contain specific proposals for further substantial additions to maternity beds over the next few years. The considerable achievement which we have behind us is a token of our intention to make further progress, and clear proof that the needs of the maternity services are not likely to be forgotten when decisions are being made on the many competing claims that come before us.
Perhaps I might now say a word or two about doctors. I know that my right hon. Friend wants to add some points on this matter in his winding up speech. As the hon. Member for St. Pancras, North said, it is crucial to the development of the hospital service that the pattern of medical staffing should be right, and it was for that reason that the joint working party on Medical Staffing Structures in the Hospital Service was set up under the chairmanship of Sir Robert Platt. The Working Party reported in 1961 on the desirable future pattern. In order to 666 plan the implementation of the working party's proposals, all hospital boards in England and Wales were invited to carry out a thorough review of their medical establishments and to present detailed plans for the next five years.
The Platt Report recommended an increase in the number of consultants. It also recommended that a new intermediate grade should be established in the hospital service to work under consultant supervision. In Scotland we proceeded rather differently. We set up a committee under the chairmanship of Dr. J. H. Wright to review the medical staffing structure throughout Scotland. This Committee reported last year. Besides making detailed recommendations on how the specialist services in Scottish hospitals should be organised, the Committee recommended increases in both consultant and supporting staff. It also underlined the Platt Committee recommendation of a new intermediate grade, the "medical assistant" grade.
The Wright Report and the proposals from regional boards in England and Wales are being examined in consultation with representatives of the profession. My right hon. Friend and I hope that these discussions, together with those on the proposed new grade, will soon be brought to a conclusion.
These discussions do not mean that action in approving additional consultant posts is being held up. Since December 1961 my right hon. Friend has approved an additional 344 consultant posts in England and Wales in terms of whole-time equivalents. Over the same period, in Scotland I have approved an additional 73 posts.
Now I turn for a moment to nurses, because it is not only the medical staffing structure which has been engaging our attention. Last year my right hon. Friend and I set up a Committee under the chairmanship of Mr. Brian Salmon to advise on the senior nursing staff structure in the hospital service, the administrative functions of the various grades, and the methods of preparing staff to occupy them.
The report of this Committee, which is expected next year, is likely to be important for the future development of the nursing service in our hospitals. In spite of local shortages, on the whole 667 recruitment has been good, and the number of nursing staff in the hospital service continues to rise. At the end of September, 1963, there were more than 72,000 nurses in training for a nursing qualification, which was about 12,500 more than ten years ago.
§ Mr. Eric Lubbock (Orpington)
Will the right hon. Gentleman give separate figures for State-enrolled nurses?
§ Mr. Noble
Not without notice, but perhaps my right hon. Friend will be able to give the hon. Gentleman the information that he requires.
Today hospitals employ 7,200 more whole-time and 13,000 more part-time qualified nurses than they did in 1953. The increase in part-time nurses is particularly gratifying. In these days of earlier marriage, it is important that the nurses leaving on marriage should not be lost to the profession for ever.
How many nurses do we need? This question is, if anything, even more difficult to answer for nurses than for doctors. It is fairly easy to establish that in a given hospital so many additional doctors are needed in a particular speciality. In nursing, there are no general standards against which one can measure the need for nursing staff. So much depends on the way in which nursing resources are deployed in the various departments of the hospitals. My right hon. Friend and I are therefore aiming to develop as soon as possible objective methods of assessing the content of nursing work and the number and grades of staff required to do it in the different types and sizes of wards and departments. Studies for this purpose, involving the co-operation of more than 100 hospitals, are at present in hand.
The capacity of the hospital service to rise to an emergency is well illustrated by the way in which the hospital service in Aberdeen has coped with the large influx of typhoid patients. As I have mentioned typhoid, the House may be pleased to know that only eight extra cases have been announced from Aberdeen this afternoon. Although there are only 239 beds in the City Hospital, which is the main infectious diseases hospital for the region, the hospital services in Aberdeen have been able to accommodate all the patients from their own resources. Two hundred and four of the beds at the 668 City Hospital have been allocated to deal with the outbreak, and a further 420 beds have been found in other hospitals, making a total of 624 beds available to deal with it.
Naturally, this redeployment of beds has not been achieved without some cost. It has been necessary to defer the admission of non-urgent cases to hospitals within the city, and to send home some convalescent patients earlier than would normally have been the case. The hospital authorities are satisfied that it is right to take these exceptional measures, in order to confine the typhoid cases as far as possible within Aberdeen itself rather than spread them over other hospitals and to other regions. To have done this would have meant that relatives would have had to travel outside Aberdeen to visit patients, which would have increased the risk of spreading the disease to other areas. But if the situation should deteriorate to the extent of requiring more beds than the region can reasonably find, additional beds are available in the neighbouring Eastern region.
The staffing situation also is satisfactory. More than twenty volunteers answered a local appeal for fever-trained nurses, and I am sure that hon. Members on both sides would like to express their appreciation of their assistance.
In addition, the regional board has obtained the services of a retired consultant and three trained nurses from the Western region. Beds in other hospitals which are being used for the typhoid cases are, of course, already staffed, and although the majority of the nurses in the hospitals are not fever trained, there is a sufficient nucleus of trained staff from the City Hospital and those who have volunteered to give any specialised guidance which is necessary.
The laboratory service is coping with the very heavy pressure of work on its side, but again arrangements can be made to bring in assistance if this should prove to be necessary.
All the staff in the Aberdeen hospitals have risen nobly to the occasion, and I should like to take this opportunity of paying a tribute to their devoted efforts and skill which have enabled the hospital service to cope with this very difficult situation.
669 I have referred to the hospital building programme and to the contribution that it is making to the expansion and improvement of the service.
§ Mr. Hector Hughes (Aberdeen, North)
Will the Minister say a word about the cleanliness of Aberdeen, in view of the attack made on the city by a newspaper last Sunday, in which the city was described as being dirty? Does he agree that it is a clean city that has never had an epidemic of this kind before, and has never had typhoid before, or any diseases of a serious nature, until the present epidemic?
§ Mr. Noble
I was going to say that I have given Dr. MacQueen adequate praise, but that sounds stingy. I have given him full praise and support on two occasions in the House.
The hospital building programme has to be complemented by increases in current expenditure. The total expenditure on revenue account on the hospital service in 1964–65 is estimated for the whole country at £622 million.
Expenditure on the health service as a whole is at present increasing in real terms by 2½ per cent. per annum. That is on top of the allowance for increases in wages and prices. In addition, a further £4 million for England and Wales and £500,000 for Scotland has been found this year to provide for maintenance of buildings and plant and to replace medical and domestic equipment. This goes at least some way to answer the point made by the hon. Member for St. Pancras, North, when he talked about the need for keeping up maintenance in view of rising costs.
§ Mr. K. Robinson
I think that the right hon. Gentleman will find that this allocation was much more concerned with the arrears of maintenance which arose out of the maintenance squeeze 670 imposed by the right hon. Member for Wolverhampton, South-West (Mr. Powell), and that it will do nothing whatever to deal with the problems of the future, to which I was referring.
§ Mr. Noble
I can only say that whether it is arrears of maintenance or new maintenance—if there can be such a thing as new maintenance—those hospitals which have the money will be pleased to be able to go ahead with the jobs that they realise need doing.
Some have felt that the present rate of increase in expenditure is not sufficient to meet the growing needs of the service. We certainly intend to keep the sums available for development constantly under review, since we recognise that the amount may have to be varied from time to time to keep in step with the pressures on the available money. But I should like to emphasise that over the years the increase in expenditure has been very substantial; this year the revenue allocation to the hospital service for growth reaches the considerable sum of £12 million.
Increases of this order, year by year, have enabled the service to expand in almost every direction. I have already given some; figures to illustrate the large increases of staff that have been achieved. This substantial reinforcement of staff, coupled with advances in methods of treatment, is reflected in the numbers of patients who have received hospital care over the past few years. In 1953 about 4 million in-patients were discharged from hospitals in Scotland, England and Wales, whereas in 1963 the corresponding figure was over 5 million, an increase of over a quarter.
§ Mr. Lubbock
But does not the Minister appreciate that in the period between 1953 and 1963 the average length of stay in hospital has diminished considerably?
§ Mr. Noble
Perhaps I should have said that it would not be to the benefit of our hospital service. The hon. Member is not making a useful point.
In the same years the figures of outpatient attendances were about 45½ million in 1953 and nearly 51 million in 1963.
The figures that I have quoted represent a considerable achievement. They mean, in simple terms, that we are giving a steadily improving service to a growing number of patients. Statistics alone, however, do not express our feelings about this great service, dedicated to the care of the sick and seeking always to find new forms of treatment to improve health and preserve life, and I would like to pay tribute to the devoted staff who care for the patients in our hospitals throughout the country.
§ Mr. John Brewis (Galloway)
Can my right hon. Friend give the latest figure for maternity patients in Paisley?
§ 5.16 p.m.
§ Mr. Gregor Mackenzie (Rutherglen)
I am sure that hon. Members will understand my feelings as I get to my feet for the first time in the House, and will accord to me the indulgence that they traditionally accord to new Members. Although I am proud and privileged to represent the interests of my constituency and to take my place in the House, I cannot help but reflect upon the circumstances which caused the vacancy, and I take this opportunity of paying tribute to my predecessor. It was never my privilege to meet Mr. Brooman-White, but I know the high regard in which he was held in my constituency by political friend and foe alike. He was respected for his sincerity, for his ability and for his courage—and not least, perhaps, for his courage, because, as hon. Members on both sides of the Committee know, it was this which helped 672 him to battle against illness over the last two or three years, in his attempt to serve his country and his people, whom he represented in the House of Commons faithfully and well.
Hon. Members will know that we in Scotland take our politics very seriously indeed. They know that we are very much alive to the social and economic problems of our nation, and I warn the Committee that we in Rutherglen take precisely the same line as is taken in other Scottish constituencies.
The Royal and very ancient Burgh of Rutherglen has a long tradition of social progress, as has its neighbour Cambus-lang—also in my division—which proudly boasts that it is the largest village in Scotland, and which is the industrial heart of my constituency. The interest in social and economic progress which we have in the west of Scotland, in general, and Rutherglen in particular, was manifested in the recent by-election campaign—a by-election which gave every opportunity to satisfy the appetite of the most avid political supporter. During the campaign we discussed at length a number of political issues affecting Rutherglen and Scotland. We discussed school building, housing, jobs and pensions. I shall not go into detail on these subjects today. I am given to understand that in a maiden speech one must not be too controversial, and that to depart from this path would lead me into a little difficulty.
Not least, however, we discussed the record of the Government in respect of the hospital services. I heard the Minister refer to the millions of pounds spent on these services. I have heard similar figures given before. A simple and untutored mind, such as mine, tends to translate the millions of pounds spent into the actual number of beds provided. It may sound very impressive to quote figures like £50 million, £60 million or £70 million from a political platform, but we must think of what is actually happening in terms of the provision of beds for acute and for long-term cases. When we in Scotland think of this, I have to confess that we are rather disappointed. The numbers fall very short of the figures for which we had hoped by 1964. The social conditions, houses and the like, in the west of Scotland have created many hardships for our people and have brought 673 disease and suffering to many families. So we hoped that by this stage we should have made very much greater progress in providing beds in our area.
The second point which I wished to make is purely local. In Rutherglen we have been pressing the need for beds for maternity and general cases. We are delighted to know that after a very long time and lengthy discussions, and after a great deal of negotiation, we are to have a maternity unit. But we are still bereft of any decision to put a general hospital in the area. I should have thought the most sensible thing would have been to build a maternity unit at the same time as a general hospital. This would seem to me to be economical.
I trust that the Committee will not think that I am being parochial in putting this point to hon. Members. Rutherglen is the centre of West Lanarkshire. It serves the area and also south-east Glasgow. There is a great need for hospital accommodation of this sort. The Rutherglen Burgh Council has made every effort to accommodate the Western Regional Hospital Board. The council has offered site provisions and the like, but still we have no decision. I hope most sincerely that the Minister will use his good offices with the Western Regional Hospital Board in this matter. I speak for everyone, the medical people in my division, the town council and the county councils, when I urge the need for a general hospital in Western Lanarkshire.
We are very conscious of the hardship involved for many people who have to travel to the out-patients' departments in the city of Glasgow, which is quite a considerable distance. A number of people have to spend long hours and indeed a lot of money—much of which they can ill-afford—in visiting relatives in the general city hospital. There is a growing number of people who must wait for ages before they can have a bed in a hospital and receive proper treatment.
Not least we are concerned about the older people in the constituency and those who suffer from some chronic condition. We in Rutherglen are very much alive to the problems created by an ageing community. I have heard figures quoted of the percentage increase of old people that we are to have in the years 674 ahead and we want to do something about that. I think that the town council and the county council have tackled this problem seriously. They have looked ahead and they are doing a useful job of work.
We realise that old folks do not take kindly to having to go to hospital and that some would be best treated in their own homes; in familiar surroundings where they would be with their own families. This helps to lessen the period of illness. We know, too, that older people form the greater proportion of those who are admitted to our general hospitals and the period for which they must stay there is much longer on average than for other cases. Both the local authorities in my division have done a very useful job in looking after the interests of what is sometimes regarded as a rather neglected section of the community. So have the voluntary bodies, but this afternoon I wish to comment and give praise for one effort which I think worth the attention of hon. Members.
Some time ago, after a great deal of research and thought, the medical officer of the Borough of Rutherglen and his colleagues in the medical profession decided to inaugurate a consultative health centre for older people. I regard this as one of the most useful pieces of work and examples of initiative that we have experienced in the constituency and I pay tribute to those who have been involved in this experiment over the years. The aim of the centre is very simple. It is to keep the old people healthy and to prevent hospitalisation; or to reduce the period of hospitalisation should it prove necessary. We have had a great deal of co-operation from the general practitioners throughout the whole constituency. They have sent to the centre many people who are over 55 years of age and approaching the retirement age.
When they come to the centre they are examined in three different ways. First, there is the normal medical examination which I think very important, because it provides an opportunity to deal with disease in its very early stages and to preventing disease. People who are getting on in years are advised about the problems which they are likely to face as they get older. Diet problems are 675 discussed and they are given advice on this matter. The care of their bodies is discussed, and I think that this sort of thing helps in dealing with the whole problem of physical health.
What is also important is that there should be some sort of inquiry into their social conditions. As a fairly young man—I am sure that this also applies to many hon. Members—I find that sometimes we do not appreciate that there are many problems about growing old. There is a great deal of concern in the minds of those approaching retirement age and this is something for which assistance may be provided in a centre of this sort. A man who is approaching retirement age may be reassured and given proper advice about his retirement and how his leisure time may be spent. I am sure that in a considerable measure this will help to alleviate his problems and reduces anxiety.
Not only is there an inquiry into the personal circumstances of these old people, but also inquiry is made into the circumstances of their families. Advice is given to the old man or woman and also to the family on how to tackle the problem of looking after an ageing parent. I think that very real help may be given in this way. Advice may be given on housing and on financial problems. No one will dispute that these problems create a great deal of depression and anxiety among older citizens which in the long run leads to much illness among the members of this section of the community.
Many people have attended the centre and receive much benefit from the advice given by the medical staff, by laymen associated with it and by the voluntary bodies who help in this work. To sum up, I would say that in essence the centre is a projection of the geriatric unit into the ambit of the local authority in a joint effort to make a preventive attack on illness and to endeavour to keep older people active, healthy and in their own homes. This seems to me an excellent notion. My plea to the Minister is that this whole question may be properly examined. I hope sincerely that as the years go on the number of such centres will be multiplied, and that eventually they will occupy a statutory place in the country.
676 I know that a project of this sort costs a great deal of money. It means that many more people must work with the medical profession and that there must be training and so on. I know that already many calls are made on local authorities for money, but I have been persuaded that this would be money worth spending and the staff find it worth while to spend time and effort on a job of this sort. If we can save our old people from moving into hospital, save time spent in hospital beds and, above all, give a better way of life to those who have given their best years of their working life, we shall equate those benefits with the amount of money spent.
I make this my first plea to the Secretary of State and to the Minister of Health. When I came to this House a few days ago I was told by a very senior hon. Member that he made a plea in his maiden speech but it was 14 years before he saw the fulfilment of his ideals and aspirations. I trust that it will not be 14 years before I see my hopes fulfilled. If the Minister accepts and studies the problem, he will earn my gratitude and the gratitude of those concerned with the welfare of our older people.
§ 5.31 p.m.
§ Dame Edith Pitt (Birmingham, Edgbaston)
It is a very great pleasure to congratulate the hon. Member for Rutherglen (Mr. Mackenzie) on his maiden speech. All hon. Members will have been impressed by the sympathy and insight he has shown into the problems of the constituency which he now has the honour to represent. Not least, from this side of the Committee, may I say to him how much we appreciated his generous comments about his predecessor, Dick Brooman-White, who commanded the affection of all of us.
I thought the hon. Member was very wise to make as his main point the provision of services for old people to enable them to stay in their own homes. This is absolutely right, because what our older folk need is to have their own bits and pieces around them, to feel that they still belong to the community and to enjoy their independence. I was most interested to learn of the consultative health centre for old people which has been established in his constituency. He must have a progressive authority. I 677 hope to hear that it is being copied by other authorities in Scotland.
I cannot follow the hon. Member on his other points, because of course Scotland has its own Health Service, of which it is proud, but no doubt there will be further comment from Scottish hon. Members who hope to take part in this debate. I do understand what a task it is to make one's first speech in this Chamber. I have been thinking today of my own maiden speech, because I spoke, among other things, on the Health Service. I wish to assure the hon. Member that we all felt he acquitted himself very well, and we shall look forward to hearing him on a future occasion. [HON. MEMBERS: "Hear, hear."]
This is almost a maiden occasion for me. There is a tradition that when one has been a Minister in a Department one does not speak on that subject matter until a decent interval has elapsed. No one has ever laid down what a decent interval is, but I thought that with nearly two years gone since I had the honour of being at the Ministry of Health I could properly make a contribution here today, and I am very glad to do so.
It is perhaps as well that I had the pleasant task of congratulating the hon. Member on his maiden speech, because that reduced my temperature, which had been rising considerably during the speech of the hon. Member for St. Pancras, North (Mr. K. Robinson). The Hospital Development Plan was a very fine piece of work, and I take pride in my own share in it. When the hon. Member said the plan had been built on guesswork, I thought he could have very little realisation of the tremendous amount of work which was contributed to that plan.
I should like to explain to him and to the Committee that, although, of course, the plan owed much to my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), who brought his tremendous drive, energy and enthusiasm and humanity to it, it also owed much to the departmental officers and the members and officers of regional hospital boards. It was time that we had an overall plan, because we had not had one since the 678 introduction of the National Health Service in 1946, although, of course, we had been developing in various parts of the country.
My right hon. Friend decided to set up machinery for assessing what would be needed in the years ahead. We found that already regional hospital boards had done a great deal of work on this. They had been thinking about it, and almost all of them had some kind of plan prepared.
§ Sir B. Stross
On a point of order, Sir Harry. Is it possible for us to get a little comfort by having some of the light precluded, because we cannot see?
§ The Temporary Chairman (Sir Harry Legge-Bourke)
Notice has already been taken of the hon. Member's discomfiture and steps are being taken to relieve it.
§ Dame Edith Pitt
I was saying that regional hospital boards had already been busy in preparation which went towards the Hospital Development Plan. It is right that we should put on record the work which went to the actual production of the plan. The Department itself was driven extremely hard. Although I know that those in the Department loved it, they found themselves caught in a wave of enthusiasm for the plan. They and the Ministers worked very hard late into the night and at the weekends in its preparation.
Thus the plan was produced, but it was not meant to be a firm plan. The hon. Member of St. Pancras, North recognised that. We stressed that it was to be flexible, but it gave the broad cohesive pattern in which hospitals were to be developed, the types of bed which were needed and the amounts of money we thought could be made available, which was another important factor. When the hon. Member said that it was playing at planning, I wondered what his own party did when hon. Members opposite were in power—very little indeed. Two hospitals were started and none was completed.
§ Mr. K. Robinson
I do not want my temperature to be raised like that of the hon. Lady, but she must know that it takes more than three years to build a 679 hospital from the beginning of planning to completion. We were in charge of the Health Service for only three years.
§ Dame Edith Pitt
Yes, but too little was set on foot and we have made such good progress in recent years that I think we have made a contribution. I wrote down at the end of my notes when I heard the hon. Member speaking, "An exercise in eyewash".
§ Dame Edith Pitt
We are making considerable progress in hospital development. In contrast to the position in 1951, when the party opposite quitted power, we are spending ten times as much on hospital building. That in itself should prove what developments are taking place all over the country. There are more beds. I hope that hon. Members opposite have bothered to obtain a copy of the progress report, which shows the total number of beds. There are more hospital doctors. There are more hospital nurses, full-time and particularly part-time.
We have spent a great deal more money, particularly in the last three years, since the plan was introduced. My right hon. Friend the Secretary of State for Scotland gave the figure. When the plan was introduced it was meant to be a living thing, or, shall I say, a dynamic plan, as "dynamic" is a very popular word with the party opposite. It was meant to move forward all the time and was to be reviewed all the time. This means it is now envisaged that, instead of the original £500 million of expenditure in the first decade, after two reviews the expenditure rises to £750 million, or an increase of £160 million in real terms, as my right hon. Friend has already told the Committee. Further, the last revision showed that about 60 new schemes had already been included in the plan for England and Wales. So we are taking care of changes as they arise.
§ Sir B. Stross
I know that the hon. Lady believes—this is her argument— that much has been done in the last few years. Indeed, the Review says this:…95 major schemes have been completed, and 66 new or substantially remodelled hospitals and 84 other major schemes have been started.680 Could the hon. Lady tell me how many of the major schemes were not in existence before the plan about which she is talking?
§ Dame Edith Pitt
I have not that detail, as the hon. Gentleman will appreciate, but I have no doubt that my right hon. Friend will be able to say something about it in winding up. It was envisaged when the plan was presented three years ago that we should need far more maternity beds and far more beds for the chronic sick. We know that the demand for maternity beds has been even greater than was envisaged when the plan was drafted. It is true that the Registrar-General's estimates fell short of the mark. This is not surprising. The people have enjoyed prosperity over a continuous period of years. They have more babies. They have them at a younger age. This leads to pressure on maternity beds.
There is another factor in the pressure on maternity beds which arise in towns such as the one I represent. We have a large immigrant population. They are happy in big families. They are less happy in their housing, which is often most unsatisfactory and overcrowded. Thus, when the women are pregnant it leads to demand for beds in a hospital and pressure on the maternity accommodation in the area. This is a problem in big cities. I am sure that it has added to the demand for maternity beds.
The plan also envisaged that there be more beds for the chronic sick. I hope that this means more beds for geriatric treatment in the light of our continuing experience of that branch of medicine. I am sure that it is a good thing—I take up a point made by the hon. Member for Rutherglen—when we can provide accommodation in a geriatric bed, because it means that the patient is there for probably only the same number of months as he would be for years in a chronic sick ward, because one can rehabilitate him and return him to his own home. I should be pleased if more money was invested on geriatric beds.
The plan also said that there would would be a gradual running down of the number of beds needed for mentally sick patients. The last figures I saw indicated that the running down was 681 much as had been expected. I would like to know if this is still the case.
The plan also envisaged a reduction in the number of beds for the treatment of tuberculosis. This is why my own maiden speech sprang to my mind when the hon. Member for Rutherglen was speaking, because, although I was speaking on the Loyal Address, I was so happy to tell the House, fresh from my experience as a member of a hospital management committee, what a wonderful vista it was that at last we were almost on top of this dread disease and really were conquering what used to be thought of as a killer. This has meant a marked reduction in the number of beds formerly devoted to the treatment of tuberculosis.
I have a little concern about this, and I hope that my right hon. Friend can give me some information. Again because of the number of immigrants in large towns, beds are being occupied for the treatment of tuberculosis which we did not expect. I wonder if the tremendous reduction in the number of beds devoted to this disease is now less marked, because, from what I have read and from what I have seen in hospitals, I believe that a very large number of coloured patients fall ill with this disease. It would be very useful to have figures.
The results of what we have achieved under the plan are to be seen. The hon. Member for Stoke, Central quoted figures from the plan, which I would have given the Committee, of the number of schemes completed or in hand. This is not a paper plan. It represents real performance. The results are to be seen. If hon. Members question this, I suggest that they use their eyes when they go round the country or, better still, refer to the results in their speeches, as I always do. In speeches I have already made during the course of the current year I have been happy to say, for instance, up in Cumberland, "The Hospital Plan is making progress and you can see the results of it in the big new district hospital at Whitehaven". I visited that hospital four years ago to see phases 1 and 2, so this is not a recent development. When I was speaking at Devizes by-election, I said to the local people, "Look at your wonderful new Princess Margaret Hospital in Swindon, most of which has 682 already been completed". When I was speaking in Norwich I could say to them, "Look at the development plan for your Norwich and Norfolk hospitals ". In my own town of Birmingham I could say," Look at the new department of Selly Oak hospital. Look at the new geriatric unit which was opened only last week. Look at the development in the East Birmingham Hospital", which is the one nearest to me.
This is perhaps a very minor detail, but I was very happy to be told only a week ago by a member of the East Birmingham Hospital Management Committee—this will not figure in the Plan, but it is one of the things which is going on—that the Committee had converted a ward to make beds available for general practitioners to treat their own patients in the hospital. I think that is a very good thing. If anyone wants any further evidence, I advise them to look across the river at the new St. Thomas's rising there, or to go round the corner to what is called "The Members' Hospital"—Westminster Hospital—where the street is blocked at the moment because of the new development taking place there.
I have looked in vain through "Signposts for the 'Sixties" for any reference to proposals in connection with the National Health Service. If I may borrow a phrase from the hon. Member for St. Pancras, North, what, did I find?—not a hint; well, perhaps just a hint, because it referred to the fact that the Service had ceased to be a free Service. Since then some members of the Party opposite have said that they will review the health charges. If they do, I hope that they will tell the public how they propose to raise the extra £200 million which will be needed for the programme. [Interruption.] If an extra £200 million is to be raised, would it not be better spent on the provision of more maternity beds and more geriatric beds?
§ Mr. Wilkins
The hon. Lady should remember that it is not so long ago that her party raised £300 million by a poll tax and then did not use it for the purpose for which they had raised it.
§ Dame Edith Pitt
I am not clear. I hope that the hon. Gentleman is clear. He has not made me so. The hon. Member for St. Pancras, North mentioned the health and welfare activities of local 683 authorities. Perhaps the extra £200 million might be used for those activities. For the first time local authorities have been asked to set out their proposals for 10 years, a good thing because provision up and down the country is patchy and the exercise in asking them to say what they propose to do is also an object lesson in showing them that some local authorties are better than others. That in itself is a good thing. Perhaps the money might be used to establish more training centres for the mentally subnormal. We should always have these people, particularly the youngsters, in mind because they should have the same chances as the rest.
The hon. Member for St. Pancras, North concluded his speech by saying that his remarks had been rather arid and he would have liked to have spoken at length about the human issues behind the problem of the provision of hospital services. I am glad he said that. There is a phrase in the Hospital Plan which reads, "Hospitals are for people". I wrote it. I am glad I wrote it, because this is what is means to me. We can have good buildings which are well staffed and well equipped. I have seen hospitals in many parts of the world, from the United States to Russia, Turkey to Mexico, but our new ones are as good as the best of any I have seen, although I agree that we can make further progress.
We can all be proud of the National Health Service. The people of this country value it. I am glad that we have more humanity and kindness in the Service than ever before and I pay tribute for this to those who work in the Service. The hon. Member for St. Pancras, North was kind enough to say that my right hon. Friend the Member for Wolverhampton, South-West was the first to say publicly that good relations in hospitals were an important part of the work. This is very true, and I tried to say it privately, when Parliamentary Secretary, at every function I attended in hospitals. I was hesitant about whether it was the job of the junior Minister to say it publicly, and I was equally hesitant about the way doctors would take it. In fact, they were ahead of me. They felt the necessity for kindness and understanding, and particularly for telling 684 patients what was wrong with them, so far as was medically practicable.
I know that the Service is not perfect. My sister went to a hospital in Birmingham for an out-patients' examination. She waited a very long time. She was the last in the queue, and when her turn came the out-patients' sister took a note of what my sister said and then stated, "Oh, varicose veins. Skirt and stockings". That was all. I dare say that that sister had had a long and tiring session. However, it is still a human job which she must perform.
I prefer to quote the story of a friend of mine who is still in hospital in Birmingham. She has been there for six weeks while the doctors are looking for a remote bug. She cannot praise the Service enough. They have been wonderful to her, she has told me, in kindness and in every other way, even though she accepts that she is a difficult case. She tells me that they explain to her what they are doing and treat her as an adult, intelligent woman. She says that the doctors sit on her bed and tell her what kind of tests and so on they are doing. I am not sure that some of the matrons of the past would approve of doctors sitting on beds, but it is an indication of the change in the pattern of the Service, the quality of the people in it and their outlook. When I think of matrons I used to meet in the Department, when I chaired their committee meetings, serene and dedicated women, I know that we have a good National Health Service and can look forward to it expanding in the direction we all want.
§ 5.56 p.m.
§ Sir Barnett Stross (Stoke-on-Trent, Central)
I have often had the pleasure, particularly in Committee upstairs, of being the speaker to be called after the hon. Lady the Member for Birmingham, Edgbaston (Dame Edith Pitt). She is a formidable controversialist who knows a good deal more about political infighting than I do. Indeed, I think she is more practised in speaking than I am, but while listening carefully to her remarks today I had to think that her speech was very much like the curate's egg—jolly good in parts; the parts in which she showed what great affection she has for the National Health 685 Service as a result of her work as Parliamentary Secretary for some years. It is impossible for anyone who has touched the Service at any point professionally not to have very great pride in it.
I desire to make my speech in my own way and, in doing so, I will be answering some of the points she raised. Some of my hon. Friends will, no doubt, also refer to her remarks. My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) made a fighting speech in which he suggested that things had gone wrong. He was not blaming the Department but a political Minister for having produced a plan in a hurry. He accused him of having done that to get political advantage and kudos.
The hon. Member for Edgbaston would not deny that there was a great deal of pressure of work. Indeed, she spoke about people in the Department working late into the night. In other words, people were overworked in the matter and demands were made from the regions and hospital management committees for quick answers. As the hon. Lady told us, people had to work late often at weekends—the Minister as well as the professional advisers—and this tends to show that a little more thought would have been better and that a little more time would not have done any harm to the Hospital Plan.
The answer we have been given is that this was not a 10-year plan but a sort of perpetual motion plan—something which was flexible and about which we could not think in terms of five years now and five years after that. It is on that basis that we debated it at the time. We are now told that it is a perpetual plan and I am accepting that it is. I certainly hope that it is, because it should be.
If one is doing one's work properly, in accordance with the sort of service we are discussing, the housing of patients in hospitals is something which we must go on improving all the time. There never can be a real pause because we do not want obsolescence to catch up. This means that we must work continuously, not for two periods of five years, but all the time—and everything depends on what is available in the way of manpower and resources to devote to the service. All the time one must consider 686 how many men will be available to build, what materials are available, what are the priorities and where it all comes in the general priorities of the nation.
I am, in part, agreeing with the hon. Member for Edgbaston, although this is not the way the matter was presented to us in 1961. I interrupted the hon. Lady when she was speaking and suggested that I thought that many of the schemes which are described were started appreciably before, most of them some years before, the plan was presented to us. I am not sure how many, and I hope that the Minister will tell us. I think I am not being unfair in saying nearly all the completed schemes were well under way before the so-called 10-year plan was debated in Parliament. If I am wrong I hope I will be corrected.
There have been miscalculations and they were due, as my hon. Friend the Member for St. Pancras, North said, to the fact that the whole thing was done in too much of a hurry. We have, in part, been discussing money this afternoon, but what has money really got to to with this problem? Statistics do not build hospitals. Men and materials and will power build hospitals.
The fact that expenditure was £500 million three years ago and now is up to £750 million, which the British Medical Association suggested in the first place, does not worry me very much. I do not think that there has been difficulty through lack of money per se. The difficulty has been that we have not had our priorities right and architects and contractors have been more interested in building great office blocks than in building hospitals because the offices were much more profitable. I remember the right hon. Member for Wolverhampton, South-East (Mr. Powell) when he was Minister of Health answering my question whether the limiting factors were that we had not been able to obtain a sufficient number of architects, quantity surveyors and contractors all ready at the same time. When I asked two years ago whether this was going to be the real bottleneck his answer, quite typically, was just "Yes". He said that and sat down.
§ Mr. Geoffrey Johnson Smith (Holborn and St. Pancras, South)
I noted the 687 hon. Member's comment about office building and that we had the priorities wrong. My information is that if we had stopped all office building some years back the amount of resources freed from office building would have made only an infinitesimal difference to the hospital building programme. If the hon. Member does not have the figures to prove his statement he should withdraw it.
§ Sir B. Stross
That is an interesting doctrine. I have not the figures to prove or disprove what has been said but, like every other hon. Member, I have a pair of eyes and I see the vast amount of work that is being done in the building of these office premises.
§ Mr. Keith Stainton (Sudbury and Woodbridge)
May I have the opportunity to give the hon. Member a figure? Office building represented 4 per cent. of the total financial resources devoted to building, which were £3,100 million, in 1963.
§ Sir B. Stross
If that had not been used for office building it would have made the task of the present and past Ministers of Health much easier and it would have pleased all of us. I am grateful to the hon. Member for that figure.
In 1938–39, at today's prices, hospital building was running at about £40 million. In 1962–63 it was about £35.9 million. Now we have heard today that it is appreciably more, at the rate of about £66 million this year. Therefore, at last, and for the first time, we are spending more money this year on hospitals than we did in the last year before the war. Then we had the war years and the stringent years after the war when capital expenditure on hospitals was very low. The leeway to be made up therefore is enormous, and if we are talking about priorities and trying to get them right we must think not only in terms of the fact that it is now 19 years since the war but in terms of our knowledge that there are new needs. This is a great service which has existed since 1948, and the £750 million now spoken about may well prove insufficient to meet the nation's requirements.
If, as I suggest, it is true that these plans were produced too quickly this 688 would account for what is now happening by way of revision of the plans year by year. I do not find this objectionable provided that one condition is met, namely that the work goes on. I want to know how much priority the service will have and how many hospitals will be built. I said earlier that nearly all the completed schemes that have been mentioned started before the Hospital Plan was instituted. I should therefore like to ask three questions.
The first and a most important one is whether the Ministry is able to declare that as a result of its endeavours it can shorten the time it takes to give approval to a set of plans. It used to take a very long time for the plans to go backwards and forwards between the region and Whitehall, and sometimes it was two years before plans could be agreed. I should like to know therefore whether the Minister has done anything to shorten this period.
Secondly, the Ministry has instituted a campaign for standardisation and I think that the Minister ought to say something more about what success has been achieved in this matter. Thirdly, is the Minister satisfied that enough help comes from the regional boards themselves? Two years ago I felt certain that there were not sufficient architects available at a regional level for this new building programme. I hoped then that the regional boards would not hesitate to go out and employ architects to augment their staffs. I should like to know to what extent this is being done.
When I raised the question of standards I was assured by the Secretary of State for Scotland that there would be no lowering of them. I was glad to hear this, because I am certain that although we use prefabrication and industrial building techniques we can build magnificent hospitals. After all, we do not need to build them to last for 10,000 years. It is enough to build them to last for 50 to 60 years, and if anybody is interested in substandard hospitals there are many of them to be seen. We do not want those to remain for very much longer. We on this side of the Committee feel that this is a matter of urgency, and I hope that hon. Members opposite feel the same.
689 There will be competing and most clamant and urgent claims. Implementation of the Robbins Report will mean a demand for architects and contractors similar to those we demand for the hospital service. There will also be tremendous competition from the Buchanan Report recommendations, and if we do not strike a blow now and insist that hospitals should have the highest priority we shall have revised plans year after year but very few hospitals in the end.
I am delighted that a high priority is being given in the hospital service to increasing the number of maternity beds. Society is changing and families are not the size that they used to be in Edwardian or Victorian days. Standards are very much higher and it is one of the great crimes of our time that a mother should ever die in childbirth or that the child should die or that their lives should be in danger. We want to make it possible that at least every first baby is born in a maternity hospital and that maternity hospitals should be attached wherever possible to a general hospital so that every skill in medicine and surgery is made available.
I applaud what the Government are doing about this but I should also like to inquire about psychiatric needs. Provision to meet these needs is most uneven throughout the country—good in some places and extremely bad in others. It is equally true of provision for the aged. There are some authorities which feel that the provision of geriatric services is very important and they act accordingly. The City of Stoke-on-Trent, for instance, does so or is determined to do so. However, the same standard is less apparent in other areas.
The Secretary of State for Scotland spoke at length on infectious diseases and about the outbreak of typhoid in Aberdeen. I was fascinated to learn that 20 State-registered nurses trained in fevers had come forward voluntarily to help. This was fine. But I wonder whether it is true—I am told that it is—that it is in the mind of the Ministry to put an end to this particular register and to have no more specific fever training. If this is so, I suggest that we ought to think again.
Moreover, if we are to plan for a reduction of 12 per cent. in the number 690 of beds—the hon. Lady touched on this point—because we are able to control mental illness to some extent without hospital treatment, we are conquering the ravages of tuberculosis, and infectious diseases no longer seem to be the problem they used to be, we must remember nevertheless that there are other antagonistic factors at work which are putting society in danger.
For example, our habits are changing. We are eating out more. This is certainly true in the big cities. When we eat out more, we are in greater danger than when we eat at home. Air travel is now quite common. Many, if not most, of the 100 cases of typhoid we used to get in a normal year were contracted abroad. Since air travel is increasing, we can expect more trouble. We have considerable immigration, and, as typhoid is commoner in other countries than it is in Britain, we can expect a greater number of people who work in kitchens, in restaurants and where food is served to be symptomless carriers who have escaped notice. We have supermarkets now instead of the small intimate shop, and we know very well that the supermarket is a dangerous place, if there is likely to be any contamination of food, because of the large number of people served there. Moreover, in London and the great cities there are residential homes for people who have not got homes of their own, and these people tend to be riddled with dysentery, with sonne bacillus and with other forms of enteric disease.
For all these reasons, we should not be complacent about the Aberdeen disaster at all, and we should not assume that it will not happen similarly in other places at other times. If it does happen, it may well be that, instead of 250 cases, we shall have 1,000 on occasion.
If my fears are well founded, I hope that the Minister will reconsider some of these matters. I have been looking recently at a survey covering the years 1961 and 1962 at the Western Hospital in the Fulham Road in London where there are about 90 cubicles for infectious diseases and two sets of 20 beds each for the treatment of people who need artificial respiration; 20 are kept in use and 20 are kept in reserve in case of a sudden outbreak of polio of the paralytic type. The people 691 involved in this service fear that the number of beds they have available will be diminished very shortly because of excessive optimism in the Ministry about the fall in infectious disease.
They have told me that, in the years 1961 and 1962, they had to refuse over 1,000 cases which they could not take in at all. This is rather bad, remembering that in the area of this hospital 500,000 people are served by these 90 cubicles. They serve Fulham, Kensington and Westminster and, in addition, are intended to provide an extra service to another 1 million round about in case of trouble, though they have not been called upon for this latter purpose for many years. However, if in two years the service has had to refuse 1,000 people, this proves that there are not enough beds available rather than too many. Yet the fear is that beds are to be closed, the Ministry's policy being that, as we build the new hospitals about which we are talking, a ward of about 24 beds will be put at the top of each hospital for acute septic cases, and for the sort of staphylococcal infections which one cannot control, the assumption otherwise being that there will not be any serious outbreaks which cannot readily be handled.
When I heard the Secretary of State speak about how Aberdeen has handled the outbreak of typhoid there, I felt very proud of the way in which the people of that town have taken it in their stride, but, by Jove, it has incommoded a lot of other people, and no one can say that it has been easy for them. It has dislocated the town's normal services. I hope that it will be a lesson to us all in the South as well as in the North.
A word now about staff. If the Governments of India and Pakistan were to change their policy and say that they would not allow their young people to spend years here "practising on the natives", as they do, and they wanted them at home because they needed them there, as is the fact, our hospital service could break. Forty per cent. of the junior registrars would go in a moment. I know why we have got into this state. We remember the Willink Report and the miscalculation there. We are, I think, better off for nurses than for doctors. In my opinion, the doctor-staffing 692 of hospitals is the most dangerous of all now.
Next, the pharmacists. I heard only today that, at any time now, this week or next week, a great teaching hospital in London, the Middlesex, is to go in for prescribing on E.C.10 forms because the authorities there cannot staff the pharmaceutical department of their own great hospital. This is tragic. It is due to meanness on our part, or, may I say, on the part of different Ministers. We have never been able to attract enough pharmacists into the service because, even though we on this side have agitated for years, they have always been paid very much less than they were paid outside. Pharmacists are difficult enough to get in the ordinary chemist's shop outside the hospital service. They are at a premium there, although they are very much better paid than in hospital. I hope that the Ministry will give further consideration to this. It seems absurd to throw money away because one cannot dispense in a great teaching hospital.
Lastly, food. My hon. Friend the Member for Stoke-on-Trent, North (Mrs. Slater) told me this afternoon that at St. George's Mental Hospital in Stafford it had been found possible to make considerable savings for only a little capital expenditure. A great deal of food tended to be wasted because it was not properly cooked, it had been cooked too long and the taste and savour had gone. People would not eat it, and there was great waste.
§ Sir B. Stross
And it was not well served. By altering their techniques, the hospital authorities have been able to prove to themselves that it is possible, by the better preparation and service of food, to save a great deal of money and to make the patients much happier, which, of course, in a mental hospital is very important.
We are all involved when we discuss a service of this type, for it is romantic, wonderful and great. It is true that in the early days—and I served on the Committee stage of the National Health Service Bill—attacks were made by hon. Members opposite. They did not like it. They regarded it as socialisation of medicine. I believe that they would 693 not now allow this service to be taken away.
I know that the hon. Lady the Member for Edgbaston, who is good at infighting, knows that this is the best service probably in the world. Only the other day, I saw an interesting analysis by an American professor of medicine of the difference between our hospital service and the American one. On average, our in-patients stay for 16 days. In America, they stay for eight days, because every trivial thing is taken into hospital. We pick our cases, take them in and do a piece of work on them. Our staff are a team and have great pride in their institutions. In America, however, the outside doctors can come in and follow their patients and are jealous that no one should come near them, because money enters into it. Therefore, their system is poor compared with ours.
When we get tributes of that type from knowledgeable people in the United States, it is fair to say that we should on no account begrudge our own Service whatever it costs to make it what we think it is already—the best in the world.
§ Mr. G. Thomas
On a point of order. Before the hon. Member speaks, Sir Harry, and with the kind permission of my hon. Friend, do you think that we could now enjoy a little of our summer light because the sun has gone?
§ The Temporary Chairman
I am not certain whether natural illumination comes under the heading of getting out of order, but I will certainly see that the wishes of the Committee are made known.
§ Sir B. Stross
Further to that point of order. When I asked that the candles be put out, they were very bright. I entirely agree with my hon. Friend the Member for Cardiff, West (Mr. G. Thomas) that we should have them introduced again.
§ 6.22 p.m.
§ Mr. Arthur Tiley (Bradford, West)
I hope that Opposition Members will be speedily restored to the comfort which they deserve. I like to see the light shining in the dark places. It is a happy thing that: I am able to follow the hon. Member for Stoke-on-Trent, Central (Sir B. Stross). I usually feel glad if he follows me, because if I drop I know 694 that I am being followed by the medical adviser of the House and will receive sustenance. Indeed, an old friend of mine recently sent me a sympathetic article which the hon. Member had published in one of our national papers about the general health of Members of the House of Commons. I hope that the hon. Member thinks that I look all right this afternoon. If not, perhaps he will see me outside afterwards. The old friend of mine who sent me the article said, "Read this and be careful".
The hon. Member made a point about immigrants. In my City of Bradford, we are happy that so many immigrants are serving in our hospitals. In our vast industrial areas and cities, they are doing immense work. It should, however, be considered that there is a good deal of illness which has been brought about by this great entrance to our family life as a nation and that these people are in effect, in service and in help, repaying in the best way for our own well-being.
§ Sir B. Stross
I entirely agree and I am glad that the hon. Member has said this. They repay us handsomely. The hon. Lady the Member for Birmingham, Edgbaston (Dame Edith Pitt) pointed out that some of those people are occupying beds because they get tuberculosis when they come here. The truth is that in the main they are negative reactors and they pick up their tuberculosis from others when they come and live a different life here. It is, therefore, our fault. We should be more careful and considerate for them.
The hon. Member for Bradford, West (Mr. Tiley) has said how those people serve us. I was merely drawing attention to the fact that, because they come from countries where typhoid is more prevalent than it is here, there will tend to be a high percentage of them who are symptomless carriers. Therefore, we should be careful.
§ Mr. Tiley
I was glad that my hon. Friend the Member for Birmingham, Edgbaston (Dame Edith Pitt) dealt with some of the things that the hon. Member for St. Pancras, North (Mr. K. Robinson) said from the Opposition Front Bench. My hon. Friend said that after a decent lapse of time, she would make a decent speech. It was an excellent one. We must try 695 to be here some time when my hon. Friend makes an indecent speech!
I could not help feeling that it was harmful to our standing in the House of Commons to listen to the type of speech which the hon. Member for St. Pancras, North made. It surely does no good to the standing of the House of Commons when Government White Papers are alleged to be dishonest—misleading, possibly, if one likes, or giving a slant, yes; but to allege that Government White Papers, presented to the nation and to the House of Commons, are dishonest does no service to our standing either in the House of Commons or as politicians outside it I was glad that my hon. Friend reproved the hon. Member.
The hon. Member for St. Pancras, North seemed to think that when my right hon. Friend replies to the debate tonight he will shirk answering all the actuarial calculations which were presented to him. I assure the hon. Member that my right hon. Friend will not shirk them, because he is from Yorkshire and Yorkshiremen do not duck from fast bowling.
People are a bit sick of party politics in the National Health Service. If some of our speeches when we make these party points were made to the doctors or to the nurses, they would not be received very kindly. We politicians, on both sides, often make mistakes in this field, but the service is saved all the time by those who work in it and, very often, in spite of the decisions which the politicians make.
I wish that I could find a greater humility in the attack which was made from the Opposition Front Bench and a greater awareness of the problems involved. In reply to my hon. Friend the Member for Edgbaston, it was said that it was not possible to build hospitals during the three or four years when hon. Members opposite were in charge of the Administration. I have with me a newspaper cutting, which I shall not read maliciously. I wish to read it only so that there may be an awareness on the benches opposite of the problems involved. I took this cutting from the Yorkshire Post last Saturday, 6th June. It is quite brief, so I will read it.
696 It states:Faced with cuts in expenditure for the coming year, the hospital management committees in the area of the Leeds Regional Hospital Board are finding it difficult to revise their estimates without impairing their hospital services. The cuts in the Harrogate and Ripon area have resulted in the dismissal of more than 60 members of hospital staffs, mainly part-time workers, and similar reductions have had to be made by other committees. The chairman of the management committee said a portion of the cut would fall on provisions 'and at a time when the cost of provisions is rising steeply it may be necessary to curtail the dietaries of both patients and staff'.That is not a reference to last month or last week. That was life under the Labour Government of 1951.
I want hon. Members to consider the problem which faces us with a little more awareness of the difficulties. Hon. Members opposite bore the heat of battle of those difficult days. I admit that. Not only were we not building hospitals. We were even dispensing with staff. We were not merely failing to cure many people in the hospitals which were not being built, but we were not able at the same time to feed properly the staffs and the patients.
In view of that experience, I wish that hon. Members opposite would view a little more kindly the problem which is facing us in trying to improve the National Health Service. It is unfair to say that members of my party opposed it. Certain sections of the service were opposed. The problem which this article in the Yorkshire Post deals with is the result of some of the mistakes made in the grand concept of the National Health Service which now, I admit, is the envy of the world. My hon. Friends and I are concerned to improve it and not to stunt its growth.
§ Mr. G. Thomas
Since the hon. Member is getting historical facts on the record, he will recall that the party opposite, to which he belongs, voted against the Second Reading and Third Reading of the National Health Service Act, and we do that only if we are opposed to the principle of the Measure.
§ Mr. Tiley
That is not true. [HON. MEMBERS: "It is true."] It is not true. Only against certain important Amendments was there an overwhelming vote on this side. The party which I represent, and which I have represented for many years in the House of Commons, has spent 697 many millions of £s on every aspect of the National Health Service which was created in 1948.
§ Mr. Julian Snow (Lichfield and Tamworth)
I ask the hon. Gentleman to consider the real historical facts of the opposition to the general proposition of the National Health Service Act. When it was going through Committee upstairs, I was acting as a Whip, and I can say that not only on Second Reading and Third Reading but day after day on every conceivable form of Amendment the Conservatives opposed the Measure.
§ Mr. Tiley
The hon. Member is helping to confirm my case. My party voted against reasoned Amendments and it voted for reasoned Amendments during the Committee stage of the Bill, but it has never been against the National Health Service, and the proof of our interest in it is to be seen in the increase in expenditure which there has been on all aspects of it since we came to power.
I am not surprised that there were opponents on these benches to some of the things which hon. Members opposite did. Some very grievous errors were made. No matter how noble the concept might have been, no matter how wonderful the scheme might be now, many of the difficulties we have encountered in the last few years have been due to the initial grave errors which were made. These errors have been pointed out not merely from these benches. One of the first mistakes made concerned the cost of the scheme. It was said that its cost, in its first impact on the economy, would be about £100 million. I may be £40 or £50 million out. The one thing that I am certain about is that at the end of the first year it was £200 million in debt. The estimates made of its cost were out—
§ Mr. A. Woodburn (Clackmannan and East Stirlingshire)
As one of the Ministers who initiated the National Health Service, may I say that the hon. Member's recollection is totally wrong? The estimates for the scheme were not out, but the Labour Government found that it had to improve the conditions of work of the nurses. We had to give them shorter hours and better wages. The increased cost of the National Health Service in the years following its initiation was due entirely to the 698 improvement in the conditions of work of the staff, especially the nurses, and this could not be avoided.
§ Mr. Tiley
Yes, they were. Millions of £s more for spectacles and the dental service were needed than was anticipated. The opticians were working 23 and 24 hours a day. Taking 100 as the figure for spectacles provided, 60 people had two pairs. All that was miscalculated, and a great deal of the trouble which has ensued has arisen because the party opposite always gets its sums wrong. It is brilliant in English. It would pass the 11-plus any day. But it falls down on its arithmetic.
The other great mistake which was made was that a great deal of the voluntary service which he hospitals had been receiving was destroyed. The party opposite cut it like a knife. It was a grave disservice to the well-being of our country when so much voluntary work was stopped.
§ Dr. Dickson Mabon
The hon. Gentleman was a Member of the House of Commons when the Guillebaud Committee was formed by the party opposite and reported to the House. Is it not true that the Guillebaud Committee acquitted the National Health Service of false charges of extravagance and waste? Is it not also true that at the time dealt with by the report in that malicious cutting, as the hon. Member described it, from the Yorkshire Post the Conservative Party, in opposition, criticised the Labour Government for spending too much money on the Health Service?
§ Mr. Tiley
The party opposite, when in power, had to impose the first charges on the National Health Service. The Chancellor of the Exchequer in the Labour Government had to impose the first ceiling on the National Health Service. What we were doing was trying to get the Labour Government out as quickly as possible so that we could come to power and improve the service.
§ Mr. K. Robinson
Just before the intervention of my hon. Friend the Member for Greenock (Dr. Dickson Mabon), the hon. Gentleman made a point about voluntary services. Does he not give a thought to the thousands and thousands of men and women who are doing hours of unpaid work per week on hospital management committees, regional hospital boards and boards of governors?
§ Mr. Tiley
I am indeed thinking of them. I want to see their numbers trebled and multiplied to what they were in the days before the National Health Service started.
I did not intend to retail this little story, but at the commencement of this great service there came to my office in Bradford an old man of 75 who for 35 years, and paying his own expenses, had acted as a secretary to a small nursing association in one of the villages near Bradford. He stood there with tears in his eyes because hon. Members opposite had sacked him and in his place there was a clerk getting £750 a year for doing a job which an old man of over 70 had done for 35 years for nothing. That is the type of work which hon. Members opposite stopped. Seventy-five per cent. of hon. Members opposite gave a promise in writing to day-to-day working people, largely members of their party, who were helping to run the approved societies and link up the collection—[Interruption.]—I am dealing with the intervention. I shall deal also with the hon. Member for Cardiff, West (Mr. G. Thomas) if he goes on.
§ Mr. G. Thomas
I am endeavouring, to the best of my ability, to get into the debate, and I hope to deal with the hon. Member after he has sat down.
§ Mr. Tiley
I shall get on a lot quicker if hon. Members opposite do not interrupt. It adds to the interest of the debate, but I intended to make a very constructive speech. I will go back to my notes.
I am in the very happy position of gazing from my bedroom window in the house where I live in my constituency and watching a new hospital being erected. It is taking away part of the view, but I am pleased that it is being built because it will be a great asset to 700 our city. It is lovely to see a new hospital growing. This one is being built very quickly. The winter was excellent for building, and the hospital is well up to date. I hope that before long the Minister will be visiting our city to open it.
But there was a long delay before the first sod was cut, and I want to say a word or two in a constructive fashion about the delays which occur when a new hospital is mooted. The land is provided and the money is made available, and then we have the interminable eternal triangle—the hospital management committee, the regional board and the Minister. I cannot believe that in these days of executive administrative ability one would choose this method for building hospitals quickly. I should like to ask my right hon. Friend if he is certain that we have the best way of linking these three things.
Our management committees consist of men who built hospitals before Whitehall ever thought about it. Indeed the hospital outside my house is being built to replace one that is more than a hundred years old, built before the Labour Party was born. Even if we have a very efficient hospital management committee matters must go to and fro between the committee and the region and between the region and the Minister at the centre. A month elapses before plans are approved. With all the schemes which are coming about, a mountain of clerical work, plans and specifications must be accumulating in London. I do not see any way out of this but decentralisation.
Another important point is that all the time building costs are growing. That is to be deplored. It is a matter very largely of wages, and no one wants wages curtailed. But when sketch plans are agreed by the hospital board and then agreed by the regional board at, say, a figure of £1 million, they then have to go to London, and by the time final approval is obtained the cost will have risen to £1,100 million. Then the scheme has to go back to the region for rechecking to find a way of cutting out the £100,000. Some means must be found to deal with these matters more expeditiously.
I want now to make a comment about the epidemic in Aberdeen and say how 701 much those of us in cities where similar epidemics have been endured in recent years have admired the work of the Medical Officer of Health in Aberdeen. I am sure that we are all glad that the epidemic is drawing to an end. In my city we had the last major epidemic in the country. This was about 18 months ago when we had a smallpox epidemic. It extended over the Christmas Recess. Hon. Members representing Aberdeen need not be alarmed about the future when they read horrid articles about their city. The same things were said about Bradford, and when I came back here after Christmas nobody asked me whether I had had a happy Christmas. Everybody said "Have you been vaccinated?". It is on that theme that I want to make a point.
One of the disturbing features of our epidemic in the West Riding was that certain pathologists, in other parts of the country as well as in our city, were themselves infected with smallpox. When we had a debate in the House at that time I implored my right hon. Friend to provide a service within his Ministry which would ensure that all doctors and hospital staff in the National Health Service would be checked with regard to vaccination. As has been pointed out, in the light of aircraft travel and other means of swift movement which have increased as the years have gone on, there has been increased contact between people in all parts of the world. Thus, it is more important than ever that safeguards should be taken before trouble occurs. I should like to feel that an attempt was being made through the National Health Service to make sure that every doctor, pathologist and nurse in the hospitals was checked for revaccination so that no risks should be run.
I am certain that at long last, after very great difficulty, we have got the National Health Service back on the course on which I wish it had started, in which case the emphasis would have been placed on hospital building and on prevention of illness. Many of our difficulties have accrued over the years because of the methods by which the scheme was introduced. But here at last the emphasis is in the right direction. My right hon. Friend has this great hospital programme in the forefront of his mind. 702 It is flexible, as we know. Hospitals are being built, and more will be built in future. I have very great pleasure in supporting the work now being done by my right hon. Friend and his Department.
§ 6.46 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
I should like first to add my congratulations to those already given to my hon. Friend the Member for Rutherglen (Mr. Mackenzie). I think that the whole Committee was very impressed not only by the manner of his delivery but by the content of his speech, the very real knowledge which he obviously had about the problems with which he dealt, and the very great sincerity of his speech.
I turn to some of the other speeches which have been made. The hon. Member for Bradford, West (Mr. Tiley) began by saying that he wished we did not introduce party politics into the National Health Service. In the light of what followed in his speech—
§ Miss Herbison
I have heard the hon. Member on this subject before. In the light of what followed in his speech, I can only tell him that the first part of his speech was most nauseating humbug.
The hon. Member tried to claim that the Tory Party was in favour of the National Health Service from the word "go". He cannot put that over in the country, and he certainly cannot put it over in this Committee. One of my hon. Friends has been to the Library and obtained the OFFICIAL REPORT of the Second Reading debate on 2nd May, 1946. The hon. Member, who was not a Member of the House at the time, has at least been long enough in the House to know that if one votes as a party against the Second Reading of any Measure, one is voting against the principle of it. [HON. MEMBERS: "Withdraw."] I am not concerned with whether the hon. Member for Bradford, West withdraws what he said or not. I am concerned with having the facts on record. There were 359 hon. Members in our Lobby on the Second Reading, 703 and 172 of the small number of Tories that there were at that time went into the Lobby against the National Health Service.
The hon. Member said that we did not realise the cost and misjudged it. One of the reasons was that even then we did not realise what a mess the Tories had left behind them. The hon. Member spoke about teeth and spectacles. There were many people who under Tory rule could never have had one pair of spectacles, far less two, and they suffered greatly because of it, and there were many whose health was undermined because they could not afford dental treatment or dentures. Of course we miscalculated how great was the backlog that we had to take up. The hon. Gentleman has listened to this debate, and he must have realised that the Government have greatly miscalculated the cost of this plan, which they produced two years ago. They have been almost 100 per cent. out in the cost of it.
§ Miss Herbison
I am sorry, but I cannot give way. There are hon. Friends of mine who want to speak, and I am anxious that they shall have the opportunity to do so. The Government were out by almost 100 per cent. and there are nothing like the same reasons for the Government's being out in their figures as when we were out in our figures.
The hon. Member spoke about the mistakes which Labour had made and said that we were still suffering from them. That is not an indictment against this side of the Committee, but it is a very strong indictment against his own Ministers and Government. If in 13 years of power they cannot rectify any mistakes, they are more incompetent than even I have ever believed them to be. The hon. Member should be more careful when he is slamming this side that what he says does not boomerang against his own Ministers.
I wonder if the hon. Member has ever heard of the Korean War, and about how well this country was doing in all 704 sorts of ways until the Korean War hit us. I wonder if he knows what that war cost us and how many things had to be held back because of it. I should like a little honesty in these matters instead of the sort of statements that we are getting.
I want to turn to the speech made by the hon. Member for Birmingham, Edgbaston (Dame Edith Pitt). She said that the speech of my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), who opened the debate with a first-rate contribution, had been intemperate. I could hardly believe my ears. It was far from being intemperate; it was very factual indeed, pointing out just what had happened since the plan was first announced. She twitted us with the fact that we had not built a great many hospitals. The National Health Service began on 5th July, 1948, and the Labour Government lost power in October, 1951. During those three years, we had started two hospitals. The Tory Government have been in power for 13 years and their record of completion is four hospitals. When one looks at that record of 13 years, perhaps there is something to be proud of in our record of the first three years of the National Health Service.
The hon. Member for Edgbaston also spoke about our policy of doing away with prescription charges. She said that it was a question of either having prescription charges or not having the hospitals. She posed these as alternatives—if we do not keep the prescription charges then we shall not have the hospitals. I do not accept those as alternatives. I know that they are Tory alternatives, but we on this side do not accept them. When the Government raised the prescription charges and National Health Service charges they told us that the contribution to the National Health Service was going to be used for the building of hospitals. It has not been used for such a purpose. Again I emphasise that I do not accept these alternatives at all. We have made it perfectly clear where we stand, and in another economic debate I could show very clearly where the money could come for what we consider to be an essential service.
The Parliamentary Secretary and the Secretary of State know very well that 705 the whole of the British Medical Association is against prescription charges. If I had the time, I could list the reasons for it. When the Secretary of State made his speech he was all sweet reasonableness. There was not much party political stuff in his speech. I think that he made his speech in that way to keep down the temperature and to try to fob off any real criticism that could be made about what was happening to hospital building.
I can remember the great flourish, almost of trumpets, on the occasion of the announcement of the 10-year Hospital Plan—the White Paper, the statement from the Government Front Bench. We got a White Paper on the revised plan, but there was no flourish about it, no statement from the Government Front Bench, and the Government hoped that it would go unnoticed. I say to the Secretary of State that he has done a very wrong thing because when we want to find what will affect our areas individually in detail in many instances we have to depend on reports in the Press of meetings of our regional hospital boards. From what I have found from their reports, there seems to me to have been as little validity in the 10-year plan announced two years ago as there was in the Tory posters about what the Tories had done in hospital building and which, because of their lack of truthfulness, had to be withdrawn very quickly.
When my hon. Friend was speaking about the revised plan, the hon. Member for Hertford (Lord Balniel) asked him to read a little further in the White Paper which said that there had been additions to it, although some hospitals had been delayed. I want to look at what has happened to the plan of the Western Regional Hospital Board. That Board caters for more than half of the whole of the population of Scotland. It is true that it has received an extra allocation of capital investment in the revised plan, but what is it going to provide? The extra allocation will provide only 188 more beds and a rehabilitation centre at Belvedere, but the delay in hospital building means that 2,000 beds that could be provided in the three hospitals of Motherwell, Paisley and Ayr have been postponed—188 beds extra but 2,000 beds postponed. We do not know when they are going to be provided.
706 The Board's senior administrative medical officer said at its last meeting:There is no doubt that a lot has been achieved but a lot still requires to be done and the longer this is delayed the greater will be the expenditure required on make do and mend procedures which at the end of the day can be regarded only as a waste of money.His statement backs up the Report of the Plowden Committee on the "stop-go" policy of the Government and he is an expert on the hospital service. The Government's handling of hospital building has been very much in line with their handling of school building. Their "stop-go" policy has led to greater financial burdens being placed on ratepayers and taxpayers, who are very often the same people and who are thus hit twice by the Government's incompetence.
Mr. John Dunlop is chairman of the Western Regional Hospital Board and at the same meeting he criticised the Scottish Department of Health and the Government. I understand that he predicted that the Board would not catch up this century—not even within the next 10 or 20 years but this century—with the arrears in hospital building and replacements which have accumulated since the First World War. This is not a Socialist politician speaking but the chairman of a regional board catering for more than half the population of Scotland. Another member of the Board, at the same meeting, when it was discussing the revised plan, said that his reaction was that of complete frustration and bitter disappointment.
I quote these gentlemen to show that we have not picked this subect out merely for party political propaganda but because we on this side of the Committee are concerned at the effect that this revised plan has had on those excellent people who do the voluntary work on regional hospital boards and who know so intimately, even more than hon. Members, the needs of their areas.
The hospitals in the Western Regional Board's area have 37,000 beds. Of these, 27,000 are in hospitals mainly or wholly built before 1914 and I understand that most of these 27,000 are in hospitals built before the beginning of the century. The chairman, according to the Press, considers that the majority of these 27,000 beds cannot be regarded as satisfactory by present-day medical standards. That is a very serious matter.
707 If we are at all concerned about the health of our people then this kind of statement from a responsible person worries us very much. The Secretary of State advised us to look at Bellshill and when I intervened I suggested that hon. Members should also look at Stonehouse. It may be that in the last two years great improvements have been carried out in Stonehouse. I do not know. It is not in my constituency. But, 10 years after the Government came to power, I drove a friend there with her little girl due to have a tonsil operation.
I was taken to see the unit where such operations were carried out. A board was pulled back from one of the walls to reveal the holes and cracks. And that was only one part of the wall. I had always understood that, in anything to do with throat and ear cases, the utmost care had to be exercised against infection. Such conditions should not have obtained in a hospital even two years ago. This weekend I shall be finding out just what has happened since. But this kind of thing, and the reaction of the Western Regional Hospital Board, does not worry the Secretary of State. It certainly worries almost everyone else in Scotland.
§ Mr. Noble
Of course the reaction of the boards must be of great interest and a worry to the Secretary of State if they are disturbed. But I do not think that the hon. Lady means to mislead the Committee over the number of beds in toe Western Region. She is forgetting the new hospital at Gartnavel, producing 500 beds. That is in this area Again, perhaps she did not put the picture quite fairly in talking about money for the Western Regional Board. I understand that it has gone up from £5 million at the beginning of the plan to £11 million or £12 million. This reflects not only rises in costs but rises in standards as well as the number of beds which the Board wants and appreciates.
§ Miss Herbison
I certainly do not want to give a false picture. I said that there was an increase over the whole 10-year period which has now been extended further than 10 years. But what are we able to build there? The result is 188 extra beds.
§ Miss Herbison
No. I am quite certain that if the right hon. Gentleman has a look again at these figures he will discover that my information is correct. Our trouble is that, because of the postponement of the start of these three new hospitals, a very serious position will arise. Mr. Dunlop says:How long will it take to make good the deficiencies of these 27,000 beds if in 10 years we can build only 5,300!That is the point I was making. I was not saying that no beds were being provided at all. I was dealing with the extra ones and the ones that the Board will still be able to provide, a total of 5,300. The chairman is worried because he says that, if the Board can build only 5,300 beds in 10 years, what is to happen to the other 22,000 which are not up to present-date medical standards?
The Secretary of State would receive a letter this morning from the chairman of the Board of Management of the Southern Lanarkshire Hospitals. The Board had a meeting yesterday. It is very distressed at the information given to it. It wrote to the right hon. Gentleman and sent a copy, I expect, to all Lanarkshire Members. It begins by saying:My Board has received a copy of the Hospital Plan for Scotland and they are most perturbed about the curtailment of the Hospital Building programme in Lanarkshire.The letter goes on to point out what a densely populated area Lanarkshire is and its need for new hospital accommodation, and says:All these factors would seem to demand a higher standard and ratio of hospital provision; notwithstanding which the hospital accommodation is inadequate, consisting mostly of temporary prefabricated buildings quite unsuited to modern standards of treatment, comfort or hygiene.The three large hospitals in the county, i.e., Law hospital, Carluke, Hairmyres Hospital, East Kilbride, and Stonehouse Hospital are all wartime emergency hospitals, or extensions of hospitals. … The general standards are poor and the ward facilities primitive.This is an area being affected by the delay in building Strathclyde Hospital. This is the central growth area for Scotland. The letter goes on:For these reasons this Board had expected that the new hospital for mid and south Lanarkshire would receive a high degree of priority and they are astonished to learn that the erection of this hospital has been postponed to some future unspecified date.709 The letter adds:The Board of Management is also most disappointed to realise that the decision to postpone this hospital was taken without reference either to themselves or to any other hospital authority in the County, including even the Western Regional Hospital Board.The chairman says:I am therefore instructed to protest most vigorously against your decision and the manner in which it was arrived at.This is the view of the people concerned, and they are highly critical of the Government's hospital building policy. I praise these people for their hard voluntary work, just as I praise all the medical and nursing staff in these hospitals who sometimes work in trying conditions, but who give devoted and untiring service to the people of Lanarkshire.
I hope that as a result of the debate the Secretary of State will have second thoughts and will ensure that in this growth area we are given a date for the building of this hospital, and that it is that dale which was given in the first place.
§ 7.13 p.m.
§ Mr. Geoffrey Johnson Smith (Holborn and St. Pancras, South)
Whatever the shortcomings of the hospital service of this country—and there are some and the hon. Lady the Member for Lanarkshire, North (Miss Herbison) has referred to those in her own area—we are not unique in this respect, for there are shortcomings in other countries. The fact remains that we are in some danger in this inter-party battle of losing sight of the fact that we are in the middle of the biggest hospital construction programme in our history, and that is not one to be sneezed at.
After all, the hon. Member for Cardiff, South-East (Mr. Callaghan), who leads for the Opposition on financial matters, is on record as saying that no Government with any sense of responsibility could consider exceeding the hospital programme, the road programme, or the housing programme. Of course one wants to see more hospitals and to ensure that the plan is carried out with the greatest degree of efficiency, but if we are to preserve a sense of responsibility, let us also preserve a sense of balance, without any undue complacency.
It is an excellent thing that we should have started on this hospital building 710 programme I take tremendous pride in it and believe that we all owe a great debt to the intellectual and physical vigour of my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), the previous Minister of Health, for starting this programme, and to the hard-working members of the Ministry itself. The new Minister of Health is also to be congratulated on the manner in which he has approached his task. He has made an excellent impression all round. Let us put an end to trying to kid people into believing that this is a programme which somehow is miserable or which can somehow be exceeded. We all know the brutal fact that it cannot be exceeded to any remarkable extent. Let us take pride in what is being accomplished.
I should like to take up an interesting comment of the hon. Lady the Member for Lanarkshire, North. I appreciate her concern about the conditions in some of the hospitals which she mentioned, but was she not forgetting the essential fact that this is not a static plan? It is a plan which is reviewed annually, and in these annual reviews one finds new hospitals or new improvements coming into the plan. I would take a terribly pessimistic view about the plan if I thought that it was static, but the fact that it is dynamic should lead one to a more optimistic conclusion than that formed by the hon. Lady.
In the three years that it has been m operation, we have seen a gradual stepping up of the programme as the result of these annual reviews. In the first three years. 95 major building schemes have been completed; there have been 66 new or substantially remodelled hospitals, while 84 other major schemes have been started. Remembering that we have a school building programme and a vast road building programme, even if we had the extra money to spare—assuming that we wanted to increase taxation all round—where would we get the physical resources, unless we starved the school programme, or the trunk road programme, or any other pet project which anyone has in mind? This is not on, and there has been too great a tendency to take a too pessimistic view.
711 I want mainly to discuss the care of children in the hospital service, but before doing so I want to make three comments which concern the teaching hospitals in my constituency. This may be special pleading, but it is honest special pleading, because, as hon. Members will know, I have many teaching hospitals in my constituency.
Without meaning any disrespect to my right hon. Friend the Secretary of State for Scotland, may I say that it always seems to be my misfortune when I speak in debates like this to have either him or the Parliamentary Secretary to listen to me and not the "Number One" on the Front Bench, but I hope that he will pay close attention to what I say, so that these special points may go to my right hon. Friend who is in charge of the Health Service in England and Wales.
Some teaching hospitals have been told that if they want new hospitals, or to expand, they must leave the central area of London, but others have been told that it is desirable that they should stay in central London. If they are to do so, and I do not quarrel with that, I wonder to what extent the Minister appreciates what an expensive project this is. If they are to rebuild, they first have to pull down and then buy land, which is very expensive. It is natural that land should be expensive in the central part of London. This is true of all cities anywhere in the world. I want an assurance that the Ministry appreciates the considerable additions to costs involved in the decision to stay in London and that the programme will not be slowed down because of insufficient financial support for the purchase of land.
The second matter concerns staff. It is a fact that it costs more to live in London. Teaching hospitals have great difficulty about getting the staff they need. I am not thinking of nursing staff in this respect, because, after all, these are prestige hospitals, so that there is no trouble in that respect compared with some other types of hospitals in the provinces.
Let me take, for example, the administrative grades, the clerical grades. A girl of 18 starts at £353 per annum, with a London weighting of £15. This is a mere bagatelle. lit rises to £525 when she is 712 23. On that salary scale it is not always possible to get competent staff to carry out jobs like this. The teaching hospitals spend money on advertising, but only occasionally do they get someone who is competent enough to do this work. The result is that they go to an agency, but this is a very expensive way of doing things.
It could be suggested that the London weighting should be increased, but I suggest that we should give the secretaries of these hospitals more discretion when it comes to applying the Whitley scale to people whom they wish to employ. I do not think that people responsible for administration in the hospitals will take this as a blank cheque and spend as much money as they like on administrative staff. If we delegate more responsibility to them, they will spend more money to obtain the services of one girl than is laid down, and is thought right, but they would prefer to do that to make sure that the girl has a sense of responsibility and will stay with them, rather than fritter away the money.
There is a general levelling up going on in the National Health Service and we cannot quarrel with that, but there is a danger that some of our teaching hospitals might be misplaced from world leadership by the lack of financial support which a 2 per cent. revenue increase each year imposes. These hospitals are something more than a credit to our National Health Service. Their influence extends beyond the limits of this country. They help to set world standards, and the extent to which we as a country are regarded as setting these high standards depends largely on the ability of our teaching hospitals to keep in the vanguard of medical progress. I suggest that a slight easing of the brake of financial control, even if it was only 1 per cent., would be a great encouragement to these hospitals.
We know that we are in the midst of a medical revolution. New techniques are being developed all the time. One has only to think of the transplantation of organs such as kidneys, the study of the biochemical aspects of mental retardation, the surgical treatment of congenital malformations in the newborn, and so on. Tremendously exciting things are happening. We cannot allow a vacuum to be created between successful research and clinical treatment, especially as a 713 great deal of this research is financed from voluntary sources.
Perhaps I might sum up this part of my speech by saying that if some hospitals in our National Health Service are not treated more equally than others, we shall not get the pace-setters that we ought to have in this country.
I turn now to what is really my main theme—children and the hospital service. Here again I make a piece of special pleading. I am prejudiced. I have two children under five, and, as my right hon. Friend knows, in my constituency I have one of the most famous teaching hospitals for children. I also have a wife who is a doctor, but I assure the Committee that not one of these sources of information can take sole credit for putting me in such a prejudiced frame of mind.
I should like to be assured that children's hospitals will receive the priority which they deserve in our hospital building programme, because there are very few children's hospitals in this country. Altogether, about 20 per cent. of the children who are in hospital are in children's hospitals, and about another 20 per cent. are in adult wards. I do not think that anyone would approve of that state of affairs.
We appreciate, too, that pediatrics have got out of the amateur stage. It is a professional speciality these days, and there is a growing awareness that the needs of children are best served by having specialised children's hospitals, or very good and efficient children's departments in other types of hospitals.
During the last few years two reports have underlined the need for developing children's hospitals in this country. I think that all hon. Members are familiar with the Platt Report, "The Welfare of Children in Hospital." The second was the Report by the Royal College of Physicians in the Lancet in 1957, "The care of Children in Hospital."
Perhaps I might for a moment be a little more specific than I have been so far. Why this emphasis on children's hospitals and on pediatrics? It is interesting to note that although children are getting healthier, the rate of admissions of children to hospital does not decrease. It continues to rise. Between 1950 and 1959 there was a 27 per cent. rise in the admission of children to 714 hospital. We can account for part of this rise by the number of children who get mown down on the road, or injured in accidents in the home by all the new devices which people have acquired. It is due also, of course, to the increase in the number of children, but one might also add that it is due to us knowing more than we did about how to deal with infants and their diseases.
In 1900 the infant mortality rate was one in six. I believe that the figure is now one in fifty. By new medical techniques, it is now possible to perform surgical operations on young children which would not have been attempted many years ago. As hon. Members know, there have been tremendous improvements in anaesthetics and in resuscitation techniques. There have also been technical developments in the miniaturisation of surgical instruments which makes these operations possible.
Before it was recognised that there was a need to draw upon the concentrated resources of modern pediatrics, in one region of the country the mortality rate among babies with congenital abnormalities was 80 per cent. When the services were concentrated, during the first six years 1,000 cases were treated, with an 80 per cent. recovery rate. That is a very telling example.
In such groups people begin to develop a tremendous expertise in the art of dealing with young children. I am thinking of those dealing with the 0 to 5 age group. They have to learn to deal with tiny areas of a tiny human body. They have to obtain and to assess extremely small specimens. As one person said, "The chaps who work among adults are rather like watch repairers who work on Big Ben. We work among little wrist watches". The nurses who have to deal with patients who cannot communicate as freely as an adult can have to interpret the sounds made by these young children.
But my plea to my right hon. Friend does not really rest on the need for expert attention and the concentration of resources within hospitals for children. The medical services to which I am referring are designed to keep children out of hospital. I am referring to the need for day centres for the chronically sick. One hon. Member has already touched upon 715 this subject. The chronically sick young child is probably the most pathetic case we can think of—the case deserving of the greatest amount of sympathy from the community. Such a child has very little to look forward to, unless we see that it is integrated with society as far as possible. The Scottish Health Council published a report on the young chronically sick, recommending the creation of day centres for physically handicapped, which parents can visit.
An interesting experiment is about to take place in my own constituency, with the co-operation of the Ministry of Health, the Ministry of Education, the London County Council, and the Institute of Child Health and voluntary funds. The task is to help these children to be as self-reliant as possible. Teachers should be available at the centres, and parents can also help there, and can see what is being done. The work should all be done in an atmosphere in which there is no hurry. As we all know, there is often quite a bit of hurry in an outpatients' department. Voluntary groups blazed the trail in dealing with spastics. The success of these day centres will depend on their being closely affiliated with specialised children's hospitals. I hope that we can move forward to the day when we have psychiatric day centres as well.
I now come back to the hospital itself. I want to make a brief reference to the Platt Report on the welfare of children in hospital. It contained two strong recommendations which will be within the recollection of hon. Members. The first was that the principle of unrestricted visiting should be admitted, and the second that greater provision should be made for mothers to stay in hospital with their children if they were under the age of 5. In reply to a Question put to my right hon. Friend we were told that about three-quarters of the hospitals in England and Wales allow unrestricted visiting. This statement has been strongly repudiated by an organisation known as Mother Care for Children in Hospital. I understand it to be a responsible organisation, but there have been other repudiations of this figure. There have been a number of articles in journals recently—one of them that comes to my mind was in New Society—which also take issue with the figure given by the 716 Minister. I am not getting after him; he has to rely upon the returns given to him. But there is a certain amount of disquiet about the reliability of those returns and the extent to which hospitals have accepted the Platt recommendation that there should be unrestricted visiting.
I want to take a balanced view on this matter. If parents interpret unrestricted visiting as dropping in at the hospital almost every other minute of the day, this is obviously not always possible. A child which had just returned from surgery, having had a tonsillectomy, with blood running from its mouth, would probably make its mother run up the road screaming. A child may also have been sedated.
In the Hospital for Sick Children in Great Ormond Street the principle is accepted, but it is applied with common sense. It is realised that there will be occasions when, for the welfare of the child, it would be inadvisable for a parent to visit it. But the principle is accepted. I hope that my right hon. Friend will be able to allay some of our disquiet on this score. What progress has been made? What inquiries is my right hon. Friend instituting to ensure that the figures he is given are reliable?
I should also like to know what progress has been made to make it easier for mothers to stay in hospital with their children. An excellent report was published on this question last year. I hope that we shall be given some information on the point. This question touches on what my hon. Friend the Member for Birmingham, Edgbaston (Dame Edith Pitt) urged. This hospital service is for people. If the two principles to which I have referred are acted upon it will be clear to the parents that this is essentially a human and kindly service. I hope that my right hon. Friend will not think I have overdone the advocacy in my plea for the provision of more children's departments in hospitals.
To back up my advocacy I want to end with a quotation from an article which appeared in the Guardian last year, called "Children's Hospitals", by Mr. David Lawson, consultant pædiatrician, Queen Mary's Hospital for Children, Carshalton, Surrey. Referring to toddlers, as he called them—and they 717 are the children I have specially in mind—he says:It is of the greatest importance that this group should be cared for in an environment which they can recognise as designed for them, by nurses who are not only willing, but also competent to help them. The nature of this environment, which should seem to the child to comprehend his mother, whether she is there or not, and in which he can feel as nearly at home as possible, is difficult to define. But its presence is easy to recognise. So is its absence. And there is little doubt that it is more easily achieved when everybody, porters, domestic staff, doctors, nurses and administrators, are working all the time toward it in a hospital where all the children's resources of the area are concentrated in a co-operative team.I commend those sentiments to my right hon. Friend.
§ 7.37 p.m.
§ Mr. W. A. Wilkins (Bristol, South)
Amidst the disadvantages that one experiences when one has to sit in the Chamber, as I have done, since 3 o'clock this afternoon—
§ Mr. Wilkins
—I will give my hon. Friend a chance to speak—there may also be advantages. I am sure that I have experienced one advantage this afternoon; my temperature now is slightly lower than it was when I listened to the hon. Member for Birmingham, Edgbaston (Dame Edith Pitt), whom I would have liked to have had the opportunity of following. She talked about eyewash, and we must give her credit for being very knowledgeable upon that subject. Nevertheless, it is perhaps timely that we should debunk some of the statements made this afternoon in connection with the alleged achievements of the Government in hospital building, and the odious and quite irresponsible comparisons made with what the Labour Government did during the few years when they were in office.
I would remind the hon. Lady—and this has already been pointed out in her absence—that the National Health Service Act was passed in 1948, and that the Labour Government were out of power in 1951. In that period we had built or commenced to build two hospitals.
In answer to Questions asked in the House and by means of advertisements in the newspapers which contain a photograph of the Prime Minister, we and the 718 public are being told that the Conservative Party is building, or commencing to build, one new hospital every 19 days. I am going to ask them to withdraw from circulation any such fraudulent advertisement, and I do so on the strength of their own figures, not mine. I wish to refer the Minister to a Written Answer to a Question from my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) which appeared in the OFFICIAL REPORT of 11th May. The Minister also answered a Question of mine to which I will refer later. The Question of my hon. Friend related to the number of schemes which have had to be deferred for ten years, until the 1973–74 programme. The list appears in col. 22 among the Written Answers on 11th May. I have studied this list carefully for two reasons—if the Prime Minister would not distract the attention of the Minister of Health it would be helpful.
The first reason is to see how many new hospitals or what could well approximate to the building of new hospitals—that is rebuilt hospitals—have been cancelled until, presumably, 1973, by this latest instruction. I find that the number is ten.
§ The Minister of Health (Mr. Anthony Barber)
The hon. Gentleman asked me to answer this point, and it may be helpful if I do so now. The hon. Gentleman referred to new hospitals and used the phrase, "or those projects which approximate to new hospitals". If one refers to the normal progress in hospital building it is not sensible to distinguish between a new hospital and a substantially remodelled hospital which may contain just as many beds. Regarding the Conservative poster or leaflet, or whatever the hon. Gentleman was talking about, I can tell the hon. Gentleman the figure I have used, which was that we were starting one new or substantially remodelled hospital every 19 days. During this financial year we shall start one new or substantially remodelled hospital more often than that.
§ Mr. Wilkins
This makes strange logic when we have to rely on the information supplied to us by the Minister's Department in reply to Questions which we 719 ask. Here are ten new hospitals, or proposed new hospitals, the building of which has been deferred. According to my arithmetic if a new hospital is built every 19 days that means 19 new hospitals every twelve months. If ten have been deferred for some indefinite period, one is entitled to suppose that the programme has been cut by 50 per cent. Perhaps when the Minister replies he will be able to unravel this arithmetical problem.
§ Mr. Barber
I should like to state categorically that during this financial year we shall be starting one new or substantially remodelled hospital more frequently than once every 19 days, and that is a fact.
§ Mr. Wilkins
May I ask the Minister to what period this programme of deferment refers, with the various items which he stipulated? When is this to apply? Is it next year? Are these buildings already commenced and they cannot be stopped, and is that the reason why this is something which is to be left as a legacy for the incoming Government? What is the explanation? We are entitled to have an explanation when the Minister replies.
There are a number of things which I wished to say, but I know that my hon. Friends are anxious to speak and so I will confine myself to two points. One is a constituency point with which I will conclude my speech. The other matter to which I wish to refer is causing a good many people great concern. It might be described as the two-tier National Health Service which is growing up in this country. I do not know whether my hon. Friends have had any representations made to them on this matter, but I have been receiving representations from trade union organisations and other bodies who express the gravest concern about the two-tier National Health Service which is being permitted to grow up in this country. What do I mean by this? I mean that now there are organisations which I suppose are akin to the kind of organisations which exist in the United States, and which make it possible for contributions to be paid and then at some future date, when the contributor may need it, private medical treatment is provided. I do not 720 object on the grounds of people wanting to belong to such organisations, but why should they wish to do so, and what is the inducement to a person to belong or to subscribe to such an organisation?
Mr. W. M. F. Vane (Westmorland)
I can give the hon. Gentleman a good reason. If one has to go to hospital, as I had not so long ago, one can arrange the timing so as to suit Parliamentary business. If I had done this through the ordinary National Health Service channels, naturally I would have been on a waiting list and the time of the entry in hospital might have worked out very inconveniently. That is one good reason which appeals to a lot of people.
§ Mr. Wilkins
Now I will give the hon. Gentleman another reason. It is the published reason, the advertised reason, why these organisations seek to receive subscriptions from people who prefer private treatment. It is very interesting:By the end of 1961 more than half of the middle and upper income groups in Great Britain were members of a private patients scheme either through business groups or as individual subscribers. The extensive use of hospital private wards and nursing homes with no 'waiting for a bed' and with the surgeon or specialist of the patient's choice in charge of the case is largely if not wholly due to the better facilities provided for meeting the personal requirements of each patient. The cost of private treatment is heavy but can be conveniently budgeted forunder the membership of this organisation.
One could go on reading from the prospectus which is circulated and which actually gives one of the reasons why people go in for this sort of service.… they choose the alternative of arranging in consultation with their doctor to see the specialist of their choice privately in his consulting room and if in-patient treatment is necessary, to speedily arrange admission to a nursing home or hospital private ward thus avoiding harmful and anxious delay 'waiting for a bed'.In other words, this is a scheme designed to purchase privilege—one of the things to which we took the strongest possible exception when we were bringing in the National Health Service Act I wish to ask the Minister whether he condones it, whether he agrees that this sort of thing should be permitted to go on.
§ Mr. Wilkins
I wish to ask the Minister whether he condones this sort of thing and whether he agrees that there should be a private system operating side by side with the National Health Service. If not what does he propose to do about it? I wish to make one other reference—
§ Dame Edith Pitt
If the hon. Member disagrees with private patients, why, when his own party framed the National Health Service, did they allow for private beds and amenity beds?
§ Mr. Wilkins
I should like to know that myself, because I strenuously resisted it and was advised that we were compelled to give way under pressure from the consultants—[HON. MEMBERS: "Oh."] Yes, and unfortunately the architect of the scheme is not here to defend himself when we discuss these matters. That is the reason why one would not wish to discuss the matter because he is not here to defend himself, but I know what happened at those interviews—at least at some of them. I rootedly objected, and still rootedly object, to private privilege in this matter. There should be only one test either of the accommodation or of the surgeon who is to look after any patient. That is the patient's need. This should be the only test applied and it should be applied for amenity wards and amenity beds.
But for the lack of time available, I would have raised the matter of charges imposed by the party opposite on the use of amenity beds and things of that kind and how the Government raised £300 million allegedly to build more hospitals, but in fact used it to reduce Surtax [Laughter.] Hon. Members opposite may laugh but this has never been challenged in the House. Indeed, it was said openly by the ex-Minister of Health that he was imposing increases in contributions for the purpose of finding revenue to build 722 more hospitals. Even if he had spent the whole of the first Budget of £750 million on building hospitals there would have been 50 per cent. from the contributions obtained in the first year. It is time that some of these home truths were brought into the light of day and that people were made to realise that they have not been charged for the purpose of providing more hospital accommodation but to relieve the Exchequer from the necessity of having to levy more taxation.
I am sorry that I have been side-tracked and I am sorry to have to attack the present Minister in the way I have been attacking him, because he is not necessarily the person responsible for the Service as we have it today. I do not know if any of my hon. Friends read the Aprocrypha. If they do, they will find in Ecclesiasticus, Chapter 49, verse 14:But upon the earth was no man created like Enoch; for he was taken from the earth.If ever there were an earthy Minister, a really down-to-earth Minister, it certainly was the ex-Minister of Health. Such is the legacy which the present Minister has inherited from his predecessor.
The hon. Lady the Member for Edgbaston chided us earlier for not having left plans, but she could not possibly have read the Hospital Plan which she said she and her colleague helped to produce. In paragraph 6 of the long-term plan, it is said:It takes several years to plan and carry out any major hospital development, and much of the work to be begun in the next few years is already decided upon. It would, therefore, be hardly worth while looking ahead for a period of less than ten years in terms of starts, which means roughly fifteen years in terms of completions.I turn to the policy which is supposed to be operating. I am thinking particularly of the South-Western Region. In the statement on the South-Western Region, in the Hospital Plan I read—and I hope the Minister will take special note of this because this is a point I want particularly to raise with him:The policy is to base the hospital service on district general hospitals in the principal towns, supported where necessary by smaller hospitals.The plan on page 189 says:It is expected that the following major schemes will start in the years 1966–67 to 1970–71:—On 11th May I asked the Minister why the proposed new general hospital to be sited in Bristol, South, according to the local regional hospital board, had been deferred. He said:
- (i) Bristol Royal Infirmary—maternity unit.
- (ii) Bristol Royal Infirmary—new ward block.
- (iii) First phase of a new hospital in South Bristol."Cmnd. 1604 listed the first phase of a new hospital in South Bristol among major schemes expected to start between 1966–67 and 1970–71."—[OFFICIAL REPORT, 11th May, 1964; Vol. 695, c. 21.]I had alleged in a Question—perhaps wrongly, although I have a feeling that I was right about this—that when asked about the general hospital for Bristol, South the ex-Minister of Health had said in one cryptic sentence that it would begin at the end of 1965 or the early part of 1966. I have spent a good many hours in the Library trying to track down that Answer, but up to the moment I have been unsuccessful. Perhaps it is not necessary for me to rely for the evidence of the intention to begin this hospital almost forthwith upon any reply I might have had from the Minister because the plan says that the first phase could be expected to be begun in the years I have mentioned. When I turn to page 190, I find it says:As far as can be foreseen, the following major schemes, which are not expected to start until after 1970–71, will have to be undertaken as the next steps in the modernisation of the services of this area:—Mark that—"completion"! I do not know what sort of explanation the Minister can give about this decision to defer, but one thing which has gratified me today has been the emphasis placed by hon. Members in all parts of the Committee on the need for rapid and great extension of the maternity services. That is one of the features of this debate which has been very welcome. The position over maternity services in Bristol at the moment is extremely acute. I came to the Committee with the intention of quoting from certain reports which would emphasise beyond a shadow of doubt the terrific strain imposed upon the maternity services in the city.
- (i) New district general hospital in Weston-super-Mare.
- (ii) 'Completion' of the new hospital in South Bristol, including an orthopaedic department."
724 I remind the Minister that the proposed hospital in Bristol, South was planned in 1936; land was set aside 30 years ago. The hospital was to be sited on the fringe of the population which must number something like 75,000. This afternoon my hon. Friend the Member for St. Pancras, North accused the Government by saying that one of the things they have failed to do has been to take account of the shift of population. He could not have been more accurate.
There has been a shift of population into the area where the hospital was to be built up. The service is now being extended in the teaching hospital in Bristol right in the heart of the city, amidst all the noise, bustle and inconvenience, where nearly all the private dwellings have been demolished. These people have been transferred to the very area, in the main, where this proposed hospital is supposed to go. In other words, the population has shifted to the very area where the hospital is supposed to be sited.
I am extremely unhappy about what is happening with the regional hospital board in the South-West. I am very critical indeed. I am concerned. Some one is pulling strings. I should like to know who that someone is. More and more improvements are taking place in the hospital which is dominating the whole scene. I have in mind the developments, both foreshadowed and agreed in the teaching hospital. The policy is wrong.
The revised plan and the Minister's reply to me on 11th May show that another proposal has crept into the future programme. For the first time it is stated that Frenchay Hospital is to be provided with a maternity block. How has this come about? Why have the Government decided to defer the building of a hospital in Bristol, South, when the Minister of Health promised me that the first work would be two maternity wards with facilities for 34 beds. These facilities could not be needed more urgently than they are needed in that district. There has been this sudden shift in population.
However, the proposal is to put a maternity ward in Frenchay Hospital. I know this hospital extremely well. I know its secretary extremely well. I have no criticism to make of the hospital, 725 but it is already a highly specialised hospital. It carries out thoracic surgery, plastic surgery and brain surgery. It has a burns unit. It is to be the principal accident centre for the South-West of England, which I think is a mistake. However, that is the Government's decision.
Why are all the eggs being put into one basket? In view of the urgent needs, which have brought upon the Minister and his Department the condemnation of the local health committee, why has this happened? Who is responsible? Is it the Minister, or is it someone at the regional board? I have my own views. I think that it is time that some of these questions were answered, because they are questions which I am asked. I cannot answer them, and I want to know the answers.
I know that I have been aggressive. I have felt strongly about this for a long time and I have waited for this opportunity to let off some steam in the Chamber. I hope that the Minister will forgive me, especially as I said a few moments ago that I did not hold him responsible. I should like to think that in his period of office a little more humanity will be shown to the Service than has been shown in the past. I ask him now to reconsider the proposal to defer the building of this hospital in Bristol, South. I should like to know why this proposal has been made and where it comes from. This is one of the things that concerns me. When he replies tonight, if he can say no more than that he will re-examine the position I shall be gratified. If he wishes to have a talk with me about it, when one can feel more free to express one's personal opinions, I shall be delighted.
§ 8.5 p.m.
§ Mr. John Brewis (Galloway)
I hope that the hon. Member for Bristol, South (Mr. Wilkins) will forgive me if I do not follow him round Bristol, except to express my sympathy for the case he has put forward with such obvious sincerity. There must be priorities. I am the only speaker today who represents a rural area, and I believe that the priorities are all in favour of the larger towns such as Bristol.
I am a Scottish Member rather left behind by the rest of the Scottish debate. The position in Aberdeen at present is 726 of great concern to us. The Secretary of State for Scotland gave us some interesting information about the hospital beds available. The hon. Member for Stoke-on-Trent, Central (Sir B. Stross) made some interesting remarks about the dangers of typhoid spreading in this country owing to better communications, more people eating out and away from home, and therefore the greater danger of contagion from food.
The medical authorities in Aberdeen deserve great credit for the rapid way in which they discovered the source of the infection and also for tracing the contacts with the supermarket in Aberdeen. I believe I am right in saying that all the cases which have so far broken out outside Aberdeen were in a measure expected, had been tracked down, and were known to their local medical officers of health, and praise is due to those concerned for this.
It is interesting to note that in this melancholy outbreak, with over 450 cases to date, there has mercifully been only one death, and it cannot be stated with certainty that that was due to typhoid. In the Croydon outbreak just before the war there were probably fewer cases but about 50 deaths. The fact that there has been this absence of deaths in Aberdeen reflects credit on the medical services of this country and underlines the improvement which has been made in the intervening years.
Aberdeen's Medical Officer of Health is correct in his emphasis on hygiene, because I believe that typhoid is, in technical terms, contagious and not infectious. It is a question very largely of looking for infection through dirty food and dirty handling of food.
There is one point on this which is important and which affects a large number of food shops in the city. If a case breaks out in a fruit shop, for example, and the stock has to be destroyed or, to take a more extreme case, if a market gardener has a contact and all his lettuce crop has to be destroyed, will there be a suitable measure of compensation for such losses? There is the interesting case of the great and well-known bacon factory of Lawson's of Dyce. It is in the nature of a bacon factory to have a great deal of stock on hand, which is kept in stock and has to be disposed of over a period. I understand that this 727 factory is closed, but that it could possibly be reopened if there were adequate laboratory facilities not only to test the personnel working in the factory to ensure that they did not include a typhoid carrier but also to give a certificate of cleanliness and purity for the bacon which is in stock. I hope that, in reply, my right hon. Friend will be able to give us some reassurance about what can be done to help this major industry in Aberdeen.
I leave those matters and turn to the Hospital Plan. Everyone can see from the figures that the plan is getting into its swing. I notice from a Parliamentary Answer yesterday that expenditure has gone up from £1.2 million in 1960–61 to £3.2 million in 1963–64. There is a gradual increase taking place all the time and I believe that this will continue as the plan reaches fruition. I notice, too, that the anticipated expenditure has increased from £70 million to £105 million, which represents a large increase in real terms, even allowing for inflation.
I am rather concerned about whether or not we are getting a great deal more in terms of hospital building for this increased expenditure because this form of building appears to be remarkably expensive. Something may be achieved by a study of the industrialised methods of building which have been used for schools in Lanarkshire and elsewhere. I should have thought that those methods would have been suited to the building of large maternity hospitals like the one at Bellshill.
I appreciate that studies into this matter have been made in England and I understand that at Greenwich a hospital has been built by industrial methods. Will these methods be used elsewhere, particularly in Scotland? In this connection, I understand that an exhibition of industrialised building methods is to take place in London next week and I wonder whether a representative of the Department of Health for Scotland will attend it.
I accept that it is necessary to have a sense of priorities and to establish district general hospitals covering a region with a fairly large population—between say, 100,000 and 200,000 people, but there are large areas of Scotland where to get 728 such a region would mean covering a great deal of ground and I am sorry to see that so far it has not been possible to include Peel Hospital, in the Borders, or Ballochmyle in the 10-year plan. It should be remembered that both of those hospitals are old, were left from the war, that they serve wide districts and that the time has come when they should be replaced. I should also like to know what is happening at Fort William because, with the great increase in employment in that area, an increase in the hospital accommodation available at Belford Hospital will undoubtedly be needed.
There is good reason for having large hospitals in which one can concentrate the best facilities available, but in a rural area it is not every patient who needs great and varied facilities. There may be a patient suffering from a sprained ankle as a result of a bicycle accident, or perhaps a woman having an uncomplicated baby.
§ Mr. Brewis
Such cases can be catered for in local hospitals, where families and friends can visit patients more easily.
We must also consider the activities of the general practitioners, the backbone of the Service. They like to think that they can have access to a certain amount of special facilities, including X-ray equiment, perhaps a laboratory and certainly an operating theatre in some of the more remote districts. In my constituency is situated one of the few health centres, at Stranraer. It has been a great success. Its success has resulted from the community spirit of the people in the district and the equal community spirit of the doctors, along with the help of the auxiliary workers in the town.
Any organisation, particularly this sort of health centre, needs this community spirit if it is to be really successful. In a big town or in the suburbs of a city like, say, Glasgow. I doubt whether it is possible for the same community spirit to exist and for there to be the same co-operation among the doctors. However, our Health Service must be flexible and if we are to continue to build new towns like Livingstone and Cumbernauld it might be worth considering having more health centres, and 729 establishing more of them in the small rural towns throughout Scotland.
The hon. Member for Rutherglen (Mr. Mackenzie), who made an exceptional maiden speech, spoke about the need for community care for the elderly sick. It is not only the elderly sick who need community care but also those who are suffering in mental health, particularly those who are discharged from hospital after a mental illness. They often come home to find no facilities awaiting them. They may have been living alone and it is in the face of this sort of situation that better community care is needed in Scotland, not only for the elderly but for the mentally ill and the young chronically sick. A great deal more can be done by the provision of health centres, with community centres attached to them.
§ 8.17 p.m.
§ Mr. Eric Lubbock (Orpington)
I should like, first, to add my word of congratulation to the hon. Member for Rutherglen (Mr. Mackenzie), who made a notable maiden speech. His remarks were eloquent, well informed, and he paid an extremely nice tribute to his predecessor. His whole speech displayed remarkably humane concern for the problems of the old people in his constituency.
I was also interested to hear his remarks about the provision of beds in his part of the world, because this is the crux of our hospital building programme. As Dr. Abraham Marcus said in the Observer recently, many doctors and hospital administrators feel that the true measure of the problem is the number of beds being provided. It was this that I had in mind when I intervened in the Minister's speech following his remarks about the number of patients treated in hospital having increased between 1953 and 1963. I asked him to give the figures of the length of stay, because unless one has both figures one cannot see what the true increase in the provision of beds has been between those years. I hope that when the Minister replies he will provide those figures.
I would also like to congratulate the hon. Lady the Member for Birmingham, Edgbaston (Dame Edith Pitt) on what she described as her second maiden 730 speech. I recall bidding farewell to her when she made her last speech as a junior Minister, and I was hoping that she would be in her place now to hear me congratulate her on her resurrection in her new rôle as a back bench speaker on health matters. I can assure the hon. Lady that her tongue has lost none of its sharpness in the interim.
It is a shame that the hon. Lady is not in her place, because I wanted to tell her that she has been rather selective in the constituencies she has visited, because each one of those she mentioned has a new hospital being built in it. I am wondering what she would say if she came to visit Orpington, where we are gravely anxious about the future of the Orpington Hospital, which is not mentioned in either of the two revisions of the plan and which, in the original document, was shown to have in the 10 years half the number of acute beds but the same number of geriatric beds as today. In that event, it would indeed be a badly planned hospital and no longer viable. I appeal to the Minister not to upset the balance of this hospital in any future revision of the plan, since it is doing valuable work in my constituency.
The hon. Lady the Member for Birmingham, Edgbaston does the hospital service a disservice when she paints such a glowing picture of the progress which, she claims, has been made, because if hon. Members opposite go on in this vein Ministers will begin to believe their own propaganda. It is easy for Ministers and hon. Members opposite to talk about this being the biggest hospital building programmes in history, for they started from such a low point 10 or 12 years ago. There are so many years of neglect to be made up.
I should like to cast a little light on the truth of this matter. In Cmnd. 2235 on Public Expenditure the total expenditure on health and welfare, and this includes the local authority health services as well as the hospitals, is projected to grow at an average annual rate of 33 per cent. at constant prices between 1963–64 and 1967–68. As this is less than the N.E.D.C. target for the expansion of our national economy, it means inevitably that a declining proportion of our gross national product will be spent on health in the next few years.
731 This is confirmed by some calculations in the interesting publication, "The Cost of Medical Care "produced by the Office of Health Economics. I commend the book to the Minister, because it is presented with a clarity which is very often lacking in Government publications. Figure 1 on page 6 shows that the percentage of gross national product taken by Health Service expenditure is due to decline from just over 4 per cent. In 1962 to 3.8 per cent. in 1967. One of the results of this is, as stated in the headline to the article which Dr. Marcus wrote, that the "Cash crisis slows hospital building".
I agree with the hon. Member for St. Pancras, North (Mr. K. Robinson) that the document on the revised Hospital Plan for England and Wales, 1973–74 is highly misleading, whatever the hon. Lady the Member for Edgbaston may say. According to the title of Appendix II it purports to contain both the schemes brought into the programme for the first time and the consequential amendments to other schemes, but it deals only with the first part of the title. It states on page 1 thatAppendix II lists schemes which are now included in the programme up to 1973–74 for the first time, and the schemes which in consequence are no longer necessary.Those are not listed in the Report. I should like to know why these projects which are deferred or cancelled are excluded. Is it because it would not go very well with electoral propaganda to include these things in the White Paper? We are entitled to know and I hope that the Minister will give us this information in another form, perhaps as an addendum to the White Paper.
My hon. Friend the Member for Devon, North (Mr. Thorpe) has drawn my attention to one of the consequences of these revisions which affects his constituency. I have the letter which was written to him by the group secretary of the North Devon Hospital Management Committee, Mr. Woolley, who says:The North Devon Hospital Management Committee has learned with considerable dismay that, arising from the Second Revision of the Hospital Plan, the second phase of the new North Devon Hospital, originally scheduled to commence building in 1967–68, has been postponed until October, 1971.732 I was surprised by the intervention of the hon. Member for Torrington (Mr. P. Browne) during the speech of the hon. Member for St. Pancras, North because he also has a copy of this letter and knows the feelings of the Hospital Management Committee.
The letter was accompanied by a memorandum in which some remarks by the chairman were reported. He said of the White Paper:No direct information had been included concerning schemes and phases of schemes which had been deferred, and it was necessary to infer such information from omissions in the lists given. The first phase of the new North Devon Hospital, the maternity unit, was included in the schemes listed to commence before 1968–69, but not Phase 2, although the planning date for this phase had, prior to the revision, been for 1967–68.Later in the memorandum the reasons which led to the postponement of the scheme, which I suppose were given by the Minister, are listed, and I quote two:(i) first phases of major schemes now planned and costed in detail were proving far more expensive than had originally been expected.This ties with what the hon. Member for St. Pancras, North said about the inadequate planning that went into this scheme in the first place, and I take it that this experience is fairly general and not confined to this hospital. The memorandum added:(iii) building costs had increased sharply together with the speed of building construction, so that considerably greater sums were spent annually on each scheme actually building, leading to a concentration of the available money on a smaller number of schemes at any one time.If that is true one would have thought that there would be a greater number of completions in the earlier years of the 10-year plan, but that has not happened and we should like to know about this.
What is the Minister doing to make sure that the available money which has been allocated to the hospital building programme is being used in the most economical way? The Secretary of State for Scotland said that both his Department and the Ministry of Health were spending considerable amounts on research. That can mean more or less anything. It can mean that ultimately we shall have the kind of consortia in hospital building which we already have in educational building, and that would 733 probably be a good thing. If we had modular construction for hospitals we might achieve quite substantial economies.
I also entirely agree with the hon. Member for Galloway (Mr. Brewis) that by continued use of smaller hospitals for such applications as maternity centres we could have a greater number of beds over the 10 years with the expenditure of a smaller amount of money, but we should have a statement on which smaller hospitals might be retained in use for this kind of application.
Secondly, it is important to tie together the plans for new hospitals and for the health ad welfare services of local authorities. The booklet issued by the Office of Health Economics states on page 13 thatIt would be misleading to consider expenditure on domiciliary and hospital medicine independently or in isolation from other personal expenditure on health.Yet this is exactly what we do in this Committee and in the House.
At the moment we are considering the hospital building programme. Later in the year, we hope, we shall have the revision of the local authorities' health and welfare plans, when, no doubt, we shall have another debate on that. We never look at the whole picture of expenditure on health and welfare at one time. I regard this as a great mistake in our machinery of Government. I raised the matter first in the debate on the Hospital Plan two years ago and I was told then that the local authorities' health and welfare equivalent to the ten-year hospital plan would appear shortly, which it did. We never seem to discuss the two matters at the same time.
The Parliamentary Secretary has told me that the revision of the local authorities' health and welfare plan is about to appear, but we are still waiting for it. Incidentally, we have, as far as I know, had no revision of the initial local authority plans whereas we have had two of the Hospital Plan. Surely, it is better for these revisions to occur once a year, at the same time of year, so that we may consider them as a unity.
I hope that the Minister will accept the proposition which I first put two years ago, that the Hospital Plan can be successful only in the context of the health and welfare provision made by 734 the local authorities. The hon. Member for Rutherglen illustrated this in his contention that there was great need for co-ordination in the provision made by hospitals and by local authorities for old people and that, by meeting this need, one could save old people going to hospital for as long as possible. The provision of Part III accommodation by local authorities ought to be directly related to the provision of places in the geriatric wards of the hospitals.
Similarly, the provision of home help by local authorities must be related to the provision of places in Part III accommodation. By giving old people more home help, we may be able to keep them in their own homes longer and thus reduce the call on Part III accommodation. On this subject of home help, I wish to raise the case of a constituent of mine—I told the Parliamentary Secretary that I intended to do so—who is totally disabled. This lady is a very brave person indeed. She spent some time in hospital and, when she was discharged to go home where her family needed her—she has a small boy of eight and a husband—she was first given eight hours' home help a day by the local authority. Then, suddenly, without warning, the local authority reduced the period to three hours a day, so that she now has home help only from 9 o'clock until 12 o'clock in the morning. Her husband gets her breakfast before he goes out. He has to find someone else to come in and cook her lunch and clear it away. Someone else has to come in when the boy comes home from school to get his tea and so on, until the husband comes home at night, when he takes over.
It is very important for the sake of the family life of these people that the mother should be enabled to stay at home. The husband has made strenuous efforts to find someone to come in and do all the work in the home for him but he has so far been unsuccessful. What happens when he becomes ill? Who is to look after the small boy at night, for example? The mother will have to be taken back into hospital in such circumstances. Of course, the situation puts a severe strain on the husband.
It is particularly important that we should get this point straight. The provision of home help by local authorities in cases of total disability like this may 735 be instrumental in saving a person from having to go into hospital. The Parliamentary Secretary says that it is not necessarily true that keeping a totally disabled person at home is cheaper than keeping him or her in hospital. I really cannot believe this. Certainly, in this particular case, when the husband has to reimburse the local authority for at least part of the cost of the home help which he is given, it could not possibly be true.
In my view, greater provision could be made by local authorities. If not now, they should make plans to do so later as they get into their stride with their ten-year programme. I asked the Parliamentary Secretary what revision of the plan for the provision of home help was in train in the County of Kent. I received his reply today and, unfortunately, it is very disappointing. He tells me that, in the revision which is shortly to come out, it will appear that the total number of home helps in post in 1963 in the county of Kent was smaller than it was in 1962 and the number which the county hopes to provide by 1973–74, at the end of the ten-year expansion, will be smaller than at the end of 1963. This is a curious kind of expansion. In my opinion, there is not much point in having a ten-year plan for local authorities if the provision of this kind of service is to grow smaller year by year.
I once put a Question to the Minister to ask him whether some persuasion could be exercised on local authorities which refused to live up to their responsibilities in this way. That is a strong expression to use, and I use it advisedly. He said that, on the publication of these plans, local authorities would be encouraged to look at the average and at what other authorities were able to do and they would bring their standards up. This has not happened in the County of Kent, and I think that it is time one considered whether some other machinery is necessary.
About two years ago, I proposed that we should begin to think in terms of area health boards in which one would integrate the functions of the hospital boards, the local authorities and general practitioners, and that one should have a homogeneous Health Service instead of the tripartite structure which has 736 existed ever since the passing of the 1946 Act.
Whatever the hon. Member for Bradford, West (Mr. Tiley) may say, the Conservative Party certainly opposed this Act when it was going through the House. But now it is almost sacrosanct. Hon. Members opposite do not want to amend it in any respect. When somebody puts forward a radical idea like this, after 17 years' experience of the working of the Act, they say, "No; it is perfect as it is," and refuse to make any alteration. This has subsequently been adopted by my party's Health Committee and endorsed by the B.M.A. I hope that, whatever Government comes to power after the General Election, they will think again about this proposition that we should have area health boards and create a more homogeneous structure for the Health Service.
I want to say a few words about the staff. I know that other hon. Members are waiting to speak, so I will try to be as brief as possible. With the Robbins expansion and the new universities which we are creating, we have a great opportunity to build new medical schools. I entirely agree with the hon. Member for St. Pancras, North that one new medical school, taken in relation to all the new universities projected, is not enough.
I should like to quote from the Financial Times of 24th February this year. It is not a newspaper which is notably sympathetic to the Opposition. The heading of the article is, "Shortage of Staff Threatens the Hospital Services" and the writer says:… there were some 1,300 Indian doctors working in Britain in 1962, mainly in junior hospital posts. But with the build up of medical facilities in India (such as, for example, the All-India Institute of Medical Science in Delhi), many Indians are going to find that it is no longer necessary to come to England to get the right qualifications. Already there are signs (at Northampton and Bolton for example) that this erstwhile 'bottomless' pool of labour is beginning to dry up.What plans does the Minister have to deal with this? Does he consider that one new medical school will replace these 1,300 Indian doctors who are likely to leave when the postgraduate facilities are started in their country?
The same applies to all the other professions in the Health Service, not only in hospitals. Taking the nursing profession, the Minister said that he was 737 very satisfied with the number of nurses in training at the moment. He gave the number of those in training. I think that it was 72,000. Has he considered this figure, looking at it in relation to past figures, in the light of the more intensive treatments which patients are undergoing in hospital and the shorter working week which fie promised to the nurses?
Incidentally, I am surprised that no breakdown of these fifigures could be given and that he was not able to quote separate figures for State enrolled nurses, because the picture is not as bright as one would wish. One can hardly be surprised at this considering that State enrolled nurses are paid a salary, in real terms, lower than the salary which they were receiving when the National Health Service started. Hon. Members may not believe this, but if they look up a Question which I asked on the subject they will find that it is true.
Similarly with the administrative staff. The hon. Member for St. Pancras, North spoke about the advertisements placed in the newspapers to get these people. Incidentally, the cost of advertisements to obtain staff in the hospitals is not given separately in the costings. This is a great shame because it would be an index of the difficulty which the hospitals are having in obtaining staff in all grades and professions.
I know that other hon. Members wish to speak, so I will resume my seat.
§ 8.39 p.m.
§ Lord Balniel (Hertford)
I understand that it is expected that I shall resume my seat within a few minutes. I am glad to have the opportunity of following one of the members of the Liberal Party, a party which at one time was the arch apostle of the principles of laissez faire.
The two sentences in the speech of the hon. Member for Orpington (Mr. Lubbock) with which I agreed were his references to the desirability of coordinating the health and welfare plans with the hospital plans and the desirability of debating these two aspects of the Health Service together. With the overwhelming mass of the hon. Member's speech I profoundly disagreed, because he merely hitched himself to the cause which had been advanced by the hon. 738 Member for St. Pancras, North (Mr. K. Robinson) in denigrating the Hospital Plan and regretting the revisions which had taken place subsequently.
The part of the hon. Member's speech which surprised me was his proposal concerning the home help service. I remember his advocating this before. At that time, it was pointed out to him that the home help service, in common with other health and welfare functions, is one of the services which are run by local democracy. The hon. Member advocates that these health and welfare functions which are run by local democracy should be taken out of local democracy and be run by a bureaucratic structure. He tells us that this has been accepted by the Liberal Party as their national policy. I hope that this will be fully appreciated by all those who take part in the service of local government.
§ Mr. Lubbock
Ultimately, these area health boards would be fitted into the structure of regional government which we have proposed in another context.
§ Lord Balniel
Regional government alone would destroy local democracy in the normal understanding which we have of such a system.
The hon. Member followed the arguments which had been advanced by the hon. Member for St. Pancras, North in criticising the original Hospital Plan and the subsequent revisions. They criticised the original plan on the ground that it was rushed and inadequate and had been pressed forward too vigorously and too fast. It is, however, right to remember that at the time the Hospital Plan was produced, there were many hundreds of hospitals, some of which had been built at the time of the Battle of Waterloo and others—great numbers—during the reign of Queen Victoria. Some, particularly the cottage hospitals and many of the poor law institutions, had been built during the reign of King Edward. One or two of them had been built during the inter-war period, but the one feature in common with all the hospitals was, that none of them had been built since the war. To have criticised my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell) for having pressed ahead with a Hospital Plan is short-sighted.
739 I remember that after the debates which had taken place on the Hospital Plan in the House of Commons and in another place the Hospital and Social Service Journal referred to the Hospital Plan as being a grand design whose stature remained undiminished. I should be the first to accept that revision was necessary, but to have allowed the fear of making mistakes to have held up the presentation to the country of a tangible plan for a decade ahead would have been a weak and feeble form of government.
I do not understand the argument of the hon. Member for St. Pancras, North. We have all listened with respect to his speeches on the Health Service. Today, however, he talked about financial matters and I fear that his mathematics are not up to the quality of his understanding of the Health Service. The hon. Member referred to the revisions of the Hospital Plan. The original plan forecast building during the decade 1961–71 to a value of £500. The revision which followed that for the decade 1963–73 increased the expenditure on hospital building from £500 million to £600 million.
The revision which has just been published has increased the expenditure which is forecast on hospital buildings for the decade 1964–74 from £600 million to £750 million. The hon. Member for St. Pancras, North says that this demonstrates gross under-estimating. That is one way to look at it. Another way to look at it would be that this is a very massive advance in the hospital building programme which we are able to afford because of the increasing prosperity spreading throughout the community.
I understand the hon. Gentleman's argument, and he is entitled to make partisan attacks on the Government, but when we point out that there has been an expansion, hon. Members opposite go into a huddle to see how they can knock the Hospital Plan just as they knock everything British and everything put forward by Her Majesty's Government. They think "What can we do to knock the Hospital Plan?" They say, "But these are in money terms, not real terms, and the rising costs will wipe out the expansion in expenditure." But in real terms, not money terms, there is 740 an expansion under the present revision of the plan to the extent of £160 million.
Again, hon. Gentlemen opposite go into a huddle and try to think of ways in which to attack the plan. They say, "This is all paper planning." It is not paper planning. We already know the figures of actual expenditure on hospital planning during the first three years of the plan: in 1961 £32.8 million; in 1962 £35.9 million; in 1963 £48 million.
Then hon. Members opposite begin to panic. These figures are impressive, and the public are impressed by this expansion. So hon. Members opposite begin to panic and lose their unanimity. The hon. Member for Cardiff, South-East (Mr. Callaghan), the very "shadow" Chancellor of the Exchequer, says that the Conservative programme for hospitals could not be exceeded by any party with any degree of responsibility. Three weeks later the hon. Member for St. Pancras, North says that these are paper plans. I should like to invite the hon. Member for St. Pancras, North and many other hon. Members opposite to my constituency to see what these "paper" plans are, to see the new hospital built within the boundaries of Welwyn Garden City, the first of the new district general hospitals. [Interruption.] If the hon. Member for St. Pancras, North wishes to intervene, he should at least take his feet off the table.
§ Mr. K. Robinson
The noble Lord knows perfectly well that the planning of the new Queen Elizabeth II Hospital at Welwyn Garden City started in 1951 or 1952. It has nothing whatever to do with the Hospital Plan.
§ Lord Balniel
As the hon. Gentleman says, I should know. I revisited it only the other day. Indeed, I pay tribute to the way in which the Hospital Plan has accelerated the building work undertaken at the Welwyn Garden City Hospital. The hon. Gentleman may well say that I have taken as an example the first of these magnificent new hospitals, but it is not the only example that I could give. There are others in the pipeline, at various stages of building, in my constituency and the surrounding area. There is the planned extension of a psychiatric unit of a further 100 beds in that hospital, there 741 is a new maternity department in Watford, there is a major redevelopment of St. Albans City Hospital, there is the second phase of the Luton Maternity Hospital, there is the new Lister Hospital between Hitchin and Stevenage, and there is the new maternity department in the Herts and Essex Hospital, Bishop's Stortford. This is the area that I know. I should have thought that almost any hon. Member could point to similar examples in his constituency.
§ Lord Balniel
I want to say a word about the new district general hospital, because it will set the pattern for much of the hospital building which will be undertaken during the next decade or so. This hospital is by no means unique. It is, in fact, one of the 95 major building projects which have been completed in the last three years. In those three years we have also seen 66 new or substantially remodelled hospitals and 84 other major projects started.
I should like to pay a great tribute to those who work in that hospital, particularly in relation to the atmosphere which they have managed to create in a very short time. This is partially due to the regional hospital board having instituted a nucleus of staff around the matron before the hospital came into commission, and it is also due to the dedicated work by the matron, the staff and the secretary in creating a happy, friendly and remarkably efficient atmosphere in the matter of a very few months.
The thing that is most impressive to anyone acquainted with hospital work is the atmosphere of calm, quietness and tranquillity in this hospital. This is partly due to the structure of the hospital itself, which has been designed to achieve a quiet and tranquil atmosphere comparable with the atmosphere in which a sick person would like to be treated at home. It is so quiet and has the appearance of such tranquillity and leisure that none of the wards have doors or glass partitions between them and the corridors, but still the atmosphere is one of great quietness.
Obviously, the establishment of a new hospital on such a scale in an area 742 disturbs the existing hospital structure, and I should like to ask my right hon. Friend to give very careful thought to this problem. It has an effect on all the small cottage hospotals which surround a new general district hospital. I know that my right hon. Friend has given an undertaking; never to close any single hospital unless it has been very carefully examined that the needs of patients in the area will be met by a new hospital. Most of us expect to see those hospitals used for geriatric work once a new general district hospital has been established. In the case of Welwyn Garden City, it is now some time since the new Queen Elizabeth hospital has been brought into commission and the old cottage hospital is still not in use as a geriatric unit.
I have undertaken to curtail my remarks in view of the time, and I should like only to repeat that I regret very much indeed the attack which the hon. Member for St. Pancras, North made on the Hospital Plan and on my right hon. Friend's predecessor. There are many hon. Members who, if they could do as much for the Health Service in their lifetime as my right hon. Friend the Member for Wolverhampton, South-West did in a very short space of time as Minister would be very proud men indeed.
§ 8.45 p.m.
§ Dr. J. Dickson Mabon (Greenock)
If the hon. Member for Hertford (Lord Balniel) wants another job he should consider himself for the position of President of the Institute of Practitioners in Advertising; because I admired the way in which in true platform style, as though he was on the hustings, he was able to read out one by one all those splendid developments in his own area—no doubt long overdue. It was most impressive. I was also impressed by the hon. Member for Birmingham, Edgbaston (Dame Edith Pitt) who manages to make a speech wherever a new hospital is being built. I suggest that she should come to Scotland. She might find it more difficult to see all these new buildings.
§ Dr. Mabon
I will give way in a moment but I should like to develop this a little more. I want to say to the hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) 743 that he does a grave injustice to his own pre-war Government because the Conservatives then—albeit tired and languid just as they are today—actually had a better hospital building programme than the present Government. Let us not be too harsh. Even the Victorians had a very good hospital building programme. The hon. Member was being a little extravagant in talking about the present programme being the greatest ever.
§ Dame Edith Pitt
I was able to refer to so much development taking place in the Hospital Service, either in new buildings or improvements, because wherever one goes to make a speech it is possible to find a development to talk about.
§ Dr. Mabon
I am sure that the hon. Lady could find a development if she wanted to talk about it.
I now want to contribute to the congratulations to my hon. Friend the Member for Rutherglen (Mr. Mackenzie) on his excellent maiden speech. He is, indeed, an honourable friend of mine—we have been lifelong friends—and I am pleased to see him here. I have heard him make many speeches but never a better one. I have no doubt he will continue to make excellent contributions which will be appreciated not only by hon. Members opposite but very much by his hon. Friends.
I join the Secretary of State in his comments about the Aberdeen typhoid outbreak and the splendid work done there by the doctors, nurses and others concerned in trying to contain this terrible contagion. We are, nevertheless, a little concerned about what he said on Monday.
On the tape tonight it is stated that two Sheffield hospitals have posted notices concerning the consumption of corned beef in those hospitals which appears to be from the same consignment as the Aberdeen batch. We were told by the Secretary of State that the Government had in March taken a calculated risk on this affair. One wonders whether this calculation is not proving a most serious miscalculation
If that is the case, then the Government must think again about what was said by my right hon. Friend the Member 744 for Belper (Mr. G. Brown) on Monday, when he suggested that the proposed inquiry should be replaced by a much more substantial investigation concerning Ministerial judgments as well as the origin of infection. This is a very serious matter which we wish to press upon the Government.
The Secretary of State no doubt appreciated the comments made by my hon. Friend the Member for Rutherglen, who dealt with consultative health centres. I must say that my hon. Friend dealt with it skilfully within the terms of order because, strictly speaking, we are not discussing that subject. Nevertheless, such centres are relevant to the hospital building programme. I was disappointed that the Secretary of State did not tell us about the Scottish position regarding supplementation of the programme.
When will we get the Scottish equivalent of the English publication "Development of Community Care"? If we do not get it this year we shall be two years behind. We congratulated the Secretary of State at the time on not having produced a Scottish one yet because the English version was so bad. We were glad that he appeared to be taking more time. Unfortunately, he has still not brought it out. Nor has he told us when it is to be published. We cannot ignore the provision of community services in relation to the hospital building programme. Unless some needs are satisfied by community care, the Hospital Plan must be adjusted to meet them.
Nor can we ignore the position of general practitioners who are, after all, in the front line in the battle against disease. They are the infantry who deal with about 90 per cent. of the enemy attacks. One cannot ignore their position in relation to the programme.
Today the Minister presides over a medical profession which is in ferment and full of dissatisfaction and discontent such as it has never known before—not even in the days when it was led by Lord Hill. Even then it was never as angry as it is today.
There is no long-term plan for general practitioners. The Government have no solution for the problem of the development of practice premises or health centres. I was very pleased to hear in 745 the reasonable speech of the hon. Member for Galloway (Mr. Brewis) his reference to the success of the Stranraer centre. A good deal is being missed by the Government in not appreciating that these centres can and do play a notable part in the proper provision of a health service in this country and are able to take up a great deal of the demand which would otherwise fall upon the Hospital Service.
When he was boasting about the Government's performance—and he rarely does—the Secretary of State claimed—and this is a relevant figure—that the Government had spent £300 million in 13 years. This is an average of £23 million a year on hospital building since right hon. Gentlemen opposite took office. My hon. Friend the Member for Stoke-on-Trent, Central (Sir B. Stross) pointed out that in real terms—and we like to talk in real terms, as Treasury spokesmen always do—that was half the 1938–39 figure. After 12 years of Toryism, we in Scotland have 475 new hospital beds more out of an expenditure of £300 million over the whole country, a rate of 40 beds a year. That is the position for which the Secretary of State is taking great credit.
I am not denying that there are enormous difficulties. Of course there are. Enormous difficulties faced the Labour Government, are facing the present Government and will face the next Government in the development of the hospital building programme, but it is more than extravagant for the Government to make these claims about their performance. This is why the Prime Minister got into trouble. He actually believed the posters and thought that all this had happened. He did not realise that it was just another claim when it was said that one new hospital was built every 19 days which, by a statistical coincidence, works out at 19 hospitals a year. Fortunately, when he was advised otherwise, he quickly withdrew the claim, but he was not out of step because the Conservatives withdrew the posters and we have not seen them any more.
§ Mr. Noble
I did not boast at all. The hon. Member for Orpington (Mr. Lubbock) suggested—as far as I could make out and I think as far as the Committee could make out—that it was better if patients stayed in hospital longer, and what I said was—and it was not a boast—that I thought the medical profession would object.
§ Dr. Mabon
I withdraw the word "boast". However, the right hon. Gentleman is making a very great mistake as a Minister if he imagines that it is always a good thing for patients to stay in hospital for a shortening length of time. Is he talking about maternity cases, for example, maternity patients who are kept for 24 hours, eight hours in one Liverpool hospital, and two days in the Western District Hospital in Glasgow quite recently? Obviously, he is not talking about those cases. What was he talking about?
§ Dr. Mabon
I shall look at HANSARD again to see what he was talking about. If he was talking about all hospitals and not just maternity cases, he will find great difficulty in showing me that he is able to arrive at such a figure, because general hospitals give general returns although they have large maternity sections, and it would be difficult to say that his figures were reached solely because of that.
Even if I am wrong, it is still not a fair argument to say that doctors are entirely and solely responsible for the discharge of patients and that it is always medically sound for a patient to be discharged and that the doctor is always willing to accept responsibility. I have known doctors who, because of other patients coming into the hospital, have been obliged to discharge people before the time which they thought best. I know doctors who have worked all 747 kinds of somewhat dubious manœuvres to get old people into hospital because they ought to be cared for there. They did so by claiming that these people were suffering from diseases from which they were not in fact suffering. I often wonder whether, Hippocratically, that was dishonest, but I have seen it happen. I have seen many distinguished members of my profession indulging in such manœuvres. Doctors in hospitals also are under pressures to do things of that kind, so the right hon. Gentleman had better be careful when he talks about matters like this.
The right hon. Gentleman referred to the Montgomery Report. After the speech of the hon. Member for Bradford, West (Mr. Tiley), I must not say that the right hon. Gentleman was dishonest, but he was misleading when he said that an average of 76 per cent. of maternity cases were already admitted to hospital. In Scotland the figure may be 76 per cent. but it is not homogeneous. One of the most shameful areas of the country in terms of the lack of maternity beds is the western region of Scotland, and my hon. Friend the Member for Fife, West (Mr. W. Hamilton) illustrated the point by referring to another great conurbation of Scotland where there have been scandals of all kinds in connection with people being sent out of hospital far too soon after their confinements.
I did not admire the right hon. Gentleman's manœuvre this afternoon, when he got the hon. Member for Galloway (Mr. Brewis) to prompt him into correcting the position to which my hon. Friend the Member for Paisley (Mr. J. Robertson) referred in relation to maternity cases. The figure in Paisley may not be 44 per cent. as suggested by my hon. Friend, but 66 per cent., but this is still below the figure recommended in the Montgomery Report. Under this Hospital Plan revision which we are discussing today, Paisley has lost one of the three Scottish hospitals in the Western Region to which reference has been made.
§ Mr. J. Robertson
The figure that I gave of 44 per cent. was for 1963. The figure extracted from the right hon. Gentleman was for one particular month, or for a shorter period. It tells us nothing.
§ Dr. Mabon
Knowing the Secretary of State, and knowing also my hon. Friend's reputation for research, I would be more inclined to accept my hon. Friend's figure than that given by the right hon. Gentleman. But even if the right hon. Gentleman is right, it is still a bad argument for him to accept the position in Scotland as being all right. It is no argument for him to say that this is the average figure, and that we can ignore what happens in other places. That is not a fair argument to use in relation to Renfrewshire, or in relation to North Lanarkshire, as was pointed out in the excellent speech of my hon. Friend the Member for Lanarkshire, North (Miss Herbison).
We have been told of the reaction of the Western Regional Hospital Board to the revision of the plan. In a Press statement the Board expressed disappointment, but my hon. Friend read a letter which contained some fierce comments by several of the members of that Board. The Minister of Health also has had some experience of this matter since he published his revisions. I understand that the North-East Metropolitan Board sent a deputation hot foot to see him almost before the publication was off the presses to protest against the way it had been dealt with.
Perhaps the hon. Member for Birmingham, Edgbaston ought to make speeches in the North-East of London and in the Western Region of Scotland. She will then discover how we feel about the postponing of the building of many of these vital hospitals. There is no satisfaction to be gained from looking at the list referred to by the hon. Member for Hertford. There are still many places in the country which are deprived of the hospitals.
I come now to the main theme of my argument. Our criticisms of this plan were made two years ago, and they were as accurate then as they are now. The concessions made by the Minister since then show that we were right. One has only to consider the provision of maternity beds to realise that our criticisms were fair.
The hon. Member for Edgbaston talked about how this plan was prepared. The Conservatives had been in office for more than 11 years. Suddenly it was decided, 749 says the hon. Lady, that she, the Minister, and his officials should get down to preparing it, and after a burst of feverish activity, including long weekends of work, it was produced. Is it any wonder that mistakes were made? Is it any wonder that it is a half-baked plan, or that it has come under such heavy criticism from many medical people who are not in politics at all?
I want to quote from the Spectator, which I believe is held to be a respectable journal by hon. Members opposite. An article written by Dr. Emrys Roberts on 21st February of this year says:We are faced with a plan concocted in great haste with virtually no field research and no consultation with official representatives of the medical profession.Why was it rushed? Why were mistakes made?
§ Lord Balniel
The hon. Member is complaining vigorously about the flexibility and the revisions of the Hospital Plan. He is quite entitled to take that view. But the hon. Member for St. Pancras, North (Mr. K. Robinson) at the time of the publication of the plan, said:After all, one favours flexibility; there is much to be said for it."—[OFFICIAL REPORT, 4th June, 1962; Vol. 661, c. 50.]One particularly favours flexibility when it enables us to increase expenditure on the hospital building programme by £250 million over the next decade.
§ Dr. Mabon
I admire the noble Lord for trying these things on, but that is a false argument. I am not arguing on the question of flexibility. I am talking about the mistakes in the plan. There are four mistakes. Some attempt has been made to correct one of them. The mistakes were in the assessment, first, of the number of maternity beds; secondly, the assessment of geriatric beds; thirdly, the assessment of psychiatric beds, and, fourthly, of general practitioner beds.
§ Dr. Mabon
Why were mistakes made? Because of the rush. Why the rush? Because, on 1st February, 1961, the then Minister of Health said that the whole idea of the health charges wasto carry through a long-term programme of modernisation of hospitals."—[OFFICIAL REPORT, 1st February, 1961; Vol. 633, c. 988.]750 All the Parliamentary activity in the succeeding months after February, 1961 was based on the need for raising new health taxes, which have been and continue to be far in excess of all the money spent by the Government on hospital building. They have had a very neat profit on that financial exercise, and at the same time the Government have been trying to make as much propaganda capital out of the hospital building programme as they could.
I understand that Groucho Marx is the favourite comedian of some hon. Members. On Monday he was asked to say whether, when they were making their films, he and his brothers were concerned about the social content or message of those films;. Groucho Marx, whom I admire much more than Karl Marx, said, "No, we just try to make money". That is exactly what the then Minister was doing. He was not interested in the social quality of the programme; he had just come from the Treasury. He was an outstanding Treasury Minister, and when he found himself unable to continue in the Cabinet under the present Prime Minister, after his enormous success at the Health Ministry, what better than to promote another Treasury man to be Minister of Health and to carry on the good Tory fiscal work that had been begun by the right hon. Member for Wolverhampton, South-West (Mr. Powell).
As for this flexibility that we hear about, listening to the right hon. Member for Wolverhampton, South-West talking about the programme one could almost see that stern, ascetic military face commanding the troops in action, when he said:Throughout most of the country there is an already agreed timetable … for every named scheme in the ten-year plan, so that the progress of each scheme can be policed from stage to stage."—[OFFICIAL REPORT, 4th June, 1962; Vol. 661, c. 155.]What a helpless police force there has been. What flexibility! All the police have been india rubber men. They have never caught anything. In the Scottish Western Region we have lost three hospitals, worth 2,000 beds, and have got 166 in exchange. There is policing for you! It is no doubt what he argued was going to be done. The hon. Lady went on to tell us of the weeks of preparing 751 this programme, and as soon as that programme was published there was a massive Press campaign and we had all the posters.
What the members of the party opposite failed to do was to look at the mistakes they made. However justified they may have been in their own minds in taking this step to save money and to do a good propaganda exercise in the country, they should have looked at the mistakes they made in their hurry. Take, for example, their back-bench campaign to save the cottage hospitals which followed the Press campaign. It was a milder campaign, a tranquil campaign, which was conducted as I say mainly by hon. Members opposite. There were a few hon. Members on this side of the Committee who took part in it too.
They fought a campaign for the cottage hospitals. Hon. Members should look at the list of Adjournment debates and they will find that most of the Adjournment debates on hospitals were initiated by Conservative Members who all made the same plea. It was argued that the position of the general practitioner would be severely undermined if all the cottage hospitals were closed. I suggest that if the Government intend to go ahead with this programme they should put up new posters and tell the truth, which would be that general practitioner hospitals are to be closed at the rate of one every ten days between now and the end of 1975. That is the truth.
What have me Government done about the general practitioner position? The Scottish plan made no calculation on the question of G.P.S beds. The General Medical Services Committee, which publishes an attractive pamphlet—I need not remind the Minister that it is not a professional body in the narrow sense of voluntary subscribing members, it does represent the profession—complained bitterly about the position of G.P. hospitals being totally unresolved. It stated:What the Committee wants in practical terms is this. Keep the general practitioner hospitals which are scheduled for closure under the Hospital Plan. Provide more general practitioner beds in maternity hospitals and in the District Hospitals proposed in the Hospital 752 Plan. Give G.P.s open access to all diagnostic aids. And give G.P.s more opportunities to work in the Hospital Service.I am not saying that I would subscribe to all that. But I do say to the Minister that it is high time he told the profession what he intends to do and what really ought to be done about the integrating of these hospitals. Are they to be completely written off? Is that still part of the programme? After all, we shall be terribly short of doctors in the years to come.
The anti-planners on the benches opposite made their most grievous error—comparable only to their error politically in voting against the Second and Third Reading of the National Health Service Act—when they accepted without question the recommendation of the Willink Committee in 1957 to cut the intake of medical students to the universities. We shall suffer from this until 1969. Since then the Government have reversed engines. By 1960 they realised their mistake. But the damage has been done, and it is substantial damage, to the medical manpower position in this country.
Tonight my hon. Friends have demonstrated adequately how much we depend presently on doctors who were not born in the United Kingdom to sustain the medical services in the hospitals of this country. There is little point in building a lot of hospitals if we have no doctors to staff them. If the Government do not waken up to this, they will find themselves in an almost impossible situation. When the Minister advocates one new medical school and that is all, and when the Government have so far not designated that school, it is a cause of great alarm to the medical profession. We firmly believe that four new medical schools ought to be designated now, and there should be one in the north, possibly in Durham, as that is the part of the country where the shortage is most acute.
§ Dr. Mabon
No, I am fighting against time in order to meet the request of the Minister, despite the fact that I did not get all the time that I wanted earlier.
I am coming to my point. Until we can resolve the present difficulty about medical manpower, it is almost nonsensical for us to talk about the Reports of 753 the Wright Committee and the Platt Committee.
When we are already short of doctors and seeking in various ways to save medical manpower, the closure of many G.P. hospitals prematurely seems nonsensical. On the other hand, we are seeing dissatisfaction among many National Health Service patients about the long waiting lists to see consultants while a significant minority of people are jumping the queue by various means and getting to see consultants before their equitable time.
This is a matter that is causing considerable concern, yet we recognise that until the implement of many of the proposals of the Wright Committee and of the Platt Review we shall not be able to cut down waiting lists and service the hospitals as should be done. We are waiting on the Minister with some concern to tell us the percentage increase which the Platt Review will suggest for the next five years. I am told that it might be about 28 per cent. One looks at the shortage at Newcastle, where there should be a 50 per cent. increase, and then in the South-West, where perhaps there should be a 20 per cent. increase. One has to look at the distribution of these increases in all parts of the country.
I conclude on this note. If the previous Minister has been able to sit alongside the Prime Minister he would still be Minister of Health and the present Minister would still be at the Treasury. But this is not so and perhaps we could have been more unlucky.
For example we could have had the present Minister of Housing and Local Government, who, when secretary of the Social Services Committee of the party opposite, actually proposed that prescription charges should be raised by 2s That was in June, 1959. The proposal was quickly hushed up but it was resuscitated when the party opposite succeeded in the General Election.
So we are happy in the sense of not having the worst Minister in this office. The present one has been a good Treasury Minister. He has observed all the Tory fiscal principles and has been bent on applying them to the National Health Service ever since he came into office. By a statistician his predecessor has been called "The high priest of crude quantification". I should not call the present 754 Minister that. He is only a mere acolyte compared to the high priest, because he has not questioned his predecessor's activities, He has refused to re-examine any assumptions of the plan and has commissioned no social research. He has made himself a willing and eager party to the deceptive propaganda carried out by the party opposite in relation to the health programme. All in all he has been the best available Minister of Health as Ministers of Health go with the party opposite—and, thank heavens, they are going soon.
§ 9.24 p.m.
§ The Minister of Health (Mr. Anthony Barber)
All those who were present in the Committee when the hon. Member for Rutherglen (Mr. Mackenzie) made his maiden speech were impressed and would wish to join me in congratulating him. I am sure the whole Committee was pleased that he saw fit to pay such a generous and well deserved tribute to Dick Brooman-White, whom we all knew so well in the House.
The hon. Member went on to make a speech which was full of interest and backed up by an obvious knowledge of his subject. He said—I hope I have got it right—"We in Scotland take our politics seriously". I must say that with considerably subtlety he indulged in a delicate avoidance of controversy, but left most of us with the clear impression that he was a supporter of the Labour Party. It is normal on these occasions to conclude by saying "We hope to hear the hon. Member on many occasions in future", but I am bound to say that I should be less than honest if I were to say that about any Scottish Member of Parliament. The hon. Member will be heard with respect by all those who are concerned with Scottish affairs.
Having made that observation about Scottish Members, perhaps I may say that I thought that the speech of the hon. Member for Greenock (Dr. Dickson Mabon) was a most agreeable one. The hon. Gentleman made some point about an observation of my right hon. Friend's concerned with the advantages and disadvantages of a long stay and a short stay in hospital. If I ever find myself in hospital again, I hope that, despite what he said, my stay will be a short 755 one, apart from the unlikely possibility of finding myself in a maternity unit.
Earlier in the debate, my right hon. Friend the Secretary of State for Scotland spoke in general terms on what I believe any objective person will consider to be the very considerable progress in the hospital service in Britain which has taken place over the last few years, progress which has been due to the medical profession, the nurses and midwives, the administrative and technical staffs, and the many others in the hospital service, who together number over 600,000 men and women.
I should like to add one more category of person without whose interest and devotion it would be impossible to run the hospital service on the lines to which every Member of the House of Commons subscribes. I am referring to the 10,000 voluntary members of regional hospital boards, boards of governors, hospital management committees and house committees, who are prepared to devote so much of their time, with no reward other than the satisfaction they glean from the influence for good that they have on the hospital service.
Among these men and women are several hon. Gentleman and hon. Ladies on both sides. Indeed, the hon. Member for St. Pancras, North (Mr. K. Robinson) is himself a member of a regional hospital board. It is characteristic of the way we order our affairs in this country that he and others have always acted as loyal agents of the Government of the day, because the boards are the agents of the Minister, without the slightest embarrassment to the Minister, and, I hope, without embarrassment to themselves, although I know that on many matters concerning hospital administration, the hon. Gentleman takes a different view from myself.
The hon. Member for Greenock, and, indeed, a number of other hon. Members before him, referred to the typhoid outbreak in Aberdeen. He referred to one particular aspect. I would like to say a few words about this. I had hoped to do so in any event, because I believe that there is considerable misunderstanding and I should like to take this, 756 the first opportunity I have had as Minister of Health, to make the position clear. The question has been asked: why when it was known in March that cans of corned beef at a canning plant in South America were being cooled with unchlorinated water, no further shipments from that plant were accepted but stocks already with wholesalers and in the shops were not recalled? I want, therefore, to explain to the Committee as briefly as I can just what happened.
An official of the Ministry of Agriculture, Fisheries and Food inspecting plants in South America notified his Department in early March that a plant in Argentina was not chlorinating its cooling water. The official told the management of the plant that no further shipments would be accepted until the chlorination plant was in operation. A principal medical officer at the Ministry of Health was informed. He took the view that, as there was no pointer to any illness arising from the product of this plant and no information of any typhoid outbreak in the area in which the plant operated, or, indeed, connected with its products, it would not be reasonable to arrange for the withdrawal of such stocks of corned beef from that plant as he knew to be in circulation.
I will come in a few moments to the merits of that decision, but perhaps I can first set out the chronology. It was on 1st June—that is, after the outbreak of typhoid in Aberdeen—that these facts were brought to the notice of myself and my right hon. Friends. After inquiries had been made in the course of the afternoon, it was learned on the same evening that some stocks from the plant in question produced during the period when cooling water was not chlorinated had been distributed through normal trade channels to the shop concerned in Aberdeen. On the following day my right hon. Friend announced that it had been decided to advise the withdrawal of certain 6 lb. cans from sale for the time being. I have met the representatives of the trade on a number of occasions, and this morning and this afternoon I have had further discussions with the representatives of the two plants in South America which have been referred to by my right hon. Friend.
757 I was told this evening that comparatively small quantities of tongue in 6 lb. cans were processed at these two plants over the same period as the 6 lb. cans of corned beef recently withdrawn from sale as a precautionary measure. I am told that these cans are not implicated in the Aberdeen typhoid outbreak in any way and that the possibility that any risk might attach to them must be remote indeed.
In present circumstances, however, my right hon. Friend the Secretary of State and I consider that it would be prudent for them to be withdrawn from sale for the time being, and the trade, with whom I have had discussions today, while strongly expressing the view, and they may be right, that there is nothing to indicate any danger of typhoid from these cans are, nevertheless, giving cooperation in making arrangements for their withdrawal.
§ Mr. Charles Loughlin (Gloucestershire, West)
Would the Minister clarify this point? He says that since there may be an element of risk, there is to be the withdrawal of these 6 lb. tins of tongue for the time being. If the element of risk is present now, does he mean that at a future date these 6 lb. tins will be distributed by the trade so that the risk will still be there?
§ Mr. Barber
That is a fair question. I am saying that there is no question of these cans, or the cans referred to by my right hon. Friend the Secretary of State the other day, being condemned. After all, views have been expressed by Dr. MacQueen and others as to what the cause of the outbreak might be. An inquiry has been set up by the Government specifically to consider the primary cause of the outbreak and how it was spread.
It would be the height of folly, on very small evidence, to condemn this considerable amount of beef, and this much smaller number of cans of tongue. We must put it in cold storage, if I may use that phrase, until we get the report of the Committee—and then we shall decide. Having said that, I wish to turn to another matter which is very important; the merits of the decision taken by the Principal Medical Officer in March and the reasons why that decision was taken. I quite understand that this 758 was an error, but a very important one, made the other day by the right hon. Member for Belper (Mr. G. Brown) in an intervention.
These were the reasons taken into account by the Principal Medical Officer. First, no ill-effects had been associated with corned beef imported from the plant, which is named Argentina 1A, whether or not the cans had been cooled with unchlorinated water. Secondly, to admit organisms during cooling there must, I am told, be a defect in the seam of the can, and I am given to understand that this happens only rarely. Thirdly, the chances of disease-causing organisms being admitted to the can without the organisms causing obvious spoilage of the contents are even more remote.
Unchlorinated cooling water is not of itself a cause of infection, and obviously what matters is the purity of the water. The Ministry of Agriculture inspector has confirmed that, as a result of inquiries which he made on the spot, there was no information of any typhoid outbreak in the area in which the plant operated. I ask the Committee to remember that this differed significantly from the circumstances last year when typhoid outbreaks in England became, on cumulative circumstantial evidence, connected with the output of corned beef from a particular plant which had been cooled with unchlorinated water after there had been an outbreak of typhoid upstream of the intake of the cooling plant. In those circumstances, the same Principal Medical Officer at once advised the withdrawal of all cans produced since the outbreak of typhoid in question. I might add that, throughout, the trade has cooperated fully to comply with the Government's wishes, regardless of their own views.
The average rate of consumption of canned corned beef in the United Kingdom in the last 20 years has been of the order of 60,000 tons a year. Well over 1 million tons were consumed between 1944 and 1963 alone, much of it from cans cooled in unchlorinated water.
§ Mr. Walter Monslow (Barrow-in-Furness)
This is important because of the statement made by my right hon. 759 Friend the Member for Belper (Mr. G. Brown) and I want to supplement what he said. I understand that as far as the high seas were concerned a stop was put on, but certain corned beef had arrived. What was the time factor in this recall?
§ Mr. Barber
I want to deal with that very point. I have dealt so far with the reasons for the decision not to withdraw stocks in this country when it was known by the Principal Medical Officer in March. Obviously I have given this matter considerable thought. In fairness to the Principal Medical Officer concerned, I must say that if I had been asked for my view at that time I have no doubt that I would have endorsed his decision and, what is more, my Chief Medical Officer takes the same view.
The point which the hon. Member is making is really the same as that raised by the right hon. Member for Belper (Mr. G. Brown) the other day when he asked very properly, "If that decision was right, why on earth was it decided not to accept further shipments?" The answer is that this was meat presented for import with a certificate known to be inaccurate as a result of the inquiries which had been made. It was very properly rejected because of that failure, but rejection of food at the port, in those circumstances, does not mean that a specific health hazard exists which alone would warrant action to call in supplies which have already been distributed in this country. It has not been possible before to give the Committee a full account, firstly of what happened and secondly the reasons for the decision taken, and I am grateful to the hon. Member for Greenock for permitting me to rise a little earlier than normal to make this clear.
§ Mr. William Ross (Kilmarnock)
Surely the facts remain as stated and brought out by my right hon. Friend the Member for Belper (Mr. G. Brown), that the Government were aware that there were distributed within this country stocks of corned beef from a factory in respect of which further stocks were stopped on the high seas and that these stocks which had been distributed—and this may be the trouble about the fact that they had been distributed—were also imported on the basis of certificates 760 which carried false information since the same circumstances arose. Is the right hon. Gentleman denying that his Department in the circumstances took a calculated risk, and we do not know yet just exactly what the risk was?
§ Mr. Barber
I see the hon. Member's point, but what the right hon. Member for Belper said the other day was that the Minister, my right hon. Friend, said that he and his right hon. Friend were advised months ago, presumably in time to avoid this outbreak, to withdraw these supplies of corned beef, but the right hon. Member for Belper said that he did not do so. All I wanted to explain was that this was not what happened.
I do not wish to detain the Committee because I want to go on to other matters, but I can give examples. I know of a consignment of an entirely different product which arrived at a port in this country from another country which is well known for its hygienic conditions. This product arrived with no certificate with it, and it was turned back at the port even though we were told that a certificate would follow and even though there was no reason to think that there was any health hazard of any kind. It was nevertheless turned back on those grounds.
As for the suggested calculated risk, serious though the outbreak in Aberdeen has been, we must keep a sense of proportion. [HON. MEMBERS: "Oh."] I will explain what I mean. I am not being discourteous. It is quite impossible to take steps to ensure that 100 per cent. canned food or indeed any other food is not contaminated in any way. Of course, it would be possible to go to inordinate lengths, but the consequence would be that there would be virtually nothing left to eat. [HON. MEMBERS: "Oh."] I am advised that, in fact, canned food is in general less liable to infection than fresh food.
I have had opportunities before of explaining this particular point outside the House of Commons, but I did not do so because I had in mind that there would be this occasion. The hon. Gentleman allowed me to rise a little early, and I wanted to make the matter clear.
§ Mr. Ross
This is a serious matter, and I think that the difficulty arises from the fact that the right hon. Gentleman is making what is virtually a Government statement at a time when he cannot be properly questioned by the Committee and without the usual courtesy of a copy of that statement made to the other Front Bench. [HON. MEMBERS: "Oh."] That is perfectly true.
We are discussing the matter within the context of our knowledge of an outbreak and within the context of our knowledge that the medical officer of health on the spot has certain definite opinions on the cause of the outbreak. It was nine days after the event before the Secretary of State issued his statement about the withdrawal of certain cans. The right hon. Gentleman has not satisfactorily dealt with what my right hon. Friend the Member for Belper said. I have no recollection of my right hon. Friend saying that the Minister had been advised to withdraw. What he was saying was that the Minister's Department knew of the existence of such stocks which had been distributed.
§ Mr. Barber
I quoted what the right hon. Gentleman had said. I have explained why what he said was not true. I have not the slightest doubt that the inaccuracy was quite inadvertent, but it was important nevertheless to have the record straight. This is all I have done. I have explained exactly what happened, and I said that I believe the decision taken to be the right one. I thought it right to give the Committee this information. If I may say so—I do not want to pursue this unduly unless the hon. Gentleman wishes me to do so—the only bit of news I have given tonight was the information I learned only this afternoon about the comparatively small number of cans of tongue. I thought that, as it would only take a minute and a half to give the information to the Committee, it would be right to do so, particularly as many hon. Members will be away tomorrow, Friday.
§ Mr. Denzil Freeth (Basingstoke)
Is it not a fact that, until 1955, virtually none of the corned beef consumed in this country was cooled in chlorinated water, and virtually no outbreaks of typhoid on a serious scale occurred?
§ Mr. Barber
My hon. Friend is absolutely right. The first pointers to any serious association with typhoid were the outbreaks last year.
I come now to some of the points made in the general debate. There were three or four references to the question of typhoid, and I thought it right to deal with that matter first. A great deal has been said in the debate about individual projects, all of which, of course, have a bearing on the size of the hospital programme and, consequently, on the demands which that programme makes on both physical resources and finance. I shall come back in a few minutes to these over-riding considerations, but I wish first to deal as quickly as I can with one or two aspects of the Hospital Service raised by hon. Members in the course of the debate. If I do not answer in the time available all the points which have been raised, this is not through lack of goodwill but because there is very little time left.
The hon. Member for St. Pancras, North asked me about the Platt Report and suggested that I was holding back publication of it for some ulterior motive. I can tell him that the difficulty is that we are still discussing a most important point with the profession, namely, the terms and conditions of service for the new intermediate grade. We hope to reach a conclusion fairly soon, and I expect that it will not be too long before we are able to publish the outcome. Obviously, it is a matter of general interest.
My hon. Friend the Member for Birmingham, Edgbaston (Dame Edith Pitt) referred to beds for mental illness and asked whether the number was likely to be reduced, as was envisaged at an earlier stags;. The probable number of beds required for 1975 for mental illness, as shown in the original Hospital Plan, represents overall a reduction of 40 per cent. on the beds in 1960. Other forecasts of requirement have been made, including a recent study of the Leeds Regional Board, which was probably the one referred to by an hon. Member opposite. We are now looking at this. No beds will be closed as long as they are needed. The fact remains that the total number of beds in use has declined year by year since 1960.
The hon. Member for Orpington (Mr. Lubbock) asked about enrolled nurses, 763 My right hon. Friend was talking generally about the increase in the number of nursing staff in the hospital service over a period of 10 years. The number of enrolled nurses over the same period has gone up by nearly 3,000.
My hon. Friend the Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) made a particularly interesting and forceful speech. I am sorry that I did not hear all that he said. I will, however, certainly look into the point that he made. I recognise the difficulties which some teaching hospitals have in coping with the amount available for expenditure on current account. I agree entirely that it is undesirable for children to be in the same wards as adults. Nothing has distressed my wife more than when coming around a hospital with me a short time ago she saw a small child in bed next to an old lady who was very ill.
My hon. Friend the Member for Galloway (Mr. Brewis) asked, ought not more beds to be provided at Fort William? He will be pleased to know that the new general hospital will be open at Fort William before the end of this year.
My hon. Friend the Member for Birmingham, Edgbaston asked for figures about tuberculosis and diseases of the chest. I have the figures here, but perhaps I may write to her. They bear out, I think, the point that she was making.
§ Mr. Barber
I was told Fort William, but Scottish affairs are rather beyond me.
Perhaps I can answer quickly the criticism made by the hon. Member for Greenock about the Western Region. I thought that he was indicating that we were not even reaching the Montgomery standards of maternity provision. I am told that the returns from the medical officers of health in the Western Region showed that the institutional confinement rate in the region as a whole in 1963 was over 76 per cent. The hon. Member will 764 be particularly pleased to hear about that. [HON. MEMBERS: "Oh, no."] It is no good saying "Oh, no". This is what the medical officers of health say.
§ Mr. Barber
All right—Paisley, within the region. Montgomery said 70 to 75 per cent. The hon. Gentleman knows that for Paisley it is 75 per cent. Therefore, it is not so bad.
§ Mr. Barber
Yes, but he was referring to 1962. I have been a bit quicker off the mark. I have the 1963 figures, which are very much better.
I should love to say a great deal about small hospitals, but, frankly, it would take me a fair time. I have said it all before, and if the hon. Member for Greenock really wants to know my policy I will be delighted to let him have it. I have a large bunch of papers concerning manpower—doctors, nurses, and so on.
§ Miss Herbison
The Minister has been dealing with the Western Regional Hospital Board. Can he give the members of that Board any comfort, particularly about the Strathclyde hospital in the growth area?
§ Mr. Barber
The hon. Lady might have given me notice of that. I should have been happy to answer it.
I turn to the hospital building programme. There has been considerable criticism today of the programme. I remember that in the last debate, in December, the hon. Member for St. Pancras, North said:When Labour left office in 1951 the Health Service was poised for a great push forward towards the full realisation of the ideals upon which it was founded.It was the hon. Member, and not me, who chose 1951.
I ask the Committee to consider how the Labour Party set about, to use the hon. Member's own words, poising themselves for a great push forward. We 765 all remember that the Leader of the Opposition resigned from the Government because, as he said, there was for the first time a cutting into the social services. That was the Labour Government's swansong. To use his own words, the Leader of the Opposition's reason was that British industry stood disorganised and threatened by partial paralysis. That was after six years of Socialism. Then, the hon. Member for St. Pancras, North went on to declareNever since that time has the Health Service enjoyed under Conservative Governments anything like the special priorities which were accorded to it by the Labour Government that set it up."—[OFFICIAL REPORT, 19th December, 1963; Vol. 686. 1467.Hon. Members opposite have today chosen to debate the Hospital Service. Let us consider, therefore, what the hon. Gentleman was saying in relation to that Service. In those halcyon days of Socialist public affluence—[Interruption]—no, not in 1945—
§ Mr. Lubbock
On a point of order. Hon. Members have asked a large number of questions during the debate, Sir William, and we are waiting for the replies to them. Will we get them?
§ Miss Herbison
On a point of order. I wonder, Sir William, whether you can help me in a difficult situation. [Laughter.] It may be funny to all those hon. Members who have not attended the debate. But when I intervened with the Minister to seek an answer to a specific question which I had put to him in the debate he said that he would require notice of it. Where is the liaison between the two Ministers? May I have a reply?
§ Mr. Barber
I offer my humble apologies to the hon. Lady and will write to her immediately. If she would like to put down a Question—[Interruption.]—I apologise if I missed the question; otherwise I should have tried to find the answer.
766 These general questions which have been brought up time and time again during the debate are very relevant. For example, the hon. Member for Greenock, in winding up the debate, and the hon. Member for Bristol, South (Mr. Wilkins) both derided the Government because, they said, the Conservative Central Office had withdrawn a poster about hospital building. I want it to be known clearly that that is quite untrue. No poster was withdrawn.
§ Mr. Barber
Furthermore, it is a fact that last year's programme included the start of one new or substantially remodelled hospital every 19 days. I hope that the Opposition will not be too dismayed when I say that this year we shall start one every 10 days. To listen to some hon. Members opposite, one would get the impression that a Labour Government would increase the hospital programme.
The hon. Lady the Member for Lanarkshire, North (Miss Herbison) said that what we want is a little honesty. But is there a single right hon. or hon. Member on the Front Bench opposite who would pretend that a Labour Government would increase the present programme?
§ Mr. Barber
I will quote what the hon. Member for St. Pancras, North said and I will answer him. This is what he said about the future of the hospital programme under the Labour Party. The Committee will, I hope, ponder on these words. He said: "What would a Labour Government do? It is difficult to answer that question in precise terms. Schemes now under construction we would not touch, but with regard to the second quinquennium, we should take a long and hard look at it with the hospital authorities." I think the House will agree that those are words pregnant with significance.
§ Mr. K. Robinson
The right hon. Gentleman is not making very profitable use of the few minutes left to him. However, he might go on to say that I reminded the Committee that there were five specific things that we would do.
§ Mr. Barber
All I was saying was that I assume that the hon. Gentleman and all other right hon. and hon. Gentlemen 767 on the Opposition Front Bench agree with the hon. Member for Cardiff, South-East (Mr. Callaghan), who said that the hospital programme could not be exceeded by any party with any degree of responsibility.
The fact is that throughout the debate hon. Members opposite have bemoaned the inadequacies of the hospital plans in their own constituencies. I hope they will now go back to their electors and tell them that the policy of the Labour Party is to do no more than the Government propose. If they are not prepared to do that, let the hon. Member for St. Pancras, North tell the Committee in what other parts of the country he would make compensating cuts in the programme.
There is also the question of how one finances the hospital programme. The health charges are to be abolished at a cost of £50 million. When I asked the hon. Gentleman whether there would be £50 million less for the Health Service, he said "No". When I asked him on another occasion whether there would be a £50 million increase in taxation, he said "No". So the only remaining alternative is a cut of £50 million which would otherwise be available for some other
§ public service. I hope that in due course we shall be told which.
§ That is not all. There is an Opposition proposal to abolish the weekly Health Service contribution which helps finance the hospital service. At last year's Labour Party Conference a resolution was passed which would cost £160 million a year, which is equivalent to 9d. on the standard rate of Income Tax. Is that what we can expect for abolishing the Health Service contribution, or is there to be an increase in Purchase Tax or an increase in Profits Tax?
§ The issue before the Committee is clear. All I would say is that if hon. Gentlemen opposite are not going to fulfil the views expressed by the Labour Party Conference, by the hon. Lady the Member for Cannock (Miss Lee), who is now leaving the Chamber, and by the Leader of the Opposition, they still have a few more months in which to try to settle their differences. Meanwhile, we shall get on with the job.
§ Mr. K. Robinson
I beg to move, That Item Class VI, Vote 13 (Ministry of Health), be reduced by £5.
§ Question put:—
§ The Committee divided: Ayes 219, Noes 274.771
|Division No. 108.]||AYES||[10.0 p.m.|
|Abse, Leo||Darling, George||Hale, Leslie (Oldham, W.)|
|Allaun, Frank (Salford, E.)||Davies, G. Elfed (Rhondda, E.)||Hamilton, William (West Fife)|
|Allen, Scholefield (Crewe)||Davies, Harold (Leek)||Harper, Joseph|
|Bacon, Miss Alice||Davies, Ifor (Gower)||Hart, Mrs. Judith|
|Barnett, Guy||Deer, George||Hayman, F. H.|
|Baxter, William (Stirlingshire, W.)||Delargy, Hugh||Henderson, Rt. Hn. Arthur (Rwly Regis)|
|Beaney, Alan||Diamond, John||Herbison, Miss Margaret|
|Bellenger, Rt. Hon. F. J.||Dodds, Norman||Hewitson, Capt. M.|
|Bence, Cyril||Doig, Peter||Hilton, A. V.|
|Bonn, Anthony Wedgwood||Donnelly, Desmond||Holman, Percy|
|Bennett, J. (Glasgow, Bridgeton)||Driberg, Tom||Hooson, H. E.|
|Benson, Sir George||Duffy, A. E. P. (Colne Valley)||Houghton, Douglas|
|Blackburn, F.||Edelman, Maurice||Howell, Charles A. (Perry Barr)|
|Blyton, William||Edwards, Rt. Hon. Ness (Caerphilly)||Howie, W.|
|Boston, T.||Edwards, Robert (Bilston)||Hoy, James H.|
|Bottomley, Rt. Hon. A. G.||Edwards, Walter (Stepney)||Hughes, Cledwyn (Anglesey)|
|Bowden, Rt. Hn. H. W. (Leics, S. W.)||Evans, Albert||Hughes, Emrys (S. Ayrshire)|
|Bowen, Roderic (Cardigan)||Fernyhough, E.||Hughes, Hector (Aberdeen, N.)|
|Bowles, Frank||Finch, Harold||Hunter, A. E.|
|Boyden, James||Fitch, Alan||Hynd, H. (Accrington)|
|Bradley, Tom||Fletcher, Eric||Hynd, John (Attercliffe)|
|Bray, Dr. Jeremy||Foley, Maurice||Irvine, A. J. (Edge Hill)|
|Brockway, A. Fenner||Foot, Michael (Ebbw Vale)||Janner, Sir Barnett|
|Broughton, Dr. A. D. D.||Forman, J. C.||Jay, Rt. Hon. Douglas|
|Butler, Mrs. Joyce (Wood Green)||Fraser, Thomas (Hamilton)||Jeger, George|
|Callaghan, James||Galpern, Sir Myer||Jenkins, Roy (Stechford)|
|Carmichael, Neil||Ginsburg, David||Jones, Dan (Burnley)|
|Chapman, Donald||Gordon Walker, Rt. Hon. P. C.||Jones, Elwyn (West Ham, S.)|
|Collick, Percy||Gourlay, Harry||Jones, J. Idwal (Wrexham)|
|Corbet, Mrs. Freda||Grey, Charles||Jones, T. W. (Merioneth)|
|Craddock, George (Bradford, S.)||Griffiths, David (Rother Valley)||Kelley, Richard|
|Cronin, John||Griffiths, Rt. Hon. James (Llanelly)||Kenyon, Clifford|
|Crosland, Anthony||Griffiths, W. (Exchange)||Lawson, George|
|Cullen, Mrs. Alice||Grimond, Rt. Hon. J.||Ledger, Ron|
|Dalyell, Tam||Gunter, Ray||Lee, Frederick (Newton)|
|Lee, Miss Jennie (Cannock)||Oram, A. E.||Sorensen, R, W.|
|Lever, Harold (Cheetham)||Oswald, Thomas||Spriggs, Leslie|
|Lever, L. M. (Ardwick)||Owen, Will||Stewart, Michael (Fulham)|
|Lewis, Arthur (West Ham, N.)||Padley, W. E.||Stones, William|
|Lipton, Marcus||Paget, R. T.||Strauss, Rt. Hn. G. R. (Vauxhall)|
|Loughlin, Charles||Pargiter, G. A.||Stross, Sir Barnett (Stoke-on-Trent, C.)|
|Lubbock, Eric||Parker, John||Swain, Thomas|
|Mabon, Dr. J. Dickson||Parkin, B. T.||Swingler, Stephen|
|McBride, N.||Paton, John||Symonds, J, B.|
|MacColl, James||Pavitt, Laurence||Taverne, D,|
|MacDermot, Niall||Pearson, Arthur (Pontypridd)||Taylor, Bernard (Mansfield)|
|McInnes, James||Peart, Frederick||Thomas, George (Cardiff, W.)|
|McKay, John (Wallsend)||Pentland, Norman||Thomas, Iorwerth (Rhondda, W.)|
|Mackenzie, Gregor||Popplewell, Ernest||Thompson, Dr. Alan (Dunfermline)|
|Mackie, John (Enfield, East)||Prentice, R. E.||Thomson, G. M. (Dundee, E.)|
|McLeavy, Frank||Probert, Arthur||Thornton, Ernest|
|MacMillan, Malcolm (Western Isles)||Proctor, W. T.||Thorpe, Jeremy|
|MacPherson, Malcolm||Pursey, Cmdr. Harry||Timmons, John|
|Mallalieu, E. L. (Brigg)||Randall, Harry||Tomney, Frank|
|Mallalieu, J. P. w. (Huddersfield, E.)||Rankin, John||Wainwright, Edwin|
|Manuel, Archie||Redhead, E. C.||Warbey, William|
|Mapp, Charles||Rees, Merlyn (Leeds, S.)||Weitzman, David|
|Marsh, Richard||Reid, William||Wells, William (Walsall, N.)|
|Mason, Roy||Rhodes, H.||White, Mrs. Eirene|
|Mellish, R. J.||Roberts, Albert (Normanton)||Whitlock, William|
|Mendelson, J. J.||Robertson, John (Paisley)||Wilkins, W. A.|
|Millan, Bruce||Robinson, Kenneth (St. Pancras, N.)||Williams, D. J. (Neath)|
|Milne, Edward||Rodgers, W. T. (Stockton)||Williams, LI. (Abertillery)|
|Mitchison, G. R.||Ross, William||Williams, W. T. (Warrington)|
|Monslow, Walter||Royle, Charles (Salford, West)||Willis, E. G. (Edinburgh, E.)|
|Moody, A. S.||Shinwell, Rt. Hon. E.||Winterbottom, R. E.|
|Morris, Charles (Openshaw)||Silkin, John||Woodburn, Rt. Hon. A.|
|Morris, John (Aberavon)||Silverman, Julius (Aston)||Woof, Robert|
|Moyle, Arthur||Skeffington, Arthur||Wyatt, Woodrow|
|Mulley, Frederick||Slater, Mrs. Harriet (Stoke, N.)||Yates, Victor (Ladywood)|
|Noel-Baker, Francis (Swindon)||Slater, Joseph (Sedgefield)||Zilliacus, K.|
|Noel-Baker, Rt. Hn. Philip (Derby, S.)||Small, William|
|Oliver, G. H.||Smith, Ellis (Stoke, S.)||TELLERS FOR THE AYES:|
|O'Malley, S. K.||Snow, Julian||Mr. Short and|
|Mr. G. H. R. Rogers.|
|Agnew, Sir Peter||Channon, H. P. G.||Gardner, Edward|
|Allan, Robert (Paddington, S.)||Chataway, Christopher||Gibson-Watt, David|
|Allason, James||Clark, Henry (Antrim, N.)||Gilmour, Ian (Norfolk, Central)|
|Amery, Rt. Hon. Julian||Clark, William (Nottingham, S.)||Gilmour, Sir John (East Fife)|
|Arbuthnot, Sir John||Clarke, Brig. Terence (Portsmouth, W.)||Glover, Sir Douglas|
|Ashton, Sir Hubert||Cleaver, Leonard||Glyn, Dr. Alan (Clapham)|
|Atkins, Humphrey||Cole, Norman||Goodhart, Philip|
|Awdry, Daniel (Chippenham)||Cooper, A. E.||Goodhew, Victor|
|Balniel, Lord||Cooper-Key, Sir Neill||Gough, Frederick|
|Barber, Rt. Hon. Anthony||Cordeaux, Lt.-Col. J. K.||Grant-Ferris, R.|
|Barlow, Sir John||Corfield, F. V.||Green, Alan|
|Barter, John||Costain, A. P.||Griffiths, Eldon (Bury St. Edmunds)|
|Batsford, Brian||Coulson, Michael||Gurden, Harold|
|Bennett, F. M. (Torquay)||Craddock, Sir Beresford (Spelthorne)||Hamilton, Michael (Wellingborough)|
|Bennett, Dr. Reginald (Gos & Fhm)||Critchley, Julian||Harris, Frederic (Croydon, N. W.)|
|Berkeley, Humphry||Crowder, F. P.||Harris, Reader (Heston)|
|Bevins, Rt. Hon. Reginald||Cunningham, Sir Knox||Harrison, Brian (Maldon)|
|Bidgood, John C.||Curran, Charles||Harrison, Col. Sir Harwood (Eye)|
|Biffen, John||Dalkeith, Earl of||Harvey, Sir Arthur Vere (Macclesf'd)|
|Biggs-Davison, John||d'Avigdor-Goldsmid, Sir Henry||Harvey, John (Walthamstow, E.)|
|Bingham, R. M.||Deedes, Rt. Hon. W. F.||Harvie Anderson, Miss|
|Birch, Rt. Hon. Nigel||Digby, Simon Wingfield||Hastings, Stephen|
|Bishop, Sir Patrick||Doughty, Charles||Hay, John|
|Black, Sir Cyril||Douglas-Home, Rt. Hon. Sir Alec||Heald, Rt. Hon. Sir Lionel|
|Bossom, Hon. Clive||du Cann, Edward||Henderson, John (Cathcart)|
|Bourne-Arton, A.||Duncan, Sir James||Hendry, Forbes|
|Box, Donald||Eden, Sir John||Hicks Beach, Maj. W.|
|Boyle, Rt. Hon. Sir Edward||Elliot, Capt. Walter (Carshalton)||Hiley, Joseph|
|Braine, Bernard||Elliot, R. W. (Newc'tle-upon-Tyne, N.)||Hill, Mrs. Eveline (Wythenshawe)|
|Brewis, John||Emmet, Hon, Mrs. Evelyn||Hill, J. E. B. (S. Norfolk)|
|Bromley-Davenport, Lt.-Col. Sir Walter||Erroll, Rt. Hon. F. J.||Hirst, Geoffrey|
|Brooke, Rt. Hon. Henry||Farey-Jones, F. W.||Hobson, Rt. Hon. Sir John|
|Browne, Percy (Torrington)||Farr, John||Hocking, Philip N.|
|Bryan, Paul||Fell, Anthony||Hogg, Rt. Hon. Quintin|
|Buck, Antony||Fisher, Nigel||Holland, Philip|
|Bullard, Denys||Fletcher-Cooke, Charles||Hollingworth, John|
|Bullus, Wing Commander Eric||Forrest, George||Hope, Rt. Hon. Lord John|
|Burden, F. A.||Foster, Sir John||Hopkins, Alan|
|Campbell, Gordon||Fraser, Ian (Plymouth, Sutton)||Hornsby-Smith, Rt. Hon. Dame P.|
|Carr, Compton (Barons Court)||Freeth, Denzil||Howard, Hon. G. R. (St. Ives)|
|Carr, Rt. Hon. Robert (Mitcham)||Galbraith, Hon. T. G. D.||Howard, John (Southampton, Test)|
|Cary, Sir Robert||Gammans, Lady||Hughes Hallett, Vice-Admiral John|
|Hughes-Young, Michael||More, Jasper (Ludlow)||Stanley, Hon. Richard|
|Hulbert, Sir Norman||Morrison, Charles (Devizes)||Stevens, Geoffrey|
|Iremonger, T. L.||Morrison, John (Salisbury)||Steward, Harold (Stockport, S.)|
|Irvine, Bryant Godman (Rye)||Neave, Airey||Stodart, J. A.|
|James, David||Nicholls, Sir Harmar||Stoddart-Scott, Col. Sir Malcolm|
|Jennings, J, C.||Nicholson, Sir Godfrey||Storey, Sir Samuel|
|Johnson, Eric (Blakeley)||Noble, Rt. Hon. Michael||Studholme, Sir Henry|
|Johnson Smith, Geoffrey||Nugent, Rt. Hon. Sir Richard||Talbot, John E.|
|Jones, Arthur (Northants, S.)||Orr-Ewing, Sir Ian (Hendon, North)||Tapsell, Peter|
|Jones, Rt. Hon. Aubrey (Hall Green)||Osborn, John (Hallam)||Taylor, Sir Charles (Eastbourne)|
|Joseph, Rt. Hon. Sir Keith||Osborne, Sir Cyril (Louth)||Taylor, Edwin (Bolton, E.)|
|Kerans, Cdr. J. S.||Page, Graham (Crosby)||Taylor, Frank (M'ch'st'r, Moss Side)|
|Kerby, Capt. Henry||Page, John (Harrow, West)||Teeling, Sir William|
|Kerr, Sir Hamilton||Pannell, Norman (Kirkdale)||Temple, John M.|
|Kershaw, Anthony||Partridge, E.||Thatcher, Mrs. Margaret|
|Kimball, Marcus||Pearson, Frank (Clitheroe)||Thomas, Peter (Conway)|
|Kirk, Peter||Percival, Ian||Thompson, Sir Richard (Croydon, S.)|
|Lancaster, Col. C. G.||Pickthorn, Sir Kenneth||Thorneycroft, Rt. Hon. Peter|
|Leavey, J. A.||Pike, Miss Mervyn||Thornton-Kemsley, Sir Colin|
|Lindsay, Sir Martin||Pitman, Sir James||Tilney, John (Wavertree)|
|Linstead, Sir Hugh||Pitt, Dame Edith||Touche, Rt. Hon. Sir Gordon|
|Litchfield, Capt. John||Pounder, Rafton||Turner, Colin|
|Lloyd, Rt. Hn. Geoffrey (Sut'nC'dfield)||Powell, Rt. Hon. J. Enoch||Turton, Rt. Hon. R. H.|
|Lloyd, Rt. Hon. Selwyn (Wirral)||Price, David (Eastleigh)||Tweedsmuir, Lady|
|Longden, Gilbert||Price, H. A. (Lewisham, W.)||van Straubenzee, W. R.|
|Loveys, Walter H.||Prior, J. M. L.||Vane, W. M. F.|
|Lucas, Sir Jocelyn||Prior-Palmer, Brig, sir Otho||Vaughan-Morgan, Rt. Hon. Sir John|
|Lucas-Tooth, Sir Hugh||Pym, Francis||Vickers, Miss Joan|
|McAdden, Sir Stephen||Quennell, Miss J. M.||Walder, David|
|MacArthur, Ian||Ramsden, Rt. Hon. James||Walker-Smith, Rt. Hon. Sir Derek|
|McLaren, Martin||Rawlinson, Rt. Hon. Sir Peter||Wall, Patrick|
|Maclean, Sir Fitzroy (Bute & N. Ayrs)||Redmayne, Rt. Hon. Martin||Ward, Dame Irene|
|MacLeod, Sir John (Ross & Cromarty)||Rees, Hugh (Swansea, W.)||Watkinson, Rt. Hon. Harold|
|McMaster, Stanley R.||Rees-Davies, W. R. (Isle of Thanet)||Wells, John (Maidstone)|
|Macmillan, Maurice (Halifax)||Renton, Rt. Hon. David||Whitelaw, William|
|Maddan, Martin||Ridsdale, Julian||Williams, Dudley (Exeter)|
|Maginnis, John E.||Robertson, Sir D. (C'thn's & S'th'ld)||Williams, Paul (Sunderland, S.)|
|Maitland, Sir John||Rodgers, John (Sevenoaks)||Wills, Sir Gerald (Bridgwater)|
|Markham, Major Sir Frank||Roots, William||Wilson, Geoffrey (Truro)|
|Marlowe, Anthony||Ropner, Col. Sir Leonard||Wise, A. R.|
|Marples, Rt. Hon. Ernest||Royle, Anthony (Richmond, Surrey)||Wolrige-Gordon, Patrick|
|Marshall, Sir Douglas||Scott-Hopkins, James||Wood, Rt. Hon. Richard|
|Marten, Neil||Sharples, Richard||Woodhouse, C. M.|
|Mathew, Robert (Honiton)||Shaw, M.||Woollam, John|
|Matthews, Gordon (Meriden)||Shepherd, William||Worsley, Marcus|
|Maude, Angus (Stratford-on-Avon)||Skeet, T. H. H.||Yates, William (The Wrekin)|
|Mawby, Ray||Smith, Dudley (Br'ntf'rd & Chiswick)|
|Maxwell-Hyslop, R. J.||Smyth, Rt. Hon. Brig. Sir John||TELLERS FOR THE NOES:|
|Maydon, Lt.-Cmdr. S. L. C.||Soames, Rt. Hon. Christopher||Mr. Chichester-Clark and|
|Mills, Stratton||Speir, Rupert||Mr. Finlay|
|Montgomery, Fergus||Stainton, Keith|
§ Original Question again proposed.772
§ It being after Ten o'clock, The CHAIRMAN left the Chair to report Progress and ask leave to sit again.
§ Committee report Progress; to sit again Tomorrow.