§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Howie.]
§ 4.0 p.m.
§ Mr. F. A. Burden (Gillingham)
This Adjournment debate might almost be classed as a climax to our earlier proceedings. The House has been discussing the growth of the authoritarian and paternalistic State, and the debate which I am initiating somewhat deals with that matter.
The previous discussion has shown that, in many ways, Socialists do not care about the individual to the extent that they often proclaim. I am reminded of the comments of my right hon. and learned Friend the Member for Huntingdonshire (Sir D. Renton) about our taking care to ensure that individual men and women are not trampled under the feet of bureaucracy.
§ Mr. Burden
I wish to refer to the tragic case of a woman who died in my constituency on 2nd October. Mrs. Lilian Martin was riding in a Maidstone and District bus when she collapsed. The attention of the conductor-driver was 910 drawn to her condition, which he considered to be so critical that he at once took his bus out of service and drove Mrs. Martin to the Medway Hospital, the nearest hospital.
§ Mr. Burden
On arrival at the hospital, he was confronted by the gate porter, who told him that he must take Mrs. Martin to St. Bartholomew's Hospital, two or three miles away.
§ Mr. Burden
I am grateful for the support of my hon. Friend the Member for Ormskirk (Sir D. Glover) but I wish that, instead of interjecting, he would just nod his head in agreement.
Mrs. Martin was taken two or three miles to St. Bartholomew's Hospital because there were no casualty facilities at the Medway Hospital. We shall never know whether this unfortunate woman was alive at that time, but we do know that she was beyond aid when she arrived at St. Bartholomew's.
The local newspapers, somewhat naturally, carried reports of this unhappy incident; on Friday, 6th October and on Tuesday, 10th October. On 11th October I sent to the Minister a copy of a report published by one of my local newspapers on 6th October and, because of its relevance, I will quote the letter:I have had a number of telephone calls and letters as a result of a report that appeared in the … local paper … last Friday. I think you should see the article.It does seem to me to be a fantastic state of affairs if a gate porter at a hospital can turn away a person who is critically ill and unconscious without even consulting a doctor. The very fact that the driver of a public vehicle was so concerned at the condition of Mrs. Martin that he took his bus off route to get her to hospital should surely have been reason enough for the porter to contact a doctor and for the latter at least to treat the woman and, if necessary, call for an ambulance to convey her to St. Bartholomew's Hospital. I am not saying that her life could have been saved, but there is just the chance that it might have been, and certainly that might be true of some cases in the future.If this statement attributed to Mr. T. Rhodes is true, it is callous, stupid and reprehensible. I trust you will ensure that whatever technical mistakes the public may make in their assumption of hospital duties, where minutes or even seconds may mean the life or death of a person brought to them, it is the duty of hospitals to give succour, and then arrange the niceties of responsibility for admission.911In my view this is a very serious matter. Surely every general hospital should have facilities for dealing with urgent casualties.I referred to Mr. Rhodes who is the Secretary of the Medway and Gravesend Hospital Committee. In the first report Mr. Rhodes said:The public should know there is no casualty department at Medway Hospital. All casualties are taken to St. Bartholomew's and the gate porter would give a straightforward, plain instruction for the patient to be taken there.How are the public all to know that this is not an admission hospital? This hospital was the Royal Naval Hospital and it became a civilian hospital about three years or so ago. At that time, was it said in the Press, and through the other means of communication, that the new hospital would not be an admissions hospital? I will make a guess that if it had still been the Royal Naval Hospital, and that person had been taken there, she would at least have received some attention before being sent elsewhere.
On 12th October I sent a cutting from another paper to the Minister. The report in that paper said:Mr. Wimsey, the bus driver, said Mrs. Martin seemed rather vague when she got on his 'pay-as-you-enter' bus at Wigmore, but he did not know she was ill until one of the passengers told him when he stopped in the High Street. 'I know a little bit about first aid ', continued Mr. Wimsey, so I went back and had a look at her. She was a nasty colour, her breathing was shallow and her pulse was weak. Rather than waste time I decided to take her to the nearest hospital, which was the Medway. I drove her to the gates, and the porter came out of his lodge and asked what I wanted. I told him I had a very ill woman on board, but he said that I would have to take her to St. Bartholomew's as they did not take casualties there. Every second was precious', said Mr. Wimsey, so I did not argue but took her straight to Rochester, but she was dead when I got there'.Mr. Wimsey said he lost valuable time on his way to Rochester by having to double-shunt his vehicle round the junction of Windmill Road and Chatham Hill but he got to Rochester as quickly as he could.I come now to the Secretary of the Medway and Gravesend Hospital. In another cutting Mr. T. Rhodes said:'The porter was obeying instructions and could not know the case was urgent. The bus driver did what he thought was right in going to the nearest hospital, but if he had called a policeman he would have been told to go to Rochester.' Mr. Rhodes said there had not been casualty facilities at the Medway 912 and Gravesend Hospital for the past 20 years, and the public should know this.In the first place the Medway Hospital has not been a National Health Service hospital for more than a few years. Of course, the gate porter could not know whether this was an urgent matter so why is the responsibility left with him? When the Secretary of the Medway and Gravesend Hospital says that the bus driver should have found a policeman I am quite sure that the Minister will agree with me that even in London one can go for miles without seeing a policeman. This driver had on board a woman who was obviously collapsed and critically ill; he had no time to go searching for a policeman.
So when I forwarded that cutting I wrote to the Minister and said:Further to my letter of yesterday's date regarding the failure of the Medway Hospital to give attention to a woman who was critically ill, I am sending you the front page of the other local paper. Mr. Rhodes has apparently made another statement. Anything more stupid than to say that the hospital porter was obeying instructions and could not know the case was urgent I find it difficult to imagine.How on earth can a porter, in these circumstances, be given such responsibility.The last paragraph of Mr. Rhodes' statement is almost as ridiculous, anyone knows that you can travel miles without seeing a policeman and to say that the bus driver should have called a policeman passes my comprehension. It seems to me that Mr. Rhodes should be the first person to be disciplined or replaced.On 2nd November, the Minister wrote to me as follows:You wrote to me … about the accident concerning the late Mrs. L. Martin who was taken by a bus driver to Medway Hospital after she had collapsed in his bus on 2nd October.I understand from the South-East Metropolitan Regional Hospital Board that, at about 11.00 a.m. the bus driver brought Mrs. Martin to the main entrance of Medway Hospital and informed the gate porter that she had collapsed in the bus. Following the instructions with which he had been issued, the porter directed the bus driver to St. Bartholomew's Hospital, Rochester, where all casualties are referred. On arrival at St. Bartholomew's Hospital, the Casualty Officer certified Mrs. Martin as dead. The Pathologist who conducted the post-mortem examination states that he referred the case to the Coroner as death from natural causes due to coronary thrombosis associated with two previous attacks of myocardial infraction'.The report of the Sub-Committee of the Standing Medical Advisory Committee on 913 Accident and Emergency Services, which was published in 1962 and recommended to Hospital Authorities advised that only certain hospitals should provide accident and emergency centres. You will appreciate that proliferation of these centres at every hospital large or small is not feasible for they require very expensive and sophisticated equipment and highly trained, expert staff. The South-East Metropolitan Regional Hospital Board have accepted this advice and the centre for the Medway Towns is at St. Bartholomew's Hospital, Rochester …The gate porter at Medway Hospital has been instructed that all accident and emergency cases must be redirected as this hospital has no department to deal with them, and no special facilities for resuscitation.Does this mean that there are no facilities for resuscitation? What "special" facilities would this woman have required, anyway? If this implies that there are no such facilities at the Medway Hospital, the sooner they are introduced, the better.
The Minister's letter concludes by supporting to the full the action which was taken. I am very sorry that the Minister is not here today, because the strictures and criticisms I made of the attitude of the Secretary to the Hospital Board concerned, I am afraid, I would launch—omitting the word "stupid"—at the Minister, because his attitude in this is also reprehensible and callous. This is extremely surprising, because this is something which I have never found the Minister to be. Perhaps it would be better to say that he has been misguided, and I hope that the Parliamentary Secretary will be able to give me some assurance that this sort of thing will not happen in future.
I agree that it is impracticable, and must be, for every hospital to have full casualty facilities, but surely all general hospitals should be able to give some attention when cases as urgent as that of Mrs. Martin are brought to them, even if only to render first aid and transfer the patient by ambulance and under proper care to another hospital. This cannot be asking too much, but the hospital management committee apparently says, with the full support of the Minister, "No", and that any one of the many persons in the Medway towns, with about 200,000 people and a further catchment area of probably 50,000 must all be served in casualty services by the one hospital. What would have happened 914 if driver Wimsey—as surely he was entitled to do—had said, "I will take this woman no further" and had dumped her on the pavement? Would she have been left there? Would the porter of the hospital have called a medical officer? Or would she have been left to die on the pavement?
May we be assured that St. Bartholomew's is equipped to deal with an accident which might involve 30 or 40 people, for example if a bus ran away down Chatham Hill or if there were a rail disaster like that at Hither Green or if we had a repetition of the accident when a number of sea cadets were mown down by a bus? May we be assured that there would be sufficient people on duty in the casualty department at St. Bartholomew's to deal with such accidents expeditiously in order that life could be saved?
If not, what would happen? Would the Medway hospitals and All Saints say, "In no circumstances will these people be admitted here. They must be sent miles away" and more people might die who could perhaps have been saved? We must apply common sense and realism to such circumstances. I hope that the Minister will be able to give me such an assurance. I place the responsibility firmly in the Minister's hands. If his answer is "No" to the questions which I have posed, then if anything happens of this nature he must accept full responsibility for it.
I ask the Parliamentary Secretary to consider this point of view: Mrs. Lily Martin, as far as he is concerned an obscure personality, is just a name. But suppose it had been the Minister's wife or the Minister's child or the Minister's parents. Would he not then have said, "I believe that some action should have been taken to have given this person succour"? If so, I hope that he will make his reply from that point of view. It is very important that he should do so. I believe that this is a disgraceful and frightening story of how the dying Mrs. Martin was refused treatment at the nearest hospital. It must never be repeated. It must surely be possible to take any person who is critically ill into any general hospital for immediate help if only in order to arrange transportation 915 to another hospital with proper supervision. I strongly repudiate the apparent view of the Minister that convenience and protocol must be observed even if it means loss of life.
§ 4.18 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)
The treatment of accident and emergency cases in the hospital service is likely to be a matter for concern at one time or another for all of us. The problem of dealing with this situation is one of a changing pattern. However, it is a subject to which my Department has paid particular attention in recent years, so that it is a useful subject which the hon. Member for Gillingham (Mr. Burden) has raised. He has indulged in some emotive words, and he will not be surprised if I reciprocate to the extent of criticising him for the part which he has played in the matter. I should like to concentrate on the general issues before I turn to the case of Mrs. Lily Martin.
It is a natural instinct on the part of any person to seek out the nearest doctor when there has been an accident. Indeed, family doctors will normally treat their own patients for minor injuries which do not require hospital treatment. It is this latter, though, which has changed in recent years. There is a much better chance of saving life in a serious accident now than ever before, but this means the use of specialised skills which not every doctor can have. It is this aspect to which I shall turn first.
I will first quote a passage in a report which forms the basis of present policy. It was the Report of the Sub-Committee on Accident and Emergency Services which reported to the then Minister of Health's Standing Medical Advisory Committee in 1962—and I remind the hon. Gentleman that the Minister then was the right hon. Member for Wolverhampton, South-West (Mr. Powell). The Report said:We realise that much education of the public will be needed before it is generally accepted that a patient in urgent need of treatment should not be taken to the nearest hospital if it has not an accident and emergency department.This Report, which examines in depth the best way of providing accident and emergency services, was commended to 916 hospital authorities in May, 1963, by the right hon. Gentleman and it still forms the basis of our policy, as I have said. In essence, we consider that all injured patients requiring hospital treatment should be taken direct to a hospital having an accident and emergency department, staffed and equipped to deal immediately with major injuries and other emergency cases at any time of the day or night.
The policy has involved a thoroughgoing rationalisation of their services by Regional Hospital Boards during recent years. That progress is being made in this field is shown by the fact that an estimated 80 per cent. of new accident and emergency cases are now dealt with in such custom designed and equipped accident and emergency departments. In 1966, 7,145,000 new accident and emergency cases were dealt with in the hospital service, compared with less than 5 million 10 years ago.
I would like the hon. Member to consider this first from the point of view of the hospital service, and in particular of the extent of the requirements in terms of staff and resources. We would expect to see one consultant, preferably an orthopaedic surgeon, in day to day control of the accident and emergency department. This means that, allowing for rota duty periods, each department should have a total of at least three consultant surgeons in order to secure consultant cover at all times.
In addition to the consultant surgeons, there will need to be at least three doctors of intermediate grade and an adequate number of senior house officers to provide a service at all times day and night. The surgical staff of the accident and emergency department should be supported by anaesthetists, radiologists, pathologists and psychiatrists, and by physicians.
The medical staff must be supported by nursing, radiographic, secretarial, clerical, reception, portering and other ancillary staff readily available at all times. There is thus a large staff complement required to provide an accident and emergency service. To these must be added the material resources of special building and costly equipment. The department must be designed to allow patients to be brought in direct from the street.
§ Mr. Snow
I have not time. This means having separate entrances for stretcher cases, with easy access for ambulances, and for walking cases. Provision should be made for children to be treated out of sight of adult casualties. The department itself needs theatres, with all their costly equipment, recovery rooms, diagnostic X-ray facilities, special rooms for the handling of fracture cases, and resuscitation rooms equipped for anaesthesia, piped oxygen and suction.
The hon. Gentleman is making a great mistake about the porter being given rigid Instructions to turn everyone away to another hospital with special facilities. If the porter is given discretion, is not that imposing an entirely unwarrantable responsibility on a man doing such work? Furthermore, if the porter is to use his judgment and say, for example, "This woman is very ill and must come in", that delay itself may be fatal.
Does not the hon. Gentleman understand that he has been indulging in a superficial examination of the case and that the very delay involved in a patient going to the wrong hospital which may not have the expertise or facilities would have a serious result? The important thing is to get patients in these cases to the right hospital as quickly as possible.
The hon. Gentleman asked about this particular hospital, the Medway Hospital. As he said, it was taken over from the Navy and has not always been a National Health Service hospital. In relation to what the public know about this, I have some Press cuttings which show that among those who gave their opinion some said that they knew it was not a casualty hospital.
I want now to come to certain matters of particular importance.
The sub-committee to which I have referred recommended a substantial reduction in the number of accident and emergency units and a concentration of the service in a pattern of accident and emergency units which would each serve populations of at least 150,000. Morevoer, advances in medical science and techniques—which imply always a greater chance of saving life—mean that accident and emergency departments have to be located where they can call on the assistance of the new specialties. For example, special services such as neurosurgery, plastic and thoracic surgery 918 should be available if not in the same hospital, then in other regional units within a reasonable distance of the centre. Again, the development of mechanical procedures for the treatment of anuria, respiratory failure and cardiac arrest has made possible newer methods of therapy for complications which may accompany certain accidents.
This means that not every hospital can continue to provide a casualty service, as it is commonly called, which in many cases was only a preliminary service to the specialist treatment provided at the major hospital. Indeed, the future pattern of district general hospitals, which is already well under way, must mean that the services provided by a multiplicity of smaller hospitals, to which local residents are understandably attached, are curtailed or closed down.
I have been dealing so far with what I might call the economic aspects. I want to turn to the sad case of Mrs. Martin. We must never, however, in talking of any aspect of the hospital service forget that the interests of the patient come first. When an ambulance is called, for example, to take an unconscious patient to hospital the ambulance crew cannot be expected to diagnose his condition and decide which of several hospital departments is the appropriate one to receive him. All undiagnosed emergency cases must, therefore, be taken to an accident and emergency department for professional opinion.
I have already referred to the cogent need for the planning of hospital services in all fields. In the field of accident and emergency services the South-East Metropolitan Regional Hospital Board began to plan the accident and emergency service for the region well in advance of the official guidance which the then Minister of Health issued in 1963. In the Medway Towns, with which the hon. Member is concerned, St. Bartholomew's Hospital provides this service. Those most directly concerned, namely, general practitioners, the ambulance service, and the police are well aware of this fact. I agree that perhaps more could be done to alert the general public, but the evidence is that the general public was not entirely misinformed It was perfectly understandable that the bus driver in question should have taken his passenger Mrs. Lily Martin 919 to the nearest hospital on his route, namely, the Medway Hospital. He was acting from a sense of common humanity which I am happy to see frequently characterises those engaged in public services. He was told by the hospital porter to take his passenger to St. Bartholomew's hospital. There is no truth in the suggestion that the porter acted incorrectly or inhumanly. He could not have done otherwise than refer the driver to St. Bartholomew's Hospital which, as it happens, was only 1¼ miles away. I repeat that it is a tremendous responsibility. Seconds might have mattered in whether specialist treatment could be applied to save a patient's life, but if the facility is not available at one hospital, then ideally the patient should go to a second hospital. On arrival there the casualty officer certified Mrs. Martin as dead. I am advised that, unfortunately, there seems no doubt that whatever action was taken, and wherever it had been taken, poor Mrs. Martin could not have survived or been revived.
There have in fact been no facilities for dealing with accident and emergency cases at the Medway Hospital since the inception of the National Health Service in 1948, but, as the hon. Member will 920 know, the hospital is to provide the site for the first district general hospital in the area. There will be 84 accident beds, an accident and emergency department, two theatres, three X-ray rooms, kitchen and dining room, staff accommodation and other supporting facilities. I trust unconsciously, the hon. Member has been making political capital about this in his constituency. I wish that he had gone about it in a calmer way—
§ Mr. Burden
On a point of order. I consider that I am quite right in bringing this matter to the House. Whatever happened in my constituency, this case has caused great concern.
§ The Question having been proposed at Four o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order
§ Adjourned at half-past Four o'clock.