HC Deb 03 May 1967 vol 746 cc696-706

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

11.27 p.m.

Mr. R. W. Elliott (Newcastle-upon-Tyne, North)

I welcome very much this opportunity to raise the subject of the great need to continue in being the mobile ancillary physiotherapist service in Newcastle-upon-Tyne, and in the adjacent area to it, which is covered by the South-East Northumberland Hospital Management Committee. It was on the basis of an article published in the Medical News for November, 1963, which illustrated the possible value of a mobile physiotherapy service, that the senior medical officer in geriatrics in the Health and Social Services Department at Newcastle-upon-Tyne asked the Northumberland Red Cross Society if it would be prepared to establish such a service in the city.

It seemed that under Section 28 of the National Health Act, the local authority was not empowered to provide such a service. An appeal was made to Newcastle University Rag Committee, which eventually raised £2,035. The money having been raised, the scheme was started on New Year's Day, 1965, and an extension of it was started in what we know in the region as the coastal area in October, 1965.

I should like to say a number of things about this service. First, it has been carefully supervised. Very full records have been carefully kept. It has been a highly successful venture. The service has been effective and greatly valued by patients and medical practitioners. Thirdly, and most important, the money which has been used to operate the service is running out, and unless financial backing is given very quickly indeed by the regional hospital board, this valuable service will cease to exist.

This grave situation led the Red Cross Domiciliary Committee to open negotiations with the Ministry of Health with a view to the service becoming a proper charge upon the hospital authorities. Serious consideration was given to this proposal by the Department. I think this is generally appreciated. Indeed, no better illustration of the serious consideration given to the proposal can be forthcoming than the fact that the letter to the Ministry, sent on 25th August, was not answered till 3rd November. Despite this lengthy consideration, the answer when it came was that the resources of the Health Service in Newcastle, as in other parts of the country, should be devoted to providing a hospital physiotherapy service. This reply, I should like to impress upon the Parliamentary Secretary, has been received in Newcastle-upon-Tyne and in the region with considerable dismay.

Dame Irene Ward (Tynemouth)

Hear, hear.

Mr. Elliott

Because of this dismay, on 20th March I asked a Question, as did my hon. Friend the Member for Tynemouth (Dame Irene Ward), the unsatisfactory answers to which have led to this debate tonight. We were supported on that occasion from the other side of the House by the hon. Member for South Shields (Mr. Blenkinsop), and I am very pleased to see that he, too, is in his place at this late hour.

I wish on this occasion to appeal strongly to the Parliamentary Secretary to look very carefully once again at the possibility of this service becoming an official one within the hospital service. I think that I am aware, as I think, are those involved in the scheme, of the fiancial problems involved. We realise that once a scheme like this is financed for Newcastle-upon-Tyne there will be demands for similar schemes elsewhere. We know that the high cost of such schemes must be something that the Minister must bear very firmly in mind. But I should like to say a little about costs in a moment.

The suggestion generally made by the Minister and by the Department that adequate hospital physiotherapy services are the real answer, is accepted by those involved in the scheme. But at the moment the hard truth is that in Newcastle and the region, if this well organised and greately appreciated mobile service ceases to exist there are nothing like enough hospital facilities to replace it. I appeal to the Parliamentary Secretary to consider this decision which we ask him to reverse in the light of the availability of local facilities.

I know that stroke patients are usually referred either to a geriatric unit or to the department of physical medicine. Comparatively few are admitted to hospital beds for active and intensive treatment. Nevertheless, a considerable number are. According to statistics which I have been given relating to the Newcastle region, there is only one geriatric bed per 1,000 head of population. This is the least ratio of any area in the country.

I should like to call in aid to this point an extract from a letter dated as recently as 20th April, 1967, which was sent to the Chairman of the Red Cross Mobile Physiotherapy Committee by the consultant geriatric physician at Preston Hospital in the constituency of my hon. Friend the Member for Tynemouth. It reads: As you will know. this area has the least allocation of geriatric beds in the whole country. Any claim that can alleviate the pressure of beds is therefore to be encouraged. The domiciliary rehabilitation scheme worked very well. The family doctor found it invaluable. It did not use one physiotherapist who could work in hospital and it ensured the early recovery of many patients. In addition, the physiotherapy department at the Royal Victoria Infirmary in Newcastle has a six weeks waiting list. This is a very long waiting list indeed for outpatient treatment. In our general hospital in the city there is only one establishment of 13 physiotherapists to cover 1,050 beds, and the position outside Newcastle is worse.

It is highly improbable that the regional board can improve this position until new hospitals are built. There is going to be a gap of quite a number of years in the adequacy of geriatric provision generally. This gap, in the opinion of many who know this scheme and many who are involved in it, can be substantially filled in the immediate future by a continuance of the domiciliary service.

I should like to emphasise a few advantages which the pilot scheme has very clearly illustrated. First, the result of treatment given so far by the service statistically suggests that 58 hospital weeks have been saved. To return to the point I made earlier about our realisation that the establishment or approval would lead to others at high cost, this saving of 58 hospital weeks has been estimated to save £1,740 over a period of nine months.

Secondly, it is distinctly proven—and we have evidence over and over again to suggest—that the physiotherapist actually visiting the home of the patient, as against the patient undergoing the physical strain of out-patient treatment, has been very greatly appreciated. This mobile service, with the physiotherapist actually visiting the home, must itself have saved money by lessening the transport requirement.

Thirdly, physiotherapists working this service are, in the main, young married mothers who are able to give part-time service only. In some of the correspondence, copies of which I have seen, between the chairman of the service and the Ministry of Health, it has been suggested that this part-time service would militate against the extension of hospital services by taking up people who might otherwise work in the hospitals. This, I am sure, is not so.

Most of these people who are working this service, if not all, cannot give full-time service in hospitals. Indeed I am given to understand that these young married physiotherapists welcome this opportunity to give part-time service to make continued use of their training—training which would otherwise be lost at the present time, at least to the National Health Service. I have been told by some of them that they see this part-time service as a continuation of their experience, and that when their children are old enough they anticipate going back into full-time hospital service.

I wish to conclude by paying tribute to those who have instigated and manned this highly valuable service. In particular I should like to commend for their energy and enthusiasm Miss Greenlees, Director of the Northumberland Branch of the Red Cross Society, and Dr. Hall, who has been such an able chairman of the services committee.

Once again, I should like to emphasise to the Parliamentary Secretary that the local domiciliary physiotherapy service run by the Red Cross in Newcastle-upon-Tyne forms a vital supplementary service which, as we see it, cannot be done without. Its continuance is vital.

11.40 p.m.

Mr. Arthur Blenkinsop (South Shields)

I support what has been said by the hon. Member for Newcastle-upon-Tyne, North (Mr. R. W. Elliott) in his reasoned and very moderate expression of axiety about this situation. I feel some personal responsibility, because I suspect—I am not absolutely certain—that when I was at the Ministry of Health many years ago, this kind of proposal came up, although more generally over the country, and was rejected, as it had been by other Governments. I am not making any complaint about that.

Here we have a scheme which is run by private funds and which has shown the clear value of the scheme for using physiotherapists who would not be available to the hospital service, probably not even for part-time work, certainly not in most cases. I have such personal knowledge of and trust in the medical advice and the medical support which has been given to this scheme and the control which has been established over it that I would unhesitatingly say that it is a first-class and most valuable scheme and that, were it to collapse, many would be denied care and treatment early enough, which might be very damaging to them.

I appreciate the difficulties of introducing or in any way supporting a scheme in one part of the country when it would not necessarily be applied elsewhere, but one needs to be flexible enough to try to meet this kind of case and to be willing, because of the value of this specific scheme in this area, to say that it should be supported even though it might not be acceptable in other parts of the country.

11.42 p.m.

Dame Irene Ward (Tynemouth)

I want to add only a few words to what has been said by my hon. Friend the Member for Newcastle-upon-Tyne, North (Mr. R. W. Elliott) and the hon. Member for South Shields (Mr. Blenkinsop). I want to clear up one matter of tremendous importance. The other day I asked the Minister of Health whether the Chartered Society of Physiotherapists supported the scheme and, to my consternation, the right hon. Gentleman did not appear to know anything about it. For many years I have been a member of the Council of the Society and I want to put it on the record, so that it is there for certain, that the Society is fully in support of the scheme.

Matters of this kind must be seriously considered by the Minister of Health and it is surprising that he should not have consulted the Society, when he would have been able to get the full facts about the shortage of personnel and what is behind the scheme. It would have been more helpful, particularly in view of the effort which has been put into the scheme, if the Minister had been willing to receive a deputation led by those of us who are interested in the subject and who support those who have done the professional work within the Newcastle Regional Hospital Board. We could then have ensured that the Minister did not reach conclusions based on incorrect information.

I am grateful for this opportunity to add my words in support of those who think that the Minister should reverse his decision and take steps to ensure that this very good service in the North-East is not dispensed with because of lack of support from the regional hospital board, which, of course, depends on the Minister to give consent to it.

11.45 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

I have noted the remarks of the hon. Lady the Member for Tynemouth (Dame Irene Ward) and I was pleased to listen to the studied moderation of my hon. Friend the Member for South Shields (Mr. Blenkinsop) and the hon. Member for Newcastle-upon-Tyne, North (Mr. R. W. Elliott).

I accept, following the hon. Lady's intervention, that it is conceivable that there may have been some misunderstanding of my reply the other day about the Chartered Society of Physiotherapists. I said on that occasion that no representation had been made to us, and that was the position. I assure her that there has been a great deal of consultation. Indeed, I would be surprised if there are any facts about this matter that are unknown to my Department.

I am grateful to the hon. Member for Newcastle-upon-Tyne, North for raising this matter and I will begin by discussing some of the medical aspects which gave rise to the decision of my Department. Recent developments in medicine have had a marked effect on the practice of physiotherapy. Increasing knowledge of the nature of various disorders of the locotomor system has led to radiant heat and massage being replaced by more active forms of physiotherapy. I speak with personal experience about the exercises that are prescribed.

I wish to refer to the advice which the then Minister of Health, the right hon. Member for Wolverhampton, South-West (Mr. Powell), received from his Standing Medical Advisory Committee, a body of experts of the highest repute, more than five years ago. This advice was circulated to all hospital authorities in March, 1962 The report stated: Many patients still ask for massage because it gives symptomatic comfort at the time of application and they assume it must be doing good; but in the long run it is kinder to teach them how to use modern aids to minimise their disabilities". The Committee also commented that it was perhaps noteworthy that hospitals with fuller facilities for rehabilitation made less use of massage. The Committee found that, while there had been a marked reduction in the use of massage and electrotherapy, there had been a greater increase in the demand for other forms of physiotherapy, notably the modern type of active remedial exercises which are used in all stages of medical rehabilitation in a steadily increasing number of hospital departments and special centres.

All this remains true. What we must aim to do is to give patients the best chance of regaining their independence as quickly as possible. They possibly do not realise that attendance at hospital and receiving treatment with other patients in similar difficulties to their own in itself is also of therapeutic value.

Hospital authorities have been advised for many years that physiotherapy in the National Health Service should be provided only under consultant prescription as part of the hospital and specialist services, and that responsibility should be accepted by hospital boards only for treatment prescribed by hospital specialists and carried out under their supervision.

Moreover, the considered advice of responsible and expert professional opinion is that if physiotherapy is necessary following a stroke, it should be provided daily and intensively. This applies whether the patient is recovering in hospital or at home under the care of his general practitioner. In this connection, it is important to bear in mind that it may not be essential for every patient who has suffered a stroke to be given physiotherapy treatment.

On the question of staff, my figures are somewhat at variance with those provided by the hon. Member for Newcastle-upon-Tyne, North. There is a further argument in favour of concentrating treatment in hospitals. Although the numbers of physiotherapists in post continue to increase and recruitment of students remains at a high level, there are nevertheless shortages in some areas. Steps are being taken to increase training facilities, but in the meantime it is important that the best use should be made of the staff available.

Often part-time staff are able to make a most valuable contribution and in 1965 the Department asked hospital authorities to review their staffing and recruitment policies and to make provision wherever possible for regular part-time service. Some 20 per cent. of all hospital physiotherapy is now carried out by part-time staff. Concentration in hospital departments is more economical of staff than a mobile service, which takes up the time of the staff in travelling. Our present policy points, therefore, to not encouraging this sort of domiciliary treatment.

In the light of the current concept of the use of physiotherapy and staffing difficulties, we consider that physiotherapy should continue to be provided, as it has been since the early days of the National Health Service, as a hospital service. Because there has been a shift of emphasis from massage and heat treatment to various types of exercises, including group exercises and the use of appliances, some of which are bulky, we feel that it is essential that, to obtain maxi- mum benefit for the patient, physiotherapy should be carried out under medical supervision backed by the full facilities of a hospital physiotherapy department. Such facilities per se cannot be provided in mobile units, nor can treatment be as closely supervised by consultant staff. Further, since physiotherapists are in short supply, maximum returns can only be obtained by concentrating their efforts in hospitals.

Domiciliary physiotherapy is relatively expensive in resources and relatively ineffective. Furthermore, it is inconsistent with modem concepts of therapeutic practice and, in the National Health Service, is prescribed only in special circumstances and by a hospital specialist at a hospital or through a domiciliary consultation.

I turn now to the specific point about the position in Newcastle-upon-Tyne. The scheme for a mobile service was started in 1965. The local health authorities had previously advised the Northumberland Branch of the Red Cross that their powers were not wide enough to provide such a service under Section 28 of the National Health Service Act. The regional hospital board had held out no hope that it would be able to finance the scheme at a later date. I make that point because there appears to be some argument that the service had the full support of the board That is not so.

However, in the light of the experience gained and because financial resources were not available to enable these services to be maintained indefinitely, the branch wrote to the Ministry last August. Once again, I am sorry about the long delay in replying to that letter, but it was a matter for deep consultation and consideration. In support of its application, the British Red Cross Society submitted a paper setting out the results achieved, together with other information relating to the work of the service. This was given the most careful consideration against the background of the Ministry's policy on physiotherapy services, but none of the information that it contained provided sufficient grounds to justify asking the Board to assume financial responsibility for the continuance of this service, and the British Red Cross Society was so advised.

It appears that patients were treated twice weekly, and that, on average, treatment was spread over a period of seven weeks. The Minister was advised that some, if not all, of the patients who benefited from this twice-weekly treatment at home would almost certainly have achieved the same result sooner if they had been treated in a hospital department, and might have needed fewer total attendances.

It is the responsibility of the hospital authorities in the Newcastle Region to ensure that adequate physiotherapy services, in common with other hospital and specialist services, are available in the region. If the service being run by the Society closes down, the hospital service itself would have to accept responsibility for the treatment of those patients for whom physiotherapy is prescribed, and this would be subject to consultant prescription and supervision. My right hon. Friend has accordingly asked the regional hospital board and the board of governors to review their present physiotherapy services, bearing this eventuality in mind, with a view to bringing them into conformity with the very expert advice which he has received and which I ask the House to accept as being the mainstay in my right hon. Friend's argument.

One further point which I should like to deal with is the argument that the mobile service does not drain away staff from the hospital service because the people concerned could not offer part-time service at a hospital. There is nothing to prevent a hospital authority employing part-time physiotherapists who are willing to work there, even for a few hours a week. Attention has been drawn to the need to assist women returning to the profession after a break, by the provision of informal refresher training, and by the support and guidance of experienced staff during their first weeks of service.

I understand from the Newcastle Regional Hospital Board that the hospital management committees in its area do in fact employ part-time physiotherapists. A mobile service is likely to impede, to some extent, the provision of a fully satisfactory hospital service in places where physiotherapists are scarce by attracting some into the mobile service who would otherwise be willing to work, even if only on a part-time basis, in hospitals.

I should not like hon. Members to go away feeling that voluntary effort is not appreciated by my right hon. Friend. In reaching his decision he was very mindful of the voluntary effort which has gone into the launching of this scheme. The hon. Gentleman suggested that we ignore, or do not react favourably to, voluntary effort in these matters. Local encouragement given to the project has been very marked, and we appreciate it, but at the outset the regional hospital board did not give out any hope that it would be able to finance the scheme at a later date, and this fact has been acknowledged by the British Red Cross Society.

It may well be true that the difficulties of the hospital service in meeting demands for physiotherapy in Newcastle are greater than in some other regions, and that the Red Cross Service in this instance is well run and of special value in view of the local circumstances. On the other hand, it would be quite untenable for the Ministry to attempt to discriminate between this scheme and similar schemes in other parts of the country which have been set up at various times over the past 15 years.

The decision in regard to the Newcastle Unit did not, however take into account the success or failure of these other units. The decision was based simply and solely on the fact that we are bound to ensure that, as far as possible, the limited resources at our disposal are devoted to providing the kind of service which, in the considered opinion of the Minister and his professional advisers, is of most benefit to most patients over the country as a whole.

I should like to have elaborated somewhat on the question of the existing numbers of physiotherapists working part time and whole time in the Newcastle region, but I intend to send to all hon. Members who have participated in the debate the existing establishments. There are practically no vacancies at all, but if it can be demonstrated that their establishments should be increased in regard to either whole-time or part-time staff, we shall give the matter very sympathetic consideration, bearing in mind that the responsibility must be that of the National Health Service through the regional hospital board.

Question put and agreed to.

Adjourned accordingly at four minutes to Twelve o'clock.