§ 3.16 p.m.
§ Mr. Harold Gurden (Birmingham, Selly Oak)
I want to raise the case of the Witton Isolation Hospital. First, I should make a correction to the spelling of Witton on the Order Paper, which spells it as "Whitton".
I wish also to apologise to hon. Members on both sides, many of whom are not here today, for the change in the debate. I sought at first to discuss the question of referenda in relation to capital and corporal punishment and to the Common Market and to show that Governments of both parties carry out policy and introduce legislation for which they have had no mandate. But I am prevented from doing this by the rules of order. It was not lack of desire on my part to discuss the urgent need for referenda but, as you know well, Mr. Speaker, it would have been out of order and I have therefore substituted the case of the hospital, which is still nevertheless a very important matter.
I know that I shall use strong words but I have considered them carefully. It is the disgraceful and highly dangerous neglect of this hospital, which could have cost many lives, which has caused me to raise this matter. The hospital was used since 1894 for smallpox cases. Smallpox was one of the most serious diseases of the past in this country and it could be of the present. About 1,000 patients passed through the hospital but that does not mean to say that it was not a very important place serving a very useful purpose in its time. It was last used to a great extent in the outbreak in about 1960, when a number of immigrants brought the disease into the country.
In parenthesis, I would ask the Parliamentary Secretary to comment on the possibility of the further introduction of this disease by immigrants, although, fortunately, immigration has been at low ebb for some time. However, there is always the risk that this hospital may be necessary in future, when immigrants still come in from areas where smallpox is unchecked. The hospital itself was run down after this period in the early 1960s to complete disuse. The Ministry had the hospital surveyed about a year ago, but no action was seen to be taken as 1962 a result of that survey. I do not know what was in the Minister's mind at the time.
About six months ago, the caretaker left. I do not know whether that has anything to do with the survey, but, as it happens, he was a very important man. When he left, he was not replaced and there was no substitution of any kind of security. The hospital was left, so it seems, completely unattended with no security check. As was to be expected, children and young persons found their way into its grounds and into the building. It is not known how long that went on before the general public noticed, but by then it was obvious that there had been a considerable amount of vandalism and that a number of people had entered the hospital building itself as well as the grounds on many occasions.
Around the building there is or was an easily scaleable wall and broken wire fence, but nothing to prevent children or young people from going in if they wished. When an examination was made, it was found that there were rats and mice and even domestic cats in the building, which was what mattered because, belonging to local families and straying around the hospital building, cats then went back to people.
This was discovered by an employee of the Birmingham Mail. He saw all this happening daily from the top of a bus and when it seemed to reach serious proportions he thought that it was time that something was said about it and so he reported to a Mr. Lynn, a reporter on the Birmingham Mail, who thought that it might be important as it was an isolation hospital.
On 10th April, Mr. Lynn informed the hospital group what was happening and immediately an inspector was sent along. As a result, nothing was seen to happen, although something was probably put in train. Mr. Lynn was unable to obtain any definite promise that something would be done and he was not in a position to demand it, and, as he was so concerned, he telephoned Dr. Millar, the Birmingham Medical Officer of Health. On 11th April, Dr. Millar showed his tremendous concern by recommending almost at once that the hospital be destroyed by fire. Councillor Franklin, the chairman of the local health committee, and his committee immediately consulted the Ministry of 1963 Health and pressed for the hospital to be burned.
Apparently, the Ministry agreed—I am not sure, but I suppose that it must have—and arrangements were made for this to be done. But during all this time there was the possibility, and even the probability, that the virus was in the building, and this is a densely populated area. Not only could the virus have been in the building, but it could have been conveyed by either people or animals into homes. It is generally known that smallpox is a virus which lives on in dry dust and that it is shed from patients by way of scales falling from the skin.
So it was that these facts must have been accepted, and caused the Ministry to agree that the hospital be destroyed by fire. Volunteers had to be found from the fire brigade, because of the risk involved, and they were all immunised Four tons of highly combustible material were provided, to create intense heat which would have a sterilising effect, and which totally destroyed the building on 3rd May. It would now seem that everything is safe and that there is no risk, but there is no certainty about this.
The Minister took a considerable interest in this, and a virologist was sent from Hampshire. He took samples of the dust to find out whether there was any risk of contamination remaining. It is likely that the prompt action taken by the Birmingham Mail, the medical officer, the health committee and the fire brigade, stopped an outbreak of smallpox in Birmingham. No one can say whether it did, but there was clearly the possibility. This shows the great value of the local Press, and the local authority, as distinct from the Ministry and hospital boards. The former are able to ginger up some action when Whitehall seems to be silent, remote and slow to act.
Several children who admitted to having been in the building were immunised. Everything now appears to have been done by the Ministry, and the local medical officer of health, and I am glad that this is so.
Several important questions are being asked by many people in Birmingham. A local residents' association has been formed, not through any action of mine, 1964 to deal with this matter. People are asking, as I am asking, that the Minister should reply to some of these questions. I am grateful to the hon. Gentleman the Parliamentary Secretary to the Ministry of Health for coming to answer the debate. I would have hoped that the Minister of Health could have come too, because this is a very serious matter. These are the questions which people are asking. Why was there not adequate security at the building? The caretaker had been absent for six months. Why was the Ministry unaware that vandalism was taking place, and that people were entering the building until it was reported by a newspaper? Thirdly, what other hospitals in the country are exposed to risks of this kind or to inattention? Fourthly, what did the samples taken by the virologist reveal? Fifthly, what is the planned use for this six-acre site which stands in an area which, as the Minister will know, is very short of land? It could be used for building. While this may be recognised, very quick action should be taken to bring this land into reasonable use. It has been unused for some years.
Why were not statements made by the hospital board or the Minister when all these things were known and were published in the Press? Surely the public has a right to expect the Ministry to give an explanation or some assurance. But no statements were made, as far as I know.
I think that the Minister will agree that this debate will serve to reassure the public on the up-to-date situation, not only in Witton Hospital in Birmingham, but in the rest of the country, if such a thing should happen again.
§ 3.30 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)
I am glad that the hon. Member for Birmingham, Selly Oak (Mr. Gurden) has given me the opportunity, not only to put on record the facts about Witton Hospital, but to explain the arrangements for hospital provision for smallpox cases. I am sorry that the hon. Gentleman saw fit to drag in the question of immigration. I fear that immigration in Birmingham, like smallpox, tends to be an emotive word. I am aware that some of the Tory Members representing Birmingham constituencies have dragged in 1965 immigration in the past in an undesirable way, although there have been honourable exceptions.
§ Mr. Snow
I am talking about immigration. I shall come to smallpox in a moment.
Smallpox is a disease which must be treated with respect, but I think that, through ignorance, there is some popular misconception about what is necessary to avoid the spread of infection. For instance, I see from a report in a Birmingham newspaper that some people thought it dangerous to buy meat from a shop near Witton Hospital. Quite properly, a suitable assurance was given by the local authority that there could be no harm in buying food from any shop in the neighbourhood. I hope that what I have to say today will fulfil the same desirable object of dispelling ignorance. I do not accuse the hon. Gentleman of lending himself to spreading emotive altitudes about this problem, but he must be very careful about satisfying himself on certain matters.
I should like, first, to explain briefly the general arrangements for providing hospital accommodation for people suffering from smallpox and for the prevention of the spread of infection. The general pattern of hospital provision for smallpox consists of first-line hospitals which are held empty on a care and maintenance basis. These are supported by second-line hospitals which are normally used for other purposes but can be evacuated at short notice. In this way there is provided immediate accommodation for a small number of patients suffering from smallpox, and a reserve of accommodation in the event of a very large outbreak. A first-line smallpox hospital is used exclusively for the care of patients suffering from or suspected to be suffering from smallpox.
The scheme is that first-line hospital accommodation for about 20 patients should be available to each hospital region. Experience in recent years has suggested that this should prove sufficient for most outbreaks in this country. Each regional hospital board, however, is required to make arrangements for second-line hospital accommodation by earmarking suitable hospitals which 1966 could be evacuated at short notice. We have not fixed any definite scale of provision for second-line hospital accommodation. The aim is that first-line smallpox hospitals should be so placed throughout the country that patients needing admission should not have to travel for more than about two hours by ambulance. Then in the event of a major outbreak, second-line hospital accommodation is opened as near as possible to the main focus of infection. The primary requirement for a first-line smallpox hospital is that it should be structurally separate from any other building. In siting smallpox hospitals, whether first-line or second-line, the medical officer of health of the district is invariably consulted by the hospital authority and kept informed of developments.
It has been strongly emphasised to hospital authorities that anyone connected in any way with a hospital in which smallpox is being treated—whether as nurse, doctor, domestic staff or in any other capacity—must be re-vaccinated. Advice has also been given on precautions to be taken for preventing the spread of infection from the hospital to people outside it.
I come to the particular provision in the Birmingham region, Witton Hospital in particular. Until it was destroyed by fire on 3rd May, Witton Hospital was the first-line smallpox hospital for the Birmingham Hospital Region. It was built by the Birmingham City Council at the beginning of the century as an isolation hospital. It has been one of the hospitals managed by the East Birmingham Hospital Management Committee. It had 24 beds, and so was the right size for use as a first-line smallpox hospital.
Hon. Members will remember the outbreak of smallpox in the years 1961–62. A full report on this outbreak was published by the Ministry of Health as No. 109 in the series of Reports on Public Health and Medical Subjects. As will be seen from this report, successful use was made of Witton Hospital during this epidemic. Two patients were admitted, one after a diagnosis of smallpox had been established, on 3rd January, 1962. This patient recovered uneventfully and was discharged on 20th January. A second patient whose infection was in no 1967 way connected with the first, was admitted as a suspected case of smallpox on 15th January, 1962. He also subsequently recovered and was discharged on 6th February of that year.
The official report to which I have referred comments most favourably on the way in which action in the face of the outbreak was firmly concerted by all concerned, beginning with a meeting for planning purposes of local medical officers of health and representatives of the regional hospital board when the first case appeared. I quote from the report, page 59:This is very close to the ideal solution in the particular circumstances as obtained locally. It calls for a strong will and maximum co-operation between authorities and the rest of the medical profession. It is, of course, easier to sustain if similar restraint is being shown elsewhere in the country.My examination of this case has shown that, far from its exemplifying any slackness or failure, it seems to be a model of what should have been done in the circumstances. Minor criticisms could be made, but I think that in principle it was a model.
On this occasion Witton Hospital was first opened for use on 3rd January, 1962, and was finally closed for terminal dis-infection on 13th February of that year. At no time was it deemed necessary to bring into use the second-line accommodation in the region. However, the use of Witton Hospital during this outbreak served to make apparent the limitations on the usefulness of the building imposed by its physical condition. There was some initial difficulty when the second case was to be admitted there, because the central heating system had been affected by the bad weather.
In 1964 the board came to the conclusion that the hospital was unsuitable for further use, even as reserve accommodation, since it was increasingly difficult to maintain in tolerable condition, owing to the age of the buildings and the equipment. The board accordingly began to look for a suitable replacement in consultation with the local and other authorities concerned. In the meantime, however, the hospital retained its function as the first-line smallpox hospital for the region and received its last patient there during the year 1966.
1968 After careful consideration and full consultation with all concerned, the choice of the board fell on Catherine-de-Barnes Hospital, Solihull, in the same hospital management group. This had been designed, also at the beginning of the century, as an isolation hospital. Its 20 beds have been used, in conjunction with Solihull Hospital, for maternity patients who have had their confinement. It was used as a smallpox hospital during the epidemic of 1966 and it was then demonstrated that it would make an excellent first-line, regional smallpox hospital.
Accordingly, since June, 1966, while not fully designated for use as the first-line smallpox hospital for the region, it has remained empty and available to receive smallpox cases. Naturally, the board was not in a position to seek the Minister of Health's formal approval to the change of use of the hospital, from maternity to smallpox, until it had satisfactorily concluded all its consultations with interested authorities. Similarly, the board was not in a position to recommend the final abandonment of Witton Hospital until a replacement had been secured. This has now been done.
However, when the last patient was discharged on 4th May, 1966—I draw the hon. Member's attention particularly to this—a thorough terminal fumigation was carried out by the department of the medical officer of health. This was so effective that when the building was again examined this year immediately prior to its destruction on 3rd May those applying the scientific tests paid tribute to the thoroughness of the earlier terminal fumigation.
Since the hon. Member mentioned, quite rightly, that advice was sought from the virologist, he may be interested to know that the Micro-Biological Research Station at Porton, Salisbury, was asked by the senior administrative medical officer of the hospital board and the medical officer of health for the City of Birmingham to investigate the possibilities of smallpox virus surviving at Witton Hospital, and 26 samples of material from the hospital wards and drainage system were examined for smallpox virus, and no clear evidence has so far been obtained to indicate the presence of smallpox virus from any of the samples.
That is why I was a little bit alarmed when the hon. Gentleman said, I thought 1969 —he will correct me if I misunderstood him—that there was a probability of there still remaining virus infection. I hope that what I have just said will satisfy him. Smallpox virus of the type present in the cases at the hospital before it was closed was mixed with some of the material removed from the hospital, and this material had an adverse effect on the survival of the virus. The disinfecting procedures carried out at the hospital have been adequate.
I want to discuss the events leading up to the destruction of the hospital on 3rd May. By the middle of last year, 1966, as I have explained, Birmingham Regional Hospital Board concluded that in Catherine-de-Barnes Hospital it had a suitable replacement for Witton. It remained to complete the necessary local consultations and to obtain the Minister's formal approval. In the meantime it considered what should be done with Witton, once abandoned. It concluded that it had no further use for it for hospital purposes and consulted with the Medical Officer of Health of the City of Birmingham—the responsible public health authority—on the precautions necessary prior to its disposal. I hope the hon. Member takes that point. The medical officer of health gave his opinion that the hospital should be burned to the ground before the site could be used for other purposes.
During its life as a first-line smallpox hospital Witton had a resident caretaker. But on 2nd May, 1966, the caretaker resigned. Not unnaturally, in view of what was going to happen, a resident successor was not available. Immediately on the caretaker's resignation the hospital management committee appointed a member of its staff who lived in the house only 600 yards away to look after it, and to make visits for the purpose of discharging this duty. The committee also informed the police authority that there was no longer a resident caretaker. A warning notice was placed outside the hospital and the physical obstacles to entry were strengthened. This included the use of barbed wire. New padlocks were provided for the doors, some of which were screwed up. The hospital secretary made regular visits of inspection.
1970 The seriousness with which the hospital authority regarded its obligations to secure the public from any risk of infection may be evidenced by the following example. The city council, which owned the hospital prior to the inception of the National Health Service, naturally expressed interest in resuming ownership of the site, and accordingly asked the regional hospital board for permission to look over the building. The board sought advice from the city's medical officer of health and he advised that this would be hazardous and that it could be allowed only after precautions had been taken—that is, the successful vaccination of the persons visiting: otherwise they could only inspect the periphery. One of my hon. Friends brought this to my notice in the belief that this showed perhaps undue zeal on the board's part, but there are rules and procedures which should be followed, and which were followed. We assured my hon. Friend who had mentioned the matter to us that the Department's medical advisers considered that this caution had been well founded and endorsed the advice which the medical officer of health had given.
On 10th April a telephone call was received at the board's headquarters from the Press asking for the board to comment on the incidents of vandalism at the hospital. The implications of this, from the point of view of public health, received immediate and serious attention. At this point I should, perhaps, mention that the role of the Press in this matter is not at all to be criticised. We have a good free Press in this country and I hope that it will always remain so. We depend on the Press as a check and balance on other normal, routine precautions.
On 12th April the board's senior administrative medical officer discussed the situation with the city's medical officer of health and in consequence, at the end of their conversation, the senior administrative medical officer asked the medical officer of health to carry out the demolition by fire on the lines already proposed. Arrangements were immediately set in train and the destruction by fire took place, with complete success, on 3rd May. The operation was fully reported and one account stated that it was attended by 50 Press and television representatives.
§ Mr. Gurden
Would not the hon. Gentleman agree that what he has said bears out what I said; that there was not security? Although he has pointed out that someone was living nearby, that locks had been placed on doors and so on, vandalism nevertheless took place. That the building was a hazard and danger was surely proved by the board not allowing anyone to go in it unattended. Would not the hon. Gentleman agree that there is some justification for my remarks?
§ Mr. Snow
The hon. Gentleman may not have fully understood what I have been saying. When he reads the report of my remarks he will understand that over a long period certain procedures and routine measures that had been laid down were carried out.
The attendance of 50 Press and television representatives no doubt shows that this matter was newsworthy. I am somewhat alarmed at the connection between the emotive word "smallpox" and some ignorance about what this disease means and what was being carried out by the responsible authorities. I am a little concerned about whether this was fully understood or, if it was, whether sufficient publicity was given to the matter. However, in view of this attendance of Press and television representatives, it is not necessary for me to record the details.
There is one point, however, which I should make clear. The decision to destroy the hospital was properly taken by the board, but the choice of the methods to be used was made by the responsible medical officer of health.
We have been asked what the Minister intends to do with the site of Witton Hospital. The Birmingham Regional Hospital Board has reported officially to my right hon. Friend that the site is now surplus to its requirements and it has recommended that it be disposed of. It has also received an official report from the city's medical officer of health saying that he is "completely satisfied" that the site is now entirely free from smallpox infection. I should add that the site was inspected personally in the afternoon of 3rd May by the medical officer of health and his deputy, who is a member of the Ministry of Health's panel of advisers on the clinical diagnosis of smallpox.
1972 I believe that it has been suggested that the site could be used for a small new hospital, but the practice of modern medicine requires the provision of large district general hospitals where full facilities are available. Facilities for this area are provided by the General Hospital and Good Hope. In this connection, I draw the attention of the hon. Gentleman to what is contained in the publication issued by the Minister on the hospital building programme, with all its implications about the future role of, and the economic reasons for, district general hospitals as opposed to small hospitals. I commend this to him because hon. Members have a great rôle to play in disabusing people of the idea that, to use a colloquialism, small hospitals are on.
The reason why I say that is that in modern medicine, which involves most expensive equipment, techniques and staff, it is possible to give the public what it is fully entitled to only through the medium of a big local or district general hospital. Local attitudes and loyalties about small local hospitals are very understandable, but they are not economic and they are not a reasonable proposition from the technical and medical points of view.
It therefore remains for my right hon. Friend to decide whether the site can be disposed of. If he does, the normal procedure for disposal of surplus hospital premises will will come into operation. In the meantime, the board has received tenders for the final demolition of the buildings on the site, and the district valuer has been asked to value it. The normal procedure for selecting a purchaser of surplus hospital premises is to offer them to public authorities, which take priority in the following order. First, there are other Government Departments: there is established administrative procedure for dealing with this. Secondly, where the premises were formerly hospital premises taken over from a local authority in 1948 without compensation, as in this case, the local authority is given an option to acquire them. Thirdly, the premises are offered to the county and district councils in whose areas the premises are situated.
To this procedure there is one exception. Where it is known that surplus hospital land is required by a local health authority, or local welfare authority, 1973 it would, with the Minister's approval, be offered to that authority before the other offers were made. If, for example, there was local agreement that there was need for a health centre, then an application by the local health authority to purchase the land for this purpose would receive first consideration. The city, as public health authority, has already declared that the area is safe for redevelopment, and any future use of the land will be subject only to the normal planning authorisations.
I hope that the hon. Gentleman will consider this suggestion. It is not the responsibility of my Ministry, except in a much later context, to suggest where health centres should be. This is a matter for the judgment and consideration of the local health authority. I have not surveyed the area, nor is it my responsibility, but I can assure the hon. Gentleman that if by any chance—I put it no higher than that—the local health authority—no doubt he could use his influence here—considers that a health centre might usefully be placed there, it is up to the local health authority to prepare a plan. Machinery in my Department has now been so designed for considering these applications that we can deal with plans most expeditiously. But it must be the suggestion of the local health authority. If the hon. Gentleman is interested, I shall be very happy to send him a copy of a publication which has been sent to local health authorities explaining the procedures in the up-to-date context.
In the light of what I have said, I think that the House will agree that all proper precautions were taken by the board and the local health authority for safeguarding the health of the public. There can never be complete insurance against human folly or ignorance. It seems to be in the nature of small boys that they are tempted to break into empty buildings and go climbing where they should not.
§ Mr. Snow
I am glad to receive support from my hon. Friend the Member for Woolwich, West (Mr. Hamling). It is the experience of many of us.
As soon as this situation was brought to the notice of the responsible hospital 1974 authorities, immediate action was taken, quite literally, to remove the temptation. It so happens that latterly the whole policy and practice of hospital care for smallpox patients has been considered by the Standing Medical Advisory Committee. The result is essentially confirmation of existing arrangements, and a circular supplementing and modifying advice which was given out by circular a little over 10 years ago will be issued to hospital authorities early next month.
This makes the point that the perimeter of a first-line smallpox hospital should be surrounded by a wall or fence so constructed as to prohibit unauthorised movement in or out of the hospital. It also explains that there should be a single entrance to the hospital under the supervision of a custodian. I have no doubt that hospital authorities will continue to treat this disease with the respect that it demands and which has been fully evidenced in the case of Witton Hospital. I am glad to be able to say, as I think the hon. Gentleman knows, that the boys known to have entered the hospital buildings were vaccinated and kept under daily surveillance. They have remained well, and are now free from any danger of developing smallpox as a result of their entry into this hospital.
I hope that what I have said will reassure the hon. Gentleman not only that in this case the necessary procedures were adequate, and full contact was maintained by the two authorities concerned, but that, generally, for protecting the public against this sort of infection, the procedures are being properly enforced with the specialist techniques advised by my Department.
§ Mr. Gurden
Before the hon. Gentleman sits down, I wonder whether he would deal with the point that I raised about whether any other hospitals are at risk in the country?
§ Mr. Snow
To the best of my knowledge it is the case that the procedures to which I have referred are being properly applied, and I have no information that any other hospital is at risk. Naturally, it is the continuing responsibility of my Department to see that this information is at our disposal.