HC Deb 14 May 1968 vol 764 cc1181-92

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

10.15 p.m.

Mr. John Cronin (Loughborough)

I have taken this opportunity to draw the attention of the House to the gross dissatisfaction which is felt by my constituents in Loughborough and the surrounding area about the casualty services provided by the Loughborough General Hospital, and to refer also to the tragic death of a small boy, Nigel Haywood, who was unable to avail himself of appropriate casualty services.

I shall draw upon a recent Report by the Gillespie Committee, with which the Parliamentary Secretary must be very familiar. I have written many letters to the Minister about casualty services at Loughborough General Hospital. I also put into his hands a petition signed by about 15,000 of the inhabitants of Loughborough, which is some indication of the strong local feeling.

The Loughborough General Hospital has been in existence for over 100 years, and there was general satisfaction with the casualty services until about 1965. At about that time, owing to various retirements, there was a breakdown of the casualty services there. It was then decided that emergencies requiring major surgery and seriously ill people should be sent directly to the Leicester Royal Infirmary. I have no quarrel with that at all, although it was a matter of some controversy at the time.

The real difficulty which has caused the strong local feeling has centred upon treatment of two categories of casualties, the first being people who have minor ailments or minor injuries—one can call them minor casualties—and the second being people who are seriously ill or seriously injured and who have been brought to Loughborough General Hospital fortuitously or through a lack of knowledge of the arrangements for taking them straight to Leicester.

The arrangements for these two categories of casualties have been grossly unsatisfactory, are grossly unsatisfactory and will continue to be grossly unsatisfactory unless something is done to improve the situation. The Leicester No. 1 Hospital Management Committee, which is responsible for Loughborough General Hospital, made arrangements for general practitioners to provide a casualty service between the hours of 9 to 5 on weekdays and also on Saturday mornings. The Sheffield Regional Hospital Board suggested to the Leicester Hospital Management Committee in the summer of last year that minor casualties which would normally have gone to the Loughborough General Hospital should be referred by the hospital to their own doctors and that the hospital doctors at Loughborough General Hospital should treat only those who were not registered with a doctor in Loughborough or who were seriously ill or injured and had been brought to the hospital through misunderstanding or lack of knowledge that they should have been taken straight to the Leicester Royal Infirmary.

The Leicester Hospital Management Committee agreed to implement the board's wish on or about 7th July, 1967, according to the Gillespie Committee's Report, with which the Minister is familiar. I suggest that even those arrangements which the Regional Hospital Board recommended were inadequate. It seems most unsatisfactory that a person who has a minor injury or a minor ailment should be referred to his private doctor. Except during surgery hours, the vast majority of general practitioners are on their rounds seeing patients in their homes. Therefore, this suggestion seems an inadequate one. But even the limited and, to my mind, unsatisfactory proposals of the Sheffield Regional Hospital Board were not implemented by the Leicester No. 1 Hospital Management Committee, although it had apparently accepted the Regional Board's recommendation and agreed to implement it. One sees from the Report of the Gillespie Committee that there appears to be some reluctance on the part of the medical staff of the Loughborough General Hospital to co-operate in treating casualty patients. On page 11 it is stated: Nevertheless, we had evidence from two of the hospital porters that it was extremely difficult to obtain any help in dealing with casualties from the house officers. The Report later states: The present hospital secretary and his predecessor were aware of the difficulties in obtaining the concurrence of the medical staff in the carrying out of casualty duties when the department was closed, and the group secretary states he also was aware of them. So the picture one has is that the Leicester No. 1 Hospital Management Committee has undertaken to provide a limited and still unsatisfactory casualty service but has difficulty in obtaining co-operation from the medical staff in putting this into practice. There may well be good reasons, but none of them appears in the Gillespie Report. It seems to me rather an anarchic situation when a hospital management committee recommends that certain casualty services should be provided but they cannot be provided because there is difficulty in obtaining the help of the medical staff.

The situation was brought to a head on 23rd September last year when an 18-month old child, Nigel Haywood, was brought by his mother to the Loughborough General Hospital desperately ill, having accidentally taken a poison, oil of winter-green. The incident occurred a few yards away from the hospital at 1 p.m. on a Saturday. It was obviously desperately urgent to get the poison from the child's stomach by a stomach wash, and this could have been done by any trained nurse. The hospital had many nurses, and presumably also had resident doctors available, but the child was given no treatment there. He was simply referred by a porter to his own doctor, who had him removed by ambulance to the Leicester Royal Infirmary. As a result, there was considerable delay in treatment, and the child died next day.

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

Is my hon. Friend saying that the doctor in question did not want to treat the child?

Mr. Cronin

No. I think that my hon. Friend misunderstands me. There is no question of the general practitioner's not wishing to treat the child. He took the sensible course of sending the child straight to the Leicester Royal Infirmary after the refusal of treatment at Loughborough. I do not intend to comment on the child's treatment at Leicester, but I do feel that it is gross inhumanity when a desperately ill child is taken to a general hospital containing many nurses and, presumably, medical staff and it is turned aside without treatment. Admittedly, the child was referred to his doctor and ultimately to another hospital.

It is probable on the evidence that Nigel would have died in any event, but I think that he was deprived of a good chance of survival by the failure of the Leicester No. 1 Hospital Management Committee to insist on its medical staff providing a proper casualty service. I shall not pursue that point further, but I suggest to my hon. Friend that this is just one tragic example of where it is obviously necessary that there should have been a 24-hour casualty service at the Loughborough General Hospital. I have heard that since then another child has been taken to the hospital, having drunk a large quantity of alcohol. On this occasion, efficient treatment was instituted by one of the nurses. The child's stomach was washed out and it survived. But I would not wish to continue now to dwell on individual cases. The important thing to point out is that Loughborough as a town and its surrounding area is entitled to a 24-hour casualty service.

Population of Loughborough is 40,000. The General Hospital has a catchment area of over 100,000 persons. I believe that the staffing ratio at the hospital is quite favourable for the provision of adequate casualty services. There are three resident doctors for about 60 occupied beds. I cannot understand, in these circumstances, why a 24-hour casualty service cannot be provided, bearing in mind that there are also general practitioners who work in the casualty service between the hours of 9 a.m. and 5 p.m. on weekdays and on Saturday mornings. This is not putting too much of a strain on the medical staff.

It may well be that there are occasions when there is a grave lack of medical staff at the hospital, but I understand that this is not normally the case. Usually, there are three resident doctors who only look after 60 beds, and I would not have thought it impossible for them to provide some sort of casualty service for the population of Loughborough and the large catchment area around it when the general practitioners who are engaged for the purposes of a casualty service during the presented hours are off duty.

We must bear in mind also that Loughborough is a university town, with a large number of sporting and recreational activities and that numerous injuries result. We should also bear in mind that Loughborough has many industries and that there are numerous minor industrial injuries. Yet the fact remains that a worker who cuts a finger and needs it stitched has to go to Leicester for such elementary treatment, if he is so unfortunate as to have his injury out of the normal casualty hours at the General Hospital. I would have thought that, from the point of view of maintaining productivity alone, it would be desirable for an industrial town like Loughborough to have a 24-hour casualty service.

I hope that my hon. Friend is not going to give a final reply tonight. This matter should be studied and I feel sure that, when it has been thoroughly investigated, the balance of opinion will be strongly in favour of Loughborough having a 24-hour casualty service.

Loughborough has had a 24-hour casualty service for over 100 years, and it is difficult to understand why this service should cease about 1965. It must mean either that Loughborough is being discriminated against by the hon. Gentleman's Ministry, or else there has been a general deterioration of casualty services in all hospitals, or the majority of them. This is an inescapable conclusion. Both, or either, of those circumstances seems discreditable to the Ministry of Health. I hope that my hon. Friend will look at this matter carefully. I do not expect him to give a full and complete answer tonight, but I hope that he and the Minister will look at this and put an end to the justifiably strong feeling of discontent in the town of Loughborough about its casualty service—this feeling that it is not getting fair treatment from the National Health Service.

10.30 p.m.

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

My hon Friend the Member for Loughborough (Mr. Cronin) has raised tonight a distressing constituency case which has already been the subject of exhaustive inquiry by a specially constituted committee of inquiry. The inquiry referred to is the Gillespie Report. That report was published last month under a statement by the Sheffield Regional Hospital Board, of which I sent my hon. Friend a copy in advance of this debate. My hon. Friend asked whether he might also have a copy of the transcript of evidence given to the Committee. I must tell him that the Committee sat in private and that I am not at liberty to disclose the evidence to him. I would however assure him that the transcript of evidence is available in confidence to members of the Sheffield Regional Hospital Board, including a gentleman well known to my hon. Friend. I would also emphasise that the members of the committee of inquiry—a solicitor, a hospital matron and a consultant paediatrician—were quite independent of the area concerned.

The report is about the case of a 17-month-old child, Nigel Haywood, who shortly after mid-day on Saturday, 23rd September last, drank a quantity of oil of wintergreen in Loughborough. His mother took him to the local hospital, Loughborough General Hospital, where she found that the casualty department was closed for the weekend. A porter telephoned the family doctor who, through his wife, advised that the child be taken by ambulance to Leicester Royal Infirmary. This was done without delay. The child was admitted there but eventually died.

The committee of inquiry raised a number of points about what happened after the child was admitted to Leicester Royal Infirmary, and in pursuance of these the Sheffield Regional Hospital Board is setting up a panel to investigate the professional behaviour or competence of one of the doctors at that hospital. We are not however concerned with that tonight.

The committee also commented on the fact that Leicester Royal Infirmary was not forewarned of the imminent arrival of a potentially serious case. I too, having examined the record of events after Nigel had left Loughborough, have formed the opinion that better arrangements should be made in such cases, and I understand that the Sheffield Regional Hospital Board has this in hand.

My hon. Friend is concerned about the arrangements for dealing with such cases at Loughborough General Hospital. He gave notice, in a letter of which he supplied copies to the local Press, that he wished to raise two major objections to the committee of inquiry's report. First, the committee concluded that in this particular case the correct procedure was followed at Loughborough. My hon. Friend has attacked this conclusion by saying that it cannot be correct procedure for a desperately ill child to be seen only by a porter. The committee did not say that the arrangements at Loughborough were satisfactory. Indeed, it criticised them, and, even before it reported, the hospital's arrangements were so modified that any patient seeking treatment when the casualty department is closed would now be seen by a trained nurse, who then seeks advice from a doctor before disposal of the patient.

Nevertheless, it remains true, though it can be of little comfort to the bereaved parents, that the death of Nigel Haywood cannot in any way be blamed on the fact that when his parents took him to their local hospital it was a porter, rather than a nurse, who dealt with the case.

Mr. Cronin

I am in some difficulty on account of my hon. Friend's refusal to let me have the minutes of evidence, so could he tell me, when the child was taken to Loughborough General Hospital, how many resident doctors were present and how many nurses were present?

Mr. Snow

I do not have that information. My information is that there was some difficulty in obtaining the services of resident doctors for this particular case. I would like to check on that and I will advise my hon. Friend.

Concerning the minutes of evidence, persons known to my hon. Friend have this information at their disposal.

The committee's report shows that the porter promptly and efficiently telephoned the patient's general practitioner, just as a nurse would have done, and, on his advice, which was a clinical decision, summoned an ambulance to take the patient to Leicester Royal Infirmary.

My hon. Friend has implied that if Nigel Haywood had been seen at Loughborough General Hospital, not by a porter or a nurse, but by a doctor, the outcome might have been different. He said that the dose was probably fatal, but he also said that the child might have had a better chance. This seems to be doubtful. I should therefore make it clear, at this point, that the committee of inquiry found that the dose which the child had taken was almost certainly fatal from the start. Moreover, the child could indeed have been seen in Loughborough by a doctor—his own general practitioner—but this doctor decided that the best course was to send the child by ambulance to Leicester Royal Infirmary.

My hon. Friend's other criticism is of the committee's conclusion that the casualty department at Loughborough General Hospital should be closed down entirely. I can well understand that this conclusion is unwelcome to my hon. Friend, who has for so long fought hard to keep the casualty department open. My hon. Friend referred to the large representations which have been made locally on this point.

My hon. Friend has a point in saying that the committee of inquiry misrepresented the views of the Platt Sub-Committee of the Standing Medical Advisory Committee which reported in 1962; for it is true that the Platt Committee said that at some hospitals, not designated as accident and emergency centres, there should be provision for the treatment of minor—I stress minor—injuries. The Sheffield Regional Hospital Board pointed this out in the statement under which it published the committee's report. But I must make it clear that major accident and emergency cases should normally be taken as quickly as possible to a major accident and emergency centre staffed and equipped to deal with them.

I must point out here that when my hon. Friend talks about discrimination against Loughborough or a general degeneration in the quality of services for accidents, I think that he has the position wrong. I believe that in the past he has been in charge of a casualty point. Therefore, he will know that shortage of trained medical staff, which exists all over the country, and the very high degree of sophisticated treatment which can only be provided at certain focal points, is the basis of the trouble.

Mr. Cronin

I talked about minor casualties.

Mr. Snow

I am coming to that in a moment.

That the committee of inquiry was mistaken about what the Platt Sub-Committee said does not, however, vitiate the conclusion that it reached, after studying the arrangements at Loughborough, that the casualty department there should be closed. The Sheffield Regional Hospital Board will take this recommendation into account in reviewing the accident and emergency services of its region, as my right hon. Friend has recently asked all Regional Hospital Boards to do. The Sheffield Regional Board has said in its statement that there will be full local consultations before any final decision is taken.

I would not attempt tonight to anticipate the decision which the Sheffield Regional. Hospital Board will have to take on this matter. But I would like to inform my hon. Friend of the reasons why my right hon. Friend has asked Regional. Hospital Boards to review their services, and particularly their accident and emergency services, with a view to rationalisation and economy.

As long ago as 1962 the Platt Sub-Committee recommended that the accident and emergency services should be rationalised on the basis that all injured patients requiring hospital treatment should be taken direct to accident and emergency units staffed and equipped to deal immediately with major injuries and other emergency cases at any hour of the day or night. They recommended a substantial reduction in the number of accident and emergency units then existing and a concentration of the service in a pattern of accident and emergency units which would each serve populations of at least 150,000, with some smaller hospitals receiving less serious cases.

The reason for that concentration was, and is, that if an accident and emergency centre is to be able to provide expert medical and surgical attention at any hour of the day or night on any day of the year it must be served by a substantial team of doctors, including several consultants as well as doctors of intermediate and junior rank. My hon. Friend referred to the fact that the population of the catchment area of the Loughborough Hospital was in the neigh- bourhood of 100,000. That is not my information. The population of the town is about 40,000, and that of the surrounding area about 75,000, which is substantially lower than the 150,000 specified under the Platt Sub-Committee recommendations. At a time when the resources, particularly medical manpower, available for the National Health Service are fully stretched, we could not provide a team with all the facilities that I have mentioned which are normally provided for a population of 150,000 for the lower figure of the Loughborough catchment area.

It is difficult when people are opposed to the district general hospital principle to persuade them to surrender their loyalties and their attitudes to their local hospital which is held in great affection. I understand that, and therefore I think that my hon. Friend who is himself a surgeon must understand that, and I hope that he will be able to explain it to his constituents. It is natural that in a case like that of Nigel Haywood there is a feeling that it would be better to deal with emergency cases locally, but I assure my hon. Friend that that feeling is mistaken. The expert Platt sub-Committee was unanimous in its view that the best service could only be provided by concentrating specialist staff at large accident and emergency centres.

Mr. Cronin

My hon. Friend is answering a point which I have not raised. I am not contesting that major emergencies should be taken to a proper centre. What I am insisting on on behalf of my constituents is that there should be a proper service for minor casualties and also serious injuries or illness.

Mr. Snow

I understand that. I was addressing myself to the major principle when I said that the Platt Sub-Committee had been slightly misrepresented in the Report of the Committee of Inquiry in that the Platt Sub-Committee provided for hospitals taking in minor—and I stress minor injuries. It ought to be possible to provide such a system if there is good will on both sides, between lay and medical. My hon. Friend has a great part to play in achieving that local good will.

I do not see why, in the review being conducted by the regional hospital board under the direction of my right hon. Friend, we cannot provide some sort of organisation which will give a minimal service within the competence and resources of the National Health Service, apart from the general intention to have a proper scheme for major cases on the basis of the properly organised but reduced number of centres to which I have referred.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Eleven o'clock.