§ 3.27 a.m.
§ Mr. Peter Hardy (Rother Valley)I deeply regret Mr. Deputy Speaker, that you, the Under-Secretary and I are detained here at this late hour. Perhaps in view of the hours of debate that have gone before it is appropriate that an English Member should be raising the last item of the day's business. I am sure that the matter which I wish to raise deserves consideration since it is relevant to a number of people who suffer severe ill health and disability.
There are grounds for serious doubt about the effectiveness of our present arrangements and the adequacy of our provision of portable breathing appliances for those who need oxygen supplies and who are immobilised and confined by that need. I do not think that we could possibly be satisfied with the arrangements in the National Health Service in view of the number of appliances which have been provided. I suspect that this number is astonishingly small.
However, before I enlarge upon that point I shall explain how I became concerned about the matter. One of my constituents is Mr. Jack Aisbitt of Dinnington. He suffers from severe pneumoconiosis. When I first visited him at his home earlier this year he seemed a sick man, regrettably unable to enjoy a varied life. For months at a time he was unable to leave his home, and his condition was such that he had to be close to the large oxygen cylinders at his home. This confinement was hardly conducive to his physical well being.
474 Mr. Aisbitt gave many years of valuable service to the mining industry, latterly at Dinnington Colliery, and for that, like so many thousands of other miners, he has paid the bitter price of pneumoconiosis. I am delighted that the Government are to take certain helpful action to ease or offset that burden. However, Mr. Aisbitt also gave excellent service in the Army and he has long been associated with the Royal British Legion. There is a very good branch of the Legion in Dinnington, and some time ago Mr. Aisbitt became the honorary treasurer.
The branch showed the compassion for which it is highly regarded and local members felt an increasing concern for Jack Aisbitt. This spring it was decided to investigate the possibility of acquiring a portable oxygen appliance to assist him. The secretary of the branch, Mr. Ernest Kirk, went into the question with commendable zeal. The British Oxygen Company was contacted at the Rotherham works and the staff were extremely helpful. A visit was paid by British Oxygen representatives to Dinnington where they met local Legion officials and Mr. Aisbitt and discussed the matter. Eventually a Portogen appliance was purchased, and it was hoped that the quality of Mr. Aisbitt's life would be enhanced.
I was kept informed about the case by Mr. Kirk and Councillor Don Keeton, a vice-chairman of the local branch of the British Legion. Like me, they were concerned that the appliance had to be purchased privately, for they realised that while the local branch could act to assist its own member, who suffered the dismal effect of debilitating immobility, other people in similar circumstances could be much less fortunate.
I considered this point, and because I felt that it had relevance I raised the question in correspondence with the Department. During and since the summer of this year I have also tabled a number of Questions. I have been rather disappointed. That disappointment has been increased as the months have passed and I have noted what a pleasing difference the appliance has made to Mr. Aisbitt's life. He was housebound for months before he received the appliance. I learnt that once he had it he was able to get to the branch meetings to which one of his many friends could not take him 475 by car. He could spend an hour or two out of his home regularly.
In the last long recess, while carrying out a series of meetings and home visits in the Dinnington area, I had a little time free and decided to call on Mr. Aisbitt to have a chat with him. I found no one in. Further on in the High Nook Estate in Dinnington, where Jack Aisbitt lives, I encountered Mr. Kirk and Councillor Keeton, who informed me with a very proper satisfaction that Mr. Aisbitt was away from home. His son is in the Parachute Regiment in Aldershot, and Mr. Aisbitt, an ex-soldier, was visiting him there. I learnt that the Army had laid on an oxygen supply and generally shown an exceedingly kind and helpful attitude so that it was possible for Mr. Aisbitt to be away from home.
I was pleased to hear of this development. It was excellent news, coming, as it did, after all those dreary days and months of immobility. I again reflected that without the help of the Dinnington British Legion Mr. Aisbitt would still have been confined to his home.
I then paid a visit to the British Oxygen Company at Rotherham, where I met Mr. Coulson Smith, who occupies a senior position with that company, and who has kindly given me helpful advice and assistance, for which I am very grateful. The company's main activity is to provide oxygen and other gases for industry and commerce. I do not think that I can be accused of seeking to drum up business for the company, as the provision of portable breathing appliances can be only a tiny part of its activities. But that side of the business should be encouraged and should expand. I am sure that it needs to. Even if it did, it would still be only a tiny part of the company's overall activity.
In May my hon. Friend the Minister responsible for the disabled wrote to me informing me that in the 1968–69 survey of the handicapped and the impaired it was recorded that there were 4,300 people severely handicapped due to chest disease. He suggested that the figure today was probably 4,500. I was also informed that on 31st March this year there were 1,953 people receiving constant attendance allowance because of respiratory conditions. Some of them 476 could probably benefit from the provision of a portable appliance. At any time there are 14,000 beds occupied by hospital patients suffering from severe chest disease, and perhaps some of them could benefit, too.
I am certain that a number of those who suffer serious chest disease could enjoy the extra mobility that the portable appliance provides. The numbers involved may in total be comparatively small, but I am sure that the existing provision does not match even the smallest estimate of need. I believe that the need in mining areas such as that which I represent, and perhaps that represented by my hon. Friend the Minister, is such as to justify increased provision. I have asked quite a number of Questions about the matter, and I have been disappointed by the replies.
On Tuesday, 18th June, my hon. Friend the Minister informed me that he was satisfied with the procedures. My most recent Question on the subject led to my being informed that the figures for the provision of portable appliances were not available centrally. I strongly suspect that if my hon. Friend had the figures he would be as disappointed with them as anyone could be. Those figures should have been made available to hon. Members.
I have not obtained figures for the whole of Britain, but I have received information for virtually half of England which is relevant. In the east of England hospital authorities appear to have acquired relatively few portable appliances—less than a dozen in total in the two years 1972–74. Only one appliance was purchased in the first few months of the current financial year. The fact that so few machines were obtained is astonishing since I believe that there are quite a few people about like Mr. Aisbitt. The Minister may say that the few appliances obtained would in any case not be going to out-patients but would be retained for hospital purposes, for emergencies, and midwifery cases, and not for people who spend most of their time in their own home.
Of course these appliances may be purchased privately, but the Minister should bear in mind that many of those disabled by chest disease have been among the poorest in the community for 477 years, perhaps decades, and the £40 or so involved in purchasing the appliance and recharging equipment could not easily be found by them. I hate to think that sheer lack of funds causes anyone to be housebound because this inevitably shortens their lives.
The Minister might feel that the situation cannot be too bad because the appliances can be provided through the hospital service. However, the fact seems to be that the hospital service is not providing the appliances on an adequate scale. Only a very few appliances appear to be on loan from hospitals at present. I know that the Department feels that it would be difficult to arrange for the supply of such equipment under general medical and pharmaceutical services. Clearly the chemists could not always keep the appliances in stock and it might be right therefore for the hospital service to stock them and to distribute them to chemists as necessary.
Whatever the administrative procedure involved, it should not be such as to discourage the necessary provision. That seems to be the case at present. I consider that where a person has oxygen cylinders in his own home and is incapable of moving far from those cylinders, a portable appliance could be made available to give him or her the 20 to 30 minutes supply which should be enough to allow reasonable mobility within that individual's community.
Experience suggests that it should not be necessary for hospital consultants to have the sole right to prescribe these appliances. In many cases the local general practitioner may be far and away the best arbiter. If he can be instrumental in securing the provision of the larger appliance, why not the small one, too? Whatever procedures are adopted, the supply of the appliance could come from the local pharmacist who supplies the large cylinders.
Here it would be right for me to pay tribute to local chemists who so often in this matter act with kindly thought-fulness. I understand that this has certainly been the case with Mr. Aisbitt and with others in South Yorkshire whose chemists ensure that the large cylinders in the homes of the disabled and the immobilised are properly handled. This arrangement usually works well, not least because of the chemists' involvement. I 478 do not believe that they would find the provision of portable appliances an intolerable task, even though personal profit is quite meagre. I would imagine that a local order placed with a pharmacist could be met within a week or 10 days.
At one point the argument was advanced that care and caution was needed to avoid establishing oxygen addiction. However—and I hope that the Minister will comment upon this—I am told that the Portogen appliance which I have in mind is designed to ensure that a proportion of ordinary air is admitted to the mixture inhaled. I understand that this makes the development of addiction very much less likely.
It is fair to say that in many cases addiction could not develop, at least not for a long time. With the ordinary brightness of life provided by a little more mobility, time may not be a particularly relevant factor. These appliances are light, easily handled and ideal for those in the weak condition brought about by lasting chest disease.
I had felt tempted to try to bring one of these appliances into the Chamber. I have been loaned one for examination and it is in the building. However, knowing of our present concern about illegal criminal action, I felt that discretion was needed; otherwise, if I had produced the appliance in the Chamber, I might have found myself in the Tower rather quickly. However, in view of the lateness of the hour I feel tempted to say that it might have been useful, if not for myself, for either you, Mr. Deputy Speaker, or my hon. Friend the Undersecretary of State. We have the appliance in the building, and I was able to show it to the Minister who will, I think, agree that it is ideal for its purpose—a useful and appropriate tool for living and to provide the greater capacity to enjoy living.
I hope that the Minister and the Department will be prepared to look again at this whole question. I trust that the Minister will concede that some needy people could be helped, and that too few of those like Mr. Aisbitt are helped in this way at the present time. I repeat and emphasise that the parliamentary Answers I have received have not been at all encouraging or properly informative. Information of the kind sought ought to 479 be provided, particularly given the months over which my concern has been expressed.
I must also repeat and emphasise that as a result of the provision of an appliance of the kind mentioned, my constituent's life has been greatly improved. There must be scores, even a few hundreds, of others in like physical condition—I do not think there are more than that at any time—who would benefit from a portable appliance and who have not been loaned one. I believe, therefore, that the present arrangements and procedures are excessively cautious and inadequately effective in dealing with need.
I conclude by reminding the House that my constituent's experience justifies the Department's reconsideration. May I add that I believe that Mr. Aisbitt is most appreciative of the appliance and of the help that he has received from the Royal British Legion. Not every person in his position can be said to qualify for its assistance. However, such qualification should not be essential for the sort of extra mobility which Mr. Aisbitt now enjoys and which no one else should be prevented from enjoying.
As I said at the beginning of my speech, I regret the lateness of the hour, but I hope that the Minister will feel that even though it is late, the question before us is a worthy one.
§ 3.43 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alec Jones)May I first congratulate my hon. Friend the Member for Rother Valley (Mr. Hardy) on raising this subject, even at this late hour, and on his eloquence on behalf of those who are so unfortunate as to be housebound because they suffer from respiratory disease. It is, sadly, a subject of great concern in my hon. Friend's constituency, and I assure him that it is a matter of equal concern in my constituency and in many parts of South Wales because in that area there is a high incidence of pneumoconiosis and other respiratory diseases.
My hon. Friend has been concerned about this matter for some months, and I have read the several Questions put to and the Answers given by my right hon. Friend the Secretary of State about the availability of portable appliances. 480 The present policy was made known to my hon. Friend by the Minister of State in a letter of 22nd May 1974, and I am glad of this opportunity to explain this policy in rather more detail. I shall read my hon. Friend's speech and consider carefully the points that he has made tonight. I was grateful to him for showing me the appliance, and in view of the lateness of the hour I feel in need of its services.
I emphasise that the prescription of breathing appliances is a medical matter, the most vital need of the patient being for an appliance that will suit his or her own respiratory condition, but the importance attached to mobility will doubtless be taken into account by the doctor, and I accept the point that mobility is desperately important for the individual. In most cases this means an appliance supplied through the domiciliary oxygen therapy service under which pharmacists purchase standard non-portable oxygen apparatus which is loaned out to patients on the prescription of a general practitioner.
As to portable appliances for patients who need a certain amount of oxygen in order to remain active, these appliances can be, and are, obtained by the hospital concerned whenever a consultant believes that the use of such an appliance would be beneficial to a particular patient. There is no limitation on the type of appliance to be supplied, although, of course, as for all other appliances the cost must be met from within the budget of the area health authority.
I have not hitherto any evidence that the hospital service is failing to supply appliances suitable for patients suffering from respiratory disease, and it is estimated that the present rate of issue runs at about 3,000 sets a year. This figure is somewhat better than the figure my hon. Friend mentioned.
There are several reasons why portable apparatus is supplied by the hospital. First, in order to determine the oxygen requirements of a patient who needs this therapy, a consultant chest physician will carry out a number of clinical tests, including lung function studies, and on the basis of the results of these tests he will advise his patient and prescribe the ventilator appropriate to his patient's needs. Such facilities are not available to a general practitioner, who would be 481 unable to recommend the type of respirator needed with the same degree of accuracy as a consultant who has the facilities at his disposal.
I should like to refer to the 1969 report of the Scottish Standing Medical Advisory Committee sub-committee on the uses and dangers of oxygen therapy. The report of this expert sub-committee under the chairmanship of Professor Donald contains a good deal of excellent advice on oxygen therapy. As to patient-carried oxygen sets, it referred to advice given by Dr. Coles of the Pneumoconiosis Research Unit of the Medical Research Council and it concluded that the problems of portable oxygen therapy were far from simple, and I think that that understates the problem. It was difficult to select those patients who would be likely to benefit and it was difficult to be sure that the equipment was properly used and maintained. I am sure that my hon. Friend will agree that whenever the equipment is supplied it is vital that it be properly maintained.
The report also outlined some of the physiological hazards attendant upon prolonged inhalation of oxygen, especially with the risk of dependency, and mentioned the increased risk of fire when pure oxygen was present in the atmosphere. This is certainly a possible danger when we talk of portable cylinders being refilled from a main cylinder.
I am sure that my hon. Friend will appreciate how essential it is that those who are prescribed oxygen therapy must be able to understand what is involved and cope with the standards of safety required. The sub-committee went on to recommend, however, that the value of portable oxygen sets should be investigated in a larger number of patients, and I shall be speaking about this in a few moments.
The chief problem with the portable breathing appliances available is the relatively short duration of the oxygen supply, linked to the need to reduce the weight of the apparatus so that it can be carried, which means that either the patient must recharge the portable cylinders from a larger cylinder in his home, increasing the hazards, or replacement cylinders in large quantities must be readily available to him.
There is no doubt that having portable breathing apparatus helps quite a number 482 of people, but it would be wrong if I did not sound a note of caution in case false hopes are raised. Although wanting to do everything possible to help people in this condition, it would be wrong for us to raise hopes which we could not satisfy. There are some patients suffering from respiratory disease for whom oxygen therapy would not be of benefit, and again this must be a matter for the clinical judgment of a consultant.
Finally—this was mentioned in the letter of 22nd May, to my hon. Friend— there would be difficulties in establishing a satisfactory method of supply of such equipment under the general medical and pharmaceutical services. As so few sets of portable apparatus are required, it is not practical to expect chemists to stock such equipment for the few occasions on which it would be prescribed. In these circumstances, although it would of course be possible to make special individual arrangements, the hospital service is in fact the quickest and most practical source of supply. I would not, however, attempt to press this last argument far; it is our conviction that the expertise of the hospital consultant is desirable for this type of prescription. This is what weighs most with us, combined as it is with our belief that at present in most cases the hospital provides to these people a satisfactory service. I am sure that my hon. Friend does not suggest that the hospital service is not adequate, I am sure that if he had examples of inadequacy he would send me the fullest details for me to investigate. I do not think that that was the point he was making.
I should like to finish by referring briefly to the Medical Research Council multicentre trial of long-term oxygen therapy which includes an investigation into portable breathing appliances. A meeting of experts was organised early in 1972 to consider the feasibility of mounting a multicentre trial of the effects of long-term domiciliary oxygen therapy on pulmonary hypertension in patients with such complaints as chronic bronchitis and emphysema. This meeting recommended that an informal working group should be set up to draw up proposals for such a study, and at the same time suggested that the Medical Research Council, in consultation with the Department of Health, might consider ways of improving equipment for the supply of 483 domiciliary oxygen, including the supply of portable breathing appliances. The proposals for the study were approved by the council and these trials are now taking place, including the use of a commercially available portable system as well as conventional methods of oxygen supply.
As information from these trials becomes available we shall be reconsidering our policy on the provision of portable apparatus, but for the sake of the people concerned—the sufferers—we should want some degree of certainty that our present method of supply is unsatisfactory before we could contemplate 484 changing it. It is not that we wish to close our minds to my hon. Friend's suggestion. We are always willing to examine anything which can improve the conditions in which people like Mr. Aisbitt have to live. I welcome the improvement which Mr. Aisbitt has experienced, as a consequence of which he is able to lead a more normal life, and hope that the trials to which I have referred will lead to an improvement in the facilities for many sufferers like Mr. Aisbitt.
§ Question put and agreed to.
§ Adjourned accordingly at seven minutes to Four o'clock a.m.