HC Deb 24 May 1974 vol 874 cc791-805

12.45 p.m.

Mr. Lewis Carter-Jones (Eccles)

I wish to raise an entirely different subject from the last debate. It concerns the paramedical services of the National Health Service. I have been assured by a substantial number of professional people that though we have discussed disability in this House on previous occasions we have never discussed the para-medical professions as such. I pay a tribute at the outset of my speech to the Library of the House for having gathered so much information for me.

When I began this exercise I was concerned mainly with radiographers, physiotherapists, occupational therapists and remedial gymnasts, but up to the moment of entering the Chamber today I have been receiving messages from other professional people within the health service. I have thanked the Library for its efforts, but I regret that I cannot use all the material it provided.

There is a common thread running through every submission I have received from every para-medical profession. If I can insert a "commercial" at this point, may I say that should I fail to mention any of the para-medical professions, if they write to me I shall try to raise their case with the appropriate Minister. The common theme that runs through every submission is that the Whitley Council is a dead loss for negotiating. The Government and the Opposition must get it clear that the Whitley Council is not a place for negotiation; it is a place which is visited by Treasury officials who are armed with figures and who sit on one side of the table and state "That is the offer." There are no negotiations. The system makes a mockery of unionism.

Every submission I have received has been deeply concerned about the quality and status of the profession in question. These people are anxious to get better recognition, and they are anxious to do more. They are desperately keen to keep up to date with events, and, above all, they would like to involve themselves in research. These are very worthy aims. I was delighted to read last night that my debate had been anticipated and that my right hon. Friend the Secretary of State for Social Services has announced that Lord Halsbury will chair an inquiry, that the nurses deservedly will get their increase, and that the inquiry will also cover physiotherapists, radiographers, dieticians, chiropodists, the occupational therapists and so on. We must be extremely careful about the "and so on", because if they were omitted that would leave out a most important group of people who do a good job in the health service.

I think that the pay problem will now be resolved, but we need to move on and raise the status and dignity of the para-medical professions. There is the question of rehabilitation, which involves good teamwork throughout the paramedical professions. Then there are the radiographers. We assume that these are the people who help the medical men to diagnose the problem, and that is true. But the shortage of radiographers is such that with the therapy work they do, particularly in connection with cancer, there are just not enough people to do the work.

We must all collectively accept responsibility. It would be easy for me to attack the previous Government, but the complaints in this respect have been ignored for up to five years, and that means ignored by successive Governments. Perhaps, in view of the position of the Whitley Council negotiations, the employers must share some responsibility. If they simply accept the statements made by the Treasury no progress can be made, and they must have seen the decline of facilities in the health service. Hon. Members, whether on Front Bench or back bench, must accept responsibility, and so, for that matter, must the public outside. We are all involved in the health scene. The fact that radiography treatment is sometimes not given through the service is a disgrace to our nation.

I quote from a letter written to the Secretary of State by the Society of Radiographers: I am sure you know that there is a serious shortage of radiographers and this shortage is being accentuated by the drift of radiographers from National Health Service appointments to take up work with Agencies where they enjoy payments far in excess of those paid to National Health Service radiographers with whom they may be working. Such a situation creates considerable instability in X-ray Departments, and impairs not only the standards of the profession but also the service to the Department and particularly the service to the patient. I hope that I shall not hear any cheap party political points made in this debate, because we are all responsible for this situation. We should tackle this serious problem now. One eminent rehabilitation medical man assured me that if my hon. Friend the Under-Secretary of State gave me an assurance today that he would do everything in his power, the requisite supply of these essential people would still be three, four or five years away.

The medical laboratory technologists are also concerned that they are not sufficiently recognised. Their institute states: Medical laboratory technology demands substantial professional attainment and an obligation to become state registered; a professional code of ethics must be observed and high standards of conduct are required in the exercise of judgment, skill and responsibility for the life and well-being of patients. We pay such people a miserable pittance and yet give high rewards to "pop" singers and "pop" stars.

The chiropodists have made a similar submission. The president of their organisation, in his presidential address at Blackpool in April this year, said: We do not look on the service which we provide as palliative as we normally do. Our contribution is not only the relief of pain—though in all conscience this is important enough; we, by an effective school chiropody service, can stop the development of conditions which could be disabling in later life; we can keep people mobile who would otherwise be housebound; we can teach the young, the elderly, the sick and infirm how to look after their feet. We surely save the country a very large sum of money each year by keeping people active who might in the absence of treatment and/or advice fill the doctors' surgeries and go on the 'sick list'. We tend to despise the profession of chiropody, but we sometimes desperately need its service.

Everybody in the para-medical professions is desperately anxious to raise the status and standard of his profession and of its teaching.

I promised to mention the dieticians, and I had better do so, otherwise I shall be in trouble. One dietician has written to me saying: Nutritional knowledge is advancing all the time, and we are finding out how dietetics plays a preventive and curative part in many disorders and diseases. The role of a National Health Service dietician is that of an expert on the application of nutritional knowledge for the benefit of all patients in all types of hospitals. Surely an expert should be paid as such. I wish to make a collective plea. I hope that the occupational therapists, remedial gymnasts and physiotherapists will forgive me—because they are my friends—if I group them together, as they did themselves for the purposes of the MacMillan Report. They perform vital skills and are in professions which can play a major part in rehabilitation. The difficulty is that if they play their part there will be severe shortages in other sectors of the health service. A tremendous injection of trained people into these three professions is needed.

I am in a dilemma, Mr. Deputy Speaker. I understand that one hon. Member has dropped out of the list of Members raising Adjournment debates. Consequently, my speech can be short or long——

Mr. Deputy Speaker (Mr. Oscar Murton)

One hon. Member dropped out, but has been reinstated. Therefore, the hon. Gentleman should stick strictly to the timetable on the Order Paper.

Mr. Carter-Jones

I am grateful, Mr. Deputy Speaker.

It has been proved across the river at St. Thomas's Hospital by people like Dr. Geoffrey Spencer and by the work of people like Philip Nicholls at Mary Marlborough Lodge in Oxford that severely handicapped people, if given proper rehabilitation facilities, can return to their homes and lead full and independent lives. The two men I have just named—and there are others—believe that they lead teams. They think that they are part of a team and that the physiotherapists, social workers, remedial gymnasts and occupational therapists, together with nurses and the skills of other medical people, can help people to return to their homes. I am not advocating a cut-back in expenditure on the health service. I am merely calling for the intelligent application of rehabilitation services so that many more people may be able to live happily in their own homes.

To achieve that, we shall require more people at work in the para-medical professions. That is why the physiotherapists, occupational therapists and remedial gymnasts must be given maximum support.

Mr. Wyn Roberts (Conway)

I respect the emphasis which the hon. Gentleman puts on the para-medical services, but how does he relate the priority which should be given to them to other priorities in the National Health Service? I have particularly in mind the rate of remuneration of mental health nurses, particularly those in the lower grades.

Mr. Carter-Jones

That is the trouble of having a short debate. I have not time to deal with that question, but I assure the hon. Gentleman—he is an honourable Friend in the sense that we travel home in the train together—that a tremendous amount of rehabilitation work is being done in mental health. I have not time to touch on that matter. A tremendous amount of work is being done on rehabilitating geriatrics. I have not time to deal with that matter. All this means that there will be even bigger demands made on the para-medical services.

I conclude with a quotation from a letter from a great friend of mine and of this House, Mary Greaves, who pressurised some of us in the years before the "Alf Morris Act" and who succeeded Megan du Boisson as the Director of the Disablement Income Group. She says: I would like to emphasise the importance of really good rehabilitation. In my own case, without the excellent rehabilitation I received at Mary Marlborough Lodge, at 67 I would be in a geriatric ward. She is saying that, given good rehabilitation, many people who are now in long-stay hospitals would not be there.

I will not quote one more individual para-medical profession. But I say that the sooner we make proper financial provision for the para-medical professions, the sooner we give them proper professional status, the sooner we provide them with research facilities, and the sooner we provide them with good job prospects, the sooner we shall return to the concept of the National Health Service as envisaged so long ago by Aneurin Bevan.

1.1 p.m.

Mr. Clement Freud (Isle of Ely)

As did a number of hon. Members in yesterday's debate on nurses' pay, the hon. Member for Eccles (Mr. Carter-Jones) prefaced his remarks by saying that he hoped no one would make cheap party political points. I am sure that all hon. Members on both sides of the House echo that sentiment, because we are all in the same position of having grave concern about the para-medical professions.

I have today received a letter from a constituent, a radiographer, who tells me that three years of training and years of skilful dedication brought him last month, a full working month with on-call payments, £3 more than his heating bill. He received £90, and his heating bill was £87. That is a fearful position.

I do not want to make cheap party political points. I want to tell the House that the para-medical professions are sick and tired of both parties' tactics of giving them a report by way of a palliative, and finding an elderly worthy who is dusted off and set up in an upstairs room to consider the future of, say, speech therapists.

One of my first surgery calls last July after I became Member for the Isle of Ely was from a lady speech therapist who asked me about the future of the Quirk Report. She wondered when it would be published and when it would be implemented. I and many other hon. Members on both sides of the House have tabled Questions about the report. There is a great shortage of speech therapists. Speech therapists who hoped for so much from Quirk are going into other professions because they have neither the honour that should go with the job nor the money. In my constituency, where there is an urgent demand for speech therapy, speech therapists have gone to ground. Many of my constituents are in desperate need.

It is not enough for the Minister to say "It will be all right. We have an elderly gentleman sitting somewhere considering your problems." As my hon. Friend the Member for Hazel Grove (Dr. Winstanley) said yesterday, shortages beget shortages. If there are 400 advertisements for speech therapists, such speech therapists as exist decide that they are in the wrong profession, because if they stay in it they will be overworked and useless.

I urge the Minister to have more action instead of having more reports, and to let people see not only the colour of his money but perhaps the value of his support and his endorsement.

1.5 p.m.

Mr. Alec Woodall (Hemsworth)

I apologise to my hon. Friend the Member for Eccles (Mr. Carter-Jones) for unavoidably missing the beginning of his speech, but I am sure that he will have covered all grades in the para-medical professions.

I want to make a special plea on behalf of radiographers. As a miner, I am particularly concerned about them as I have been X-rayed many times, as have all my ex-colleagues in the pits, because of the dangers of disease caused by dust.

I was appalled when I was canvassed by a constituent who is a radiographer, who explained that radiographers have a starting salary putting them at a disadvantage of £625 a year compared with someone entering the National Health Service as a clerk. Even after 10 years' full-time service, radiographers still find themselves at a disadvantage of £278 a year. It shows an error in the valuation of the contribution made by people in the health service that a clerk after 10 year's service is still more than £5 a week better off than someone giving 10 years' valuable service in an essential part of the medical profession.

On behalf of all miners who have to be X-rayed periodically to check and control the dreaded mining diseases, I make a special plea for radiographers. We owe a great deal to the dedicated people within that part of the medical profession.

1.7 p.m.

Dr. Gerard Vaughan (Reading, South)

I congratulate the hon. Member for Eccles (Mr. Carter-Jones) on initiating the debate. I support everything he said, apart from his remarks about party political jibes, because this is not a subject that divides hon. Members. We all feel the need to do more about the nurses and to support them, and even more to support the other services that go with them, because they are an integrated whole in the National Health Service. As this is the season for declaring interests, I must declare that I have a major medical interest in improving their circumstances.

The nurses have the sympathy of us all. We support them and welcome the proposals of yesterday, but I am disappointed that the Secretary of State did not see fit to make an immediate salary payment. We have all watched their deteriorating position in the health service with horror. This would have been the time to give a definite sum of money, because we know that their salaries will have to be improved.

The hon. Member for Eccles talked about the shortage of radiographers, physiotherapists and speech therapists. The hon. Member for Isle of Ely (Mr. Freud) mentioned the urgent need to implement the Quirk Report for the speech therapists. That will not only increase the numbers of them coming into training. They desperately need to have put in order their standards, their whole way of organising themselves. They need a much more effective central body. Until they have that, the discrepancies of training and working conditions between one part of the country and another are bound to put people off going into the service.

Just as important as the services that have been mentioned are those of other para-medical and supporting services; for example, the plaster technicians. They are desperately needed in orthopaedic departments. Theatre technicians are also of great importance, for an efficient modern operating theatre cannot be run without the supporting staff to see that the equipment is maintained and that the theatres are cleaned to the standards that major operations today need. This is also true of dental mechanics, not the dentists alone, but those who support them, those who make the plates and do the skilled engineering that goes with modern dentistry.

Perhaps even worse is the shortage of technicians in the pathology departments where blood samples are taken for skilled analysis. The technicians is these departments are underpaid and overworked, and they change so repeatedly that they often do not know where the materials are within their own laboratories because they have not been there long enough to find out.

Things of this sort do not get the headlines and do not get investigated, but they are a running sore and a source of dismay in the National Health Service. I hope that the Minister can reassure us about them. There is a need to review not only the salaries of these people, but their status, job prospects and their opportunities for research.

1.11 p.m.

The Under-Secretary of State for Health (Dr. David Owen)

My hon. Friend the Member for Eccles (Mr. Carter-Jones) has been fortunate in being able to focus attention on the wider issues of this debate. Had this matter come before the House before yesterday, the debate would rightly have concentrated on pay. I do not want to hide from the House my belief that pay lies at the root of many of our current problems, but that issue was dealt with yesterday. It is our intention that the results of the inquiry for the nurses should be applied to those in the professions supplementary to medicine whose pay has been traditionally linked to that of the nurses. We propose to discuss with those concerned, through the Whitley Council machinery, how best to link them and in what way they wish to be linked to the nurses.

It is right that the debate should have concentrated on the wider issues. My hon. Friend the Member for Eccles drew especial attention to what he described as status and standards. I have read with considerable interest the Report on the Remedial Professions that was prepared by the working party under the chairmanship of Mr. McMillan. No one can read that report without recognising that there is a considerable anxiety, which has not been assuaged by the publication of the Tunbridge Report. I pay my tribute to the considerable personal interest of the previous Secretary of State in the remedial professions; it resulted in this special working party being established. We are giving considerable thought to the main conclusions, which appear in paragraph 63.

That report stresses the need for the development of a comprehensive and unified therapy profession, increased professional and managerial responsibility, a new career and salary structure reflecting new methods of training and new responsibilities, the increased use and recognition of aides and other supporting staff, and the need for research, which many hon. Members have mentioned. I promise the House that we shall look at this matter urgently. I share the view that intelligent application of rehabilitation can undoubtedly save money. There is no doubt, whether one is dealing with geriatrics, the mentally handicapped, or even people with serious injuries, that prompt application of rehabilitation can get them out of hospital and into their own homes, and so reduce the cost to the National Health Service.

However, there are immense problems. One of them is the remarkable expansion of the professions supplementary to medicine that has occurred since 1949. In 1949 the hospital service in England and Wales employed only 791 occupational therapists, 3,100 physiotherapists and 2,063 radiographers. The 1973 figures represent increases of 115 per cent., 47 per cent. and 155 per cent. respectively, and those are substantial increases.

Recruitment is a major problem, and, of course, pay is a major factor in that problem. But it is not the only issue. A career that is attractive needs to be fully satisfying, and that is one reason why we are right to attach importance to the whole career structure. The hon. Member for the Isle of Ely (Mr. Freud) drew particular attention to speech therapists and had some strictures to make about inquiries and commissions. I share his view. There is a terrible tendency, when the facts are well known and all that is required is action, to establish yet another committee. The Quirk Report was accepted by the previous administration, with some important qualifications about timing, but, as the hon. Member knows from answers to his Questions, we are considering the whole matter afresh, and I hope that we shall be able to do some of the things in which the hon. Member has taken an especial interest.

Radiographers were mentioned by my hon. Friend the Member for Hemsworth (Mr. Woodall). If I may say so, I am glad that he entered the debate, because the mining industry has a long-standing interest in rehabilitation. I have spent much of my time talking to representatives of the mining industry about the problem of the Firbank Rehabilitation Centre and others. This is mainly a management problem, and the Government have been able to meet many of the representations and to retain some of the distinctive characteristics of mining rehabilitation centres.

It must be admitted that some hospitals have substantially fewer radiographers than they would like, and some are certainly too short of staff for the full provision of the services that they would wish to provide. Where such staffing difficulties occur, the health authorities will make adjustments to the radiology services. I recognise that this kind of adjustment can lead to delay for some patients and that priority must be given to urgent cases, but we shall do everything possible to minimise the inconvenience. We must see whether we can improve recruitment, which in the first place is a matter for the area health authorities, and I am reviewing current methods of advertising, as I said in reply to a Question, for these and a range of other people in the National Health Service as part of our search for improved methods of stimulating recruitment.

Similarly, I acknowledge the problem of wastage. In part this is inevitable in these predominantly female jobs, but we are looking at ways and means of encouraging married women who are already qualified to return to practice in the National Health Service when they are able to do so. That means flexible working hours and making a job as attractive as possible. Personally, I do not exclude the need for having facilities for looking after young children in hospitals if we are to get young mothers to come back to work in hospitals. Just as industry has seen the necessity of providing facilities for the under-5s, so the hospitals will have to take that aspect into account.

There is a shortage of teachers of physiotherapists, which must affect the rate of growth and the rate of intake. We shall be thoroughly studying problems of this kind as part of our overall look at the Report on the Remedial Professions.

There are other aspects that I should like to mention. The remedial professions are essentially members of a rehabilitation team. This concept of people from different disciplines—doctors, therapists, social workers, nurses, disablement resettlement officers and others, and I include voluntary workers—working together in a co-ordinated manner to provide treatment and assessment is of great importance. We are anxious to see medical rehabilitation services improve and become more uniformly distributed throughout the country.

The Tunbridge Report pointed to a number of ways in which these services might develop, and the hospital demonstration centres—eight of which were announced by the previous administration—are intended as focal points throughout the country from which area and district services will spread. I am happy to say that we shall be announcing more very soon and that consultants from the centres will be attending a conference in June to discuss how the best use can be made of their contribution.

Without therapists, rehabilitation services cannot grow as we would wish. The 1974 report has made some far-reaching recommendations, including integrated training and some of the other matters that I mentioned. Not all the views have yet been received from the various bodies which we felt necessary to consult about this important report, but there has already been some very useful and constuctive comment, and a number of suggestions for a way ahead are beginning to emerge.

One problem, of course, is who is to pay for all this? But again I think that there is a general feeling in the House, which emerged from yesterday's debate, that the Government's emphasis on people first and foremost in the National Health Service is the correct priority. I hope that hon. Members on both sides of the House will recognise this when they press for all the other admirable projects which they want to see brought into being.

Activity is already under way. We are exploring with the local people concerned the feasibility of some development studies on the new management relationships proposed. A study has been commissioned by the King's Fund into the content of an integrated syllabus of training for occupational therapists and physiotherapists. There have been discussions with the local authority associations and others about liaison between health and local authorities on the deployment of occupational therapists. The new collaboration machinery offers an effective way of looking at the problems of making the best use of skilled but scarce resources, and guidance is being drawn up in consultation with those concerned. Even if we improve the pay, the advertising, and the recruitment, and even if we cut down on wastage, I suspect that we shall still have fewer people than we need. As so often is the case, one of our resource shortages is not just money. It is the skilled man and woman power, and how we use it most effectively is a matter of fundamental importance. It follows that the management issue is of great importance.

Further ways of linking medical rehabilitation with employment services are also under study, and we are anxious to encourage research into all forms of rehabilitation techniques. An active programme is in train inside the Department. It was started by our predecessors, and we shall carry it out and give it a new impetus within the terms and resources available to us.

Like my hon. Friend the Member for Eccles, I have seen constantly the advantages of the rehabilitation services and the remarkable change which can occur in someone who may have languished for too long in a hospital or an institutional home and who, with the application of skilled rehabilitation techniques, becomes a completely different person, going back into the community and often suddenly capable of looking after a house. It is quite remarkable. But most of us see all too few examples in our constituencies of what rehabilitation can do.

There is no doubt that in terms of industrial injuries, too, speedy rehabilitation of the person injured at his place of work can often ensure that he is back at work earning a family wage far quicker than he would otherwise have been. This is a subject which has interested me for many years. Again, it represents a saving of scarce resources.

I hold strongly to the belief that money spent on rehabilitation is money well spent, provided that we can ensure that it is used effectively. If we can harness the team feeling, I think that a great deal can be done. I have often said that this House makes it comparatively easy to cut the local authority social services budget, and to reduce the amount of chiropody services. Often that can be done without a bleat from anyone. That has to be compared with the tremendous furor which will occur if a hospital programme is postponed. However, the provision of regular chiropody for old people means many of them remaining mobile and able to look after themselves and not being a cost to the community.

We need to look at this subject not just from the point of view that the provision of these services would be a good idea. There are innumerable demands on our resources which we should all like to provide, but I believe that good rehabilitation services, to use a jargon phrase, are a cost-effective solution to many of our problems in the National Health Service. It is in that spirit that I shall look at the whole of rehabilitation.

On a personal note, I might say to my hon. Friend the Member for Eccles that before coming to this House I was very much involved with the Disablement Income Group, and it has remained an interest of mine. I well remember that remarkable woman Megan du Boisson who with Brit Thornberry started the Disablement Income Group. As a neurologist dealing with many of these cases in those days, it was obvious to me that our rehabilitation services were very defective. The hon. Member for Reading, South (Dr. Vaughan) also speaks with considerable knowledge of these matters.

The times when money is shortest are the times to look most carefully at how the money available is spent. Lord Rutherford once said "We have no money. We must now think". This is a lesson which has to be borne in mind in the coming years. Money will be short. We have to think, to reassess the basic allocation of our resources and to put the available money and skills where they can give the greatest return.

A high candidate on that list is the overall rehabilitation services. We shall not achieve the end that we all desire if we do not attach great importance to the professions supplementary to medicine which provide our overall rehabilitation services in terms of pay, status, training and research

. I hope that this debate has stimulated a greater interest in the subject and that perhaps we shall have rather more debates on it than we have had in the past.