HL Deb 15 April 1919 vol 34 cc330-7

EARL STANHOPE rose to ask the Under-Secretary of State for War—

  1. 1. What is the object of moving patients in military hospitals so constantly that the stay of the average patient in one hospital is seldom more than a few weeks.
  2. 2. Whether patients on removal from one hospital to another are accompanied by medical history sheets.
  3. 3. Why educational training sheets should not similarly follow atients from one hospital to another, thereby ensuring continuity of training.

The noble Earl said: My Lords, I ventured to put before your Lordships on March 19 the question of the technical instruction of soldiers in hospital. At that time the Under-Secretary of State for War said that there were considerable difficulties in regard to giving this training owing to the short time the men stayed in hospital. He said: "The stay of the average patient in any one hospital is, as a matter of fact, seldom more than a few weeks." I have put those words down in my first Question, as possibly my noble friend might wish to modify them. In any case I think the House would desire to know why the stay in any one hospital is so short, because quite obviously it is bad for the patients. It is far better that people should stay under the same medical practitioner and not keep on changing from one to another, and I cannot see why patients in military hospitals should be placed under this disadvantage. Naturally they have to be brought back from France, and other battle areas, and then they are received into the bigger hospitals and distributed to the smaller ones. That necessarily does mean a certain amount of change; but these patients have to be taken from one hospital to another in motor-cars when their wounds are severe, and that is only inflicting unnecessary pain and suffering which every one would wish to avoid.

The disadvantage of changing from one doctor to another is mitigated to a considerable extent, because I believe the patients are always accompanied by a medical history sheet—that is, papers which describe the disability under which the man is suffering, the treatment which he has been given, his diet and so on in the hospital he has just left. The object, of course, is that the treatment should be continued on similar lines in the hospital to which he is sent. If that is possible in regard to medical treatment, I maintain that it is also possible in regard to educational training; in other words, what is sauce for the military goose is also sauce for the educational gander. I think that a training sheet should be given showing what subjects a man has taken, what progress he has made, and what proposals have been put forward for continuation of that training. That is all the more important when we realise what now happens to men as they leave the Army. A man gets his training in a military hospital; he is still receiving medical treatment, and he passes under the Ministry of Pensions where he can continue to have a certain amount of educational training, and eventually he passes under the Ministry of Labour. Your Lordships know very well when you pass from one great Government Department to another that you fail to get that continuity in training which is so essential to real progress and success. I therefore suggest that we should have some sort of educational sheet in the same way that we have a medical sheet showing what training a man has received. I hope that my noble friend will not give me at any rate one answer, which is that my suggestion is receiving consideration. These are suggestions that I made a good many months ago, and as far as I know they have only been receiving consideration since. I believe that they were approved, but the fact remains that they have not, so far as I know, been put into operation. I therefore hope, unless more objection is found to them than was the case at the time they were originally made, that my noble friend will be able to carry them into effect.

THE UNDER-SECRETARY OF STATE FOR WAR (VISCOUNT PEEL)

My Lords, the first Question asked is in regard to the object of moving patients in military hospitals so constantly that the stay of the average patient in one hospital is seldom more than a few weeks. My noble friend suggested that I wished to modify the statement that I made a short time age. I have no desire to modify that statement. The statement was perfectly correct. As to the object of moving patients from one hospital to another there are a great variety of reasons for that, arising from the disposition of the hospitals themselves. First of all, as my noble friend probably knows, patients may be sent into hospitals of a general character, and afterwards, according to the particular ailment from which they may be suffering—neurasthenic or cardiac or some other ailment—they are drafted into special hospitals where they get the best treatment from the best specialists. It is obvious if you have patients scattered in small hospitals, or gathered together in some particular parts of the country in general hospitals, you cannot get in the nature of the case that particular treatment and care which you get if the patients are concentrated in certain hospitals where they obtain particular forms of treatment from specialists. That is one very general reason for the shifting of patients from one hospital to another

Another reason is that after they have been taken to hospitals it may be, and often is, to their advantage to be removed to hospitals as near to their homes as possible in order that their relatives may be able to visit them in comfort. A further reason is this. My noble friend is aware that the number of hospitals in this country is very large. Many of them are small, and many are scattered, and many of the buildings that have been taken for hospitals are urgently required for various purposes, such as public service, education and so on. The number of patients, too, in hospital is constantly decreasing, and therefore there must always be a process of concentration going on—a leaving certain hospitals and a bringing together in others. Those I think are the main causes why the stay of patients in these hospitals is not as long as my noble friend would desire, and I think he will agree that there are very sound and strong reasons for these removals.

The second Question is whether patients on removal from one hospital to another are accompanied by medical history sheets. The answer is a simple one, that they are so accompanied. It is obvious that they must be so accompanied in order that their treatment may be carried on.

The third Question is why educational sheets should not similarly follow patients from one hospital to another, thereby ensuring continuity of training. My noble friend urged me not to give what he calls the stereotyped answer, that this matter is receiving consideration. I have no intention of giving such an answer, because there has long been an Army Order to the effect—I have the paper with me—that this continuity of training idea is to be carried out. In some cases no doubt it is a very difficult thing to carry out, but it has long passed the stage of consideration. What I want to make plain is this. You have to combine these two matters, the medical history sheet and the training history sheet. The medical, history sheet is the more important, because men are distributed into these different hospitals according to their ailments. It does not therefore follow that it is always possible in the hospital to which a man is transferred to give him precisely the same continuity of training from an educational point of view as he received in the hospital from which he came. Continuity of medical treatment does not of course present the same difficulties.

As your Lordships will see, it is a little difficult to combine the two things, but when a man is transferred to a hospital the object is that he should get as far as possible education in the particular subjects in which he is most interested, and he is given as wide a choice as possible. During March I understand that instruction has been actually received in eight-four different subjects, of which twenty-nine have been general or theoretical, and fifty-five occasional. Your Lordships will see that the widest possible opportunity is given to those who are moved from one hospital to another to take up a considerable variety of subjects. I have a list of them here—I am not of course going to read them out because they are so numerous. They embrace a great variety of general and theoretic subjects, and also technical, commercial and agricultural subjects, as well as general educational subjects of a miscellaneous kind including cookery and matters of that kind. My answer to the third question therefore is that Orders were issued some time ago about these educational training sheets.

I also wish to qualify the estimate of value which my noble friend placed upon them, because the educational object is to give as wide as possible an opportunity to these men who are transferred to different hospitals, and it is not possible to carry on precisely the same kind of educational training owing to the necessity of removing men to different hospitals for special medical treatment. Owing to that a continuation of the same educational training is not always practicable. Everything must be generally subordinated in the first place to the medical treatment and the healing of the man's physical ailments or wounds.

LORD BURNHAM

My Lords, the answer of my noble friend prompts me to press him a little further in this matter. I know that he imparts all the information he has to the House, but I venture to think that the War Office has exercised an economy in posting him up in the case, which leads to the result that the knowledge that we have is neither very full nor very up-to-date. The matter is of the highest importance, because there has lately been a complete change made in the policy of training men in the hospital and after their discharge from the Service.

My noble friend below me (Earl Stanhope) in a previous debate pointed out that up to the date of the Armistice in November no training whatever had been given to men in hospital, for reasons which one need not explore further on this occasion. We refused to follow the example of New Zealand, which he quoted freely, and also of Canada, where there was an admirable combination of therapeutic treatment and vocational training given in hospitals, both on this side of the Atlantic and the other. At the same time, now a start has been made, and no doubt in the hospitals there is at the present moment being given in a certain number of cases training both vocational and general which is important, but the moment that the man passes out of hospital, or rather goes outside the area of medical treatment, he now comes, as my noble friend says, under another Department of the Government, and is subject to another course of education. My noble friend says that these are now linked up in such a way as to secure continuity of educational training. He says that the education sheets are passed on. I can only tell him that, though it may be in art experimental stage, nothing whatever is known of this by those who have the charge and direction of training men after they come out of hospital and passed under the care of the joint pensions sub-committees. We had a conference in this part of the country the other day of the chairmen and vice-chairmen of those different committees, and they knew nothing whatever of the statement which has just been made by my noble friend.

As things now are, the man in hospital is under the Ministry of Pensions, both in respect to treatment and in respect to training. The moment that he is said to be quit of medical treatment he passes under the care of the Minister of Labour. But this is not a fixed time, and it is not even a fixed term. A man does not suddenly become quit of medical treatment; it may be true more often with those who have lost a limb, but in the case of neurasthenia and cognate troubles arising out of the war it is obvious that for months, nay for years, a man may still have to be under medical treatment, and at present no line of demarcation has been drawn which sets up a proper system of dealing with these cases.

I wish to point out that it is highly necessary for my noble friend to link up, as he can from the War Office, the treatment of the men who are still under medical treatment and dealt with by the joint pensions sub-committees who have been working partly under the Ministry of Pensions, partly under the Ministry of Labour, and the further education that they will receive when they pass entirely under the Ministry of Labour. If it is vocational training he will see that it is even more necessary. It is of no service to the community, it is of no profit to the service man, if he has received special train ing in some trade while he has been under medical treatment and then is switched off to some other, or at any rate to a different, course of training when he is no longer supposed to need medical treatment.

The worst of it is that it is not only the efficiency of the training, it is the opportunity of earning a livelihood that is also in question. There ought to be a means of combined counsel between these different Departments of the State as to what sort of recommendation should be made to different classes of men in order that when they have acquired the training, become expert workers, they should have a reasonable chance of being able to follow the employment. I think your Lordships know that this is dependent to a great extent on agreements made with the trade unions of the country as to the number of men to whom they would issue tickets or cards of membership, and all sorts of other conditions. Unless there is some co-ordinating authority—which does not now exist—to combine and get the best out of the training of men in hospital and when discharged, there is bound to be not only great waste of money and effort but great hardships involved to the ex-service man.

My noble friend said he understood that this was arranged. Well, if it is so, it is a very strange thing that nothing is known of it, to the best of my knowledge, at the Ministry of Labour; it is a strange thing that no information has been imparted to the joint pension sub-committees throughout the country, who have recommended men for training as they have been passed to them and have come to agreements in respect to each case with the technical committees who are at work either in London or in other centres of population. I ask the noble Viscount therefore to go a little further. I know he has all the good will, but we also want him to do something to organise the system in such a way as to tend to the efficiency of the worker, and also, of course, to relieve the community which will otherwise be saddled with the upkeep of these men who come out of hospital with injuries received from the war, and unless they have special training, in the inevitable hardships and economic competition of the workshop, are likely to have a poor chance of earning a livelihood. This is not a subject of controversy, and I do not wish to urge it in a controversial spirit. I do it because, having acted as chairman of these conferences, I know there is neither method nor system in the course that is at present adopted.

VISCOUNT PEEL

My noble friend Lord Burnham has been travelling on a rather wider subject than that dealt with in the Question. He spoke about discharged men. Of course, I am answering from the point of the War Office, and as soon as they are discharged my noble friend knows that they pass entirely outside the purview of the War Office. The points that my noble friend raises as to the question of these men dealt with by the Ministry of Labour is an extremely important one. What I would suggest to my noble friend, if he desires a full answer, is that he should put down a Question to the Ministry of Labour. I would certainly have dealt with the question, but I was speaking from the point of view of the War Office and from the point of view of the Question on the Paper.