§ LORD GREVILLE had the following Notice on the Paper: To call attention to the hospital service of London in case of emergency; and to move to resolve, That this House is of opinion that a detailed scheme should be drawn up and issued to hospitals giving exact instructions as to what steps should be taken in case of air raids. The noble Lord said: My Lords, I must apologise for the shortness of the Notice given in putting down this Motion. It is not put down with the view of embarrassing the Government or attacking them in any way; it is really put down to endeavour to throw a little more light on the subject of the evacuation of persons wounded during air raids. As your Lordships are well aware, this is a very important question and practically enters into the defence of the Realm, because at the beginning of any war there would be intense bombing, producing confusion and panic, and it is essential that all the arrangements for preventing this should be known to those concerned beforehand. This question of air-raid precautions and the treatment of casualties has been under consideration for some two years, and the voluntary hospitals, through the Voluntary Hospitals Association, have endeavoured to get some information from the Government Departments on the subject. I understand that at the beginning the responsible Department was the Home Office, and since then the matter has been handed over to the Ministry of Health.
I quote from a minute of a meeting of the Voluntary Hospitals Association as late as July 5:
Following the Committee's letter to the Home Office taking exception to the failure of the authorities to inform hospitals as to what may be required of them, Mr. Chad-wyck-Healey has been asked to serve on the Committee advising the Home Secretary and has accepted the invitation
Sir Charles Wilson, M.C., M.D., who has been appointed Chairman of this Committee, has stated that it is hoped within a month to present an interim report on the general policy to be adopted by hospitals in the event of air raids.
That, as I say, was as late as July 5. There was issued from the Ministry of Health a letter which is dated July 26, and that really is the first document we received at the voluntary hospitals, giving us any sort of instructions as to what we were to do. That letter reached the hospitals about the beginning of the month of August, which is the time when the honorary staffs generally take their holidays and when committees meet at not such frequent intervals. The Voluntary Hospitals Association was not meeting until October. This letter arrived, and said that the hospitals must now await a direct approach by the Ministry as to the part they would play in the casualty service. As I say, most members of the honorary staffs and of the committees were away on their holidays, and those of us who saw the document had practically no opportunity of criticising it or making recommendations of any sort.
We then come to September 14, when the Ministry of Health, at four o'clock in the afternoon, sent round to all the secretaries of voluntary and other hospitals in London summoning them to appear at the Ministry at six o'clock that evening. They were told then pretty well the same thing as appears in the pamphlet—namely, to evacuate all civil cases, prepare to take in a very large number of casualties, crowd our beds up, and make all other arrangements. I may add that the medical officer who addressed these secretaries kept impressing on them that all this was "secret." Certain facts were not written down because they were "secret." Why there was this mania for secrecy about information which could have been shouted from the house tops, I do not know. So many Green Line 'buses, they were told, would arrive at a certain hour to take patients away, and they would supply stretchers, gas masks, and a few other things, and the hospitals were supposed to do the rest. Paragraph 8 of this letter from the Ministry of Health is rather important, and I should like to read it:
The all-important question of the medical and nursing personnel required in connection with the scheme is receiving urgent consideration in consultation with representatives of the professions.
Of course we never heard one single word about who was going to do the medical duties in the hospitals or whether they were taking our nursing sisters from the danger area and sending them to base hospitals, where they should rightly be.
§ At our hospital we were fortunate in having a senior surgeon on the staff who was all through the War and also a distinguished Lieutenant-General on our committee, and in the course of a very short time we had everything prepared; but to do that cost us about £3,000. To a voluntary hospital that is a very considerable sum of money. To a London County Council hospital it does not matter because the expense is borne by the rates. Had we had more time, had this scheme, for which we had been asking for two years, been prepared a little sooner, no doubt we should have been saved an enormous amount of expenditure. We should have known what we had to get, and also probably would have approached the Ministry of Health and asked exactly what it could supply. We were told we could have some extra bedding and blankets, but we had to buy an enormous quantity of drugs, bandages, plaster of Paris, and all sorts of things, and there was a great shortage. We had to buy sandbags, timber for shoring up, bricks, and cement, and, as I say, we spent £3,000 of which we shall get very little back, because I understand the Government do not propose to pay for structural alterations, covering windows, and so on.
§ This pamphlet does not represent a scheme. It is merely an emergency statement. We had merely to clear the hospitals of civil cases and fill them up with casualties. We were not told how to staff the hospitals. Voluntary hospitals do not have large resident medical staffs. They call on the members of their honorary staffs to come in. The duties of an honorary staff are to attend and give lectures to the students and perform operations for demonstration purposes, so that our own medical staff is very small; but fortunately our honorary staff came up to the scratch, and at once said they would work, although many of them had other jobs elsewhere. Some of the junior members of the staff are members of the Territorial Force or the Royal Naval Reserve, but we succeeded in making a roster for a twenty-four-hour service, with three operating theatres going on 299 continuously. Naturally our honorary staff asked: "How long are we expected to do that? We do not mind coming in in an emergency for a few days, but we have our own patients to attend to." We could tell them nothing at all. I think if there had been a little less secrecy and a little more consultation in the past few years, a great deal of that rush and that expense would have been avoided.
§ I know the enormous difficulties. It is a very large subject, and I am not altogether blaming the Minister of Health. So far as I can make out this work was only handed over to him in June or July, and it was rather a case of swapping horses while crossing a stream. But the point I should like to make clear is that we really never had a chance as hospitals of expressing an opinion on the scheme, and we have not yet been asked to express an opinion. Personally I think that fundamentally parts of the scheme are wrong. I do not think it is right to fill the London hospitals with all the leading surgeons in the profession. London would become a front-line trench, and therefore totally unsuitable for collecting large numbers of casualties within the hospitals within its borders. In an aerial bombardment the hospitals would be in the greatest possible danger, though this would be of less significance were there any possibility of protection for the large numbers of patients, and the nursing and medical staffs.
§ I should like this matter really to be thrashed out in conjunction with the hospitals: I mean the question of whether it is a wise policy to put thousands of people into the hospitals of London. Take the Westminster Hospital, opposite. If that hospital was hit by a high explosive bomb you would have anything from 500 to 1,000 casualties, and amongst them would be valuable medical men and members of the nursing staff who could not be replaced at a moment's notice. The hospital on the other side of the river is more fortunate; that has separate blocks, but few hospitals in London have separate blocks. Surely it would have been a wiser policy to have arranged for hundreds of small dressing stations to be attended by medical officers and members of voluntary corps like the Red Cross and the St. John Ambulance Association. An 300 ambulance service could take the injured straight away to clearing stations somewhere outside London, say, seven or eight miles away, and from there they could be distributed to the base hospitals where the leading medical men and the extremely valuable nursing staff would be kept. That was done in France, and I see no reason why it should not be done here.
§ I shall no doubt be told that with the removal of the Houses of Parliament and the Government offices, the War Office, Admiralty and so on, with their many thousands of occupants, there would be so much congestion on the roads that it would not be possible to adopt the suggestion which I have made. But I have never yet heard any Government official suggest: "You are near a magnificent river; you have a line of hospitals stretching from Westminster down to Hammersmith, all in close touch with the river. You could evacuate thousands of casualties as far as Oxford, Reading, Henley and other places along the river, from where they could be distributed to other hospitals." That would obviate the blocking up of the roads which would be bound to take place in view of the vast demands made upon both the roads and the railways in the circumstances which we are considering. That, I hope, is a phase of evacuation to which the Ministry of Health will give serious consideration. I am sure that if you put a naval officer to deal with evacuation by water, he would produce a scheme which would lessen the enormous congestion which is bound to occur on the roads.
§ There is another question upon which I should like to touch and that is the domestic side of hospitals. I will speak only for my own hospital, because it is the one that I know. We have 80, 90 or 100 young women of seventeen, eighteen, nineteen and twenty years of age who come from the distressed areas of Wales, Durham and other similar places, and serve as ward maids and in the carrying out of various domestic duties. Is it natural, is it right, to ask children like them to stay in the hospitals of London and work while continuous bombing is going on? I say it is not. The first thing that happened during the recent crisis was that the parents of these girls wrote to them to come home, and it was with the greatest difficulty that we were 301 able to prevail upon them to stay. The fact that pay-day had not arrived was an inducement to many of them to stay on. A hospital in London during a period of war is not the right place for girls of that sort to serve in. Your hospitals in London should, when we are at war, be staffed chiefly by males.
§ Another question to which I will refer is that of the health services of the hospitals. Of what use is a hospital without light, without warmth and without other essential health services? You are bound to have bombs dropping in the streets and there is the danger that the sanitary services will be damaged. Most of our sanitary services are laid very little below the surface, and there is the greatest likelihood that they would be damaged and rendered useless. We shall be told that they can be easily repaired. That may be so, but in the meantime the hospitals will be left without these essential services for carrying on their work. Moreover, we have to consider the effect of continual bombing on the patients and on the members of the nursing and other staffs. The morale of patients who have already been bombed will not be very good. Then you can imagine the effect upon surgeons who have been working continuously performing operations, and upon the nurses. Your Lordships can imagine what the effect of a week of that sort of thing would be upon the staffs of the hospitals as well as upon the patients. You have to keep up the morale of your nursing staff as well as that of the patients. The nurses will be harassed by all the serious exigencies which they have to confront, and they will be on duty practically from morning till late at night. What will their morale be like at the end of a fortnight? My suggestion is that the London hospitals should be really clearing stations.
§ I hope that the Home Office, the Ministry of Health and the authorities concerned with the evacuation and treatment of the wounded will now really consult the hospitals a little more and give serious consideration to this matter of the overcrowding of London hospitals. I do not know what the general staff at the War Office have said about this scheme, and I do not know if the Ministry of Transport has been approached, but certainly the medical authorities have not been consulted quite as much as I should like to see. It was only the other day 302 that the British Medical Association sent a deputation to the Minister in another place. As I said at the beginning, I have not put down this Motion with any view of embarrassing the Government or of hampering them in any way. The only thing we in the hospitals wish to do is to help the Government in every way we possibly can. If you want the voluntary system to succeed, if you do not want to have National Registers and all the other things made compulsory, you must take into consultation those who will have to work the voluntary system. They should be consulted and afforded an opportunity of expressing an opinion upon any scheme before it is finally adopted. I hope some other noble Lords connected with hospitals will speak in this debate, as I believe that the mere fact of having a debate on this subject will do much good. I beg to move the Motion standing in my name.
§ Moved to resolve, That this House is of opinion that a detailed scheme should be drawn up and issued to hospitals giving exact instructions as to what steps should be taken in case of air raids.—(Lord Greville.)
My Lords, as I am, I think, the only other chairman of a hospital in the House at this moment, I would like to say a few words in support of my noble friend. I have had the advantage of reading the report of the speech made by Mr. Bernays yesterday, and I must say that that went a long way to satisfy me that a good deal is being done. I have also had the advantage of a conversation with the noble Viscount who will reply for the Government this afternoon. I understand that progress is being made, but still what the noble Lord, Lord Greville, has said is quite true. If we could be told a little more about the plans of the Government that would enable us to get on with what we have to do a little more quickly. On behalf of the hospital with which I am connected, a letter was written on October 20 to the Ministry of Health giving very full information as to possible expansion of our services at the hospital and as to our staff. The Ministry replied a few days later saying that various matters were under consideration and that we would very shortly receive a visit from the hospital officer for London. That was six weeks ago 303 and we have had no message from that officer yet. I do not know whether there is a single hospital officer, but it seems to me that possibly more than one hospital officer might be necessary for such a large place as London with so many hospitals.
One point affects us most particularly, and that is that we want to know whether we can be certain that we shall be allowed to retain our medical staff. If, having made our arrangements, we find when the emergency arises that part of our medical staff is to be taken away for other duties, we shall be put in a very awkward position. I personally tried to obviate that by getting undertakings from retired surgeons who have been connected with my hospital to come back, and they were good enough to say that they would do so. A second point is whether we are going to be allowed to retain our nursing staff. If we are going to be told that 50 per cent. of our nurses will be drafted under some order of the Ministry of Health or of the Home Office to other duties, we shall be left in the position of having to deal with a greatly increased number of casualties with only half the usual number of nurses. I have tried to meet such a situation by starting a voluntary panel of women who would come in and have some sort of training once a month to get them at any rate up to the level of the V.A.D.
One of the promises contained in the letter from the Ministry of Health was that they would supply us with all materials necessary when an emergency arises. Personally I am not particularly satisfied, nor is my committee satisfied, with that. Even supposing that dressings, mattresses, blankets and other necessary things are ready, the question is whether we are going to get them quickly. Personally I should like to know that we should get them in advance. However, I rather gathered from the speech of Mr. Bernays yesterday that we are to get a good deal of material fairly soon. One other point—I do not know if it has been considered at all by the Ministry of Health—is whether there is going to be anything in the nature of compulsion to get nurses to remain at their jobs. We rather fear that when the emergency arises a number of these young women may say that they are going off 304 to drive motor-cars, to help make munitions, or do this that and the other. The highly trained nursing staffs of our hospitals, as everyone knows, get very small wages and they may be tempted for quite proper reasons to go to other work. I do not press for an answer today, but I wonder whether the Government might be willing to consider the possibility of a recommendation being made by the Ministry of Health that, when the emergency arises, the needs of the country would be better served by people who were trained for a particular job remaining in that job instead of trying to go and do something else, which would disorganise the service in which they were engaged.
Those are the only matters I have to bring forward. My last wish is in any way to embarrass the Ministry in what I am sure is a most difficult task. I quite understand that there may have been very sufficient reason for not saying too much about the arrangements that were being made for the emergency at the time of the emergency, but I do think that responsible officials of hospitals might be kept informed as to what is being done and what is expected of them. They would, I am certain, help in every way they could, and I think it would make the machinery run more smoothly when it had to be put into operation.
My Lords, I am sure we all regret that the voluntary hospitals on which we should rely in war, as we do now in peace time, should feel in any way aggrieved by lack of information about the intentions of the Government. We naturally agree that they should have this information, and that it should be as detailed as we can make it, so that they shall know how their medical staffs and their patients can best be disposed of and be able to conform with the preparations made by the Government. We naturally regret that all this information was not in readiness when the last crisis came upon us. I think it has already been admitted, and freely admitted, that the crisis did catch the Government incompletely prepared in several directions. In fairness to the Ministry of Health, however, who only took on this duty in June, I ought to say that the hospital scheme had progressed some considerable way. I think my noble friend Lord Greville said he was unaware that there 305 was a scheme, and perhaps we have been at fault in not saying more. I can only recount to your Lordships what has been done and what we have told the hospitals, and leave it to your Lordships to judge.
In the first place a survey was undertaken a considerable time ago of all the hospital accommodation in the country. It was a very comprehensive survey. It covered accommodation, equipment, and the possibility of improvement and expansion of services. It will indeed have considerable value in time of peace as well as of war. This survey was conducted partly by Ministry of Health officials and partly by officers of the London County Council, whose services we acknowledge with gratitude. The information gained from that survey was used as a basis for the preparation of the casualty scheme itself. In this matter the Government had to deal with a state of affairs which was, and still is, largely hypothetical. No one really knew, or knows, what objectives the enemy would choose or how far our defences would deter the enemy.
At the end of July last, as we have been told, a committee of medical experts and other experts having knowledge of hospital organisation, under the Chairmanship of Sir Charles Wilson, reached a series of general conclusions as to how this London casualty service could best be organised. Shortly after receiving those conclusions the Ministry sent out a circular to every county council and county borough council and to every voluntary hospital in the country, which, as we have been told, was not a detailed plan, but did set forth certain guiding principles. The London hospitals were told, for instance, that the Ministry were not recommending the abandonment of any hospitals in London, but that each hospital should be prepared to receive patients until such time as those patients could be transferred to a less dangerous area. In order to provide extra room for these air-raid patients, they were asked themselves to arrange that, on receipt of the emergency warning, they should clear as many beds as they could of those who could be removed in ordinary motor cars. They were also asked to consider how best their accommodation could be expanded if necessary.
Then, having despatched that circular, the Ministry set about preparing the complete scheme and filling in the details. 306 Three hospital officers were detailed for this work, which had to cover the hospitals of the whole of Greater London. On September 1 they were asked to accelerate their work, and further plans were put in hand for the complete evacuation of some thirty-four general hospitals—that is to say, complete evacuation except for some of the most serious cases that could not be moved. These plans necessitated arrangements for the removal, not only of the less severe cases, but also of some three or four thousand stretcher cases. The London Passenger Transport Board were approached, and it was arranged that some 300 'buses should be converted into ambulances. The railway companies made arrangements for ambulance trains. Arrangements were made through St. John Ambulance and the representatives of the receiving towns for the reception and treatment of these evacuated patients. Stretchers were distributed to the evacuating hospitals, and I think I can say that by September 24, so far as evacuation was concerned, the plans were fairly complete. The thirty-four general hospitals which were marked for complete evacuation would have acted, in war phraseology, as the casualty clearing stations, where the very serious air-raid casualties would have received attention before being sent down to the base hospitals which, we hope, would be outside the danger area.
My noble friend Lord Greville talked about these base hospitals, it seemed to me, rather as if there were a quite recognised front line, as there was in the last War, and as if it could be said with some certainty that these base hospitals would be outside the danger area. Well, we hope that they will, but it is not quite so settled as all that.
That in itself raises considerable difficulties. There are about 200 hospitals in London and Middlesex, and most of the remainder of these would have been partially evacuated as well as acting as reserves to the thirty-four casualty clearing stations of which I have spoken. In all, about 25,000 beds would have been vacated in readiness for casualties in London. The arrangements for transportation and reception of all these evacuees had been made, and the 307 scheme was in such a state of preparation that we calculate that within twelve hours of the receipt of emergency orders it could have been put straight into operation. So I do not really think that it is fair to say that there was no plan.
I did not say that there was no plan; I said that no plan was communicated to us except for that one letter of July 26.
I understand that, but I think the noble Lord also said—at any rate I gathered that he said—that there was no plan.
I also understand that his complaint was that, if there was a plan, the hospitals did not know of it; and secondly, apart from the evacuation altogether, they did not know what to do in connection with the reception of air-raid casualties. As regards information, as soon as the arrangements were completed the representatives of all the voluntary hospitals were invited to the Ministry and the scheme was explained to them. The arrangements were not complete until September 24, but actually the meeting, as the noble Lord said, took place on September 14.
In regard to the reception of these air-raid casualties, I understand—and the noble Viscount, Lord Mersey, has also supported this—that the voluntary hospitals did not know what staff to retain, whether to try to expand it, whether to order new stores, and so forth. I am very far from protesting against these complaints being made. I feel that we are lucky that those in charge of the hospitals are anxious to make their cooperation with the Government as effective as they can, and of course we must try to meet that desire. But I must point out that there are matters on which the Government themselves are in considerable difficulty. Take the question of medical staff. We all know that, owing to their long training, the number of qualified doctors in the country cannot suddenly be expanded, even if the services of some of the advanced medical students are utilised. We also know that, as opposed to the last War, there are two entirely new medical problems. First, we have not only the service needs to think 308 about; we also have the additional needs of those areas into which the evacuation of London generally is to take place; and secondly, the situation arises of air-raid casualties in London itself and elsewhere. Not unnaturally there is considerable divergence of expert opinion as to the extent of the medical demands these casualties would make, and that must really depend on events.
There are really only two certain principles to guide us—first, that every doctor in the country must be employed to the best possible advantage; and second, that the doctors must possess a considerable element of mobility. I cannot say that the plans for the proper utilisation of medical staff have even now been worked out completely, but I can say that they are being worked out, and I can say further that, had the crisis developed, the registers which were already in the possession of the British Medical Association would to a large degree have prevented unnecessary waste of effort. The organisation of mobile medical units had already begun. As regards stores, it must be remembered that a little less than half the hospitals in London are administered by the London County Council—or, at least, that a little less than half the accommodation in London is under the control of the council. Reserve supplies of tetanus anti-toxin, blankets and stretchers had been made available to them on a large scale. A proportion of these stores were to be retained centrally, and doubtless emergency arrangements could have been made to transfer some of them to the voluntary hospitals had occasion demanded it. The issue of some of these stores has, in fact, already begun. Further instructions on this point would be issued in future.
As to the future generally, some announcements were made yesterday in another place, that additional emergency preparations were being made should the whole scale of our needs have been shown to have been under-estimated. In addition to the issue of stretchers and blankets specially earmarked for this object, the Department are making arrangements for further emergency ambulances and, in fact, several hundreds of small vans have been earmarked for this purpose, and in particular for picking up casualties after air raids. The Ministry are preparing to supervise a number of new first aid dressing posts to relieve the hospitals of 309 minor cases and they are considering a scheme for linking up the principle casualty hospitals in London more directly with what I have described as the base hospitals, that is, hospitals at what we hope would be a safe distance from London, which had been specially cleared for casualty work and provided with arrangements for expansion. Consultations have been taking place with the War Office and other services in regard to the allocation of medical staff, and some definite conclusions have already been reached.
With regard to the particular plans about which we have been asked questions, I understand that the hospital officers are now making visits to each of the voluntary hospitals individually, and are trying to agree with them precisely the class of case which they could undertake in the event of war. Some of the specialist hospitals will no doubt be used for specialist purposes, but I understand that the majority of them will be used for general casualty work, and if they are not in possession of suitable surgical appliances to deal with general casualty work, these will be supplied through the Ministry. The noble Viscount, Lord Mersey, asked some special questions. I understand that he is Chairman of a specialist hospital, and I cannot here give a general answer covering all special cases, but I understand that in the course of a few weeks the scheme will be complete. From what he said, I gather that his hospital has not yet been visited, but it will be, and in the course of a few weeks all the hospitals will have been visited, detailed plans will have been agreed with them, and they will know exactly what their task shall be. I hope that this reply, as far as it goes, is satisfactory to my noble friend.
I do not regret the fact that more Notice had not been given of the Motion, but perhaps if it had been given the reply would have been more satisfactory. I cannot answer the question about structural 310 alterations, because that is not in my Department, and I do not know the answer. I think a question was asked about evacuation of hospital patients by river. I understand that that is being considered, but again I can give the noble Lord no precise answer. I would, however, repeat that we do appreciate the anxiety which is being expressed by representatives of the voluntary hospitals to make them as effective as they can be for these new purposes of war. We hope that they will never have to be so utilised, but for the present we are determined to press on, and by mutual arrangements we hope in quite a short time to attend to all the points that are troubling noble Lords.
My Lords, I am deeply grateful to the noble Viscount who has replied. Quite frankly, I have heard more to-night than I have been able to extract from anyone else in the last two years. I will only make one other remark. I hope the Government will bear in mind that the casualties are in inverse proportion to the amount of shelter which is supplied. If you give good underground protection the casualties will be fewer, and I hope that some member of the Ministry of Health will visit some of the underground arrangements for first aid in Paris. I beg to thank the noble Viscount, and to ask leave of the House to withdraw my Motion.
§ Motion, by leave, withdrawn.