HL Deb 14 June 1939 vol 113 cc458-92

4 p.m.


had the following Notice on the Paper: To ask His Majesty's Government what arrangements have been made for the evacuation of hospitals in vulnerable areas in England and Scotland respectively; whether the alternative accommodation required in areas not classed as vulnerable has now been completely decided; and how far provision has now been made for the buildings, beds and stores necessary; and to move for Papers.

The noble Lord said: My Lords, the Question which I have ventured to put down for to-day relates to a matter which is causing a good deal of anxiety in different parts of the country, and I make no apology for asking His Majesty's Government to give us fuller details than are as yet available about their preparations for hospital accommodation and treatment in time of war, because such arrangements are a most important part of national defence. I hope that the noble Earl who will reply will be able to tell us whether some real progress has been made since the matter was debated in this House. We see large posters everywhere saying: "We have got to be prepared," and almost every branch of national defence has attention focused upon it, except this question of hospitals, though that in a way is as important as any because on the smooth functioning of the hospital system in a crisis depends public confidence, and that, perhaps, has been taken too much for granted. One knows that a great deal of work has been done behind the scenes by the Ministry of Health in England and by the Department of Health in Scotland, but it seems to a number of us that it might not be unhelpful to these Departments themselves if more public interest were exhibited in a matter which is really of such great public importance.

I should like very briefly to deal first with the task which the hospital organisation of this country would have to face at once if war broke out, and then with the question whether the methods now being pursued are adequate to support the extra burden that would be thrown upon it. Perhaps it is unwise to harp too much upon the number of casualties which may be expected right from the beginning of the next war, if it comes. It is clear, however, that we shall have to face a situation entirely different from that which confronted us in the Great War. In the Great War there was first a trickle of casualties, gradually increasing, but in the next war, if it comes, the peak will come at once and we shall have to face in the first days of war a load of additional cases in our hospitals which must be reckoned, not in thousands or in tens of thousands, but, as some of the most sober and experienced experts assure us, in hundreds of thousands. It is a question of hundreds of thousands of casualties occurring in the first few days and weeks of the war. The first month will probably be the most prolific of casualties.

I think it will be agreed that if our hospital organisation proved unequal to the task of handling this sudden and terrible load that would be thrust upon it, the morale of the civil population, which is vital to our success in the war, would receive a most damaging blow. It seems most important, therefore, to inquire how far the Government's preparations have gone, whether they are of such a scope as to deal adequately with the emergency which may suddenly be thrust upon us, and how far—and I would like, if I may, to emphasize this—they have been translated into definite sites, buildings, beds, stores and personnel. Clearly it is no use saying, and I am sure the noble Earl who will reply will not merely say, that arrangements have been made or plans have been completed. It is no use saying that, unless these arrangements or plans are capable of being translated at once into buildings and stores, doctors and certified nurses on the scale required. A deal of attention has been paid to the hastening up of the munitions of war, but hardly less important than the manufacture of the munitions of war is the preparation of what might be called the munitions of healing, and there, I believe, we are not up-to-date on the scale which these critical times demand.

From what is known of the Government's preparations it is clear that there must be a great displacement of the existing hospital patients from vulnerable areas into areas which are less vulnerable. Let me take London, for example, and there are noble Lords here who can speak with great experience and great personal knowledge of London hospitals. These will be wholly or largely evacuated when an emergency breaks out and the patients will be sent to other hospitals or institutions in safer places in the country. I submit that here we have two separate problems and that some further light from the Government would be acceptable on both of them. The first problem is as to the number of patients who are expected to return to their homes. I have heard it estimated that they will be about 50 per cent. Another figure that one has heard is 60 per cent. I think that is a most serious thing. We have to remember that these patients in hospital are not there except for the most serious causes. They are there in hospitals seriously ill, it may be for what is called examination, which really means, in many cases, awaiting a verdict as to whether they are to live or to die; but they are there because in units of some hundreds they can be most efficiently looked after. That is the most efficient way of looking after them, of healing them, of saving their lives.

If all those thousands of people are to be dispersed into their homes, I should like to ask why that is being contemplated ab initio on such a scale and what special provision is being made in the way of medical attention and nurses to look after these people. There is a good deal of uneasiness on that point. I think that the dispersal of thousands of hospital patients to their own homes is really a step about which we ought to have some further information, not only as to the proportion of patients which it is proposed to disperse—perhaps the noble Earl will be able to give us a figure—but also, as I say, as to the provision that is to be made in their own homes.

Another problem of this moving on of patients from vulnerable hospitals to those in less dangerous areas is that the patients or inmates of the hospitals or institutions which have to receive this extraneous load will have themselves largely to be moved on elsewhere. Thus they cause a further displacement and the process goes on right down the line till, I suppose, you have schools used for this purpose. I think the noble Lord, Lord Addison, during the Great War arranged that a very large number of schools in this country should be treated as hospitals. I do not know whether it is proposed to use schools as hospitals should another emergency occur. I think it is fairly clear to those who have, studied the problem that, in view of the vast total numbers of hospital cases for which provision would have to be made, there is probably not even in England and certainly not in Scotland, even after taking into account large private houses and other buildings which may be offered and the public institutions, sufficient accommodation adequately equipped to deal with the burden.

I grant that in this respect England is better circumstanced than Scotland because, for historical reasons with which I need not trouble your Lordships, the development of public assistance in Scotland has gone on different lines, and England has admirable public assistance institutions and hospitals, which Scotland has not. Therefore in that respect England is much better equipped to deal with this load of patients coming down the line than is Scotland. Scotland possesses medical schools and hospitals in very dangerous areas. Scotland also must make provision on a large scale to house the patients who have been evacuated from dangerous places. In common with many others, I can see no adequate answer to the problem except the provision on a really wide scale of temporary accommodation in considerable hospital units in safer areas, probably of several hundred beds each.

I would ask the noble Earl how far His Majesty's Government have gone in the provision of these temporary buildings, and what proportion of them has actually been delivered and erected. Have they all been ordered? We read in the newspapers on Monday a speech made by the Minister of Health. He, as I understand it, said that 40,000 beds were being arranged for in temporary buildings. I submit that that is not nearly enough. I doubt whether it is one-tenth of the number which ought to be provided for in temporary buildings, and even that number it would appear, is arrived at only by sending to their homes many thousands of people who have had to be taken from their homes in the interests of life and health, or by crowding existing institutions in a way which makes it most difficult for the personnel to carry on with efficiency. I hope there is no cheeseparing in this matter. These temporary buildings are excellent, and may last for twenty years. Perhaps the noble Earl when he replies, would give us some particulars as to their provision.

Perhaps he would also deal with this matter. If the work in these temporary buildings or huts—the word is a misnomer in a way because they are excellent buildings—is to be efficiently carried on, they must not be overcrowded. Can he tell us how many patients it is intended to put in each hut? That is a most important piece of information which I have not been able to extract from any other quarter, though I have heard from medical friends recently that, in the interests of economy, it is proposed to place a larger number of patients in each hut than most medical men consider advisable. Another point I should like to mention to the noble Earl—a point of detail, but still a point of some importance—is this. It is quite obvious that if we have these collections of hutments all over the country they will be down on every German map as munition factories. It has been demonstrated—the noble Earl will correct me if I am wrong—that by proper camouflaging, such buildings, seen from 8,000 or 10,000 feet, merge into the surrounding country. Can the noble Earl give us any assurance that this system of camouflaging is being applied to these temporary hospitals?

The question of hutments, beds, stores and so on is important, but even more important is the provision of trained personnel. On this subject I should like to say a special word about a matter that is arousing considerable anxiety in Scotland. Your Lordships may remember that during the last War something between 30 and 50 per cent. of all the non-fatal casualties were orthopædic cases—that is, cases involving injuries to bones, joints, and the spine—and it has been found from experience of air raids in Spain that 50 per cent. of the casualties are orthopædic cases. In England we are fairly well equipped to deal with these cases. There are no fewer than forty orthopædic hospitals—Oswestry and others—where young surgeons and nurses can be trained in orthopædic work. It was different in Scotland before the Great War, and we suffered for it. There was no orthopædic hospital in Scotland capable of giving nurses an orthopædic certificate, and consequently Sir Robert Jones arranged for American orthopædic surgeons to come to Scotland during the War. It would be true to say that the United States ran the orthopædic surgery of Scotland during the War.

Unfortunately that is still the case in Scotland. We have magnificent hospitals, like the Edinburgh Infirmary, where orthopædic work of a very distinguished kind is done. Scotland has not been niggardly in the provision of hospitals, but Scotland still has no orthopædic hospitals of a kind which can treat adults and therefore can qualify to train young surgeons and orthopædic nurses. The result of that is that we in Scotland have got to steal our orthopædic nurses from England—from places like Oswestry—and there are none too many of them here. There is, however, an institution near Edinburgh, called the Princess Margaret Rose Hospital, which treats children, under a very distinguished surgeon. They are most anxious to help the country in this emergency. They cannot give an orthopaædic certificate to nurses; but what they can give is ground for hutments free of charge, and they can give their own knowledge, skill and enthusiasm, and that they are most willing to do. They are willing to do their bit to remedy this rather humiliating position.

What is the attitude of the Government towards it? It is, of course, one's natural instinct to defend the Treasury, and the Treasury have got a very difficult job, but I cannot think that in this matter the Treasury have taken a wide enough view. The Treasury have said—and my information comes from a noted orthopædic surgeon, practising in Scotland, whose name would be known to many of your Lordships: "We will give you these buildings, we will fit them up. There will be no charge, but the moment you start to train nurses to meet an emergency, you will have to pay 4 per cent. on the capital cost." These people have not got the money. They are anxious to give what they have in the way of knowledge and personal service, but to run their own hospital they require every penny they can secure, and they are doing a fine work. I cannot think that this attitude of the Treasury, however admirable it might be in an ordinary case, is in line with the requirements of the situation. It has had a most oppressing effect upon these people, who are only too anxious to help the country. They are putting it in this way, which perhaps is rather too strong: "As long as we do nothing and leave the buildings to rot, everything is done for us. The moment we start to help the country to prepare for an emergency by training nurses, then we pay the penalty because of our enthusiasm and our desire to help the country." Perhaps that is not a very fair way of putting it, but it is understandable when you get people who are keen and, without pecuniary means, are doing what they can in the way of preparation.

Perhaps the noble Earl will be good enough to tell us whether the Treasury will alter their attitude because here we have a glaring gap in our national defence to be filled, and I submit we should not be held up by too much red tape. The position is that these people are really trying to help and they are being strangled by red tape. The Minister of Health and other Ministers are excellent men, but they are all overburdened by this problem on top of others. I wish we could get a man who could get rid of all this red tape and let the country get on with its job of preparation. Perhaps the noble Earl would tell us whether one of the Ministers would take a special care of this work and not be immersed, as Ministers are at present, in their Departments in the burden of an overwhelming task of which this particular problem is only a part. The position in regard to Scotland in respect to ordinary hospitals is excellent, and the public have not been ungenerous. I do rot want to pursue this matter of orthopædic treatment further, but it would be interesting to hear whether in this as in other matters the Government have grasped not only the importance but also the dimensions of the problem, and whether the arrangements they are making are not only good and efficient in themselves—I am sure they are from some knowledge of the people who are tackling them—but are on the scale that is now necessary.

Finally, may I ask one or two questions about the medical and nursing personnel and stores? On the arrangements made for qualified medical men, of course there are other noble Lords who can speak with an authority to which I could not pretend, but I should like to ask this: In all these allocations of doctors and surgeons to the various civil hospitals, have the requirements of the Navy, the Army and the Air Force been kept in mind? These requirements will be very large and it would be a pity to set up a system which must of necessity be upset when war breaks out, if war should unhappily break out, and the requirements of the Forces are to be catered for. Your Lordships will probably remember that during the last War we had the great advantage of the services at the War Office of Sir Alfred Keogh, who was assisted by a Consultants' Council composed of great medical men from all parts of the country, including Lord Moynihan of Leeds, Sir Robert Jones of Liverpool, the greatest orthopædic surgeon this country has ever seen, and Sir Kennedy Dalziel of Glasgow. My question is whether similar arrangements with similar advice are being made now, and what measures are being taken to secure that the War Office, in the unhappy event of a war, should know from day to day exactly what accommodation is available for military casualties in every civil hospital in the country.

Now I come to the question of nurses. I am not sure whether His Majesty's Government are satisfied with the number of nurses available, including V.A.Ds. I should be rather surprised if they were so satisfied in view of the enormous number of cases which will require treatment. But for the Government to be able to draw to the fullest advantage upon the immense fund of enthusiasm and self-sacrifice available, I suggest that we must have some nucleus now in the different districts round which we can work if we are to increase much beyond the present scale the number of V.A.Ds. which at present is only sufficient to deal with local A.R.P. requirements, apart, of course, from those who are mobile and could go anywhere and who are in numbers unfortunately still insufficient. If the provision of temporary buildings in various areas was tackled on the scale which the emergency seems to demand, then in each of those areas there would be a rallying point. You would have something to show. You would have buildings where training might go on. You would have a nucleus staff, and that would, I suggest, very largely ease the position of those who are doing their best to secure a more adequate supply of nurses.

May I say a further word about another branch of personnel? Those with great experience of hospitals, including some members of your Lordships' House, have told me of the great difficulty they experienced in September on the question of domestic staff. One noble Lord informed me that when the crisis came the mother of almost every member of his domestic staff wrote to him saying that her daughter must go home at once. Those who remember the state of affairs in the last War will know how difficult it was for hospitals to carry on because not only of the attractions to the staff of their own homes but the excitements of employment in other directions. I have no doubt that that problem has engaged the attention of His Majesty's Government, because, clearly, a hospital without a domestic staff is a hospital which can hardly carry on at all. Perhaps the Government might consider whether some special means might not be taken to point out to these people that domestic work of this kind in hospitals is in a real sense work for the nation and an essential part of national defence. Perhaps recognition of that fact by those concerned might be made a little easier if some distinguishing badge or uniform could be provided for those engaged in that type of work. I merely venture to throw that out as a suggestion to those responsible.

In raising this question I certainly do not wish to be understood as criticising His Majesty's Government in any way, and still less as finding fault with the very able officials of the various Departments who are spending so much time and energy on this matter. On the contrary, I believe that, although the work they are doing has largely escaped public notice, it is work of the most essential kind, and is being tackled by them not only in a spirit of ungrudging service but with a measure of ability and enthusiasm for which we cannot be too grateful. I certainly am not an expert on these things but speak merely as an ordinary member of the public who happens to have had a little experience. Sometimes an outside business view may perhaps be helpful to the experts themselves, and there are experts like my noble friend opposite who can guide the House on these matters. All I wish to say is that, while not criticising the Government, I think that Parliament has a right to be kept informed on a matter of such great importance to the country, and the more frank the Government are with your Lordships' House the more secure they will be in receiving the sympathy and the help which everybody wishes to render to them. I beg to move for Papers.

4.27 p.m.


My Lords, I am sure we are much indebted to the noble Lord for raising this very important matter. I confess that the speech of the Minister of Health the other day caused me profound uneasiness. I take it that it was meant to reassure. I sincerely hope that the noble Earl upon whom the burden of replying is, I believe, to be cast to-day, and who I notice is not being assisted by representatives of the Ministry of Health and the other Departments which are specially under criticism, will have something more reassuring to say to us than the Minister of Health had. We all expect frequently to be comforted and helped by him, but he has a difficult task if he is going to answer all the questions which the noble Lord has addressed to the House just now. I venture to suggest that no answer can be forthcoming, because all the evidence seems to show that a good many of these matters are not in fact being tackled at all at present, certainly not on the scale which, if these deplorable conditions should occur, will be required.

May I take the first point? I understand that the scheme of the Government is that 40,000 beds should be provided, and the Minister, I see, comforted himself with the fact that in some way or other he had made arrangements for those 40,000 beds to which the noble Lord referred. I would not pretend to prophesy how many casualties may arise out of air raids. Let us hope they will be nothing like as numerous as many people fear, but if they are half as numerous as many people fear 40,00o beds will be of no use. I well remember—and I think this was the experience to which the noble Lord referred just now—being confronted during the last War, when I was at the Board of Education, with a sudden demand one morning from the War Office to tour the country and produce 150,000 beds. This was done mainly by appropriating the best schools, much to the chagrin and sorrow of the managers and the staffs of the schools. Necessity knew no modification of what we had to do: the schools had to be taken. The figure then was 150,000 beds. It became much larger, very much larger. That was the first instalment. If our great cities are to be the target—if they are going to be, at all events, the target that is going to be hurt—what is the good of thinking in terms of;40,000 beds in huts? That is not beginning to tackle the problem. Therefore I do not derive any comfort from the statement of the Minister of Health. I was alarmed, and I think that what the noble Lord has said to-day will not add to our comfort.

Next I would refer to one or two other aspects of this question, to which I hope the noble Earl will be able to reply, although I do not think it would be at all reasonable to complain if he is not able to do so. The scheme, I understand, is that something like 50 per cent. of the patients will be evacuated from our central city hospitals. Why are they in hospital now? They are kept in hospital because it is felt it would be undesirable to send them out, because they still need hospital treatment. Well, we must do the best we can and they will be sent, no doubt, mainly to their friends in the country and to other places. The less urgent cases, of course, will be selected. Still, there will be presumably 50,000 left. What ought to be the function of our hospitals in the cities in case of emergency? They should be used as receiving stations, and the plan clearly ought to be to use them in that way and make arrangements for transport on as liberal a scale as possible in order to get the patients out of the danger zone as quickly as possible to hospitals provided in the less dangerous areas. I want to know what the Government have done with regard to the provision of emergency receiving stations in London. A good many medical men, I believe, think the right way of providing receiving stations to give first-aid and such other treatment as casualties may require, is to have underground clinics. The present Government seem to have what I may call a psychological aversion from anything subterranean.


Hear, hear.


The noble Marquess takes that expression in a metaphorical sense. I was using it in the real sense. The Minister responsible for Civil Defence seem to have an unreasonable aversion from underground shelters, but whatever may be the case in regard to underground shelters for the civilian population there is not a doubt that the surgical staff required to deal with a sudden influx of city casualties ought at least to be able to deal with their patients in reasonable safety. That is why we ought to have underground clinics. They ought to have been provided by now, but I have no doubt they are still the subject of discussion between Government Departments and a number of local authorities.

I saw a statement in the newspapers a short time ago, excusing the inability of Sir John Anderson to arrive at a decision about something or other, which was to the effect "Well, he could not be expected to come to a decision because he has not yet been able to consult the rural district council of Great Peddington." That is what happens. There is nobody competent to deal with this job. The Minister of Education has a very important share, the London County Council has a very important responsibility, and the Minister of Health has a very important responsibility, but the Lord Privy Seal hovers about. I do not think he has any authority over anybody; still, he hovers about. Really that is a most unsatisfactory state of affairs, and I suggest that that is what is responsible for the lack of provision of underground clinics and the lack of adequate thinking-out of the immediate bed requirements in an emergency. It seems to me it is nobody's particular job to deal with the matter as a whole. That, I believe, is the real reason why the noble Lord has felt called upon to bring this matter before us today.

As he said quite truly, we in England, for once, have got ahead of our Scottish brethren. They generally come here to teach us our business—and some say to make money out of us—but in this respect England leads. We have, fortunately—and we owe it largely to the Prime Minister, to whom I would like to pay a tribute—an adequate provision of hospitals under the control of county councils. Institutions which were previously administered under the Poor Law are now being very well equipped as county hospitals. The Poor Law in Scotland may be said to have been of a more personal character than in England. They felt in Scotland that they could make shift with groceries and allowances rather than institutional assistance, and so it happens that they are much worse off for hospital accommodation than we are here. That is all the more reason why special attention should be paid to the demand which the noble Lord has brought before us.

There are four or five aspects of this matter about which one could profitably talk, but I do not wish to delay your Lordships unduly. I think the inadequacy of hospital provision, the clear absence of any provision for moving on from what I am afraid will be crowded casualty stations in our central areas to beds outside, the absence of adequate provision, so far as I can see, of clinics —these are all matters which should not be left in this unsatisfactory position any longer than is necessary. Whatever may be the answer which the noble Earl has been enabled to give by his colleagues who have not supported him by their presence to-day, we shall feel that we are indebted to the noble Lord for bringing the matter before the House.

4.39 p.m.


My Lords, I have already addressed your Lordships twice on this subject, and I make no apology for doing so a third time. This really is a very important matter and one which has not been ventilated sufficiently. I congratulate the noble Lord, Lord Craigmyle, on his speech in which he introduced so many vital matters, but I propose to confine myself to a rather more parochial point of view and to speak only about matters of which I know something. There are, I think, six divisions into which we can divide this matter. First of all, the treatment of casualties as they arrive; secondly, the accommodation for base hospitals; thirdly, the medical arrangements; fourthly, nursing; fifthly, the lay services; and sixthly, finance. I propose to deal with these matters very shortly. When I spoke last I expressed some doubt whether there was any cut-and-dried plan for this hospital evacuation, and I was assured by the noble Lord who replied that there was a plan. That was some months ago, and I think it will be interesting just to run through these various headings and see how far we have progressed now.

As regards the treatment of casualties, the noble Lord opposite has dealt with that matter very fully and I only wish to say that my hospital was prepared last September to receive these casualties. The arrangements for dealing with them in the first place were made mostly with local bodies and had not much to do with the hospitals where the casualties were to be received. As regards the base hospitals, I am credibly informed that for every bed in London you should have at least four beds outside. London has been divided into twelve sectors, rather like a cake, and a voluntary hospital is in charge, more or less, of each sector. We appointed medical men to take charge of our sector, and their duty was to go into the country and visit the hospitals and institutions to which we are told we are going to evacuate our patients. I am speaking now of the sector to which my hospital is attached, because I know more about that sector than about the others.

It was interesting to find that we were given certain buildings, certain Poor Law institutions, and there was one in particular which I think was put down as containing 1,200 beds. When our medical man arrived there, the medical man in charge of that place said: "I have 600 bedridden patients whom I cannot move; therefore you are only going to get 600 beds." It went on very much like that in all the other hospitals: there was generally something they could not move, or else they had not got the arrangements for extra beds and accommodation, their drainage was not suitable, or they had not got the proper cooking facilities. In most places there were no operating theatres and no lifts. In one of these institutions they came to the conclusion that they could only use two floors, because the staircases were so winding that they could not get stretchers up beyond the second floor. There was no provision for lifts or for making use of the upper floors. Therefore I think you will find that these accommodation beds in the base hospitals, far from being four to one, are more likely to be one for every four beds in London—unless of course there is a very large hutting arrangement of which we know nothing.

As regards the medical officers, I understand that the group medical officer in charge of a particular group is more or less responsible for allocating various medical men to the different hospitals, for saying who are to stay in the casualty clearing hospitals in London and who are to go to the base hospitals. So far we have not been told of any allocation at all—I mean by the Ministry of Health—nor have we been told how these medical men are to be paid; whether they are to be under any sort of authority with a rank, or whether they are merely civilians. Therefore one cannot say as regards the medical arrangements that the plan is fully existent so far. When we come to nursing I am afraid the story is even worse. We were asked some time ago to appoint a matron to these different sectors. From that day we have never heard a word, and we have not received one single word of information from the Ministry of Health as to how we are to carry on; whether we are to send our senior nurses to the base hospitals, whether to build up a V.A.D., whether we are to make the arrangements for these voluntary nurses, or whether that is going to be done by a central authority. That is a very serious position, considering that this A.R.P. work has been going on for something like three years.

Then we come to the lay services. You cannot run a hospital without lay services; they are most important. We were asked two months ago to send in the name of a lay officer, who, I presume, would work with the medical officer in these sections. We have not heard a word, a single word, from that day, and nothing has been done. We know that we shall be short of a great many of our domestic staff. Some, no doubt, such as porters, will be called up, as they belong to the Territorials or the Army. The almoners are the most important. They will have a tremendous lot of work to do with these casualties, looking after them and finding out about patients who are transferred to hospitals. The whole of your domestic staff is very important. I do not know who told Lord Craigmyle about mothers writing last September, but that was my experience in our hospital. The staff are mostly Welsh and Durham girls, and their mothers wrote to them to come home at once. I think I also mentioned that, as pay day had not arrived, most of them had no money to go home with, and after they had been addressed by the matron they stayed. But I am quite sure that if there were any serious bombing, these girls, who are mostly children of seventeen or eighteen, would leave; therefore they have all got to be replaced. In the same way your cooks and cooking arrangements have all got to be arranged for. Up to to-day we have heard nothing; we have had no information, at least from the Ministry of Health, on this subject.

Then we come to the important matter of finance. We do not know anything about what the financial arrangement is to be. We are told to carry on. My Lords, we should be bankrupt in a month. We have no reserve in our voluntary hospital; we have an overdraft, but no cash in hand. The subscription from the Poor Law authorities and the Hospital Savings Association payments would practically cease, as we should take in very few civilian patients. Therefore the financial question is a very serious one. I do not wish to blame the Ministry of Health or any of those very able men who are working under it, but I think the whole difficulty is that this is a very much bigger subject than the Ministry ever thought it was. I do not believe you will get satisfactory arrangements until you appoint some head who will direct the whole business. At the present moment you go from one Department to another; each Department is busy with something else and this is nobody's child. I seriously beg the Government to consider the appointment of a really efficient person who would carry some weight and have access to the Ministers concerned.

4.48 p.m.


My Lords, I should like to support the Motion, because I feel from a rather different point of view that it is most important that some general statement should be made on what is to happen to the hospitals on the outbreak of what we call an emergency. It seems to me that it would cause considerable disquietude if it happened at this moment. We know that there is going to be tremendous confusion of all sorts and kinds. It is known that children are to be sent away, but I do not believe it is realised that half the patients in the hospitals—I am talking in round figures—are to be sent home, or disposed of somehow, in order to make room for casualties which may or may not occur. I think you certainly ought to make room for them. But that is not my point. Unless the public realise what is likely to happen, they will criticise and ask why these people are being sent home, why, for example, they are being sent from a London hospital down to Southend.

I take Southend in particular because I used to represent that constituency in another place and I am in touch with that hospital. They will ask why the people in Southend—for a time only, I hope, but for a time, and again I should like to ask whether it is only for a time—are to be prevented from going to their out-patient department to receive their usual treatment. I can quite see that you may have to use the out-patient department for extra beds, or for some other accommodation for which it may be suitable—operating theatres or what not. But that is not my point If you do not soon educate the public to the necessity of their finding medical accommodation very different from what it is now, they will be taken by surprise in a very serious way. I think everybody is realising that children are going to be evacuated, and quite rightly too. We have got used to that. We do not look upon it as such a terrible thing as was the case during the emergency of last September. But I think we should also realise that hospital accommodation has got to be greatly altered, and that people may have to be sent home only partially convalescent, as the only means of making room in the hospitals. Then there are stories, about which one does not know the details, of people being sent home from lunatic asylums and such like places. If that is for an emergency it is all right, but I do not see how you can get over an emergency unless you make some accommodation.

Then I come to my second point, which is a point of criticism as to what might happen. In Southend the wards are going to have twice as many beds as usual, even in the corridors and out-patients' department—I have no doubt that surrounding hospitals in similar towns are in like case—to make room for London patients, who are to come down in order to make more room in the London hospitals. That may be perfectly all right at the beginning of war, or after a sudden air raid, but surely the Government ought to have hutments, or the skeletons of hutments, ready to be put together, so that at no distant date the casualties or sick in these hospitals shall have the proper accommodation which is required, and the ordinary services for the civil population may be resumed. I have no evidence that there is any preparation yet for making that necessary hutment accommodation, and I would welcome, and I think we ought to get the Government to issue, some statement as to what their general policy is, and whether beds have been supplied. They have been, as a matter of fact, in Southend, so that patients will have beds at least and not be crowded into the corridors. There are also extra supplies of equipment and medicine. But I do not think that is enough. Suppose a war should go on for years, we have had some months of warning now and we ought to be able to produce more hutment accommodation, or schools, if necessary. I dare say huts would be better if you can get them done in time and can afford them. That is not for me to say, but if you ventilate this subject, by making a statement, which will enable the people of this country to understand what is required, I think we shall be quicker to realise the problem. We should be happier if we knew at the outbreak of war what was going to happen to those who were already sick, to the casualties which occurred, and to those who were sure to become sick as the war progressed.

I have made the point which I wanted to make, but I was asked also to say this: It would be a help to Southend to know whether that area is a vulnerable area or not, because I am told that if it is a vulnerable area grants will be made to enable the hospital to supply air raid shelters. Hospitals like that of Southend have not got money to throw away, or to spare, in making air raid shelters for the staff. If it is not necessary there is no use doing it. We feel, however, that the Government, or someone, should give the hospital a line as to whether air raid shelters, and what sort, should be supplied for the Southend hospitals and other hospitals in the same case, and how far other protection of that sort can be supplied—whether some wards should have sandbag protection, and if so where the sandbags are to come from. My main point is publicity for the general policy of the Government. The other is a detail, as to which somebody might give me information.

4.56 p.m.


My Lords, I am sure we are grateful to Lord Craigmyle for raising this very important subject. I do not want to keep your Lordships for more than a few minutes, but it seems to me that we have two main problems to deal with—problems quite different from those with which we had to deal in the last War. We shall not only have to deal with casualties in the Forces, coming home and having to be housed in hospitals in this country, but we shall have an enormous number of civil casualties, which must be dealt with at the very beginning of the war. If one goes round the country and notices the various areas which have been called evacuation areas, or rather areas to which various evacuees shall go, it will be found that as the process of strengthening our defences moves along those very areas to which people from the towns that were in the danger zones were going to be moved have themselves become real danger zones. I know of areas in Scotland, around very large aerodromes, which are now being increased, which have been called areas to which the people from Edinburgh, Glasgow and Dundee are to be moved. These areas, in my opinion, are now much more dangerous than the areas from which people are going be moved. It seems to me that the question of placing hospitals in the country, to which people from large centres have got to be evacuated, must be very carefully considered, with a view of carrying out our defence organisation. I think Lord Addison is right in saying that at least you want one authority to deal with this question. It concerns four Departments or more, and the Lord Privy Seal has got as much as he can deal with now apart from this important problem.

The next question is whether the hospitals in danger zones are going to be available after evacuation for casualties which happen in those areas. I think that is quite wrong. I cannot imagine anything more awful than sending people who happen to be in a bombing zone to those hospitals to hear a repetition of raids coming over their heads. Therefore—the Government, I am sure, are thinking of this—it is most important that arrange-merits should be made now so that the hospitals in the danger zones should be treated purely as casualty clearing stations, and the patients should immediately be evacuated to outside hutted hospitals, where they can more or less recover from their wounds in peace. Because the strain on the nervous systems of these poor people will be something terrific if they have to be put in hospitals in the danger zones.

The demand by the Services on the medical and nursing professions will be very much greater than in the last War. I do not know what arrangements have been made by the Government with the medical schools for earmarking the older students now for the staffing of the various hospitals in the country to which the patients are going to be evacuated. It is perfectly clear that the present staffs will be kept in the danger zones to deal with the casualties which will occur there, and when the patients and others are evacuated to the outer, non-danger, zones, there will be no staff or medical attention available there unless preparation has been made beforehand to earmark in the various medical schools the extra staff required. The last War showed only too clearly how difficult it was to get sufficient trained doctors and nurses for the Forces alone, and in the next war there will be a double or treble drain on the all too small staffs. That is a point which ought to be given immediate attention.

The next point I would like to make is this. A great many of the smaller hospitals are, I believe, trying to arrange their evacuation themselves, so as not to be a drain on the resources of the authorities when evacuation takes place, because they feel that many of their patients are really quite unfitted to be sent to their homes. The difficulty is that, although arrangements can be made for transportation and similar things, when the accommodation is taken in an area in the country the hospitals will be faced with an indefinite charge for the reconditioning of the houses which they may take. They really need some sort of guarantee from the Government that when the time comes for the reconditioning of houses they will receive financial aid from His Majesty's Government. They hesitate at present to take on that obligation without knowing exactly what it will mean.

If and when we are faced with a war—and we all pray God that it will not come—undoubtedly the early stages will be the worst, because the continuous bombing of places in this country will be directed to breaking up the morale of the population, and there is nothing that tends more to break up the morale either of an Army or of the civilian population than the sight of their wounded. Evacuation means transport, and very often underground transport, for the streets will be broken up. That transport should be most thoroughly organised in peace time, so that these unfortunate people can be picked up in the various areas and removed as quickly as possible. I am convinced that the next war will be a war of nerves and of moral strength, and if we can only deal with the emergency in the early part of the war we shall get the nation settled down determined to carry the war through to a successful conclusion.

5.5 p.m.


My Lords, when this question was debated some months ago the chairmen of hospitals contributed to the discussion, and we made various suggestions to the Government, some of which have certainly been given attention. But I would like to ask the noble Earl about one or two points which were not then alluded to. The first is this: Will the military hospitals be available to civilian casualties which take place in their vicinity? The noble Lord who has just spoken referred to aerodromes, which are increasing in number; would the local civilians near those aerodromes be taken into the military hospitals? The second question is whether the Government propose to issue any statement to the nurses and the domestic staffs encouraging them to remain at their jobs and not to go flying off to some more attractive war occupation. That matter was mentioned in the last debate, and the noble Viscount, Lord Gage, who replied, gave us to understand, I think, that that would be considered. What we do not want is that when an emergency arises numbers of young women should rush off and say they are going to drive cars or to do this, that or the other, when the best thing would be for them to stay and do the work they are already doing.

The third question is that of mobile units. I have no particular complaint in regard to my own hospital. I have had a number of promises from the Ministry of Health through the local authority, and if they are all implemented everything ought to go very well. But there is the question of transport. Has the Ministry considered the number of nurses who will be required in the actual transport? We are informed that a great number of Green Line 'buses have been hypothecated for this purpose. They will, of course, take a number of lying down cases, and they will have a pretty slow journey, for the roads will be very congested. There will be other equally important users of the roads—children going out of the large cities, and possibly military units moving along. So it will be a very slow business. Nurses would have to be put in those ambulances. There will not only be the nurses of the casualty clearing stations and the nurses at the hospitals, but nurses will be moving about in ambulances. Has that been considered?

The fourth question is that of day-to-day finance. A great number of our hospitals live almost from hand to mouth. Some of them have financial reserves, but they are probably in stocks which will not be quoted at a very high figure if they have to be realised at the moment of emergency. We shall have to go on paying out money in salaries and wages, and for food consumption, as well as for the alterations that will have to be made when mains are blown up or gas-pipes disturbed. All these things have to be paid for. Will it be possible for the Treasury to give some form of guarantee of an overdraft for the essential needs of hospitals during an emergency? Those are all the points I want to make. I think it is most important, however, that the nurses should be encouraged to stay in their jobs, and some Government notice should be put up in each hospital urging that on the staff. Such an appeal from the Ministry of Health would carry very great weight.

5.10 p.m.


My Lords, I want to ask the noble Earl two questions I have not heard mentioned in the debate so far. In the first place, we have heard a great deal about the staff of hospitals, but we have not heard anything regarding the oncoming medical men—namely, students. Is there going to be any provision made whereby students of twenty years of age are going to have their training during the six months when they are called up devoted to medical work so that they will not lose time, and in order that we may have a full supply of young doctors when the emergency arises? It seems to me a great mistake if medical students of twenty years of age are to have their medical course interrupted when they would be serving the country far better by becoming qualified against whatever time the emergency may arise.

Secondly, we have heard a great deal regarding the moving of patients, civil and I presume military as well, into less dangerous areas. Is it the proposal of the Government to have the emergency hospitals ready for these removals, or are the hospitals going to be erected only after an emergency has arisen? I ask the question because a medical friend of mine has been told that he has been allocated to a hospital but that that hospital will not be erected until it is necessary for occupation—in other words, when it is necessary to move the patients the hospital will not be there. That is a very serious mistake in the plan if that is true. I sincerely hope it is not true. Further, I have been told on quite good authority that all the medical schools in Great Britain, except one, are in dangerous areas. It seems to me, therefore, essential that some provision should be made for medical schools to continue their work after an emergency arises. The only medical school which is not in a dangerous area is in the City with which my name is associated. It is a most peculiar thing that that City is right on the East Coast, and yet it is classed as a neutral area. I do not complain of that, because it is all the more satisfactory if it is supposed to be safe, but at the same time one wonders where all the medical students are to go if there is only one medical school in a safe area.

5.15 p.m.


My Lords, I am sure nobody can complain of the way in which the noble Lord has introduced this subject, and I must thank him for the tributes which he paid to the Ministry of Health and the Department of Health for Scotland. I quite understand that he does not bring the matter forward to-day with the least intention of embarrassing either the Ministry of Health or the Government, but in order to assist matters and, if possible, do good. I have a very long brief here, but it might be more convenient if I tried to reply to some of the questions your Lordships have asked. This I shall do as well as I can and as far as I have the knowledge, but anything I cannot answer I shall of course refer to the Ministry, where, as your Lordships know, it will receive due consideration.

The principle of the scheme, of course, is, as Lord Hutchison mentioned, that casualties should not be retained in hospitals in the most dangerous areas for any longer time than is necessary. Accordingly, efforts have been concentrated on increasing hospital accommodation in the safer areas and on providing adequate means of transport. The question of sending home a certain number of patients has been criticised. My information is that it is estimated that in case of necessity from 30 to 50 per cent. of the existing beds in hospitals could be cleared in this way by sending home all persons who are no longer in urgent need of hospital treatment, and it is estimated that these beds could be cleared within twenty-four hours. As regards Lord Craigmyle's criticism on this point, I am told that the nursing of patients sent home in this way would, if necessary, be provided for by the district nursing service augmented for the purpose. In London, which of course is better provided with hospitals than any other part of the country, it is hoped to reduce the beds normally in use, and these hospitals in dangerous areas would become virtually, as Lord Hutchison said, dressing or casualty clearing stations. The hospitals have been requested to make their own arrangements for the transport of patients to their homes where that is possible, but wherever it is not possible the Women's Voluntary Services are organising convoys of volunteer cars and drivers to carry out the operation. The Ministry are arranging the transfer to other institutions of a number of adult patients in hospitals in the most dangerous areas.

In London arrangements were made last September for the transfer, mainly by ambulance trains, of between 3,000 and 4,000 patients from 34 of the large general hospitals in the main congested areas to towns approximately fifty miles distant from London, such as Reading, Bedford, Cambridge, Brighton, Eastbourne, etc. These arrangements still stand. There are similar arrangements in the Provinces for the transport of patients, though necessarily on a smaller scale. The number of patients to be dealt with in that way, besides the 3,000 or 4,000 from London, would be 1,000 from Birmingham, 1,000 from Manchester, 600 from Liverpool, 450 from Tyneside, and some 1,200 from other centres. These will all be transferred to those towns which I have mentioned.

The Ministry are proposing to extend the hospital accommodation in the safer areas to which these casualties are to be sent, and there are three methods by which they are endeavouring to do that. The first is that additional beds are being crowded—that is the expression used—into existing hospitals and institutions. Secondly, what is called up-grading. Institutions which at present are incapable of undertaking surgical work would be what is called up-graded by the provision of surgical and medical equipment, and also by the provision of such facilities as operating theatres, X-ray rooms and sanitary fittings of the type necessary in such a hospital. The third method of expanding the accommodation is by the building of hutments which, for the most part, will be wards attached to existing hospitals and institutions in order that the existing administrative services can be utilised. These hutments are also in some cases being formed into ad hoc hospitals where no suitable parent institution exists.

As regards the first method, the crowding, it is estimated that approximately 100,000 additional beds could in an emergency be accommodated in the existing hospitals and institutions in England and Wales, and arrangements are in hand to carry that out. It has not been possible to avoid putting some of these extra beds into dangerous areas, but the great majority of the 100,000 beds would be accommodated in the safer areas. The hospitals and institutions which are to accommodate these beds have all been informed, and orders have been placed so that they may be equipped with the necessary pillows, blankets, sheets and other things of that kind. Nearly half of the 100,000 beds have already been distributed, and the distribution is expected to be completed by the end of July. As regards the up-grading, over 150 institutions in England and Wales have been earmarked for up-grading, and arrangements are now in hand for carrying out the necessary adaptations and the supply of extra equipment. In the last two months medical officers and engineering inspectors of the Ministry have been visiting these institutions and discussing with the hospital authorities on the spot what works of adaptation are required, and in many cases the work has already been begun. It has been decided to erect as soon as possible new hospital buildings in the form of huts which will be capable of accommodating an additional 30,000 to 40,000 beds. This is the programme for England and Wales. The noble Lord, I know, does not think it is enough. The Department of Health for Scotland are simultaneously erecting huts capable of accommodating from 9,000 to 10,000 beds.

Arrangements for the construction of three-quarters of the English programme are already well in hand. The hospitals and institutions to which the huts are to be annexed have been selected, and the consent of the owning authorities to the erection of huts on their land for this purpose has in every case been readily forthcoming. The Office of Works have undertaken to be responsible for the erection of the huts, and the Ministry have already requested them to see to the surveying of the sites and the preparation of forms of estimate in respect of huts for over 16,000 beds. While these huts are being designed to fulfil the special purpose of auxiliary and hospital accommodation in time of war, they are also capable of performing a useful peacetime function. When erected they will afford additional war accommodation, but they should not, and must not, stand idle. The hospitals on whose land the huts are built will find themselves in the position of suddenly having an extended accommodation for patients at their doors built at the Government's cost, and of taking the opportunity of availing themselves at once of this accommodation in relief of their ordinary peacetime needs. It is proposed to make the huts available to them for these peacetime purposes on very reasonable terms, and they will not have had to share in the initial capital cost or in the maintenance of the buildings. I have the numbers of the distribution of these huts, but I do not think that I need weary your Lordships with those figures.

As regards London, the expanded hospital accommodation has been planned on a sector scheme. The whole region has been divided up into ten sectors radiating from the Thames outwards, and at the apex of each of these is one of the great teaching hospitals which is to act generally as parent to the sector. The proposal is that in, war casualties will be drained outwards along each sector, and, therefore, the Department's aim has been to provide sufficient hospital accommodation in the outer part of each sector to serve the hospitals in the inner part. Approximately 500 hospitals are included in the London sector scheme. It would be impracticable to give a complete picture of that in this statement, but as an example it may be mentioned that one sector, with the London Hospital and the Bethnal Green and other London County Council hospitals in the inner part, will extend northward into Hertfordshire, and will utilise as base hospitals, among other hospitals and institutions, the Bishop's Stortford Public Assistance Institution, which will be expanded by crowding and hutting to 1,000 beds. In the Bedford Mental Hospital 1,200 casualty beds are being provided in addition to the ordinary accommodation, which will be reserved for the ordinary patients.

Another sector has St. Bartholomew's and the Royal Free Hospitals with others at the apex. This extends out to Barnet, and is increased by crowding and by huts to 1,300 beds, and again to the Bedford Mental Hospital. On the west St. Mary's and the London County Council Hammersmith Hospital will find their base hospitals at Hillingdon and Harefield, where the Middlesex County Council have hospitals and institutions. These will be substantially expanded and will use as the main base hospital the Park Prewett Mental Hospital at Basingstoke, which can accommodate 2,000 casualty beds. In the south St. Thomas' and the London County Council Hospital at Lambeth, with others, will use as base hospitals the Guildford Institution belonging to the Surrey County Council and the London County Council Sanatorium at Wokingham, and. this sector will be further served by the erection of huts for 600 beds at Botleys Park Mental Hospital, Chertsey. One of the main hospitals for the south of London will be the Horton Mental Hospital at Epsom, which is being completely cleared of ordinary patients and will accommodate 2,500 casualties. The same scheme of expanding existing hospitals and institutions in the rural areas outside the most dangerous towns is being followed in every part of the country. I cannot give details of every case, but to take one typical example, the main base hospitals for the Tyneside and Tees-side regions will be the Shotley Bridge Mental Deficiency Colony, which will provide nearly 1,000 casualty beds, while three other mental hospitals will provide respectively 1,000, 800 and 600 extra beds.


What happens to the mental patients?


I understand they are all to be closer together. They are not to be let out.


Are these beds to be in the actual wards or will they be additional beds in the grounds? If the noble Earl does not know I will not press him, but it is a material question.


Do you mean is there room for them?




I am afraid I must ask for information on that point, but I presume that they would put them closer together. I take it that in the ordinary mental hospital they live wider apart than anywhere else. But I will make a note of the question and have inquiry made.


The noble Earl has used the word "crowding" several times. I do not know what is meant by that.


It is a term which means sending more patients into a hospital.


More beds in a ward.


That is apparently the official expression. I think it was the noble Lord, Lord Greville, who talked about group officers. That is a point which affects the affiliation scheme in the provinces. One of the most important problems is the administration and staffing of institutions in the safer areas which are to be developed into large surgical hospitals. In the London region this problem is being developed as part of the sector scheme which I have already described. Group officers who are practitioners of the highest standing have been appointed from the teaching hospitals, and these officers are now working out plans for the dispersal both of personnel and equipment from the well provided institutions in the inner areas to the outer areas which are not ordinarily accustomed to undertake acute surgical work. In some cases arrangements are being made for the complete transfer of such of the staff as can be spared from the centre to one of the base hospitals in the outer part of the sector. In the provinces much the same scheme is being adopted.

The question of transport was mentioned by more than one noble Lord—Viscount Mersey was one of them. I would say that the basis of the emergency hospital scheme is the transfer of casualties from the most dangerous towns to the safer areas, and the success of the scheme therefore is entirely dependent on the efficiency of transport. For the work of picking up casualties in the streets and taking them to hospital fairly small vehicles are required capable of carrying four stretchers each, and it is hoped to earmark 20,000 of these over the country as a whole. Good progress has been made in securing these ambulances. For example, of the 2,000 required in the County of London already 1,500 have been earmarked. For the inter-hospital transport, however, larger vehicles are required, and the Ministry have been making arrangements for this with both the railways and the omnibus companies. For comparatively short journeys it is proposed to rely on large single-deck omnibuses which can be converted into eight- or ten-stretcher ambulances, and arrangements have now been made for stretcher fittings to be made for approximately 800 omnibuses in England and Wales, of which 300 are Green Line omnibuses and would operate in the London region and 500 would operate in the provinces. In almost every case these omnibuses would on demand be placed at the disposal of the Ministry's hospital officers, fitted to take stretchers, within twenty-four hours of request.

Simultaneously the Ministry, in consultation with the Ministry of Transport, have been considering the provision of ambulance trains. Arrangements were made in September last for the provision of a number of ambulance trains made up of brake vans which could take stretchers on the floors both in London and Birmingham. It is now proposed substantially to augment those arrangements. The railway companies have been authorised to fit up 340 brake vans to enable them to take stretchers in two tiers, each van taking 36 stretchers. These ambulance trains are to be available for the evacuation of casualties from any of the larger provincial towns which must be regarded as being especially liable to attack.

The noble Lord opposite talked about emergency posts or first-aid posts, and I may say in reply to that that first-aid posts are being provided for every area of the country for the treatment of casualties. It has been one of the Department's first objects to see that these posts are so planned that they will protect hospitals from a rush of walking wounded. A series of first-aid posts have been planned with this object in view, and it is estimated that there will be approximately 3,000 such posts in England and Wales of which between 500 and 600 will be mobile units—that is, vans fitted to carry all the medical and surgical equipment of a first aid post, together with a doctor and a nurse. The Department are now at work examining detailed proposals submitted by the local authorities for the adaptation of the buildings which have been selected or for the erection of new buildings in splinter- and blast-proof material where it has been decided that the erection of a new building is the right policy. Meanwhile drugs, dressings and surgical equipment sufficient to supply all these aid posts have been ordered centrally and are in process of distribution. The noble Lord opposite said that these first-aid posts ought to be under cover and I may say that they are as a rule to be put in basements.

As regards the supply of beds and bedding, orders have been placed centrally for 100,000 beds, to be accommodated at the existing hospitals. Nearly half of these have been distributed, and distribution is to be completed by the end of July. Distribution has taken place to provincial regions equally with the distribution to the Home Counties. Additional beds are also being ordered for the huts which are being erected. The Ministry are contemplating a further order of beds. A supply of 300,000 white blankets and 200,000 pillows has been ordered, and approximately 137,000 blankets have been distributed to hospitals. The distribution of blankets and pillows will be completed by the end of July. A supply of 400,000 coloured blankets has also been ordered, and of these 103,000 have already been distributed. Some 226,000 stretchers have been ordered, of which 149,000 have been distributed, and I understand that of those Scotland is to have 23,000. Distribution is to be completed by the end of August.

Orders have been placed for £234,000 worth of drugs and dressings, and it is estimated that this will provide an adequate initial supply for 250,000 casualty beds and also for the first-aid post service. Approximately nine-tenths of these drugs and dressings for casualty beds are being distributed to the provinces, as the London County Council have already acquired sufficient reserves for use in their own hospitals. It is estimated that the distribution of drugs and dressings will be completed by the end of this month. As regards surgical instruments and operating theatre equipment, orders have been placed for operating theatre and ward equipment estimated to be sufficient for 75,000 casualty beds, at a cost of nearly 500,000. This equipment is to be distributed to the hospitals being upgraded, and delivery has already begun.

In answer to Lord Craigmyle, I understand that schools are not to be used, except one or two public schools which are to be converted into hospitals of a special character—for instance, for neurological cases. As regards temporary buildings I cannot answer the noble Lord; I must make inquiries. Another question I think Lord Craigmyle asked was the number of patients in the huts. I understand that there are to be 40 beds per hut, which gives a sufficient spacing of five feet or more between bed centres.

The noble Lord referred to orthopædic accommodation. I understand that the Princess Margaret Rose hospital at Fair-milehead is one of the few orthopædic hospitals in Scotland. It is at one of those that the Department propose to erect additional huts, three in number. When the negotiations in this connection, which were entirely friendly in tone, were in progress last month, the hospital authorities suggested that in return for allowing the Department, as they readily agreed, to "hut up" their hospital, and in view of the service rendered in training orthopædic nurses, the Princess Margaret Rose Hospital should be allowed the peace-time use of the huts rent free, or at any rate at a substantial reduction from four per cent. on the capital cost of the works. The Department's representatives stated at the time that they did not feel justified in making an exception in the case of this individual hospital, and the hospital authorities in fact indicated to the Department on the day following the discussion that they would be willing to accept the standard terms. I think that means that that difficulty which the noble Lord foresaw has been settled.

The noble Lord also asked about doctors being called up for military or other requirements. I understand that the answer is that requirements of the Navy, Army and Air Force are coordinated with civilian requirements through the British Medical Association's Central Emergency Committee, which advises on all questions of medical personnel. As regards the nurses, the Civil Nursing Reserve for the hospitals is being recruited by the Central Emergency Committee for Nursing. Recruiting is proceeding steadily, although many more are required. I am afraid I cannot answer the noble Lord's question about the domestic staff: I must find out from the Department. I think I answered what Lord Addison asked about first-aid, and to Lord Greville I think I have explained about the group officers. I am afraid I cannot answer him about the arrangements to be made in regard to the lay officers and the domestic staff: I must pass that also to the Department.

Lord Iveagh wanted extra medical accommodation. I think I have described the measures that the Government have taken and are taking for that, and also for the huts. Lord Hutchison referred to the dressing stations, or casualty clearing stations. I note what he said, and I will have that also brought to the notice of the Ministry, about the staff at the base hospitals. He said that at the end of the war hospitals would require reconditioning, and therefore he suggested that there should be Government assistance. We can only wonder whether there would be any money left for anybody to do anything with after the war, but still it is worth bearing in mind. I think the noble Viscount, Lord Mersey, asked a question.


Lord Mersey asked whether it was possible to put up notices in hospitals asking those who were serving there not to take up other work when they were required for service in the hospitals.


I am sure that is very important, and I will certainly bring it to the notice of the Ministry. I have answered to the best of my ability, and I hope I have cleared up some of the points. There is one other thing which I want to say, and that is with regard to Scotland. I would like to say that nearly everything I have said with regard to England applies to Scotland, but there is this that I would add. The Department of Health have received a number of generous offers of private houses with a view to their possible use for hospital purposes. These have been inspected, and the question of their most effective use in emergency is under active consideration. I may also say that they are most grateful to Lord Craigmyle, who has offered his house, Peel House, to be used in peace time as a home for convalescent mothers and children, on condition that it is made available to the Department in time of war for hospital purposes. He has generously offered his house in that way, and he has also undertaken to contribute a large sum of money towards the cost of adapting the building for these purposes. The Government are most grateful to the noble Lord. I hope that by my reply I have satisfied the noble Lord as far as possible.

5.52 p.m.


My Lords, while I desire to thank the noble Earl for the great courtesy of his reply, I think perhaps I also owe him an apology for having been the unwilling means of bringing upon him so enormous a brief on a subject which is familiar to only a few people. I would congratulate him on the facility with which he dealt with an entirely new subject, and on the great amount of ground that he has covered, but I hope he will forgive me for saying that I and a great many others are still dissatisfied. What was his reply to the question put not only by myself, but by Lord Addison and others, as to this large number, 30 or 50 per cent., of existing patients in hospital being sent to their own homes? What provision is being made for the treatment of these very sick people? The answer which the noble Earl is constrained by the Department to give is that there exists the district nursing service. Those who live in the country know that the nurses are all too few, and at the present moment are seriously overburdened. To expect these few lonely women to carry on nursing work for perhaps 50 per cent. of the existing hospital patients is rather playing with the question.

I also put a definitely Scottish point to the noble Earl, and he, with great skill, looked it in the face and passed on. The point was that 50 per cent. of the casualty cases are known to be orthopædic cases, and there is no hospital in Scotland capable of training orthopædic nurses: what are the Government going to do about it? Although he has dealt with another side of the same question he has not dealt with this. An alarming rumour has reached us that those in Scotland who are looking after orthopædic cases with regard to children are, if they undertake the training of nurses to meet an emergency, going to be charged rent on temporary buildings for doing so. I submit that that is not a very satisfactory position. We are trying to revive orthopædic training in Scotland, and the only contribution of the Government is to try to penalise the people who are doing it. It is like the case of the coroner who asked a witness at an inquest on a man who had been drowned: "Did you do anything to resuscitate him?" and the reply was, "Yes, Sir, I searched his pockets." That is really what the Government are doing to the struggling community of orthopædic specialists.

I do hope that the Government will lay a White Paper. It is very difficult for the noble Earl or any other noble Lord to do more than has been done by the noble Earl, but these questions raise a great deal of increasing interest outside, and I appeal to the Leader of the House to see whether he cannot get a White Paper laid upon this subject. We have had the chairman of one of the greatest hospitals in the country putting questions which ought to have been answered months ago, and which the noble Earl is unable to answer, but which a White Paper might answer. I have put my Question, but I do not intend to press my Motion, and I therefore ask leave to withdraw it

Motion for Papers, by leave, withdrawn.