§ 2.48 p.m.
§ LORD BALFOUR OF BURLEIGH rose to call attention to the proposal of a subcommittee recently accepted by the Board of Governors of St. Mary's Hospital, Paddington, whereby the Princess Louise Kensington Hospital for Children will be converted from a wholly children's to a wholly adult hospital; and to ask Her Majesty's Government if they will study means whereby this modern, well-equipped children's hospital of 76 beds, with all its specialist services, including a cerebral palsy unit, shall be preserved as a children's hospital serving the needs of the densely-populated working-class area of North Kensington; and to move for Papers.
§ The noble Lord said: My Lords, I think that at the outset of my remarks some explanation is due to your Lordships of the history of this Motion, which has new adorned (if that is the right word) the Order Paper for no less than two years and a half. The reason is this. It was in January, 1955, that the Council of the Royal Borough of Kensington, of which I have the privilege to be an alderman, were informed by St. Mary's Hospital of their intention to make temporary use of the Princess Louise Kensington Hospital as an obstetric unit and subsequently to convert the whole hospital from use by children to use by adults. This seemed to me to be a matter which not only gravely concerned Kensington Borough Council but also was of such public importance as to justify a debate in your Lordships' House, and therefore in February, 1955, a Motion was put on the "No Day Named" list. There it stayed, for quite a long time.
§ The Borough Council asked the then Minister of Health to receive a deputation, and it was not until a date fairly advanced in 1956 that the deputation was received. It was at that time that I put the Motion down in a slightly different wording for debate in your Lordships' House. The Minister received the deputation and was sufficiently impressed by the importance of the proposals which we made to ask me to postpone the debate in your Lordships' House while he gave the matter further consideration. The Motion is now on the Order Paper once 367 again by agreement with the present Minister of Health. The only word which perhaps is not appropriate is the word "recently"; but if your Lordships will admit that "recently" covers thirty months, then it is in order. The fact is that the position remains the same.
§ I think that I ought also at the outset to give your Lordships a few particulars of the work done by the Princess Louise Kensington Hospital for Children, which we are anxious to save for its original and proper use. A fund was opened in 1924, in view of the urgent need for the treatment of children in the area. I have some responsibility, because I was Treasurer of that fund. A sum of £80,000 was raised locally; the hospital was built under the auspices of Her Royal Highness Princess Louise, who always took a great interest in Kensington's affairs, and we had the privilege of having it opened by Their Majesties King George V and Queen Mary in 1928. I have good reason to remember that occasion, because in the course of making my bow to Their Majesties I had the misfortune to knock over a tremendous microphone affair, about six feet high, which fell with a crash on the floor from the platform six feet up. I think the microphone was broken; and no doubt the formality of the occasion was also successfully broken, because, as your Lordships will know, King George V had a very good sense of humour: he laughed, and the atmosphere at once became friendly and easy.
I do not want to bore your Lordships with statistics, but in order to illustrate the work done by the Princess Louise Hospital, may I say that the hospital treats 30,000 out-patient attendances a year, and anything from 1,700 to 1,800 in-patients. To sum up the work of the hospital, I should like to read to your Lordships two quotations. The first is from a report of the medical officer of health, which says:
Quite simply, this does not merely involve the extinction of 76 children's beds. It involves the extinction of the most modern children's hospital in London, which gives not only specialised in-patient medical and nursing care, but also specialised out-patient service to a large population in West London.
Then I have another report which says:
As it stands to-day, the hospital has 76 cots for the treatment of children from birth to
twelve years old and an out-patient department which receives an average of 4,000 new patients every year. Children come to the hospital not only from the surrounding crowded districts, but from all over West and parts of South-West London; moreover, the highly specialised services which the hospital provides, especially the clinics for cerebral palsy cases (spastics), congenital heart disease and endocrine disorders, draw patients from all parts of England.
I think I must also read to your Lordships a resolution from the local branch of the British Medical Association. The Kensington and Hammersmith District passed the following resolution:
Being satisfied as to the continuing needs of sick children in the area, the medical practitioners of the Kensington and Hammersmith District ask the Minister of Health to give serious consideration to the necessity for the Princess Louise Hospital to continue as a children's hospital serving the needs of the area.
We would further like to impress on the Minister that these needs should take priority over the teaching requirements of St. Mary's Hospital.
I am glad that that purely medical body mentioned that point, because it is one to which I shall have to refer at greater length later.
§ I am aware that there are two possible objections that may be brought against me, and I should like to deal with them at once. One is the minor one that some question may be put as to the ratio of bed occupancy at the Princess Louise Hospital. I hope that we shall not have to bandy statistics, but I can put it in this way, which I do not think can be disputed. The average bed occupancy of the Princess Louise Hospital is within a point of the average bed occupancy of other children's hospitals in London. That is the first point. The second point is that if the proposal of the Borough Council (which I shall explain to your Lordships later) is adopted then, owing to the closure of other children's beds nearby, there can be no doubt as to the full 100 per cent. occupancy of Princess Louise Hospital. That is the point on bed occupancy.
There is, however, a much bigger question. There is the question, which I believe arouses debate in medical circles, about what is the proper treatment for children. Most fortunately for me, I have some important evidence to give to your Lordships from a report which has recently been published by the Royal College of Physicians in London. I will
read to your Lordships two extracts from the report, which is issued by the Royal College of Physicians for the guidance of individuals and authorities who are planning the care of children in hospital. They say:
There is no doubt that special children's hospitals offer the best service for children, because the staff, at all levels, and in all departments, is attuned to the special needs of the sick child. Children's hospitals carry with them a tradition of service which cannot lightly be set aside.
And, in view of the fact that there is an admirable training school for nurses at Princess Louise Hospital, I feel that I must also read this passage:
In children's hospitals where training schools for nurses exist and where all nurses have a vocational interest in the sick child, the standard of nursing care for children is likely to be higher than it is in general hospitals, where the nurses in training are doing only three months children's work.
Any medical man who expresses a contrary opinion, even to go so far as to say that all children ought to be treated in general hospitals, even in special wards, is up against formidable evidence to the contrary there.
§ Before coming to the detail of my subject, I think it would be as well if in a sentence or two I reminded your Lordships of the hospital set-up under the National Health Service Act. London is divided into four regional boards, those regional boards being responsible for hospital treatment; and in addition, there are twelve great teaching hospitals responsible both for hospital treatment and, of course, for medical teaching. The North-West region covers a very large area, extending out as far as the Borough of Edmonton, the district of Harrow, Bedfordshire and so on. But we are not concerned with that. We are principally concerned with the district of Paddington, Kensington and Hammersmith; and the teaching hospital with which we are concerned is, of course, St. Mary's Hospital.
§ The practical proposal which it was left to the Borough Council of Kensington to make to the Minister was that the Princess Louise Hospital should be transferred to the North-West Metropolitan Regional Board, and that children's beds elsewhere could be closed, and thus provide the conversion of children's beds to adult beds, which, quite comprehensively, is required by St. Mary's Hospital. The 370 Minister thought well enough of the proposal to submit it for consideration both to the hoard of the St. Mary's Hospital and to the regional board. I understand that the proposal is acceptable to the regional board, but that up to the present time St. Mary's have been unable to accept it, for reasons which no doubt will be explained to us by noble Lords later in the debate. I must admit that I find it difficult to understand why St. Mary's Hospital should not be able to accept the proposal, bearing in mind the fact that they already have a great number of beds—I think as many as 200—in Paddington General Hospital for their teaching purposes.
§ The next point is the number of children's beds. It will be said that there are too many beds for children, for reasons for which we all rejoice: that there is no longer the same necessity for great numbers of children's beds. They are still needed, but not in such great numbers; and with an ageing population it is true that there is need for conversion in this area of some children's beds into adult beds. Put in that way, the matter resolves itself simply into the question: Granted that that be so, which of the children's beds in the area is it wisest to convert from the purpose of children's beds to adult use? It does not seem to me, prima facie, that the solution of closing the most modern and perhaps the best children's beds in the area is a very sensible one.
§ I must express my sympathy with St. Mary's Hospital in their difficulties—I know that they are real. Nevertheless, it is my duty to tell your Lordships the history, because I am afraid the simple fact is that these difficulties are largely difficulties of their own creation. I have here the Annual Report of St. Mary's Hospital for 1946. That was a moment at which they were seeking, if I may use the expression, to enlarge their empire; and I am lot criticising that. They were seeking and securing amalgamations wtih several other hospitals. During 1946, they secured amalgamations in principle not only with the Princess Louise Hospital, but also with the Paddington Green Children's Hospital and St. Luke's Hospital for Advanced Cases.
§ Again I do not want to go into statistics because they are confusing and difficult, but I think it will be agreed 371 that the difficulties of St. Mary's Hospital are due to the fact that they have an undue proportion of children's beds. During the two years and more that I have been grappling with this problem, I have been puzzled how it could have happened that St. Mary's Hospital should have taken on not one but two children's hospitals, and so loaded themselves up with an excessive number of children's beds—because in both cases, of the Paddington Green Hospital and of the Princess Louise Hospital, they bound themselves, in the amalgamation agreements, to retain those hospitals as children's hospitals. That puzzled me very much, and I could not understand how St. Mary's Hospital could have done that without putting a reservation in the agreement that under the National Health Service Act there might be some rearrangement or something of that sort. However, no such reservation appeared in those agreements. It is only within the last two days that I have stumbled upon what I think is probably the explanation of that otherwise curious action by St. Mary's Hospital. It has come to my notice that both Paddington Green Hospital and the Princess Louise Hospital at that time were companies, incorporated, limited by guarantee. That meant that the consent of the Board of Trade was necessary to the proposed amalgamation. They were also charities, which meant that the consent of the Charity Commissioners was necessary.
§ Now many of your Lordships have had dealings with the Charity Commissioners, and you all know that their duty and invariable practice is to insist upon the continuity of the charity, if that can be accomplished. Consequently, I think it is probable that St. Mary's Hospital Board, who had to satisfy the Board of Trade and could do so only by satisfying the Charity Commissioners, found themselves compelled to insert that binding arrangement in their agreements in order to secure the amalgamations which, for proper purposes of their own, they desired. I think it likely that the Board of St. Mary's Hospital, knowing that the National Health Service Act was coming along, though, "Oh well, we shall be able to unscramble all this under the Act coming into force this year or next year." If that be so, it seems to me a pity that they did not insert some saving 372 clause in the agreement which would have enabled them justly to rearrange beds thereafter. That explains, I think, but does not excuse, their binding themselves to keep the Princess Louise Hospital for ever as a children's hospital if they intended to change it. I am not impugning anybody's good faith—I am perfectly certain that the noble Lords concerned in this acted in all good faith. I am seeking only to explain, if I can, and to understand their actions, because I have to ask your Lordships to consider this arrangement not only from the point of view of St. Mary's Hospital, but from the point of view of the Princess Louise Hospital.
I am authorised by the chairman of the medical committee of the Princess Louise Hospital at the time this amalgamation was negotiated to read this letter from her. The doctor's name is Dr. Janet Aitken, chairman of the medical committee who negotiated the arrangement, in some part, with St. Mary's Hospital. She says:
At the time of nationalisation and regrouping of hospitals, the Medical Committee and House Committee of Princess Louise Hospital sought an association with St. Mary's Hospital for the purpose of forming an integral part of the pædiatric unit of St. Mary's with mutual benefit to St. Mary's and to Princess Louise, and all the consultations and deliberations with St. Mary's as a whole and with its pædiatric personnel, were undertaken on this basis and understanding. No one on the Princess Louise side would have entered into such deliberations if it were contemplated that there was any risk whatsoever of the care of the children of the North Kensington area not being continued at Princess Louise Hospital as heretofore, and as far as I am aware this was not in the mind of any member of St. Mary's Hospital at that time. Certainly it was never referred to in any of these deliberations, Any contemplated change therefore in the use of the Hospital for adults, as distinct from children, would appear to be a breach of this understanding and joint basis.
That extract shows not only what the understanding was but also the hopes and expectations which were entertained by Princess Louise Hospital. Princess Louise Hospital felt they would obtain immense benefit from association with this great teaching hospital of which they definitely understood they were going to be the pædiatric unit.
§ What a commentary on the frailty of human expectations and hopes! Only ten years after those expectations were aroused and entertained by Princess Louise Hospital, what are they faced 373 with? Far from cherishment and assistance by St. Mary's Hospital, they are faced with imminent and total extinction of the work for which they were created, and which they were enthusiastic to continue. An agreement such as that entered into between St. Mary's and Princess Louise, it seems to me, imports both legal and moral obligations. Without that clause in the agreement, Princess Louise Hospital would never have gone into that arrangement. Princess Louise would today have been a member of the North-West Regional Board, where the suggestion is that they should go. I would point out to the Minister that we are not seeking to upset any arrangement which the Minister has made, but that is what would have happened if it had not been for the arrangement between the two hospitals before the National Health Service Act came into force.
§ One of the questions which I shall have to ask the noble and learned Lord, Lord Cohen, on the Cross Benches to answer—and once again I emphasise that I am not impugning the noble Lord's good faith—is how, in view of those circumstances, he can escape from the moral Obligation which he incurred for the Princess Louise Hospital?
§ 3.11 p.m.
My Lords, I am loth to interrupt the, noble Lord, but the position is this: I caused a search to be made amongst the papers, and I cannot find an agreement which contains the clause referred to by the noble Lard. I know that certainly we never contemplated at that time a change of use, but if there is a specific clause which the noble Lord can read, and it proves to be the case that we have merely lost the papers, I hope he will not mind my asking him to read it, to find out whether in fact an agreement was executed.
§ LORD BALFOUR OF BURLEIGH
Certainly. I have not the agreement here, because it is in the files of the Princess Louise Hospital. If I am found to be wrong the Minister will correct me, but I have a specific statement from the Secretary of the Princess Louise Hospital, who is an official of St. Mary's, that identical agreements were entered into between Paddington Green and St. Mary's and Princess Louise and St. Mary's. As the noble and learned Lord has challenged me on this, may I quote a copy of a 374 letter from the solicitors to the Princess Louise Hospital. It is dated February 18, 1946, and is as follows:We were unable to deal with your draft Agreement until Friday owing to Colonel Parkes' illness, and we went through it with Lord Justice Cohen.We return the draft. You will see the alterations that we have made are not in principle but merely to clarify the details of the scheme.We are negotiating with the Paddington Green Hospital for a similar amalgamation. They, like the Princess Louise, are a Company incorporated limited by guarantee. They have approached the Board of Trade who have intimated that they would make no difficulty so far as they are concerned about the amalgamation, but they recommend that a resolution, of which we enclose a copy, should be passed by a special meeting providing that your Board of Management should delegate their powers to the Board of Management of St. Mary's to cover any interim period.They have approached the Charity Commissioners who say that they are so busy that they cannot consider any Scheme which may be put before them for six months, and the Board of Trade will not finally approve any such scheme until it has been approved by the Charity Comissioners. Lord Justice Cohen thinks it might be convenient if your Hospital was to adopt the procedure suggested by the Paddington Green Hospital and pass a similar Resolution.I agree that that letter does not specifically give the clause that Princess Louise and Paddington Green are to continue indefinitely as children's hospitals, but I have that quite definitely in writing, from the Secretary of the Princess Louise Hospital. He is an official of St. Mary's, and I hardly think it possible that he could make any mistake on such a vital point. May I leave it at that for the moment?
Certainly. I asked the question only because, naturally, I had asked to be supplied with the documents. I was informed that there was a draft and, although it was described as the Princess Louise Hospital for Children, the express provision, as the noble Lord has mentioned, was not included in it. I do not think it affects the principle of the matter. I quite agree with the noble Lord that we were discussing the matter in those days on the basis that there would be no change. The only point was that, as the noble Lord charged me with a breach of contract, I wanted to see the contract which I was alleged to have broken.
§ LORD BALFOUR OF BURLEIGH
I have no objection. I take it, from what the noble Lord has said, that once he has seen the contract he will be quite happy to continue to be bound by it.
I am quite happy to continue to be bound by it, but I cannot say that the Board of St. Mary's Hospital, which is quite different from the one which entered into that contract, will be bound by it. That is a matter for the Minister to decide.
§ LORD BALFOUR OF BURLEIGH
It may be a matter for the Minister, but I am interested to see in the St. Mary's Hospital Report a glowing tribute to the ability of the noble and learned Lord, Lord Cohen, in conducting these negotiations. I am sure that that is justly deserved. But the noble and learned Lord has a personal responsibility in the matter which I venture to say he must either stand up to or give us some explanation of why not. It is not surprising that St. Mary's Hospital have been in difficulties in those circumstances from 1948 onwards, with their great plethora of children's beds.
May I give your Lordships a brief history of subsequent events? The National Health Service Act was passed in 1946 and became effective in 1948. It was hardly enshrined on the Statute Book before the Dean of the medical school of St. Mary's found himself in difficulties with his children's beds, and tried to remedy the situation. His first recommendation to his Board of Governors was that they should close the Princess Louise Hospital to children, which is the same proposal as is before your Lordships to-day. That was communicated to the Borough Council, filling us with the same consternation as it does to-day, and it was not at that time adopted by the Board.
Instead, they appointed what was called a co-ordinating committee, under the chairmanship of Mr. Sporborg, to consider and report on the clinical teaching facilities of the group. The Sporborg Committee proceeded to make a report which, I am bound to tell your Lordships, was very widely circulated, but it is marked "Confidential" in red ink. Consequently, I felt it my duty to ask whether I was at liberty to quote from it. I have been refused that permission to quote. I am bound to say I am not 376 altogether surprised, because there are some facts in the report which I think would be highly inconvenient in this discusion to those representatives of St. Mary's Hospital. Nevertheless, that must be my explanation to your Lordships why I am not able to be quite so direct on certain points as I would otherwise have been. I must, however, ask the noble and learned Lord who is going to reply for St. Mary's Hospital on the question of the priority of the teaching needs of a teaching hospital and the treatment needs of the sick poor. When, as in the present case, there is a conflict between the two, what is the decided policy of the Board of St. Mary's Hospital? Is it to give priority to the teaching needs of the group or to the needs of the sick people in the area? That is one of the questions I shall ask the noble and learned Lord to answer later on.
Although I cannot quote from the Sporborg Report, I am sure that there will be no objection to my quoting from a letter to the Press, dated 1949, from the Chairman of the Board of Governors of St. Mary's Hospital. The Chairman said:The factors which led the Board of Governors to decide that Paddington Green Children's Hospital should be converted into a hospital for adult cases"—the first recommendation was to convert Paddington Green Hospital—were as follows. Princess Louise Hospital has accommodation for seventy-five cots as compared with the cot complement at Paddington Green of fifty-two. Princess Louise Hospital is of modern construction and has land available for immediate development. Expert advice has shown that the cost of con version of Paddington Green Children's Hospital into an Institution for adult cases is not excessive….I regret that I am precluded, by the fact that I cannot quote the report, from quoting to your Lordships the eulogy passed by the Board of St. Mary's on the qualities of the Princess Louise Hospital as a children's hospital at that time, when they were contemplating closing Paddington Green Hospital. That proposal to close Paddington Green Hospital was dropped, in response to the vigorous public protest of the inhabitants of Paddington. If any agreement was made only two years before, as I am officially informed there was, to keep Paddington Green Hospital going as a children's hospital, it is not altogether 377 surprising that those protests were ultimately successful and that the proposal was dropped. Then, nothing more happened until 1955 when, as I have already told your Lordships, there came to the borough council the present proposals, which may be summarised as follows: temporary use as an obstetric unit and ultimate conversion of the whole hospital for adult use.
My Lords, it occurs to me at this point that I may have omitted to tell your Lordships the proposal which the borough council made to the Minister. It was that the hospital should be transferred to the regional hoard who would close corresponding beds and, by some rearrangement between St. Mary's and the North West Hospital Group, they could find whatever beds for adults they required. There is just one small point that I should like to make, in case the noble and learned Lord, Lord Cohen, intends to make it. I have been told that there is an idea in St. Mary's quarters that the original Memorandum and Articles of Association of the Princess Louise Hospital provide for women inpatients. I believe that it is on those grounds that it has been sought to justify the obstetric use of the Princess Louise Hospital. Perhaps the noble and learned Lord will take it from me, in advance, that I have here the Memorandum and Articles, and they provide for no such thing. They provide for the out-patient medical treatment of women whose position renders them suitable for hospital treatment, but not for any in-patient treatment.
I am quite willing to accept that; and all the more for the reason that I think that what matters is not what is in the Memorandum and Articles but what, in fact, the hospital has been used for.
§ LORD BALFOUR OF BURLEIGH
My Lords, consider for a moment what will happen to the Princess Louise Hospital if these proposals are accepted and it is transformed into a hospital for adults. It is some miles distant from St. Mary's, and it seems to me to be inescapable that its fate will be to receive aged adult patients whose cases are not considered particularly suitable for medical training. That is only an hypothesis. As St. Mary's have not, I think, made 378 very much use of the Princess Louise Hospital for teaching in the past, I cannot see why they should be more likely to do so in the future. It is for them to say. But what an irony it will be that that hospital, which was built with Kensington money specifically for children, should revert to being, in effect, a home for the aged, and almost for the dying!
There are, therefore, three questions which I must ask the noble and learned Lord to answer. The first is: to which interest does St. Mary's board give priority—the requirements of teaching or the care of the sick? Secondly, how does he escape the moral obligation of the agreement with the Princess Louise Hospital—everyone acting in good faith, I agree—that being the only reason which induced the Princess Louise Hospital to go into the agreement? Thirdly, how does he propose to replace the facilities for in-patients and out-patients in North Kensington and the other services of the hospital—the clinics for cerebral palsy cases and the nurses' training school?
As I have told your Lordships, there are 30,000 out-patient attendances and 1,700 to 1,800 in-patient attendances. The need was urgent in 1924. Of course, geography in this matter is all-important. It is no use saying "Let them go to St. Mary's". The mothers and children cannot get there. It was just because there was a need for such a hospital service in the area that we raised £80,000 and built the hospital. That need is just as acute to-day as it was then.
§ LORD BALFOUR OF BURLEIGH
The appeal was started, I think, in 1924, and the hospital was built in 1928. It cost £80,000, and I believe that since then some £30,000 of capital monies have been spent, of which at least £15,000 will be wasted if the hospital is diverted from children's use.
I have only one other point. I must tell your Lordships that I have great confidence in the strength of the case which I have put before you. I can hardly believe that the Minister will come to any other decision than to keep this hospital. If, by any misfortune, he should come to what I should consider the wrong 379 decision, I am bound to tell your Lordships that I think it highly probable that the legality of the proceedings will be questioned in the courts. Section 6 (4) of the National Health Service Act says:All property transferred to the Minister under this section shall vest in him free of any trust existing immediately before the appointed day, and the Minister may use any such property for the purpose of any of his functions under this Act, but shall so far as practicable secure that the objects for which any such property was used immediately before the appointed day are not prejudiced by the provisions of this section.I do not pretend to be able to judge legal intricacies, but to the ordinary layman I do not see how it can be said that, if the regional board are willing to offer the alternative facilities which are required by St. Mary's by some rearrangement of beds, it is not practicable to secure the continuance of Princess Louise's as a children's hospital. That is the point. I am not saying that it is right or that it is wrong. All I am telling your Lordships is that if, by some misfortune, the Minister were to take what I consider is the wrong decision, I think it is highly likely that there would be proceedings in the courts.
My Lords, I stand here representing the united opinion of the borough council; irrespective of Party, every man, every woman of the council of the Royal Borough stands behind me, and behind them 180,000 inhabitants of Kensington, 15,000 of whom have signed a petition which we have sent to the Minister. We know the area. We know that the needs can be met in no other way than by the retention of the Princess Louise Kensington Hospital for Children. I can tell your Lordships that deprivation of our hospital, built with our money, for our children, will, if it is proceeded with, cause burning resentment against St. Mary's Hospital and against the Government. I beg to move for Papers.
§ 3.30 p.m.
§ LORD WEBB-JOHNSON
My Lords, I have not been able to address your Lordships' House for some months and I crave your indulgence. I will cut my remarks as short as possible, but the noble Lord, Lord Balfour of Burleigh, has dealt with a fairly wide field. I will support him in his contention that Section 6 (4) of the National Health Service Act definitely requires the Minister to keep a hospital 380 employed on the objects on which it was employed before the appointed day. The Princess Louise Hospital is a fine little hospital in an ideal situation, accessible to a large population but set in an open space. If it is not wanted as a children's unit by the teaching hospital to which it is at present attached, it can pass to the control of the regional hospital board.
A children's hospital was needed in North Kensington long before the passing of the National Health Service Act. As your Lordships have heard, the people of the district had the local patriotism to supply themselves with such a hospital. The needs or desires of the present parent hospital should be met by other means, not by sacrificing the sick children of North Kensington, who must be the first consideration of the Minister of Health. The primary object of the hospital is to serve the people of the area and the patients who seek their assistance. Teaching is always secondary to the care of the sick. It is suggested that accommodation for the children in the Princess Louise Hospital could be found in other special children's hospitals. But these would be some distance from the children's homes, especially the westernmost of them, and daily visits by their mothers would be difficult or impossible. Alternatively it is suggested that the needs of the children could be met by children's wards in general hospitals; but that is only second best.
Fortunately the voice of authority is to be heard in the land. The Pædiatric Committee of the Royal College of Physicians has just published a report which makes perfectly clear what is the best provision for the treatment of sick children. The report is signed by the President of the College. The chairman is a distinguished pædiatrician from Liverpool, and the members include nine other pædiatricians and other specialists. The public health services are represented by the Medical Officers of Health of London and Birmingham, and the Ministry of Health is represented by the chief medical officer and the chief pædiatrician of the Ministry. The committee reports that:A special hospital offers the best service for children.Small units are not satisfactory. Forty cots or more are desirable.The hospital should meet the needs of the population and avoid the necessity for small units.381A generous provision of cubicles is essential.The provision of facilities for special techniques, for in-patients and out-patients, is extremely important.Daily visiting by the children's mothers should be encouraged, hence the importance of the hospital being near their homes.Mothers should be admitted with young children if desired.Standards of nursing care for children in special hospitals are higher than in general hospitals, where nurses only do three months children's work.All these advantages are available at the Princess Louise Hospital, The service is there, where it is needed, and it is efficient. It is obvious that the aim should be to foster special children's hospitals. The aim should certainly not be to close the children's hospitals which the committee of experts tell us offer the best service for children.
The Ministry offered to help St. Mary's Hospital over their difficulties by arranging for permanent or temporary accommodation in Paddington and St. Charles's Hospitals, but probably on a totally inadequate scale. Instead the Minister was urged to sacrifice the children of North Kensington. The Princess Louise Hospital, however, is needed for the children. It should not be taken from them, even temporarily. The children of North Kensington should not be robbed of their birthright. I yield to no one in my admiration for the achievements of St. Mary's Hospital. Indeed, the whole world is under a debt of gratitude for the lifesaving discoveries of Sir Almroth Wright and Sir Alexander Fleming. I am sad, however, to see this great teaching hospital being driven to such straits as to urge the destruction of a gem of a children's hospital—a mere seventy-six cots. The difficulties and needs of St. Mary's can be met only by a really bold scheme. St. Mary's Hospital has been bold in the past and we have all admired the imagination, the courage and the energy of the noble Lord, Lord Moran, in rebuilding the medical school and its magnificent laboratories in which therapeutics have been completely revolutionised. St. Mary's has not shrunk from bold schemes in the past. The achievements of the noble Lord, Lord Moran, should be an inspiration to all to-day.
I urge members of the Board of Governors, especially the lay members, to "think big"; and I urge the Minister of Health to realise the need for immediate 382 action and to back a bold plan. I hope that there will be generous support for such a plea. Let the Minister scan his splendid inheritance and measure his opportunities. Let him look at the hospital's long line of famous men who have been pioneers in the science and art of medicine. Then let him help the hospital to carry out a comprehensive plan of development which will be worthy of its glorious history.
§ 3.48 p.m.
My Lords, as your Lordships may have gathered from the speech of my noble friend, Lord Balfour of Burleigh, I am at the present time a member of the Board of St. Mary's Hospital. I was also a member of the Board in 1945; indeed, I believe I have been a member for nearly twenty-five years. I must admit that in the period of twelve years I had forgotten that I had been so closely associated with the negotiations with the Princess Louise Kensington Hospital for Children as the noble Lord states; but of course I accept his statement as a fact. I have a shrewd suspicion, though, that I did not actually take part in the negotiations. I believe I was called in, because I was supposed to have slight legal knowledge, to advise on the legal aspect front the point of view of St. Mary's Hospital; but I do not want to shirk any of my responsibilities.
The first thing I should like to say is that had I thought I was going to be involved in any conflict of duty because of a contract to which I was supposed to have been party as a member of the old Board as against my duties as a member of the new Board, I should have refused to become a member of that new Board, because I do not believe that anything that may have been done before the passing of the Act can relieve any member of the Board in considering the position in the light of the order that was finally made constituting the St. Mary's Group. I would add—though I am to some extent speaking from prompted memory—that at the time we were negotiating with St. Mary's Hospital over the Princess Louise Hospital we had in mind that we should receive, in Paddington, another hospital which afterwards went to the North-West Regional Board and which, had we got it, would have prevented this question born arising, because the discrepancy within the group of adult 383 to children's beds would not have been that which it proved to be. Be that as it may, if I come to the conclusion, after looking into the matter, that I was bound by the contract, I shall adopt the only course open to me and resign from the present Board, because I think the Board must consider the matter on its merits. As I am speaking for that Board to-day I shall endeavour to satisfy your Lordships that there is a real reason for the recommendations to the Minister.
If I may, I would first deal with another point which Lord Balfour of Burleigh mentioned—the question of specialised services. It has always been the Board's intention that these specialised services of the cerebral palsy unit, and the rest, must be preserved. I think I can safely say that it is not our intention to, so to speak, effect an exchange until we have made, either within our own body or with the North West Regional Board, satisfactory arrangements to continue these specialised services. I think your Lordships will all sympathise with the natural feeling of regret, putting it mildly (horror would perhaps be the more accurate expression), expressed by the noble Lord, Lord Balfour of Burleigh, that it should be thought necessary to change the use of a well-equipped hospital for children which the inhabitants of Kensington found the money to build and equip some twenty-nine years ago.
Let me say at once, both as a lawyer and also, as I hope, as a human being, that it is not congenial to have to recommend, nay, put forward, recommendations which will have the effect of diverting money collected for one charitable purpose to another, however closely affiliated the two may be—they are both for the relief of sickness. I am sure that that feeling is shared by all my colleagues on the Board of Governors of St. Mary's Hospital. They would not have been parties to putting forward these recommendations had they not believed it to be their duty under the provisions of the Act. As I said during my interlocutory intervention in Lord Balfour of Burleigh's speech, I had not been able to find an expression in the agreement binding us irrevocably to maintaining the use of this hospital as a children's hospital ad infinitum. But I do not think that that matters, because it must be plain that the old St. Mary's could not bind the new St. Mary's. Also 384 I recognise that it was not within the contemplation of either party at that time that there would be a change of use.
I think it is necessary at this stage for me to refer to the provisions of this Act. Lord Balfour of Burleigh has referred to Section 6 (4). I want the House to appreciate that there is a similar provision in Section 7 (4) dealing with endowments including endowments of a hospital. It is practically the same but not quite. Section 7 (7) says this:Shall…secure so far as is reasonably practicable, that the objects of the endowment and the observance of any conditions attaching thereto, including in particular conditions intended to preserve the memory of any person or class of persons, are not prejudiced by the provisions of this section".That being the position, I agree that there is a legal question, though I think it is more a question of fact than of law, as to whether it is reasonably practicable to achieve the objects of the Act without carrying out the change of use which the governing body of St. Mary's Hospital have recommended. If the Minister comes to the conclusion that it is reasonably practical to accomplish our object as a teaching hospital without effecting the change—well and good; he will refuse his sanction. If he comes to the conclusion (as I hope to satisfy your Lordships he should) that the objects of the Act cannot be accomplished without effecting that change, I hope that, notwithstanding his regret at disappointing those in the Borough of Kensington who so nobly established the hospital originally as a hospital for children, he will give us the necessary authority to go ahead.
As my noble friend has told you, shortly after the coming into force of the Act we appointed a Co-ordinating Committee. I was not on that co-ordinating committee, but, none the less, I had the responsibility as a member of the Board of approving the reports of that committee. It is true that the first and second reports were marked "Confidential", and there were reasons why we could not give permission to publish these, though the reasons were not as sinister as I think the noble Lord implies. But there were reasons. So far as the third report was concerned, that was sent to the Borough Council and the noble Lord was told that we had no objection to his quoting from that. That is the 385 proposition which is now before the Minister.
The committee were faced with the fact that with two children's hospitals, as well as a children's ward at St. Mary's Hospital itself, the proportion of children's beds to adults' beds in the group was far larger than it ought to be in a teaching hospital. I will not elaborate this matter any more as your Lordships are to have the advantage of hearing in due course Lord Moran, whose twenty-five years' experience as Dean of St. Mary's Hospital Medical School peculiarly qualifies him to explain the needs of a medical school. Another factor to which I shall refer was that the waiting list for children was very small by comparison with that for adults.
I pause now to deal with the question which the noble Lord, Lord Balfour of Burleigh, put to me. He asked me, I think, whether as a matter of policy the Board put the teaching considerations in front of the health considerations. I think that that is a fair statement of the question. My only answer to that can be that I have not had to consider the priority, because I hope to satisfy your Lordships that on both grounds the change we recommend is justified. In the first report, as the noble Lord has said, the hospital selected for conversion was Paddington Green Children's Hospital. Your Lordships will not be surprised to hear that when that recommendation was made public it aroused antagonism almost as violent as that which arose when we put forward the suggestion with regard to the conversion of the Princess Louise Hospital. We were asked to think again.
The co-ordinating committee adhered to their view that it was necessary to convert one of the children's hospitals, but they recommended on this occasion that the hospital to be converted should be the Princess Louise Hospital. I will not go into details as to the reasons (one of them was that it was far easier to effect conversion from the building point of view) because I think the only question of principle before your Lordships is not whether A or B should be converted, but whether, for the kind of reason which the noble Lord, Lord Webb-Johnson, gave, it is undesirable to convert any children's hospital. I do not think the question whether it should be A or 386 B would be a suitable matter for detailed discussion in your Lordships' House, where you are in the habit of dealing with principle rather than with detail.
I will direct my observations for the moment to the Princess Louise Hospital. One suggestion that was made was that we should meet the position in part by abandoning our children's ward, in St. Mary's Hospital—The Lewis Carroll Ward. That is a matter on which medical advice is required. A quotation was made from the report. The committee appointed by the Royal College of Physicians itself, I understand, thinks it is a very debatable point as to whether children are better looked after in a specialised hospital than in a general hospital. I think there is no doubt that the wards in a general hospital at least have the advantage of facilities which a children's hospital cannot have. But, that being a medical matter, it had better be left to be dealt with by the Past-President of the Royal College of Physicians.
Still looking at the matter from the teaching point of view, your Lordships may ask—indeed, the noble Lord, Lord Balfour of Burleigh, asked—why we do not accept the offer of the North-West Metropolitan Regional Board to make available a further 180 or 200 beds in the Paddington General Hospital, seeing that we already had 200 beds. I should be the last person to wish your Lordships to think that we were not grateful to the board for their offer, but I am bound to say that the advice we have received from our own medical committee, and from other medical authorities, is that the provision of beds the admission to which is not under control of the teaching hospital would not be a satisfactory solution to the problem. We might get too many patients of one kind. Here again, I should like my noble friend Lord Moran to deal with the question, and would only observe that we were advised by our medical committee, by the academic board of the medical school and by the University of London that we, as the board of St. Mary's, could not possibly meet our obligation to provide suitable clinical facilities for the medical school unless we had, subject of course to the admission of emergency cases, complete control of the admission of patients.
387 I would turn now to what seems to me, as a layman, a still more convincing reason why the change we have recommended should receive the sanction of the Minister. That reason is the change in the relative needs of children and adults since the Princess Louise Kensington Hospital for Children was founded in the late 1920's. I am afraid that I must inflict some statistics on your Lordships in order to support this part of my argument, but let me say at once that they are not the statistics on bed occupancy to which the noble Lord, Lord Balfour of Burleigh, referred. It is true, and we recognise it, that children's hospitals have a lower bed occupancy than general hospitals, if only from the fact that admissions may be completely suspended when there is an outbreak of some children's disease in the hospital. I would ask your Lordships to observe the change in the infantile death rate on London during the past half century. In 1900, there were 168 deaths per 1,000 live births; in 1911, there were 130; and in 1930, two years after the Princess Louise Hospital was opened, there were 59.
I had to refer to my statistician. Even before the Princess Louise Hospital was opened there was a considerable improvement in children's health, but in 1930 the position in North Kensington (and I agree with the noble Lord that we have to look largely at the local aspect of the question) was not so satisfactory. One ward had a death rate of 96, and another one of 64; and I fully agree that there was need for a children's hospital in Kensington. But the whole picture has now changed very considerably, and the infantile death rate in London is only 23.2 per 1,000 live births; so that that aspect of the problem has largely gone. I should have liked to go into the reasons for that, but I think that that would be wandering too far from the subject with which your Lordships are concerned. I am sure that we all rejoice at the comparatively few sick children needing hospital care. It might be said that, with more children 388 surviving, there might be a greater need for hospital beds for them. But that is not the case.
If I may, I will trouble your Lordships with some figures from another institution which has two children's convalescent homes and with which I am connected. After all, admission to convalescent homes is connected with the number of children in hospital. They have had for some time one home of 90 and one of 60 beds, which were both used for long-term convalescence. We had a school in each of the convalescent homes and for a time they were both full. By 1949 the occupancy had fallen so much that we could not find enough children in need of long-stay convalescence, and we closed the school in the smaller home and altered it for short-stay convalescence. By 1953 we could not fill even that, so we converted the smaller convalescent home into a home for the infirm aged.
We were left with the one of 90 beds; and one would have anticipated that, as it was now open to children not only for long-stay convalescence but also for short stay, it would have been easy to fill—it was a sectarian home, but it had always been full before—but the figures for 1956, which was the first year under the new régime which I mentioned, show that of 503 children admitted in the course of the year, only 68 were long-stay and 294 were what I will call "recuperative holiday", which could be regarded as short-term convalescence. The balance of more than one quarter of the whole number of children admitted were not there for medical reasons, but were there either for holidays or because, on account of difficult homes, it was thought a good thing to give the children a chance to get away and live somewhere else. I have troubled your Lordships with these figures because I think them a further illustration of the enormous improvement in children's health which, I submit, will curtail the use of children's beds and turn them into adult beds.
May I turn now to the waiting list position at St. Mary's Hospital? On May 31 this year, there was a waiting list of 1,580 adults, divided between the Main Hospital, the Samaritan Hospital for Women and the Western Ophthalmic Hospital—1,017 at the Main Hospital, 251 at the Samaritan and 312 at the Western Ophthalmic. Compare that with 389 the total of 320 children, of whom 256 were ear, nose and throat cases, which present the least problem, not merely because doctors nowadays differ on the desirability even of removing children's tonsils but because the turnover in these cases is so quick that two children per week can usually be dealt with from the same cot. Apart from the ear, nose and throat cases, there was a waiting list of only 64. I cannot think that that is a state of affairs which ought to be continued.
The economy of the National Health Service entails constant review of the services available, and if there is to be proper control over the spending of public money I would submit to the Minister, through the noble Lord, Lord Strathclyde, that there must be flexibility in the usage or accommodation. To illustrate the need for change, I would mention the following points. I have already mentioned that comparatively few children now need hospitalisation. There has been a large reduction in the demand for beds for tuberculosis of the lungs and of the joints; the need for in-patient treatment for venereal diseases has practically disappeared; but there is a very great need for more maternity accommodation and for more adult beds for surgical cases and some medical conditions. With all these things in mind, can it be right to allow such a great disparity in the waiting lists of adults and children to continue?
The noble Lord, Lord Webb-Johnson, invited us to take a bold line. I am not quite clear what he meant by that, but I suspect that he had in mind the possibility of enlarging and rebuilding the main hospital as an 800-bed hospital. As regards that, I can only say that we have submitted proposals to the Minister, but we are not on the first priority list, which has already been published, and the Board have no information which would justify them in assuming an early realisation of their desires in this respect. Obviously, we shall welcome any help we can get, from arty source, to get our plans approved and an early starting date given. Were this to happen, we should have to reconsider the use of all the hospitals in the group; and if we had the new hospital a great many of the arguments I have been addressing to your Lordships and the Minister might disappear. But nothing has yet occurred which in our opinion would justify the abandonment of our present proposals as to the use of the 390 Princess Louise Kensington Hospital for Children.
I hope that I have covered all the specific points which my noble friend Lord Balfour of Burleigh put to me; and I hope that, however much the Minister sympathises with the natural feelings of all those connected with the Borough of Kensington for the proposed transformation of the child which Lord Balfour of Burleigh did so much to father, he will have regard to the welcome improvement in children's health since the Princess Louise Hospital was founded and allow those beds to be made available to meet a greater need.
§ 4.2 p.m.
§ LORD COTTESLOE
My Lords, this is a matter which, while it is of very real and great importance to those who are closely concerned with it locally, is perhaps a little parochial to justify taking up any great amount of your Lordships' time. Certainly it does not seem to me to be altogether reasonable that, like a cuckoo in the nest, it should have swollen to such dimensions as to oust from this afternoon's proceedings, at very short notice and at considerable inconvenience to a number of noble Lords (myself included) who had made arrangements to take part in it, a debate on a Motion of far wider and far more general interest and importance, the Motion that was on the Order Paper in the name of the noble Lord, Lord Silkin. But so it is; the afternoon is yet young, and we can debate this Motion of my noble friend Lord Balfour of Burleigh at our leisure.
The Princess Louise Hospital, Kensington, is administered by the board of governors of St. Mary's Hospital, as your Lordships have been told, a teaching hospital that does not fall within the jurisdiction of the regional hospital board of which at the present time I am the chairman. But my regional board is charged with a general responsibility for the planning of the hospital services in the area in which the Princess Louise Hospital lies, and it may perhaps be helpful to your Lordships if I say something on the Motion as briefly as may be.
Looking at the matter historically there are, as it seems to me, two main factors that have contributed to the existing position. The first is a general factor, which was developed by the noble Lord, Lord Cohen; that since the Princess Louise 391 Hospital was built more than a quarter of a century ago, for the service of the children of North Kensington, the whole requirement for children's beds has changed. Great improvements in the arrangements for the care of children in infancy, and for their well-being as school children—the provision of orange juice, milk and all the rest of it—have brought about an extraordinary improvement in the general level of child health. And at the same time, the infectious diseases that I and others of your Lordships well remember from our own childhood have been shorn of their terrors by new techniques of immunisation and treatment. There has thus been a great reduction in the need for hospital beds for children; and that reduction is universal throughout the country.
That is one factor, a general factor. The other is a particular factor that concerns the Princess Louise Hospital. It is that in the period immediately preceding the introduction of the National Health Service in 1948, if I am not mistaken, the hospital fell victim to a popular delusion, the delusion that hospitals administered by regional boards were not quite "the thing"; and that if the hospital was to preserve its self-esteem, it was necessary that it should be grouped with a teaching hospital, with the crême de la crême. Those concerned with the hospital therefore pressed strongly, and pressed successfully, for the hospital to be administered by the board of governors of St. Mary's Hospital.
May I deal first with the results that flowed from this second factor? St. Mary's started their life in the National Hospital Service as a group thoroughly badly balanced for the teaching purposes for which they were grouped under a board of governors. The group was heavily overweighted with children's beds, of which it had no fewer than 160; and, no doubt partly as a consequence of that, it was short of general medical and surgical beds for teaching its medical students, and also, particularly, of maternity beds. My board and the Paddington Hospital management committee did what they could to rectify the balance by making 200 beds at Paddington General Hospital—in fact, nearly all the general medical and general surgical beds at the Hospital—available to St. Mary's for the 392 teaching of students. But ever since the National Health Service began in 1948 St. Mary's have laboured under the incubus of 160 pædiatric beds and have inevitably, for all those nine years, been attempting, by a variety of expedients, all abortive, to unburden themselves of the surplus—a surplus which, perhaps it is not unfair to observe, would never have been laid upon them if it had not been for the misplaced snobbism of those responsible for the Princess Louise Hospital.
To turn now to the general factor, there can be no doubt that there are in the Western area of London, which contains North Kensington, more children's beds than are now needed. The occupancy figures—which I am not going to quote, either, though I have seen them—make that perfectly clear. Over and above the seventy-six beds in the Princess Louise Hospital itself, there are pædiatric beds in the east, at St. Mary's Hospital, at Paddington Green Hospital and at Paddington General Hospital; in the northwest, at Willesden General Hospital; in the west, at the Central Middlesex Hospital and at Hammersmith Hospital; in the south, at the West London Hospital and at St. Mary Abbott's Hospital; and in the zone of North Kensington, at St. Charles's Hospital. I will not weary your Lordships with the detailed figures, but there are, in fact, a total of almost 350 beds for children in or within reasonable reach of North Kensington. The figures of occupancy make it perfectly clear that a considerable number of those beds might be closed without doing anyone any harm.
Taking everything into account, the case for a reduction in the number of pædiatric beds grouped with St. Mary's Hospital appears to be very strong; and if the user of the Princess Louise Hospital beds were changed, there is no doubt that other local hospitals could absorb the load without great embarrassment and without any intolerable inconvenience to the public. On the other hand, the Princess Louise Hospital is a good children's hospital, giving a good service to the local community, even though it suffers from what, in spite of the Report of the Royal College of Physicians, which has been quoted, is commonly regarded in both professional and lay circles as the disadvantage of being a small specialist hospital detached 393 from the resources that can be made available in a large general hospital. It is a hospital with a good tradition, and its closure or transformation would be something of a misfortune.
In those circumstances, when the suggestion was made to my board that we might take over the hospital from St. Mary's Hospital, we came to the conclusion, after consultation with St. Mary's Hospital and with our own Paddington Group Committee, that if the Princess Louise Hospital were offered to my regional board we should be prepared to take it over, integrating it with the St. Charles's Hospital as the pædiatric department of that hospital, which is closely adjacent to it, and closing the children's beds at present in St. Charles's Hospital, and perhaps also some of the children's beds in Paddington General Hospital. It would be necessary to include in any such arrangements certain conditions as to nurse training and medical staffing, with the details of which I need not trouble your Lordships. But should not expect those matters, though not altogether easy, to create any insuperable difficulty.
There is, I think, no doubt that such an arrangement would be, in general, beneficial. It would relieve St. Mary's Hospital of their pædiatric incubus; it would reduce the total number of children's beds in the area, and it would give the Princess Louise Hospital the benefits of integration with a large general hospital. But there is one thing it would not do, and that is to provide St. Mary's Hospital with the additional beds for maternity and obstetrics and for other specialities that they need for teaching their students. My board would be prepared to go further in an attempt to solve this problem. They have expressed their willingness to make available to St. Mary's Hospital for teaching—and it would not be altogether easy to do so—fifty beds at St. Charles's Hospital under arrangements similar to those at Paddington.
If I understand the position, however, that is not really what St. Mary's Hospital need. Their need is for beds under their own control; beds which they can use for the particular and changing specialties they need for the teaching of their medical students and the development of their medical school. That is a 394 requirement which my board cannot satisfy, and I am bound to say that I can see no way in which it can be satisfied except by building to provide additional beds for the purpose. I am myself without doubt that it would be for the benefit of the Service if that could be done, and I hope that the Minister, when he considers this matter, may be able to find the means of doing it.
§ 4.15 p.m.
My Lords, we have already had four speeches, and there are ten speakers down who have expressed the wish to follow, so I will try and be brief, even though the whole of the rest of the evening is given up to this debate. I listened with great interest to all four speeches, and I am bound to say that the conclusion of the remarks of the noble Lord, Lord Cottesloe, must have given a balanced view, being neither partisan on one side or the other, and I hope every possible attention will be given to it by the Minister. I could not, however, agree with his opening remarks, when he expressed the view that this was in the nature of a parochial matter. It certainly concerns, and vitally, the parish and whole region of North Kensington. But it seems to me that it is far wider than that.
I speak not as haying been chairman of a big London hospital, because that is in the past and is not really relevant, except that it has given me some knowledge of the terms used and the interests involved. I speak rather as having lived and worked in North Kensington for nearly sixty years, and having had a daughter, a trained teacher, teaching in one of the schools in North Kensington. Although I cannot claim at all the authority and knowledge that is Lord Balfour of Burleigh's, I do know pretty well what the feeling of all that area is, and there can be no doubt at all that it is really intense.
I listened with a great deal of interest to the noble Lord, Lord Cohen. I hoped that I should get from him something much more reasoned than, in fact, I felt we received. I am not going into figures, not only because the noble Lord, Lord Balfour of Burleigh, has dealt so fully with that side, but also because we had that very strange affair of the noble Lord, Lord Cohen, asking for confirmation of his figures from somebody outside the House. In forty years' experience in this 395 House, I have never seen that. But figures can be made to read anything, and we shall have a number of both legal and medical noble Lords speaking, on one side or the other hereafter. We have already had what I should call the almost unique authority of the noble Lord, Lord Webb-Johnson, who was very definite indeed as to the evils of destroying a unit such as the Princess Louise Hospital. No doubt we shall have another view, by an almost equally great authority, from the noble Lord, Lord Moran, and judgment will have to be made between them.
I should like to deal with one aspect on which I do not think enough has been said. There was a good deal of question and answer as to an agreement, and I am not at all clear from what was said what exactly is the position of the noble Lord, Lord Cohen. As I understood him in one of his supplementary replies, he said that he felt obliged to resign from the new Board if it does not follow out the agreement of the old. If that is so, then his defence of the action seems to me a remarkable one.
The noble Lord will forgive my interrupting him, but I do not think I said that. I said that if I came to the conclusion that my conduct was such that I had so pledged myself, if I became a member of the new Board, as not to be free to consider everything that came before the new Board on its merits—if that was the conclusion I came to when I went into the facts—then, of course, I should resign but, as at present advised, I did not regard myself as prejudiced from doing so.
From another observation of the noble Lord, I gather that I transgressed against the Rules of the House by looking back to see whether or not the figures with which I had been supplied—I had not got them with me—were correct. If I offended against the Rules of the House, I hope your Lordships will forgive me. In justice to the noble Lord, Lord Balfour of Burleigh, may I add this? I made a statement as to the contents of a letter which I believed to be true. I have now obtained a copy, and I think it right that I should read the two material clauses to the House. I have shown them to the noble Lord, Lord Balfour of Burleigh, and I think that that would be the right 396 course. The agreement is dated February 28, 1946, between St. Mary's Hospital and the Princess Louise Hospital. So far as relevant, it contains these two provisions:The Children's Hospital is to remain in existence and shall retain in its name its properties, investments and other assets.Of course, the second part of that has gone overboard owing to the Act.The name 'Princess Louise Hospital for Children' is to be retained and shall appear both in the Annual Report of St. Mary's Hospital and of the Children's Hospital if a separate Report is issued.I thought it right that the House should have the correct facts at the earliest moment that I could obtain them.
My Lords, to resume my remarks, of course nobody in any way challenges the moral rectitude of the noble Lord; there is no question of that. That is not implied at all, even by innuendo; but it is important to clear up what is going to be the attitude of the new Board towards the contract or agreement entered into by the old. There seems to be some dispute as to whether it was a contract or merely an agreement. From a moral point of view, I should have thought that there was no distinction whatever. From anything I have heard, I do not feel there is the slightest doubt that the Princess Louise Hospital for Children was handed over to the St. Mary's Board on the distinct understanding—let us use that word—that it should remain a children's hospital. Now, less than a generation after, that is all to be changed.
The reason I say that this is far more important than a parochial point of view is that there is a great moral issue involved here. Here is money subscribed from 1924 onwards for a particular purpose by a particular body of people. Nobody has challenged that that work is going on well. Nobody has raised the only two possible reasons, as it seems to me, why money subscribed for one purpose should now be devoted to another. The first is that the purpose has outlived its usefulness. Nobody has said that. The Princess Louise Hospital is doing good work and it is very much valued all around the area in which it stands. The second possible reason is that it has become inefficient. We have just heard from the noble Lord, Lord Cottlesloe, 397 a compliment to the work that it has been doing. It seems to me that there can be no moral basis whatsoever for now entirely breaking the agreement on which it was handed over. A point which for years has been raised is that of complete control. St. Mary's Hospital wants complete control of this hospital. Even in the passage which the noble Lord read out, the words "for Children" in the name were still retained. That was quite definite. If you are going now to take it away and make it an adult hospital, that seems to me a grave breach of an agreement.
From a national point of view—taking the question out of the parochial aspect—if the money given by the public for one object can be taken away, against an enormous weight of opinion and facts, and devoted to another, what hope is there in the future that anybody will willingly subscribe to anything which can come under such control in this way? I hope that some words which fell from the noble Lord, Lord Webb-Johnson, and which were picked up, I think, by the noble Lord, Lord Cottesloe, might be followed up. He spoke of the need for a new plan. It is obvious that St. Mary's Hospital has great difficulties and is stretching out its hands to take this hospital in order to solve them. They will not be solved from any point of view. It will be an administrative grab, if that is done. But surely now, on the basis of all the arguments and facts that have been given us in this House to-day, which will undoubtedly be carefully studied by the Minister, we have a very solid ground for developing a new plan which, without the tremendous heartburning that the enforcement of this proposition will cause, will meet the perfectly legitimate needs of St. Mary's Hospital.
§ 4.26 p.m.
My Lords, I apologise for speaking out of turn, but I have been asked to speak now by the noble Lord, Lord Jessel, who has had to leave for the moment, and he will be back to speak when I should have spoken. I have no special knowledge of the district to qualify me to take part in a debate of this sort, but I felt that the noble Lord, Lord Balfour of Burleigh, had made such a strong case in favour of the retention of the services provided by the Princess Louise Hospital that I 398 must say a few words in support of his very fine speech.
I found myself in some difficulty to understand the case against the retention of this hospital as a children's hospital. The noble and learned Lord, Lord Cohen, is the only Lord so far who has spoken in favour of the conversion of the hospital. He gave a few statistics. Of course, all statistics can be confusing, but it struck me that he was quoting the death rate in childbirth—if that is incorrect, I hope he will tell me so. I think those were the figures he gave. But you have to get over the hurdle of being born before you can qualify as a patient for a children's hospital. Therefore, I cannot see that those figures have very much bearing on that aspect of the matter, because the hospital is not dealing Mai childbirth. The main contention, as I see it, is whether beds should be taken from other places. I think the case has been made that there are too many beds for children. We are all very pleased to know that knowledge has brought about a situation in which, in the overall district, there are now too many beds for children.
Whenever you take anything away from anybody, always whoever you are taking it from will grumble; and, so far as I can see at the present moment, there is a very good suggested compromise where people are willing to close down children's beds and use them for adult purposes. It is, of course, a compromise, and involves give-and-take on both sides. The only case against the retention of the Princess Louise Hospital as a children's hospital, as I understand it, is that based on administrative difficulties. The teaching function of St. Mary's—which, of course, is very important but is, I think, secondary to healing—would be administratively more difficult. I have not heard it said yet—perhaps I shall—by our medical experts that the actual training and knowledge that can be imparted to and imbibed by medical students will be jeopardised in any way at all. All that is said, as I understand it, is that administratively it would be more difficult under this proposed compromise solution.
As far as the debate has gone now, I think there is a strong case on the other side. I should have thought that the administrative difficulties could be overcome, and that, by so doing, the overall benefit to the children and the specialised 399 children's hospital could thereby be preserved and maintained, at any rate for another longish period. I hope that great consideration will be given to that fact and to those arguments when the Minister has to decide on this difficult problem. So far, I feel strongly in favour of the Motion of my noble friend Lord Balfour of Burleigh. I will detain your Lordships no longer than to say that I wish to support him in his Motion.
§ 4.31 p.m.
§ LORD HADEN-GUEST
My Lords, I have the difficult duty thrust upon me of speaking at this moment. The reason why that duty has been thrust upon me is, first, that I am a doctor and, secondly, that for many years I was chairman of the Medical Manpower Committee and went all over the world inspecting hospitals, and therefore know something of that aspect of the matter. The third reason is that somebody had to be obtained who has been there recently. When I was asked first to do this I had never before been to the hospital. I had a completely open mind on the matter, and I went to see the hospital. I obtained an introduction from a former member of the staff, and I there saw the secretary and the matron, both of whom told me their story.
There is one striking fact about which I must tell your Lordships. I asked about nursing. The matron usually gave nursing instruction to the nurses. She said that there were no nurses in the hospital—why, I do not know; but that is what she told me at the time. I went round the hospital and looked at the various rooms. They were kept in an admirable condition, but I was rather staggered by this fact that there were no nurses in the hospital. There were very few children that I saw. I did not count the children; I did not feel called upon to do that. Naturally, I thought that I could get the facts from either the noble Lord who runs the hospital, if I may so describe it, or from someone else. But I confess that I was dumbfounded by the conditions that I found in the hospital. It was more like a dead than a living place. It is true that the rooms and the wards in which the little children were (there were only a few of them), were very nice rooms. They looked very nice and pleasant. But the fact remained 400 that the matron said she had no nursing work to do because there were no nurses to whom she could give instruction. It is, of course, most important that instruction should be given in children's hospitals, and I came to the conclusion that the organisation of that hospital had gone to pieces. I think it may have been only a temporary matter, but I am just outlining what I found at the time, which was within the last few days.
A number of the things that have been said today I found most interesting, but some of them were rather remote from ordinary life: they were certainly remote from ordinary hospital life and the treatment of hospital patients. I confess that I was staggered at finding what I did. I do not intend to take up your Lordships' time because, until the extraordinary discrepancy between the statements that are made about the hospital and its efficiency and the facts which I found when I walked round it has been explained, I do not think that one can add very much. What is the explanation? Why were there no nurses? How were the children looked after? There must have been somebody there, although apparently there was not. At any rate, that is what I was told only a few days ago. I do not want to continue with that theme. I just put it before your Lordships and ask that we may have some explanation of the facts at the time of my visit and whether that situation is going to be repaired, or whether it is impossible for the people in the hospital at the present time to alter it.
§ 4.34 p.m.
§ LORD AMULREE
My Lords, I do not want to take up a great deal of your Lordships' time, and I certainly do not want to go over the ground which has been covered at great length already by many noble Lords, but there are just one or two considerations that I should like to put forward that may possibly prove cogent to the argument for retaining this hospital for the purpose for which it was originally founded. The first thing of importance that one has to consider is whether, if one has a not very large hospital by itself, rather cut off from any other hospital, that hospital is more suitable for the care of grown-up people or for the care of children. My experience has been that if you are dealing with adult patients it is important to provide accommodation in a big general 401 hospital where the beds are not cut off from the general services of the hospital. In a big hospital the work generally is not so well done and the patients do not get quite the full-quality treatment which they might get.
I do not think the same thing applies to a pædiatric hospital which deals solely with the care of children. Certainly, there have been quite a number of quotations made to your Lordships from the report of the Pædiatric Committee of the Royal College of Physicians, which is a body we have to take seriously, because it comprises people who are practising pædiatricians and know a good deal about the subject on which they are talking. They say that in a children's hospital you can get very good work from purely specialised attention which you would not get in a very large hospital. We have one big specialised children's hospital in London—the Hospital for Sick Children in Great Ormond Street, in regard to which I think nobody would dream of suggesting the children should be removed into a more general hospital.
The suggestion made by the noble Lord, Lord Cottesloe, seems a very good way of solving this problem. When the National Health Service first came into being I was a member of the management committee looking after St. Charles's Hospital and the Paddington General Hospital. They both had children's wards, but I am bound to say that they were not really satisfactory children's wards. I think the suggestion that the noble Lord has made, that the regional board should take the Princess Louise Hospital from St. Mary's Hospital and that the children's wards in Paddington and St. Charles's Hospitals should be closed and should be filled by adults, and should in turn come under St. Mary's Hospital for teaching purposes, is a good point.
The noble Lord, Lord Gorell, said that if people talk about administrative difficulties it means that they do not take the trouble to solve them. I think that there is a great deal in that. It is a phrase that one has been brought up on for a long time. I think the suggestion made is worth while supporting, and I should like to recommend it to the Minister. Suppose St. Mary's found that they had not enough children's beds for teaching, it would be possible to conic to a friendly agreement with the regional board for 402 students to go to Princess Louise Hospital, if more pædiatric treatment cases were going there than to St. Mary's Hospital. That has been already done by one big teaching hospital in London. I know that it is working well and that there is no difficulty at all.
Another reason for retaining the Princess Louise Hospital is that it forms a valuable training school for children's nurses. I was rather surprised that the noble Lord, Lord Haden-Guest, found no nurses there, because I, too, have visited the hospital and I am bound to say that I found it full of nurses. One ward was, I think, shut, for some reason that I cannot remember, but there was certainly a fill nursing staff and quite a number of student nurses, so the matron told me at the time. I cannot quite follow what went wrong when the noble Lord, Lord Haden-Guest, went there.
§ LORD HADEN-GUEST
I do not think anything went wrong when I was there. I went there unannounced and that is what I was told—that is all; nothing else.
§ LORD AMULREE
My impression was not the same. We must have gone on different days and seen different things occurring.
There are two more points which I should like to raise. First of all, supposing the Princess Louise Hospital were to be changed into an adult hospital, it would be an extremely expensive business to convert it, because there is not a single room there for use by patients, from the beds to the window frames in the wards, which would not need to be replanned and rebuilt, because the plumbing and the ventilation is all wrong, and beds for adults could not be arranged in the same way as cots for children. Secondly, from the point of view of St. Mary's Hospital the Princess Louise Hospital is too far away for effective administration and running. One so often finds that if there is a little hospital or block of bees several miles away from the general hospital it becomes, as the noble Lord, Lord Balfour of Burleigh, suggests this might become, a dumping ground for patients who are not of any real interest from the teaching point of view: and that is the last thing that one wants to see occur. For these various reasons I support the noble Lord, Lord Balfour of Burleigh, in his Motion, and 403 I hope that Her Majesty's Government will take notice of what has been said in your Lordships' House this afternoon.
§ 4.42 p.m.
THE MARQUESS OF CHOLMONDELEY
My Lords, I always like to be on the same side as the man with local knowledge; and if anyone has local knowledge on this subject, it is the noble Lord, Lord Balfour of Burleigh, who has served the Royal Borough of Kensington, as councillor and alderman, for thirty years. As the noble Lord has told us, all the council, no matter to what Party the members belong, are behind him. I have some local knowledge, because for five years during the war I bicycled round the north part of Kensington. I found that there were many small houses with a big population of more or less the working type of people. They were a very worthy lot, judging by the services they gave to Civil Defence during the war. Imagine what it must mean for the parents to know that they have a children's hospital at their door! Imagine what it would mean for them if that hospital were taken away! I should like to ask the noble Lord who is to reply to answer one question, if he is in a position to do so. How much would it cost to convert this hospital, which is meant for children only, into an adult hospital? It seems to me that it would be a great waste of money.
My other point, and to me it is a very important one, which has already been touched upon by the noble Lord, Lord Gorell, is that £80,000 was raised some thirty years ago for the specific purpose of establishing a children's hospital. People subscribed small sums and great, and I only hope that I am one of those who subscribed. When one subscribes to a specific cause, is that not to be honoured? If it is not, then we are coming to a very odd state of affairs. I know that the National Health Service authorities have great powers, but I suggest to them that it is not a good thing to start taking away something that has been specifically subscribed for, for although we have a Welfare State we still have a wireless appeal every Sunday. It may be for a cause that particularly appeals to us—the blind, for example. Is the Minister going to ring up on the Monday and say to whoever is responsible 404 for that appeal: "Kindly hand over that money. I am going to give it to something else"? That cannot be done, and I suggest to the Minister that it would be a great mistake for it to be done, for it would mean losing the confidence of anybody who wished to subscribe to a specific cause.
§ 4.44 p.m.
§ EARL DE LA WARR
My Lords, I should like to intervene, only very shortly, and may I mention first a point raised by the noble Lord, Lord Cottesloe, in his most interesting speech? He suggested that it was questionable whether we were right to devote so much time to a debate on a comparatively parochial issue. That was the only point in his speech with which I strongly disagreed. I am deeply disappointed that we have not had the other debate, to which, naturally, we were all looking forward, on a matter of far wider importance; but the answer to the noble Lord, Lord Cottesloe, and possibly other noble Lords who have asked that question, is another question: Why, considering that the matter has been before him (perhaps I am wrong to say that, for I know that there have been changes of Minister) or, at any rate, seeing that the matter has been before the Ministry of Health for between two or three years at least, has the Minister not handled this matter himself and given a decision? Whatever his reason, good or bad, that seems to me the justification for the appeal by the noble Lord, Lord Balfour of Burleigh, to this House. Parliament is for the proper redress of grievances, and your Lordships may remember the words that follow:not disdainful of detail.I confess that I approach this subject with the advantage, or disadvantage, of an entirely open mind. I am not going to say that I have had no prior discussion whatsoever with the noble Lord, Lord Balfour of Burleigh. I have. But I made it very clear to him that I could not possibly promise on which side I was going to speak, or, indeed, that I was going to speak at all. I must say that everything that has been said in this debate must have convinced everyone who has approached the subject with an open or judicial mind that the case put forward by the noble Lord, Lord Balfour of Burleigh, is quite unanswerable. I strongly agree with what was said by the 405 noble Lord, Lord Gorell, that there is a great moral issue at stake, and the noble Marquess, Lord Cholmondeley, who has just sat down, has also referred to it. Within this very generation, no less than £80,000, followed up by a further £30,000, was given by benefactors who knew this district, to meet its needs. That money was subscribed for a specific purpose.
Not only that, but the noble and learned Lord, Lord Cohen, has now agreed that in the discussions that took place between St. Mary's Hospital and the Princess Louise Hospital, there was a very definite agreement that this hospital should continue, and I think the words were: "as the Princess Louise Hospital for Children." Incidentally, I think the noble and learned Lord, Lord Cohen, was just a little too modest about the part he played in those negotiations. Perhaps that is the reason he felt he could free the hoard's hands by resigning. But the board of management did not take that view of the part he played, because they tell us, in a document which they published, I believe, in 1945, that:The board of management desire to record their very real appreciation of the valuable service which Lord Justice Cohen rendered as chairman of the negotiation sub-committee which of necessity was involved in many intricate and delicate questions of policy and adjustment.
My Lords, may I just say that the board of management who paid me that compliment were the board of management of the old board. I apologise to your Lordships for remembering so little of what happened twelve years ago, but perhaps that is forgivable. All I meant was that if the present board, many of whom had nothing to do with the hospital in those days, felt that my presence created an embarrassment I should, of course, have been prepared to resign. But it is important to bear in mind that the discussions were between the old board under the voluntary system and the present hoard, appointed by the Minister.
§ EARL DE LA WARR
The noble and learned Lord is really putting forward what I think is a very novel and indeed, to my mind, very shocking proposition. That is, that if a board comes to a certain agreement and later on desires to change that agreement, all that has to be done is to change the personnel of the board. I personally take it, and I 406 thought that everyone else did, that if a board of which I am a member comes to an agreement I do not free either myself or the board from carrying it out by such a change. Therefore, I say that on moral grounds, because of the purpose for which this money was subscribed; on moral grounds, because of the agreement come to by the board, and on grounds of honour, I should have thought that there could be no other solution to this problem than that which the noble Lord, Lord Balfour of Burleigh, has put before us.
It is true that the National Health Service Act of 1946 attempts to some extent to give the Minister a free hand for dealing with trusts on a certain condition. What is the condition? It is that the Minister:shall so Far as practicable secure that the objects for which any such property was used immediately before the appointed day are not prejudiced by the provisions of this section—that is, Section 6 of the Act. That surely means that if there were no alternative whatsoever to finding a solution, or a part solution, of this problem, then his hands would be free to accept the proposals of the board of governors of St. Mary's Hospital. But is that condition fulfilled? I say, "No"; because we know that the North West Regional Board (we knew it before we came into the House, and what Lord Cottesloe has said has confirmed it) are prepared to accept the scheme put forward by the Borough Council of Kensington for handing over the Princess Louise Hospital as it is to the North West Regional Board and closing other children's beds in other hospitals in order to reduce the surplus provision for children. I think I was right in understanding Lord Cottesloe as saying that whichever of these schemes was adopted, either St. Mary's Scheme or the Princess Louise Scheme, in the ultimate result it was going to be necessary to have further buildings for making full provision for adults and teaching.
My Lords, I am afraid that I have gone on for longer than I should have done. But I want to say that, after listening to what Lord Balfour of Burleigh has said, I am completely convinced by the arguments which he has adduced, and I support the scheme which he has put forward. I hope very strongly that the noble Lord on the Front Bench, if he 407 cannot actually give us to-day the decision which I think practically every one of us in this House would wish to hear, will at least be able to promise very prompt consideration of this matter and that we shall not have to wait another two and a half years. I sincerely hope that ultimately the Minister will give a decision in favour of these—as I believe them to be—unanswerable facts.
§ 4.54 p.m.
§ LORD JESSEL
My Lords, like the noble Earl who has just sat down, I support strongly the Motion which has been moved by Lord Balfour of Burleigh. In his speech he gave all the facts and figures relating to the subject, and at this stage I am not going to attempt to cover the ground again. Incidentally, I must apologise to your Lordships because when I was clue to speak in this debate I had to go upstairs to attend a meeting of a Joint Committee. Therefore I must have missed some essential points in the debate. If, as a result, I make any stupid remarks, I must ask your Lordships' indulgence.
When I first came to study this problem of the Princess Louise Hospital for Children I thought that there was an overwhelming case for keeping it open, and in spite of what I have heard here (I have listened to all the speeches in the debate except three) I am still of that opinion. As medical opinion seems to be very much divided—an ex-President of the Royal College of Surgeons has spoken in favour of the Motion and I understand that an ex-President of the Royal College of Physicians is going to speak against it—I am sure it is not presumptuous for us as laymen to form our own view on the matter. The experts are clearly divided. It will need very strong arguments to convince me that this most modern of children's hospitals can usefully be adapted for an adult hospital. After all, it is one of the few hospitals in this country which was built for the purposes of a children's hospital, and it seems to me incredible that all this specialised equipment and plant should more or less be wasted. I think a figure was given by Lord Balfour of Burleigh showing the amount of plant and equipment which will not be needed if the change is made.
And it is not only a matter of equipment. There is the fact of the training of 408 nurses for sick children. The general hospitals, I gather, find it very difficult to obtain sufficient numbers of these. I believe that the training of nurses for sick children is just as valuable as the training given at St. Mary's Hospital. It seems to me that the proposal made by Lord Cottesloe is an acceptable one—namely, that the North Western Regional Board should take over the Princess Louise Hospital and that the children's beds in St. Charles's Hospital and the Paddington General Hospital should be closed and used for adult purposes by St. Mary's Hospital. This, I think, would be a successful solution. I hope that the Minister, when he comes to reply, will indicate that he is favourably disposed towards this view.
§ 4.59 p.m.
§ LORD CONESFORD
My Lords, in this debate speeches have been made by noble Lords with the highest qualifications of experience and expert knowledge. I have no such qualifications and knowledge, and I intervene briefly for two purposes only. I wish to say something about local public opinion on this matter, and also to put a question to my noble friend the Minister, who will speak for the Government on this Motion. But before I do either of those things I should like to apologise to my noble and learned friend Lord Cohen, because I was unavoidably obliged to attend to public business elsewhere while he was speaking, so that all I heard of his speech were the final words.
In this House, every one of us gives his own view as best he can, and never speaks or claims to speak on behalf of any body of persons outside. Nevertheless, I think it does not conflict with the traditions of this House if a Member states what he believes local opinion to be in a case where he has a special reason to know it, and the Minister concerned himself considers local views relevant and important in deciding how to exercise his statutory powers. Both these conditions apply here. Though I live, and have long lived, in Chelsea, I happen to hold an official position in a political organisation in Kensington, and I am thus brought into frequent contact with views held on local questions. Further, the present Minister of Health has himself informed my correspondent of his conviction that local views would be fully expressed in this 409 debate and of his intention to consider carefully what is said here to-day before he reaches his decision. Opinion in Kensington strongly supports the retention of this hospital as a children's hospital. I believe that that opinion is shared by members of all Parties—indeed, as this debate itself indicates, on this question there is no division of opinion anywhere on Party lines.
The question which I wish to put to the Minister who will later intervene on behalf of Her Majesty's Government concerns Section 6 (4) of the National Health Service Act, 1946. I think that it has already been read, but perhaps I may remind your Lordships of what it says:All property transferred to the Minister under this section shall vest in him free of any trust existing immediately before the appointed day, and the Minister may use any such property for the purpose of any of his functions under this Act, but shall so far as practicable secure that the objects for which any such property was used immediately before the appointed day are not prejudiced by the provisions of this section.I wish to know whether my noble friend agrees that the Minister of Health, in considering how to exercise his powers in the matter which we are discussing, is bound by the obligation set out in the subsection and that it is one of the principal matters which he must consider. I have little doubt twat my noble friend will answer, "Yes" to that question. I am reinforced in that belief by an early circular of the then Minister of Health which dealt specifically with the question of the alteration of the user of hospitals. In that circular the Minister drew the attention of Regional Hospital Boards to the fact that any alteration of the user of hospitals under their control should be made only with due regard to the provisions of Section 6 (4) of the Act of 1946, and was also subject to the Minister's powers of direction. The circular stated that the Minister could not ignore representations made to him by members of the public and the profession. The circular examined the general questions involved and the matters which the Minister would consider. The principal one, the very one that was named first in that circular, was possible loss of service to patients.
It is fair to state that that circular was addressed to Regional Hospital Boards, and we are here concerned with the board of governors of a teaching hospital; but 410 I do not think for one moment that that fact alters the principle, or should make the Minister less determined to see that it is observed. If Her Majesty's Government say that the obligation set out in that subsection is binding, can it possibly be maintained that it is not practicable to maintain this hospital as a children's hospital? I do not know whether that question is a question of fact or a question of mixed law and fact, but in either event I must express the strongest possible doubt, if it is agreed that the obligation imposed by the subsection applies, whether it could possibly be held, in the circumstances of this case, either that the purposes for which the Princess Louise Hospital was used would not he prejudiced by these Proposals which the Governors have accepted or that it was not practicable to avoid such prejudice by continuing to use it as a children's hospital.
§ 5.6 p.m.
§ LORD LUKE
My Lords, I will not detain your Lordships for more than a minute, but I should like to say a few words in support of this Motion. I have been impressed by a number of points raised by noble Lords in the debate. It seems to me that the Princess Louise Hospital is the most modern hospital for children in the area and I should have thought that it was very important to maintain it, or that at least a hospital less modern should be adapted for other purposes and not the Princess Louise. I am also impressed by the fact that the Regional Board, through their Chairman, the noble Lord, Lord Cottesloe, recognise the importance of retaining the hospital for its original purpose. I am a great believer in local support on all occasions, and it seems to me that there is great weight in what the noble Lord, Lord Gorell, said—namely, that this is a moral issue, as local money was raised for this purpose. When the National Health Service Act was discussed in your Lordships' House, great weight was given to this very matter, and I understood that where local money was used, so far as possible local money should continue to be used for local purposes and for the purpose for which it was originally raised. This matter has personal as well as public relations, because there is a very personal relationship between the public and their hospitals.
411 There is also the question of waste. I have in mind a fairly recent experience of my own when, as chairman of another hospital, I found great difficulty in getting capital from the Treasury for purposes which my board felt were greatly needed. Here we find capital equipment—I have heard the figure put to-day at £15,000—being wasted. That seems to me to be a very serious waste when other hospitals are short of capital for their needs.
I was impressed by what the noble Lords, Lord Cohen and Lord Cottesloe, said about the relative needs of adults and children. We appreciate that there has been a reduction in the need for children's beds and possibly an increase in adult requirements, especially for aged people, but surely that calls for a better balance, with less waste and less disturbance to the people concerned. I would suggest that the Regional Board's solution and the Borough Council's solution is the right one.
§ 5.10 p.m.
§ LORD MORAN
My Lords, as my noble and learned friend Lord Cohen knows, I have been reluctant to take part in this debate, because I have been attached for a very long time as Dean of the Medical School to St. Mary's Hospital, and I felt that your Lordships might well think that I could not divest myself completely of bias. My doubts were set at rest, and my reluctance was overcome, because on going into the matter it seemed to me that a basic principle, indeed, one of the two principles on which the efficiency of the hospital service depends, was at variance with, I might almost say in open conflict with, local loyalties and local feelings.
To explain the principle that I have in mind to your Lordships' House I would take you back for a moment before the National Health Service Act came in. Then, as your Lordships know, hospitals had been planted at random, a hospital here, a hospital there, without any regard to the needs of the community. When the National Health Service came into being it was determined that the Ministry should look at the hospital service as a whole; that they would not allow themselves to be taken up with one hospital existing in vacuo, as if the rest did not exist; in other words, that co-ordination would 412 govern their thoughts. It does not follow that because a hospital was founded thirty years ago for a particular purpose, at the present time, in the public need, it is still required for that purpose. If the National Health Service Act laid down no other principle, it did lay down that all the hospitals and their beds should be reviewed to see fairly and honestly whether they were serving the function which the public needs. This must mean a change of function in the beds in certain hospitals. It inevitably always results in a tremendous outcry when local feelings and local loyalties are outraged. It is, however, important that we should not give way to sentiment, however laudable.
This change, which I think many of the speakers to-day have accentuated—that is to say, that there are too many children's beds, and that some of these must be converted into adult beds—is established, and the only question is: which of them should be converted? Let me give your Lordships some examples of this changeover. Not so long ago, all over the country there were hospitals for infectious diseases. Infectious diseases are a dying industry; happily, they are declining. Diphtheria has virtually gone; and scarlet fever, which was a disease of many complications, meaning many weeks in hospital, is now almost a negligible disease. In 1949 there were 21,848 beds devoted to infectious diseases; but in 1955 that number had fallen to almost exactly a half. The result is that some of these hospitals have been taken over for other purposes. It is an example of a trend that cannot possibly be put back: that when beds cease to be needed for one purpose, whatever the arguments on the other side, they cannot be used indefinitely for the wrong purpose.
Take the question of tuberculosis. The change in social conditions and the discovery of antibiotics, such as streptomycetin, have made the death rate fall sharply; and the result is that in the last few years every year more than 1,000 beds hitherto devoted to tuberculosis have been diverted to other purposes. Here and there a small sanatorium would be closed, and then in another institution beds hitherto given over to tuberculosis were diverted to other chest diseases. The very name "tuberculosis officer" was 413 dropped, and in its place was substituted "chest physician".
I come now to the question of children's diseases. It has been generally agreed that, for a variety of reasons, the morbidity of children has fallen quite dramatically. Due to better social conditions, rheumatic fever has almost gone; because of antibiotics, pneumonia in children has become a very mild disease; with immunisation, diphtheria too has gone, and diseases like whooping cough have been made much more amenable to treatment. For these various reasons, in all the Welfare States which have a low birth rate, economic prosperity and a high-grade children's service, this fall has occurred and is continuing. The situation in Stockholm is exactly the same as that in Great Britain; but in India, where these social changes have not taken place, or, at any rate, have not taken place to the same extent, this does no apply. Therefore, it seems quite certain that we have got to agree—and I think we do agree—that children's diseases are not only falling rapidly, but they are going on falling rapidly. If the Princess Louise Hospital, as the result of this debate, received a respite, it would only be a respite.
If that is the situation, and if I am right in saying that there is this fall in the demand for children's beds, then surely it is in the light of that fact that we should look upon the undertaking given by St. Mary's Hospital in 1946. The needs of the people of Kensington do not exist at the present time in the form that they did in 1946. There have been considerable changes, and different measures are needed to meet them. If I am right in saying that many of these beds are now redundant, it would not be sensible blindly to carry out an undertaking before the National Health Service came in, given in totally different circumstances eleven years ago. Logically, if we were to say that a promise is binding for ever, then in a hundred years' time these beds would still be used for children's diseases, although we all hope that by that time children's diseases will almost have died out.
I was able to raise £250,000 for the medical school built at St. Mary's Hospital, and for the laboratories, but I lived to see those buildings taken over by another body. I did not grumble 414 about that; it was obvious to me that it was inevitable. The National Health Service Act has revolutionised things. The St. Mary's Hospital people did not in 1946, in the Machiavellian way suggested, think what the Charity Commissioners would do; they simply did not foresee what was going to happen. The whole picture has completely changed. I do not dismiss a moral obligation lightly. But this has happened all over the country; it is not an isolated case. As a result of legislation, the whole picture has changed.
Let us apply this to the question before your Lordships' House. St. Mary's Hospital found itself, as has been said, with a surplus of children's beds—150 where one half of that number would have sufficed—and it desired to convert them into adult beds, of which it was desperately short. It was under an obligation to carry out the Act of 1946, which laid upon it the duty of providing clinical facilities for the instruction of students. We have arrived at a stage in my argument, if your Lordships will agree with me so far, that children's beds must become adult beds. The only question is, which?—that is really the point. I see that we have agreement on every side on that point. Therefore, let me direct myself to the argument of which beds should or should not go.
Here I think I should refer to the speech of the noble Lord, Lord Cottesloe. We have come to look to him for an enlightened lead on medical matters—I am speaking of doctors. I was responsible for the original liaison between Paddington Hospital and St. Mary's Hospital in 1920. We found that arrangement of incalculable benefit. We have now 195 beds on which the students are taught. Therefore you may say, "If that is so, why do you not accept his offer of additional beds?" The reason is that, though it is valuable clinical material, from the point of view of teaching it has serious disadvantages and limitations. These are, that unless you have administrative control you cannot control the cases admitted to the hospital, which is half the secret in getting suitable clinical material. For that reason, if the noble Lord, Lord Cottesloe, now stood up and said, "You can have administrative control," I would sit down and say, "I have nothing more to say—I 415 accept it." It is as simple as that. At St. Mary's we are saturated with beds of which we have not administrative control, and it would take a long time and, I am afraid, be hard listening on your Lordships' part, to explain the real significance of administrative control. I have been a Dean for twenty-five years, and I am sure your Lordships will accept my word that these beds are not, as Lord Cottesloe admitted, a substitute for what St. Mary's Hospital needs.
The noble Lord, Lord Cottesloe, then went on to say that he would be willing to take over the Princess Louise Hospital. It is not really as simple as that. This brings me to a hard saying, which is, "A small hospital is very difficult to make efficient and impossible to make economic." If we are to economise in this Health Service—and if we do not I do not know where we are going financially—we must reduce the number of hospitals and have large units. There is the old argument which to laymen is not as familiar as it is to doctors, as to whether it is better to treat children in special hospitals or in a large hospital, and an important committee has been quoted in favour of the special hospital. I would say—and this is a mere opinion—that the pros and cons are about equally divided. The real advantage of having children in a general hospital is the efficiency of the accessory departments. They are developing at such a pace—pathology, radiology and the like—that you simply cannot get them in a small hospital with anything like the same efficiency. I have no doubt in my own mind that the future lies with the large general hospitals, and that children must be treated in them because of the accessory departments. There is only one exception, and that is Great Ormond Street Hospital, which is itself a teaching hospital.
If I am right in my argument, it means to say that, generous as the offer of Lord Cottesloe is, it does not bring a solution of our problem. Therefore, for a moment I should like your Lordships to look at the point of view of the Princess Louise Hospital. They say, "If we go, the inhabitants of Kensington will lose all these facilities." Now that is not really the position. The position is that Princess Louise Hospital is surrounded with 416 pædiatric units—literally surrounded, as the noble Lord, Lord Cottesloe, brought out. Within a mile there is one of the best hospitals in England—Hammersmith—which was picked out as a postgraduate hospital in this country, and which has forty children's beds and ten ear, nose and throat beds, which has a university reader in pædiatrics and a pædiatrician in charge of the department. I can imagine no better place. I should like to send my child there. I need not recapitulate the other alternatives, because the noble Lord, Lord Cottesloe, named them, but there are something like half a dozen hospitals geographically accessible.
You come to the blunt and brutal truth that the Princess Louise Hospital is no longer needed. I am forced to say that by the way the argument has gone today, but it is the truth. So here is the answer to the question of alternatives—they are there if you want them. Then they say, "We have special clinics for speech therapy, for rheumatism, for neurology, cardiology and the like." The answer to that is that those clinics can quite easily be put up in another hospital. In fact, I have no doubt at all in my own mind that, from the educational point of view, it is unsound to have these highly developed clinics in small hospital units.
Then we come to a question which I think is of importance, and that is the special training school for nurses for sick children. The authorities at the Princess Louise Hospital say, "If we go, this goes." Now first of all, St. Mary's Hospital have been able to make arrangements that they will be able to carry out their commitments to the nurses now in training at the Princess Louise Hospital. That is only a temporary solution. What is the position, taking a long-term view? The answer is that to have this training school you must have 100 beds, and since the Princess Louise Hospital had not got 100 beds it joined up with Paddington Green Hospital. Now if the Princess Louise Hospital drops out, Paddington Green Hospital would join up with another children's hospital—there is really no difficulty about it—and supply this school.
Finally, the Princess Louise Hospital says: "If we change to adults, we are violating the purposes for which this hospital was founded." I have been at pains 417 to look up this original document. This is what it says under the date October 21, 1929. It is an extract from the Memorandum and Articles of Association of the Princess Louise Kensington Hospital for Children:The Purposes for which this hospital is established are to provide for the reception, maintenance and medical and surgical treatment of the children of the poor…and to provide out-patient medical treatment for women whose position renders them suitable for hospital treatment.Now that was carried out for a short time, but I ant informed it has not been so for years. It would really appear as if this hospital had torn up this document. It is not carrying out one of its functions. A question was asked about what would be the cost of conversion of this building. I am informed—though I have not checked this figure—that it would cost between £5,000 and £10,000.
Let me, in conclusion, say this. If your Lordships would bear with me for a few moments, I should like to utter a very solemn warning. This Hospital Service was not inaugurated at the wish of the doctors, for the vast majority of them are hostile to it; it was brought in because all three political Parties felt that they were committed to the electorate to provide a comprehensive medical service. We were told that the country wanted it. If that is true, I think your Lordships may feel that responsible men everywhere would seek to strengthen the hands of the Ministry in co-ordinating this Hospital Service, which is a very unpopular thing to do. We have had this time and time again over the country.
Last year, St. George's in the East, a hospital formerly under the London County Council, was closed because it was no longer needed, and there was a tremendous outcry in the East End. Again, at Kingston the agitation went on for several years because a general practitioner hospital was taken and changed into a gynæcological unit, which I am told is now very useful to the neighbourhood and very efficient. Remember, this sort of thing is going on everywhere, and conversion is never easy. The people round the hospital invariably say that their hospital should function exactly as it began thirty or forty years ago and should never be changed. One hundred years hence it is still to be used in the same way. It is not easy, but it would become quite impossible 418 if we had not the support of thinking men.
In this connection, some of your Lordships may wonder why we are debating in this House the isolated case of a change of function on the part of a small hospital. Is this a test case, or are we to have a debate in this House every time there is a change of function? If local needs and local loyalties are to take charge, ignoring the need for co-ordination; if, when a hospital has no longer a function, it is still to go on because of local loyalties; if this controversy which has been going on for at least three years is to be taken as a pattern; if the beds which have been taken front infectious diseases and tuberculosis are to be given back when they are not needed—if, in other words, the whole of co-ordination is to be reversal, I should despair of our attempts to co-ordinate this Service.
This is a question of head versus heart. That is the blunt truth. I have the thankless task of contending for principles against emotions. I believe that your Lordships will treat this issue with the cool, dispassionate and detached care which you bring to every question. If we do not get your support, we cannot carry on this Service. It is an unpopular Service with the doctors. We are trying—I say this feelingly because, when the Act began to operate, the Royal College of Physicians was the only body that favoured this because they felt it was politically inevitable—to make it work. We received an enormous amount of abuse. I ant told by political friends that Mr. Aneurin Bevan founded the Service but I am told by my many general practitioner friends who hate the Service that I ant responsible. I seem to get the worst of both worlds. I appeal to your Lordships to put sentiment, however laudable, on one side and to concentrate on the real job that faces the Ministry and to support them in it—taking each institution and seeing whether it is really serving the needs of the public as it should.
§ 5.36 p.m.
§ THE MINISTER OF STATE, SCOTTISH OFFICE (LORD STRATHCLYDE)
My Lords, I have been invited in the course of the debate to give an answer to three questions. The first was asked me by the noble Marquess, Lord Cholmondeley, who asked what the cost of the change of use of the premises at 419 the Princess Louise Hospital would be. The best advice I can get on the matter—and my noble friend Lord Moran has already given a figure which I do not think is far out—it that the cost of changing over two wards would be somewhere around £6,000. What the cost of changing over the remainder of the hospital would be I cannot tell. Then the noble Earl, Lord De La Warr, wanted to know why my right honourable friend the Minister of Health had spent two years on this matter and had not yet come to a decision. I am advised that the time has not yet come when a decision by the Minister is called for, and that in fact the time will not come until the board are allowed to go ahead with the establishment of their new units. The third question asked me was by the noble Lord, Lord Conesford, and I will endeavour to reply to that during the course of my remarks.
May I say that it is not my intention this evening to endeavour to weight the scales of argument either on one side or the other, but, if your Lordships will bear with me, I will venture to make one or two observations. First, I should like, on behalf of my right honourable friend, to thank the noble Lord, Lord Balfour of Burleigh, for having initiated this debate. I should also like to thank other noble Lords who have taken part and who speak with such a wealth of knowledge and experience on this subject. Naturally, in a debate of this nature many varying views and opinions have been expressed, but I think your Lordships will agree that the debate as a whole has been helpful and informative, and also constructive, and should materially assist my right honourable friend to arrive at what must be a very difficult decision in regard to the proposal of the board of governors of St. Mary's Hospital. I do not think there is anyone in this House who can have any doubt at all that since it came into being some twenty-nine or thirty years ago the Princess Louise Hospital has rendered invaluable service to the sick children of Kensington, and even to a wider field than that.
It seems to me abundantly clear that medical science is constantly changing, and with it the need for various types of accommodation; and from that it would seem to follow that the use of our hospital resources must have regard to these 420 changes. I wish to assure the House that my right honourable friend the Minister recognises that he is required under Section 6 (4) of the National Health Service Act to secure as far as practicable that the objects for which any hospital was used before the appointed day are not prejudiced. I think that answers the question of my noble friend Lord Conesford.
It seems to me that the operative words are "as far as practicable", and that my right honourable friend must have due regard to changing needs, and that in this case he must consider the trend in the demand for hospital beds for children and the teaching requirements of the University, both of which are of primary importance. I am sure that your Lordships will agree that this provision in the Act did not and could not mean that my right honourable friend was required to maintain for ever unaltered the objects for which hospitals were used immediately before transfer to the Crown. For example, it is obvious that the objects of a particular hospital might be secured by providing services elsewhere.
It will further be recognised that under the Act my right honourable friend is no less bound to see that available hospital resources are used to the best advantage and in the best interest of all who need them. The particular problem which my right honourable friend has to solve here is whether this individual change is necessary. It is the responsibility of the board of governors to provide a proper balance of facilities for undergraduate clinical teaching, and they were faced with the practical difficulties within their Group of too many children's beds and inadequate facilities for the teaching of obstetrics and gynæcology. If I might expand on that aspect of the matter, your Lordships will recollect that the Inter-Departmental Committee on Medical Schools, generally known as the Good-enough Committee, recommended that the proportion of children's beds in a teaching hospital of 800 beds should be 80—that is to say, 10 per cent. The percentage of these beds in St. Mary's Medical School is 18 per cent.
The University of London has decided to establish a Chair of Obstetrics and Gynæcology at St. Mary's Hospital and the board of governors, with the Minister's approval, agreed to provide the 421 necessary hospital facilities which in the opinion of the board of governors, an opinion arrived at after long consideration and consultation with the constituent hospitals of the Group, including the house committee of the Princess Louise Hospital, could best be made available by reducing the number of children's beds, which in the Group is excessive for teaching purposes and for which the supply exceeds the demand.
My Lords, the Board decided, after having considered every alternative, that the interest of all concerned could best be achieved and the proper proportion of children's beds in the Group most conveniently obtained by making the Princess Louise Hospital an adult hospital. On the other hand, there was the fact that this local children's hospital which, as has been said in the debate, had originally been provided by the people of Kensington was deeply cherished in the locality which it served and that alternative proposals had been made suggesting ways and means whereby teaching needs could be met without changing the use of the children's hospital.
Wider issues also were involved, such as the relation between the demand for and the supply of hospital accommodation of different kinds for this part of London as a whole, and the arguments in favour of changes arising out of the falling demand for beds in various specialities, of which pæcliatrics was one. Strictly speaking, the position was that it was within the discretion of the board of governors to change the use of individual constituent hospitals or parts of them in the exercise of their duty to provide both for the adequate treatment of patients and facilities for the associated University Medical School, but in this case they consulted my right honourable friend. It seems to me that in seeking the guidance of the Minister before taking any irrevocable step the board were not only acting wisely but were making obvious their desire to act fairly in this matter, and in these circumstances I would submit to your Lordships that their action is to be highly commended.
My Lords, I am sure that we all feel, as I said earlier, that this debate has served to bring out the pros and cons of a very difficult question, and I can assure your Lordships that the arguments that have been set forth on one side or the other this afternoon will receive the earnest and 422 sympathetic consideration of my right honourable friend the Minister.
§ 5.45 p.m.
§ LORD BALFOUR OF BURLEIGH
My Lords, at this late hour, I shall not detain your Lordships for more than a few minutes, but there are some observations that I feel bound to make. In the first place, I must thank all noble Lords who have taken part in this debate. I am sorry that he has gone, but I should particularly like to thank the noble and learned Lord, Lord Cohen, for having taken the honourable course of admitting to your Lordships in the debate that he was wrong on the point on which he was quite emphatic to the contrary when I first made it. Perhaps I might be allowed to say that I am only sorry that he did not find it cut two years ago. The noble and learned Lord, Lord Cohen, and the noble Lord, Lord Moran, have made a very good case, in theory, for the conversion of some children's beds to adult beds, but I think they are a good deal less convincing on the argument that the proper beds to convert are the most modern and, I say, the most urgently needed beds in Kensington. I was extremely heartened to hear the remark of the noble Lord, Lord Cottesloe, that it would be a misfortune to close the Princess Louise Hospital.
Before I make one further reference to Lord Moran's remarks, may I refer to the remarks which felt from Lord Haden-Guest, who said that he had, visited the hospital and that there were no nurses there at the time. It so happens that both the secretary and the matron of the hospital are within the precincts of the House, and without transgressing the rules of order I have been able to refer the matter to them. I am assured by he secretary that, although one ward was closed, the hospital was fully staffed; and I am assured, through an intermediary, by the matron that there were four nurses per ward on duty at the time of Lord Haden-Guest's visit. If Lord Haden-Guest will permit me to make a humble suggestion, perhaps he had better pay a visit to his oculist.
§ LORD HADEN-GUEST
I am obliged to the noble Lord for making that statement, but I went round several of the wards and I saw no nurses at all. It was the matron there who told me that there 423 were no nurses. Obviously, it was a mistake, but that is what I was told. I am just relating the experience I had: I have nothing against the hospital.
§ LORD BALFOUR OF BURLEIGH
I accept Lord Haden-Guest's statement that he saw no nurses; I adhere to my statement that there were four nurses per ward on duty at the time.
The noble Lord, Lord Moran, referred to Article 6 of the Memorandum and Articles of Association, and said that the Princess Louise Hospital had not been doing its duty because it had not provided out-patient medical treatment for women and that St. Mary's intended to do that. The proposal which St. Mary's have put to the borough council is that they will make the Princess Louise Hospital an obstetric unit and then a unit for adults.
§ LORD MORAN
I am sorry to interrupt, but I did not say anything specific except that it was used for women. I did not say anything, beyond that.
§ LORD BALFOUR OF BURLEIGH
I will not pursue the matter. The noble Lord, Lord Moran, will not deny that he made a great point that the Princess Louise Hospital is surrounded by pædiatric units in other hospitals, and that therefore it ought to be closed. He said that the brutal truth is that the Princess Louise Hospital is no longer needed. The hospitals by which it is surrounded are the old poor law hospitals of another day—St. Charles's, the old Marylebone institution, and Paddington General Hospital, the old Paddington institution. Which is best?
§ LORD BALFOUR OF BURLEIGH
Certainly. Whatever is the fact about the diminution of need for children's beds, I do not think anybody can deny that there still remains the need for a children's hospital of seventy-six beds in Kensington.
424 The noble Lord, Lord Moran, asks what would be the position in one hundred years if we never changed anything? One hundred years can look after themselves; we have to look after to-day; and we, the borough council, know the needs of the area. We say that this hospital is still needed, and that its retention is the best way of meeting the needs of the area. The noble Lord, Lord Moran, in his very skilful speech, made an appeal to heads against hearts. I think the heads "have it." He asked would the Minister take each institution and see where it serves the needs of the public. Exactly, my Lords, if the Minister will take the needs of the public in Kensington, he will find that that public requires the services of the Princess Louise Hospital.
I find it impossible to believe that, after the weight of expression which has been made in this debate in your Lordships' House, the Minister will do other than allow the Princess Louise Hospital to continue as a children's hospital. I wish St. Mary's Hospital well. They need rebuilding. Perhaps the solution is that the Minister should get the Treasury to find the money and do the necessary rebuilding and give St. Mary's the extra beds they want. I confess that I cannot follow the logic of the noble Lord, Lord Moran, who explained at some length how impossible it was for St. Mary's to take advantage of the offer of the noble Lord, Lord Cottesloe, and the Regional Board. I should have thought that it must be a matter of rearranging beds. If money is wanted for rebuilding St. Mary's I support the plea that they should have it, but I am convinced—and I end as I began—that the Princess Louise Hospital is serving a useful purpose. It is a modern hospital and it would be a crime if it were destroyed. I beg leave to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.