§ 8.7 p.m.
§ LORD CROOK rose to ask Her Majesty's Government whether, in order to help the sick and aged, and in the interest of economy of administration, they will take effective steps to secure that arrangements are made for the cleaning of the surgical belts supplied to patients by the hospitals. The noble Lord said: My Lords, I am sorry to detain your Lordships for a few more minutes to ask this Question which is on the Order Paper in my name, again a Question dealing with the aged and the sick. In the course of moving among people in my own home area I discovered that first one firm and then another had ceased to cause any work to be accepted in their shops for the cleaning of surgical belts, and I wrote to the Sutton and Cheam Hospital, Sutton, which is mainly responsible for the patients whom I knew, to point out that after months of attempting to secure service from any other dry cleaners than the one which was first referred to by that hospital, I was in the situation that I could find no other cleaning firm to provide it. Indeed, in an area from Kingston to Croydon it was impossible to find a shop of one of the cleaning firms to do so.
§ I believe this is due to some fear on their part about faulty cleaning, but that I do not know. This is no help to the patient, who is given a belt and told to have it cleaned from time to time, and that it must be cleaned only by dry cleaning; but who then in fact causes the belt to be subjected to washing powders and detergents and to be put into a 863 washer or spin-drier. This deteriorates the belt and, as I pointed out, causes a replacement of the belt to be necessary at a very much earlier date. It probably causes the belt to be unfit to be worn either by reason of the deterioration in the washing, or even because the detergents themselves might cause a skin irritation.
I suggested that this was a position which the hospital authorities might put to the Ministry of Health. It was not for me to judge whether the hospital authorities or the Ministry should take steps to do something about it. The hospital authorities sent a copy of my letter to the Ministry, saying it was true that patients were finding it impossible to get firms to clean their belts, and that a surgical fitter who attended the hospital had told the officials there that he knew that the same difficulties were being experienced in other hospitals. The almoner of the hospital, writing to the Ministry of Health at Blackpool, pointed out that
… makers do not recommend that belts should be washed at home, because unless they are dried very quickly the steels are liable to stain the material. Moreover some of our patients live in old people's homes, bedsitting rooms or small flats and have not the facilities to wash and dry their belts. Removable steels are not considered satisfactory, as patients can remove them at will and may not wear them.
The reply came back from the Assistant Director of Supply at the Ministry of Health, and I am bound to say, as one who has had long experience of the Civil Service and the excellent service it gives and its great co-operation, I have never in my life seen a more unhelpful or useless letter sent out by an officer of a Department. He says:
There is no provision in the National Health Service for the cleaning of these supports but some contractors will undertake this work by private arrangement if patients request them to do so.
Patients who do their own cleaning, either of choice or because they are unable to get any cleaning firms to do it for them, are not advised to put their belts in a washing machine or a spin drier, nor should they use a strong detergent.
A recognised method of cleaning is to lay the garment flat and gently scrub it with a soft nail brush, using hot soapy water. This can be done with the steels, etc., in position, but where practicable it is advisable to remove them.
I do not know whether to call that a case of telling grandmother to go and suck eggs, or a complete and utter failure to recognise what had been said in the letter he had received. He says that some contractors will do this work, but the whole point of the letter sent to him was that there were large numbers of patients wanting help from someone in the Ministry because they could not get firms to clean them. He says they are not advised to put belts in washing machines. He was told that that was the reason it was being raised, in order to stop their doing that. Then he says:
A recognised method … is to lay the garment flat and gently scrub it with a soft nail brush …
Who recognised it? Recognised by the doctors who forbade it, or by the firm who made them, who forbade it and who put it in writing? Or recognised only by the gentleman sitting in Blackpool, who, without any consideration, thought he would give his own good advice?
§ He had been told the makers did not recommend that belts should be washed at home because the steels were liable to stain. He ignored some of the people in old people's homes, bedsitting rooms and flats who had not any facilities at all. Similarly, he went on to suggest that steels should be removed, where practicable. If he knew anything about the subject he would know that most of these steels are completely fixed and sewn in, with all the corners capped in leather; it is done deliberately to stop patients from taking steels out. The one thing doctors and physiotherapists are afraid of is that belts are such painful and annoying things that people will think of taking the steels out. He had been told that removable steels are not satisfactory, but he was good enough to suggest that they should be taken out.
§ I hope I am going to get, as I normally do from the noble Lord who is to reply, a much more helpful attitude than was shown by this reply, divorced as it was from any knowledge of the problem, not even recognising the facts that were put in the letter sent to the Ministry, making no attempt to solve the problem of the aged and sick, people who have great appeal to your Lordships and in whom I know the noble Lord 865 the Parliamentary Secretary to the Ministry of Health has great interest. It is not for me to say whether the solution should be one or the other, whether it should be some attempt to make arrangements for some firm to take the belts to be cleaned or whether the hospital authorities throughout the country should themselves undertake it. I say it is no good doctors prescribing the belts and saying that they should be cleaned and how they should be cleaned, with the steels left in, and then to get an unhelpful attitude such as is revealed in this letter.
§ LORD TAYLOR
My Lords, I want to add only one word, and that is to support my noble friend Lord Crook heartily in everything he said and to ask the Minister whether there is not some sort of service for washing colostomy belts and how far such a service could be available for washing ordinary surgical belts. These people are very often arthritic and find the greatest difficulty in scrubbing and cleaning the belts themselves, and if the facility could be generalised in that way it would be a help.
§ 8.16 p.m.
§ LORD NEWTON
My Lords, the noble Lord's Question asks the Government to assume the responsibility of arranging for the cleaning of surgical belts supplied by the National Health Service. This is obviously not a matter which lends itself to very lengthy debate, at any time of the day or night, but it is no bad thing that it has been raised in your Lordships' House, since the fact that it has been raised is evidence—if evidence is needed—that we who sit here are not as out of touch with stark reality as our detractors would sometimes have the world believe.
The noble Lord's request could be met in either of two ways. The first way would be to compel all laundries and dry cleaners to undertake the task (at present some refuse to do so) and make noncompliance a punishable offence. I suggest that would be an intolerable limitation of commercial freedom, and I am quite certain that Parliament would not countenance it. Moreover, having examined a number of these belts I accept unhesitatingly the recommendation of the manufacturers that they 866 should not be washed or cleaned by mechanical means. The second way would be for the National Health Service to do the cleaning. I have studied my Minister's duties under the National Health Services Acts, and I am quite certain that he has no duty to be responsible for the ordinary routine care of any appliance supplied by the National Health Service, though he does accept responsibility for repairs. But repairs are not ordinary routine care. The only exception is the cleaning of wigs, because that requires a special process which cannot be undertaken in the ordinary way.
If the National Health Service were to be responsible for the cleaning of surgical belts the annual cost to the taxpayers would be more than a quarter of a million pounds, and there would be a further bill, which we could not avoid, for cleaning other appliances, such as colostomy and ileostomy belts, to which the noble Lord, Lord Taylor referred, elastic hosiery and brassieres. With great respect, the cleaning of a surgical belt is a perfectly simple operation, provided that it is done before the belt gets too dirty, as it obviously ought to be, and as the manufacturers recommend. And the evidence we have in my Department is that most wearers do their own cleaning or, if they are sick or elderly, have it done at home by those who look after them.
I must admit that I had never seen a surgical belt until the noble Lord's Question appeared on the Order Paper. But as soon as it did I sent for samples, including a dirty one—the technical description is "soiled". I washed it, following the instructions of the manufacturers; that is to say, I squeezed it thoroughly in warm soapy water, rubbed it lightly with a nail brush where most soiled, carefully rinsed it in clean tepid water and avoided intense heat in drying it. I should think that this is a very easy operation to perform in one's own home; but I had to perform it at the Ministry of Health at the Elephant and Castle. I found a cubby-hole with a sink and water, but there was no table or draining board. However, my resourceful Private Secretary produced a tea tray, and he held the tray while I washed the belt upon it. I have the result here. With all due modesty. I 867 do not think it is a bad effort for a beginner. The creation of iron mould through the rusting of the steel supports is a slight nuisance, though I found I could get rid of most of it by rubbing with half a lemon dipped in salt. However, this nuisance does not often arise, because most of the manufacturers already produce belts with removable steels, contrary to what the noble Lord, Lord Crook, evidently believes. Moreover, we in the Department are considering amending the specifications of all surgical garments to provide that all steel supports must be removable. We are also considering with the manufacturers the use of materials other than steel.
Finally, I consulted my wife. She says that all women, whether or not they send most of their washing to a laundry or dry cleaner, always wash certain articles of apparel themselves. After fifteen years' experience of married life I was not surprised to receive that information.
Until the noble Lord raised this matter we did not know that any problem existed. Indeed, my Department have 868 been unable to find any record of a complaint by a wearer. I am told that the manufacturers receive comparatively few dirty belts for repair. This seems to suggest that the great majority of wearers have little difficulty in arranging for their belts to be cleaned or washed or in doing the job themselves and, as I said earlier, our information is that most people do the job at home or have it done at home for them. I am further advised that it is probably better for the belts to wash them at home than to send them to a dry cleaner.