THE HOSPITAL AND MEDICAL SERVICES

HL Deb 03 February 1965 vol 262 cc1154-72

2.42 p.m.

LORD AUCKLAND rose to call attention to the Hospital and Medical Services, with particular reference to the shortage of physiotherapists and other ancillary grades; and to move for Papers. The noble Lord said: My Lords, I beg to move the Motion standing in my name on the Order Paper. Parliament and the nation have paid their valedictions to one of the greatest statesman of all time, and in that connection there is one Member of your Lordships' House to whom I am sure this House, and the nation as a whole, would like to pay a very deep tribute. I refer, of course, to the noble Lord, Lord Moran. It is unnecessary for me to go into any detail of what the noble Lord, Lord Moran, has achieved. Sufficient to say that on more than one occasion it was through his ability and his courage that Sir Winston Churchill was able to lead this country through to victory.

It is perhaps another unique occasion in this House that we have to-day four maiden speakers. My noble friend Lady Brooke of Ystradfellte has a most distinguished record in the field of the Hospital Service, on hospital management committees and in the field of education, quite apart from her great contribution in the field of politics. Her husband, of course, my right honourable friend the Member for Hampstead, has served this country for a number of years in important Government and Cabinet posts, and between them they have made an admirable husband and wife team in the field of Government and public service. I am certain, that we are all looking forward very much to listening to her contribution to this debate.

Then there is the noble Lord, Lord Sorensen, who is to address us, from the Government Front Bench, for the first time. Some years ago I went to Leyton to speak for my honourable friend the present Member for Leyton, and I know in what very high regard the people of Leyton, irrespective of Party, held, and continue to hold, the noble Lord, Lord Sorensen, and of their indebtedness to him. I wish him a very happy career in this House.

The noble Lord, Lord Segal, has had a distinguished record in the R.A.F.V.R., and in a great many branches of medicine, and he will be a most valuable addition to the professional medical strength in this House. The noble Lord also represented Preston for five years. Finally, we are to have a maiden speech from the noble Lord, Lord Leatherland, who has in his time served with distinction as Chairman of the Essex County Council. I know that I represent all sides of this House when I say to all four noble Lords that I wish them well, not only in their maiden speeches but in their careers in this House.

My Lords, this is a particularly suitable time to debate the Medical and Hospital Services. It will not have escaped your Lordships' notice that in the national Press and in the medical Press a great deal of concern is currently being shown, not only about the future of the Health Service but also over the staffing of our hospitals and of local authority matters. I have not put down this Motion to play politics, although I shall have one or two controversial things to say. But I think that at the outset I can say with confidence that both Houses of Parliament, irrespective of Party, want the Health Service to continue working and going from strength to strength, and are genuinely concerned about the shortage of doctors, nurses and physiotherapists and others connected with the medical profession.

We have to-day a distinguished list of speakers, many of whom, with their practical experience in the field of medicine, know more than I. I know that the noble Lord, Lord Taylor, who is to wind up this debate, is one of our most conscientious Ministers, and I know that he is as concerned as anyone about the present situation. I have sent the noble Lord a list of questions and points, although I will not bother your Lordships with them in any detail, because if I were to quote from the correspondence I have been sent I could detain this House as long as the Covent Garden Opera Company would take to perform Parsifal. But I do not propose to do that.

I would turn first to hospitals. If I may begin with a mildly political point, the late Government have been accused from many sectors of thirteen wasted years, particularly in respect of our Health Service and our Hospital Service. I should be the very last person to defend my Party on every single decision which they made, or did not make, but I would point out that some 200 major schemes have been completed since the inception of the Ten-Year Plan, this very controversial Plan, while the number of general practitioners has increased by some 17 per cent. and of hospital doctors by some 20 per cent.

Let me say at once that that is not enough. There is one fundamental point which needs to be made at the outset, and that is that we in this country are coping with an increasing birthrate—some 3 million more babies per year are being born—and more and more are people living longer. I do not think that any of us would necessarily want that to be checked, but it is placing an intolerable strain on our Hospital and Health Services, and a strain which I suggest no Government, no Party, can solve in one fell swoop.

If I may turn to hospital building, of course building a hospital is not like building a housing estate at Esher or Epsom, or anywhere else. A site has to be found; an architect or architects must be consulted; they have to plan; the hospital has to be staffed; equipment has to be obtained. Above all, there is the problem of recruitment of suitable staffs. It is probably fair to say that the London teaching hospitals, indeed the teaching hospitals throughout the country, are not so seriously short staffed as are the general hospitals and, above all, the mental hospitals, about which I shall have something to say in a few moments. One of the problems is that we are concentrating too much on rebuilding old bits of old hospitals rather than building new ones.

Of course, there is the question of cost. It costs a lot of money to build a hospital. As I said in your Lordships' House last July, when we debated hospitals on a Motion by the noble Baroness, Lady Summerskill, I paid a visit to one of our brand new hospitals, the Queen Elizabeth II Hospital at Welwyn Garden City, a hospital which has many attractive features. The patients are exceptionally well cared for, but already the hospital is running into serious difficulties of space. For example, the physiotherapy department, which was originally built to cater for in-patients only, had now, I was given to understand, to cater for the out-patient community of Hatfield New Town and other relatively densely populated areas. I am told, too, that the Luton and Dunstable hospital additions under the Ten-Year Plan were insufficient a year ago; and this must be a problem facing many hospitals.

Of course, any ten-year plan, any five-year plan or fifteen-year plan must depend on the availability of labour and materials and staffing at any given time. I believe that Mr. Powell should be congratulated on having brought in this Ten-Year Plan. As I say, criticisms of it have not been confined to members of the present Government; there have been many criticisms from the Hospital Service as a whole and from other sources, but it is at least a blue-print.

How are we going to combat this problem of hospital building? I believe we have to fight to the death the business of architects getting together and wanting to build the most attractively designed hospital. What we need for our new hospitals are buildings, of a prefabricated type if you like, which will last a reasonable length of time but will also be pliable units and able to switch from one aspect of medicine to another. There is no doubt that there are three main needs to-day: accident departments, maternity departments, and geriatric departments—that is, of the non-mental hospitals. Of course, mental hospitals, as I shall show in a few moments, present a very different picture.

The other day I toured the new site of the future St. George's Hospital which is to be at Tooting. We have here a very curious mixture of really old, almost crumbling buildings of the old Grove Fever Hospital, constructed, as fever hospitals were, on stilts to allay the infection from them, and temporary new buildings. Let me say at once that the staffs, from senior consultants and the house governor and the hospital secretary and matron right down to the porters and the most junior student nurse, are working splendidly. The hospital on whose house committee I serve, the Victoria Hospital for Children, in Chelsea, has moved to Tooting already. There were many of us who viewed this move, when it took place, with some regret because it will be, as I understand it, some ten years under the present plan before St. George's will be completely built on its new site. Many of us felt that the hospital for children at Chelsea should continue there for a time yet. But the decision was made; the move has taken place. That has gone smoothly and the wards in which these children are now housed are very pleasant indeed.

Then there is the question of the costing of some of these hospitals. I have studied with some interest the latest progress report, No. 6, of the Ten-Year Plan, and what does rather worry me is to see that in some hospitals a new boiler unit is going to cost about £80, 000. I do not claim to be an authority on this subject, but I am quite certain that this must cause a great deal of concern. I know that hospitals must have the finest type of heating and I have no doubt that the Regional Boards and the engineering departments have gone into this matter very carefully, but I should like to ask the noble Lord, Lord Taylor, whether his right honourable friend has gone into this question of the cost of boiler units and whether other such technical developments have been gone into sufficiently carefully.

The problem of doctors, particularly of the junior grades in hospitals, is already known to your Lordships. But I was reading an article in the Sunday Times Supplement of some two months ago, which said that in Sheffield some 80 per cent., and in Manchester some 60 per cent., of the junior housemen and casualty doctors are from abroad. We are most grateful to these people, but, quite obviously, there are some extremely difficult problems here. One of the main problems is that of language. It is well known that on a Sunday, especially at a small general hospital, the casualty departments are staffed to a minimum. This is unavoidable, because otherwise the existing staff would be working round the clock. Quite obviously, this is not possible, or even fair. It may be that a young houseman who does not have a good knowledge of English is on duty. Somebody may come along with a severe cut arising from the usual weekend activities, such as gardening, and this has to be dealt with. The junior doctor sends for a certain drug, and the sister or nurse concerned may misunderstand what he has said. The result, or possible result, is surely plain: a life injury, or in any event some serious injury, may be caused.

I now turn for a moment to general practitioners. There are some noble Lords who are doctors who will be speaking in this debate, so my remarks in this respect will be brief. But your Lordships may have noticed in the Daily Express an article written about a week ago by a general practitioner, aged 54, who has served for thirty years in practice. He heads his article Why I refuse to remain a doctor in Britain".

I should like briefly to quote from what he says—namely, Let me tell you what life is like for a general practitioner under the National Health Service. I have a one-man practice of 3,000 people which I started from nothing thirty years ago. My working day starts at 8.30 a.m. and finishes, if I am lucky, at 9 p.m. I do two hours in surgery, morning and evening, and the rest of the day, almost without a single break, is spent in making visits. I work between 60 and 70 hours per week. On the average, I am called out from my bed two nights per week. I am required by my contract, under pain of heavy penalties, to be available to each of these 3,000 patients 24 hours a day, 365 days a year.

Now I come to the one really controversial point which I wish to make in this debate. The Government decided to end National Health prescription charges as from February 1. Let me say this at once. It was known for some years that the Government intended to do this, and I am not accusing them of sharp practice. But I am accusing the Government of lack of logic and lack of foresight. What is going to ensue? I know that the Minister of Health in another place said that he did not think that doctors would be overworked as a result of these charges being taken off. I have spoken to a number of my local general practitioners. They do not look after wealthy magnates but ordinary family people, and their views are most extreme. In fact, some are so angry that they regard it as a necessity that the patient should pay something for each visit for treatment. I am not going to suggest that in this House to-day. But this is what I have been told by more than one general practitioner, and there has been correspondence on the subject in the British Medical Journal and in other journals. I do not for one moment deny that the idea of removing prescription charges is a fair and sound one, but I feel that before this is done those who work in the National Health Service should be properly remunerated.

Let me make this further point. The recent pay increases to physiotherapists amounted to some £660, 000. The cost of removing prescription charges is likely to be £26 million plus. Even if £3 million of this money has been set aside for the increased remuneration of physiotherapists and their auxiliary grades, they would have got a much better deal than they are getting now. I know that the Government have decided to go ahead with this plan to remove these charges. Nevertheless, I think the point which I am making is a fair and valid one.

In their Election Manifesto the Government said that they were going considerably to increase the number of doctors in the Health Service, and also to increase the number of physiotherapists and radiographers. That is a laudable idea, and I hope that the noble Lord, Lord Taylor, is going to tell the House what plans the Government have in mind. I know that they have been in office for only just over 100 days, but I hope that among the things which they have considered is how these new doctors are to be obtained. The medical profession is extremely worried about this.

As regards doctors' pay, there have been a number of inquiries into this, and of course probably no two doctors can agree between themselves whether they should be paid as a salaried service, by capitation or by a pool system. I do not think it is fair to expect any Government to be able to solve this problem off their own bat, but I only hope that the Government will give very high priority to the conditions of service and the pay of our doctors.

I should like to turn for a few moments to physiotherapists. The increase which they are getting under the new awards system is paltry indeed, and by the time they have paid the extras which they have to pay many of them will be getting, as I understand it, an addition of about £20 net a year. A young man of my acquaintance, who is partly-sighted, has just moved to Harlow, which the noble Lord, Lord Taylor, of course, knows well. He has been a qualified physiotherapist for three years, and will get something like £800 per year, because by moving to Harlow he has lost his London weighting. He was originally in Epsom where he did in fact receive the London weighting. Even if he had moved to Leather-head, which is in the same hospital group, he would have lost the London weighting, for Leatherhead is outside the Metropolitan Area. These matters desperately need looking into by the Government.

Physiotherapy is not an easy job, and it is rueful to note that an ordinary teenage shorthand typist working in the City of London on a five-day week, seven or eight hours per day, with luncheon vouchers worth some 15s. per week provided for her, can earn more than a physiotherapist who has done three years' training; yet physiotherapists often have to be on call at evenings and during weekends. I do not think that any political Party in this country can be particularly proud of this, but I hope that the present Government, who in their Manifesto said that they intended to put this right, will in practice do so. If they do they will earn the gratitude of the nation.

If I may now revert to the question of children's hospitals, there is a difference of opinion in the medical profession as to whether children as patients should become part of an adult general hospital or whether they should have their own hospitals. Personally, I am a great believer in children having their own hospitals where they are looked after by qualified staff. They have all the services at their disposal and they have their own friends to play with. The Platt Report on the welfare of children recommended this in paragraph 32, and I hope that the Government will pay heed to it.

The same applies to hospital visiting. I should like to ask the noble Lord, Lord Taylor, what rulings the Ministry of Health have now made, not only in regard to the visiting of children but also in regard to the visiting of adults. Several instances have been brought to my notice where patients in hospital have been refused visitors during the visiting hours for reasons which one can only describe as unsatisfactory. If the noble Lord so wishes, I will afterwards give him some instances. Of course, nobody denies that the matron or sister must have discretion on this, but there should also be consideration for the patient and for the visitors, many of whom travel long distances.

Perhaps the most tragic problem of all is that of the mental hospitals. I live in an area in which there is a colony of some six mental hospitals. I recently visited one, Horton Hospital, which I know the noble Lord, Lord Taylor, knows well, and I went into the geriatric ward for elderly ladies. They are crowded some forty or more to a ward. They are very well looked after, well-fed, and the staff could not be more devoted—let me make that perfectly clear—but this situation does crowd out the younger patients who also desperately need treatment.

To instance this, I will refer to one case which was recently mentioned in the Press. A young man was picked up by the police in the Paddington area, which is the catchment area for Horton Hospital. He had been to a betting shop and lost his earnings. He got drunk, he relieved himself in the road, and was picked up by the police. He then got violent and had to be forcibly put into an ambulance and taken to Horton Hospital, Epsom. This meant a journey of some eighteen miles. Extra guards were required to hold him down, and another accommodation problem for this particular hospital was created.

I should like to ask the Government whether they have any plans for housing such patients in the London area, for otherwise the staff shortage will become really dreadful. As it is, student nurses in most of these hospitals are almost entirely non-English; there are Spaniards, Ghanaians, Indians and other races. I make no complaint about how they work; most of them work very well. But there are social problems. Many of them will not mix; some of the Indians adopt the caste system. Unless we can get more British-born nurses and junior doctors, the problem will become far worse.

There is a great deal of ground that I have not covered, but time is getting on and there are many other speakers to follow me. However, I should like to say that we in this country owe a great debt of gratitude to those who staff our hospitals and those who doctor our patients. Many are working under tremendous strain. I do not know whether the noble Lord can give any figures as to how the group practice system for doctors has worked out during, say, the past five years, but unless more group practices can be set up, many doctors will fall by the wayside, because they just cannot carry on. The problem is, of course, more acute in some areas than in others, but it is soon going to become a very serious national problem. It is the same with nursing, too.

More and more accidents happen on the roads, and I should like again to stress what I have stressed in this House before: the desperate need for more accident units on the same basis as Dr. Hindle's unit at the Luton Hospital, which works marvellously. It seems very alarming that if, for example, an accident happens on the A.1, near Biggleswade, the patient has to be taken several miles to Bedford, although it may be a very serious case. May I ask the noble Lord a question which may not come under his Department, but which concerns accidents generally? I should like to ask whether teams of trained doctors and nurses could be set up on the motorways, particularly on foggy days, to meet these contingencies.

My Lords, I am grateful to have had the chance of initiating this debate. I should like to end by sending from all sides of this House a very sincere tribute to all those who administer our Hospital and Medical Services. My Lords, I beg to move for Papers.

3.23 p.m.

LORD SORENSEN

My Lords, with confidence I ask for the indulgence of this House—in fact, for a double indulgence, because, as has already been indicated, I am speaking from the Front Bench for the first time, as well as for the first time in this venerable House. I certainly did not anticipate, when I was first introduced some weeks ago, that I should have this double task which has been imposed upon me to-day. May I express to the noble Lord who has just sat down my warm appreciation of his kind references to all those whom he mentioned, including myself? It is true that I have, and always shall have, a very warm affection for a district which I represented in another place for many years. It is some consolation not only for the fact that I have now ceased the representation of that constituency, but also for other subsequent incidents, that the noble Lord has expressed himself to me in such a friendly fashion.

I may say that the particular subject which he has brought to our attention and consideration this afternoon is not entirely unfamiliar to my own experience. We all have a great interest, I am sure, in our National Health Service, but I also had the privilege of serving for some 21 years on more than one hospital in the County of Essex. It is true that one was a mental hospital, and I do not mind confessing that when I was first elected to the Essex County Council I felt somewhat humbled when, having applied to be placed on the education and other committees, they put me instead on what was then called the lunatic asylums committee—no doubt thinking that it was more appropriate for me. But in course of time I came to appreciate what a tremendous service the mental hospitals of this country are giving both to those who, unfortunately, have to dwell within them and, indeed, to their relatives. Although it is many years since I served on the Essex County Council Mental Hospitals Committee, I shall never forget that very great experience, the insight it gave me into human nature, and the realisation which came home to me that the boundary between a mental hospital and those outside is indeed a very frail one.

I must confess that I was a little perturbed that when the noble Lord spoke he did not refer to all the matters which, with great kindness, he had intimated he would raise in this debate. Some of those he has brought to our attention; one or two others he has omitted. Therefore, he will not mind if, telepathically, so to speak, I assume that there were other questions in his mind that he would have brought out if he had had more time, and I shall do my best to deal with them. On the other hand, may I say that the wide range he has covered is an indication of. his comprehensive interest. If I am a little breathless at the end of the time that I shall use this afternoon, it will be due not only, in a very small measure, to a slight cold that I possess, but also to my pursuit of many points in a very vast territory. May I, therefore, assure the noble Lord that if I omit from my brief survey many matters that he would have wished me to deal with my noble friend Lord Taylor will not only remedy my deficiencies, but also deal with these matters and with any other aspects of our debate which arise this afternoon.

One matter which was dealt with by the noble Lord was the question of visiting hours. There was a time, of course, when it was assumed, I am afraid, in certain quarters, that the visiting by friends and relatives of patients was a kind of necessary nuisance; and everything was done not only to contract the hours of visiting, but to make those who did go to visit their friends and relatives most uncomfortable so that they were almost glad to be removed. But that state of affairs has now, of course, changed very substantially.

Certainly there is a problem here, for all who have been engaged in hospital work, either professionally or administratively, know full well that when doctors go on their rounds in the wards they must have prior consideration; and if their rounds happen to conflict with visiting hours then the doctors' function is frustrated and the visitors are disturbed. Nevertheless, I repeat that a great deal of improvement has taken place. In a Ministry of Health memorandum of 1962, these words occur: Visiting should be regarded as an important contribution to the patient's recovery, and never as a concession or as an unwelcome interference with hospital routine. But great changes took places well before 1962. My information is that while, for instance, of 200 acute hospitals, none allowed daily visitation in 1961, nearly all do now. That again shows the great advance that has taken place.

Experiments with unrestricted or very liberal visitation have been made, and are still constantly being made, though here again, of course, there is a great difficulty. Sometimes, unfortunately—perhaps unwittingly—visitors exploit the liberal time at their disposal, with the result that they tire out the patients. I would say, in passing, that it does not necessarily follow that all patients wish to see the visitors for an unlimited length of time. If patients are visited by particularly garrulous friends or relatives there is often a great burden, especially when the visitors themselves try to comfort the patient by going into almost morbid details about their own physical and other ailments. That point has to be borne in mind, and explains in some measure why some authorities have not been as eager as others to extend the hours of visitation to almost the whole day. But I repeat again that great changes and improvements have taken place.

It has been suggested by the Ministry—and I think this is carried out in some cases—that explanatory leaflets for the guidance of visitors should be issued. I know that this is done in certain hospitals which I myself have visited, and I know that, in the result, there is a much greater understanding between the administrative staff, on the one hand, and the visitors, on the other. Personally, I do not think there can be any complete or rigid rule about this. All we can hope for is that there will be this growing co-operation and understanding among visitors, patients and staff, so that there will be a maximum amount of time for the visitation to take place but, at the same time, it is kept within limits.

One matter that may interest your Lordships, if I may mention it, is that the Ministry of Health recently announced that, out of 853 hospitals with child patients, 560 permit parental visitations at all reasonable hours and 48 almost so—between, say, 10 o'clock in the morning and 6 o'clock in the afternoon—leaving only about 200 from which either there is No 1nformation or where there is some measure of restriction. Again speaking from experience, having visited children's wards and children's hospitals, I can say what a great boon this change is to many of the children, who, psychologically, are comforted by the presence of their parents or their friends and, in consequence, can often make a recovery more swiftly than would otherwise have been the case.

One point the noble Lord did not touch on, but which I thought he would mention, was the question of catering. This relieves me, obviously, of dealing very extensively with that particular matter, except to say, quite briefly, that it is encouraging to know that dietetics, kitchen equipment, and, indeed, the whole sphere of catering, have come to be of increasing significance and importance in the hospital world. We all realise now that faulty or deficient dieting, or the destruction of a good diet in the oven or in the pot, may mean that patients are relieved of one ailment only to have others imposed upon them. Therefore I am glad to report that in the new hospitals the most up-to-date kitchen equipment is being installed, and that in the older hospitals a great deal is being done to modernise the plant, although sometimes this presents very great difficulty. A building note, I see, has been issued from the Department to all hospitals giving suggestions as to how their kitchen equipment can be improved.

May I turn from that point to another which the noble Lord mentioned, the question of nursing accommodation, although he touched on it only briefly. Here, again, the Ministry, I know, are very conscious of both deficiencies, on the one hand, and progress, on the other. It is well for us, of course, to look at the various deficiencies: we all must do that. To be honest with ourselves, we should recognise them in many respects; but, on the other hand, let us also appreciate substantial progress. Nurses to-day dwell in accommodation far superior to that which I knew forty or fifty years ago, when I visited my wife who was then a trainee nurse at a certain suburban hospital.

A great advance has taken place, but with that advance has also come, in recent years at least, an appreciation that the old type of nurses' home, which has fulfilled a very useful purpose indeed, may nevertheless not be the best means of providing accommodation. One suggestion now is that we should visualise the possibility of providing flats, or even terraced houses, so that more and more they become de-institutionalised. It is also alleged that this would certainly be an economy. In fact, of course, this is a housing problem, and not merely a hospital problem, and is therefore involved in the general problem of housing. But, possibly, in due course, as our economy improves still further, we shall be able to turn our attention to this new and more modern method of meeting the need of accommodation for our nurses.

One other matter which was touched on briefly, but perhaps not to the extent that I thought it would be, is the question of the provision of maternity beds. Again on this matter I shall be brief. The Hospital Plan of 1961 envisaged an increase of about 6,500 maternity beds by 1975. But, of course, the birthrate has risen higher than was estimated—a reminder that statistical man often proposes, but, evidently, biological man, and woman, frequently disposes. Be that as it may, this, of course, has caused the whole question of the estimate of the future need to be revised rather drastically. Nevertheless, progress has been made, and by the end of 1964 670 new beds will have been provided, or a net addition of 450. The disparity between the two figures is accounted for by the fact that the balance represents the replacement of old beds which have been taken away. It is anticipated that in the current year there will be a net addition of 920 beds; so at the present rate of progress, it is still firmly anticipated that by the year 1975, when there will have been some 200, 000 extra confinements, we shall have sufficient maternity bed accommodation in our hospitals to meet this great need.

The noble Lord referred to the question of accidents. While I fully appreciate his point that, particularly in foggy weather, there should be staffs of trained nurses and doctors waiting for the accidents—rather morbidly apprehending what might happen—I would nevertheless suggest that already our medical and nursing staffs are very heavily occupied. And I hope the noble Lord does not suggest that they should just be waiting in little huts along the M.1, or some other road, for the so-called "inevitable" to happen.

This important subject was considered by a Sub-Committee of the Standing Medical Advisory Committee, under the chairmanship of Sir Harry Platt, and a Report was issued in September, 1962, and commended to hospital authorities in May. 1963. Among the recommendations—and there were many—was one that injured patients should be taken direct to accident and emergency units for immediate attention at any time in the 24 hours. That recommendation, no doubt, meets to some extent the point made by the noble Lord. But obviously, it would require a very great increase in the number of accident and emergency units.

Here again, it is one thing to have plans, to recognise a great need; it is quite another, of course, to implement them. That is why we shall still have to wait some time, I am afraid, before all these recommendations are properly fulfilled. But we are pressing on. Meanwhile, the less serious cases, of course, can continue to receive treatment in the smaller hospitals. I would add that the hospital authorities have themselves been prompted to consider this matter in the light of the Sub-Committee's Report. Some improvements have been achieved, but complete reorganisation of this particular service depends on the ability to provide new buildings and adequate staff.

I turn now to the question of the welfare of children in hospitals, to which reference has been made. The noble Lord, Lord Auckland, referred, I think, at least by implication, to the Platt Report, published in 1958, and particularly to paragraphs 30 to 35. These paragraphs, I would remind noble Lords generally, deal with the nursing of children and adolescents in adult wards, the desirability of having children's wards in general hospitals rather than nursing all children in children's hospitals, and with improved designs for for children's wards. On this matter I rather disagree with the noble Lord, if he does not mind my saying so; I hope that we shall have fewer hospitals devoted entirely to children, although, of course, some will still be required. What I want to see is more wards in ordinary hospitals dealing with children and adolescents alone. The Report, however, was interesting, and before I press on I will remind your Lordships of one or two points in it.

The Report has been carefully considered by the Ministry and hospital authorities alike, and the Ministry have asked for and received information showing the current position and progress in implementing its recommendations. A third inquiry beyond the two already made is actually taking place this year. For your Lordships' information I may say that we find that in 1960 apart from the psychiatric and exclusively children's hospitals, less than 10 per cent. of the children under 12 years of age were accommodated in adult wards but 60 per cent. of those aged from 12 to 16 were in adult wards. This shows the great shortage of hospital accommodation for that higher age group. We can only hope that we shall press on and provide the appropriate accommodation for these adolescents of from 12 to 16 years of age.

The aim is, of course, to provide a comprehensive service for children in every centre and conurbation of from 100, 000 to 150, 000 population, and the Ministry have issued building notes on children's wards indicating what is desirable and what can be done internally to avoid accidents, and to provide cheerful furnishing and, of course, effective supervision. I thank the noble Lord for drawing attention to these matters, and if I cannot go into them more fully now it is because I must cover one or two other aspects of the whole matter before closing.

I will not touch on one question which was alluded to briefly, the question of the relationship between hospital planners and architects, except to say that I think the noble Lord has a strong point here. There is often a lack of proper liaison, proper understanding and appreciation of the two functions; but, as the noble Lord will appreciate, the major responsibility for building programmes rests with the Hospital Boards. The Ministry can advise and give guidance, but they should be hesitant about imposing their views. They must have confidence that the Hospital Boards appreciate the difficulties and needs and are doing their utmost to overcome them. But the Ministry recommend for each project that a team should carry out the scheme throughout, from the individual assessment of needs and outlining of functions to the approval of the sketch plans, the cost limits and the final working drawings, and where outside firms are employed there should be the same provision of a team so that the teams can work together. Only in this way can the difficulty to which the noble Lord has referred be properly met. Again, one could say much more on this matter, but time slips by.

My Lords, I will refer to just one or two other small points. I refer again to mental hospitals and the undoubted truth that there are a large number of geriatrics, elderly people, in our mental hospitals who are given great attention and whose lives are thereby being extended. It is sometimes suggested that they may be preventing younger patients from receiving the appropriate treatment. I should be glad, and the Minister would be glad, to secure actual information about this from the noble Lord, Lord Auckland, or from any other noble Lord in the House, because we must confess that, broadly speaking, we have not received much evidence to substantiate his charge. No one here would wish geriatrics to be treated worse than they are being treated now. They are old people, often very confused; but, after all, they are fellow human beings, and once we start neglecting attention to the aged because they are aged, or because they are apparently socially useless, one does not know how far we shall go down the slippery slope until we begin to treat all human life according to its economic value. No one wishes to do that. We should aim to provide increasingly for the younger people, but I repeat that so far as my information goes there has been no serious indication that any young people have lacked treatment because of the devoted service being given to the geriatrics.

May I say again that my knowledge of mental work generally makes me increasingly impressed and inspired by the extraordinary devotion given by nurses to the geriatrics and other categories of acute mentally disordered persons. It is a labour of love, and I am positive that those who dedicate themselves to this service, with patience and sometimes in most distressing conditions, do so not for pecuniary reward, though that is necessary, but out of love of their brethren. In regard to hospital accommodation for male nurses, our information is that apparently there is no great need of this, and no overall shortage, and that indeed in some parts of the country where there may have been some local difficulties these have been overcome because there has been a lessened demand for accommodation for female nurses. The result is that the accommodation they have vacated has been made available, with proper safeguards, to the male nurses.

My Lords, the last point I wish to refer to before I sit down and allow other noble Lords to contribute to this valuable debate is on the whole question of physiotherapists. Their shortage will be dealt with by my noble friend Lord Taylor later on. I appreciate what has been said on that matter, and indeed I remember putting Questions on it in another place to obtain information some months ago. Having said that, may I again seek the foregiveness of the House for any deficiencies in exposition on my part, and thank noble Lords for their kind indulgence, while I nevertheless trust that what I have said has contributed to a greater knowledge of this important subject.