Remedial Gymnasts: Grants (Hansard, 29 April 1982)

§ Lord Vaizey

My Lords, I think it is the convention that even if the Chamber is almost empty conversations are carried on outside. The brilliant speech of my noble friend Lord Stewart of Fulham was almost ruined by antics at the beginning, and it would be a great pity if this particularly serious case which I am bringing were also ruined by the same people. The Question which I am raising today is not about that individual grievance but about a piece of bureaucratic nonsense. All bureaucracies generate absurdities, and, thank heavens! we have a free Parliament where they can be called to account, in this case in the person of my noble friend Lord Cullen of Ashbourne—who is jolly noble because he has given up his dinner in order to answer this Question.

On the edge of Woolwich Common, facing the famous "shop", is a splendid modern building, low lying and elegant. It is a 600-bedded military hospital, the Queen Elizabeth, which has replaced five former military hospitals, including the Royal Herbert and the Millbank Hospital, which is to become part of the Tate Gallery. The Queen Elizabeth Hospital does splendid work and in some respects fulfils the role of a local general hospital because it is rarely filled with 1037 military patients. Casualties from Northern Ireland come in, and perhaps—though we hope not—there may be casualties from the fleet in the Falklands. Most military patients are motorbike victims or people suffering from ordinary illnesses. Two of the most common diseases treated at the hospital are cancer, which particularly attacks young people, and heart disease which disables more men than any other cause in the army.

In the midst of the Queen Elizabeth Hospital, admirably run by a brigadier in the Royal Army Medical Corps, is a gymnasium—with playing fields near it, a therapy pool and other devices. This gymnasium is connected with the Joint Services School for Remedial Gymnasts. It is to this particular unit's problems that my Question is directed.

Your Lordships will know how important physical training is in the armed services, and will know, if only from television, how high the standards are. I shall, for convenience' sake, speak in the rest of my Question about the army, but what I say has equal force for the other two services. Some of the fittest and most able men and women are in the physical training branches of the services, from where, indeed, many of our national and international representatives in many sports have come. Many of the most able of these physical training instructors are deeply interested in remedial and rehabilitation work. As your Lordships will know, in the National Health Service there is an extensive network of rehabilitation, ranging from exercises given to patients who have broken their arms or legs to the treatment of paraplegics, stroke victims and geriatric patients. Much of this work is done by physiotherapists, but some of it is done by remedial gymnasts. There is a distinction between the two professions but it is not material to the Question I am asking.

There are two National Health Service hospitals specialising in training such gymnasts, Pinderfields in Wakefield and in Cardiff. Incidentally, these two schools were built around ex-service physical training instructors who rehabilitated wounded ex-servicemen from World War II. For the armed forces, the joint school is located at Woolwich. Men and women from all three services go there for a two-year intensive course combining theory with practice. Much of the practice is in National Health Service hospitals. In reply to a Question for Written Answer I have a list of such hospitals here. The husband of one of my distinguished noble friends is being treated at the Wolfson, which is on the list, which has such remedial gymnasts as students.

The work in the gymnasium at Woolwich is impressive and moving. One sees children being encouraged to walk, young soldiers from Northern Ireland being rehabilitated and given self-confidence, and geriatric patients being taught to manipulate their wheelchairs. In short, it is a very impressive affair. In one respect at least Woolwich leads the world. It has a unique three-week residential course for cardiac patients; those who have had heart operations, or heart attacks, or who by reason of obesity or whatever are threatened by them. As I said at the beginning of my Question, cardiac illness is the biggest single cause of disablement and death in the services. By the end of three weeks, the cardiac patients are taking three mile runs, swim- 1038 ming half a mile, and taking lengthy walks in the woods. In general, they are rehabilitated to a quite remarkable degree. We hope this work will spread throughout the National Health Service.

The remedial gymnasts course consists of 20 people. It is a tough course and one that is very difficult to join. At the end of it the students take up their work in military, RAF or naval hospitals. Eventually, most of them go to work in the National Health Service. One of them runs our gymnasium here, another runs the Institute of Directors' gymnasium in the old United Services Club in Pall Mall. This is under the Fitness for Industry scheme; and may I assure the House that there are plenty of jobs for qualified people to do.

The Ministry of Defence has made places on the course available to civilians. Obviously it is economical so to fill up vacancies, since the marginal cost is very low. But here we get to the administrative fog and confusion. A civilian student needs a maintenance grant and fees. The Department of Education and Science has laid down in a circular that grants for these courses should not be given by education authorities but by the Department of Health and Social Security. However, the Department of Health and Social Security will give grants for courses only at the two hospitals it runs itself.

So here we have the Ministry of Defence making available superb facilities at public expense, and the graduates from the course recognised by the National Health Service for the most part going to work in it. Yet the Department of Health and Social Security in a letter to my honourable friend Mr. Cranley Onslow said: Responsibility for grants to students of remedial gymnasts rests with health authorities rather than with local health authorities. But this arrangement relates only to NHS schools (there are two, in Wakefield and Cardiff), and does not extend to the Joint Services School at Woolwich. I am afraid there are no funds available within the department or with health authorities to support civilian students at the Joint Services School". The letter then goes on to refer to the case which my honourable friend in another place raised with the Minister of Health.

My noble friend Lord Cullen of Ashbourne will no doubt say that the real reason for all this trouble is money. The fee at the National Health Service School is the standard polytechnic fee of £900 a year or £2,700 for a three-year course. The Ministry of Defence charges at Woolwich £91 a week for 88 weeks on a two-year course, or £8,008. The maintenance grant for a mature student (that is, any student over the age of 25) is standard, and for a two-year course is naturally two-thirds of the grant for a three-year course. So it is a two-year course at the Woolwich and a three-year course at the National Health Service hospitals.

We are talking, then, about a sum of £4,000 a year maintenance grant for a married man with two children under the age of 11. If the children are older, we are talking about a maintenance grant of £5,000 a year. At Woolwich, the cost of a man taking a course would be £8,000 and at a National Health Service Hospital it would be £12,000. So the total cost both for maintenance grant and course fees is £16,000 at Woolwich and £15,000 at National Health Service hospitals. So for £1,000, a civilian student who wishes to go to the military school at Woolwich is forbidden to do so; that is, he is forbidden a grant plus fees out of the 1039 educational authority or the National Health Service.

But of course in any case the fees are notional. Nobody pretends that the £900, the annual fee charged by the National Health Service courses, which is the same as the annual fee charged by polytechnic courses, is other than a notional cost. Indeed, when we charge foreign students the full cost we charge £3,000 a year, and if we charged full costs to the students of the National Health Service hospitals we should be talking about some £21,000 for a three-year course rather than £16,000 on the military course. In short, the figures are phoney, and the reason why civilian students are not given grants to attend the military hospital course is because the bureaucrats have decided that they do not want to give them.

My Lords, this is a silly situation, and I see that it greatly amuses the Opposition Whip who is kindly sitting on the Front Bench opposite. It is the kind of situation which you can only raise by drawing the attention of the public, through Parliament, to what the bureaucrats are up to in these three Ministries, particularly the DHSS. I hope my noble friend will perhaps be able to say something by way of encouraging me a little. In this particular campaign which some of us are waging—the honourable Member for Birkenhead and the honourable Member for Woking and myself—he represents South Georgia, and once we have taken South Georgia we shall be sailing in a fleet for more substantial objectives, and we shall carry on until we get some solution for the people who are gravely handicapped and dissatisfied with the present muddling and stupid situation.

§ Lord Cullen of Ashbourne

My Lords, I think it might be helpful if I set out first the arrangements for the training of remedial gymnasts at the Joint Services School at the Queen Elizabeth Military Hospital, Woolich. The school has 15 established places for a two-year course commencing each September. There are no formal arrangements for reserving places for civilians on the course. Indeed, in 1979 15 servicemen began the course. But in 1980 the services required only seven places, in 1981 10 places. I understand the services are willing to accept other students on a fee-paying basis. Of the places available one was taken up in 1980 and two in 1981 by Commonwealth, prison service and self-financing students. Clearly though, the noble Lord envisages support for civilian students in all available places from public funds. To deal with that issue I should like to describe the arrangements currently in force for the financial support of civilian students elsewhere.

My noble friend referred to advice from the Department of Education and Science to local education authorities not to award discretionary grants to civilian students at the Joint Services School. Whilst the effect of the advice may be described in that way, I should not like it to be thought that the school had in any way been singled out by the department. There is in fact an agreement dating from 1968 and revised in 1976 between health and education interests, including the local authority associations, that where health services staff are trained mainly in educational institutions support would be provided by local educa- 1040 tion authorities. Three professions—chiropody, dietetics and speech therapy—are dealt with by education authorities. The professions for whom the health interests have responsibility are occupational therepy, orthoptics, physiotherapy, radiography and remedial gymnastics. Thus any responsibility for support of students in remedial gymnastics certainly does not rest with local education authorities or the Department of Education.

There are already two civilian schools for remedial gymnast students. One is the School of Remedial Gymnastics and Recreational Therapy at the Combined Training Institute of the University Hospital of Wales, Cardiff, with 25 places. The other is the College of Remedial Gymnastics and Recreational Therapy at Pinderfields Hospital, Wakefield. This has 35 places. The grants for students at these colleges come from the funds of the district health authorities and not directly from the Department of Health and Social Security. This is an important distinction and means that the Department of Health does not itself have responsibility for supporting students in remedial gymnastics.

I should explain that there is some DHSS involvement however. The department receives a list of students selected each year by the colleges and carries out the financial inquiries necessary to assess the grant payable to each student. It then provides the health authority with a schedule of amounts to be paid. But this is all carried out, as it were, on an agency basis for health authorities.

One suggestion about funding that might be made is that the health authority in which the joint school is situated should be responsible for the civilian places. But I do not think we could ask the Greenwich District Health Authority to take on this responsibility. The school is not, as is the case at Wakefield and Cardiff, their institution and they have no direct interest or control. Thus I am afraid to say that I see no prospect of specific arrangements being made either from central funds or from an individual health authority for the support of this small and fluctuating number of students.

That is not to say, however, that there are no sources of funds to which prospective students might turn. It is entirely open to any health authority to sponsor a student on the joint services course if they so wish. It may well be that, having heard the eloquent testimony of my noble friend to the school, some will be inclined to do so. We must, however, leave that to their discretion.

I should like to say in conclusion that I am grateful to my noble friend for giving me the opportunity of clarifying some of the issues surrounding the financial support of civilian students at the school, and for giving us both the opportunity of paying tribute to the fine work carried out there.