Orders of the Day — Hospital Service

Part of the debate – in the House of Commons at 12:00 am on 11 June 1964.

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Photo of Mr Eric Lubbock Mr Eric Lubbock , Orpington 12:00, 11 June 1964

I should like, first, to add my word of congratulation to the hon. Member for Rutherglen (Mr. Mackenzie), who made a notable maiden speech. His remarks were eloquent, well informed, and he paid an extremely nice tribute to his predecessor. His whole speech displayed remarkably humane concern for the problems of the old people in his constituency.

I was also interested to hear his remarks about the provision of beds in his part of the world, because this is the crux of our hospital building programme. As Dr. Abraham Marcus said in the Observer recently, many doctors and hospital administrators feel that the true measure of the problem is the number of beds being provided. It was this that I had in mind when I intervened in the Minister's speech following his remarks about the number of patients treated in hospital having increased between 1953 and 1963. I asked him to give the figures of the length of stay, because unless one has both figures one cannot see what the true increase in the provision of beds has been between those years. I hope that when the Minister replies he will provide those figures.

I would also like to congratulate the hon. Lady the Member for Birmingham, Edgbaston (Dame Edith Pitt) on what she described as her second maiden speech. I recall bidding farewell to her when she made her last speech as a junior Minister, and I was hoping that she would be in her place now to hear me congratulate her on her resurrection in her new rôle as a back bench speaker on health matters. I can assure the hon. Lady that her tongue has lost none of its sharpness in the interim.

It is a shame that the hon. Lady is not in her place, because I wanted to tell her that she has been rather selective in the constituencies she has visited, because each one of those she mentioned has a new hospital being built in it. I am wondering what she would say if she came to visit Orpington, where we are gravely anxious about the future of the Orpington Hospital, which is not mentioned in either of the two revisions of the plan and which, in the original document, was shown to have in the 10 years half the number of acute beds but the same number of geriatric beds as today. In that event, it would indeed be a badly planned hospital and no longer viable. I appeal to the Minister not to upset the balance of this hospital in any future revision of the plan, since it is doing valuable work in my constituency.

The hon. Lady the Member for Birmingham, Edgbaston does the hospital service a disservice when she paints such a glowing picture of the progress which, she claims, has been made, because if hon. Members opposite go on in this vein Ministers will begin to believe their own propaganda. It is easy for Ministers and hon. Members opposite to talk about this being the biggest hospital building programmes in history, for they started from such a low point 10 or 12 years ago. There are so many years of neglect to be made up.

I should like to cast a little light on the truth of this matter. In Cmnd. 2235 on Public Expenditure the total expenditure on health and welfare, and this includes the local authority health services as well as the hospitals, is projected to grow at an average annual rate of 33 per cent. at constant prices between 1963–64 and 1967–68. As this is less than the N.E.D.C. target for the expansion of our national economy, it means inevitably that a declining proportion of our gross national product will be spent on health in the next few years.

This is confirmed by some calculations in the interesting publication, "The Cost of Medical Care "produced by the Office of Health Economics. I commend the book to the Minister, because it is presented with a clarity which is very often lacking in Government publications. Figure 1 on page 6 shows that the percentage of gross national product taken by Health Service expenditure is due to decline from just over 4 per cent. In 1962 to 3·8 per cent. in 1967. One of the results of this is, as stated in the headline to the article which Dr. Marcus wrote, that the "Cash crisis slows hospital building".

I agree with the hon. Member for St. Pancras, North (Mr. K. Robinson) that the document on the revised Hospital Plan for England and Wales, 1973–74 is highly misleading, whatever the hon. Lady the Member for Edgbaston may say. According to the title of Appendix II it purports to contain both the schemes brought into the programme for the first time and the consequential amendments to other schemes, but it deals only with the first part of the title. It states on page 1 that Appendix II lists schemes which are now included in the programme up to 1973–74 for the first time, and the schemes which in consequence are no longer necessary. Those are not listed in the Report. I should like to know why these projects which are deferred or cancelled are excluded. Is it because it would not go very well with electoral propaganda to include these things in the White Paper? We are entitled to know and I hope that the Minister will give us this information in another form, perhaps as an addendum to the White Paper.

My hon. Friend the Member for Devon, North (Mr. Thorpe) has drawn my attention to one of the consequences of these revisions which affects his constituency. I have the letter which was written to him by the group secretary of the North Devon Hospital Management Committee, Mr. Woolley, who says: The North Devon Hospital Management Committee has learned with considerable dismay that, arising from the Second Revision of the Hospital Plan, the second phase of the new North Devon Hospital, originally scheduled to commence building in 1967–68, has been postponed until October, 1971. I was surprised by the intervention of the hon. Member for Torrington (Mr. P. Browne) during the speech of the hon. Member for St. Pancras, North because he also has a copy of this letter and knows the feelings of the Hospital Management Committee.

The letter was accompanied by a memorandum in which some remarks by the chairman were reported. He said of the White Paper: No direct information had been included concerning schemes and phases of schemes which had been deferred, and it was necessary to infer such information from omissions in the lists given. The first phase of the new North Devon Hospital, the maternity unit, was included in the schemes listed to commence before 1968–69, but not Phase 2, although the planning date for this phase had, prior to the revision, been for 1967–68. Later in the memorandum the reasons which led to the postponement of the scheme, which I suppose were given by the Minister, are listed, and I quote two: (i) first phases of major schemes now planned and costed in detail were proving far more expensive than had originally been expected. This ties with what the hon. Member for St. Pancras, North said about the inadequate planning that went into this scheme in the first place, and I take it that this experience is fairly general and not confined to this hospital. The memorandum added: (iii) building costs had increased sharply together with the speed of building construction, so that considerably greater sums were spent annually on each scheme actually building, leading to a concentration of the available money on a smaller number of schemes at any one time. If that is true one would have thought that there would be a greater number of completions in the earlier years of the 10-year plan, but that has not happened and we should like to know about this.

What is the Minister doing to make sure that the available money which has been allocated to the hospital building programme is being used in the most economical way? The Secretary of State for Scotland said that both his Department and the Ministry of Health were spending considerable amounts on research. That can mean more or less anything. It can mean that ultimately we shall have the kind of consortia in hospital building which we already have in educational building, and that would probably be a good thing. If we had modular construction for hospitals we might achieve quite substantial economies.

I also entirely agree with the hon. Member for Galloway (Mr. Brewis) that by continued use of smaller hospitals for such applications as maternity centres we could have a greater number of beds over the 10 years with the expenditure of a smaller amount of money, but we should have a statement on which smaller hospitals might be retained in use for this kind of application.

Secondly, it is important to tie together the plans for new hospitals and for the health ad welfare services of local authorities. The booklet issued by the Office of Health Economics states on page 13 that It would be misleading to consider expenditure on domiciliary and hospital medicine independently or in isolation from other personal expenditure on health. Yet this is exactly what we do in this Committee and in the House.

At the moment we are considering the hospital building programme. Later in the year, we hope, we shall have the revision of the local authorities' health and welfare plans, when, no doubt, we shall have another debate on that. We never look at the whole picture of expenditure on health and welfare at one time. I regard this as a great mistake in our machinery of Government. I raised the matter first in the debate on the Hospital Plan two years ago and I was told then that the local authorities' health and welfare equivalent to the ten-year hospital plan would appear shortly, which it did. We never seem to discuss the two matters at the same time.

The Parliamentary Secretary has told me that the revision of the local authorities' health and welfare plan is about to appear, but we are still waiting for it. Incidentally, we have, as far as I know, had no revision of the initial local authority plans whereas we have had two of the Hospital Plan. Surely, it is better for these revisions to occur once a year, at the same time of year, so that we may consider them as a unity.

I hope that the Minister will accept the proposition which I first put two years ago, that the Hospital Plan can be successful only in the context of the health and welfare provision made by the local authorities. The hon. Member for Rutherglen illustrated this in his contention that there was great need for co-ordination in the provision made by hospitals and by local authorities for old people and that, by meeting this need, one could save old people going to hospital for as long as possible. The provision of Part III accommodation by local authorities ought to be directly related to the provision of places in the geriatric wards of the hospitals.

Similarly, the provision of home help by local authorities must be related to the provision of places in Part III accommodation. By giving old people more home help, we may be able to keep them in their own homes longer and thus reduce the call on Part III accommodation. On this subject of home help, I wish to raise the case of a constituent of mine—I told the Parliamentary Secretary that I intended to do so—who is totally disabled. This lady is a very brave person indeed. She spent some time in hospital and, when she was discharged to go home where her family needed her—she has a small boy of eight and a husband—she was first given eight hours' home help a day by the local authority. Then, suddenly, without warning, the local authority reduced the period to three hours a day, so that she now has home help only from 9 o'clock until 12 o'clock in the morning. Her husband gets her breakfast before he goes out. He has to find someone else to come in and cook her lunch and clear it away. Someone else has to come in when the boy comes home from school to get his tea and so on, until the husband comes home at night, when he takes over.

It is very important for the sake of the family life of these people that the mother should be enabled to stay at home. The husband has made strenuous efforts to find someone to come in and do all the work in the home for him but he has so far been unsuccessful. What happens when he becomes ill? Who is to look after the small boy at night, for example? The mother will have to be taken back into hospital in such circumstances. Of course, the situation puts a severe strain on the husband.

It is particularly important that we should get this point straight. The provision of home help by local authorities in cases of total disability like this may be instrumental in saving a person from having to go into hospital. The Parliamentary Secretary says that it is not necessarily true that keeping a totally disabled person at home is cheaper than keeping him or her in hospital. I really cannot believe this. Certainly, in this particular case, when the husband has to reimburse the local authority for at least part of the cost of the home help which he is given, it could not possibly be true.

In my view, greater provision could be made by local authorities. If not now, they should make plans to do so later as they get into their stride with their ten-year programme. I asked the Parliamentary Secretary what revision of the plan for the provision of home help was in train in the County of Kent. I received his reply today and, unfortunately, it is very disappointing. He tells me that, in the revision which is shortly to come out, it will appear that the total number of home helps in post in 1963 in the county of Kent was smaller than it was in 1962 and the number which the county hopes to provide by 1973–74, at the end of the ten-year expansion, will be smaller than at the end of 1963. This is a curious kind of expansion. In my opinion, there is not much point in having a ten-year plan for local authorities if the provision of this kind of service is to grow smaller year by year.

I once put a Question to the Minister to ask him whether some persuasion could be exercised on local authorities which refused to live up to their responsibilities in this way. That is a strong expression to use, and I use it advisedly. He said that, on the publication of these plans, local authorities would be encouraged to look at the average and at what other authorities were able to do and they would bring their standards up. This has not happened in the County of Kent, and I think that it is time one considered whether some other machinery is necessary.

About two years ago, I proposed that we should begin to think in terms of area health boards in which one would integrate the functions of the hospital boards, the local authorities and general practitioners, and that one should have a homogeneous Health Service instead of the tripartite structure which has existed ever since the passing of the 1946 Act.

Whatever the hon. Member for Bradford, West (Mr. Tiley) may say, the Conservative Party certainly opposed this Act when it was going through the House. But now it is almost sacrosanct. Hon. Members opposite do not want to amend it in any respect. When somebody puts forward a radical idea like this, after 17 years' experience of the working of the Act, they say, "No; it is perfect as it is," and refuse to make any alteration. This has subsequently been adopted by my party's Health Committee and endorsed by the B.M.A. I hope that, whatever Government comes to power after the General Election, they will think again about this proposition that we should have area health boards and create a more homogeneous structure for the Health Service.

I want to say a few words about the staff. I know that other hon. Members are waiting to speak, so I will try to be as brief as possible. With the Robbins expansion and the new universities which we are creating, we have a great opportunity to build new medical schools. I entirely agree with the hon. Member for St. Pancras, North that one new medical school, taken in relation to all the new universities projected, is not enough.

I should like to quote from the Financial Times of 24th February this year. It is not a newspaper which is notably sympathetic to the Opposition. The heading of the article is, "Shortage of Staff Threatens the Hospital Services" and the writer says: … there were some 1,300 Indian doctors working in Britain in 1962, mainly in junior hospital posts. But with the build up of medical facilities in India (such as, for example, the All-India Institute of Medical Science in Delhi), many Indians are going to find that it is no longer necessary to come to England to get the right qualifications. Already there are signs (at Northampton and Bolton for example) that this erstwhile 'bottomless' pool of labour is beginning to dry up. What plans does the Minister have to deal with this? Does he consider that one new medical school will replace these 1,300 Indian doctors who are likely to leave when the postgraduate facilities are started in their country?

The same applies to all the other professions in the Health Service, not only in hospitals. Taking the nursing profession, the Minister said that he was very satisfied with the number of nurses in training at the moment. He gave the number of those in training. I think that it was 72,000. Has he considered this figure, looking at it in relation to past figures, in the light of the more intensive treatments which patients are undergoing in hospital and the shorter working week which fie promised to the nurses?

Incidentally, I am surprised that no breakdown of these fifigures could be given and that he was not able to quote separate figures for State enrolled nurses, because the picture is not as bright as one would wish. One can hardly be surprised at this considering that State enrolled nurses are paid a salary, in real terms, lower than the salary which they were receiving when the National Health Service started. Hon. Members may not believe this, but if they look up a Question which I asked on the subject they will find that it is true.

Similarly with the administrative staff. The hon. Member for St. Pancras, North spoke about the advertisements placed in the newspapers to get these people. Incidentally, the cost of advertisements to obtain staff in the hospitals is not given separately in the costings. This is a great shame because it would be an index of the difficulty which the hospitals are having in obtaining staff in all grades and professions.

I know that other hon. Members wish to speak, so I will resume my seat.