On Wednesday of this week in the Scottish Grand Committee we had a very helpful discussion on tuberculosis in Scotland, and I am certain that the fruits of that Debate will be felt in due course in our country. Tonight, however, I want to examine the problem within narrower limits, and to direct the attention of the House to the incidence of tuberculosis in Glasgow. I shall seek to establish that Glasgow is in a unique position, as far as this illness is concerned, not only as regards confirmed notifications of the disease and the number on the waiting list seeking treatment, but with regard to the death rate.
If we look at the confirmed notifications, we find that in 1945 they were 2,641; in 1946 they had risen to 2,809; in 1947 there was a welcome drop to 2,765; but in 1948 the number had risen, although slightly, to 2,776. These figures cover all ages, but within these figures statistics for children under 15 show a most serious rise. In 1945 the number of confirmed notifications for children was 246; in 1946 it had risen to 438; in 1947 to 469; and by 1948 it was 510. These figures reflect the extreme gravity of this problem in Glasgow.
If we look at the waiting list, we find that in 1945 the number awaiting treatment was 1,092; in 1946 it was 1,058, a welcome drop; in 1947 it had risen to 1,208; in 1948 to 1,423; and by March, 1949, it had jumped to 1,548. There are 12,000 cases on the register in Glasgow, of which 10,000 are due to pulmonary trouble. I realise fully that it can be argued justly that these two sets of figures are due to better diagnosis, but that argument must not be allowed to cloud the facts; nor does it dispose of the fact that in 1946 the number of people who died from pulmonary tuberculosis was 1,185. In 1947 there was a little drop to 1,173; but in 1948 the number had risen to 1,418, giving a death rate last year in Glasgow of 1.14 per thousand from this disease.
Trying to put that figure on a comparative basis, I find that the figures for cities that can be compared in many ways with Glasgow show that in Liverpool the rate is 0.784, in Birmingham 0.621, and in Manchester 0.664. Obviously, from these figures, Glasgow appears in a very bad light indeed. When we compare Glasgow with the position in Scotland generally, we find that it is a great deal worse, for in Scotland as a whole the death rate is 0.66 per 1,000. If we go abroad, we find that in New Zealand the death rate is 0.309, as compared with Glasgow's extremely high figure. It must be recognised, however, that in the case of New Zealand no one who is known to be suffering from tuberculosis is allowed to enter that country, so that in this way they are protected to some extent from the ravages of this disease.
If we take Glasgow, the figure, covering all forms of tuberculosis, is 1.28 per 1,000—and the only other comparable figure I can find is the figure for India, which is exactly the same. If I revert, for further comparison, to notifications, we find that in Liverpool, in 1948, there were 1,618 confirmed notifications of pulmonary tuberculosis; in Birmingham, the number was 1,132; in Manchester, 863; these against Glasgow's figure, which I have already quoted, of 2,776. In other words, Glasgow had a greater number of notifications in 1948 than the combined total of any two of these three large cities in England. In Scotland one person out of every 135 is a sufferer from this malady—in Glasgow, one person out of 92.
These figures show that the city is in a grave position, which, I admit, is recognised by the Department of Health. In page 27 of the report which has been published recently, the Department of Health recognises, to a large extent the gravity of this situation, when they say:
The City of Glasgow, for example, contributes 36 per cent. of the total deaths from respiratory tuberculosis in all its forms. It is the cause of 9.5 per cent. of the deaths occurring in that city, whereas the corresponding figure for Scotland as a whole is 6.02 per cent.
Those are the facts of the situation. In presenting them, I have to pay tribute to what has been done, so far in regard to housing and research in seeking to meet this terrible social inheritance, which we received from the party opposite. While we recognise what has been done,
I would direct the attention of my hon. Friend to one or two things which I think can still be done. It is accepted that tuberculosis is preventable. The question then arises: why not prevent it?
I want to suggest one or two points to which I hope my hon. Friend will be able to give me a satisfactory answer tonight. In view of the time, I shall not develop these points, but simply mention them. First, there is the question of Remploy factories. Tuberculosis is a peculiar disease in that sufferers tend to be ostracised by their workmates and, therefore, it is essential that we should try to get employment for them suitable to their capacities and to the mental outlook which they very often develop. Remploy factories are one method of dealing with that aspect of the trouble, and I should like to know from my hon. Friend what is being done in this respect.
Then there is the question of the allowances to sufferers. I suggest that the time is ripe for a review of the categories of allowances, and for their extension to sufferers who are at present excluded, particularly, for example, those who are suffering from spinal tuberculosis. Then there is the question of B.C.G., and I think we were all glad to hear what my right hon. Friend had to say yesterday about the use of that vaccine in this, country. There is also the question of hospitalisation, in so far as it affects chronic cases, and the question of unified services.
I would have liked to develop the point about unified services, but there is not time tonight. Finally, there is the question of housing. My right hon. Friend intimated, some time ago, that 400 houses were being set aside. Tonight, I want to ask my hon. Friend to set aside for Glasgow 1,000 houses for 1950, and, at the same time, to consider giving rent assistance to those who go into those houses.
I am sure that the House, and the City of Glasgow, will be extremely indebted to my hon. Friend the Member for Tradeston (Mr. Rankin) for raising this subject, because the tuberculosis position in Glasgow is grim beyond description. My hon. Friend indicated that the Glasgow death rate was comparable only with the Indian death rate. The Glasgow population congestion is only comparable with some of the worst cities on the Indian Continent. We are all deeply concerned about this problem, and about its amelioration and final resolving.
I join my hon. Friend in paying tribute to the Secretary of State for Scotland for what has been done. In the few minutes which I propose to occupy there is not time for me to make more than one or two suggestions. I feel that one of the reasons we are short of hospital accommodation, in the sense that there is not sufficient staff to man the beds for patients, is that when the war ended we did not make use of the thousands of young women who had given devoted service in our hospitals during the war, and who would have been very willing and anxious to enter the nursing profession as a whole-time occupation if they had been given sufficient encouragement. But they were not given any encouragement to do so.
These girls who had had five, six or even seven years' experience in hospital, were told that all their wartime service would count only as six months towards their training for the State Registered Nurse's certificate. That was a poor inducement. It was a fatal mistake when we came to manning general hospitals and tuberculosis sanatoria. I feel that, even at this late date, the Secretary of State might recruit a few hundred nurses for our Scottish hospitals if it were possible, in some way, for girls who had a real hospital training during the war, even if it was not according to the professional standards of the Nursing Council, to be induced to enter the nursing service by means of some special provision.
Another point is the position of radiologists. There was a sorry story, recently, of physicians of great distinction who, in recent months, have been deprived of opportunities to carry out their work as clinical physicians for Scottish hospitals. Laboratories have been taken from them in some cases, and in other cases their wards have been taken away. That is not a good thing for Scottish medicine, or for the general development of medicine in Scotland, because a good clinical physician is the man who has access to the laboratory and, at the same time, to the ward and the patient. My hon. Friend the Member for Tradeston paid tribute to better diagnosis, which is largely a matter of better radiography. But now radiologists are threatened with a new classification which deprives them of the opportunity to rise in their profession. That cannot be good for Scottish medicine or for any concerted drive against tuberculosis; for, without the radiologist, a concerted drive against tuberculosis is impossible. I hope the Under-Secretary, when he replies, will give this matter, which I have been able only to touch upon tonight, real consideration so that we can go right ahead to make a really effective attack on this terrible Glasgow problem.
I am sure that the remarks of my right hon. Friend in the Scottish Grand Committee the other morning left hon. Members from Scotland in no doubt as to the anxiety which is felt about the rate of deaths from tuberculosis in Scotland, and the feeling that they must not remain at their present high level. But it would be wrong if I let it go out from this House that the position in Glasgow is as my hon. Friend the Member for Tradeston (Mr. Rankin) made it out to be—about the worst in the world. It is bad enough, but it is not the worst, even in this country.
It is a very serious matter, indeed, but Glasgow does not have the highest death rate in Scotland, or in this country; there are several towns in Europe, quite apart from India, which has been mentioned, where there is a higher rate of tuberculosis than in Glasgow. The position in this largest of Scotland's cities is very serious, but we must not let it go out that the position is more serious in Glasgow than in any other part of Europe. Comparisons with India rather tend to give the impression that there was no comparison which could be made with this country or, indeed, with Europe. The truth is that there are towns in this country, and in Scotland, where the tuberculosis rates have been more serious than in Glasgow. There are also several cities in Europe with worse rates. I make these remarks merely so that we shall not get a false impression of the situation. To say that Glasgow's position is the worst of all is not true.
The death rate in 1948 was 1.14 per 1,000. I believe my right hon. Friend said yesterday that the highest figure in Scotland was 1.10 per 1,000 and graded down to.10. Surely that emphasises the extreme gravity of the Glasgow position.
I agree with my hon. Friend that this is a very important matter; the tuberculosis position in Glasgow is certainly not out of the mind of my right hon. Friend. To some of these suggestions which have been made by my hon. Friends I am sure they will not expect me now to reply.
My hon. Friend the Member for Rutherglen (Mr. McAllister) said he was throwing out suggestions which he hoped would be given consideration by my right hon. Friend. I can assure him that they will. My hon. Friend the Member for Tradeston asked about Remploy Factories. He knows that consideration is being given to the desirability of having such a factory in Glasgow. That is a matter for the Minister of Labour, but I can tell him that the Glasgow Corporation have co-operated with the Ministry of Labour and with the organisation responsible in selecting a suitable site, although I do not know whether work has yet begun. I can also tell my hon. Friend that the Glasgow Corporation, through their T.B. officers, continue to co-operate with the Ministry of Labour in securing that suitable employment is offered, where possible to sufferers from tuberculosis, who, it is believed, can be aided towards rehabilitation by being enabled to go back into industry.
My hon. Friend also asked whether there could be a review of allowances for sufferers from tuberculosis. I cannot say much on that, as he will appreciate that my right hon. Friend is no longer responsible for allowances, it now being a matter for the Ministry of National Insurance. I am afraid there is nothing more I can add on B.C.G. to what my right hon. Friend said in our Debate in Scottish Grand Committee.
We shall have a look at what my hon. Friend has said, and I will see that it is drawn to the attention of the Ministry of National Insurance. If he wants to pursue the matter further, perhaps he will do so with the appropriate Minister.
My hon. Friend also favoured a unified service. I agree with him that there should be a close link between the hospitals and the clinics. I can assure him that the process is being extended wherever possible. Tuberculosis clinic services within the City of Glasgow are under the control of two boards. Each has set up a Committee, and the contact between the two committees is facilitated and extended by the fact that the medical officer of health is the chairman of one of them and another medical officer of health in the Department is chairman of the other. It is thought that in that way satisfactory co-ordination is being created, and that as time goes by co-operation with the regional hospital board and the local health authority should become progressively more apparent.
My hon. Friend spoke about the need to provide houses for sufferers from tuberculosis. The House knows that in August, 1948, 1,000 Blackburn houses of the aluminium type were allocated to local authorities with a high incidence of tuberculosis. My right hon. Friend was able to allocate 284 of these houses to Glasgow. Of those 284 houses, 48 are complete; 175 are under construction and 61 are not yet begun. But it will be appreciated that they are bungalow houses, and when the slabbing has been put down and the site preparations are completed, the erection of the house is a speedy matter.
My hon. Friend asked whether 1,000 houses could be given to Glasgow to help to deal with this awful problem of tuberculosis, or at least to make possible the segregation of contacts, and so on. I can refer to the programme of 4,000 Blackburn houses, two-storey houses, instituted by my right hon. Friend with a view particularly to helping local authorities with a high incidence of tuberculosis to combat the spread of the disease. The houses, of course, will be available for the general population; but in making their allocation my right hon. Friend indicated to the local authorities that his primary aim was to secure the building of houses in areas where additional accommodation would be of greater benefit in combating the spread of tuberculosis. It is hoped that the local authorities who are getting these houses will, wherever possible, allocate the houses which become available to let in proper proportion to the tuberculosis sufferers. They need not necessarily wait until the houses are completed. Of these 4,000 houses which my right hon. Friend has allocated for 1949, no fewer than 1,020 have been allocated to Glasgow; so that my right hon. Friend seems to have anticipated the request of my hon. Friend the Member for Tradeston.
My right hon. Friend is conscious of the seriousness of this problem. The House is aware of the committee especially appointed to go into this whole question of tuberculosis in Scotland. A lot was said about that the other morning in the Scottish Grand Committee, and there is not much more that I can say now. When we get the report of that committee we will take whatever steps we can to put into operation any positive recommendations they may make to help to deal with this matter.
We are concerned at the shortage of nurses for this work. There is a shortage of nurses generally in Scotland, but it is more difficult to get nurses to do this particular class of work. I hope——