I must first of all thank the Joint Under-Secretary of State for his explanation of this Estimate For both the Scottish Ministers who are in charge of the Health Services to be off ill is very much like the Minister of Health and his Parliamentary Secretary being ill and asking the Minister of Education to come to present the Supplementary Estimate We are all grateful to the Joint Under-Secretary of State for doing his very best to give an explanation of this Supplementary Estimate.
We are being asked to vote a sum of more than £2¼ million. The Joint Under-Secretary of State has said that the hospital service is the biggest single item, that is, if we take in with the hospital service the ambulance service and the other ancillary services. If we take this single item, the biggest is the pharmaceutical service at £641,000. My right hon. Friend the Member for Warrington (Dr. Summerskill) dealt with this subject very fully on the English Supplementary Estimate and I propose to say very little indeed on the matter, not because I do not think it is of the greatest importance that we should have savings wherever we can and not because I do not think that many people would feel that savings can be made, but because my right hon. Friend dealt so fully with the subject. Some of my hon. Friends may want to deal further with this Scottish point.
I want to make only one point. The Minister said that prescriptions had been fewer than had been estimated for, but the cost of the ingredients had been very much higher. Would he tell us when he replies to the debate—I understand that the Joint Under-Secretary of State is also to reply—what is now the cost of the prescriptions?
I want to deal with the Supplementary Estimate for the pharmaceutical service, which shows a saving. Had it not been for this saving we should be voting more than £673,500. We are told that the saving, in dispensing fees and rota payments, was £83,000. I want to get information on this subject, if possible.
In Scotland we have had experience of this rota system being stopped by executive committees in some areas. The Joint Under-Secretary will know about one of the cases that I took up at Newmilns in my own area. When the rota system is stopped, no chemist's shop is open at any time on Sunday in the area. When there is illness in the home on Sunday and a doctor has to be called in—which usually means some serious illness—a member of the family has to travel a fairly long distance to get the medicine that is on the prescription. That causes very great inconvenience in a home that is already suffering from the illness.
The Government first made the prescription cost 1s. and then made the prescription cost 1s. per item. This bears very heavily when sickness comes. It is a tax on the sick man or the sick woman. By taking away the rota system in some areas it means that not only have people to pay these extra shillings for the prescription, but they have to pay extra money for travelling from the village, in sonic instances long distances, to get the medicine from the chemist.
I ask the Joint Under-Secretary to have a word with the members of his Department and with the Secretary of State to see if the right hon. Gentleman will ensure that where an executive council has stopped the rota system—it seems that quite a number have—there is no great hardship, as there was in my constituency until, after investigation by the Secretary of State, the rota system was started again.
I want to deal with the ambulance service, which comes under Subhead D.7. There we are asked to vote £69,000, of which £17,000 is for the purchase of vehicles and equipment. The Joint Under-Secretary told us that, because of the financial difficulties of the Government, the hospital services were asked to save as much as they could and there was a saving of £400,000. I wonder it some of that was a real saving. That is why in this instance I want to examine the matter. My hon. Friend the Member for Motherwell (Mr. Lawson), put a Question to the Secretary of State on 23rd February. He asked about ambulances that had been ordered on behalf of the St. Andrews and Red Cross Scottish Ambulance Service in 1958. This
was the Answer given by the Secretary of State:
The Joint Central Committee for the Scottish Ambulance Service advised me that it was urgently necessary to provide additional vehicles to avoid a breakdown of the Service during the winter."—[OFFICIAL REPORT, 23rd February, 1959; Vol. 600, c. 119.]
That was a very serious position for our ambulance service to get into. It had urgently to order new ambulances—I take it that this £17,000 is to pay for some of them—because there might be a breakdown in the service. Would that breakdown have been due to these economies which were imposed on the hospital service by the Government?
There is another point to which we on this side of the Committee must refer. When it was discovered that there would be a breakdown of the ambulance service what did we find? Instead of the order being placed with a Scottish firm, although we are always complaining of the very high rate of unemployment in Scotland compared with that in England, the order went to an English firm. Scottish firms were not even allowed to tender, but the order went to an English firm without any tendering at all. We criticise the Government, first, that when they insisted on savings in this instance they were not real savings, and that they might have been a grave danger to our hospital service and to the lives of the patients. Because they are insisting on this saving the Secretary of State had to say, "We had not time to put this out to tender and we just gave the orders to an English firm." On all these complaints, the Secretary of State deserves very great criticism.
I come to Subhead K.1. and the grants to local health authorities. We are asked for an extra £45,000. We are told that this is:
Additional provision required mainly because of extension of clinic services.
If the Joint Under-Secretary can give me the information, I should like to know exactly where these extensions were. If the hon. Gentleman cannot give the information now I shall understand and perhaps he will give it later in writing. In my area the population is scattered and the villages are some distance from the towns. For a considerable time we have been trying to get adequate clinic facilities in some of the villages. Adequate clinic services cover a very wide
field and make a great difference to the health and to the spirits of people in some villages.
Another point I wish to raise is the Supplementary Estimate for which we are asked for the midwifery service, amounting to £8,000. We are told that this is
to meet the cost of additional staff.
The Joint Under-Secretary may be aware of a debate held in the House on this matter. I ask him if by the spending of this £8,000 he feels that we shall have an adequate midwifery service in every part of Scotland. My information is that that is not so. There are complaints about salaries and complaints about promotion. When the Parliamentary Secretary to the Ministry of Health dealt with this question, he showed that, although many trained, they did not actually work as midwives. That may be due to the amount of salary, to blocked promotion and general conditions. I hope we shall have an answer on that question.
I want to deal now with what I feel is one of the most serious weaknesses of the National Health Service in Scotland at present. That is the inadequate supply of maternity beds. This comes under Subhead A—"Advances to Regional Hospital Boards: Capital Account", and the figure is £394,000. The details we are given say that this is
Additional provision required for the acceleration of the programme of works.
What are these works? Do they cover a greater provision of beds for maternity hospitals? That is very important.
This morning I had a visitor who came to see me when I was in Committee upstairs. She was from Fort William, where she is a bailee. She is a member of the W.V.S. and yesterday she was entertained by the Queen at Buckingham Palace. I was telling her about the debate we were to have this evening, and I asked about the adequacy or inadequacy of the provision of maternity beds in her area. She told me that when it is decided by the doctor or the hospital authorities that an expectant mother ought to go to hospital to have her baby the woman has to travel to the nearest hospital, which is 65 miles away. Mallaig, in her district, is 100 miles away from the hospital. That is a very long distance for women to travel to find accommodation in a maternity hospital.
Recently a Report was published by a Committee appointed by the Scottish Health Services Council of the Department of Health for Scotland entitled "Maternity Services in Scotland." I want to quote from paragraph 81, on page 38, to show how serious is the position in Scotland. It reads:
We turned next to the distribution of the 70 per cent. institutional confinements.
This was 70 per cent. for Scotland as a whole.
A breakdown of the figures for 1957
—these were the latest figures which this high-powered Committee was able to get—
into local health authority areas showed variations from 96·4 per cent. to 50·4 per cent., with 21 areas over 80 per cent., 12 between 70 per cent. and 80 per cent., and 22 below 70 per cent., all but six of these last being among the 27 areas in the Western Region, which covers about half the population of Scotland.
This variation between 96·4 per cent. and 50·4 per cent. of the women having their babies in hospital is a very big variation. I would also point out that the Western Region covers the big industrial area of Scotland. It is very serious indeed that the worse provision should be found in the western area.
The Report continues:
On a regional basis the same discrepancy between the Western Region and the other four regions appears perhaps even more clearly. Only the Western Region, at 65·0 per cent., is below the national figure of 70 per cent. (Glasgow as low as 57·6 per cent. if only National Health Service accommodation is counted); the three smaller regions are all above 74 per cent. and the South-Eastern Region is 76·3 per cent.
That presents a very serious picture. The figures for the Western Region and particularly for Glasgow show that my hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann) has been absolutely right when she has been pressing the Secretary of State about the maternity hospital at Bellshill. The figures show that Lanarkshire, too, in the Western Region is not adequately served by the provision of maternity beds.
Paragraph 82 reads:
As to overcrowding and length of stay in hospital, the average length of stay in obstetric units in the Western Region is again markedly shorter than in the other Regions.
That must mean that where in other regions it is felt that women ought to
be kept in hospital for a certain period, in the Western Region they are not being kept in hospital sufficiently long. The Report continues:
and it is obvious that there is very little margin for the occasional emergencies, great or small, which are hound to rise in maternity units, from the closing of an entire unit because of infection, to the closing of one ward while it is painted.
That is a very serious matter. In the whole of this Western Region, covering half the population of Scotland, if any crisis arises, great or small, there is very little possibility of dealing adequately with it.
In Appendix VI we find the areas with a high hospital confinement rate and the areas with a local hospital confinement rate. Port Glasgow Burgh is the lowest with 52·4 per cent. of hospital confinements, Sutherland County is next with 53·2 per cent., Airdrie Burgh is next with 55·6 per cent., and the next lowest is Lanark County, which had over 6,500 births in 1956 and the percentage for which is only 56·3. For Dumbarton Burgh it was 57·2 per cent. and for Orkney County 58·1 per cent. All of these figures are well below the national average of 70 per cent., and if one reads the Report one is inclined to believe that even the national average of 70 per cent. is too low.
I will not quote too many figures but I will turn to Appendix VIII and to the figures of vital statistics for 1957. The still-birth rate per thousand live and stillbirths was 24·0 for the whole of Scotland. The figure for those who died when less than four weeks old was 20·0 out of every thousand and the figure for those who died under one year of age was another 29 out of every thousand. It is very difficult to obtain comparative figures—perhaps some of my hon. Friends have them—but we see that the figure was 29 for the whole of Scotland, and we know that in some areas it was very much worse. Indeed, all these figures are much worse in some areas. Nevertheless, we can compare the figure of 29 for the whole of Scotland with a figure of only 22 for London, which has a big, and a very mixed population. That shows a great difference.