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National Health Service (Chiropody)

Volume 465: debated on Thursday 2 June 1949

The text on this page has been created from Hansard archive content, it may contain typographical errors.

Motion made, and Question proposed, "That this House do now adjourn."—[ Mr. Snow.]

10.1 p.m.

I want tonight to raise the question of the position of chiropody within the National Health Service. As the House knows, I take some interest in dentistry, and chiropody is a new interest for me—a move from one extreme to the other, from the head to the feet, or from troubles of the teeth to those of the toes. Both these troubles have something in common. Both are minor ailments, but they can cause considerable discomfort.

As I see it, the present position is that in certain very limited areas there is free orthopaedic treatment and treatment for chiropody if there existed a clinic which gave treatment before the provisions of the National Health Service Act came into operation. In those areas—my constituency is one of them—a patient may get a note from the doctor to say that the ailment or impediment is very serious. Only in very serious cases does this happen. If the patient takes the note to a specialist and he considers it necessary, free orthopaedic treatment and chiropody may be obtained. But this happens only in a very small number of cases and in a very small area of the country. Even then, only the worst cases are treated. In the majority of areas there is no such machinery for free treatment. I am told—I do not know how true it is—that where local health authorities are keen to develop a chiropody service under the National Health Service a circular has been published by the Ministry of Health which discourages them from doing so.

I want tonight, therefore, to discuss this question of the relationship of chiropody to national health, but in a narrow and limited field. I am concerned with it simply in so far as it relates to the treatment of old people, especially old age pensioners. I raise this question because numerous constituents—old age pensioners—have asked me why it is that when they have sore feet, which limit their movement, they cannot get, as they would if they required teeth or spectacles, treatment under the National Health Service.

Does chiropody apply to feet as well as to hands?

As far as I know practitioners are called chiropodists, and I will continue to use that term.

I have raised this question because a large number of my constituents have approached me about it. The amount of misery caused by sore feet is out of all proportion to the seriousness of the trouble. The House will recognise that a considerable number of old age pensioners cannot afford to pay chiropodists' fees for the treatment of their sore feet. Many old people, who otherwise are quite healthy, have their movement either partially or almost wholly restricted because of troubles of the feet. From a medical point of view, a considerable number of these old people, as the result of this lack of mobility, suffer degeneration in their mental powers and become ill in other ways, simply because they cannot get about and do their daily work.

My desire to raise this question is strengthened by a book I recently read. It was published at the end of last year and entitled "The Social Medicine of Old Age." It is published by the Nuffield Foundation and is an inquiry into the conditions of life of the old people of one section of the community in my constituency. I would recommend it to the House, especially to the hon. Member for South Edinburgh (Sir W. Darling) who is one of the two Opposition Members present. I believe that in the coming months and years this question of the health of our aged population will be one of the major problems facing us and certainly one of the major problems in medical politics which we shall discuss in the times ahead. I recommend it to the hon. Member because it is a valuable book in itself, and also because it is written by a very distinguished constituent of mine.

This book is a report on the health of a section of the people in the town of Wolverhampton by Dr. Sheldon, director of medicine in the Royal Wolverhampton Hospital. In it he tells how he took a section of 500 old people in the town which I have the honour to represent. He inquired into the whole question of their health and some interesting facts came to light. Dr. Sheldon points out that some types of treatment which old people can at present receive under the National Health Service Act are to a certain extent wasted, while other types of treatment, which are more necessary, they are not getting. In regard to dentures he says:
"There does not appear to be any reason to advocate the supply of dentures to those old people who do not already possess them. Not only was there no evidence of any special failure in digestive functions in those who depended on their gums for mastication, but no less than 15 per cent. of those possessing dentures made no use of them—at any rate for eating."
In such cases it is not very important whether they have them or not. I am not suggesting that the service should be withdrawn. Dr. Sheldon goes on to argue after two or three years' study of the problem, and before the National Health Service Act came on to the Statute Book:
"There is little doubt that the two measures which at the present time would give the greatest relief to the old people are adequate provision for chiropody and the supply of suitable spectacles. By no means all the affections of the feet would be relieved by chiropodial assistance, but many would derive great help. Such assistance would be much easier to provide than physiotherapy for rheumatic disorders and there can be no doubt as to the gratitude with which it would be met. Pain in the feet is worthy of special attention for two reasons: (a) it is apt to render the subjects immobile to a degree out of all proportion to the seriousness of the condition, and (b) it was almost the only physical complaint which caused great resentment in the sufferers."
This medical authority went on to examine the statistics which he had elaborated as a result of his survey, and he found that out of some 500 old people whom he had studied in detail, 39 per cent. of them were troubled with bad feet of one kind or another. He states:
"It is probable that in many instances the conditions present would have been capable of prevention if attended to early enough, and that in half the subjects concerned—who amount to 18 per cent. of the whole sample—life would be made more bearable were it possible for them to visit a chiropodist regularly. The actual extent of the disability caused is not in itself severe; but the otherwise good health of many of the subjects meant that the purely local trouble in their feet was both a distressing handicap and—even more, because of the effort their general health still allowed them to make—a very painful one. The misery endured by many of the women who were still running their houses made a great impression on my mind. The provision of chiropody would be a great boon to many old people. Even more desirable, however, is an expert examination of the feet of a random sample of old people"—
I commend this to the Minister—
"which alone would provide the detailed in formation which is very necessary."
Perhaps the Minister might even do that to begin with. Furthermore—and I think the House will agree—this book stresses the tremendous strain which is placed not only on the old people who are immobile, but on the large proportion of our population who are tied to these old people looking after them. We all know from practical experience that there is always one relative who has to look after them, do their shopping for them, cook their meals and fetch and carry for them. Dr. Sheldon refers to some of these people who do without a holiday year after year, and whose health is suffering. I think that it these old people could have some treatment to enable them to walk more easily, a tremendous strain would be removed from the people who look after them.

I know the need for economy at the present time. It may be impossible for us to bring the new service within the ambit of the National Health Service and to give free chiropody treatment to everyone who wants it, or even to everyone who needs it. I do not expect too much tonight, but I would appeal to the Minister to consider this question. Could we not extend the clinics in our hospitals so that old age pensioners would have the right to go in without a doctor's note and without their ailment being very severe? Even more important, could not the Minister begin now to evolve a system whereby we could have in our hospitals and our health centres, when we get them—which I hope will be soon—a corps of chiropodists who would go out to all these old people in their own homes? If we do that, we shall be doing a great benefit to the old people of this country.

I finish by saying that we all know that the National Health Service is not perfect yet. We still have a long way to go. We have only created the skeleton. We have to add to it as time goes on. I ask the Minister, when we consider extending the Health Service to chiropody, to agree that old people should have a special priority.

10.15 p.m.

My hon. Friend the Member for East Wolverhampton (Mr. Baird) has, by descending from teeth to toes, demonstrated his versatility and given the House another illustration of his wide interest in human affairs. I wish to support the suggestion of my hon. Friend for the provision of chiropody under the National Health Service.

My experience as a doctor has shown me that chiropody is most needed among old people. I have found many of them handicapped in walking by defects of the feet which could be remedied by a properly qualified chiropodist. We should do our utmost to help the aged. A service providing free chiropody for all old age pensioners would add to their welfare and increase their happiness. I gave my views in this House some weeks ago on the present financial position of old age pensioners. I now make the further claim that the majority of these old people cannot afford the fees of a chiropodist. These are the people who are most in need of this treatment and they are the least able to afford it. I hope that my hon. Friend the Parliamentary Secretary will give favourable consideration to this proposal.

In addition, I should like to take the opportunity of asking the Parliamentary Secretary to consider making use of Ministry of Health propaganda to lessen the incidence of defects of the feet. Many of these troubles are caused by the wearing of incorrectly fitting boots and shoes. In the past women have been the chief offenders in sacrificing comfort for appearance and thereby doing harm to their feet. I am pleased to notice nowadays that many young women select footwear which is both becoming and comfortable. I think that this sensible trend towards a healthy combination of elegance and ease should be further encouraged.

10.18 p.m.

I think at the opening of my remarks I should declare some personal interest in the subject raised by my hon. Friend the Member for East Wolverhampton (Mr. Baird). Quite apart from my personal interest in the feet, as someone who enjoys walking on every possible occasion, it also happens that my wife is a qualified chiropodist though not, at present at any rate, a practising one. I hope that will absolve me from any charge of being disinterested in the subject.

Indeed, we all realise what a great deal of benefit can be derived from an effective chiropody service. I realise the particular value of such a service to old people, as has been pointed out tonight. My hon. Friend stressed that at this moment he would not expect any promise of any very speedy development of this service within the National Health Service, for obvious and natural reasons. Today we face a great number of urgent problems within our National Health Service and obviously it would be impossible to suggest that we could give this matter any special priority at the moment. That does not mean that we are disinterested in it.

I would like, first of all, to say something about the provision that is being made at the moment under the Act. Under the National Health Service today, provision is made through the hospital service for chiropody which is required as part of that hospital service. Of course, this is a very limited part, so far as general chiropody is concerned. It is often found necessary as part of orthopaedic treatment, and it is sometimes found necessary in the treatment of diabetics and others. At the moment, there are 196 hospitals that are providing a service of this kind.

Of course, I agree it is a very small proportion, but they are spaced about the country and there are 268 chiropodists, both full-time and part-time, engaged in it, though the great majority are part-time, and they give attention through the hospital service. I am not claiming that that is a very good position.

Yes, they are England and Wales figures, as the hon. Gentleman rightly points out. There is also a limited service, a preventive service, under the local health authorities which existed before the Act came into force and which has been continued. No provision which local health authorities had before that Act came into force has in fact been closed down, and there has been no reduction in the service available through local health authorities. Nor indeed has there been any circular such as my hon. Friend suggested may have been sent out to local health authorities discouraging them from considering this particular aspect of the service. Naturally, this is only one service out of very many which the local health authorities are today developing, and it is obvious that they must weigh up in their minds whether this is a service which deserves special priority at this time over the many other services which they are providing.

I am not at all clear about this. What is the position? First of all, the Minister is discouraging the development by the local health authorities of clinics for chiropody, secondly, he is neutral on the question; and, thirdly, he is encouraging them again. What is really the position?

The position is quite simple. We are leaving this particular matter to the decision of the local health authority, but we are prepared to consider any proposals which local health authorities put forward. Quite frankly, we must face the fact that we do not expect that many local health authorities will be able to press forward very rapidly at this time with this service, knowing how many other directions there are in which they are involved.

Would it be correct to say that the hon. Gentleman is marking time until his sore feet permit him to go forward?

One appreciates the genial interruption of the hon. Member opposite.

I should say, with regard to the future, that we can offer no hope of speeding up this service as one would like to see it developed, but, when the Health Service becomes more fully established, we hope it will be possible to develop this part of it more actively. As local health authorities go ahead with some of their other provisions, it will be more possible for them to undertake these schemes. I was interested in the suggestion put forward by my hon. Friend the Member for Batley and Morley (Dr. Broughton) that there should be further propaganda by my Ministry on the subject of proper footwear and the care of the feet. That is something which I can certainly look into to see whether anything can take place in that direction. I rather support his view that in recent years there has been some development towards more sensible footwear for women in this country, and I hope that is a trend which will continue.

In conclusion, I would merely say that we are very interested in the suggestions put forward by my hon. Friends, and that they can be assured that we shall keep a very close watch upon this position and do all we can to consider the possibilities of its development, if not immediately, at any rate in the not-too-distant future.

Question put, and agreed to.

Adjourned accordingly at Twenty-six Minutes past Ten o'Clock.