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National Health Service

Volume 480: debated on Thursday 16 November 1950

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Chronic Sick, Essex (Accommodation)

3.

asked the Minister of Health what steps he is taking to overcome the acute shortage of accommodation for the elderly sick in the County of Essex.

The Regional Hospital Board have asked that at least 10 per cent. of the beds in each general hospital should be set aside for chronic sick patients. Additional beds have been provided as staff has become available, special geriatric units have been set up, and arrangements have been made for private institutions to take a considerable number of patients. Everything possible will continue to be done compatible with the staff and medical resources available.

While appreciating that answer, may I ask the right hon. Gentleman if he is aware that there are still large numbers of people, in Essex at least, who, in the opinion of their doctors, should be removed to a hospital? As great suffering is caused thereby, will the Minister not treat this matter with greater urgency?

There is a very large number of people in this category, far more than ever there were and far more in hospitals now than ever before. This is a very difficult and grave social problem.

Is the Minister aware that of all the people who have been helped by the National Health Service Act the old, chronically sick have been helped least of all? Is it not a fact that they were better housed in Poor Law institutions and——

Arguments are not in order at Question time. Hon. Members should only ask for information, or press for Government action.

Part-Time Nurses

8.

asked the Minister of Health why the number of part-time nurses has fallen from 136,000 to 25,000; and what his policy is in regard to part-time nursing.

The hon. Member seems to have been misinformed. The number of part-time nurses has never been higher than the present total of 25,000, and was about 17,000 when the National Health Service began. My policy is to encourage their employment wherever there are serious staff shortages.

Tuberculosis

9.

asked the Minister of Health how many notifications of new cases of tuberculosis in England and Wales were recorded in 1949.

I think it is an increase. These increases are due to the fact that we are now using mass radiography. Although we are discovering more tuberculosis of a respiratory kind—the increase in the number of notifications being 5½ per cent.—there has been a decrease in the number of deaths, over the last five years, of 12½ per cent.

In view of the fact that these tragic figures continue to rise and good housing is preventive medicine, will the right hon. Gentleman not now consider treating houses as a No. 1 priority?

The hon. Member has obviously ignored the last part of my last reply. The number of fatalities is falling, although the number of notified cases is on the increase. I should have thought that everyone would rejoice about that.

24.

asked the Minister of Health what arrangements have been made to ensure that those who, as a result of the mass radiology tests are found to be in the early stages of tuberculosis have the requisite treatment.

They are referred to a chest physician and treated according to their need and the facilities available.

Is the right hon. Gentleman satisfied that there is not now very much delay in many cases before these people can get any sort of treatment?

There is delay. As I explained in answer to an earlier Question, many people have been discovered to be suffering from respiratory tuberculosis at an earlier stage, but, fortunately, the treatment is resulting in a reduction in the number of fatalities.

25.

asked the Minister of Health how long a tuberculosis patient has now to wait for a hospital bed.

It depends so widely on the individual circumstances and local resources in each case that no average figure would have much meaning.

Can the right hon. Gentleman assure the House that this situation is improving, because it seems to a great many of us that it is getting steadily worse?

I have already indicated, in two answers, that the general overall position is improving.

Does not my right hon. Friend agree that the real problem is a shortage of nurses?

That is a reason why I issued a circular asking hospital authorities to make beds available for this type of case in general hospitals. I have had an interim report on the matter, and there has already been a very large increase in the number of beds.

35.

asked the Minister of Health how many patients are waiting accommodation in tuberculosis hospitals and sanatoria at the most recent date for which figures are available.

Annual returns as at 31st December last showed that the number was then approximately 11,000.

In view of the long waiting lists of people for this kind of treatment, does the right hon. Gentleman feel that any revision in relation to priority of needs within the hospital service is called for and that any solution could be found by making use of beds which exist in Switzerland?

I have already replied that tuberculosis patients have been moved on the priority lists by asking the general hospitals to set aside wards for such patients.

Did not the Minister hear the concluding remarks of my hon. Friend's question, which was that he might give consideration to relieving these heavy lists by making use of the large number of beds available in Switzerland?

I have been prepared to consider it, but, as the right hon. and gallant Gentleman knows, currency difficulties are involved.

Yes, but is it not the case that currency difficulties have now existed for a considerable time? In view of the great shortage of beds and the well-known fact that it will not be possible to catch up with these lists in a reasonable time, could there not be some acceleration?

I shall be able to give to the House before very long a report on the progress which has been made in making beds available in this country.

Hearing Aids

13.

asked the Minister of Health what steps he is proposing to take to accelerate delivery of a hearing aid to a Surbiton resident, particulars of whom have been sent to him, who has been awaiting delivery of a hearing aid for over a year, and who has been informed that he will not receive it for a further two years.

As the hon. Member has been informed, this patient has no exceptional claim to priority. The service as a whole will be expanded as resources permit.

Does the right hon. Gentleman say that a delay of the nature set out in this Question is normal, or is this gentleman particularly unfortunate?

This citizen has been prevented from obtaining or has been unable to obtain, an aural aid for many years. We have issued 100,000 aural aids, and we are providing them first for individuals who need them urgently on medi- cal grounds, or for the purposes of employment.

Does that answer mean that people of this age must expect to wait three years?

32.

asked the Minister of Health whether he will expedite the delivery of a hearing aid to Mrs. M. McCarthy, 5 Buckingham Avenue, Thornton Heath, who was examined in November, 1948.

Does not the Minister agree that a wait of some two years for the result of an examination is far too long?

It would be very desirable to be able to hand out hearing aids immediately. We have handed out over 100,000 of them, and the limitation now is in skilled personnel to examine the patients.

Male Nurses (Training)

17.

asked the Minister of Health what negotiations he has had with the General Nursing Council to see if the hospital training received by men during their period of service with the Armed Forces can be more fully recognised in attaining qualification as a State registered nurse; and if he will make a statement on the correspondence sent to him on this subject.

This matter has been discussed with the General Nursing Council and the Service Departments at various times. The question of what, if any, remissions of training can be granted is entirely for the General Nursing Council. The list of concessions granted by them is rather long, and I will, with permission, circulate it in the OFFICIAL REPORT.

Following are the concessions:

1. The rules of the General Nursing Council provide:

  • (a) for a remission of six months in the period of training for State registration to members of the Armed Forces who have had not less than two years experience since 3rd September, 1939, in the nursing of the physically sick in hospital under the super- vision of trained nurses. Application must be made within six months of discharge from the Forces. The trainee may take the preliminary examination on the termination of six months' training instead of on completion of one year;
  • (b) for persons who have attained the rank of Nursing Orderly Class I in the Army, or the equivalent rank in the Navy or Royal Air Force and have had not less than two years' experience in the nursing of the physically sick in hospital under the supervision of trained nurses, to be allowed to qualify for registration by a 12 months' intensive course.
  • (c) for men who have undergone a course of not less than three years' nursing instruction in accordance with the syllabus of the Council, in the service of the Admiralty, the Army Council or the Air Council, to be allowed to take the examinations for State registration without further training.
  • 2. Arrangements have been made between the General Nursing Council and the Service Departments to enable nursing orderlies in the Army and equivalent ranks in the other Services, during their period of service, to train for the preliminary examination for State registration in Service hospitals approved by the General Nursing Council.

    Ambulance Service (Cost)

    23.

    asked the Minister of Health to what extent the estimated cost of about £8 million for the Ambulance Service for the current year is likely to be exceeded, and what steps he is taking to ensure greater economy and efficiency in the use of this service.

    I trust it will not be exceeded at all, but I am about to put before the bodies concerned certain suggestions to secure greater economy and efficiency in the use of the Service.

    Will not the Minister agree that there is a certain divided responsibility which makes these matters rather difficult in this respect? Doctors and hospitals order, and the county councils pay.

    There is a certain divided responsibility, but I am not sure at the moment it is leading to additional expense. However, we are making inquiries.

    Hospital Patients (Examination)

    27.

    asked the Minister of Health if his attention has been called to the common practice, in teaching hospitals, for patients to be examined intimately by groups of students, often against the natural inclination of the patients; and if he will issue a general regulation to the effect that the consent of every patient must be obtained before an examination may be performed.

    I am not aware of any general dissatisfaction with the existing arrangements, or of any sufficient reason for suggesting they should be changed. My hon. Friend will realise that it is vital that medical students should have adequate clinical training.

    Is it not also right that the patient should be consulted before his body is employed as a nationalised exhibit?

    That is a very wicked statement to make. It has always been the case that in teaching hospitals medical students must be taught with the clinical material available, that material being human beings. The hon. and gallant Member ought to have a greater sense of public responsibility than to make a statement like that.

    Cortisone

    28.

    asked the Minister of Health when he expects to make general use of cortisone in the hospitals.

    29.

    asked the Minister of Health what is his policy with regard to recommendations by doctors for patients to be treated with cortisone.

    The use of this drug is still experimental, and wider use must depend on greater knowledge.

    Can the right hon. Gentleman say what is the extent of the demand for this drug by general practitioners, and will he comment on the case in my constituency to which I have directed his attention?

    I hope that there is no demand for this drug by general practitioners at the moment, because the consequences of taking the drug have not yet been established. Until experiments are concluded, it is not possible to make this drug generally available.

    Is the Minister aware that, in the case to which my hon. and gallant Friend has drawn his attention, three doctors who knew the patient recommended the use of this drug; that one specialist did not recommend its use, and that the right hon. Gentleman took the advice of the specialist and not of the three doctors?

    Is the Minister aware that in one experiment in this country some encouraging results have been obtained? Will he do all he can to obtain further supplies of this drug?

    I am quite ready to obtain further supplies of the material to enable further experiments to be made, but the hon. Member knows that it is far too early to arouse expectations about the use of this drug.

    Hospitals (Private Patients)

    31.

    asked the Minister of Health what are the reasons for the increases for private ward treatment in the Merseyside hospitals, where the costs have increased by 100 per cent. from July, 1948, up to September, 1950.

    Partly owing to increased costs, and partly to the fact that the charge now covers full cost in all cases.

    As the use of private wards must relieve the pressure on public wards, will the Minister consider the possibility of a reduction in the charges for private wards?

    That would really mean that a larger number of people would be able to pay for beds at the expense of others.

    Is the Minister aware that local opinion is that administrative costs are unduly high and that if he inquired into this, he might make a great deal of saving?

    I will certainly make inquiries to see whether that is so in a particular instance, but a proper share of the administrative costs must be set off against the pay beds.

    36.

    asked the Minister of Health whether he is aware that patients who, by reason of having to wait many months before they can be admitted to hospital, agree to go in as fee paying patients, are admitted with little delay; that this is a cause of dissatisfaction among other patients awaiting treatment; that in some instances it causes financial hardship; and if he will take steps to end this practice.

    If my hon. Friend will let me have particulars of any cases known to him where admission was medically urgent and was refused, I shall be only too glad to look into them.

    Is my right hon. Friend aware that I have sent him particulars of a case where a patient who was waiting for 11 months to go into hospital, because of the long wait became a private patient and was able to enter hospital in less than 11 days?

    If the patient was not suffering from anything requiring urgent medical treatment no problem arises, but he had no right to go into hospital ahead of people in greater medical need.

    But if the patient was not suffering from something requiring urgent medical attention, why could he enter the hospital as a paying patient in under 11 days?

    I quite agree with my hon. Friend about that, and if he will send me particulars I will investigate the matter. I am far from satisfied with the way in which it is possible for doctors to get their private patients into hospitals.

    Part-Time Specialists, London

    39.

    asked the Minister of Health how many part-time specialists in the London area are holding more than nine, and more than 11, sessions weekly, whether with or without pay; and how many of those are engaged in the speciality of psychiatry.

    Disregarding honorary contracts, for which records are not available, about 341 part-time specialists in the Metropolitan area are giving the equivalent of over nine half days, and 79 the equivalent of over 11. The corresponding figures for consultant psychiatrists are three and none.

    Does not the right hon. Gentleman agree that if—as is true—certain over-zealous practitioners are putting in more than 11 sessions a week, for some of which they are not being paid, they are blocking promotion for those under training and, therefore, doing the profession no good? Will he make arrangements to check this practice?

    Aureomycin

    40.

    asked the Minister of Health how much aureomycin was imported from the United States of America during the nine months period ended 30th September, 1950.

    One hundred and forty thousand and seventy-five grammes, apart from small quantities for sample and trial purposes.

    As I am sure the Minister knows that this is regarded by the medical profession as a life-saving drug in the case of bronchial diseases, how can the Government justify spending millions of dollars on importing tobacco while limiting the import of the drug?

    I would urge hon. Members not always to believe everything they hear about every drug which is produced on the other side of the Atlantic.

    Prescriptions

    44.

    asked the Minister of Health whether, in view of the evidence received from the Joint Pricing Committee for England that the average cost of prescriptions per person from 1st January to 30th September, 1949, was 11s. 4½d., he is prepared to review the present dispensing capitation fee paid to doctors who supply medicines to patients on their National Health Service lists.

    No, Sir. The figure quoted and the fee are not comparable. In addition to the fee, pro rata payment is made to the doctors for certain individual items supplied.

    Is there not a great disparity between the capitation fee of 6s. 6d. a week and the average cost of prescriptions at 11s. 4½d.?

    If the hon. Gentleman will look at my reply he will see why the figures are not comparable.

    Doctors' Lists

    78.

    asked the Minister of Health how far under his regulations executive councils, in using their power to bring the excess list of a doctor within the prescribed maximum, allow a margin of 5 per cent. for contingencies.

    This is a matter for the discretion of the executive council in the light of local circumstances.