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Tuberculosis Cases (Accommodation)

Volume 481: debated on Friday 24 November 1950

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

4.0 p.m.

Last night we had a very useful and interesting debate on the subject of nurses in tuberculosis hospitals, at the end of which the Parliamentary Secretary was very helpful and decided that he would certainly look into the suggestions which had been made from both sides. I hope that we shall find him in an equally helpful mood this afternoon when he has heard all that I have to say on a similar subject.

I am speaking of tuberculosis generally, and what I am now going to say I feel sure will reflect the thoughts of thousands of people throughout the country, because they know, as hon. Members know, that there is a very terrible lack of treatment facilities at present. The position is becoming so crucial that when I appeal to the Parliamentary Secretary with constructive ideas, I hope he will be able to say that he will take some action.

There is no need to tell sad harrowing stories of the ravages of tuberculosis throughout the country, for all those things are only too present in the minds of hon. Members, but I would just remind the House that at present there are on an average 400 deaths every week from this scourge, deaths in many cases at an important and productive time of life, of people in the middle of their lives just when they are ripe to do their best work. So, for humanitarian reasons it is essential to do something. At the moment people are dying without any treatment at all and others are left so late that there is little hope of their recovery. We must compel ourselves to act and to do it quickly.

The two great problems are shortage of accommodation and shortage of nurses. The latter point was dealt with very fully by the hon. Member for Bermondsey (Mr. Mellish) last night, and so I shall concentrate chiefly on accommodation. Apart from the humanitarian side—and thank goodness in this country, in spite of all our difficulties, we still have a very great horror of human suffering—tuberculosis is actually endangering the health, the prosperity and the economic future of the whole country because treatment is not readily available.

The slight cases are suffering because the time lapse between diagnosis and treatment is in many cases a very long one, and physicians have the harrowing task of seeking a hopeful case deteriorate into a serious case and finally into an almost hopeless case, and then of course the treatment takes longer. The bad cases are even worse; sometimes they do not even get a chance of obtaining treatment because it may be said, it is more important to treat the slight cases which can more easily be cured. The bad cases are sometimes even left in their homes to die. When they are in their own homes they realise what a nuisance they are to their relations and friends. They realise that they are infectious. In many cases they have to get up to do their own cooking. These things are preying on their minds all the time and discouraging the improvement which they could make if they had proper treatment.

This is not only terrible to think of but it is utterly unsound as well, because the people who are in contact with tuberculosis cases are five times more susceptible to the disease than those who walk about in their every-day life. The result is that infecton is spreading, and that is increasing the already overwhelming demand for beds. If the problem is tackled now we can not only save the lives of many of these people but also save a great deal of money. I know that the Parliamentary Secretary will say that he is up against it and that we have no money, but—

indicated dissent.

I am glad to see that he shakes his head. He will probably agree with me that money spent now will save millions in the years to come. I am trying to make him believe that it is an economic proposition to spend money on tuberculosis treatment. There are two three minor suggestions, such as that for night hostels, where people could get a room for themselves away from their families. Such hostels would probably require no trained nurses. They would prevent men having to share a room with their wives or children at home. Another suggestion—it is a difficult one—is that people might volunteer to lease rooms to people suffering from tuberculosis. If proper precautions are taken they should not come to any harm.

The big point I want to make is that there are plenty of beds available abroad. Before the National Health Service was introduced, local authorities were able to send patients abroad, paying half the cost. At present the Dutch are sending people to Switzerland and other places. We have 11,000 people waiting for treatment and yet we are not taking advantage of this. All the time the position is growing worse by geometrical progression. In Switzerland there are experts on the treatment of tuberculosis of the eyes, which in this country it is very difficult to get adequate treatment for at all. Indeed, some people in this country are condemned to blindness simply because they cannot get that treatment.

Not only in Switzerland but in France and in Scandinavia also there are sanatoria which are prepared to take patients from this country. In France the difficulty of exchange would not be so great. But let us take Switzerland in particular. There are three places, Davos, Leysin and Montana. I have taken some trouble to find out the expenses of treating people in those places. To send them out there of course, would be an extra cost, but a second class fare including sleeper to Montana is £15 exactly or by air £18 13s. Similar figures for Davos are £15 10s. and £19 2s by air.

Weekly costs vary according to category, according to the accommodation that the patients have, but the costs vary from £9 a week up to £18. an average of £12 or so. On top of that, of course, as the Parliamentary Secretary will know, there will be expensive items such as radiography, investigations medicines, as well as operations. Now, it is estimated that these can be carried out on the average for three Swiss francs a day; that is, the equivalent of £1 15s. a week. So that means that we can send patients to Switzerland to have expert treatment —the finest in the world—for a sum of £13 15s. a week. In addition, they would probably want £1 a week pocket money.

In these three places I have mentioned, Davos, Leysin and Montana alone, at the present time—this may be giving some information to the Parliamentary Secretary, but I hope he knows it already—now in November, 1950, there are available 1,435 beds. That is in Switzerland alone. If the cost of sending people to make use of those beds which are actually offered to us were entirely extra to what we are already spending through the National Health Service it would be well worth it; but already here the treatment of the patients per week is at a cost of between £10 and £12. So the cost over there, apart from the fare, would be very little more per week, and I have no doubt at all that all these places would make a reduction if the Government guaranteed patients would go for so many months a year or for so many years ahead.

The Parliamentary Secretary may say there is difficulty over obtaining exchange. Well, I have given him the alternative of France and of places in Scandinavia, but, even in the case of Switzerland. I believe it is not beyond the wit of the Government to get over the control of exchange to allow a little more to be spent, or, at least, to be a little more lenient in allowing money for such an important cause. The beds are there, and it is wicked not to use them. Apart from what I have said about the humanitarian reasons, to spend half a million now is bound to save millions in years to come, and I think all hon. Members will agree.

I believe that when the public knows the facts as I have put them today, and as other people, no doubt, will put them in the future, there will be such a movement of opinion that the Minister will he forced to do something about it. I think the time is coming when for humanitarian and economic reasons he will be driven to act. I appeal to him to do it now. We have a problem here, and we have a tragedy. Both can be solved. So I say to the Parliamentary Secretary that I hope he will tell us tonight that he is going to do it right now

4.12 p.m

I think that most people considering this very urgent problem of tuberculosis agree with the opinion which was once expressed I believe, by King Edward VII, "If it be preventable, why not prevent it?" But I think there is this danger that robust common sense must not lead us into over-simplification of the problem. It is not a problem which we shall solve only by building more houses, because it is not wholly a social problem. It is not only in the foetid air of the slums that tuberculosis is bred. In that part of these Islands where I have my roots, in the Western Hebrides, it has always been the greatest scourge of family life.

I do not want to go into figures at all, but this disease is the only major killing disease in the treatment of which in these last few years—and I am not arguing whether the curve is going up or down at the moment—we have not reached the benefits one would have expected to reap from the increased knowledge and skill of our scientists and our doctors, and from our increased knowledge of hygiene, diet and other important matters

Let us look at the set-up as it is under the National Health Service for a moment. There is, if I may borrow a popular word, a dichotomy between prevention and cure, between the local health authorities and the regional hospital boards. A person may first of all be the responsibility of a local health authority, then of a regional hospital board. He may then be discharged and come under the after-care provisions of the local health authority But after-care, in its normal sense, means after-cure as well, and that does not apply in tuberculosis, for in many cases patients have left and are leaving sanatoria because those sanatoria can do no more for them.

The only suggestion that I want to put to the Parliamentary Secretary is one which raises great implications, which I would not expect him to reply to this afternoon, except that I would like him to say that his mind is not closed to it, as I am sure that it is not closed to any suggestion in this field. We have this set-up under the National Health Scheme of regional hospital boards and hospital management committees, and we are satisfied in general, as I am, that this is the best set-up that we can have for the whole of the National Health Service

I would say, in passing, that there are people who argue that the local health authorities should be brought more firmly into this and other parts of the health service, but it is my personal view that that should follow and not precede the general review of local government boundaries. The point I want to make is that we have at this moment this method of National Health Service, and I think that it is the best, but I do not think it necessarily follows that it is the best answer to every single disease. I think that we ought to consider treating tuberculosis as something which does not—and the figures seem to justify me in saying this—quite conform to the arrangements which we have made for the health of this country in the last two years.

The Secretary of State for Scotland very recently held a Press conference in which he proclaimed a priority for this disease. The Ministry of Health writ does not run north of the Tweed and being a Scot. I am not going to indicate whether that is a good or a had thing for Scotland, but I would like to see something like that declared from the Despatch Box by the Minister and by the Parliamentary Secretary For this reason I think that we must declare a priority and accept that something else must go to provide for that priority.

Let me give an example. My hon. Friend mentioned the question of hostels. In the City of London, the London County Council have been forbidden by the Ministry on grounds of expense to build certain night sanatoria, and certain hospitals for this disease, of which St. Peter's, Stepney, is the example of which I am thinking. In my view, we can only justify that refusal on the grounds of finance, which was the reason given, if, at the same time, we are satisfied that the whole of this immense sum of £400 million spent on the Health Service is being spent on more worthy objects.

I am not one of those who think that we should try to get quarts out of a pint pot. I know the difficulties, and I know that in asking for a priority for tuberculosis, I am also asking that something else in the Health Service should go short, but I think that the importance of this disease is such that we should take that step.

4.18 p.m

I am grateful this afternoon, as I was last night, that we have had an opportunity of considering this subject, and that we have had two opportunities during these two days so that we can, as it were deal with separate parts of what we all agree is a vital and most important subject

Perhaps I may first deal with the point which the hon. Member for Tonbridge (Mr G. Williams) raised about facilities it Switzerland. As my right hon Friend said, in answer to a Question the other day, we have this matter under review, but all the information that we have from Switzerland suggests that the contribution which they can make, even under the most hopeful circumstances, would he very much smaller than the one which he has mentioned. The figures which we have are by no means as encouraging, or as large, as those which he has suggested

I shall be very pleased to hand over the figures to the hon. Gentleman, which I know to be authoritative.

In any case, I would only say that the matter is under review. But there are very varied medical opinions about the value of treatment in Switzerland for particular types of tuberculosis cases. Therefore, we do not want in any way to commit ourselves on this matter. I would assure the hon. Member, however, that the matter is under review, both by my right hon. Friend and the Secretary of State for Scotland.

I am anxious that we should keep some sense of proportion in this matter. The hon. Member for Tonbridge has rightly called attention to its importance and urgency. He did seem to be indicating, however, that we have not been making any progress during the last few years. That is not true. We are encouraged by a steady fall in the death rate of tuberculosis. I know that we do not want to be over-encouraged by this figure, or to be satisfied, but at least we should recognise the very great improvement that has taken place during the last few years. The figures for 1947, 1948 and 1949, as well as the latest figures available for this year, show a most encouraging steady decline in the death rate. The figures are: 1947, 23,550; 1948, 21,983; 1949, 19,834, and the figures for this year show a continuation of that most hopeful and encouraging trend.

Yes, Sir. They are the total figures. This means that the number of deaths today is only about half the number 20 years ago. It is true that, largely because of mass-radiography, the diagnosis rate is very much larger. It is not necessarily very much larger than in the old days, but it is at a very high figure. Some people say that, because of that, we ought either to close down or limit the mass-radiography work. That is far from what we should do.

Even though we may be short of accommodation, and even though there may be these long waiting lists, we should know where this disease is. Even in the home, we can do a great deal to limit the spread of this very serious scourge in the country I am very conscious of the importance of the matters that have been raised, but I think it right that we should bear in mind the success that has attended the development of new medical techniques and the like.

I have some figures about the development of mass-radiography that may interest hon. Members. We now have some 50 units operating in England and Wales, and I find that the total number of examinations carried out, up to 30th June this year, is some 5 million, and of that number only.37 per cent show active tuberculosis. That is a static figure; it has stood at the same level for the last few years. It shows that we are doing a great deal of work on the diagnostic side. Although it has undoubtedly led to an increase in the waiting lists, it is work which is certainly well worth carrying out.

What, then, can be done with these waiting lists? I said a good deal last night about the action we are taking both to try to recruit more nurses, which is the most important measure of all, and to encourage the secondment of nurses from teaching hospitals; I mentioned also what we are doing to try to make available wards or blocks in general hospitals for the care and treatment of T.B. cases. All these efforts will undoubtedly have a very real and useful effect in cutting down the long lists, but we must also consider what more can be done in respect of cases at home in addition to the question, which is under investigation, of what can be done abroad.

So far as housing is concerned, nearly every local authority regards T.B. as one of the grounds-for priority when considering the allocation of houses. That has been referred to in the report of a subcommittee of our central housing advisory committee, and I think it is fair to say that practically every authority gives all possible consideration to this aspect. There is also the question, which was mentioned last night, of what further information can be given in the home to those who have care of patients. This is another matter about which we have been advising local authorities during the last few months.

Is it true that 20 per cent. of the people who die of T.B. are not known to have been suffering from it until after their death?

I could not, off-hand, confirm or deny that figure. I should not like to accept it merely on an exchange in the House.

I wish to call attention to a circular which was issued a few months ago, which at the same time provided for the use of further general hospital beds for T.B. treatment, and pointed to certain ways in which we hoped that further help could be given. The circular reads as follows:
"Boards"—
that is, regional hospital boards—
"should make themselves familiar with a scheme at present operating in connection with the Central Middlesex Hospital and a neigh- bouring chest clinic which combines rest and collapse therapy in the home with short periods of in-patient treatment. A system of this kind depends on local conditions and resources, but it is clearly one which may prove suitable in some areas as an expedient for alleviating a local insufficiency of institutional beds."
The circular went on to say:
"Every effort should be made to discover active tuberculosis at the earliest stage and to give the closest attention to contacts and the ascertainment among them of non-reactors to tuberculin with a view to raising their immunity by B.C.G. vaccination"—
which is now becoming available for domiciliary use as well as for hospital care.
"Chest physicians will recognise that it is important to concern themselves no less with prevention and after-care than with their clinical work; and that it is necessary to give sedulous attention to case-finding and the supervision of the tuberculosis family, including visitation in the home"
I agree that this is not a matter which can be tackled by any one of the three arms of our existing Health Service on its own. Clearly this problem requires the very closest co-ordination of the work of all three forces working together for the same end—the local health authority, the general practitioner service through the executive councils, and the hospitals themselves.

I was grateful to the hon. Member for Enfield, West (Mr. Iain MacLeod), for his thoughtful contribution. We have under consideration die question of the administrative organisation of the Health Service in relation to some of these particular problems, both in T.B. and in other special fields. Our minds are by no means closed to any changes that might necessary in order to secure more effective cooperation between all the agencies concerned.

I cannot say more today except again to assure the House of our great anxiety about this problem. While we are glad to see the steady fall in the death rate which has been taking place, we are still anxious to make fuller use of all facilities that can be made available and to reduce the long waiting lists which are, we admit, a discouraging factor.

Before the Parliamentary Secretary sits down, will he—

The Question having been proposed at Four o'Clock and the debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Half-past Four o'Clock.