§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Kaberry.]
§ 10.0 p.m.
§ Mr. William Wells (Walsall)
It may seem somewhat strange that, after the consideration of questions of global interest and importance which have been before us all day, the House should now pass to the consideration of a chest clinic in Walsall, the constituency which I have the honour to represent. There is, however, more than a question of purely local interest involved, although I should make no apology for raising the matter were it confined purely to a local question.
The question involved in the arguments which I shall seek very shortly to deploy is whether, in a large industrial town, whose hospital facilities have to serve not only the population of the town itself but also, for many purposes, parts of the surrounding country, it is proper for so vital a part of the town's health services, in the broadest sense of that term, to be so indissolubly bound up with the general services of the local hospital as must necessarily follow when the chest clinic has no independent X-ray apparatus.
That is the general question. There is a history to be considered in the context of the events which happened. In the first place, the incidence of tuberculosis is higher in Walsall than the average of the country and the mortality rates from tuberculosis remain on average higher than those of adjoining towns, although happily there is a decline in the figures. The tuberculosis problem, therefore, important though it is everywhere, it more pressing and urgent in Walsall than it is in most places, and I can certainly say with confidence that it is more pressing than in any other place in what is generally known as the West Midlands.
Until recently the tuberculosis investigation facilities in Walsall were very poor indeed, but a marked advance has been made in that a more modern building than was previously available has now been made available in the grounds of the general hospital for the purposes 552 of the chest clinic. A store has been converted for use as a chest clinic. That is a marked advance; it means that instead of Walsall having a third-rate chest clinic, it now has a second-rate chest clinic. That is better than no improvement.
This question had aroused a great deal of local interest and has been before the House previously. Perhaps I may refer to Questions which were put down by my hon. Friend the Member for Lichfield and Tamworth (Mr. Snow) and myself, which are reported in HANSARD, volume 512, column 554. My hon. Friend and I asked the Minister of Health, in effect, whether he was aware that the Birmingham Regional Hospital Board had refused to establish a fully-equipped chest clinic in Walsall and on what grounds the decision had been taken.
At that time, the Minister replied that notice had been taken and the matter was under discussion. My hon. Friend the Member for Lichfield and Tamworth pointed out that this particular clinic was necessary because of the large urban area which is outside Walsall. The Minister, in reply, pointed out that there was a chest clinic in Walsall, although it was not adequate in its facilities, having no X-ray apparatus. The extension of these facilities was a matter—that was in March and April of last year—which was being discussed with the regional board.
Unfortunately, the regional board came to the conclusion that it would not sanction the increased expenditure that a separate X-ray apparatus would involve—an expenditure of £4,500—and the present position, therefore, is that the patients at the chest clinic have to be dependent for these services on the Walsall General Hospital. There is no complaint locally—and I make none—about the extent of the co-operation which has been given by the hospital authorities and, in particular, by the radiologist and his staff in helping, and offering to help, with the work of the chest clinic.
On the contrary, the radiologist has gone very far indeed towards meeting the requirements of the clinic, and I think that all concerned recognise that he is doing his best. He has offered a timetable which makes three hours available 553 on Monday, four on Tuesday, four on Wednesday, three on Thursday and three on Friday of each week. It is estimated that 110 cases can be dealt with in that time.
The first point that necessarily emerges is that there are always in hospitals likely to be emergencies which will interfere with the normal flow of patients. If there are accidents and if there are emergency operations, in which there may be a question of immediate life or death—and these things happen in hospitals, and sometimes quite often—then clearly patients who have come in for an inspection in the chest clinic have to wait. That is one of the difficulties. But there is another, and even greater difficulty, because, even in the normal course, it involves patients going to the chest clinic, undressing, dressing, crossing over to the main hospital building, undressing again, dressing again and going back to the clinic for probably a further investigation there. It adds enormously both to the amount of time that the individual patient is kept waiting and to the work of the staff of the clinic.
It not only adds in the purely objective ways which I have described to the difficulties of operating the chest clinic efficiently. It also provides a certain psychological barrier to the effective use of the clinic. With a disease of this gravity there is with many people a resistance to accepting the fact that they have this condition or are in danger of having it. Many of them want to make an excuse for not being examined. If they hear from their friends about these delays in going to the clinic and then being told that they must come at some other time because the X-ray facilities are not available, and if there are long periods of waiting, it will get known very quickly that the chest clinic is not the sort of place where one's case can be dealt with quickly.
This is a serious disease, a disease of great gravity. It is not just a question, as it often is in hospitals, of the patient being put to some inconvenience. The patient when he comes to hospital is probably in a state of distress, and it is not only inhuman, but it may impair gravely the working of the clinic, if the full X-ray facilities are not available.
What is involved is the sum of £4,500, admittedly a sum of some little 554 importance. On the other hand, however, the question is whether with this grave disease and with these highly skilled people who are giving their services to combat it, we are going to admit that these services are not used to the full advantage. Are we to admit that these people are to be partly frustrated in their work, not in one year or in two years, but over a considerable period, because of this comparatively small sum?
There can be only one proper answer to this question, and I hope that when she replies the Parliamentary Secretary will not take refuge behind the decision of the regional hospital board. We all applaud when a matter is dealt with with propriety and economy on the part of hospital boards, but this is not a mere matter of routine. It is a matter of principle. It is a proper matter for the intervention of the Ministry, and I ask urgently, on behalf of my constituents, that the Ministry does intervene to ensure that Walsall and, in due course, other towns have a full, complete and efficient chest clinic.
§ 10.15 p.m.
§ Mr. Julian Snow (Lichfield and Tamworth)
As my hon. Friend the Member for Walsall (Mr. W. Wells) has explained, my interest in this matter is that a large suburban area around Walsall which lies in my constituency depends on those services for medical attendance.
My first point is that the hours which have been offered by the Walsall General Hospital for the use of cases referred by the clinic are hours which lie wholly within the normal working day of a person in employment. There are two objections to this. I depend for my information on an opinion which has been expressed to me by a consultant in a different part of the country on this kind of problem.
The first objection is that there is some degree of delay likely if the patient feels that he must disclose to his employer the fact that he must go to the chest clinic or to a hospital. These things are better done outside working hours. Though it is hard to imagine that this would be the case, the patient may feel that the employer would be reluctant to employ people who are suspect of having T.B., since the ignorance about contact in these cases is profound.
555 Before I make my second point, may I ask the Minister to look into this fairly small one? Is this chest clinic equipped with the small-scale X-ray apparatus which permits a fairly quick diagnosis to be made, and which is routine equipment in an efficient clinic? That is a matter which ought to be looked at.
My second point is also of psychological interest and has been mentioned in passing by my hon. Friend. It is that, where patients must go through the rigmarole of first going to the clinic and then to the hospital, we automatically increase the period of apprehension. If the patient who goes for the first time under suspicion must then go to another place for the X-ray, it all tends to increase apprehension, and I am advised that the psychiatric element in these cases is being recognised to an increasing extent. Indeed, I am told that psychiatric treatment for tuberculosis is becoming of increasing concern to doctors and they are beginning to realise how important is the psychological aspect of these cases.
So I hope the Minister will listen to the remarks made by my hon. Friend, because I know that in the locality the demand for a properly equipped clinic is causing much concern to the medical and local authorities concerned.
§ 10.18 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I agree with the hon. Member for Walsall (Mr. W. Wells) that there is a particular interest in tuberculosis in Walsall because there is a higher than average incidence of the disease in that locality, though it is not quite the worst in the Midlands; nevertheless it is something which has caused the board and the authorities anxiety and which they wish to mitigate.
It is true that the death rate in this area has fallen as a result of the measures so far taken and, indeed, of the new drugs that are provided. It was 58 per thousand at the end of March, 1951, and .35 per thousand at the end of March, 1953. At the present time there are regular weekly sessions provided and evening clinics. It has been recognised all along by the regional hospital board that the facilities in the present clinic which is an old converted building of six rooms are inadequate and that a new chest clinic 556 was necessary. It has been on the priority programme of the board since they took over in 1948, when they recognised that something had to be done to provide better clinical facilities.
They have gone a considerable way to step up the service there. The chest physician status has been upgraded. A consultant appointment has been made instead of a senior H.M.O. and recently an assistant S.H.M.O. has been added to this area. This officer will take up his duties in September.
It cannot be said that the Birmingham Regional Board or the hospital management committee are not alive to the need, and are not endeavouring to meet it. In discussing the question of the new T.B. clinic and centre to be put up in the grounds of the general hospital at Walsall in a converted pavilion there, the board agreed first that the new clinic should be built there, secondly, that the X-ray department in the general hospital itself could and should provide the radiological service for the chest clinic—and that is the item in dispute—and, thirdly, that X-ray screening apparatus should be provided inside the clinic, and that meets the second point raised by the hon. Gentleman, who asked for small apparatus for immediate screening. That is now to be available in the clinic.
The point that is challenged is whether or not additional apparatus should be provided inside the clinic, which itself would be in the grounds of the general hospital. My right hon. Friend has been very bitterly attacked in the local newspapers, most unfairly, I feel, and has been accused of looking at this matter solely on the grounds of finance. That is not true, and I am grateful to the hon. Member for the restraint with which be put his case. The only thing we are concerned about is the "patient needs." Can a patient obtain the necessary services within the orbit of the clinic in this area, and can patients get adequate and proper service in their T.B. treatment?
There are three issues to consider in this matter; first, distance, second, use, and, third, the capacity of the equipment provided. At the present time, patients travel a mile from the old clinic to this hospital for their X-ray. From some of the things which the hon. Member said, one might have thought that nobody would go for an X-ray if it was not to be 557 at the clinic, but thousands of patients have regularly journeyed a mile for the purpose of their X-ray, and they will now be asked to go about 50 yards.
The X-ray unit in the general hospital is nearer to the proposed T.B. clinic than it is to the out-patients' department, and is anybody going to say that it is not worth while walking 50 yards? It is no more unreasonable to ask the patients in the clinic to travel these 50 yards than to ask a suspected ulcer case to do so from the out-patients' department. Generally speaking, the X-rays are not given immediately. A small screening is given immediately, but, normally, the more intensive X-ray is not given immediately, but an appointment is made. Therefore, the undressing and dressing which the hon. Gentleman described so graphically does not take place in so short a space of time, but an appointment is made for the intensive X-ray, which is given at another time.
I beg hon. Members to be reasonable in this matter and recognise the capacity and extent of the equipment already available in this hospital. The hon. Member said that, so far as the sessions are concerned, they were ample, but he asked about evening sessions. The difficulty about evening sessions is not one of equipment but of staff. The Walsall Hospital Management Committee has for a long time been trying to fill two vacancies, which are now being advertised, and the radiologist has agreed that, when these vacancies are filled, an evening session will be granted. New equipment will not solve that. It is staff which is preventing an evening session, which I agree would be most helpful, and which the hospital management committee, under the proposed set-up, is ready to provide, subject to staffing.
The present X-ray department can provide the service required for the clinic. My right hon. Friend has himself gone carefully into the numbers that can be dealt with, the capacity of the apparatus. Not only is the department sufficient to provide for the requirements of this clinic as well as hospital work but it is also able, because of its size, equipment and staff, to provide a general practitioner service as well.
I am assured by those responsible for the radiological department at the general hospital that the provision of X-ray facilities for these patients is not 558 dependent on the convenience of the general hospital, and the requirements of the hospital are not such as would mean that only a limited service would be available for the chest clinic. Of that my right hon. Friend has been assured, and he has been most particular to ascertain the capacity and the total possible output of this Department.
Equally, the requirements of the chest clinic will not interfere with the normal requirements of the hospital. There are two four-valve sets in the X-ray department, one two-valve set and one portable set, and short of a major disaster in which there was a vast number of patients to be X-rayed in an emergency, there is no reason whatever to suppose that there would be a breakdown or long delays in any appointments made for patients from the chest clinic to be X-rayed in the Department.
The regional hospital board's decision has not been an easy one, but the fact remains that it has very substantially improved the services; it seeks to provide and believes it will provide, by the provision of this new, up-to-date tuberculosis clinic, a good service and also a fully equipped and adequate X-ray service in conjunction with the quite extensive X-ray department in the general hospital.
The hon. Member merely says that it is a question of £4,500. What the board has to ask itself is whether it is to ignore the fact that the expensive and comprehensive equipment in the hospital would not be fully used, and whether this additional sum of money should be spent for a clinic only 50 yards away from where alternative machinery is available, on the grounds of patient need. There would be involved not only the expenditure of that sum but cost of maintenance plus additional staff, which would increase the board's difficulties as it has not been able to fill its vacancies in its existing X-ray department.
The board maintains, and I and my right hon. Friend believe it to be true, that the patient need can be fully met by the existing X-ray department equipment and by the co-operation which the hospital staff are only too ready and anxious to give. If the hospital management committee or the regional hospital board deliberately duplicated equipment already adequately provided it would be failing 559 in its responsibilities. What is more important, it would be denying to priority needs elsewhere the money that would be expended on this duplicate equipment. It would add to staff maintenance costs and deny that expenditure to other services.
I believe that the decision of the regional hospital board is the right one. My right hon. Friend has gone into this matter closely himself, and I hope that the hon. Members representing those areas will take back to their friends, particularly those on the local council who have let themselves go in their abuse 560 of my right hon. Friend, till fact that we seek to have a fully comprehensive service there, and I believe it can and will be provided when this rim clinic is opened in the autumn. I am sure it will do much to help mitigate this very difficult problem.
§ The Question having been proposed at Ten o'Clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at Half-past Ten o'Clock.