§ 4.14 p.m.
§ Sir Robert Cary (Manchester, Withington)
It is a long time since we had a discussion on the Floor of the House on the subject of limbless ex-Servicemen. We always associate the limbless with the two great wars through which the nation has passed in this century, but as a result of industrial injury and the great toll of road accidents which occur every year there is also a need for national concern outside the British Limbless Ex-Servicemen's Association.
This afternoon, we are concerned with the organisation known as B.L.E.S.M.A. I have the privilege to be chairman of an all-party B.L.E.S.M.A. committee in this House. I also want to take this opportunity to thank my right hon. Friend the Minister of Health and my hon. Friend the Parliamentary Secretary for the decision to supply small motor cars to the disabled. This is a matter that must be in the mind of every hon. Member who travels about our countryside.
I have always been dissatisfied with the vehicle with which the limbless ex-Service man has been supplied. Only to the limbless man with 100 per cent. war disability has it been possible for the Government to supply the Morris 1000 small motor car. The Government, in their wisdom, have now seen fit to take seriously the provision of a motor car, or 1565 Minicar, to all the grievously disabled. We have thought about this a great deal within the organisations of B.L.E.S.M.A. It has been thought about a lot in the Department, in the British Legion and elsewhere, and in the world of the motor car manufacturers and traders.
Fortunately, we have the invention of the Minicar, which is very small and plentiful on our roads, and everyone wants to acquire one. I am delighted to know that the Government will at last make it possible for all limbless ex-Servicemen to have a small motor car. I hope that my hon. Friend will pass on to the Chancellor of the Exchequer the suggestion that the privilege which applies to the Morris 1000 should also apply to this small motor car and that it should be free from Purchase Tax.
The provision of artificial limbs and appliances is now an integral part of the National Health Service, but I do not want to elaborate matters which affect directly the responsibility of the National Health Service. I want to put as briefly and as cogently as I can two broad questions to the Parliamentary Secretary. First, will she bear in mind that I in no way deride the great work which has been done at Roehampton for so many years? That is not the purpose of the debate. I would ask my hon. Friend if the work at Roehampton could be decentralised by the creation of area limb clinics attached to the main orthapaedic hospitals. This is a thought in the minds of all those who study the affairs of the British Limbless Ex-Servicemen's Association. Is it possible to get easier facilities brought to our limbless by having adequately staffed limb centres attached to the main hospitals in different areas of the country? That would be a step forward in the development and range of the great National Health Service itself. It would be a progressive step, and I have asked my hon. Friend if she and her advisers would look at this problem of whether technically and in a practical sense any such step forward is possible.
My second question concerns that which is vital to a limb centre. It is the question of limb fitters who are employed by the limb contractors and who therefore do not come under the control of the Minister of Health. Here 1566 is a category of specialists whose whole life, and aspirations, if need be, ought to be upgraded. This work has a certain likeness to nursing and a certain amount of emotion in it. The fitting of limbs can be a tedious exercise, with so many persons to see and provide for and with whom it is necesary to exercise the greatest degree of patience. I should like to see the limb fitters centralised as a qualified body. While I acknowledge that the short training courses at Roehampton do good, in my opinion they are not enough. I should like limb-fitters to be upgraded to the point where they would become fully qualified orthopaedic technicians. This would give to the limb-fitter a new cachet, a new status which he does not enjoy at present.
May I draw to my hon. Friend's attention the research which is carried out at Roehampton. I regret that a recent deputation of the British Limbless Ex-Servicemen's Association to the Scandinavian countries was a little nonplussed to find that its hosts did not think very highly of the Association's artificial limbs and appliances. Indeed, surprise was expressed at the fact that our own limbless were not enjoying the greatest benefits of research and modelling which were becoming commonplace in other countries such as Germany and America.
Many years have passed since Roehampton first carried out research into the improvement of artificial limbs, but in recent years very little has emerged from that great centre. It hurts me to hear of a deputation of members of my own association going to a Scandinavian country and finding that their artificial limbs were not greatly admired and, indeed, were almost laughed at. That should not happen to an organisation from a great country like ours with its technical skill, for no country has a greater tradition in the care of sick, wounded and those in distress. Indeed, the existence on the Government Front Bench of Ministers representing the Ministry of Health and of the Ministry of Pensions and National Insurance is a guarantee of that fact, and the creation of the National Health Service is one of the most progressive things which have occurred in this century.
1567 I therefore appeal to my hon. Friend the Joint Parliamentary Secretary to regard this not as some small sectional matter which affects only the British Limbless Ex-Servicemen's Association but as an important step to further the interests of the great traditions in health and amenity which survive in our country.
§ 4.23 p.m.
§ Mr. L. M. Lever (Manchester, Ardwick)
I join with the hon. Member for Manchester, Withington (Sir R. Cary) in thanking you, Mr. Speaker, for giving us this opportunity to voice some of the grievances in the minds not only of the limbless ex-Servicemen, but also of the general public throughout the country.
Since the formation of the all-party committee of the British Limbless Ex-Servicemen's Association, of which I have the honour to be the honorary secretary and the hon. Member for Withington its chairman, we have been able to secure from various Governments enormous sums of money for the limbless ex-Servicemen; and not least of the amenities provided is the B.M.C. Minicar, which will be a boon to many limbless ex-Servicemen who will be able to drive with others instead of driving alone.
I do not want the Minister to think that one is unduly critical of the service provided by the Ministry. On the contrary, I am sure that the Ministry of Pensions and National Insurance provides one of the finest services in this country. I have always found the various Ministers and Parliamentary Secretaries most helpful in discussing improvements that we wish to make on behalf of this most important and deserving section of ex-Servicemen.
I support what the hon. Member for Withington has said. He referred particularly to the delays which occur in repair and renewal. Recently, in answer to a Question I put to the Minister, it was admitted that it takes three or four months for artificial limbs to be repaired at Roehampton and about 98 days to secure a new limb from the date of first measurement. This ought not to be. A protracted period between measurement and delivery serves only to aggravate the existing difficulties in fitting because, in the interim, the stump condition often 1568 completely changes from what it was at the time of original measurement. I earnestly ask the Minister to do everything possible to reduce the long delays.
Decentralisation seems to be the only solution to this problem. If there were special clinics at orthopaedic hospitals in every regional hospital board area of the country, we should be able to reduce the delays immeasurably. Therefore, in this matter of delay in repairs and renewals, the plea must be for decentralisation from Roehampton. Roehampton has done and is doing very valuable service, but, inevitably, it cannot cope with all the demands made upon it. With 120 out-patient attendances each day, it is not possible to maintain the necessary personal and clinical approach to limb fitting in present conditions there.
Limb fitters are doing very good work. They are laymen. As we all do, they gain in efficiency by experience. But the artificial limb fitter should be recognised as a skilled person within the framework of a profession. He ought to be an orthopaedic technician, someone like the physiotherapist, having an understanding of the processes and the stresses of the human body. It is a matter of science. We live in a scientific age, and, whenever any aspect of our national life calls for the application of science, each person concerned should be fully qualified by examination for the work on which he is engaged. In America, there are special courses at the universities for limb fitters. In Germany, there are qualified orthopaedic technicians. What those countries can do this country could do better, once it set its mind to it.
The hon. Member for Withington referred to the research work at Roehampton. Ideas have been pouring through Roehampton since the establishment of the research department in 1947, thirteen years ago, but, apart from the suction socket limb for above-the-knee amputees, there has been no improvement in the design or fitting of artificial limbs. As the hon. Gentleman pointed out, improvements have been made in other countries. We should keep abreast of them. If we do, we can provide for our limbless ex-Service men what other countries are providing for theirs, and better.
There is not sufficient information available to limbless ex-Service men. 1569 Admittedly, those who have lost their limbs in war are issued with artificial limbs and appliances as a direct entitlement. The National Health Service has rightly given to the disabled amputee the opportunity to choose the type of limb, fitting and suspension, and the Ministry's limb surgeons, of necessity, must advise the patient. But it seems to me that there ought to be some display for disabled limbless ex-Service men of the various types of limb from which they can choose.
The National Health Service patient is given the opportunity of choice. Why should not limbless ex-Service men have a choice of fitting? A consultative body should be established in this country which carries consumer representation. There is full liaison between the Ministry and the contractors, and I am sure that both are combining to give the best possible service to limbless ex-Service men, but, as 93 per cent. of all artificial legs are provided by one manufacturer it seems to me that the system ought to be loosened so as to provide a wider choice.
In countries abroad much emphasis is placed on sports for the disabled as part of their physical rehabilitation. I wonder whether the Ministry will take the initiative and call together organisations in this country which are concerned with the problems of the disabled in an endeavour to secure the creation of an organisation in the United Kingdom which might initiate sports festivals and recreational facilities for the handicapped on similar lines to those developed by Dr. Ludwig Guttmann, at Stoke Mandeville, for paraplegics.
We know that the Ministry is as concerned as we are to provide the best possible service for these people, and we are grateful to the Ministry. I therefore hope that we shall have a reply from the Joint Parliamentary Secretary which will enable us to go ahead in establishing an even better service for limbless ex-Service men. When I was addressing the Manchester branch of the Association of which I am honorary president, I was very pleased to hear how grateful these men are for the manner in which the Ministry is seeking to improve their situation. As I say, with the assurances which I hope the hon. Lady will give us, we will be enabled to go ahead in improving the position of ex-Service men who are deserving of our fullest support.
§ 4.32 p.m.
§ Mr. Eric Johnson (Manchester, Blackley)
I am very grateful for this opportunity to support my hon. Friend the Member for Manchester, Withington (Sir R. Cary) and the hon. Member for Manchester, Ardwick (Mr. L. M. Lever). There is very little that I can add to their contributions, but I should like to join in the expressions of gratitude for the provision of this small car, which is of tremendous importance to limbless and disabled men.
I should like, first, to stress this feeling of disappointment and dissatisfaction in the minds of the limbless that there has been so little improvement in the type of artificial limb. We all recognise the great and valuable work which is being done at Roehampton, and the delay which has occurred seems to have been unduly long.
My hon. Friend the Member for Withington mentioned the development of artificial limbs in other countries. I hope that my hon. Friend the Joint Parliamentary Secretary will tell us why, as these limbs have been thoroughly tested and used successfully in other countries, when they come over here they have to go through the whole process of research and testing again before they can be used. The suggestion that there should be more clinics in orthopaedic hospitals for people with artificial limbs is most valuable.
Equally valuable is the suggestion made by the hon. Member for Ardwick that a greater amount of information should be given to the amputees themselves so that they can see displays of the limbs. It must be difficult for a person to decide what is most suitable unless he can see a fairly wide choice. I remind my hon. Friend the Parliamentary Secretary that not so long ago, as the result of a debate in the House, we had a display upstairs of spectacle frames. We do not necessarily want to see a display of artificial limbs here, but it would be helpful if there were displays of them all over the country in the great cities, like Manchester and Birmingham. There should also be more close consultation between the Ministry and its contractors and the people who are to use the limbs.
This has been a brief but valuable debate and I know that my hon. Friend 1571 will reply with the usual amount of sympathy that she feels for all these people. We have been, perhaps, a little critical. I hope that my hon. Friend will agree that on the whole we have been constructive and that she will at least be able to give practical effect to some of the ideas which have been put before her this afternoon.
§ 4.37 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
It is a little singular that the three contributions to this debate have all come from Manchester Members.
§ Miss Pitt
Manchester must have a tremendous, big heart. I am glad that this subject has been chosen for the last of our Adjournment debates today and I hope that what I have to say will show that the needs of the war pensioners are very much in the mind of my Ministry and that there is a continuing interest in the Ministry of Pensions and National Insurance, as is shown by the presence here this afternoon of my hon. Friend the Joint Parliamentary Secretary to that Ministry.
All the hon. Members who have spoke have acknowledged with gratitude the statement by my right hon. and learned Friend on 4th April about the supply of cars. My right hon. and learned Friend is glad that he has been able to take this step. It has given pleasure generally and collectively to all the Service and ex-Service organisations which, over the years, have been pressing for larger vehicles for war pensioners instead of the powered tricycles at present supplied.
The deputation which came to see my right hon. and learned Friend on 5th April—as it turned out, the day after the announcement was made in the House—and which was arranged and led by General Sir Roy Bucher, chairman of the British Legion, and represented forty-four Service and ex-Service organisations, expressed its considerable satisfaction at my right hon. and learned Friend's statement.
My right hon. and learned Friend told the deputation that, in his view, the appropriate type of vehicle seemed to be the B.M.C. type of small car. I should like also to mention in this con- 1572 text of cars for the war disabled the interest of the chairman of the I.T.A., who tried one of the B.M.C. small cars as soon as they appeared and published an interesting report in the current number of the Association's journal. I realise that I am using the initials that we all use, but I should, perhaps, explain that the I.T.A. is the Invalid Tricycle Association.
My hon. Friend the Member for Manchester, Blackley (Mr. E. Johnson) asked about research, as did the hon. Member for Manchester, Ardwick (Mr. L. M. Lever). I answered two Parliamentary Questions on this subject from the hon. Member for Ardwick early last month. In particular, I said of the research department at Roehampton that limbs and foreign components are tested there with a view to incorporating any approved beneficial features in British limbs. I said in reply to his other Question:The work of the research department is guided by a committee which includes the Deans of the Institute of Orthopaedics and of the City and Guilds School of Engineering and the scope of its work is constantly being extended."—[OFFICIAL REPORT, 4th March, 1960; Vol. 618, c. 178–9.]The Minister told B.L.E.S.M.A.—I must use the initials this time—when it came to see us on 8th December last, when we had a very long interview which lasted two hours and when all the points were discussed, that he could assure the Association that patients in this country could obtain at Exchequer expense the best limbs available here, and that the British limb was a good limb.
Here I want to answer what appeared in this debate to be implied criticism of the British limb. I do not think it was deliberate, but I would answer it in fairness to the limb makers. Shortly after we received that deputation in December Group Captain Bader who is a member of B.L.E.S.M.A.'s advisory committee, wrote an article in the News of the World. He has British limbs, one above the knee and one below the knee. In his article he gave strong support to the Minister's view, and he said he had seen artificial limbs in many countries, including the United States of America, Canada, Germany, South Africa, Australia, and New Zealand, and he said:I have not yet seen one which I would exchange for the British Government issue.1573 Speaking of legs he refuted emphatically the suggestion that Britain was out of date in its approach to the problem of artificial limbs, and he paid tribute to the fitters. Coming from a man of that status, who has made such gallant efforts himself, I think that that is a tribute one would most warmly welcome.
The point has been made today about having all the limbs on display. I should like to reply by telling hon. Members that all the limbs of the different makers are on display at the centres.
§ Miss Pitt
The disabled go there for fitting them and axe able to see them. I myself have seen them when I have visited Roehampton. I have seen a display of arms, legs, joints, and so on.
My hon. Friend the Member for Manchester, Withington (Sir R. Cary) raised the question of the siting of the limb centres. He asked that the work of Roehampton should be decentralised and suggested that each orthopædic hospital should have a limb clinic attached. I was not quite sure what he meant. In December B.L.E.S.M.A. suggested that the main orthopædic hospital in each region should have an artificial limb and appliance centre attached to it. There are 39 orthopædic hospitals, but many general hospitals have an orthopædic department, and that was why I was in some doubt. In the Ministry we decided some time ago that this was to be our general principle, but there are practical and financial difficulties in going ahead quickly.
When we talk about limb centres it has to be remembered that most of them— Roehampton is the main exception—deal with the organisation of the invalid vehicle and chair services as well, and also with medical and surgical appliances generally for the war pensioners. A large artificial limb and appliance centre is about 20.000 sq. ft. and costs £100,000 to build. The limb part takes up most of the room, as the consulting and fitting rooms, walking training school and workshops and most of the space has to be on the ground floor unless there is a lift. 1574 Centres have to be near bus stops, and there has to be plenty of space for ambulances and for testing patients in tricycles.
The pattern of the present centres is, of course, an historic one. Most of the Ministry of Pensions limb centres started as part of its regional offices, and, except at Roehampton and Leeds, we took them over in office accommodation. We want to have them in hospitals but as there are 21 centres of different sizes in England and Wales which do limb fittings—and nine others which do not do limb fittings—it must be a very costly business to get them all in the right place —beside a hospital with an orthopædic department.
We have to fit in with general hospital planning, and it is most difficult to find really good sites for this specialised purpose, as I well know in regard to my own City of Birmingham, because long before I came to the Ministry of Health I had been pressing that Department with all my vigour to try to get the present limb fitting centre in Birmingham removed from its unsuitable city centre site.
§ Miss Pitt
I appreciate Manchester's difficulties, too. Some solution has been found there, but it is not the best one. It is not as good as we would have liked.
We could, for example, think of the main orthopædic hospital in each region only if it were in the right place not only for general communications in the area, but also for immediate local communications in order to avoid too much walking for the disabled, and if there was land available. What we are doing is that where a centre has to be moved because it is inadequate we plan, in general —there may be future exceptions—to site the new centre in or beside a hospital conveniently situated for the limbless which has an orthopaedic department.
1575 My right hon. and learned Friend told B.L.E.S.M.A. in December, and he also told the deputation last week, that changes could not be made quickly, but we are now making some progress and I should like to tell the House what progress we have already found possible.
A year or two ago we moved the Wolverhampton Centre to the New Cross Hospital. This is only a very small centre. In Liverpool, we hope to start building very soon at Mill Road Hospital. In Birmingham, we hope to start building this year at Selly Oak Hospital, in Leicester at Leicester Royal Infirmary, and in Portsmouth at St. Mary's Hospital.
I said in answer to a Question on 3rd March that the Minister was considering whether an additional limb fitting centre should be established in the London area. A new centre in the area would take some of the load off Roehampton, which is certainly heavy, but no decision has yet been reached on the project. We are at different stages of discussion with regional hospital boards about new centres in other towns to replace existing centres.
I believe that B.L.E.S.M.A. considers that if some of the load were taken off the Roehampton Limb Fitting Centre delays in repairs and in the manufacture of new limbs would be reduced. But this does not necessarily follow. A new centre in the London area would reduce the "on-the-spot" repairs now done at Roehampton for patients going there, but would not really help with delays in renewals of limbs—making new limbs—and major repairs, which have to be done at the factories, whether they are Roehampton factories or factories elsewhere.
While we have not brought the limb service within the National Health Service and it remains a centralised service, as we think it must be at present, our aim is to bring the centres and the hospitals closer together. Professionally, we bring our limb doctors into closer association with orthopaedic surgeons, and there is a steady flow of orthopaedic surgeons and physical medicine consultants for courses at Roehampton.
Another point raised by my hon. Friend was that he thought that the limb fitters should be centralised as a qualified body, that the status of the limb fitter should be uplifted and that the limb 1576 fitter should be called an orthopaedic technician. B.L.E.S.M.A. told my right hon. and learned Friend in December that limb fitters were not always sufficiently trained for their task, and that they were primarily technicians who ought, in addition, to have a wide knowledge of medical matters. It suggested that there should be a national diploma and that over a period of time only those qualified should provide limb-fitting services and that the institution of training courses should be proceeded with at once.
Limb fitters, who are employees of the independent limb manufacturers, as my hon. Friend the Member for Withington said, and not employees of my Ministry, have an important rôle in the limb service. They are members of the team serving the patients, and partners of our doctors in the service. Certainly in our minds, and, I am sure, in the minds of the patients, who always like to be looked after by the same fitter, there is no question about their status and importance.
There are, of course, orthopaedic technicians employed in the National Health Service, but that title covers a variety of different kinds of work and not, I think, such responsible work as the limb fitter undertakes. Limb fitters are not our employees and it is not, therefore, for us to consider whether their title should be changed, but it is an honoured title that has been in use for many years and expresses just what its bearer does and will go on doing. We have not heard of any desire on the part of the limb fitters themselves for a change of name.
Limb fitters do not, I understand, have to have formal qualifications but are given considerable practical training. The practice of one of the major manufacturing firms illustrates this. When a vacancy occurs a trainee is carefully selected from existing employees. He goes into the fitting rooms on probation for six months to ensure that he is the right type of man to become a limb fitter handling patients. If he passes his probation, he is appointed a trainee fitter for three years. He is then appointed as an assistant fitter for two years or more.
A fitter is also encouraged to study textbooks on anatomy and the general principles of limb fitting. During his work with our doctors the trainee learns 1577 a great deal about medical matters and from time to time the doctors at Roehampton arrange special courses there for fitters from all over the country, particularly on new developments—as recently, on the Canadian tilting table limb.
My right hon. and learned Friend told B.L.E.S.M.A. in December that he accepted that limb fitters should be adequately trained, but the men were not Government employees and he did not feel able to impose on them and on the firms which employed them any restrictions which would affect the normal labour relationship in the industry. At present the work was done by people with considerable training and experience and although the point raised by B.L.E.S.M.A. about formal training with diplomas could be pursued, there could be no specific promise of action, or dictation to the firms concerned.
We are discussing with manufacturers the question of training. Whether anything will emerge as regards formal training cannot be foreseen at this stage. The intake of trainees in one year is very small. In the largest firm it is only two or three a year. I am informed that in one of the major firms the average experience of their fitters is twenty years, which suggests that the steps which I have described turn out good men who stay in their jobs.
The question has been raised of new limbs and major repairs. Minor repairs of limbs are done on the spot at limb centres. For major repairs a limb has to go back to the factory, and a new process of limb fitting is needed, just as in the supply of a new one. Major repairs take much longer than we would like and we wish to improve this.
I said on 7th March that the periods were about 98 days and between three and four months respectively. The war pensioner waiting for a new limb or a major repair does have a duplicate limb which he can use, but in many cases he does not like wearing it, preferring his favourite. We would like to encourage amputees to become accustomed to both limbs.
The periods are too long—they are longer than they were a year ago. In March, 1959, the hon. Member for Southampton, Itchen (Dr. King) was told that they were 85 and 80 days. One of 1578 the main reasons was the stoppage of work which occurred last year at the Roehampton factories. The delay, when the men were out for some weeks, followed by the annual holidays, was never made up. We have been discussing with the manufacturers what can be done, but there are difficulties. At Roehampton, for example, there is lack of space for expansion of the factories.
On our side, we have taken several steps. The times include not only the period when the limb is being made, but the periods when the limb is at the centre for the patient to be called up and fitted. We have reviewed our procedure to reduce delays. While patients have freedom of choice, which is very important, they are told which contractors from time to time can offer the best delivery dates. Our current information is that the times for producing new limbs and doing major repairs are somewhat less now than they were in March when I gave the figures, but the time for major repairs is slightly misleading. For all the repairs, major and minor, the average period in March was slightly less than it was a year ago—33 against 36 days. I am not complacent about that and we would like to improve it still further.
When representatives of B.L.E.S.M.A. came to see the Minister in December, they asked that there should be a consultative council on limbs, or, alternatively, that they should be represented on the Standing Advisory Committee on Artificial Limbs. That Committee is an expert committee composed of surgeons and engineers, one of whom wears an artificial limb. The Minister told B.L.E.S.M.A. that he thought that a consulative council was inappropriate and when writing to B.L.E.S.M.A. later, as he did after the meeting, he said that he was not satisfied that it would be the right method to change the nature of the expert committee by adding lay members to it. The sort of association which he would like to see developed was between B.L.E.S.M.A. and his officers at Roehampton, so he encouraged visits to Roehampton to discuss ideas about and criticism of the limb service.
Recently, at Dr. Ritchie's invitation, the Chairman and Secretary of B.L.E.S.M.A. and another member visited Roehampton. They saw the work on 1579 research which is being done there and had a full discussion with our officers. We hope that they found it useful and that they will accept the invitation which they were given to visit again from time to time.
When the Minister saw the much larger deputation last week, from the British Legion, the Royal Air Force Association and B.L.E.S.M.A., he said that he hoped that representatives of other interested organisations would also go and see the work which was being done at Roehampton. We understand that the Chairman of the British Legion is going quite soon.
I want also to refer to recreational facilities, a matter which was also raised. When B.L.E.S.M.A. sent a deputation last December, the Minister explained that that was really a job for the local welfare authorities, but he promised to 1580 take up the question with them and he has since written to the local authority associations.
Finally, I think that the limb fitting service—and I have had occasion to inform myself about it in considerable detail since I came to the Ministry, and one of my first jobs in the Ministry was to go to Roehampton—is a good service. I take the opportunity afforded by the debate to pay tribute to it, to the limb manufacturers and the fitters and all those in my Department who provide this essential and very humane service to men who have been disabled in Her Majesty's service.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Five o'clock, till Tuesday, 26th April, pursuant to the Resolution of the House of 12th April.