HL Deb 28 January 1959 vol 213 cc876-966

2.45 p.m.

LORD BALFOUR OF BURLEIGH rose to call attention to—

(A) the proposals of the Board of Governors of St. Mary's Hospital, Paddington:

  1. (a) to convert 39 out of 76 beds of Princess Louise (Kensington) Hospital for Children for temporary use as maternity beds, and
  2. (b) ultimately to convert the whole of the children's hospital for adult use;

(B) the decision of the Minister of Health communicated to the Royal Borough of Kensington in his letter of the 16th June 1958 to allow proposal (a) and to defer a decision for proposal (b);

(C) the facts that—

  1. 1. the number of in-patients at Princess Louise Hospital was, in 1950, 1,212; 1951, 1,478; 1952, 1,643; 1953, 1,665; 1954, 1,729; 1955, 1,372; 1956, 1,744; 1957, 1,282; 1958, 1,536; (bed availability reduced by infection in 1955, 1957 and 1958);
  2. 2. the number of out-patient attendances has averaged well over 20,000 during the period of the last ten years: now out-patients numbered over 4,000 in 1957 and approximating 5,000 in 1958;
  3. 3. during the spring of 1958 the Princess Louise Hospital coped successfully with an outbreak of a virulent and rapidly fatal complaint in infants known as bronchiolitis;
and to move to resolve, That Her Majesty's Government foe requested to reconsider the Minister of Health's decision of 16th June 1958 with the specific object of:—
  1. (a) securing such maternity beds as are temporarily required by St. Mary's Hospital, Paddington, by converting to adult use other children's beds in older hospitals, e.g., St. Charles's and Paddington General, or elsewhere;
  2. (b) maintaining unimpaired the vital service being increasingly rendered by this modern children's hospital in a densely populated area.

The noble Lord said: My Lords, the subject of my Motion was debated at some length in your Lordships' House in 1957. I am not apologising to your Lordships for bringing it back to-day, the reason being that a decision in the matter was reached by the Minister a few months ago, and that was a decision which I regard as most unfortunate. This, therefore, is, I feel, the last opportunity, the last effort, to secure reconsideration of the whole matter. There are really four parties to the dispute: the Board of Governors of St. Mary's Hospital, Paddington, the Regional Hospital Board for the area, which is the North West Metropolitan Regional Hospital Board; the Royal Borough of Kensington, which I can assure your Lordships has the whole population to a man, woman and child, behind them, and lastly the Minister of Health.

Let me begin by clearing the ground, because there is a good deal of ground which is common between us. There are two factors: one, the surplus of children's beds, and two, the shortage of beds for adults. The first factor, the surplus of children's beds—which we so rejoice about because it means a reduction of ill children—is, happily, common pretty well throughout the country. The shortage of adult beds happens to be acute at the moment in the North Kensington and Paddington area in the matter of maternity beds. With regard to the first factor, the reduction of the number of sick children, I would only say to your Lordships that that is so marked that it has reached the stage where it requires complete re-thinking of the whole policy of the treatment of children in hospital. The case which I am going to put before your Lordships is that the Minister's decision, which was conveyed to the Kensington Borough Council a few months ago, in favour of the proposals of St. Mary's Hospital is wrong—doubly wrong, because I say it offends both in the particular and in the general.

I shall deal first with the particular case, and I must preface what I have to say about that with the assurance to your Lordships that I speak in no spirit of hostility to St. Mary's Hospital. All I want to do is to set out the facts, not in the least because I want to be censorious, although I am afraid your Lordships may think I shall be, but solely because it so happens that only if we can get the facts of the situation clear shall we find that we have ready to hand a solution of all the troubles which beset us. That in this instance, is literally true. In my submission, what I am going to propose will cure the situation. That is something that seldom happens. One often finds oneself in a difficulty and one says that something must be done about it. How often do we hear that? In this instance I am in the fortunate position of being able to put before your Lordships a definite policy which I believe will make a radical cure.

With that introduction, I turn to the particular case of the Princess Louise Hospital. There the trouble has its roots as far back as 1946. In 1946, St. Mary's Hospital took over two children's hospitals—one at Paddington Green with, say, 50 beds; the other the Princess Louise with 76 to 80 beds. There are four wards which I believe can hold either 19 or 20 beds. That, I believe, is the root of the present trouble, and I do not think it will be denied by noble Lords who speak for St. Mary's, because St. Mary's has continually complained ever since then about their overload of Children's beds, conveniently forgetting that it was entirely their own doing.

For the record I must tell your Lordships that those agreements were made just before the passing of the National Health Service Act, when the terms of that Act were already known. Your Lordships will see that that action by St. Mary's in the early part of 1946 had the effect of depriving the future Regional Board, which of course did not exist then, of both the children's hospitals which are in that Regional Board's area. Moreover, those amalgamations with the children's hospitals were made by St. Mary's with knowledge of the report of the Goodenough Committee—the Interdepartmental Committee on Medical Schools—which made a specific recommendation that, for a teaching hospital, the appropriate percentage of children's beds was 10 per cent. I must add that the agreement made between St. Mary's and the Princess Louise was expressed to be, and was intended to be, for the mutual benefit of both hospitals. But there were two particular conditions which were vital to the Princess Louise. They were, first, that St. Mary's would make the Princess Louise an integral part of its pædiatric unit; and secondly, that the Princess Louise Hospital should continue as a children's hospital.

That story is highly relevant because it is the possession by St. Mary's of the Princess Louise Hospital through all these years that alone has prevented the Regional Board from converting their less efficient children's beds to adult use. That could have been done years ago. It should, and would, have been done but for the fact that St. Mary's were in possession of the Princess Louise Hospital; and the integration as part of the pædiatric unit was never carried out. Now we have before us the present proposals, first to convert half the beds of this children's hospital to adult beds for temporary maternity purposes, and then, later, to convert the whole hospital to adult use. Not only has that situation prevented the regional board from converting their inefficient children's beds in the past but, so far as I can see, it would put an end to any chance of the Regional Board ever giving proper hospital treatment to children.

Just consider for a moment what the position would have been had that agreement never been made between St. Mary's and the Princess Louise Hospital. Inevitably the Princess Louise Hospital would have been under the Regional Board, and that would have made all the difference in the world. The Board would have had at their disposal all these years this delightful children's hospital, expressly built for the treatment of children in an open site—for although it is in a densely overcrowded area it includes a bit of open ground—with light airy wards entirely suitable for children.

It so happened that I became a member of the Kensington Borough Council just thirty-five years ago, at a moment when the Council were closely occupied with the project to build a new children's hospital in North Kensington. As I happened to be particularly interested in the housing question I spent a good deal of time in North Kensington, and I remember well the reasons given to me by the people there for wanting a new children's hospital. Your Lordships will remember that in those, may I call them, "bad old days", the housing conditions in North Kensington were very bad. There was great overcrowding, very bad housing, large numbers of children, and no easily accessible children's hospital. I say that with full knowledge of the fact that two and a half miles away—or two and a quarter miles, according to the point one takes—lies the Paddington Green children's hospital. I shall say a word about the inconvenience for North Kensington of Paddington Green later, when I have to ask the noble Earl the Minister for his idea about alternative facilities.

To continue my story, the money was raised; the Princess Louise Hospital was built, and was opened by King George V and Queen Mary in 1929, exactly where it was most wanted, and, my Lords, still is most wanted. Had the Regional Board had that hospital at their disposal I say with complete confidence that the present difficulties would not have arisen. It would have been quite definitely a question of solvitur ambulando. It is only the possession of the Princess Louise Hospital by St. Mary's through those years that has prevented that from happening.

Regrettable as all that is, what we have to do is to tackle the situation as we find it to-day, under which full use is not being made of all the available hospital beds in the area. There is a plus and a minus in the area—a plus of children's beds and a minus of beds for adults. Why have the two not cancelled out? Quite simply, because there is, and has been, a divided responsibility between the Regional Board and the teaching hospital; and between them they have failed to adjust their differences. Just to remind your Lordships, and to illustrate that point, I will quote briefly from the debate of 1957 The noble Lord, Lord Cottesloe, chairman of the Regional Board, then said [OFFICIAL REPORT, Vol. 204, col. 393]: In those circumstances, when the suggestion was made to my board that we might take over the hospital from St. Mary's Hospital, we came to the conclusion … that if the Princess Louise were offered to my Regional Board we should be prepared to take it over, integrating it with the St. Charles's Hospital as the pædiatric department of that hospital, which is closely adjacent to it, and closing the children's beds at present in St. Charles's Hospital, and perhaps also some of the children's beds in Paddington General Hospital. A little later in the same speech the noble Lord said: There is, I think, no doubt that such an arrangement would be, in general, beneficial. It would relieve St. Mary's Hospital of their pædiatric incubus; it would reduce the total number of children's beds in the area, and it would give the Princess Louise Hospital the benefits of integration with a large hospital. But there is one thing it would not do: and that is to provide St. Mary's Hospital with the additional beds for maternity and obstetrics and for other specialities that they need for teaching their students. My board would be prepared to go further in an attempt to solve this problem. They have expressed their willingness to make available to St. Mary's Hospital for teaching—and it would not be altogether easy to do so—fifty beds at St. Charles's Hospital under arrangements similar to those at Paddington.

That offer was met with a definite and categorical refusal by the noble Lord, Lord Moran, speaking for St. Mary's Hospital. In that same debate he said [col. 414]: 'If that is so, why do you not accept his offer of additional beds?' The reason is that, though it is valuable clinical material, from the point of view of teaching it has serious disadvantages and limitations. These are, that unless you have administrative control you cannot control the cases admitted to the hospital, which is half the secret in getting suitable clinical material. For that reason, if the noble Lord, Lord Cottesloe, now stood up and said, 'You can have administrative control', I would sit down and say. 'I have nothing more to say—I accept it'. It is as simple as that. I do not quote these statements for the purpose of apportioning blame or adjudicating between the two views. I think it is a question for the doctors. It seems to me that power to select is very important, and it might be the critical question for a teaching hospital, and therefore I am not judging who is right. But I have told your Lordships about it because it illustrates my point that it is the dichotomy between these two bodies which has prevented full use of beds and directly produced the current difficulties. One word about the duty of the Minister in these circumstances. The Minister is, I suppose, head of the National Health Service, and it is his duty to see that it works efficiently. I say that the Minister of Health could, and should, have taken action years ago. What his powers are under the Act I do not know, but he obviously has great influence, and if he is powerless to interfere in a case like that then there must be something very wrong with the set-up under the Act. But I do not believe that it is so. I believe that the Minister, had he seen fit, could have taken action which would have made matters right.

There it is, my Lords. If I am right there was a failure on the part of a whole series of Ministers of Health, and because of it we are now faced with the imminent destruction of the Princess Louise Hospital: not merely partial, temporary occupation, as your Lordships might think, for St. Mary's are asking for a complete conversion—though what for, we have never been told; there is something of a mystery about it. They are asking for complete conversion to adult use in the future. On that point the Minister has reserved his decision, but who is going to suppose that if this conversion takes place it will ever go back?

In the last debate the noble Lord the Minister estimated the cost of conversion at £6,000. I believe that to be a complete underestimate. Such experts as I have consulted tell me that the cost might easily be as much as £10,000. But be it £6,000, £8,000 or £10,000, who is going to suppose that after two years the Minister will have enough money at his disposal to allow that money to be spent on reconverting? I simply cannot believe that that is possible. Once converted, that hospital will never go back, more particularly as that is the aim and object of St. Mary's. I was under the impression that one of the great objects of the Minister in administering the National Health Service Act was to retain the good will of the population—an important aspect, because he still requires a good deal of voluntary help. This particular decision has aroused fierce resentment: the whole population who use the hospital are really furious about it and feel that they have been deprived of an asset which really belongs to them.

My Lords, there is a quite minor point—a medical point, on which I will merely touch, in passing. I am told that this division into half maternity and half infants' beds in this small block is highly objectionable from a medical point of view, particularly the pædiatric point of view. I would ask the Minister in his reply to tell the House what authoritative pædiatric advice was sought before this move was given the official approval of the Minister. It is important that it should be pædiatric advice, and not merely general medical advice. I am told that, whatever may be the merits of this scheme, if it were a question of building afresh now, no one would dream of putting up a building of that size for the "half and half" use now suggested.

I now come to the question: is this hospital needed? I put that question because it would not matter what St. Mary's or anyone else had done if it were to be proved that the Princess Louise Hospital is no longer needed. I ask your Lordships to look at the figures on the Order Paper. I had the figures of in- and out-patients put in the form of a fact because I think they are so important. Of course, the hospital was closed to in-patients during the war; the children were evacuated. In 1950 in-patients numbered 1,212, and there has been a steady rise to over 1,700 in recent years, the only exception being where certain beds were closed because of infection, something that must happen from time to time in any children's hospital. As regards out-patients, in the debate in 1957 I said that there were 30,000 out-patient attendances. The recent figure is 20,000, as the Ministry of Health have adopted a new classification. They separate what they call the referential departments—I understand that that means X-ray, physiotherapy, bacteriological and pathological tests, and so on. That those things are now classified differently accounts for the odd 10,000; the total number of out-patient attendances remains at 30,000 annually. It is worth noting that out-patient attendances in 1958, the year just closed, were actually substantially greater in number than in any other year since 1950.

One other point on the need for Princess Louise is that your Lordships will see on the Order Paper that during the spring of 1958 Princess Louise coped successfully with an outbreak of a virulent complaint in infants known as bronchiolitis. I understand that this is an acute respiratory condition; and the particulars are that within a matter of weeks 104 infants were admitted to the hospital. One was dead when brought in; one died after half an hour; but every other single life was saved. So much attention was given them that sixteen of these infants were in oxygen tents simultaneously. Please compare those figures, and that fact with the statement of the noble Lord, Lord Moran, in the last debate, that the blunt and brutal truth is that the … hospital is no longer needed. I think that the figures really disprove that assertion.

The noble Lord also made another remark which I will quote. He said [OFFICIAL REPORT, Vol. 204, col. 413]: … children's diseases are not only falling rapidly, but they are going on falling rapidly. If the Princess Louise Hospital, as a result of this debate, received a respite, it would only be a respite. Taken quite literally, that remark means only one thing: it must mean that, in the noble Lord's opinion, within a very few years there will be no sick children needing hospital treatment. It may be that the noble Lord may wish, on reflection, to modify that opinion. If not, I venture to disagree; and I maintain that this children's hospital is still, and will be, for all the years that we can foresee—at least, which I can foresee—needed in this densely populated area.

I have no official connection with the Princess Louise Hospital. I am not on the board. Therefore your Lordships might think that my information is out of date. But I know how keen the medical committee were about this agreement in the old days; I have taken such steps as I can to ascertain the views of the present medical committee, and I believe it is true to say that they like it as little as their predecessors who made the agreement with St. Mary's would have done.

I turn for a moment to the legal position. I will quote the Minister. The Minister says: On the coming into force of the National Health Service Act the terms and conditions of the amalgamation agreement between St. Mary's and Princess Louise were terminated. That is the view of the Minister's legal adviser and one must accept it. It seems a little odd, if that is literally true, that, while the possession of Princess Louise by St. Mary's was not terminated, only that part was terminated which was vital to Princess Louise. Of course, some legal decisions are odd—I speak in the presence of a good many distinguished lawyers—and this one seems to be very odd indeed. But your Lordships will see that it was highly convenient to St. Mary's. They were enabled to keep their asset without fulfilling the very obligation they had come under in order to acquire it. They had acquired a valuable asset for a definite consideration, and by this queer legal quirk they are relieved from carrying out their bargain. However, legal obligations are not the only thing in this world; there is such a thing as a moral obligation. In fairness to the board of St. Mary's, who are honourable people, I would say that they have not thought so; and I must remind your Lordships of why not.

We had different explanations from two noble Lords who spoke for St. Mary's on the last occasion. The noble and learned Lord, Lord Cohen, said that, in his view, the new board were not bound by the decision of the old. If that is his view, I say, with great respect, that it seems to me to be both legalistic and founded on a technicality. The noble Lord, Lord Moran, took a different line altogether. The noble Lord, Lord Moran, said—and I quote from col. 413: If I am right in saying that many of these beds are now redundant, it would not be sensible blindly to carry out an undertaking before the National Health Service came in, given in totally different circumstances eleven years ago. My Lords, the noble Lord's memory betrayed him. St. Mary's did not wait eleven years. The Dean of St. Mary's Medical School waited only for the coming into force of the National Health Service Act, which happened in 1948, before seeking to change the whole occupation of the hospital from children to adults. The noble Lords who represented St. Mary's on the last occasion were doubtful about an agreement that I quoted then, although they were honourable enough to admit afterwards that I was right. In case they are doubtful about this, let me say that I have in my hand a copy of a resolution of the Public Health Committee of the Kensington Borough Council, and that a copy of it was sent to the Board of Governors of St. Mary's Hospital by the Town Clerk of Kensington in January, 1949. So, my Lords, I do not think that Lord Moran's arguments about a change of circumstances really have much validity.

So much for the particular as concerns the Princess Louise Hospital: now I come to the general question. I believe that, in the new circumstances as regards children, the treatment of children in hospital needs entire rethinking, and I do not see any evidence that that has happened at the Ministry of Health. It would be more surprising if it had happened than that it has not, when one remembers that there have been four Ministers of Health since 1955. There have been four Ministers of Health since these proposals were put up. In 1956, the then Minister, Mr. Turton, said in answer to a deputation from the Borough Council, of which I was a member—and I quote verbatim: … that he was informed by his medical advisers that the modern trend of medical opinion was against having separate institutions solely devoted to children's cases. It was in favour of having children's beds in general hospitals because of the superior availability of highly specialised staff, equipment and resources. On the other hand, the noble Earl, Lord Onslow, answering a Question asked by me recently, said [OFFICIAL REPORT, Vol. 212 (No. 9), col. 499]: My right honourable and learned friend "— that is the Minister of Health— fully recognises the merits of special children's hospitals". So it does not seem to me that the Ministry of Health have quite made up their minds.

Very relevant is the unanimous report of the Pædiatric Committee of the Royal College of Physicians published in 1957; and here I quote the late Lord Webb-Johnson, whose loss we all deplore, who quoted that report during the last debate. It is a unanimous report, and it is signed by the President of the College. Its members were the medical officers of health of London and Birmingham, representing municipal health, the Chief Medical Officer of the Ministry of Health (who, of course, was on it in his own capacity as a Fellow of the College), and also the Ministry's chief pædiatrician. I quote only one paragraph from that report. It is quite short. It says: There is no doubt that special children's hospitals offer the best service for children, because the staff, at all levels and in all departments, is attuned to the special needs of the sick child. Children's hospitals carry with them a tradition of service which cannot lightly be set aside. In a published letter the present Minister of Health says that he accepts the report and lays special emphasis on the feature which it advocates, of the importance of visiting facilities. On the question of facilities for visiting, the Princess Louise Hospital, in addition to being an efficient children's hospital, is absolutely at the top of the class, because it was put right in the middle of these thousands of densely-crowded people, just so they could visit daily.

In passing, there is this very minor point. It seems to me a little peculiar that, when the cause of the trouble is a greater demand for maternity beds, no one should have thought that that position might involve an increase in the number of babies. If there is going to be an increase in the number of babies, what a moment to smash the babies' hospital! Summarising the Royal College of Physicians' report, I would say that it is that the policy should be to close small, inefficient children's wards and use them for adults; transfer the children to larger and more efficient units, and keep those units at full capacity. That is a fair summary of the report. This decision by the Minister does precisely the opposite. It closes an efficient, large unit, and it scatters the children over the face of the earth.

The Minister's approval of this application is based on his assurance that similar facilities exist in suitable, neighbouring hospitals. There are three vital words there. The facilities must be "similar," and the hospitals must be "suitable" and "neighbouring." Will the Minister, in his reply, please say where he thinks the 1,700 in-patients and 30,000 outpatients now annually attending the Princess Louise Hospital will go? I assume he will refer to Paddington Green. If one takes a central point of the catchment area of the Princess Louise Hospital, Paddington Green is two and a quarter miles distant. To get there you have to take a threepenny bus fare and then change on to a threepenny trolley-bus fare—a total fare of a shilling return for each adult. The mere journey takes not less than an hour—inconvenient and possibly harmful to a small child, and very burdensome to the mother. Remember, my Lords, that for in-patients daily visiting is recommended by the College of Physicians; and, surely, for out-patients, who have to go quite often, easy access is important. In this same large area they can get to the Princess Louise Hospital by pram. I am dealing with Paddington Green Hospital at the moment because I anticipate that that will be one of the hospitals recommended by the Minister for the displaced children. But that was why the Princess Louise Hospital was built—because Paddington Green was so inconvenient.

The next choice may, perhaps, be Hammersmith Hospital. That is the favourite of the noble Lord, Lord Moran. Hammersmith is neighbouring and it is efficient, but is it suitable? Can it provide similar facilities? Hammersmith is a post-graduate teaching hospital and is consequently highly selective in its admission—just as selective as Lord Moran wishes to be in his maternity cases. How many of the 1,700 in-patients and 30,000 out-patients could Hammersmith take, to say nothing of sixteen babies at one time in oxygen tents? Picture the consternation of the management committee of Hammersmith if they were told that they had to handle those cases on top of those they have already.

In the last debate all sorts of distant places were mentioned. It was even suggested that Willesden General and Central Middlesex could take the overflow. I need hardly tell your Lordships that those hospitals are neither neighbouring nor suitable. These are not people who take their children to hospital in taxis. They either walk or go by public transport. Finally, the Minister may mention a group of what are fairly described as the old poor law hospitals. There is Paddington General, not neighbouring, St. Charles's (formerly Marylebone Hospital), and St. Mary Abbott's (formerly Kensington), which are both neighbouring but have no other qualifications. The children's beds in these three hospitals are the very beds which ought to have been converted to adult use long ago. It so happens that those three alone contain the number of beds which St. Mary's now seek to get in Princess Louise. It is not only unfair to the Princess Louise children, it is uneconomic, because it is not making the best use of the expensive equipment which has been provided for a specific purpose. When the Minister replies on the question of available facilities, will he please specify, in particular, in which hospitals he thinks epidemics such as bronchiolitis will be treated. It is perfectly clear that lives were saved on that occasion which would have been lost if the facilities had not been available.

To sum up as briefly as I can, it is common ground that the full and efficient use of hospital beds in the North West Regional Area is prevented by the lack of balance—the surplus of children's beds and the shortage of adult beds. I say that that is entirely and completely due to the action of St. Mary's—for two reasons: first, their acquisition of an excessive number of children's beds, and, secondly, the retention of the Princess Louise, which had been acquired solely on an undertaking which they have not seen fit to carry out. That is what all these years has prevented the Regional Board from closing less efficient beds. The difficulty of the Regional Board about children's beds will continue indefinitely if St. Mary's demands are agreed to.

I would ask the noble Lords who speak for St. Mary's whether they do not feel inclined to admit that their attitude has been, and is, a little of the dog-in-the-manger. Princess Louise is not essential to them for teaching and never has been. If it is not a rude thing to say, they do not even seem to know what they want it for—at least, I have never been told. But it is vital to the Regional Board if children are to get the hospital treatment to which they are entitled.

What is the solution? I say that the solution is obvious, when the facts are grasped, and it is essentially a simple one—to transfer Princess Louise to the Regional Board, as was suggested by the deputation from Kensington Borough Council to the Minister four years ago. It happens to be the very solution proposed in a cogent leading article in The Times to-day. There will remain to be made the administrative adjustments which seem to cause St. Mary's and the Regional Board so much difficulty. They can and must be made. I say that it would be intolerable if the efficiency of the National Health Service Act were to be impaired merely by the lack of cooperation between the two bodies responsible for working the Act in this area—and that is what is happening. I claim that I am entitled to the support on this Motion of anyone who takes a personal interest in the work and efficiency of the National Health Service Act. Of course, my Motion does not go anything like so far as to propose that solution. It involves no commitment on anybody. What I ask for is reconsideration, and I submit to your Lordships that I have made a case for reconsideration, both in the particular and in the general, and I hope that the Government will agree to have another look.

What would be lost? I venture to hope that the noble Lords who speak on behalf of St. Mary's and the Regional Board will join in my appeal to accept the Motion. I cannot see why the Regional Board should not, and if St. Mary's does not, I must ask noble Lords to consider, why not. Look at the Motion. What I am asking is that such maternity beds as are temporarily required by St. Mary's should be secured elsewhere than from Princess Louise. If it is temporary, what does it matter to St. Mary's where they have them? Why should they insist on having them at Princess Louise, unless, of course, the hope of St. Mary's is to smash up this children's hospital and get the job finished with. I do not believe that; but if it is not so, then I think that there is no reason why they should not support my plea to the Government for further consideration. This is an opportunity, I venture to say further, for the noble Lords who represent St. Mary's to make a generous gesture which would be in keeping with the traditions of the great hospital they represent. Would the Minister not welcome an opportunity to think again? Surely there is food for thought in the facts that I have put before your Lordships. I hope for your Lordships' support. If I get it, and if the Government will not reconsider, I shall certainly press my Motion to a Division.

Moved to resolve, That Her Majesty's Government be requested to reconsider the Minister of Health's decision of 16th June, 1958, with the specific object of:

  1. (a) securing such maternity beds as are temporarily required by St. Mary's Hospital, Paddington, by converting to adult use other children's beds in older hospitals, e.g., St. Charles and Paddington General, or elsewhere;
  2. (b) maintaining unimpaired the vital service being increasingly rendered by this modern children's hospital in a densely populated area.—(Lord Balfour of Burleigh.)

3.26 p.m.

LORD MORAN

My Lords, listening to the noble Lord who has just sat down, I could not help wondering whether we could not set this whole question in its proper perspective without making debating points. It must be very unpleasant to all of us to criticise an institution which he has so much at heart, and indeed I should not have been drawn into this controversy at all if it were simply a squabble between two hospitals. There is a basic principle involved, and that principle is the very core of the efficiency of the hospital system—namely, that if hospital beds are no longer necessary for the purpose for which they were originally designed, then they must be set free by the Minister for purposes which the community requires.

There are two reasons why the Minister must set beds free when their function has passed away. The first is the capricious distribution of hospitals before the National Health Service Act was passed. They were dumped anywhere, without any regard to the needs of the community, simply according to the capricious bounty of donors. The result was that one might get two children's hospitals in the same street. When the National Health Service Act came in, it was obvious that the Minister had to provide hospital accommodation for every kind of malady for the whole population, and inevitably he had to review the uses to which hospital beds were put.

The second reason is that diseases which thirty or forty years ago were a menace to the community, have in the passage of time lost their sting and become relatively innocuous. I remember when diphtheria was a dreaded malady; to-day, a medical student never sees it. In 1949, infectious diseases took up 21,848 beds; six years later they occupied 9,607 beds. With tuberculosis there is the same story. In 1955 it was possible, because of antibiotics and the like, to take 1,000 beds from tuberculosis and devote them to other purposes. The following year it was possible to take away 3,700 beds, and in the next year, 1957, it was possible to take away a further 3,900 beds. That is to say, in three years' time between 8,000 and 9,000 beds hitherto devoted to tuberculosis were set free to be used for other diseases. And it is the same happy story, as is generally admitted, with children's diseases.

Clearly, the Minister is faced with the bounden duty of seeing that these beds are properly used, yet whenever he attempts, in a very modest way to perform this co-ordinating function, there is a terrific outcry. When St. George's-in-the-East was closed, the agitation went on for about three years. When a general practitioner's hospital in Kingston was converted into a gynæcological unit the out-cry lasted for even longer than that. Today we are simply running according to form.

I must repeat to your Lordships the warning that I ventured to give in 1957. If local loyalties and local feelings are going to take charge, and if, everywhere, co-ordination is to be forgotten; if beds which are no longer needed for the purpose for which they were designed are still to be used for that original purpose because of local clamour; if this controversy which has been going on for three years is to become a pattern; if the beds taken away from tuberculosis and infectious diseases, to which I have just referred, are to be restored to them, not because they are needed, but again because of local clamour—if, in short, the whole attempt to co-ordinate the hospital system is to be given up, then I shall despair of the future of the hospital system.

It is in the light of all these facts that I think, we should review the undertaking given by St. Mary's in 1946. The noble Lord, Lord Balfour of Burleigh, has called it. "a legalistic change of mind". What are the facts? A new board of governors, after the National Health Service Act transformed things everywhere, were faced with new responsibilities and new duties. Was it the duty of that new board to fulfil those duties or to be bound by an agreement come to by a former board of governors, in totally different circumstances, when they had not these responsibilities and when, moreover, there was only one survivor of that board of governors? Surely the noble Lord, Lord Cohen, was right when he said that the old St. Mary's cannot bind the new St. Mary's.

In spite of that, when this came up in 1957 speaker after speaker rose and expressed his abhorrence that charitable monies given for a special purpose should be diverted to other purposes. Has not that always happened? When a charity has outlived its usefulness, it has been the practice for the trustees to go to the Charity Commissioners and ask if they could use the money for other purposes; and it has been the habit of the Charity Commissioners to go into the matter carefully and, if satisfied, to grant that request. We appealed to the Ministry of Health, who in this case acted as the successor of the Charity Commissioners, for permission to use these beds temporarily for obstetrics and after long consideration that permission was given.

Could the Minister of Health have come to any other decision? On the one hand he was faced with the fact that there was an acknowledged surplus of children's beds; and on the other hand there was the most acute shortage of obstetric beds. For example, a woman now goes to Paddington Hospital seeking admission to have her first child. In the old days she would have got that without a murmur, but she will not now get it unless there are special circumstances in her environment which make it necessary. The Minister may well have said that the very purpose for which these beds are borrowed—that is, for obstetrics—is just what the community needs, because they are being borrowed for two years so that the unit at St. Mary's can be rebuilt and enlarged from thirty beds to fifty beds, which will make a considerable contribution to what in this region is one of the most vital questions at the moment; that is, to provide proper obstetric treatment for the inhabitants of the region.

Not only are these beds needed by the community, but they are needed by the medical staff of Princess Louise. I do not know whether the noble Lord, Lord Balfour of Burleigh, is aware of that fact. If your Lordships have grandchildren, you may be happy in the feeling that they are not likely to be cut off by the old infections, diphtheria, pneumonia and the like. Broadly speaking, the dangers of childhood are two: accidents, such as burns, and the infections which happen in the first month after birth—what are. called neo-natal diseases. These are so important that no complete pædiatric unit can be put up that is not in close conjunction with an obstetric unit. Indeed, I shall make a prophecy that in two years' time the staff of the Princess Louise will come to us and say: "Do not take away these obstetric beds; they are far too valuable" And if we have to do so, they will be very sad.

I sometimes wonder whether the noble Lord, Lord Balfour of Burleigh, keeps in close touch with the medical staff of the Princess Louise. Their attitude has completely changed. They are now—and they said this a few days ago, on January 21—completely willing to co-operate with St. Mary's in carrying through this arrangement for obstetric beds. I think that is a remarkable fact.

LORD BALFOUR OF BURLEIGH

I beg the noble Lord's pardon for interrupting, but as he has made that statement I feel bound to read a letter which I received from Dr. Chester, a senior member of the medical staff of the Princess Louise Hospital. She writes: I attended the last Board meeting of St. Mary's Hospital, which was held on Thursday the 22nd January, as an observer. At each of these Board meetings one representative attends from each of the constituent hospitals, by courtesy of the Board of St. Mary's Hospital. In such capacity I could not take part in the proceedings of the Board, and therefore could not comment upon a statement made by Lord Cohen to the Board. This was to the effect that he understood that the Medical Staff of Princess Louise had accepted willingly the proposition that two of the wards of the Hospital should be converted, as soon as possible, from children's wards to maternity wards. He indicated that he intended to make use of this in the House of Lords debate to-morrow. We have not had the opportunity of considering the statement of Lord Cohen formally at a meeting of the Princess Louise Medical Committee, but after consultation with several of my colleagues I can say that the Medical Staff at Princess Louise still feel strongly against the part-conversion of the Hospital, even for a temporary period, accepting neither the necessity nor the desirability of such a conversion. They are also apprehensive about the policy for the future of the pædiatric hospital. Nevertheless, if the Minister does not reverse his decision in respect of the conversion, and we are instructed by the Board of St. Mary's Hospital to proceed with the proposition, my colleagues and I, as loyal members of St. Mary's Group, will co-operate with the medical staff of St Mary's to the best of our ability, and will endeavour to make the combined pædiatric and obstetric unit a working one.

LORD COHEN

May I say that I agree with part of that statement, but not all of it. However, I think it will probably be convenient if I reserve exactly what I have to say about it until I come to address your Lordships.

LORD MORAN

I accept entirely that that is the opinion of that member of the staff. I was informed by the officials of the hospital. I am sure that the noble Lord, Lord Cohen, is far more competent to deal with this than I am. I simply quoted what was given to me by the officials and one or two members of the staff.

To continue my remarks, I do not think I need take up any more of your Lordships' time in arguing that beds should be able to change their function, and that the Minister should support it, because the noble Lord, Lord Balfour of Burleigh, said in the previous debate that it was inevitable in this area that children's beds should be converted into adult beds. There is no dispute about that, but he naturally discusses where these beds shall come from. He agrees that children's beds may have to be cut down, but not in the Princess Louise Hospital. That is where we join issue. In support of that he has made great play with a report of the Pædiatric Committee of the Royal College of Physicians. I listen attentively to pronouncements from that body, because I was its President for nine years. Therefore, when he quoted this report I thought I ought to write to the twenty members of that Committee asking them what was in their minds. They had to answer by return—it had only occurred to me at the last moment—and all but two have answered. One was a complete exception to what I am saying, and the rest were practically unanimous in what they said.

The first thing they laid down was that they all felt, after the debate of 1957, that this report had been quoted out of its context and with a meaning never intended by the hospital; and that pædiatricians could stand by it only if it was placed in its proper context. The report said that there was no doubt that special children's hospitals offer the best service for children. Not one of them had in mind all special children's hospitals; they were thinking of the Sheffield Children's Hospital which had 221 beds in it. Further, it was pointed out to me that if the noble Lord who admires this report had turned over the page he would have found it referred, quite explicitly, on page 2 to "a children's hospital or a children's unit of adequate size"—it did not matter which, provided two things were supplied. One was that it was of adequate size, and the other that the ancillary departments, mainly pathology, radiology and the like were first-rate.

Now why is it important that a children's hospital should be large? If it is not, it will not be able to compete in the open market for first-class personnel for the accessory departments. The good radiologists and pathologists want to go to a hospital where there is plenty of material. Therefore we come to this sombre conclusion, which I do not think anybody disputes, that the days of small hospitals in every branch of medicine are numbered. They are not economic and they cannot possibly compete for the personnel necessary to run their ancillary departments effectively. That means to say that to get first-rate accessory departments the pædiatric unit of the future should be big enough to supply them itself. To do that it must either be another Great Ormond Street Hospital or, alternatively, it must be a pædiatric block attached to a general hospital which itself has these departments.

I do not think any of us feel that it is practical for the country to go on building "Great Ormond Streets." At most one will be built. So if you are going to get first-class departments you have to get them in general hospitals. Let us apply this to Princess Louise Hospital. The Regional Board Chairman. Lord Cottesloe, said: Princess Louise Hospital suffers from the disadvantage of being a small specialised hospital detached from the resources that can be made available in a large general hospital. One of the leading pædiatricians in the country wrote to me. He was on this Committee. He said: I have personal experience of small children's hospitals or units from a remote adult parent hospital, and I know how unsatisfactory and frustrating and inefficient they are. The Royal College Hospital itself, in its Report, emphasised the gain of being adjacent to the first-rate departments of a large hospital. Having said that, I think it is only fair that I should add a postscript. In all these letters, which I have tried to analyse fairly, there was one recurring thought. It did not matter a hit whether it was a children's hospital or a pædiatric block; what mattered was this: It is not everything to have a large pædiatric block, either in a teaching hospital or large general hospital; it is necessary to have something in addition, and that something is this: pædiatric nursing, pædiatric pathology, pædiatric radiology, pædiatric psychiatry, and so on, are so different from those branches in the adult that it is necessary that these adult departments should be attuned to children's uses. Now, I think everybody of experience will admit that, if you have a really understanding pædiatrician in charge, will the right sisters, you will get things attuned in that way.

The first thing I would say to the inhabitants of Kensington who may fear for their children is this: that in spite of all the noble Lord has said, I do not think there is any doubt at all that the six pædiatric units which almost surround Princess Louise can supply this service. There is another danger—namely, that if half these beds are closed to children for two years the stream of admissions, often a trickle, may dry up altogether. I would reassure them by telling them that when on June 17, 1944, the West End Hospital for Nervous Diseases was hit by a flying bomb the authorities subsequently borrowed 33 beds from the Princess Louise Hospital and administered them with their own nursing and medical staff. That went on until May, 1946, two years later. Apparently that did not have any effect upon the demands for admission, which I think is a refreshing fact. It is feared that the centres for speech therapy, radiology, cardiology, neurology and the like, would be lost. Speaking personally, I am sure it is unsound that highly developed clinics of this kind should be in a small medical centre. Again, there is the question of the Princess Louise training for nurses. The Board of St. Mary's have already guaranteed that nurses in training will not suffer. But what happens to subsequent nurses? All I can say is that recent developments have made it possible to go ahead and to see what can be done with 37 pædiatric beds at Kensington. Add the 52 at Paddington Green, and we shall see whether that meets with the requirements of the Nursing Council. If it does not, I understand that another children's hospital is willing to help.

The noble Lord who opened the debate quoted my remark about the Princess Louise hospital not being needed. I believe that, for the reasons I have given, it will eventually suffer the fate of all small hospitals.

The noble Lord spoke of Poor Law infirmaries, and I rubbed my eyes. This is going back twenty years. I was on the staff of what was called a Poor Law infirmary at Paddington and it was gradually converted into a first-class hospital. Though I have been off the staff for a long time, when I left it was a first-class hospital. There are no such things now as Poor Law infirmaries! The noble Lord is completely out of date.

LORD BALFOUR OF BURLEIGH

May I interrupt? I did riot say they existed now. I described them as the old Poor Law hospitals.

LORD MORAN

I thought the innuendo was there: that that was their weakness. But, in any case, it is not a weakness; they are going concerns.

With regard to administrative control, the noble Lord suggested a solution. I have nothing against that solution except that I do not think you are going to find that the administrative body, the Regional Board, will agree. They are preoccupied with the need for obstetric beds. Whereas they might have countenanced taking it over at one time, I am sure they are not going to do it now. I do not think the Regional Board will feel themselves in a position to play. That is the answer. As to administrative control, when I said beds must be under administrative control I was not stating a fad. The London University, which provides the funds for all medical schools, have said definitely they do not think St. Mary's could fulfil their obligations if they had any further beds of this order of which they had not got administrative control. Finally, my Lords, I feel that I ought to crave your Lordships' indulgence for the length of my arguments, particularly as some of them must bear a great family resemblance to those I used in June, 1957.

3.53 p.m.

VISCOUNT ALEXANDER OF HILLSBOROUGH

My Lords, I am quite sure we shall agree, first of all, that this is not in any sense a Party question. It is a local case; and it is of great human interest. We have listened to two speeches from opposite angles which have both reached a very high standard of debate. The position that I take up on this matter is a purely personal one. My noble colleagues on these Benches will, if this Motion should go to a Division (I hope it will not) vote as they please, according to their own individual views about this human and health problem. I myself feel that I have been long committed to maintaining as far as possible the voluntary interest of the nation, and especially of the individuals who make up the nation, in health treatment, and we have in the working-class movement in consequence a national hospital of our own. One may easily, whilst pursuing what one calls the best basis of hospital and medical organisation, at times cut across and wound feelings which ought not to be wounded, in trying to harness the whole sympathy of the nation for the best possible treatment of medical cases, whether adults or children.

The facts which were placed before the House on the previous occasion by the noble Lord, Lord Balfour of Burleigh, seemed to show that there was certainly strong ground for a local Kensington grievance. The agreement that was entered into in 1946 between the board of St. Mary's and the board of the Princess Louise Hospital seemed to me to have been made with full knowledge of the provisions of the Bill (which afterwards became the Act) which was passing through the House at that time and was under consideration. It is certainly true that the appointed day of the consequent Act did not occur until 1948, but in fact all the likely happenings under the Act which was put into operation in 1948 were known to both sides in the negotiations between St. Mary's and the board of the Princess Louise Hospital. It seems to me that that agreement has not at any time been carried out or attempted to be carried out. It was to keep the Princess Louise Hospital out of the general health scheme of hospital treatment; it was to secure for St. Mary's a teaching hospital for pædiatric purposes; and an undertaking was given, so far as I remember from the papers I have read, that if the Princess Louise Hospital carried out their side of the agreement then that would secure that the Princess Louise Hospital would be retained for that particular purpose.

It is perfectly true that there are bound to be (as was pointed out in the very forensic speech made to the House by the noble Lord, Lord Moran), large and wide-spreading questions with regard to diseases which have to be considered. There are not only medical science, research and medical skill and the improvement of nursing skill, but there are social factors which have been changing in the last thirty-five to forty years especially, which all contribute to the desired end, and we are all very glad about it. But I am bound to say that there are also some objections made by some medical officers, even though they may not always be in a majority, against the principle that has been enunciated by the noble Lord, Lord Moran, so ably to-day. Some still consider that if you get a unit which is large enough for the particular circumstances required and have all the proper ancillary services in there, the proper treatment of children can be secured that way. I am quite content to sit down and listen to the medical experts battle that out from one side to the other, but certain it is to my mind that the failure of the Board of St. Mary's Hospital to carry out their agreement or to attempt to carry it out puts them in rather a bad position in the present controversy.

THE EARL OF SWINTON

My Lords, may I interrupt the noble Viscount? I agree that there is no Party point in this at all. But one thing is puzzling me and I think it is puzzling a great many of your Lordships. We have not been told what are the precise terms of the agreement which St. Mary's entered into with the Princess Louise Hospital for maintaining it. Could not somebody tell us what is the term in the contract?

LORD BALFOUR OF BURLEIGH

My Lords, perhaps I may answer that. It was a perfectly legal document setting out that the Princess Louise Hospital was to be maintained for ever as a children's hospital, that its name was not to be changed and that the care of children was to continue. The other arrangement which was part of the bargain, and the reason why the medical staff of the Princess Louise Hospital agreed, was that the hospital was to be made part of the pædiatric teaching unit of St. Mary's. That part has never been carried out, and St. Mary's are now seeking to break the main condition, which was that it should continue to be a children's hospital.

VISCOUNT SIMONDS

My Lords, may I ask whether it was for a children's hospital only, or for a children's hospital so far as it was needed for a children's hospital?

LORD BALFOUR OF BURLEIGH

I am afraid that I should have to refer to the original. I do not think there was anything of that sort at that time. That consideration did not arise.

LORD COHEN

May I remind the noble Lord of what appeared in the course of the debate? I think it was I who read out the agreement. It was dated February 28, 1946, and is recorded in column 396 of the OFFICIAL REPORT for June 26, 1957. So far as it is relevant it contains two provisions. The first was that The Children's Hospital is to remain in existence and shall retain its name, its properties, investments and other assets. The other provision which I read was: The name 'Princess Louise Hospital for Children' is to be retained and shall appear both in the Annual Report of St. Mary's Hospital and of the Children's Hospital if a separate Report is issued. I think those are the two relevant provisions. I hope that has answered the question of the noble Earl, Lord Swinton.

VISCOUNT ALEXANDER OF HILLSBOROUGH

My Lords, it seems to me that that answers the question up to a point, but it refers only to the title, and to nothing else. I always like to admit it if there is a point to be made on the other side. That extract from the agreement refers only to the title; but certainly the understanding has been, as I am assured, that it was to be a teaching hospital for pædiatric purposes, and attempts have never been made to carry out that understanding. I am assured by Lord Balfour of Burleigh and his friends that they would never have made that agreement if that promise had not been made. That is my information. I thought the one weakness in the speech which was so ably put before us for our study by Lord Moran was that he did not touch upon the fact of where the children are to go. Lord Balfour of Burleigh made some reference to that—he pointed out the facts and the difficulties that would arise; but Lord Moran made no reference to that at all.

It seems to me that, if there is such a shortage of maternity beds, there ought to be some real programme to provide an adequate number of beds in the proper sort of obstetric unit. Apparently, that has not been going on. What is proposed is the temporary use of Princess Louise beds for maternity cases while they are waiting for places in other hospitals under the National Health Service. I mention that point because this is not the only case where this sort of thing is happening. Anybody who reads the Sussex papers will know of the great controversy which is going on in Brighton about the proposal to close the Sussex Maternity Hospital, which has been in existence there since 1831, and to transfer the beds to the Brighton General Hospital, another of the old infirmaries which has been brought up to date as a general hospital. This scheme will provide, in relation to an expanding population, fewer beds for maternity than are now available as between the National Health Service hospital and the Sussex Maternity Hospital.

I quite agree with Lord Moran that changes are matters to take into consideration in great schemes like this, but surely it is vastly important that one should not alienate the sympathies and the support of any sections of the population by riding roughshod over opinions very firmly held and justified by strong local needs as well. On that point, I would say that I have received a personal letter from Mr. George Rogers, the Member of Parliament for North Kensington, in which he says—I will not read all his letter, but just a short extract: This Hospital was created by the people of Kensington, paid for out of their own pockets. There is widespread resentment in all Parties at the move to take it over as an adult hospital. At the moment the Minister's decision is to take part of the hospital for maternity purposes, but it is clear that this will be the thin end of the wedge. I am not completely reassured on that point by the statement that Lord Moran made, although I realise that he was probably going as far as he could go, in his individual capacity, upon a matter that has to be decided by a main board.

There are two other things that I should like to say. First of all, in all the circumstances I regret the decision of the Minister in refusing the request, long since made by the Kensington Borough Council, for a proper inquiry. I think that the people were entitled to have an inquiry. It is a great pity that that has not been done. In the circumstances as they have been presented to-day, I think there is a case for reconsideration of this matter: not for giving the board of St. Mary's all that they would ask, and running the risk of having empty beds, but for making the best possible use of Princess Louise Hospital on the basis mentioned by the noble Lord, Lord Balfour of Burleigh, that it will be handed over to the North West Metropolitan Regional Board, so that they, unhandicapped by the promise, or the failure to fulfill a promise, by the Board of St. Mary's, can make proper provision in all the circumstances.

It might well be that there would be no danger of there being only a trickle of children going into the Kensington Hospital. In that case, many of the maternity needs in general, apart from special teaching in obstetrics, would not have to wait so long as happens to-day before they can be met by other hospitals. I understand that there is a real shortage of beds in that connection, and that in those circumstances St. Mary's want to make temporary use of these beds in the Princess Louise Hospital. The real solution could be arrived at to-day. I would ask the Government to promise just a reconsideration, and, if possible, out of that reconsideration to make an arrangement for the Princess Louise Hospital to be handed over to the North-West Metropolitan Regional Board, to be used, so far as possible, for the Borough of Kensington but to be absorbed into the general needs of hospital treatment in the region. If that is done, my Lords, I shall be very pleased indeed.

4.8 p.m.

THE EARL OF ONSLOW

My Lords, it might perhaps be of some use to the House if at this stage of the debate I were to give a few facts as to why the Minister considered it best to make the decision which has given grounds for this most interesting debate. After most careful consideration, he decided that he was justified in approving the temporary use of two wards in the Princess Louise Hospital for Children for maternity patients. He made it quite clear that he was not at present prepared to approve the long-term use of that hospital for adults only, but would review the future of the hospital again towards the end of the period for which it had been temporarily part used, as to these two wards, for maternity purposes.

The noble Lord, Lord Balfour of Burleigh, said that he understood that it was not particularly sound medical practice for these two classes to be mixed. He also quoted from the report of the Royal College of Physicians Pædiatric Committee. If the noble Lord would look at paragraph 11, entitled "Infants in Maternity Units", he will find these words: The Committee has already stated that all maternity hospitals and departments should have pædiatricians on the staff and they should undertake full responsibility for the care of the new-born. In the larger units the services of a pædiatric registrar are advisable, and the obstetric house surgeons should be directly responsible for the infants to the pædiatric registrar and consultants. Every maternity hospital should be linked with a children's hospital or children's department of a general hospital and thus be able to call upon the special facilities in the pædiatric unit. I do not think that that shows that the Minister has failed to pay due regard to that particular section of the report.

VISCOUNT ELIBANK

My Lords, does that cancel out paragraph 3 of the report?

THE EARL OF ONSLOW

No, my Lords. Perhaps I might also refresh your Lordships' memory as to the exact history of the hospital itself, as there has been a certain amount of discussion on it. As some, at any rate, of your Lordships will be aware, the hospital consists of 76 children's beds. It was built in 1928, as has already been said, very largely out of local subscriptions. The committee of management voluntarily joined the St. Mary's Hospital Group in 1946, in anticipation of the coming into effect of the National Health Service in 1948, as the noble Viscount, Lord Alexander of Hillsborough, has mentioned.

In February, 1955, the St. Mary's board of governors notified the Minister of their proposal to change the use of the hospital, and the two proposals put forward were, first, that two wards should be converted temporarily to accommodate maternity patients whilst the maternity department of St. Mary's Hospital was being turned into a professorial wing for obstetrics and gynæcology in connection with the appointment of a professor by the University. Those wards are being used temporarily because this other section of the group's available beds will be out of use for (I believe) about a couple of years while the alterations are being made. The second proposal is to make the hospital entirely an adult hospital. The Minister has agreed to the temporary use of two wards for two years, but has said definitely that he will defer his decision on the second proposal so that he may be better able to give his view in the light of experience. I believe your Lordships will agree that that was a wise decision.

The reasons why these proposals have been put forward by the board have already been stated, but it will not hurt if I reiterate them. There is a disproportionately high number of children's beds in the group—in fact, 18 per cent. of all the beds in the group—and there is also a fall in demand for children's beds, both nationally and locally. At the same time, the board have a statutory duty to provide the associated medical school with facilities for medical teaching and therefore they must (1) find other accommodation for the St. Mary's maternity patients while the new professional wing is under construction, and (2) reduce the number of children's beds in order to increase the number of adult beds in the group, so that the proper balance may be maintained.

Before reaching his decision the Minister gave very careful consideration to the many views that had been expressed on the matter, including those expressed in the debate in your Lordships' House in June, 1957, and those of the deputation which he received from the Royal Borough of Kensington; and these are some of the factors he took into account. In 1949 the board proposed to convert the 52 children's beds at Paddington Green Children's Hospital to an adult hospital. This proposal, however, was not formally submitted to him and was resisted as strongly as the present one has been; and the conversion—which would still have left the board with an excess of children's beds in the group—was not pursued. Since the board's original proposal to convert Paddington Green the children's outpatients clinics at St. Mary's Hospital have been transferred to Paddington Green Hospital and developed there; and the pædiatric teaching of the group is now mainly concentrated at Paddington Green and the Lewis Carroll Ward at St. Mary's. For geographical reasons alone it would be impracticable to use the Princess Louise Hospital for these purposes.

The figures supplied to the Ministry of Health by hospital authorities in the National Health Service indicate a falling demand for pædiatric beds together with a shorter duration of stay. Perhaps some of these figures may be of interest to the House: 1954, occupied beds, daily average 5,108, average duration of stay, 18.4 days. 1955, daily average 4,527, duration of stay, 17.7 days. 1956, daily average 4,383 beds; average stay 16.7 days. 1957, 4,361 beds; average stay 15.9 days. I believe that these figures bear out the argument that there is a decline.

LORD STONHAM

My Lords, would the noble Earl allow me to interrupt? The figure of the average stay of a patient in the Princess Louise Hospital last year was less than ten days.

THE EARL OF ONSLOW

My Lords, I am coming to that. The board of governors say that there is a similar position at the St. Mary's group and they supply the following details of the waiting list for children's beds. In 1953, the figure was 539. That total is broken down and consists of 435 E.N.T., and 104 others. In 1955, it was 320 (256 E.N.T., 64 others). In 1957, it was 222 (184 E.N.T., 38 others) In December, 1957, it was 131 (92 E.N.T., 39 others).

LORD SILKIN

My Lords, would the noble Earl excuse my ignorance—would he explain what "E.N.T." means?

THE EARL OF ONSLOW

E.N.T. means "ear, nose and throat". The figures supplied to the Minister indicate that the waiting list for the Princess Louise Hospital itself fell from 180 at December 31, 1955, to 39 on December 31, 1957; and I understand that all of those 39 cases could have been admitted in less than one month and that of the 39, 23 were tonsils cases. These figures show that almost all the applicants for the Princess Louise Hospital could, I submit, still be admitted. The board also said that in contrast the adult waiting list was never less than 1,600; in other words, there were three waiting patients for each bed throughout the three years preceding these proposals.

The board also claim that the outpatient demand at the Princess Louise Hospital has declined, and the figures supplied annually confirm this decline in the consultant clinics. These figures, again, relate to the Princess Louise Hospital: 1953, new patients, 2,650; total attendances, 10,291. 1954, new patients, 2,253; total attendances, 9,697. 1955, new patients, 2,269; total attendances, 8,623. 1956, 2,634, and 9,121 total attendances; and 1957 (the last available total figures), 2,260, and 8,434 total attendances. I am sorry to bore your Lordships with these figures but I think they are very relevant to the dispute.

LORD BALFOUR OF BURLEIGH

My Lords, I must apologise to the noble Earl for interrupting him, but if I heard him aright these figures are entirely different from the figures on the paper.

THE EARL OF ONSLOW

These are the figures that are sent by the Hospital direct to the Ministry and the Minister.

LORD BALFOUR OF BURLEIGH

My Lords, I will reserve my remarks on them until my reply. I must not further interrupt the noble Earl.

THE EARL OF ONSLOW

My Lords, as I say, these figures were the ones sent to the Minister from the Hospital in the returns which they have to make, and I feel we must consider that they are reliable figures, otherwise we cannot consider that any of these things are workable. The Minister saw no reason why the needs of the area could not be served by St. Charles's Hospital, W.10, Hammersmith Hospital, W.12, West London Hospital, W.6, St. Mary Abbott's Hospital, W.8, Paddington General Hospital, W.2, as well as Paddington Green Hospital, also W.2, and St. Mary's Hospital, W.2, which together have 205 children's beds. Public transport facilities between the various districts appeared to him to be adequate and distances not unreasonable.

A fairly recent investigation into the districts from which patients for Princess Louise Hospital came showed the percentages to be: from W.10—that is, North Kensington—22.1 per cent.; W.11, Notting Hill, 19.8 per cent.; W.12, Shepherds Bush, 24.2 per cent.; W.14, West Kensington, 6.7 per cent.; W.6, Hammersmith, 5.8 per cent.; W.3, Acton, 2.5 per cent.; W.2, Paddington, 2.8 per cent.; W.4, Chiswick, 1.2 per cent.; and further afield, 14.9 per cent, making 100 per cent.

An examination of the occupancy of the children's beds during 1956 in the hospitals to which I have just referred, other than Paddington General Hospital, showed that the occupancy varied from 66 per cent. to 34 per cent.

I should like to stress that my right honourable friend recognises the advantages of special children's hospitals, as I believe was said in reply to an earlier Question which the noble Lord raised a few weeks ago; but he does not think that these necessarily outweigh all other considerations. It is a matter, he feels, of assessing the advantages in relation to the circumstances of every case. To be effective and economic a separate hospital needs to be of a fairly considerable size, and such a hospital must serve a big enough population to justify it. If one planned to meet all children's needs in separate children's hospitals a large number of patients would have to travel long distances from their homes; and the modern idea of treatment is to do everything possible while the child is in hospital to preserve the link with his or her home by frequent visiting by parents and others. I believe that that is also quoted in this report. The report of the Pædiatric Committee of the Royal College of Physicians, to which I have referred, as others have done also, contemplates that children will often be nursed elsewhere than separate children's hospitals, and, provided they are not put into adult wards, there is no overriding objection to this proposal.

London is, of course, certainly big enough to support a number of children's hospitals; but I would suggest that the siting of these in relation to each other and to the general hospitals needs careful thought. I said earlier that the Minister has not yet decided on the long-term use of the Princess Louise Hospital. What he has decided, having regard to the falling off in the demand for children's beds arid to the sufficiency of such beds in neighbouring hospitals, is that there is no justification for not approving the board of governors' proposals to utilise temporarily two wards in this hospital for maternity patients.

In reaching this decision my right honourable friend had regard to his obligations under Section 6 (4) of the National Health Service Act, 1946, and he came to the conclusion on the evidence that it would be practicable for those entitled to the benefit of the objects of the Princess Louise Hospital to avail themselves of those objects in nearby hospitals during the temporary use of the two wards for maternity cases. In informing the board of governors on June 16, 1958, of his decision, my right honourable friend sought an assurance from them that suitable arrangements would be made in consultation with the North West and South West Metropolitan Regional Hospital Boards to ensure that, if necessary, local children, especially those from the postal areas W.6, W.10, W.11 and W.12, who are unable to gain admission to the Princess Louise Hospital because of the change in use of the two wards, will, subject to medical needs, be admitted to another hospital as near to their homes as possible.

The Resolution moved by the noble Lord, Lord Balfour of Burleigh, appears to be designed to precipitate the Minis- ter's decision on the long-term use of the Princess Louise Hospital, a decision which he intends to defer until towards the end of the period of the temporary use of the two wards, and then, as I have said, to make it in the light of the existing circumstances and the experience gained. My right honourable friend has authorised me to say that he is not prepared to direct the North West Metropolitan Regional Hospital Board to convert children's beds in other hospitals to meet the needs of the board of governors of St. Mary's Hospital, but if, at this eleventh hour, the Regional Board and the board of governors of St. Mary's Hospital in consultation with each other can agree on a satisfactory alternative proposition to meet the board of governors' requirements for obstetric beds while the new professorial wing is constructed, he would willingly consider such a proposal on its merits, provided it would not further delay the construction of the professorial wing. It would, of course, involve immediate consideration of the long-term future of the Princess Louise Hospital in the light of the board of governors' need to redress the balance of beds for children and adults; and as I have already said, the Minister would prefer to delay his consideration a little longer so that the experience gained by this temporary arrangement can be of assistance in making a final long-term decision.

4.28 p.m.

LORD COTTESLOE

My Lords, I think we must all sympathise with my noble friend Lord Balfour of Burleigh's feelings at the prospect of the Princess Louise Hospital for Children, for which he was in the first instance so largely responsible and in whose affairs he has ever since taken so active a part, being used for purposes other than those for which he brought it into existence. We can all sympathise, even though, if I understand the position correctly, it is intended that half the hospital shall continue to have children's beds in any case, notwithstanding the purpose to which it is proposed temporarily—and I was glad that the noble Earl, Lord Onslow, laid so much stress on the temporary character of the Minister's decision—to divert the use of the other half of the beds. The production rather than the treatment of children is, in a sense, perhaps not so remote from the original purpose.

I cannot speak with the long and deep professional knowledge of the noble Lord, Lord Moran, who has spoken on these matters. I speak as a layman; but I think it may help your Lordships, if I, as Chairman of the Regional Hospital Board within whose area the Princess Louise Hospital and St. Mary's Hospital lie, tell your Lordships how the Minister's decision that Lord Balfour of Burleigh's Motion calls in question appears to those on whom is laid the responsibility for the service of the public in the area. The Regional Board are entrusted with that responsibility, and although they have no jurisdiction over the Princess Louise Hospital or St. Mary's Hospital, or any other teaching hospital whatever, it is the fact that they have to depend, to a very large degree, on the teaching hospitals to provide in the London area the necessary service to the public.

My Lords, the hospital services are not static. The hospital service is a living and growing organism which has to adapt itself, like other organisms, to the changing world around it; and the requirements from the service are constantly changing. As the need for beds for tuberculosis cases, as Lord Moran said, grows mercifully less, so, in an ageing population, the need for beds for geriatric patients grows ever greater. In the same way as the need for children's beds has in recent years greatly diminished all over the country, owing to remarkable improvements in ante-natal and post-natal care, and in immunisation and treatment, so the need for maternity beds grows greater in a growing population and in some places has been much increased locally by an immigration from overseas which adds both to the local population and to the local birthrate.

The area of North Kensington and Paddington, in which the Princess Louise Hospital and St. Mary's lie, is such a locality. Although I am told that the population in Paddington may recently have fallen a little, the increase in the birthrate has by far outweighed that. While many of the children's beds in the area lie empty (for instance, half the small number of children's beds, 22 in all, at Paddington General Hospital are empty at this moment: and, in passing, let me say that I do not in the least accept Lord Balfour of Burleigh's suggestion that the children's beds at Paddington General Hospital are inefficient, or less efficient, beds) at the same time the requirement for maternity beds has rapidly outgrown the number available.

The normal practice, of course, is for the doctor or clinic to book a maternity bed in a hospital beforehand, when the family circumstances or the family accommodation make that course desirable. Unfortunately, there are no figures available from the Emergency Bed Service for the period before the first quarter of 1956, but until that time the supply of maternity beds in the area in question was adequate, and the Emergency Bed Service had no calls, or only a small number of calls, to find last-minute maternity beds: but later in that year such calls began to come in, and the number of mothers who have been found beds by the Emergency Bed Service at the last moment has grown, and is still growing. Those numbers have been (I am speaking only of the general area of North Kensington and Paddington): in 1956, 60; in 1957, 109; and in 1958, 158; and the figures are still growing.

I am told that mothers expecting their first baby are now being advised in the clinics that a bed cannot be booked for them in advance, and that the mother should ring up her doctor when she feels her first pains and that he will then get her an emergency bed if it is impossible for her to have her baby at home. I need not tell your Lordships that that is a quite shocking state of affairs—a state of affairs that must be remedied at the earliest possible moment. I need hardly say that my board have made, and are making, strenuous efforts to ease this grave situation by whatever stopgaps they can devise. But, my Lords, our own resources in the area are limited, and in this matter we have to depend very largely on the teaching hospitals. St. Mary's have for a long time planned the rebuilding and the enlargement of their maternity department, with the intention of increasing their number of maternity beds from 29 to 60, if I am correctly informed; and if, by some magic process, that rebuilding and enlargement stood completed to-morrow, there would be no further need for concern. That increase of 31 beds would provide for some 600 births in the year, and there would be no need for calls for such purposes on the Emergency Bed Service, either now or in the foreseeable future.

When Lord Balfour of Burleigh raised this matter of the Princess Louise Hospital in the debate in your Lordships' House in June, 1957, this maternity problem was only developing, although even then it was a matter that was beginning to cause some concern. In that debate I said that I hoped the Minister would find the means of enabling St. Mary's to build the additional beds that they needed. It was urgent then; it is far more urgent now, and the Minister's decision of six months ago. enabling St. Mary's Board of Governors to convert half the beds at the Princess Louise Hospital for temporary use as maternity beds, is designed to effect just that purpose by providing for the decanting of St. Mary's maternity department so that they may rebuild and enlarge it at St. Mary's.

Now, my Lords, it is no good saying, as Lord Balfour of Burleigh's Motion would have us say, that the decanting should be carried out by using empty children's beds in Paddington General Hospital or in St. Charles's Hospital—the only two hospitals the Regional Board has in the area. It is true that of the small number of children's beds in these hospitals a considerable proportion are empty, but in any substantial general hospital serving an area there must be some children's beds available for casualties and emergencies. Despite the dictum of the Royal College of Physicians, on which Lord Balfour of Burleigh has laid so much stress, there is a sharp division of professional opinion on whether children are better looked after in special children's hospitals or in special children's wards in general hospitals. But the one thing on which there is no division of opinion is that children should not in any circumstances be taken into adult wards in general hospitals.

It is therefore essential to have some children's beds in a large general hospital, and it is simply not practicable to suggest that the ten or a dozen children's beds that happen to be empty in the children's ward at Paddington General Hospital at this moment, and the six or eight which happen to be empty in the children's ward at St. Charles's at this moment, should be converted to use as maternity beds. Efficient maternity treatment cannot be provided in that piecemeal sort of way, let alone proper facilities for teach- ing obstetrics to medical students from St. Mary's.

Some reference has been made to an article that has appeared in The Times this morning, and I think that perhaps I should say one word about that. What I should like to say about that is that it is easy to pontificate if you do not really understand the problem; and The Times leader is behind the times—eighteen months behind the times. It is true that eighteen months ago the Minister of Health asked my board whether we would accept the Princess Louise Hospital for Children as a children's hospital if we were offered it. With some reluctance, but in a desire to be helpful, we said that we should be prepared to do so. We went further and said that we should be prepared to make 50 beds at St. Charles's Hospital available to St. Mary's for teaching on the same basis as we make 200 beds at Paddington General Hospital available to St. Mary's for teaching at this moment. That offer, for reasons that I can well understand, did not meet the requirements of St. Mary's, who need not only beds under their own hand but beds for particular purposes at one time and for other particular purposes at another time, as they are carrying through a scheme of rebuilding and reconstruction. So that suggestion fell to the ground.

There is some suggestion that something of the sort might be revived now. But the fact is that events have moved on; the situation has changed. And I think that if the same question were put to my board now, against the background I have outlined to your Lordships, they would not be prepared at this moment to renew the offer they made earlier. The process of decanting that is envisaged in the Minister's decision will mean, as I am informed, some temporary small reduction in the number of maternity beds during the period of rebuilding, and that in itself will aggravate the already serious maternity position; but that difficulty must be faced sooner or later and the longer it is put off, the more difficult it will become. The service of the population dictates that this rebuilding should be carried through as a matter of the utmost urgency, and I must hope that St. Mary's will press forward with it, as I know they are anxious to do, at the earliest possible moment. It is long overdue and the effect of adopting this Motion would be to delay it still further. If the noble Lord divides the House, as I have told him, I shall feel myself impelled to vote against the Motion.

4.44 p.m.

LORD AMULREE

My Lords, I want to confine myself to one or two of the more general medical aspects of this controversy which has been going on for so long. I should like to say first that among the medical profession there will be a good deal of support for the Motion put down by my noble friend Lord Balfour of Burleigh. I am not going to say that it will command universal support—that would be saying far too much; but it has a good deal of support. Only last night I was talking on the telephone to my noble friend Lord Evans, who greatly regrets that he cannot be in his place this afternoon. He told me that if he were here, he would certainly speak in favour of the Motion.

The first point I should like to mention is agreed, I think, by all noble Lords who have spoken: that there are too many children's beds in London at the present time, and particularly, I think I am right in saying, in the part of London where this controversy is raging. Therefore it is quite right to shut a number of these beds to children and turn them to other purposes. But there is a growing opinion on this matter, and I would venture to prophesy about what is going to happen in the not too far foreseeable future to children's hospitals and children's beds. In this matter I have the support of a number of pædiatricians, although I know that quite a number do not support it. I think that the future lies largely in specialised hospitals for children, although, as my noble friend Lord Cottesloe mentioned, there must be a few children's beds in general hospitals for emergencies and accidents. Such cases, however, could be moved as soon as practicable to these specialised hospitals.

There are a number of sound reasons for this view. One of them is that the training of nurses for children is much better if, after they have done their general training, they can train and work in the wards of children's hospitals. I think that that is accepted by a great many people. The second point is that a good deal of the work, particularly technical and medical work, is different and is far better done from laboratories attached to children's hospitals than from a general hospital. I will give an example of this which may sound rather foolish but which I think is quite sound. A pathological technician who has to draw blood from a child for various tests finds it a very different matter to draw blood from a one-year-old from drawing blood from, say, a Member of your Lordships' House. The apparatus used is similar but the technique is different. That is certainly the opinion at the big teaching hospitals for children in London, such as the Hospital for Sick Children at Great Ormond Street.

Another important point is the difficulty of dealing with sick children if they get infections. I admit that these are not nearly so common as they were, but it is essential to have proper isolation for children when such cases do occur. That is something which is easy to get in a children's hospital but difficult to get in a general hospital. I am not going to say that it is impossible, because nothing is impossible in that way: but it is a far simpler matter in a children's hospital than in a general hospital. And that applies particularly to children suffering from gastro-enteritis, which is becoming a relatively uncommon disease but which, when it does occur, is very lethal in its effects, particularly among very young children.

The fourth reason is that the nursing and teaching staffs get greater experience of children in children's hospitals. Although the Princess Louise Hospital, for example, is not a big hospital, there are more children's beds there than in the children's wards in general hospitals. This, I think, is one of the important things about medicine now. Much of the work is specialised and it is no longer the case that a man who has one or two cases a year is as good as the man who sees fifty or 100 cases. That is not true. A further point, which is important from the economic point of view, is that children's hospitals of a certain size are a more economic way of treating children than in the wards of general hospitals.

I know that there will be two big objections raised against my views. One is the trouble about undergraduate teaching. I agree that that is a difficult point, but I do not think that it is one which is insoluble. I sometimes think that the care of the people has to come first, even though teaching is a little more difficult. The other objection is the vexed one of children being visited by their parents. Here I can see grave difficulty, but I think that it could be overcome if it were felt to be in the interest of the children to keep them in specialised hospitals.

I believe that there is some support for what I have said in the tendency towards specialised hospitals for children which is to be seen in provincial cities and in foreign countries, particularly the United States of America. The feeling in America is more and more in that direction. At present, the feeling has not reached London very much, and I do not know whether it will. Probably there may be a change of opinion before the belief in specialised hospitals does get here, but certainly this is the tendency at the present time. I think that these are the factors which we must take into consideration.

There is another point about the Princess Louise Hospital which I think is important. It is, I think I am right in saying, the newest and most modern place for the treatment of children in that part of the town. It therefore seems a pity to shut it down unless there is some very good reason to do so, and I have not heard of one up to the present time.

The noble Lord, Lord Balfour of Burleigh, has quoted a lot of figures which I do not propose to repeat, because I think we have heard quite enough of them. What I want to ask, however (I know it has been asked before, and I exert asked it myself in the debate in 1957), is why it is necessary to close Princess Louise Hospital when you are going to keep children's beds in Paddington and St. Charles's. I know that there has been a great improvement in those two hospitals. When the National Health Service first came into operation I was a member of the management committee of those two hospitals, and I well remember what rather sad cases they were in 1948. I have not been there much since 1951, but a great improvement was made in that time and much more has been done since. They are not as melancholy and gloomy as they were, although I agree that the appearance of the building is somewhat forbidding. Why riot make these wards into the maternity wards that are required? I have never had an answer to that question, but I hope the noble Earl will be able to give one when he comes to reply. That would certainly solve the problem from the point of view of the maternity patients, about whom the noble Lord, Lord Cottesloe, is quite rightly so worried.

Another question that has been raised is the advantage of having maternity wards in a children's hospital. That may be an advantage, but it is something that I have never come across and I cannot believe that it will ever come to stay. It may have certain rather minor advantages, but even now the number of newly born children who need to go into a children's hospital must he extremely small: if I might venture a figure, I should think that .5 or .05 of 1 per cent. of total births would cover it. While I think we should all agree that it is most important to have a good link between the maternity hospital and the pædiatric hospital, I do not think it is a good idea to put maternity cases in the same building as children. There is a certain amount of evidence, which I do not think is universally accepted, that it may lead to increased infection. However, I do not know whether that is true and I do not want to press it at the moment.

I feel that the answer might be (and I am sorry at what was said by the noble Lord, Lord Cottesloe), if it were possible, for the Princess Louise to be given to the Board for a first-class pædiatric hospital. Here I should like to make a somewhat strange suggestion. As a return, it might be possible to give more than the use of beds, the actual administrative control of the beds in one of the hospitals, preferably Paddington, where teaching is done now, to St. Mary's. I sympathise with St. Mary's; they are short of beds and they have a great work to do. There would be a precedent for this. In the case of my own hospital, we got into it rather more quickly than St. Mary's, and on the appointed day we took over the infirmary of the old St. Pancras Institution, which has been of great value to us. I was not on the staff at the time this happened, but I understand that there was a good deal of argument. I think that that would be a good solution to the difficulty because even if St. Mary's do get the Princess Louise changed, they will, in time, be confronted with a shortage of beds. The only way to overcome that is to build a new hospital or to carry out some kind of exchange. I should like to recommend that suggestion to the Minister, to the noble Lord, Lord Cottesloe, and to the board of governors of St. Mary's.

LORD COTTESLOE

My Lords, before the noble Lord sits down, may I say that he has suggested that the making of beds available by the Regional Board to St. Mary's for teaching, and the possibility that they might come under the full administrative control of St. Mary's, is something that might ease the situation, if it could be arranged. This is a technical matter and I do not want to worry the House too much with it, but I might tell your Lordships that the 200 beds at Paddington available to St. Mary's under the present arrangement are in no way under the administrative control of St. Mary's. When I came into the House to-day I received a copy of a note from the Medical Director of Paddington General Hospital, which says: As you know, at Paddington General we have a teaching arrangement with St. Mary's which has worked very successfully for the past eight years. We feel here that its success has depended on the fact that administrative control has remained with the hospital management committee and the Regional Board. He sent me a memorandum on the subject which he tells me has been favourably received by St. Mary's also.

LORD AMULREE

I am most interested in what the noble Lord has said. It seems as if there is a possibility of some kind of solution, maybe not on the drastic lines that I mentioned but on similar lines, which might be agreeable to the parties.

4.56 p.m.