§ 6.2 p.m.
§ LORD FRASER of LONSDALE rose to ask Her Majesty's Government whether they are considering the recent Report by the new planning unit of the British Medical Association and the Paper presented in January, 1968, to the B.M.A.s Working Party on Mechanical Aids for the Disabled; and what steps they are taking to find out whether better materials and better methods are in use in other countries. The noble Lord said: My Lords, during the First War and up to the Second War Britain made probably the best artificial arms and legs, and other aids to disabled persons, which 409 were made anywhere, and the service was reasonably good. Shortly after the Second War I met a friend in South Africa who had fought with us here in Britain and on the Continent. He had lost a limb, high up on his leg, he could not get repairs or replacements in South Africa, and he wanted to come back to Roehampton to get a replacement. He wrote to ask me if I could help him. He was a rich man (it is important that I should mention that fact, as will appear from my subsequent remarks) and flew here to get a replacement. I was able to help him to get one during his two or three days' stay in this country. He was very grateful to Roehampton, as I was, for obliging him.
§ I again met this friend of mine (who is an Afrikaans-speaking farmer) earlier this year, and I asked him, "How is your leg?". He replied, "I am sorry to say that I have now found a German one, which is better, stronger, lighter and more functional". Of course, "one man's meat may be another man's poison", and it does not follow that German artificial legs are better than British—they may or they may not be: but that was the experience of my friend. Therefore, in January last, I was not surprised to read a Report, called the Fulford Report (Fulford is a surgeon, I understand) which was written in 1967 and which said that the British were to be criticised because their artificial limbs and other artificial aids were not as good as those manufactured in certain Continental countries and in North America. This Report was followed up recently by a paper written for a B.M.A. committee which emphasised the criticism of British aids for the disabled and our system in this country.
§ Before accepting that criticism, before even commenting upon it, I will tell your Lordships of my own experience as Chairman of an organisation called St. Dunstan's. There are among the blinded soldiers in this country some 50 who as well as being blind have lost one limb. There are 21 grievously wounded men who as well as being totally blind have lost both their hands. All these 50 men are known to me, as well as the 21 others, and they are known to the people of Roehampton personally. Every one of them, especially the handless men, is dealt 410 with personally by Dr. Fletcher and Dr. Jolly, who are both to be warmly praised for their kindness and skill over many years. Every one of those men goes to Roehampton from time to time to get an easement of a joint which is hurting, or a fitting which is rubbing, or to have an adjustment made, or to get a new limb. I have nothing but praise for the system as I see it at work.
§ The point is that I cannot know what is being done in Germany. Nor can the blinded soldier, or indeed any other ordinary ex-Serviceman, be expected to do what my friend can do—because, as I have said, he was rich and could fly round the world to get the best artificial leg possible. We cannot do that. Therefore the point of my Question is to ask Her Majesty's Government to do this for us and to give us an assurance that at least they know what is being done in Germany, or in Russia, or in the United States, and to let us know. If St. Dunstan's, with its experience, can be of any service in helping in this matter, and if the Ministry would like my mecnanical engineer, who is a very skilled man (he is not of course at Roehampton, but is in St. Dunstan's) to help the surgeons or doctors when they go to Germany, or to the United States, or anywhere else, I will gladly pay for him.
§ 6.9 p.m.
§ LORD VIVIAN
My Lords, in associating myself with the Question put down by the noble Lord, Lord Fraser of Lonsdale, may I ask Her Majesty's Government whether they would agree that the designs of appliances for the disabled shall be as gainly as possible, for reasons both psychological and physical? In this connection, would Her Majesty's Government remember that calliper splints, for instance, practically unchanged in design since 1930, should be done away with and redesigned, since they are pieces of antediluvian ironmongery? Lastly, would Her Majesty's Government also agree that this is the time when every encouragement should be given to young designers and craftsmen who make surgical appliances to press on and bridge the gap between the point at which medicine ceases to be able to help the lot of the disabled and the lives they are unfortunately compelled to live?
§ 6.11 p.m.
§ BARONESS PHILLIPS
My Lords, I am glad to have this opportunity to express preliminary thoughts on the Report recently issued by the planning unit of the British Medical Association entitled Aids for the Disabled, to which the noble Lord who put the Question has made reference. That Report is a mixture of criticism and helpful suggestion—and, if I may say so in passing, extraordinarily easy for the layman to read, which is certainly a point in its favour. I cannot claim that our methods and our aids are incapable of improvement—indeed, no member of Her Majesty's Government would do so—but we shall be considering very carefully the many ideas that are nut forward in the Report. I noted that the noble Lord, Lord Fraser of Lonsdale, expressed disagreement with the criticisms of British artificial limbs and mechanical aids when he recently addressed a St. Dunstan's conference at Brighton and, if I may say so, I am grateful to him for the expression of this view.
The Paper which the noble Lord has mentioned was presented to the B.M.A. Working Party in January, 1968, and was of course devoted exclusively to artificial limbs. Therefore, I am sure the noble Lord will expect me to devote my reply to this subject particularly. One of the recommendations of both the Report and the Paper is that the method of producing artificial limbs should be changed, and I think this is a point which the noble Lord, Lord Vivian, also made. At present, limbs are manufactured individually for each patient, necessitating in turn measurements, partial manufacture at a factory, fitting, completion at the factory and final delivery. The recommendation is for a much greater use of prefabricated parts, so that the finished limb can be produced within a few days, sometimes even on the day of measurement.
My Lords, prefabrication is not a new idea, but specifications need to be drawn up and various concepts tested. The Department's Biomechanical Research and Development Unit has been working on a project of this nature for just over a year, and will have prototypes ready for preliminary trial very shortly. At the same time, one of the firms under contract to the Department has been pressing on with its own version of a prefabricated 412 limb. We have welcomed this initiative, and have encouraged it. When a prefabricated limb is generally available, opportunities could arise for a change in the administrative arrangements for providing it to the patient. The Report and Paper go on to argue strongly for the complete integration of the limb service with the Hospital Service; that is, for the provision of a team at a selected district general hospital in each region to look after every aspect of care for the patient, from amputation to delivery of the limb and training in its use.
At present, as the noble Lord, Lord Fraser, will know, limbs are provided through 22 artificial limb and appliance centres in England and Wales administered directly by the Department, the patient being referred to the nearest centre after amputation. The advantages of medical attention by the same surgeon throughout are clear, and the Department has for some years been building its new centres in the grounds of general hospitals as a move towards closer working arrangements. Seven centres have been built, and another 15 are in hand. The extent of eventual integration has not yet been determined. We have time for experiment because there will necessarily be a transitional period of several years before the new limbs are acceptable to all patients, particularly those needing replacement of traditional, bespoke limbs. During this time, existing administrative and contracting arrangements will have to be kept going.
The noble Lord has asked what steps are being taken to find out whether better materials and better methods are in use in other countries. The Department relies in this field upon its Biomechanical Research and Development Unit at Roehampton. Its Director, who is a figure of world standing in this field, his deputy and his senior officers maintain contacts, both formal and informal—particularly, I would emphasise, the informal—through conferences, visits and correspondence, with research workers in other countries. The Unit holds seminars from time to time, inviting workers from abroad; and it runs an information service through the library at Roehampton. I do not think there is any doubt but that the Unit is aware of all worthwhile research being conducted abroad, and is quick to decide 413 upon the scope for the introduction of improved materials and methods in this country. The noble Lord, Lord Fraser, will probably know that the Unit is now producing its own Bulletin, describing the work done at Roehampton and at other laboratories collaborating with it, and I have a copy with me which makes reference to some twenty different schemes in great detail.
Perhaps I could now just turn briefly to the remaining major points in the Report, which was not restricted, of course, to artificial limbs. I think the noble Lord, Lord Fraser, would agree that there are two main criticisms—and I think the noble Lord, Lord Vivian, particularly emphasised one of them. First, much of the equipment furnished is clumsy and old-fashioned; and, secondly, its delivery to the user is often inordinately delayed by a slow and cumbersome administrative procedure. There are a variety of ways in which aids and appliances can be supplied to disabled people. As the noble Lord will know, surgical appliances are provided directly by the Hospital Service on a consultant's prescription. On the other hand, wheelchairs and vehicles are provided, following a hospital consultant's prescription, directly by the Department through one of its artificial limb and appliance centres.
There is clearly a need, which the British Medical Association Report recognises, for closer co-ordination between the different parts of the services responsible for supplying aids. This is one of the themes of both the Seebohm Report and the Green Paper on the structure of the National Health Service. There is also a sub-committee of the Standing Medical Advisory Committee looking at the question of rehabilitation, and I have no doubt they will have something to say about ways in which the provision of aids might be improved. But while we must do what we can to cut out duplication of effort, we must bear in mind that it is important for a person to be able to get help from the part of the services with which he comes into contact.
The B.M.A. Report suggests that the permissive character of some of the local authority powers should be changed. The noble Lord, Lord Fraser, did not touch on this point, but this is an opportunity 414 to make some reference to it, for it is important. The Report suggested that it should be mandatory for authorities to provide the services needed by disabled people. My Lords, this is somewhat to misunderstand the situation. For the past eight years local welfare authorities have been under a duty to exercise their powers under Section 29 of the National Assistance Act 1948 in respect of persons ordinarily resident in their area who are substantially and permanently handicapped by illness, injury, or congenital deformity. The selection of priorities must nevertheless be decided locally by people who are familiar with local resources and needs. Though the powers of local health authorities under Section 12 of the Health Services and Public Health Act 1968 have not been the subject of ministerial direction, so far as we know all local health authorities make use of these powers to provide a very wide range of items.
My Lords, these are preliminary observations on a searching and wide-ranging Report. I hope that I have been able to assure the noble Lord that we are constantly on the lookout for advances made elsewhere and that we shall give most careful consideration to the various suggestions put forward for administrative and technical improvement. At the same time, I think it worthy of mention that, taken as a whole, the scope and quality of the aids provided for the disabled in Britain rival, if not surpass, those of any other country. I do not doubt that in some countries, some patients receive more elaborate aids more quickly; but on the other hand, the standards applied in respect of other patients in the same country may very well fall below ours. The comprehensive nature of our provision is something not to be forgotten. We do not propose to rest on that but continually look for improvements, and I am grateful to have had the opportunity of saying a few words on the subject to-day.
§ LORD FRASER OF LONSDALE
My Lords, if I have the leave of the House, I should like just to thank the noble Baroness. There was such a noise going on of dogs and bitches that I may have got muddled. But from what the noble Baroness said, she seemed to think that I was criticising her Ministry. On the 415 contrary, I was praising it. But I cannot know what is going on in other countries.
§ BARONESS PHILLIPS
My Lords, by leave, may I say that I am sorry if the noble Lord, Lord Fraser, got that impression. In fact, I was saying that we 416 were delighted to know that the noble Lord had expressed disagreement with the criticisms in his excellent speech, of which I have a note.
§ House adjourned at twenty-two minutes past six o'clock.