Health Bill [HL]

I do not think we should forget how lucky we are to have had this amendment proposed by the noble Baroness, Lady Masham. I say that because she will never forget how lucky she was to survive her accident all those years ago. The survival rate for people with such injuries was pretty low at that time. Indeed, if we may put it in terms of before Guttmann—and what an extraordinary man he was—the life expectancy of people who had suffered a severe spinal injury was very short indeed. If they recovered from the immediate injury, it was odds-on that before long they would die of a kidney infection, a urinary infection, bedsores or other associated problems. Guttmann made the difference. It is due to him that so many people survive today. Noble Lords may recollect that following the IRA/Sinn Fein attempt to murder my noble friend Lady Thatcher, who was then the Prime Minister, my wife and I, who were injured, were taken initially to hospital in Brighton and then, if my memory serves me rightly, she was transferred a week or two later to the spinal injuries unit at Stoke Mandeville, and I was allowed to accompany her. I might say in passing that it was later realised, just before I left Stoke Mandeville Hospital, that I had not been a fake; I had a fractured spine. I had fractured a vertebra in the course of the bombing, and it was not noticed until just before I left hospital. Oddly enough, it was the second time that I had fractured a vertebra and nobody had noticed until some time afterwards. I have been very lucky indeed in my life. From that, I conclude not just that I have been lucky, but that the diagnosis of such injuries among other traumatic injuries in a patient is not quite as easy as we might suppose at times. More to the point, it now seems quite likely that my wife’s injury was more complex than the early diagnosis suggested. It might well have been better for her had she been airlifted straight to a spinal injuries unit immediately she was extricated from the wreckage of the hotel. To me, that underlines the force of what the noble Baroness, Lady Masham, and other noble Lords have said. Twenty-five year ago, my wife and I were pretty lucky in that the spinal injuries unit at Stoke Mandeville had recently had been rebuilt, not least, as has been said, due to the work of Jimmy Savile. Things were different then from the way they are now. It was accepted in those days that a unit such as that at Stoke Mandeville should have vacant beds and that the bed occupancy rate should not be anything like as high as is now demanded. Of course, those empty beds were held at units like Stoke in those days for spinally injured patients. Now the box-ticking bed occupancy rate philosophy that has permeated the National Health Service requires that those beds are occupied. It is regarded as a failure if they are not occupied. Since spinally injured patients do not turn up obligingly to replace one who has just been let out of hospital, the only way that can be accomplished is by putting into such a unit patients who are in hospital for general surgery. The result is quite catastrophic, both for patients and for the health service. First, I suspect that many of those patients would be better off not in the spinal injuries unit but in the mainstream hospital. Secondly, as we all know from some of the tragic incidents that have occurred, someone who is in need of a bed in a specialised unit may be weeks in getting one. Their recovery will be at least grossly impaired, and it may be that they will not recover at all. I emphasise that this is not just a matter of the medical and nursing care; it is a matter that in those units, patients generally stay for quite a long time. Many are young people who have suddenly been transferred from a life of action and taking risks, which is how they were before they arrived in hospital, and who find themselves facing a very different future. My wife and I saw a number of patients who simply could not cope with that. They just turned their faces to the wall and died. They pulled up their roots. That so many survived was not least due to the peer pressure of other patients, which was enormously important, as well as the remarkable nursing care that was offered. That is in danger of going. The last time that I was at Stoke Mandeville, a year or so ago, the medical staff were gravely concerned at the fact that their bed occupancy rate was high solely because they had patients there who did not need the services that they could provide. Equally, they knew that elsewhere there were patients who desperately needed those services and who were blocking beds in other hospitals. I say that they were blocking beds because sometimes they were in high dependency beds, and even intensive care beds, where they did not need to be. They were damaging the interests of other patients. Like the noble Baroness, Lady Wilkins, my wife recently had to have an overnight stay at the Royal National Orthopaedic Hospital. There is an excellent spinal unit there, and it is a wonderful hospital. It somehow underlines my belief that very often the best hospitals are in the worst buildings; and there are some pretty awful buildings there. It is a hospital where I find that people are happy. The atmosphere of the hospital is a quite extraordinary thing. My wife was on a general ward for an operation that was not directly related to her spinal injury, although it to some extent stemmed from it. The staff there were jolly good, nice people, who well trained, but they were not trained in dealing with a spinally injured patient. Fortunately, that hospital is very wise, and it was able to provide accommodation for one of my wife’s carers to go with her. Otherwise, there would have been very considerable difficulties. It is much quicker to get a pressure sore than it is to cure one. It can be extremely expensive, both to the patient and to the health service. So we are looking at a system which has come not to satisfy the needs of the patients. As I have said, the spinally injured may make much less of a recovery than might have been, with all that that entails for the patient, their family and, of course, for the public purse, with the costs which rattle on down for many years afterwards. Something needs therefore to be done to ensure that those beds are held open, ready for spinally injured patients. If that is not to be an inefficient system, it needs some form of backup of the kind which the noble Baroness, Lady Masham, envisaged. A little bit of planning could avoid great suffering and expense. It is time that it was done.