PUBLIC HEALTH (SCOTLAND) AMENDMENT BILL. (Hansard, 1 July 1924)

The SECRETARY for SCOTLAND (Mr. W. Adamson)
I beg to move, "That the Bill be now read a Second time."
This short Bill applies only to Scotland, and has arisen out of the discovery of insulin, which, as is well known, is a most potent drug in the treatment of diabetes. It has not only kept alive many who would, but for it, have died; it has also enabled many who would otherwise have been laid aside to remain, or, indeed, again to become useful citizens of the community, able to take their share in its work and its activities. Fortunately, it is not required in the majority of cases of diabetes; they yield to treatment by means of diet; it is necessary only in serious cases. When it was first introduced into this country in 1923, insulin was most expensive, and, although it has been very substantially reduced, it still remains very costly. The cost of it in the average case amounts to no less than 4s. or 5s. per week, and in some cases the cost exceeds that sum very substantially. The serious feature of this treatment to the individual is that it must continue for a very long period of time, in some cases almost throughout the whole of the life of the patient. An expenditure of 4s. or 5s. per week is a serious burden for a large number of the people to face, and the principal object of the Bill is to enable the public health authorities in Scotland to assist such persons in obtaining the treatment. Under existing legislation, provision is made whereby the following classes may obtain insulin: Persons insured under the National Health Insurance Act receive it as part of their medical benefit; persons on the Poor Roll receive it as part of the medical relief to which they are entitled; and expectant mothers and nursing mothers and their infants and children under five years may receive it through the medium of the maternity and child welfare schemes. The rest of the community are thrown upon their own resources, and to them it is a serious burden. The rest of the community to 1164 which I refer are the men who are working on their own account for a small wage, and, as we know, there are many such cases, and the wives and children of the insured persons who require the drug.
The Bill enables local authorities under the Public Health Act to provide insulin to persons who need assistance in obtaining it. It is an enabling Bill only, and I think some of those who have already expressed opposition to the Bill as it stands have failed to note that it is an enabling Bill only and not compulsory. Local authorities will not be asked to provide the drug free, except to those who cannot afford to pay anything. They will make such charges as the recipient can reasonably be expected to pay, and they will work under a scheme made by themselves and approved by the Scottish Board of Health. Local authorities under the Public Health Acts have at present no power to provide medicines or treatment in such cases as this Bill provides for. Their powers are limited to infectious, epidemic and endemic diseases. Provision under the existing English Public Health Acts empower local authorities to provide insulin in suitable cases. It is intended that the Scottish local authorities should be provided with the same power.

§ Sir WILLIAM JOYNSON-HICKS
Would the right hon. Gentleman quote that Section?

Mr. ADAMSON
I think I can— Any local authority may, with the consent of the Local Government Board, themselves provide, or contract with any person to provide, a temporary supply of medicine and medical assistance for the poorer inhabitants of the district.

§ Sir W. JOYNSON-HICKS
I beg your pardon. I thought you said that it referred to insulin. Of course, I know that Section

Mr. ADAMSON
I think the right hon. Gentleman will admit that it includes insulin.

§ Sir W. JOYNSON-HICKS
indicated assent

Mr. ADAMSON
The purpose of the Bill, as I have already stated, is to put the Scottish health authorities in the same position as the English public health authorities. As the Bill stands, the powers contained therein may be extended to other diseases than diabetes by an 1165 Order of the Scottish Board of Health. The object is to enable medicines to be available in the event of an equally effective remedy being found for some other disease, such as cancer. It was the opinion, when we were dealing with legislation of this character, that it would be well to confer upon our local authorities the power to deal fully and adequately with the health of our people under proper safeguards, these safeguards being such as are provided in the Bill, namely, that an extension will not take effect until it has been laid before both Houses of Parliament, and unless either House has not within 21 days' sittings objected to the Order, or that any Order extending the powers under the Bill to another disease shall not come into operation until confirmed by Resolution passed by both Houses of Parliament. While this will involve a definite determination by Parliament, it will dispense with the necessity for the whole procedure of fresh legislation being gone through whenever a new medical discovery renders it desirable to give additional powers to local authorities. We have had a little experience in connection with this Bill of securing fresh legislation. The First Reading of the Bill took place some time ago, and we have had considerable difficulty in finding the necessary time to give a Second Reading to a very necessary Measure. I think that justifies the step we are taking in making provision for the extension of these powers to other diseases in the event of an effective remedy being found for them in the future.
I understand that this extension is likely to be opposed on representations made by some of the local authorities in Scotland. I would like to say to my fellow Members from Scotland that that is a part of the Bill they will have an opportunity of discussing on the Committee Stage, and if the majority are of the opinion that the extension is undesirable, then it will be within their power to have the Bill amended in that direction. Personally, looking at this matter from the point of view of the health of our people, I hope that will not be their view, but should it prove to be so, then they will have to accept the responsibility, instead of me, of deleting the extension. I have explained as fully as I can, and as shortly as is possible, the objects of the Bill of which I am now moving the Second Reading. I hope the 1166 House will see its way to agreeing to the motion without taking up very much of the time of the House. I believe my fellow Members from Scotland are in full sympathy with the main object of the Bill, and I believe also that such local authorities as have been in communication with certain Scottish Members are equally sympathetic with that object. Therefore I do not think there is need to spend much time on a Second Reading debate. I shall be willing to discuss all questions fully in the Scottish Grand Committee and I repeat that if in the wisdom of the majority of hon. Members this extension is not deemed desirable then, much as I regret it, I shall feel bound to accept its deletion.

§ Sir W. JOYNSON-HICKS
This is the first occasion on which I have intruded on a Scottish Bill. These Measures have all been so adequately discussed by the Scottish Members that it has been usual to leave the matter with them, but as I had something to do last year with an important part of the question raised, perhaps I may be allowed to say one or two words with regard to this Bill. I have read it with great care, and I have also ploughed through the Scottish Public Health Act, 1897, upon which this Bill is to be grafted. I agree with everything the Secretary for Scotland has said with regard to the necessity for the Bill so far as its general principles are concerned, and with regard to the need of insulin for people who cannot afford to pay for it. A great advance was made last year in the use and cheapening of insulin. When I first went to the Ministry of Health it was exceedingly dear. It had become very much cheaper by the time I left, and I believe it will become still cheaper as months go on. I think we English Members, as well as the Scottish Members, are bound to see that any legislation which comes before this House is in proper form. I submit that the right hon. Gentleman, in grafting this Bill on to the Act of 1897, is doing something which is not on all fours with the main object of the Bill before the House. In the Scottish Act of 1897 there is no Section such as is to be found in the English Act of 1875. It is not for me to say why that Section was not inserted in the Scottish Act of 1897, which is almost entirely a sanitary Act dealing with epidemic diseases, insanitary houses, and a great number of sanitary matters in 1167 Scotland. Here we have a Bill which enables the local authorities in Scotland to exercise certain new powers. The right hon. Gentleman mentioned something about payment. Where the recipient is in a position to pay it is desirable that he should pay, but there is no condition, as far as I can see, in the Act of 1897 which will enable Scottish local authorities to make charges for insulin in proper cases and, therefore, that would mean an extension of the Bill to give the local authorities powers which are not included in the Scottish Act of 1897.
The principal point I want to deal with is the proposed extension of the powers of this Bill to other diseases. I want to call the attention of House to the Conference of Scottish Local Authorities, to which the right hon. Gentleman has referred: I believe he has met representatives of it within the past week. The local authorities are very anxious that the Bill should pass, provided, in the first place, that power is inserted in it to enable them to charge recipients for insulin, and they do not desire that the further powers proposed as to other diseases should be imposed on them until they have seen how this particular Clause of the Bill will work They never had power at all with regard to any disease, and I think they are quite right, and the House will be quite right, in saying to the right hon. Gentleman, "You must eliminate the particular Clause with regard to other diseases." After all, it is only a small body of people who are affected by this Bill, because already the poor and insured persons are dealt with and insulin is provided for them as well as for expectant mothers and for infants under five years of age.
I hope the right hon. Gentleman will meet the views of the local authorities throughout Scotland who, by a very large majority, agree that he should here and now eliminate from the Bill the provision as to other diseases. Sub-section (2), as the whole House knows, simply says that any Order made by the Scottish Board of Health shall lie on the Table of the House for 21 days, and unless an Address is passed against it by either House of Parliament it shall then become law. Everyone who has had experience in this House knows well that from the time 1168 these Orders are usually laid on the Table towards the end of the month of July there is never an opportunity for a proper discussion of them, and therefore this particular safeguard is a pure myth. The right hon. Gentleman wants to get his Bill through. We are willing it should go through, and that this supply of insulin should be provided for the inhabitants of Scotland, but we do not want the right hon. Gentleman, in trying to get his legislation through as rapidly as possible, to plunge the House into a discussion on the proposed extension. It will of course come before the Scottish Grand Committee, but members of that Committee will forgive me for saying that this is a question for Parliament, and, whatever view they may take, the matter will have to come back to this House, and on the Report stage there may be further discussion and, possibly, objections to the Third Reading. I suggest that the right hon. Gentleman should accept the proposal I have made here and now and eliminate this Clause and thus get his Bill through its remaining stages in both Houses in the course of the next ten days.

§ Mr. RAFFAN
I am sure that this Bill has the heartiest sympathy of Members in all parts of the House. If the Scottish Health Department can do anything to relieve the sufferings of those who are afflicted with this terrible disease, I am quite certain it will be the desire of every Member of this House to afford every opportunity in that direction. In this matter I feel confident the Secretary for Scotland has the almost unanimous support of the House. The right hon. Gentleman is bound to recognise, however, that in a Measure of this kind it is of supreme importance he should carry with him the good will of the local authorities. The Conference, to which the right hon. Gentleman the Member for Twickenham (Sir W. Joynson-Hicks) has referred, was a most representative one; it was attended by representatives of all the great Scottish cities, and by, probably, the great majority of the smaller local authorities. It would have been very difficult, indeed, to get together a more representative conference, and I would suggest that, whether they are right or wrong in their conclusion, it is extremely desirable for the Secretary for Scotland in a matter of this kind, to endeavour to work with them.
1169 What will be the use of these further Orders which impose new obligations on the local authorities to take action if those bodies are entirely out of sympathy with that action. Very recently hon. Members from Scotland who support the Government were very keen—and rightly so—in urging the right of the Scottish people to control their own affairs. If there is to be a further development in that direction I would point out it will not be assisted by this Measure, which, so far from securing control of their own affairs, will prevent them from having the voice they desire in the management of those affairs. Let us see what the position is. The Secretary for Scotland says there is great difficulty in getting Scottish Bills through this House of Commons, even when they are practically agreed Bills. He tells us that he introduced this particular Bill some time ago, and with regard to its main principle there is no objection, but the congestion of business has been so great that it has been impossible to bring it forward for Second Reading until now. If similar circumstances arise in the future the House is being asked to abrogate its functions as a legislative assembly, and to allow him or his successors to issue Orders which cannot come before Parliament for discussion in an effective way. As the right hon. Gentleman opposite has said the safeguard of these Orders is a perfectly illusory one. As my hon. Friend said, there would be no objection to any Order issued by the present Secretary for Scotland. I cannot conceive, therefore, that the thing would arise at present. But if hon. Members had any objection to any Order issued by any future Secretary for Scotland they might have, perhaps, a bitter experience if these Orders were placed upon the Table, and they wished to discuss them, for they might find very few opportunities for doing so. It is not, therefore, unreasonable that the local authorities, including the most progressive local authorities in Scotland, should say: "If we proceed to deal not only with this matter but with other matters, let Parliament decide as they arise, step by step." I do say that this short notice might lead to very serious results; results which, in the long run, nobody would possibly deplore more than my hon. Friends above the Gangway.
At any rate it is, I think, extremely de- 1170 sirable when a matter of this kind has to be decided that whatever steps are taken should be taken with the good will of the local authorities concerned. All, however, that I have risen to point out, and to suggest, to my right hon. Friend is this: he has said with great frankness that if the Scottish Committee decided to take this step he would bow to their decision, and not allow the ship to be wrecked if he can steer it into harbour with certain of its cargo thrown overboard. I congratulate him upon that decision. He has said he is willing to receive representations and practical suggestions; and the practical suggestion that I make is that in the meantime he shouuld be prepared to meet the local authorities—and, after all, they are vitally interested in this matter—for the purpose of discussing it with them. I venture to suggest that if before the Committee meet he is able to find agreement with the local authorities it will be well. If on the one hand the authorities convince him that he should meet their point of view, or the right hon. Gentleman convinces the local authorities that he is right; or, again, in the ordinary British way—some compromise may be effected—if he can come to the Scottish Committee with a Measure agreed to by the local authorities that will be a much more satisfactory way than if what is to happen is that this Bill is to be carried through in the teeth of the opposition of local authorities representing cities like Glasgow, Edinburgh and Aberdeen, and the great majority of the smaller local authorities in Scotland. If the right hon. Gentleman cannot see his way to accept the suggestion made by the right hon. Gentleman opposite, at any rate I do plead with him to confer with the local authorities in the meantime, so that if this Measure comes before the Scottish Committee there may be a reasonable hope that it will be a Measure which the local authorities will not only accept but will be willing to work with that hearty co-operation which can alone make a process of this kind successful.

§ Sir GEORGE BERRY
The Measure before us proposes new powers for the public health authorities in relation to the provision for the treatment of disease. The Act of 1897 referred only to infectious diseases, but public interest in these matters and in these duties has increased. Anyone can provide for him- 1171 Self the benefit of this treatment if he so desires. Yet one must naturally desire to give or to help to give to diabetics who are unable to provide it for themselves the benefit of this insulin treatment. But is this the most expedient way to do it? It is allowed that it is not a cure, though it alleviates sufferings, unless an individual is so very far gone that he is not likely to be restored to a measure of normal health. It requires, however, daily use, and it requires also that the patient should be under medical supervision; and it is costly. Therefore, this form of treatment is in a different category, as it were, from any other sort of treatment. I cannot understand, however, why it is that this insulin treatment should have led the Secretary for Scotland to introduce further words to the effect that or such other diseases as the Board may by Order prescribe. The reason why the right hon. Gentleman has introduced this Bill has obviously been that he has been inspired by the Fifth Annual Report which the Scottish Board of Health sent in some time ago. But there is no mention whatever of any other illness or any other form of treatment than the insulin treatment for diabetes. Let me read a few sentences from page 89 of the Report— Diabetes is not at present regarded as epidemic, endemic, or infectious disease, and local authorities have therefore no power to treat it. We have suggested, however, that a short Act should be passed providing that the powers of a local authority under the Public Health (Scotland) Act, 1897, shall include power to make such arrangements as they may think fit and as may be sanctioned by us for providing medicines and treatment to persons suffering from diabetes, and who in the opinion of the local authority require assistance in obtaining such medicines and treatment. Not a word about any other disease. I submit that this sort of anticipatory legislation in connection with diseases for which there may possibly be a treatment in the future is not only a new departure but it is a dangerous departure. Such departure indefinitely widens the scope of any Bill, and seems to me to be unnecessary. Some day extension powers may be wanted, but these should be obtained by further legislation, and after due consideration of the circumstances, and not by an Order to be made by the Scottish Board of Health. Therefore, I 1172 should like the Secretary for Scotland to allow us to have the main Clause of this Bill, and that these words in the Bill, or such other diseases as the Board may by Order describe shall be deleted. Like my right hon. Friend, if these words are deleted, I shall support the Minister, but not if he insists upon retaining the interpolated words.

§ Mr. DICKS0N
The hon. Gentleman who has just sat down suggested that to have something here of an anticipatory character in a Bill was a new and dangerous proceeding. I myself think that one of the most dangerous proceedings in these matters of public administration, as embodied in previous legislation, is that we have never had sufficient anticipation for circumstances that might arise or matters that might develop in connection with any disease in the community. If that were the only comment on the Bill we could all join in a chorus of praise. I think that the proposal coming from all those who have spoken is one that is very necessary; but I rather disagree in regard to one point, and that is this: that I think disease of almost any character, particularly disease of an epidemic, infectious, or contagious character, should not be looked upon as merely the business of those in whose area it may arise, or in which that disease requires to be cured, and for that reason I rather regret there is not some provision in this Bill indicating that the local authority, in regard to the expenditure in this Bill, for the provision of insulin for diabetes, or for the provision of any other necessary medicine or treatment for any other disease which the Board may think ought to be so treated—that there is not some provision or indication that the local authorities will be in some measure relieved from the expenditure incurred. I know that the Secretary of State may say that he is simply following the precedent in operation under the English law.
That seems to me, however, if it be so, the poorest reason that; you could have for any Scotchman to take up an attitude of that sort, especially upon matters affecting finance, I did expect that a Sotchman, and particularly a Fifeshire Scotchman, would have taken up a slightly different view on financial questions to those of our weaker brethren in England. The first call, it seems to me, ought to be in relation to the health 1173 of the people, irrespective of the financial burden that is to be placed, or whomsoever the charges are to be made against. Our first business is to cure, to apply the treatment, and if possible to cure the disease.
The right hon. Gentleman the Member for Twickenham (Sir W. Joynson-Hicks) thought that there should be some provision in the Bill in order to insure payment of such treatment by those who were able to pay. It seemed to me that the last line or two of Clause 1, Sub-section (1), deals with that point, because the treatment is only to be given to those who, in the opinion of the local authority, require assistance in obtaining medicine and treatment. It is given only to those who, in the judgment of the local, authority, require assistance. It is unlikely they will get the treatment without pay if they can pay for it or pay for the medicine. I wish to press upon the right hon. Gentleman the Secretary for Scotland that if it be possible—I do not know whether it is, but it may be—for him to-night to indicate that there will be some measure of financial support or assistance to the local authorities, he will do so. Because what is going to happen is this: that you are going to have the conduct of the local authorities determined, not by the need for the provision of such insulin, and for the need of such treatment, but by the financial considerations, and also a desire to keep the rates down in any particular area. For that reason I think that the right hon. Gentleman ought to have indicated whether or not it is possible to get the Treasury to pay, in some measure, the cost of all such treatment. We are faced in Scotland, as, I think, in every other country, with a continual increase in the local rates for the treatment of this and other matters, and I want the right hon. Gentleman to take the point of view that it is not merely a concern of the local authority in which the disease may exist, because disease has a habit of flying over frontiers, and may change its place from one month to another. There is a question of national responsibility here, and I am sure the right hon. Gentleman accepts that point of view. The fact that the Secretary for Scotland brings forward the Bill is a recognition of that national responsibility. I hope alongside that he will also recognise 1174 some principle of national financial responsibility.

§ Dr. CHAPPLE
I would like to congratulate my right hon. Friend upon introducing a Bill which, in its main purpose, has secured the unanimity of all parties. It has secured the unanimity also of the vivisectionists and the antivivisectionists, a result which has always before been considered beyond the power of man. We have the support of anti-vivisectionists in the application of a remedy rendered available as a result of operations upon dogs. There is a great deal to be said for making the costs of treatment for this disease national. There is, under the treatment by means of insulin, a tendency for all those suffering from the disease to come to centres with large hospitals, where the treatment which is still highly technical can be best carried out. People suffering will tend to gravitate to those centres and may become a cost upon those particular areas, while at the same time giving immunity from rates to country districts from which they have come. There is a great deal to be said therefore for making this a national charge. As these patients gather around great hospitals and great centres where the treatment is easily and skilfully applied, we shall find that the cost will not be equally distributed throughout all classes of the community. The extreme danger that follows defective or delayed treatment makes it essential that those suffering from diabetes should have a ready access, not only to insulin but to hospitals where they can get continuous as well as scientific treatment. If you once start treating a patient with insulin, you have not only to keep up the treatment but you have to keep it up with regularity, because if you once stop it the patient, in many cases, is in greater danger than if you had not started with the treatment at all. Therefore I am in favour of making the cost national if this can be done, but this is a point we can deal with in Committee. [HON. MEMBERS: "No!"] If that be so, we ought to take this point into consideration now.
I admit that the disease is geographically equally distributed in one sense, but it tends to be unequally distributed in the sense I have indicated. The Secretary for Scotland referred to those who require financial assistance. Those require- 1175 ing insulin will require financial assistance in order to buy it. With regard to the issuing of Orders as opposed to a new Measure, when occasion may arise in the future, the hon. Member for the Scottish Universities (Sir G. Berry) said, "We could legislate when the necessity arose owing to the discovery of some new treatment." I am opposed to that entirely. What we want is promptness. There has been considerable delay in introducing this Bill. It might have been introduced at the beginning of the year and passed with the unanimous consent of the House. In regard to this disease, there is great danger in delay. A very much-beloved Member of this House was dying when this remedy was first discovered, and if he had lived only a few months longer he would have come under the influence of this treatment and would have been living now. I know the case of a young man in Glasgow who was dying of diabetes when the value of insulin was first made known. He saw it in the Press and made some inquiries amongst his friends, but they threw cold water on it, and said that its virtues had probably been very much exaggerated. He heard of six others being treated, but he lost interest in following up those who were being treated and he was put off from having the treatment himself because someone had told him it was hardly worth while. Those six are alive and well to-day, but that young man died within a few months because treatment had not been adopted. Therefore there is a great deal to be said for promptness, and Orders laid upon the Table give promptness when Bills entail delay. I think it is quite inconceivable that the Scottish Board of Health would lay on the Table anything which would provoke the hostility of any party in regard to this matter. We might have a discovery for cancer at any moment. The whole scientific world at the present time is concentrated upon that most dreaded of all diseases. One out of every seven over the age of 45 die of cancer, and it is dreadful to think that, because of delay or ignorance, anyone should die of a curable disease. Therefore I strongly support the Bill, not only in its operative part but in regard to its other provisions as well. I think, however, that the cost might press severely upon certain localities in which the hospitals are 1176 situated whilst giving other areas immunity altogether, and consequently the cost should be a national charge.

Mr. STEWART (Parliamentary Under-Secretary for Health, Scotland)
I appeal to the House to allow this Bill to go through. The arguments which have been used have dealt with two particular faults in the Bill. One is with regard to giving us power by an Order in Council to deal with other diseases in case a cure is discovered, such as cancer, or perhaps some form of nervous disease. I submit that in the natural order of things that is absolutely necessary. It takes a long time for a Bill to get through this House and become an Act of Parliament, and in the meantime neither the local authority nor the central authority have any power to deal with the matter until Parliament has given them the power. Therefore, we ask that the central authority, combined with the local authority, should be given the necessary power. I do not think there is a great deal of opposition on the part of the local authority, and all the opposition which has been raised, I submit, can be met between now and the Report stage. If there should be a difference of opinion the proposals can be altered in Committee.

§ Mr. RAFFAN
Would the Under-Secretary be prepared to meet representatives of the local authorities?

Mr. STEWART
I dare say the Secretary for Scotland will reply to that argument. The next point which has been raised is the right to charge for treatment, but I do not think the local authorities press that point. There are in Scotland 3,000 people suffering from diabetes, and of that number only 25 per cent. Can be treated with insulin. Of that 750 a great many are in a position to pay for it, because some of them are well-to-do. Some of them are paupers, but all these, combined with the cases of women and children, are already entitled to the treatment, and provision can be made for them under the National Health Insurance Act or child welfare schemes. That leaves a very small number to be treated by the authority, and the cost of the basis of to-day's charges would be less than £5,000. The average cost of weekly treatment per patient is estimated at something between 4s. or 5s., and that would mean that the total cost to authorities like Edinburgh, Glasgow, Aberdeen 1177 and the county authorities would not amount to anything more than a few pounds per annum.
It has already been pointed out that this is a matter of vital importance to the individual, and if it is not dealt with immediately damage will be done, and death may ensue. It will save many a mother who is not insured, and whose husband may be earning between £2 10s. or £3 a week, and who cannot find the wherewithal to continue this treatment, because it must be continued throughout life if the person is to be maintained in a proper state of health. I appeal to hon. Members to let us have the Second Reading of this Bill now, and if any Amendments are necessary, they can be dealt with on the Committee stage, where we can make such changes as will meet with the unanimous approval of the House.

§ Mr. T. JOHNSTON
Most of the objections which have been raised to this Bill are not objections to the terms of the Measure, but they happen to be criticisms which could be made in regard to any Measure in relation to local taxation. The hon. Member for Dumfries (Dr. Chapple) has argued in favour of this being made a national charge. Anybody who has had any connection with local authorities in regard to the administration of public health is fully aware of the difficulties that arise, in this connection. For example, the very serious question arises, will persons who go to a treatment centre which may be erected for the treatment of diabetes acquire residence? If so, they will then become chargeable, to the parish in which the treatment centre is situated. That problem, however, is one which arises in connection with other diseases, but these points do not concern us this afternoon. They are part and parcel of the larger question of public health administration in relation to Imperial taxation. The point with which we have now to deal is this: Are we going to give an enabling power—it is not a compulsory power—to the more progressive authorities to deal now with cases of diabetes where they arise? I quite agree with the suggestion that has been made that powers ought to be taken to enable local authorities to make charges, where charges can be suitably made, to persons who are able to pay, or to pay a part of. 1178 the necessary expenses of treatment. That, however, is a Committee point which ought not to be raised here at all.
I forget how many months have passed since this Bill was first brought before the House. I am told that it was first introduced 15 months ago, and I do not know how many persons have died since that date who would not have died if this Bill had been speedily passed though and become law. With regard to the point raised by the hon. Member for North Edinburgh (Mr. Raffan), that this Bill ought not to be allowed to go through because we are also in favour of Home Rule, that is an argument which I totally fail to understand. This Bill simply gives local authorities an enabling power. It gives more local power, to the people who know the circumstances best, to deal with these cases as they arise, and to give assistance from the public funds to persons who would die if they did not receive such assistance. The argument that the Secretary for Scotland should not take power to deal rapidly with other diseases is really an amazing one, coming from a Scottish representative. English public health authorities have this power now; why should not we also have it? I have been the convener of a public health authority in Scotland, and I know that there are a dozen diseases with which we cannot now deal, and in regard to which we are simply helpless; and I suggest that it is high time that greater powers should be given to the local authorities to deal with these diseases. The Convention of Royal Burghs, or the dominating figures therein, have succeeded in getting a resolution passed to prevent local authorities from dealing urgently and rapidly with cases of diabetes.

§ Mr. RAFFAN
No, not as regards diabetes. I do not know if there is a misunderstanding on this point. This was not the convention of Royal Burghs, but a body specially convened to consider this matter. They do not at all object to the provision as to diabetes, but they do say that other diseases should be dealt with by legislation, in the same way as this.

§ Mr. JOHNSTON
That is the point I am trying to make. If to-morrow morning a cure was discovered for cancer, it is proposed that no local authority in Scotland should be entitled to deal with that until it can get the permission of 1179 this House. I put it to the hon. Member, who is a pledged Home Ruler, that that is not an attitude which he can logically defend upon the platform, and if he has had that idea pumped into him from some of the reactionaries who run the convention of Royal Burghs, he should no longer take his instructions from people like that. This is only an enabling Bill, and progressive authorities only need deal with it. Reactionary authorities need not do so. I hope the Secretary for Scotland will not yield, or, at any rate, that he will listen before he does, to the pressure that is being brought to bear upon him this afternoon to take that provision out of the Bill. Every progressive local authority which wants to deal with disease will want to have these powers. It need not exercise them in every case if it does not wish to do so, but it ought to have them without being tied up by this House. I could not understand the objection taken by the hon. Member for the Scottish Universities (Sir G. Berry) to proceeding by an Order of the Board of Health, because such an Order must receive the approval of this House.

§ Mr. PRINGLE
No.

§ Mr. JOHNSTON
The Order is laid on the Table, and if no objection be taken within 21 days it goes through and automatically becomes law, but any one Member of this House can make a Motion against it.

§ Mr. PRINGLE
No; you must put down an Address.

§ Mr. JOHNSTON
Any One Member can do it.

§ Mr. RAFFAN
Six hundred of them could not, although they were all desirous of doing it. They would get no opportunity of discussing it.

§ Mr. JOHNSTON
The authorities can dispute about this matter—

§ Mr. NEIL MACLEAN
Is it not it fact, Mr. Speaker, that, when an Order has been laid on the Table of the House, any Member can, by moving that an Address be presented to the Crown, have the matter debated, and, if a majority of the House go into the Lobby against the Order, the Order is rejected?

§ Mr. JOHNSTON
Every Member of this House can take objection to any Order that is placed on the Table. It has been done, and I have sat in this House when it was done.

§ Mr. PRINGLE
Those are Orders that require the approval of the House.

§ Mr. JOHNSTON
No amount of interruption on a side issue of that kind is material. The point is that this is an enabling Bill. The Secretary for Scotland has asked that powers be given to progressive local authorities to deal with a disease which is carrying off thousands of our fellow-citizens. I understand that those who have made certain indirect objections are prepared to waive them, but objection is also taken by Liberal and Conservative Members to the provision which would enable progressive local authorities to deal with other diseases when proper remedies are discovered for them. I trust that the people of Scotland will take note of that.

§ Mr. MACPHERSON
I rise to say that I welcome this Bill. As the Secretary for Scotland pointed out in his clear and comprehensive speech, this is a Bill to enable him and the Scottish Board of Health to perform a very useful public service. The amount of suffering caused in Scotland by diabetes is appalling. The House will have been surprised to hear that there are actually 3,000 people in Scotland suffering from this disease at the present moment, and, as I understand, no more than 760 of them are able to afford the very expensive medicine which this Bill will provide.

Mr. STEWART
No, what I said was that only 750 of them require this medicine.

§ Mr. MACPHERSON
I am sorry if I did not catch exactly what the hon. Gentleman said, but there is clear evidence that this disease is very prevalent, and I am delighted that the Secretary for Scotland is coming forward now with a Bill to help the poorer classes of the community to procure the medicine that is necessary to care them. In presenting this Bill, the Secretary for Scotland is merely placing Scotland in the same position as England. I know that my hon. Friend who will probably follow me disagrees with that, but I put it to the House that the real reading of the 1181 Section in the English Act is the reading which the Secretary for Scotland gave to it in his introductory speech. In any case, if I may humbly say so, I am perfectly satisfied that he is right in his reading of the Section. Every Member who has spoken is really in favour of the Bill, but some local authorities in Scotland say that they are being asked to do something to which they object if the words are put in or such other diseases as the Board may by Order prescribe. I do not share the fears of my hon. Friend the Member for North Edinburgh (Mr. Raffan), or of hon. Gentlemen who have spoken from the other side of the House. I think the House must have been impressed by the speech of my hon. Friend the Member for Dumfries (Dr. Chapple). There is no doubt at all that the greatest necessity is for precaution and speed, and these words ensure those two things. These words are a precautionary measure. At any moment a disease may break out, and, without these words, it would be necessary to collect in the Scottish Office all the paraphernalia necessary to go through the long routine of getting a Bill through this House, while it is so often the case as every medical man will tell you, that, if you get a case of disease early and quickly, you are all the more able to stem its progress. Accordingly, I see nothing wrong in leaving these words in, and, so far as I am personally concerned, I am prepared to support my right hon. Friend in the Lobby on the Bill as it stands. I know perfectly well that the placing of a Resolution on the Table of the House of Commons has been proved in practice not to be very effective, but I agree with the hon. Member for Govan (Mr. N. Maclean) that it is possible for a Member of the House to give effect to a Resolution placed on the Table in the way that is proposed. We Members of Parliament are very quickly advised of any such proposal by the local authorities, and those of us who attend to our business are able effectively to see to it that the Board of Health or any local authority cannot abuse its power or its office. A public health authority in Scotland would be afraid to come forward with a stupid proposal to include any quack medicine within this Order, and I am content to rely on the sound judgment and wisdom 1182 of any great public Department placed in control of so serious a matter as the health of the people. I am quite willing to allow the words enabling any new disease to be brought into the category to remain in the Bill. With regard to the cost, I think the public health of the community ought to be kept up at the expense of the public purse. By that I mean that if you are going to give, for a special medicine of this kind, special facilities for the poorer classes to get it the public Exchequer should come forward and provide the necessary sum to pay for that medicine. I do not think I have the support of the party sitting behind me in its entirety in the attitude I am taking up—[HON. MEMBERS: "Yes!"]—but I feel very strongly that this Bill should be given a Second Reading at once and that we should hesitate long before, by omitting these words, we give room for any delay on the part of the Public Health Authority in Scotland in treating a disease which can come on very suddenly and very rapidly. We must bear in mind the words of the hon. Member for Dumfries (Dr. Chapple) that it is so often the case that a remedy speedily applied is the most effective cure that can possibly be applied.

Captain ELLIOT
We do not wish in any way to delay the discussion of the Measure, but, it is the supporters of the Secretary for Scotland who have contributed most to the discussion in the last half hour. [Interruption.] We have confidence in our leaders, if the hon. Member has not. But there are one or two points which it is still necessary to make. The first is as to delay under this Measure. It is said that because of the delay in introducing the Bill, certain persons have died who otherwise would have been kept alive. Is it not the case that the local authorities have been taking action under this, although it was straining the law considerably, all the time, and that no one has been applying for this remedy who has been unable to get it on account of cost in Scotland? So that the first point falls absolutely to the ground. It would be one of the most damaging accusations which could be brought against the House that, for a mere desire to indulge in debate, they have held up the application of a remedy vital to the health of the people of Scotland.

§ Dr. CHAPPLE
That is hardly the case. I heard from a medical friend in Scotland recently that quite a number of people were suffering from diabetes and not getting the treatment.

Captain ELLIOT
I am quite willing to take the statement of the Under-Secretary for Health in the matter.

Mr. STEWART
In this matter we decided to ask the local authorities to treat cases, we guaranteeing that we would do all we could to get them the power to do so. Some of them may not have attended to it. I have not learned officially of any case which has not been provided with insulin, but I have no information to the contrary.

§ Mr. PRINGLE
Can the hon. Gentleman say how many local authorities have in fact used the powers which have been provisionally granted?

Mr. STEWART
I am sorry I cannot, but I know that the large authorities and centres—Edinburgh, Glasgow and elsewhere—have been dealing with the matter.

Captain ELLIOT
That absolutely disproves one of the main points which have been made, and particularly made against hon. Members who do not entirely see eye to eye with the solution that by debating this Measure, or by insisting on an opportunity for debate, they have in any way prejudiced the health of the people of Scotland so far as it has come to the notice of the hon. Gentleman, who is, after all, officially responsible for it in this House.

Mr. STEWART
May I make one other explanation Before the Board of Health took action in this matter, there were some cases who were dying because of poverty and inability to get the treatment.

Captain ELLIOT
The hon. Gentleman has pointed out that by administrative action it was competent for him to deal with the situation. [HON. MEMBERS: "By straining the law!"] After all, the essence of authority is that it should be exercised with a certain amount of common sense, and in this matter I think it is obvious that if there is any straining of the law it is infinitely more in England than in Scotland, for the Section which the Secretary for Scotland read out states clearly that the local 1184 authorities in England have only power to make temporary provision, and it has been most clearly brought out in the Debate that this is not a temporary, but a permanent provision, and indeed Gentlemen speaking with the full weight of medical authority have said this treatment, once entered upon, has to be continued for all the person's life long, so if there is any straining it is much more in the case of the English than of the Scottish local authorities. Further, the situation is not, I think, quite as has been described by the Secretary for Scotland and his supporters. They have claimed on several occasions, more particularly I think the hon. Member for Stirling and Clackmannan (Mr. Johnston), that this is merely an enabling Bill. Let us read the words of the Bill: The powers of a local authority shall include power to make such arrangements as may be sanctioned by the Board of Health for providing medicines and treatment to persons who are suffering from diabetes or such other diseases"— Let us read the Section of the Public Health Act to which this addition is to be grafted. It says: The Board may from time to time make alter and revoke such Regulations as to the said Board seem fit…and may declare by what authority or authorities such Regulations shall be enforced and executed.

§ Mr. PRINGLE
Clause 1 of this Bill does not amend any Section of the Public Health Act. It is a general Amendment of the Act and simply relates to powers.

Captain ELLIOT
Surely that leaves the Act with all its powers. One of the powers, which the Board thinks is of the highest importance, which the local authority has and which the Board therefore may command it to execute, is the power to treat persons suffering not merely from this disease but any such other disease as is prescribed by the Board. This puts the Scottish local authority into a position differing fundamentally from the position in which English authorities are since the English authorities, it is said, merely shall have power to make temporary arrangements. This says the Board shall have power to command the local authorities to make arrangements.
This brings me to the point of cost. It is surely not a mere question for the Committee stage even as to whether any proportion of the cost should be borne by the 1185 Central Authority or not. We are putting by this Bill a mandatory power into the hands of the central authority. I think that stands out clearly from the legislation. This mandatory power may be exercised without one penny of contribution being paid by the central authority.

§ Mr. SULLIVAN
I understand this is carrying out public health work, and if that is so does not the State contribute so much for public health work?

Captain ELLIOT
If the Financial Secretary to the Treasury will assure us that the Treasury has made provision for the payment of, not 100 per cent. grant as was suggested by the right hon. Gentleman the Member for Ross and Cromarty (Mr. Macpherson), but for a 50 per cent. grant, or for any contribution at all, towards this expense, the point which has been made will have been met, but we have not any statement by the Financial Secretary to that effect. He makes no pronouncement. We must take it that in this case there is no suggestion whatever that one penny of this expenditure will be borne by the central authority, and whereas it may be necessary to have this accepted by local authorities for the particular case of diabetes, it is extending the principle to a great length if we say, as the hon. Member for Stirling said, that there are a dozen such diseases which he is anxious to get ahead and treat now, because it may be that a very heavy burden will be laid on the local authorities which they have no guarantee or indeed any promise of a halfpenny of support from the central authority for. For example, with all the other things which have been mentioned, maternity and child welfare, you get a considerable grant—a 50 per cent. Grant—towards them. In the case of tuberculosis you get a 50 per cent, grant. In the case of venereal disease you get as much as a 75 per cent. grant. We are embarking on an entirely new field when, we say that not in respect of this disease alone, which will fall with peculiar severity upon local authorities which have large hospital accommodation in their area, but of such other diseases as may be prescribed under the Act, no contribution of any kind shall be made by the State. It is a question of principle that this Bill should have been preceded by a Financial Resolution which would have helped local authorities to make a certain contribution—at least 1186 a 50 per cent. Contribution—towards the expenses of the Bill which it has made in the case of other diseases. I congratulate the right hon. Gentleman on dealing with this question, which we ourselves had under consideration and which I was very anxious to see dealt with in the course of last autumn.

§ Mr. MACLEAN
Are you going to bring in a Financial Resolution?

Captain ELLIOT
I was pressing naturally for financial support, as indeed I have no doubt the Under-Secretary for Health and the Secretary for Scotland have. We put the case up to the Treasury on more than one occasion.

§ Mr. MACLEAN
What success did you get?

Captain ELLIOT
The measure of our success may be observed by the fact that we did not bring in the legislation. We considered it necessary to explore every avenue to make certain that we did not throw this big harden on local authorities without making any corresponding contribution towards their expenses, and I submit that hon. Members have been worsted in their battle with the Treasury, and it is necessary for us on this side of the House to support them in every way we can, and to point out to them that the chances of success of their Measure are being greatly militated against by the fact that this contribution is being thrown on the local authorities alone. I, too, have sat on that bench and have often been greatly indebted to the Opposition for support for a view which, although not officially supported, was regarded with the deepest sympathy, and the strength of the criticism the House makes against this Measure will be the measure of strength the right hon. Gentleman will have in putting up a case, for further consideration of this by the Cabinet and, more particularly, by the Financial Secretary to the Treasury. I claim that the effect of this discussion has abundantly justified the demand which we on this side made for a full discussion of this Measure. The greater part of the time has been taken up by hon. Members opposite, and there is by no means the unanimity about the Measure which the right hon. Gentleman would have us believe. We, therefore, claim that he should still consider whether he cannot now give us an 1187 indication that, if this Measure of emergency is extended to diabetes, he will not seek to extend it to all the other diseases which he may afterwards see fit to prescribe. Not that we are lacking in sympathy for the people suffering from these diseases, but, that we are opposed to the principle of this House conferring mandatory powers upon the Scottish Board of Health without contributing one penny towards the cost of carrying out its own mandate. That is the principle against which we must protest, as being responsible to our own country, and we must see that it is not carried into effect without serious protest.

§ Mr. PRINGLE
I think the hon. and gallant Member has been in error in his interpretation. He suggested that Clause 1 was an Amendment of Section 78 of the Public Health (Scotland) Act, 1897. If hon. Members will examine Clause 1 they will see that there is no reference in that Clause to any Section of the Public Health (Scotland) Act. If Clause 1 was to be construed with Section 78, it would have been drawn in such a way as to make it absolutely clear that the powers conferred under Clause 1 were to be exercised in accordance with the machinery of Section 78. In the absence of any such reference, I submit that the hon. and gallant Member was in error in reading the machinery of Section 78 into Clause 1. I gather that the Secretary for Scotland is in agreement with me on that point.
Clause 1 is, in general terms, an addition to the powers at present enjoyed by local authorities under the Public Health (Scotland) Act. It does not enjoin a duty, but confers a power upon those authorities to act, first of all, in regard to diabetes. I understand from the Under-Secretary that already several authorities have so acted, and the Clause indicates that the legality of those powers is being sanctioned by the phrase— The powers of the local authority under the Public Health (Scotland) Act, 1897, shall include and be deemed, as from the first day of March, nineteen hundred and twenty-four, to have included power to make such arrangements. and so forth.
I understand that the object of these words is to legalise what has been done by certain local authorities at the instance 1188 of the Board of Health since the 1st March. It may be that the Secretary for Scotland is acting in this way and simply conferring the power on local authorities because the Treasury does not wish to contribute. If the Secretary for Scotland had been making this a duty upon the local authorities, then the question of cost would have arisen and the local authorities would have had a claim upon the Treasury.

Captain ELLIOT
May I ask my hon. Friend, from his great knowledge of Scottish legal affairs, whether a patient would not have the power to sue a local authority and take the local authority to the Court under the provisions of this Act?

§ Mr. PRINGLE
That is a question which it is very difficult to answer offhand, but my view would be that no ratepayer or resident within the area of any local authority would have an action against that authority for its failure to exercise a discretionary power.

Captain ELLIOT
That is the gist of the Bill. The Bill says: The powers of a local authority…shall include. Therefore, the local authority can be taken to the Court, either by the central authority or by a local person, for failure to carry out these powers.

§ Mr. PRINGLE
I am surprised that my hon. and gallant Friend does not appreciate the difference between powers and duties. If it had stated that the duties of a local authority "shall include the duty to make such arrangements," there would have been an action on the part of any resident dissatisfied with the action of the local authority, but when it is merely a power to the local authority to do a thing, then there is a discretion left to the local authority. It is left with a discretion, which it may or may not exercise as it sees fit, and failure to exercise the discretion does not give cause of action either in Scotland or in England. I think the right hon. Member for the Scottish Universities (Sir H Craik) would bear out that interpretation.

§ Sir HENRY CRAIK
I am afraid that I should have very grave doubts. According to the hon. Member's own description, certain duties are placed upon the local authority. Would not that entitle 1189 a person who was intended to benefit to take action under the Act against the local authority if it failed to carry out its duty?

§ Mr. PRINGLE
I am sorry that I have not made it clear that in this matter we are not dealing with a duty. The right hon. Member assumes that it is a duty that is placed upon the local authority. There is a clear distinction in all our legislation between powers and duties. May I give an illustration from educational legislation. There are powers in regard to continuation schools exercisable by local authorities. These powers have been exercised in some cases and continuation schools have been set up. In other cases the powers have not been exercised, but the failure to set up continuation schools has not been a ground of action by any child or the parent of any child, I have said that certain powers are granted under this Bill, but no duties are enjoined and, therefore, there can be no right of action.

§ Sir H. CRAIK
There is a good deal in the point made by the hon. and gallant Member for Kelvingrove (Captain Elliot) that this Clause 2 does involve the creation of certain powers and duties, because there is a mandatory power of the central authority to require the local authority to do a particular thing.

§ Mr. PRINGLE
That is a point upon which I was endeavouring to combat the arguments of the hon. and gallant Member. I hold that the hon. Member has misconceived the structure of the Bill. He assumed that because he was dealing with the powers of the local authorities in relation to public health that it was an Amendment of Section 78 of the Public Health (Scotland) Act. In terms, it is not an Amendment of Section 78. Section 78 does not deal with the powers of local authorities, but with the powers of the Local Government Board, as it then was, and the Scottish Board of Health which it now is, which is entitled to make regulations enjoining duties upon local authorities. That is not the structure of this Bill. I am glad to see that the Secretary for Scotland agrees with me that this a discretionary power which certain authorities have already exercised, and which I understand certain other authorities propose to exercise. I do not think there is any difference of opinion in any 1190 part of the House as to the wisdom of conferring these powers and as to the desirability of those powers being exercised.

§ Sir H. CRAIK
In Clause 1 there are the words as the Board may by order prescribe. It does not say "as the Board may approve." The Bill indicates that the initiation is taken by the Board in prescribing certain diseases which are to be treated in a particular way by the local authorities. If the words had been "as the Board may approve," the initiative would have been with the local authority, but by putting in the words as the Board may by Order prescribe. the initiative rests with the central authority.

§ Mr. PRINGLE
By looking at a subordinate phrase in the Bill the right hon. Gentleman has been misled. The first Clause does two things. It confers a power in regard to diabetes. For the purpose of the treatment of diabetes the local authorities will have power to give treatment and medicine. A further power is granted that in other cases in future, and in regard to such other diseases as the Board may by Order prescribe, the local authorities will have similar powers. It is only in relation to these other diseases that the Board will have any power to prescribe. It has not powers in regard to diabetes.

Captain ELLIOT
Surely that makes it all the more urgent that we should not have two such widely differing laws in the same Act.

§ Mr. PRINGLE
That is a matter of argument. I assume now that I have convinced my hon. and gallant Friend on my first point. The hon. and gallant Member admits that I am right that, as far as diabetes is concerned, it is simply a discretionary power.

Captain ELLIOT
No.

§ Mr. PRINGLE
Then there is no difference between the two parts of the Bill. The contention put by the hon. and gallant Member was that we had two different things in the Bill and that, therefore, we should deal with them separately. That was the argument of the right hon. Member for Brentford (Sir W. Joynson-Hicks). The whole point about Sub-section (2) 1191 was that we were dealing with two things. First of all, a perfectly clear issue in regard to diabetes. The right hon. Member for Brentford said: "You are giving powers to deal with diabetes. Stop there. Do not give power to make Orders in regard to other diseases, because that is a power it is not safe to trust to a Department. Even the safeguard given under Sub-section (2) to have these Orders laid on the Table of the House is not a sufficient safeguard. Let the Minister come to the House and get Parliamentary authority in a Statute for any further powers." I observe that the hon. and gallant Member is converted to that. I assume that I have made out my case that as far as diabetes is concerned this is merely a power which local authorities may exercise or no as they please, but no duty is imposed upon them, and that if they carry out the powers conferred upon them the cost is to be borne by the local authority.
There has been some dispute as to where the cost should fall and the hon. and gallant Member, trusting to his interpretation, which I have shown to be inaccurate, has suggested that it should be borne by the National Exchequer. If the Secretary for Scotland had imposed a duty he would have had to take over, at least, a share of the expense by way of grants-in-aid, but as it is merely a discretionary power, apparently, he is able to escape financial liability. It is extraordinary that so few representatives of Scotland have insisted upon getting something from the Treasury. In all my experience, whenever a Bill relating to Scotland has been before the House, I have found unanimity on all sides amongst Scottish Members that the cost should fall upon the Treasury. This is the first time that I have found any difference of opinion in regard to such a matter, which rather indicates a deterioration on the part of Scotsmen.
A further question which arises is as to the granting of the power to the Board under these Regulations to prescribe other diseases in respect of which the local authority may act. I do not think it is a very dangerous power under the circumstances. I do not attach much importance to laying Orders on the Table of the House. I have had experience in endeavouring to upset Orders 1192 laid upon the Table of the House by the Scottish Education Authority.

§ Sir H. CRAIK
Does the hon. Member hold that in this Bill there are two distinct procedures—with regard to diabetes in which a discretion is left to the local authority and the central authority does not have any power at all, and that after that is done, the central authority may at any time intervene and prescribe other diseases by Order in Council, and order the local authority to provide treatment for those diseases?

§ Mr. PRINGLE
What I have said is right. Clause 1 gives power to the local authorities which they do not at present enjoy. It goes on to say that if in the future the Board of Health believe that there are other diseases in regard to which the local authorities may usefully exercise the same power, then the Board of Health may issue an Order mentioning these diseases.

§ Sir H. CRAIK
Prescribing the diseases.

§ Mr. PRINGLE
Prescribing the diseases in relation to which the local authorities shall have these powers. The only difference is that in one case the disease is mentioned in the Statute, and in the other case the diseases will be mentioned in Orders made by the Scottish Board of Health. The House need not have any apprehension as to a wild exercise of this power by the Scottish Board of Health, because if the Board of Health makes an Order it will lie on the Table, and, failing opposition on the part of Scottish Members, will become law, but even then it will be for the local authorities to decide whether they will exercise the powers or not. In these circumstances there is no risk of any wild exercise of the powers.

Mr. ADAMSON
With the permission of the House, I would like to answer one or two of the criticisms which have been levelled against this Bill. The hon. Member for Penistone (Mr. Pringle) is right in the general argument which he has put forward, and as he has demolished the main part of the argument of my hon. and gallant Friend the Member for Kelvingrove (Captain Elliot) there is no necessity for me to take up time in dealing with what was the prin- 1193 cipal part of the hon. and gallant Member's objection to the Bill. The only part left, so far as I can see, is that in which he says that there is no particular hurry, but I do not agree with what he said on this point. As has been pointed out by my hon. Friend the Member for West Stirling (Mr. T. Johnston), this Bill is an enabling Bill, and the authorities will be able to say in what cases they will give this assistance and what cases do not in their opinion require this provision made for them. Schemes made under the provision of the Act of 1897 will be made by the local authorities themselves, and it will be for the Board of Health to approve of the schemes that are drawn up. The hon. Member for North Edinburgh (Mr. Raffan) asked if the Secretary for Scotland would be prepared to discuss this Bill with the local authorities. I am perfectly prepared to do so, and I have already discussed the Measure with one or two of the local authorities.

§ Mr. RAFFAN
Will you be prepared to discuss it with the local authorities before the Committee stage?

Mr. ADAMSON
Yes, I am quite prepared to discuss it with the remaining authorities which object to the terms of the Bill, before we reach the Committee stage, so that they may get every satisfaction. I hope that the fact that I am willing to discuss fully in Committee all the points of difference, and that I am even prepared to meet the local authorities before the Committee stage takes place, will induce hon. Members to let me have the Second Reading without a Division, and without very much more time being spent on the Bill. Several hon. Members have referred to the fact that no provision is made for assisting local authorities to bear expenditure involved in providing such medicines as might be required. My reply is that there is no grant to any local authorities for supplying such medicines, and provision for assisting a Scottish local authority would undoubtedly mean that you would have to make similar provision in the case of English local authorities.

Lieut.-Colonel J. WARD
Not necessarily. Scotsmen always get the best of everything.

Mr. ADAMSON
There is no assistance granted except in the case of infectious diseases. There is provision in special welfare schemes, but, generally speaking, up to now, except in the case of infectious diseases, no part of the cost has been borne, by the Treasury. If it were done in the case of the Bill which we are discussing now, it would be a departure from the general practice, and it would raise an issue of some considerable importance, an issue which, in my opinion, would require to be discussed very fully by all sections of the House. It is not a matter that could be settled by the Scottish section of the House either in Grand Committee or in a discussion of this kind. I hope that hon. Members will now give me the Second Reading without a Division, and without further discussion.

§ Mr. STURROCK
I regret very much that, I am unable to fall in with the view of my right hon. Friend, but we have so few opportunities of discussing in this House Bills which affect those who live in Scotland, that we must seize any opportunity of dealing with any Measure which may come up. I confess that, having listened to the reply which my right hon. Friend has just made, and recognising as I do the generosity of his instincts in the matter of agreeing that the Bill may be amended in Committee, I still find myself under the leadership of my hon. and gallant Friend the Member for Kelvingrove, because this does appear to me to be a Bill which is based on a completely wrong principle, and for this reason, that instead of vesting the local authorities with powers, the whole purpose of the Bill is to give the Board of Health complete power to dictate to the local authorities. In the first place it is laid down, as regards providing medicines and treatment to persons who are suffering from diabetes, or such other disease as the Board may by order prescribe, and who, in the opinion of the local authority, and so on. I am not naturally a suspicious person, but I do foresee that by this well-intentioned Bill we are going to place all the local authorities for years to come another of those disabilities from which Scottish local authorities have suffered in the past. In other words, they are not going to be masters in their own affairs. They are going to have everything prescribed for them by the Scottish Board of 1195 Health. They are going to be told that this that or the other diseases are going to be scheduled, and that they will then be called on to administer these powers.

§ Mr. PRINGLE
No.

§ Mr. STURROCK
As I understand the Bill the Board of Health is going to tell the local authorities that they must do these things.

§ Mr. MACLEAN
That is only as you understand it. As I understand this Clause the local authority is to be told by the Board of Health—the Board of Health will "by order prescribe."

§ Mr. PRINGLE
Prescribe only for disease.

§ Mr. STURROCK
Yes, but—

§ Mr. PRINGLE
The local authorities will only have power; they will not be compelled.

§ Mr. STURROCK
I hope that my hon. Friend will allow me to develop my argument. If the Board of Health put forward this point the local authority is bound to act; it is compelled to take action. [HON. MEMBERS: "No!"] Then what will happen will be what happened to the Dublin Corporation the, other day. The local authority will be relieved of its functions and the Board of Health will take upon itself the duty of carrying out all the powers referred to in this Bill. When the Bill reaches the Committee stage the Secretary for Scotland ought to strengthen Clause 1 in the direction of giving the local authorities greater power than that which is given in the Clause now. We have too often passed Measures without thinking of what is to happen when they reach the Statute Book. For many years we have had the cases of local authorities being burdened with powers which they never sought and did not wish to exercise, and which in many cases they are called upon to discharge under the authority of the Board of Education or the Board of Health, or some other bureaucratic institution in London. I say that when the Bill goes into Committee I shall make sure that. Clause 1 deals clearly with the power that it is proposed to put upon the Board of Health in relation to local authorities.

§ Mr. MACLEAN
The few words which I want to say merely in criticism of the last speaker who, I understand, intends to cross the Floor of the House and to join the party opposite. Judged by the speech he has just delivered he will be a worthy ornament of that party. The statement that he is going to put down an Amendment in order to clarify the issue that is in dispute on Clause 1, seems to place him on rather a higher pedestal than that upon which one would naturally look for him. The clarification of the Clause is promised, but the hon. Member cannot see that the Clause as it stands states that the power which he believes is to be imposed on the local authorities is qualified by the very words that he has read out, namely, that the Board may "proscribe" the particular "disease" from which individuals are suffering, and the local authorities prescribe the "persons" who in their opinion, etc.

§ Mr. STURROCK
It is diseases, not persons.

§ Mr. MACLEAN
The hon. Member does not seem to have read the Clause. It states perfectly clearly "the persons who are suffering" from the disease. I want to make one remark with regard to the former Under-Secretary for Health for Scotland (Captain Elliot), who has been attacking the Secretary for Scotland and the present Under-Secretary for Health for not getting money from the national funds to assist the local authorities. The point that the hon. and gallant Member made was that he had been endeavouring to obtain that assistance while he held office, and intended bringing forward a proposal similar to this, but owing to the niggardliness of the Tory Government, of which he was a member, he could not bring forward this proposal. Does he appreciate what that means and what it will convey to the people outside? He admits that people have been dying from this disease.

Captain ELLIOT
No

§ Mr. MACLEAN
Then there is no necessity for this Bill? The hon. and gallant Member admitted that people were suffering from the disease. He must admit, therefore, that people have died from the disease of diabetes, and they must have died because of the niggardliness of the Government of which he was a member.

Captain ELLIOT
I do not intend to prolong the Debate and so I do not wish to reply to all the questions put to me. If a hack bench Member on this side of the House had prolonged the Debate when the Government was anxious to get the Bill through, it would have been regarded as an instance of disregard of the objects which the Government sought to put forward.

§ Mr. MACLEAN
That comes very well from a member of a Government which held up the purpose of this Bill for over six months.

§ Mr. STURROCK
Who is holding it up now?

§ Mr. MACLEAN
The hon. and gallant Member spoke from the Front Bench and the views he was expressing must have been expressed as those of a member of the Front Bench Opposition. We must take it, therefore, that the hon. and gallant Member and his Government have held up the purpose of this Bill for close upon six months, because they have been too mean to give money nationally for the assistance of local authorities which are willing to put this treatment into operation. That is the point which I rose to make. I trust that when the hon. and gallant Member goes back to Glasgow to speak in Kelvingrove he will be very clear in explaining to the electors that some people in Glasgow have died within the past six months as a result of the meanness of the Government of which he was a member.