HC Deb 17 November 1925 vol 188 cc273-9
Mr. DEPUTY-SPEAKER (Captain FitzRoy)

I have a manuscript Amendment in the name of the right hon. Gentleman the Member for West Fife (Mr. William Adamson). I do not think it is in order. It goes outside the Title of the Bill, which confines the Bill to making arrangements for providing medicines and treatment for persons suffering from diabetes and for purposes connected therewith.

Dr. SHIELS

I beg to move, in page 1, line 16, at the end, to insert the words The Board shall require the local authority to arrange that any medicines used for the treatment of such persons shall be dispensed by a registered pharmacist or by a registered medical officer or practitioner. This Amendment has had a somewhat chequered career. Upstairs I had it in a much more lengthy and formidable form, but it aroused considerable opposition. The Secretary for Scotland opposed it on very interesting grounds. It was suggested that its effect would be to encourage the sale of insulin by chemists instead of by the public authority. The right hon. Gentleman pointed out that the Board of Health could buy insulin in bulk very much cheaper than it could be supplied by the chemist. My disappointment in his opposition was almost compensated for by my joy at his conversion to Socialist principles, although I am afraid that conversion was probably of a very temporal and spasmodic kind. I was also opposed from my own benches. Certain of my colleagues had a suspicion that there was professional trade unionism at the back of my Amendment, and professional trade unionism was a thing, strangely enough, that some of them were not able to sympathise with. However, both of these opponents were entirely wrong as to the object of my Amendment, which is moved entirely in the public interest. This is a Bill to provide insulin for poor people who are not in the poor law class, but are yet not able to afford the very considerable price for this drug, and my contention is a very simple one, that this section of the community should have the drug given them, with the same precautions and under the same conditions as other sections of the community. Insulin is already supplied by the Poor Law authorities under medical supervision It is already supplied under the National Health Insurance Act with every possible precaution, and this is the one section of the community that is to be left without anything specified in the Bill as to the method by which it is to be distributed.

In the rearrangement of my Amendment I took occasion to meet part of the opposition which was put by the Government. They said that one objection to it, as framed, was that in the Highlands and Islands of Scotland it would be practically impossible in many places to find qualified pharmacists either in the employment of a local authority or in business as chemists. There would be many islands and other places where it would be quite impossible to find such an individual, and I quite recognise the force of that objection. I think in the medical profession we are tending more and more to discourage medical men trading in drugs, and it was for that reason that the medical man was kept out of the Amendment as formerly framed. To meet this point, which, I admit, is a difficulty, I have altered the form of the Amendment, and it reads now "a registered pharmacist or a registered medical officer or practitioner." That seems to meet the only real criticism which could be put against my Amendment. I think it is very desirable that we should include in this Bill definite safeguards in regard to the distribution of insulin. It is a very potent and dangerous drug, and unless it is distributed with care, the results may be very serious, and it is solely on that account that I ask that it should be supplied, as it is in connection with these other services I have mentioned, under the professional supervision either of a registered qualified pharmacist or medical officer. I trust that, in view of the effort which I have made to meet the criticisms by the Government, the new form of my Amendment will be. accepted, so that the people with whom the Bill deals will have the same protection and enjoy the same precautions in regard to this drug that other sections of the community enjoy.

Mr. KELLY

I beg to second the Amendment.

I want those to whom this particular drug is to be handed out to feel sure that those who are handing it out have a complete knowledge of the case and of the drug which they are handling, so that there may be that protection for which we would ask if the drug was to be handed to us.

The SECRETARY for SCOTLAND (Sir John Gilmour)

I am unable to accept this Amendment. The hon. Member who moved it said that he moved it in the public interests. We are all at one in desiring that in the administration of this drug, which is a very important drug, the greatest safeguards possible shall be observed. It is a drug manufactured in bulk. It is sold and issued in closed capsules. It is prescribed for the patient by a doctor, but, perhaps, at a certain stage of the treatment, instead of its being administered by the doctor it may, under certain careful directions of the doctor, be administered by the individual.

The point I want to emphasise to-night is that this drug is sold in capsules, and as far as its purity is concerned, or as far as the operation of the drug is concerned, it is the same whether it is handed out over the counter by a chemist or handed out by the local authority through arrangements at the various clinics. In these circumstances, I do not think it can be said in any way that the risk of the drug being mishandled is any greater under the arrangements that are made under the Bill than if the restrictions proposed by the hon. Member were imposed. As far as our experience has gone, we have been able to dispense it through the Board of Health, in working conjunction with the local authorities concerned, at a price which will bear fair comparison with the price at which it might be issued at the shop of the chemist who, of course, would have his right to make a certain profit. Under these circumstances, I have satisfied myself, as far as a layman can, that the rights of the individuals are carefully protected, and I cannot accept the Amendment.

Major Sir ARCHIBALD SINCLAIR

This is a very important point. The Secretary for Scotland admits that insulin is a very dangerous drug, as was said, with great authority, by the hon. Member for East Edinburgh (Dr. Shiels). The right hon. Gentleman says that it is sold in closed capsules. Surely there is a risk, as has been stated by the hon. Member for East Edinburgh upstairs in Committee, of deterioration in the capsules. There have been cases where chemists have rejected supplies of this drug which they have received. It is, therefore, because some of us believe that good chemists would reject bad insulin that we suggest that it would be a real safeguard if this Amendment were accepted. Can we have an assurance from the right hon. Gentleman on that point? Is it not a fact that insulin is liable to deterioration, and that the chemist has been able in the past to detect that deterioration and reject supplies of bad insulin?

Sir J. GILMOUR

This is rather a technical question. As far as I have been able to ascertain, the question of deterioration is not one which can be detected by the pharmacist, the local chemist, in any area. If there is to be proved deterioration after a certain period in this drug, that is done at the headquarters, at the factories where these tests are being made, and it would then lie with the Board of Health to issue orders to withdraw from operation any insulin which had been issued before a certain date. As far as the safety of the public is concerned, it is much more likely to be served by that method than by the local pharmacists.

Mr. WESTWOOD

I understand that there is a possibility that other Amendments on the Paper will not be called, and I am taking the opportunity to speak on this particular Amendment. I wish it had been possible to have something incorporated in the Act which would have made it clear that in the provision of insulin there would be a guarantee that the insulin had been provided only by those who by Act of Parliament had been empowered to prepare the medicine and make it available for the poor people who are to get benefit under this Clause. Some words might have been found which would guarantee that the local authority had seen that only properly qualified persons had been allowed to manufacture the insulin. There was a difference in Committee when we discussed this matter, owing to the fact that what was discussed in Committee would have precluded public bodies from purchasing the drug wholesale or in bulk, and by that means saving money for the ratepayers, and at the same time giving facilities for this wonderful medicine being provided for the poor people.

We are entitled to a guarantee in any Bill which goes through this House that only properly qualified persons shall be allowed to manufacture a particular medicine for the poor people. If I have that guarantee from the Secretary for Scotland or from the Under-Secretary for the Scottish Board of Health—who knows more about medicine than I know, and who has dispensed much medicine— I shall be satisfied. The assurance which I ask for is, that there will be a guarantee that only those who are properly qualified under the Pharmacy Acts for the preparation of this medicine shall be allowed to manufacture it. I desire that the poor people shall be provided with the best insulin, and that that medicine shall be prepared only by a properly qualified person.

Sir J. GILMOUR

I appreciate very much the proper anxiety which hon. Members feel on this matter, and their desire that every precaution should be taken with regard to the manufacture of this drug. I feel satisfied that I can give a guarantee to the hon. Member that it is manufactured directly under the supervision of the Medical Advisory Council, and that as far as the handling and manufacture of it is concerned it is done by properly qualified people. This Bill deals not with the manufacture but with the distribution of the drug. I am satisfied that the public are properly protected.

Amendment negatived.

Motion made, and Question proposed, "That the Bill be now read the Third time."

Mr. WILLIAM ADAMSON

As far as my colleagues on these benches are concerned, we are in favour of the Bill. Our objection to the Bill is that it does not go far enough. Last year I had an opportunity of introducing a Bill dealing with the same subject, and in that Bill we made provision for extending treatment to other diseases in the event of a remedy as effective as insulin being found for other diseases. This Bill provides for insulin being supplied for poor people who are suffering from diabetes. In seeking to extend the benefits in the way I advocated we were only seeking to bring our public health authorities in Scotland into line with the public health authorities in England. The public health authorities in England have a wider scope for dealing with the provision of medicine for poor people than our public health authorities in Scotland possess, even when the Bill we are now discussing becomes law. If we had extended the provisions to the extent that I sought to provide last year, it would have brought our public health authorities in Scotland into line with the public health authorities in England. We see no reason why that should not be done.

If it is a good thing to provide medicine for poor people suffering from other diseases than diabetes in England, it is a good thing to do the same thing in Scotland, and I regret that the Secretary for Scotland has seen fit to bring in a Bill of this limited character. Why, we are in favour of the Bill so far as it goes, but we want to register our protest at its limited nature. We believe that if the health of our people is to be properly attended to, the provision of necessary remedies is essential. There is such a disease as cancer, for which an effective remedy may be found at any moment. The scientists are investigating- keenly into that question, and we may be within a very short distance of finding for cancer a remedy as effective as that which has been found for diabetes, and it would be a great pity if the poor people in Scotland could not get the advantage of that remedy because of its costly nature, and we on these benches register our protest against the limited character of this Bill.

Sir J. GILMOUR

I appreciate the thought which the right hon. Gentleman and his friends have given to this particular Measure. On the question of the extension of this Bill to deal with many other problems, it is just because the problem of the magnitude of cancer to which the right hon. Gentleman has referred, about which we are all waiting anxiously to hear something, is of so great importance that in our judgment it must be dealt with when that problem arises. No one can visualise to-day either what the nature of the solution may be or what will be the cost of that solution. In these circumstances we felt that if and when that solution is found there would be no reasonable doubt that Parliament would deal with it adequately and properly at the time.