HC Deb 30 April 1929 vol 227 cc1510-24

Motion made, and Question proposed, "That this House do now adjourn"—[Captain Margesson.]

10.0 p.m.

Mr. PETHICK-LAWRENCE

I desire to raise the question of the present position of the London Lock Hospital, which I will deal with very briefly, although it is a question of much importance. Until recently the London Lock Hospital was supported by public and private money, and its management was invested in a Board with paid executive officers and an advisory voluntary committee of women who were to keep in touch with the practical working of hospital and staff. As far back as 10 years ago the women's committee found that the recommendations which they made on their inner knowledge of the working of the hospital were almost continuously disregarded by the Board of Management, and they made a protest to the Board in consequence. The Board took no steps to deal with the subject of the protest, but proceeded to appoint another body of women to take the place of those who had protested. The new body endeavoured to work under the constitution of the hospital.

As time went on they discovered that their inner knowledge of what was going on did not give them any power to deal with what they felt to be conditions of mismanagement in the hospital. Consequently they protested, but things reached a culminating point when the matron, the assistant-matron and the ward sister were summarily dismissed at a time when the committee supported those officers in their work. The women's committee were not allowed to express any opinion in their favour, and they were not allowed to discuss the matter with the management of the hospital. Faced with that culminating act of entire disregard of their advice two years ago, the women decided to resign. They resigned, and publicly made certain accusations against the management of the hospital. As these charges were made in public, I will read them. They were: That the board of management exercised no effective control over the management of the hospital. That the funds of the hospital are not expended to the best advantage. That the Ladies' Committee of the hospital is not permitted to perform the functions contemplated by the laws of the hospital and the memorandum by authority of the board. That no paid qualified social worker exists, and no adequate provision is made for the after-care or moral regeneration of the female patients. That the management of the staff is unsatisfactory. That the staff are overworked and underpaid. That the resident medical staff is inadequate. That in the year 1926 an appeal for funds was addressed to the public in terms indicating that the chapel of the hospital was in regular use by the female patients when this was not in fact the case. I have no intention of using my place in this House to make charges which I should not make outside, but I think I am well within the mark if I say that, bluntly, the charges that were made were these, that on the board were persons who gravely neglected their duty, and that on the management, including in that term the board and the salaried executive officers, there were persons who were unfitted to exercise the responsibility entrusted to them. I am not saying that these charges were proved, but, bluntly, this was the effect of the charges made by this committee. For a time nothing was done, but, as a result of the publicity given to these accusations, the board at last consented to a committee of inquiry. That was, I think, almost exactly a year and, pending the hearings by that committee and the finding of their judgment as to the position, public funds were withdrawn from the hospital, and private funds, naturally, fell off very considerably. This Committee of Inquiry was appointed in April of last year, and, after taking evidence, it reported in January of the present year, and presented its Report, as I understand, in the first instance, to the Minister of Health.

There are three possibilities. In the first place, the committee of inquiry might entirely exonerate the board and the management of the hospital, and find that the charges made by the Ladies' Committee were unfounded and unworthy of support. The second possibility was that they would find that there were certain small irregularities, certain things that needed improvement, but that in the main they would exonerate the management from all the grave charges that were made against them. The third possibility was that the Committee would support at least some of the major charges made against the Committee by the Ladies' Committee, and would support the women in their action. If either of the first two possibilities had been realised, there would obviously have been no reason why the Report should not have been published. If the board were exonerated, it would have been well that the public should know that, and that their confidence should be restored. If there were only minor mistakes or irregularities, that also would be a fit subject for publication. But if the third was the position, that some at any rate of the major charges were substantiated, then I suggest that it was a serious matter.

Let us now turn to what the Minister has already answered in this respect. I have asked a great number of questions of the Minister on this subject, and I certainly do not intend to weary either him or the House by giving them all, but I will read just one very brief extract. If the Minister thinks that I have not done him justice in this, there are other answers of his by which he can supplement what he said; I have no wish to do him an injustice by extracting any small sentence apart from the remainder. In reply to a question of mine, the Minister said: I think it is obvious from my answer that the Report of the Committee showed that very considerable changes in the management of the hospital were desirable."—[OFFICIAL REPORT, 14th March, 1929; col. 1257, Vol. 226.] That, I think, disposes of the suggestion that either of the first two possibilities I have suggested was the true report, but the Minister declined to publish the Report of the Committee of Inquiry, on the ground that he was submitting it to the Board for consideration. That is all very well, but five weeks elapsed, and then he said that the Board were meeting to consider what steps they should take in making very considerable changes. We halve waited since that time for seven weeks. I put several further questions to the Minister, and I have always been told that the Board are still making proposals for changes, and that the Minister is not in a position to make any further statement at present.

If the major charges or some of them are substantiated in the Report, I emphatically suggest that the board as at present constituted are not persons who are capable of carrying out the changes. The charges are charges of personnel; they are charges to the effect that there are persons on the board and among the salaried executive officers who are unfit to carry on the management of the hospital satisfactorily, and in these circumstances I suggest that it is not sufficient for the Minister to tell us that these very people are making reforms. My view is that the reforms cannot be carried out by them, but only by a reconstituted board and a reconstituted management, and that, if any reforms can be suggested, we need a change in the personnel. I also want to know, and I think we are entitled to know, what is going to be the position of those members of the staff—the matron, the assistant matron, and the ward sister—who were summarily dismissed. Does the Report of the Committee exonerate them from blame, and say that they ought not to have been dismissed? If it does, I do not see why these people should still continue under the cloud and stigma of dismissal which has rested upon them for two years, and has prevented them from obtaining any employment whatever. Surely it is time these matters were cleared up.

As I understand it, the Minister says, in effect, in his answer to the question, "You must not be impatient. After all, it may seem a long time to you, a few weeks, but in reality in the affairs of a hospital a few weeks are not very long." The first answer to that is that the few weeks are, as a matter of fact, 13 weeks. That is not such a very short time after all. But there is a very much bigger answer than that. It is not a few weeks or even 13 weeks, it is 10 years since the action of the Board was first brought in question and since the first body of responsible women found it necessary to resign because their protests made in another way were unanswered. It is several years since the second committee of women have been agitating to get changes which they found it impossible to get made. It is a year since the Committee of Inquiry was created, and the Board knew that it was only created because the public were very uneasy as to what was going on. All that time the Board have made no really important changes. This period of 13 weeks is only at the very end. The Board made no changes in response to the inner knowledge of the women, who knew a great deal more about the hospital than many of them did. They made no changes even when the facts were beginning to come out before the Committee of Inquiry. I must be excused if I am somewhat sceptical of these changes which the Minister says he is confident they are making, when we are dealing with people who have behaved as they have done in the past, and have been only goaded into action at all when, according to the Minister's statement, the recommendations of the Committee of Inquiry have shown that very considerable changes in the management of the hospital were desirable.

In my opinion, these promises of the Board are not good enough. The essential pre-requisite of any real reform of the hospital is a change in the personnel of the Board, and of the salaried officials who form the executive under the Board. Until we have that, no promise of reform in my opinion is of any value. That seems to me to be the absolute minimum. But, beyond that, I take the view that we ought to have this report of the Committee of Inquiry published. We have had a discussion between two people on a very important matter, and not only is it a question of the personal character of some of the parties to it, but it is also a question of very great importance to patients in the hospital, to the whole of the medical conduct of a hospital of this very important character, and also to the general public, who, if the institution is to go on and succeed, must have confidence restored. It may be said, "Why do you want to have dirty linen washed in public?" My answer to that is this. When the public once know that linen is dirty, it is better that they should see it washed than that they should be given only vague assurances that probably the washing is taking place. Therefore I feel most strongly that the present position is unsatisfactory, and I doubt very much whether it can be cured at all unless adequate publicity is given to the findings of the Committee, which only came into existence because the public needed to have the matter cleared up.

The MINISTER of HEALTH (Mr. Chamberlain)

The hon. Member has been good enough to give me notice of his intention to raise this matter on the Adjournment to-night. I do not quarrel with the first part of his history of this affair, I think it is right that I should remind the House of what is my own personal position with regard to it. This is, of course, a voluntary hospital. It is not an institution over which I have any authority by law or by statute, and I only come into it because, in consequence of a certain publicity which has been given to the charges made against the Board, as recited by the hon. Member, the Board itself made a request to me, as an impartial and independent person, that I would appoint a small committee to inquire into these charges. The Board in asking for that inquiry made it a condition that it should be a private inquiry and that the evidence should be treated as private. It was on that condition that the Committee was appointed and on that understanding that those who appeared before the Committee gave their evidence. It is quite clear, therefore, that in no circumstances could the evidence which had been given to the Committee be published, because it was only given on the understanding that it should be kept private. When you have an inquiry which is a private inquiry, it is certainly not the usual practice to have the Report itself published I do not say that such a Report is never published, but I say that the usual practice is that the Report itself should not be made public.

As I say, I have no concern with this hospital. I have no personal knowledge of the circumstances which led to the charges which have been alluded to. My concern is rather that of a person who desires to see the interests of the public in London protected. This hospital, which is, I think, the only one of its kind in London, can, if properly conducted, perform a great service, and one which there is no other institution capable of performing. Therefore, throughout, my connection with this concern that is the principle, at any rate, which I have had in view. I am not concerned to exculpate the members of the Board, nor am I concerned with the pursuing of any vendetta against them. I merely desire to do what will best serve the interests of the general public, and, in particular, all those persons who either are now or may be in the future patients of this institution.

The hon. Member has complained that a very long time has elapsed since these charges were first made by the committee against the board. I agree, but I am not concerned with what took place before the committee of inquiry. I am only concerned with what has taken place since. He is quite correct in saying that since the presentation of the report and the submission of that report to the hospital some 13 weeks have elapsed. He says that that is a very long time. I do not dispute that. I think it is fair to say that the chairman of the board has been in very bad health, and I believe that some delay, at any rate, has been due to the fact that he has not personally been able to give continuous attention to a matter which, of course, is one requiring concentrated attention on the part of those who have to deal with it. Further, I think that it must be said that a board faced with recommendations which involved a number of suggestions for the alteration of the management and for the alteration of the whole system on which the hospital was run, and involving also alterations in the use of the buildings, a board faced with a proposition of that kind, could hardly be expected to formulate proposals to carry out those recommendations in the course of one or two meetings. It is only reasonable that they should take an adequate time to examine thoroughly all the possible alternatives that were suggested in order to try and find a solution of what undoubtedly must have been a very difficult and embarrassing situation. Therefore, while I should have been glad if I could have had the proposals of the board before me in somewhat less time, I am not disposed to think that the delay has been so serious as to warrant any suggestion—I do not think the hon. Member made the suggestion—that the board had been deliberately sitting upon the proposals and deliberately postponing any serious attempt to deal with the situation.

The hon. Member asked me to publish the Report. I have already pointed out that, in the circumstances in which the inquiry was conducted, it would be unusual to publish a Report of this kind, and, indeed, I think the only thing that would justify my doing so would be if I felt that to do so was in the public interest. That is a question which I have to consider constantly, and the hon. Member well knows that if I had felt that the Board were not facing up to the situation, that they were inclined or disposed to go on as they had gone on before, and to take no serious account of the important suggestions which had been made in the Report of the Committee, I should not have hesitated to publish the Report as a means of bringing pressure upon them through public opinion; but I have felt all along that that, was a measure which I ought not to take unless I felt convinced that it really was necessary in order to bring about the reforms that were desired.

This Report does not charge the members of the Board with any moral obliquity, or any dishonesty, or any financial irregularities, but it certainly does indicate that the administration of the Board in the past might well be improved. The publication of the Report, with its criticisms, would draw public attention to this hospital in a way which would not fail to have a very serious effect upon its working and upon the hospital itself. The first result of that would inevitably be a reduction in public contributions, subscriptions and donations to the hospital. It has already suffered to some extent in that respect, and anyone who has had experience of the working of voluntary hospitals knows, if an incident of that kind has occurred and there has been a falling off in subscriptions or donations, how difficult it is to bring the position of the institution up to what it was before. I do not desire, unless things get more serious, to inflict any injury of that kind upon the hospital. The publication of the Report would undoubtedly produce difficulties for the Board in obtaining the services of a staff, not merely the medical staff but the nursing staff, of the quality and calibre which one desires to be associated with the institution.

The hon. Member has said that, in his view, it is impossible for the Board as at present constituted adequately and thoroughly to carry out the recommendations of the Committee—the general nature of those recommendations. Why should he assume that among the proposals which the Board is about to bring forward, the reconstitution of the Board does not find any place? I am led to suppose that the reconstitution of the Board does form part of the proposals which I expect before very long. A further difficulty which would occur if the report was published would be that, undoubtedly, the Board would find it difficult to attract to its services to form the reconstituted Board, just those particular men and women whose presence on the Board might give that confidence to the public which this hospital has, to some extent, already lost.

These seem to me to be good reasons why in the public interest I should not publish this Report, if, and only if, we can achieve without it the results which the hon. Member himself expects to gain by publication. This moment, when the Board has actually completed its scheme, and when I have in contemplation some further steps with which the hon. Member is acquainted, but which I do not feel at liberty to discuss in public, which might still further assist towards a satisfactory solution of this question, is the worst of all moments to break off the whole conduct of the negotiations as far as I have carried them up to the present and plunge this hospital into a situation from which they might well find it difficult to recover. For these reasons I must maintain my attitude that nothing which has occurred up to the present justifies me in publishing the report at the same time still reserving to myself the right to take the decision and publish the report if I am not satisfied that the administration of the hospital is going to be reformed in the way that I think it should be reformed. I feel confident that the Board desires to reform itself and its administration, and I feel confident that it will succeed.

Mr. A. GREENWOOD

This is one of the few occasions on which I rise with pleasure to speak. We are not discussing a purely party political question, and I should like to pay my tribute to the right hon. Gentleman himself in this matter. We are discussing the Lock Hospital, a unique institution in its way in this country. None of us would wish to diminish its utility and value to the people who need its services. The question at issue is one of procedure. I am not looking at it from a narrow point of view, and I think the right hon. Gentleman will accept my word when I say that in my humble way I am as much concerned with the efficiency of the hospital as he is himself. It is just a question as to the method of dealing with the problem. This hospital has been carrying on its work for quite a long time. Doubts have been raised in the public mind as to the efficiency of its administration. I know little about it. I have never seen it, and as far as I know I am not acquainted with more than one member of the Board. It is almost unparalleled that an institution for which the Ministry of Health is not directly responsible should be the subject of an official inquiry, and I think the right hon. Gentleman made a mistake when he regarded it as a private inquiry. I should have thought that the very fact that such an inquiry was instituted ought to have been a serious warning to the people controlling this hospital. It does not matter whether it is a voluntary or a public hospital. Both serve the same public needs and interests.

The fact that there were doubts raised, which necessitated this inquiry, ought to have put the people in control of that hospital in an attitude of grave questioning. The inquiry has taken place and the report has been presented. I have not seen the report, I do not know its contents, and I do not know even who were the members of the committee. When the report was presented to the Minister, I have no doubt that he, with his usual courtesy, conveyed it to the board of the Lock Hospital. That was, I believe, in the early weeks of this year. There had already been a warning; there had been a red light before that. They ought to have been prepared to have done something to bring their organisation and administration into accord with what the people who were interested in the institution thought was necessary. Some time elapsed and questions were asked in this House. We were told that the board were going to consider the matter. If on leaving this House I saw the members of the board I should not know them, but I regard it as a suspicious circumstance that before the presentation of the report the governing board of the hospital had not taken the preliminary steps to set their house in order.

Time went on and, so far as we can gather, nothing was done. Now we are told that the pressing of the question before this House may lead to the restriction of contributions to the hospital. I hold very strong views on that question. If the hospital is to-day suffering under the breath of suspicion, the best way to remove the suspicion is to bring the whole matter out into the open. If it be that this hospital has been inefficiently managed, if the people in charge have flouted those who are prepared to give voluntary service in the interest of the hospital, then in the interests of the hospital itself we might as well bring the matter out into the open. The worst kind of sore in this country to-day is the hidden sore, the kind of thing that people do not mention. From the point of view of the prevention and treatment of venereal disease, the more we drag it out and make people ashamed of the problem, the better it will be. For people to say that we must assume a policy of hush-hush, and must not drag the matter out, and that this body will carry on, is to recommend a short-sighted policy.

I am not suggesting that the right hon. Gentleman is trying to defend the administration of the hospital. I am convinced that in his own mind he wants to make the hospital an efficient part of the public hospitals of the London area. But his policy is different from the policy of those of us who are on these benches. I would have preferred the publication of the Report. It is perfectly true that certain newspapers which specialise in articles of pornographic interest would have made the details of this Report the feature of a particular Sunday issue, but the thing would have been dead in a day or two, and it would have been as well that earnest people who care about the problem which this hospital exists to serve should have felt that at any rate we had got an honest opinion publicly expressed.

The right hon. Gentleman is Machiavellian in his diplomacy. He has tried to use this report as a whip to be produced at the right time for the people who are the culprits. Like all of us on these benches I am a very simple minded person. I am not apologising for that fact, but, having a very simple mind, I would have preferred to have published the report and have allowed the venomous gases which emanated from this problem to have evaporated so that we might see the trouble as it really is. To me suppression is wrong. It is wrong, in my view, to think that by using the threat of publishing a report the right hon. Gentleman can reform a number of people who have, I believe, been guilty of a grave dereliction of public duty. The right hon. Gentleman, I have no doubt, is pursuing the course which he thinks is wisest. I do not suppose for one moment that he is allowing the report to lie dormant. Indeed I know he is not doing so, but my complaint is that he has not honestly taken the public into his confidence. I am not going into the details of the maladministration which has been alleged in connection with this hospital. I know very little about the details, but I have had put into my hands during the last 18 months or so particulars which show that the hospital has not been administered in the public interest.

This is one of those questions on which hon. Members opposite can agree with us. There is no electioneering value in this question, and I am looking at it purely from the standpoint of the public interest. Here is a great institution which has had an important history and which has performed useful service. I should imagine that the people concerned with its administration are not associated with my party. I imagine most of the people connected with the ladies' committee are among my bitterest opponents, politically. These ladies have been associated with the administration of the hospital and have realised its defects, and I think they disagree, or some of them at any rate disagree, with the view of the right hon. Gentleman. They would wish that the facts should be made public and that this great institution, which has been so long established in London, should be conducted with the utmost possible efficiency. It is alleged that grave injustices have been committed and that members of the staff have been treated not merely with discourtesy but with ignominy, and even dismissed, although there are no real charges against them.

If that be the case, then in the public interest it is advisable that the truth should be made plain. I know that, on occasion, the truth is a very hard thing, particularly to hon Members opposite, but the truth is a very good thing in the long run. The truth is the vital concern of all of us who are public servants, and I do not think that the broad principles of public policy would be infringed by the publication of this Report. I do not think the public interest would be damaged if the right hon. Gentleman were to take the strong line. I believe that he is slow to anger, but that he is prepared to reach the stage of anger ultimately. If I were a member of the board of this hospital, and were sitting in the Gallery of this House to-night, I should go away with feelings of the gravest apprehension. I should have read between the lines of the Minister's conciliatory and careful speech. I am sure that the Minister feels with me that hospitals, even if they are supported entirely out of the funds of voluntary contributors, are part of the public service of this country and must, therefore, be conducted in the public interest; and although he has seen this Report, and I have not, I gather from his speech to-night that he is not entirely satisfied with the conduct of the board of the hospital. On that we are agreed, from entirely different points of view, but he is prepared to exercise a further period of caution. After all, the conduct of the management of the Lock Hospital is not a new problem. It is four years old, to my knowledge. A committee was appointed, I believe, about 18 months ago. It reported more than three months ago, and until very recently, so far as one can gather, the board has taken no steps to try and meet this growing volume of public criticism.

My main objection to the right hon. Gentleman's position is this, that he is a little too patient, that he is waiting a little too long, that he is not applying the screw soon enough; and when there are people, such as the voluntary hospitals, who are not directly responsible for public enterprises, but who are only responsible to the vague general body politic, one ought to bring them to book a little sooner rather than a little later. My own criticism of the right hon. Gentleman —and I do not doubt his bona fides in this respect, as I am sure he will believe—is that he has given them a little too much rope; and although this is a dying House, I hope the right hon. Gentleman, before the House finally dissolves a week hence, will be able to report to us, in a little more detail and with a little more certainty, what steps he proposes to take to ensure that this great hospital is going to be carried on in the best public interest. As things are now, I think he is vacillating, and I hope that, before he leaves his Department a week or so hence, he will have taken the bold step and decided to publish this Report, with an ultimatum to the Board of the Lock Hospital that within a relatively short time they must either abdicate or fulfil in the letter and the spirit the recommendations of the Committee.

Question put, and agreed to.

Adjourned accordingly at Ten Minutes before Eleven o'Clock.