HC Deb 12 February 1929 vol 225 cc333-58
Mr. PETHICK-LAWRENCE

I beg to move, to leave out the Clause.

I move this Amendment, because I regard this Clause as the most dangerous and the most inimical to public health of any Clause in the Bill. I will first take the Clause as it stands unamended. The Clause proposes to alter the existing law in two main particulars. In the first place it compels local authorities to make a charge on all persons using their health institutions, with certain exceptions to which I shall refer later. In the second place, it fixes the amount that they must charge as defined in one of the explanations of the Clause. It is to be deemed to be a sum representing the average daily cost per patient of the maintenance of the institution and the staff thereof, and the maintenance and the treatment of the patients therein. I have made some investigations, as to what those sums amount to in the case of the voluntary hospitals in London, and, omitting some of the charges which I think will be excluded by these words, I reckon that they would run from £2 5s. or £2 10s. a week per patient in the case of a maternity home, to £4 5s. or £4 10s. a week in the case of a cancer hospital. What this Clause would, therefore, do in its present form, is to insist that the local authority should make a charge ranging from £2 5s. to £4 10s. a week on the persons using its institutions. Not only is that charge to be made on the patients themselves, but if the patient cannot pay all the persons on whom a patient is regarded as dependent can be called upon for payment. When the Bill was in Committee I think it was the Attorney-General who explained that the persons who would be held liable would be persons who are at present capable of being made liable under the rules relating to the Poor Law. That would involve therefore not merely the father, mother, husband, or wife of the patient, but the grandfather, grandmother, son, daughter, grandson or granddaughter of the patient. Even now I am not sure that I have exhausted the list.

The ATTORNEY-GENERAL

Yes.

Mr. PETHICK-LAWRENCE

The Attorney-General assures me that I have exhausted the list. The Bill, therefore, means that if any one of these persons can find the money required to cover this considerable charge for the patient, they must be made liable and the local authority must make that charge upon them. Of course, in maternity cases it will not be for more than two or three weeks but in the case of certain illnesses, notably cancer, it may run to three months, and the charge, therefore, would be about £50. I ought to say at this stage a few words about the exceptions. The chief exceptions are those relating to infectious disease. I understand that no actual definition of infectious disease has been included in the definition Clause and that the Ministry hold that the term will include what is commonly known as infectious disease to doctors, and also venereal disease and pulmonary tuberculosis, but that it will exclude surgical tuberculosis. That is the information, as I understood it, given by the Minister earlier in these Debates, and, if it be incorrect, I shall be only too glad to hear the right hon. Gentleman's contradiction.

We, therefore, find this position according to the Clause as it stands—that persons entering one of these institutions suffering from any of these illnesses which are not regarded as infectious, will be charged, if they or any of their relatives can pay the whole of the bill during their treatment in the institution, but that any person suffer- ing from venereal disease or one of the infectious diseases will escape payment. While the Bill was in Committee the Minister pointed out a further proviso to the effect that where the authority are satisfied that the persons from whom these expenses are recoverable, are unable to pay, they may be charged a smaller sum. It was stated from this side that that proviso would not exclude from payment a poor man, such as a labourer, in receipt of about £2 a week who had saved £40 or £50 in the course of his life and had that saving in money or in kind. We pointed out that he would not escape under this proviso and that, as the local authority would be compelled to charge that man, say, for his wife's treatment in a cancer hospital, his entire savings might be taken if the Clause went through in its original form.

It is necessary to remind the House of what the effect would be. Large numbers of working people, particularly the poorer working people, realising that if any of them went into a local authority's institution they might be mulcted of their whole savings, would go to any lengths to avoid entering such institution. Therefore, it is not merely a question of the hardship involved to these people; it is also a question of the grave detriment to public health which would arise if this Clause were carried in its original form. It would mean that persons suffering from cancer would keep out of such institutions as long as possible and would not go in until the disease had reached an advanced stage. The same remark would apply to a great many other diseases. In consequence, the Clause, as it now appears, would not only cause a heavy charge to be made upon working people but would keep out of institutions a large number of people who ought to go there in the early stages of disease. It would, thereby, do a grave injury to public health.

I am glad to see that the Minister has so far realised the force of our objections, that he has been at some pains to try to meet us. He has put down an Amendment which no doubt he will explain when the time comes but, as I am moving to leave out the Clause, I think I ought to take some account of the Clause as it would appear if his Amendment were carried. I do so in order to develop my argument that his Amendment is not sufficient and that the Clause as amended by his proposal, would still be deleterious to the public health. His Amendment would enable local authorities not to charge the full bill, not merely when they are satisfied that the patient or his relatives cannot pay it, but also when they think it unreasonable that they should pay it. I am prepared to admit that the Amendment is a great advance on the Clause as it stands. It means that the local authorities will have an option not very different from the option which they have at present as to the amount which they will charge.

At present, I understand local authorities make charges of this kind—I have only one or two illustrations which possibly may not be typical, though I imagine that they are. A local authority charges an artisan something like £1 5s. a week for a maternity case and £1 a week for a cancer case. Where they are dealing with a labourer earning about £2 a week they make only a nominal charge, perhaps half-a-crown or five shillings a week, except in maternity cases where money is definitely coming in for maternity. In those cases they make a larger charge. I realise that the Amendment of the Minister goes a long way towards enabling local authorities, in future, to do pretty much the same thing as they do at present and, as far as that is concerned, our objection to a considerable extent has been met. But I think that as I develop my case it will be seen that there is still a great deal of ground in regard to which this Clause, even as amended would fail to meet our criticism.

In the first place, with regard to the total charge which can be made, I still think that to include, as the Clause will still include, in the cost of maintenance, a sum representing the average daily cost per patient of the maintenance of the institution and staff thereof, and the maintenance and treatment of the patients therein, is too wide a definition. It covers in the case of a cancer hospital very expensive treatment and apparatus. Under those circumstances, some modification of that very wide definition is required to reduce the maximum charge below that which appears in this Clause.

In the second place I very strongly object to the wide area of relatives brought into the purview of this proposal. It may be reasonable that the patients themselves, if they can pay, should be called upon to pay such amount as may be reasonable. It may not be unreasonable that the husband and wife should be called upon to pay, but to bring in the grandfather and grandmother, son and daughter, grandson and granddaughter, as this Clause does, is spreading the net a great deal too wide. It is very unfair that some old man who has a grandchild who happens to have cancer should be mulcted in this way. It will be very much resented and rightly resented by the working people of this country that those distant relatives are to be brought under toll for the unfortunate illness which is afflicting someone so far removed from them.

That is not all. I want to lay stress upon the special case of the unmarried mother. In the interests of public health and of the future generation, we have learned that it is most desirable that any illegitimate child who is coming into the world—and into the world it must come, whether we like it or not—shall come into the world, so far as physical means are concerned with the very best chance for its own life and for the good of the community. If you have illegitimate children born under bad conditions, it is bound to be a heavy cost upon future generations both for their physical health and for their moral health as well, and that cost is going to far outweigh, even from the financial point of view, the little additional cost of taking proper care of their entrance in the world. It has been found by all the institutions which cater for maternity cases that it is most undesirable to insist upon the relatives knowing the facts with regard to an illegitimate birth. Therefore, the practice has grown up, which in the interests of public health is highly desirable, that the unmarried mother is allowed to go into one of the institutions and have her confinement and that the facts are kept as secret as possible and even her own relatives, if she does not wish it, are not told about it. If you have the provision in this Clause that, if the patient herself is unable to pay—and most of these unmarried mothers are not able to pay—you are going to the father and mother and, if they cannot pay, to the grandfather and grandmother in order to tell them all about it, then you are going to do something highly undesirable for the public health.

You are not going to get much money out of this, but you will bring it about that the unmarried mother will not go into your institutions to be delivered of her child. She will go back to her old ways of secrecy. Illegitimate children will be born under most unsatisfactory conditions. In many cases attempts will be made to get rid of the child. You will have a much greater nervous strain upon the unmarried mother which will in some cases lead to her trying to do away with the child in the moment of childbirth, when she is hardly responsible for her actions. You will have children brought into the world under conditions unsatisfactory for their health and in every conceivable way you will put back the clock of progress in our modern views as to how these cases should be treated. Therefore, in my opinion, even in its amended form, this Clause is open to very grave objection, and I hope that the Minister or the Parliamentary Secretary will see his way to accepting my Amendment and to deleting the Clause. If that be too much, and possibly it is, then I hope that they will not rest content with the Amendment which is down in the name of the Minister of Health, but that they will go further to meet the objections which I have raised.

I will just repeat them quite shortly. First of all, there is the objection that the maximum Burn to be met is too large. It covers the maintenance of the institution and the staff and involves, in particular in the case of cancer institutions, too big a maximum amount. The second point is that, in attempting to recover payment, the net is spread too wide with regard to relatives of the patient. The third point is that, with regard to maternity cases, there is very grave danger that the Clause, even in its amended form, will keep the unmarried mother out of these valuable institutions which would be a calamity. I hope, therefore, that on all these three grounds the Minister will consider whether he cannot go a little further than he has done in the Amendment which stands in his name.

Mr. MARCH

I beg to second the Amendment. I would like to add one or two points to those which my hon. Friend has put forward. As things are at present, if a person meets with an accident in the street and is taken to a hospital and the hospital is fairly full and he is then transferred to a guardians' institution, these persons will be responsible for their keep whether it is a wife or daughter or anyone of that kind. The same thing is happening in connection with persons who are suffering from cancer. People go to a hospital for treatment and advice, and frequently they pay in a voluntary hospital for weeks and weeks. Then the case gets so bad that it is impossible for the hospital authorities to do them any good. They are either transferred home or to the guardians' institution. It would be a very heavy thing for poor people to have to bear the expense, especially the amount that has been mentioned, which takes into account all the charges for staff and upkeep of the institutions. Many people would sooner stay at home and suffer than have that large liability placed upon them.

Then there is the question of the maternity and child welfare benefit. Some little time ago we heard the Minister stating that this kind of treatment was becoming very popular, but this kind of treatment will soon get unpopular if people have to pay these amounts to go to an institution. It is all very well for the Minister to say that the local authority will treat these matters lightly and charge what they think is reasonable, but, of course, they will be the people to say what is reasonable, and not the people who will have to pay. The result will be that many of these people will refrain from going into these institutions for their confinement and will stay at home, where it is very inconvenient, and we shall have more deaths of children than there are at the present time; and all the good work that has been done to bring about better health among both mothers and children will be put back by the action of the Minister in this Clause.

Sir K. WOOD

The hon. Member for West Leicester (Mr. Pethick-Lawrence), who moved this Amendment, was, I think, unduly apprehensive as to this Clause. He described it as a Clause detrimental to the public health, and he said it was a dangerous Clause. What is the reason for this Clause, and what is its object? I should have thought it was perfectly plain that the reason for this Clause is brought about by the alterations which we shall be making by the transference from the guardians of their institutions to the larger local authorities of the country; and unless we had this Clause we should have a position like this, that in cases of Poor Law administration, the local authority would be under an obligation to charge a pauper for treatment, while in cases of institutions where people did not come under the operation of the Poor Law, the local authority would have no such duty cast upon them. If we accepted the suggestion which the hon. Member has made, we should be in the impossible position that the local authority would have to charge a person who is a pauper, and there would he no charge on the person who is able to pay. The obvious reason for this Clause is to assimilate the position, so that in all cases, except cases of infectious disease, where persons can reasonably afford to make payments to the local authorities for the treatment that they receive, they shall make an adequate and proper payment.

Mr. PETHICK-LAWRENCE

That is what the Minister is going to say, but it is not what the Clause says now.

Sir K. WOOD

How one can reasonably say, having regard to the meaning of the English language, that such a Clause is detrimental to the public health or that it is a dangerous Clause, I cannot conceive. I suggest that it is a Clause in keeping with our English character and qualities, that it is a Clause which the people themselves would desire. I always think the Socialist party know very little of the habits and desires of the people. I doubt that the average man and woman in this country want to receive treatment without payment when they can reasonably afford to make it, and I totally dissent, as I so constantly do, from the views put forward by the Socialist party, who have such a limited knowledge of the qualities and the aspirations of our people. The hon. Gentleman also objected because the Clause made provision for the payment of certain expenses which would be too heavy, but he made no statement as to how the particular enumeration of the cost, as found in the Clause, was incorrect. What we say is, first, that the expenses incurred by the council or authority in providing for the maintenance of a person in an institution shall, in respect of each day of maintenance in the institution, be deemed to be a sum representing the average daily cost per patient of the maintenance of the institution and the staff thereof and the maintenance and treatment of the patients therein. Secondly, we say—and this is a matter which I treat on the basis of my right hon. Friend's Amendment being incorporated in the Bill—that when you have done that and have had regard to what is a reasonable enumeration of the proportion of the expenses to be paid, if a person cannot pay that amount, then it shall be such reasonable sum, having regard to the financial circumstances, as he or she can be expected to pay. What could be fairer and more just than that? I invite the hon. Member, by means of some Amendment, to say in what particular way that enumeration of the cost could be otherwise more satisfactorily and more justly arrived at.

Then I come to the second point which the hon. Gentleman put forward. He says that the net is spread too wide, and that we are trying to make too many people responsible for the unhappy person who has received treatment. This is not criticism of this Clause; it is criticism of the existing law, and the hon. Gentleman has not looked recently at what the existing law is. If he will look into the Poor Law Act, 1927, Section 41, he will see exactly defined the liability to relieve and maintain relatives. Is that an excessive duty or one of which the average person could complain if he were a just person and wanted to do his duty to himself and his family? Section 41 of that Act says: It shall be the duty of the father, grandfather, mother, grandmother, husband or child"— and I invite attention to the following words— of a poor, old, blind, lame and impotent person, or other poor person not able to work, if possessed of sufficient means, to relieve and maintain such person. I should have thought that that was a reasonable provision. At any rate, the hon. Gentleman's criticism is not a criticism of this Clause, but of the law, and is not a fair criticism which the great majority of people would support. I have heard of no great mass meetings against this Clause, or of people objecting to pay if they reasonably can for treatment of members of their families. The last complaint of the hon. Gentleman was in regard to maternity. He said that this Clause will prevent mothers receiving the treatment which is so necessary in difficult and exceptional circumstances, and he pictured a case—entirely, I believe, out of his own imagination—of mothers who would be frightened away—

Mr. PETHICK-LAWRENCE

Of unmarried mothers.

Sir K. WOOD

—of unmarried mothers being frightened away from nursing homes and institutions on account of this Clause. How unfounded such a suspicion is! There is riot a maternity home in the country, municipal or voluntary, which does not make a charge for their patients. How ridiculous it is to suggest that, because we incorporate in this Clause what is the practice of maternity homes up and down the country, we are frightening away, or in some way dealing some blow at, mothers who need treatment. Anyone who considers this Clause in a reasonable spirit, apart from political partisanship, knows that the Clause really embodies what is the practice of voluntary hospitals. They expect a person, who can afford a reasonable sum, to pay, and what we say in this Clause is that if a person in such circumstances can afford to pay for treatment, the local authority shall have regard to his financial means and ask him to make a reasonable and fair contribution towards his treatment. Such is the barrenness of the criticism of the right hon. Gentleman of this Bill, that he said that it was a dangerous Clause and difficult to justify from the point of view of public health. I invite the House to keep the Clause in the Bill, because it is a reasonable Clause and one that will commend itself to the great majority of the workers of the country.

Miss LAWRENCE

The right hon. Gentleman is proposing to modify a very important provision of the Public Health Act. Has he forgotten the explanation in the White Paper of the object and the meaning of this Clause? Under the Public Health Act these services may be free within the discretion of the local authority, or they may fix a charge such as they consider proper. The whole obligation of chargeability is imported into the public health service from the Poor Law, and when the Minister read the existing law he read the existing Poor Law. He did not read the existing Public Health Act, which, as the Minister very clearly explained in his White Paper, this Clause is meant to alter. Under the Public Health Act, the local authorities are free to make a charge. They very commonly do make a charge. In the case of maternity hospitals, they very commonly have a charge which absorbs the whole of the maternity benefit and a little over. They make that charge a fixed charge which is not related to the expenses of the institution, and they remit it where poverty is shown. The point which I desire to stress is that this is an alteration of the Public Health Act, and it is importing into that Act an obligation of the Poor Law. It is changing the practice of all the local authorities who now administer the Public Health Act, and it is placing now obligations upon them. The Minister said that the Socialist party do not understand what the people want. Suppose that that be true; the public health authorities do understand what the people want, and they do not by any means all belong to our party. They are people in daily touch with the facts, and have optional powers given to them under the Public Health Act to charge how and what they think proper with discretion and judgment, and with daily reference to the wishes and needs of the people.

Not only have the Government imported into the Public Health Act the obligations of charge, but they have increased and made heavier the obligations of the Poor Law authorities. The Poor Law authorities are not now compelled to charge the full cost of maintenance if the money can be obtained. The Poor Law authorities never, I think, in the case of cancer got anywhere near that sum. So that this is not merely importing into the Public Health Act a Poor Law obligation, but it is placing an additional restriction and an additional obligation on the Poor Law authorities themselves. This business of chargeable remedies is a Poor Law obligation, and not a public health obligation. Public health authorities are under no obligation whatever to go into the chargeable remedies, and they do not do so. The business of inquiring into the circumstances of the father, the grandfather, the mother, the grandmother and so on, is not undertaken by the public health authority, and is a new obligation placed upon them. These points are indisputable, and they have been slurred over by the Parliamentary Secretary, but there is no doubt whatever of the truth of what I am saying.

I come to matters which are more or less of opinion. Take the case of a woman who is told by the doctor that her confinement is likely to be difficult, and that she ought to go to a hospital. At the present time she knows that her maternity benefit and a sum equivalent to her keep at home will be the utmost that will be asked. I have inquired what has been charged by the voluntary hospitals, and it is about the amount of the maternity benefit, a charge very little more than would keep a woman in her own home; so that, with the health insurance benefit, it puts hardly any additional obligation on the family for her to go into a maternity hospital. That is the practice of hospitals: but they make remittances where the family is poor. But if you say to that poor woman, "Your grandfather is not so badly off, we shall come on him; your father is not so badly off, we shall conic on him," it is 10 to one that this woman, rather than cause any expense to her family, will say "I will chance it at home."

I will come to what really shocked me. The Parliamentary Secretary said there was no danger of frightening off the unmarried mother. I have talked over this matter with the experienced people of the Council for the Welfare of Unmarried Mothers. They told me that so great was the fear in these cases that their society, though badly off, frequently did not even allow the woman to claim her maternity benefit, lest by the scandal aroused they should frighten her away from the institution. They told me that very often the father of the girl was the person who was most concerned, and that they kept the secret from the father of the girl until the confinement was over, and she was in a more settled state. Now you say that before she goes into a maternity hospital they are not only to tell the father and get a contribution, but are to tell her grandfather —her grandfathers on both sides—although this charitable society says these women are so frightened that it does not even insist upon their claiming the maternity benefit. These people are to have their grandfathers, and their father and mother drawn into the case, to be mulcted for her maintenance in the hospital. Is there any reasonable doubt in any human creature's mind that poor girls in that position will have their babies as so many of them do now? The death-rate among illegitimate children is enormously higher than the death-rate among other children, and I think we are unlikely to make any serious progress in the reduction of infant mortality until we turn our attention more from the legitimate children, among whom the death-rate is going down, to the illegitimate children. I have not spoken of the risk of maternal mortality among these unfortunate women, but that is a very important point.

Then I come to what my hon. Friend the Member for Poplar (Mr. March) pointed out—and nobody speaks with more experience than he does—and that is the position of persons dying of cancer. That is an expensive business. You have the case of some old man, with his own pride, ill with cancer. He can die in his own home as well as in the ward of a hospital, it is true, but if he dies in his own home without the benefit of continual skilled nursing and opiates, he will die with very much greater suffering than he would die in an institution. Do you say—because no guardians will believe you, even if you do—that the knowledge that a charge will be made against the son or daughter or the grandson or granddaughter, people who can themselves just get along in life, will not deter that poor old man from going into a hospital? It will; indeed it will. It will be a deterrent, also, in a case where a woman may have something the matter with her and the doctor says, "Go and be X-rayed; do not lose a week." The woman's decision will hang in the balance if she knows that the charge may be thrown upon her relatives.

Who are the persons whom we exempt? I think this shows the conscience of the nation. We exempt people suffering from any sort of infectious disease. Why? Because we may catch it. The Minister said something the other week about treatment for infectious disease being compulsory and, therefore, free. But treatment is not compulsory in all cases of infectious disease. It is not compulsory in the case of venereal disease, and when it comes to looking at this from the human point of view, from the moral point of view, is there not something disgusting in saying to the sufferer from venereal disease, however well off he may be, however much the disease may be due to his own fault, "You shall be treated free," whereas the poor old sufferer from cancer, or the woman who is going to have a child, is to be mulcted of the utmost penny? I have never seen a Clause so repugnant not only to humanity but to the moral sense of the nation.

10.0 p.m.

Mr. A. R. KENNEDY

I confess that I have felt a little difficulty with regard to this Clause, as it stands and without the Amendment to be subsequently proposed by the Minister, but not because I think it is unreasonable that persons maintained in an institution should con tribute a sum within the limits of their resources to the cost of their treatment. On the contrary, I think the majority of people would feel that it is reasonable that persons should pay for such treatment according to their resources. Mindful of the object in view, and considering the Clause as it stands, I have endeavoured to improve it and I have drafted an Amendment which appears on the Paper below the next Amendment in my name. The two Amendments together constitute a reasoned attempt to improve this Clause, first of all from the point of view that it was desirable to relax the rigidity of the Clause, though without affecting its object, and, secondly, with the object of giving the local authority greater latitude in regard to the charges they make and the circumstances in which they make them. I appreciate fully that the Minister, in tabling the Amendment which stands in his name, has endeavoured, so far as circumstances permit, to meet my objections, but I do not think his Amendment makes the Clause as good as I should have made it. However, the Amendment does go a considerable way towards dealing with the situation. I think the effect of it, if not to tone down what I consider the harshness of the Clause, will be at any rate to give greater latitude to the local authorities than they would otherwise have had. In these circumstances, I shall support the Clause.

Mr. E. BROWN

I fear that the Parliamentary Secretary is incorrigible. My mind goes back to a triangular debate on this Clause in which I, with very great diffidence in the presence of the learned Attorney-General, ventured to criticise the Clause as it then stood. I said the fundamental trouble was that instead of breaking up the Poor Law the Minister was amalgamating or assimilating two codes of law, the Public Health law, and the Poor Law, and I said that instead of the Public Health Law prevailing, as in my judgment it ought to prevail, the Minister had made the Poor Law prevail. The learned Attorney-General, in his reply, said that was not so, or that he did not think it was so; but to-night the Minister has given the whole show away. It is perfectly true that he has skated over the objection, but in his first sentence he admitted that what this Clause does is to bring the two codes of law together. The Public Health Acts lay it down that a public authority—"may." It leaves it to the option of the local authority to recover expenses. The Poor Law gives no option; it makes it mandatory; if the money is there the guardians must recover it.

The Minister is endeavouring to bring the two codes of law together, and to make the Poor Law prevail. I regard that as a reactionary step. I cannot think that the Minister is happy in his mind. The structure of his speech made me believe that. I have always noticed that, when the right hon. Gentleman has not a very ready reply to a powerful argument, he dips into his book, which I call "Tit-Bits," and takes out some little tit-bits about the Socialist party or the Liberal party in order to distract the attention of the Committee or the House from anything that is under consideration. The Parliamentary Secretary, of course, has undoubted ability, but, when he does not use his ability hut uses his agility, I always suspect the strength of the ground on which he stands.

My objection remains. I agree with every word that was said by the hon. Gentleman the Member for West Leicester (Mr. Pethick-Lawrence) and the hon. Lady the Member for East Ham, North (Miss Lawrence). The difficulties would be very great. I am sure this is a reactionary step. The Government are going to lay it down in this Clause, which is supposed to be the health law, that expenses shall be recovered, and they are proposing to make it mandatory. What they have done is not to break up the Poor Law—I thank the Minister for that, and I would remind the House that his colleague on the Scottish Bill with regard to the same subject in another connection did claim that he was breaking up the Poor Law—but he is extending, over the public health services, in regard to the recovery of expenses from these unfortunate people, the old Poor Law, that has been so disastrous to public health in this connection. I am very glad, as is the hon. and learned Member for Preston (Mr. A. R. Kennedy), that, with regard to the word "reasonable," the Minister is making the thing a little less objectionable. But my fundamental objection remains. I am sorry that he is taking over the Poor Law and not the public health law on this particular Clause.

Dr. VERNON DAVIES

As a medical man with some experience I hope I shall live long enough to see the treatment of disease according to need and not according to the financial capacity of the patient, and to see the break up of the Poor Law. But we have been assured by the Minister that at present the time is not ripe: that it would he impossible for this Bill to function and at the same time to break up the Poor Law. So we have the position that under the Poor Law the destitute poor or their relatives can be charged by the guardians a certain amount for their treatment and maintenance and that on the other hand the people who are not poor who are treated under the Public Health Acts can escape free. That is a very alarming position and to my mind it was undoubtedly penalising the pauper. We should all have liked to have got rid of the pauper charge if we could but not being able to do that—and I accept the Minister's words wholeheartedly on that point—that as it was not possible even to put all sickness for the time being on the same level, he is making a charge for everybody according to their means. I would ask the House to remember that there is to be no increase of the present charge according to the Poor Law. We are not raising the Poor Law fees. We are not altering the Poor Law structure. They are to go on as they have been going on for many years.

I had for many years experience in an industrial practice and I had very often the experience of patients who had to go to voluntary hospitals and also to the Poor Law hospitals. I think I may say with confidence that never in the whole of my experience have I come across a case where any complaint has been made by patients or relatives of undue charges for hospital attendance, either in the Poor Law hospitals or the voluntary hospitals. The circumstances of the patient were taken into account; the circumstances of the relatives were taken into account and my experience has been that the people, when they have come out have been very grateful for what has been done to them. We are not going to alter that as I understand it by this Bill. We are simply going to put them all on the same level until the happy time arrives when we can remove the Poor Law disqualification for illness. I would suggest to hon. Members of the Labour party that they are perhaps unduly apprehensive of the dangers of this Clause. They seem to think that people will be afraid to go to the hospitals on account of the charge. As I have mentioned before in this House when people are ill money does not count. Treatment comes first and they go to the hospitals and they are only too glad to get there. I cannot for the life me understand why Members of the Labour party should have the idea that the Government, the hospital authorities, and the guardians of the poor, are simply out to rob the poor of all they can. [Interruption.] The suggestion is that the charge they are going to make, legally or illegally, is so high that the people will be terrified to go into hospitals on account of that charge.

Mr. PETHICK-LAWRENCE

The hon. Gentleman is not entitled to make any allegation of that sort. The great object of our Amendment is to leave the local authorities and the public health authorities in the locality with the option. Our objection is that this Clause takes away the Public Health option and imposes upon them a definite course of action which we think is undesirable.

Dr. DAVIES

I was referring to the statements which had been made by hon. Members of the Labour party. The hon. Gentleman the Member for West Leicester (Mr. Pethiek-Lawrence) said definitely that people would be afraid to go into hospitals—maternity cases and cancer cases—because of the charge that it was proposed to make. The hon. Lady the Member for East Ham North (Miss Lawrence) also drew the same picture that people with cancer rather than go to these hospitals and pay this enormous price would stay at home and run the risk of suffering and I believe she said would suffer for lack of opiates and die for lack of treatment. But that does not happen. I never heard a case of any patient, pauper or otherwise, suffering from a disease like cancer where a patient did not get the best medical attention and good nursing and where everything was not done that could be done to give him relief.

Miss LAWRENCE

May I point out that it is now proposed to alter the law arid to impose new obligations?

Dr. DAVIES

We are altering the law, but we are doing nothing to increase the charge which at present exists under the Poor Law. That is my point. With a fairly long experience, I have not known these things happen up to the present under the Poor Law, and therefore I fail to see why it should be imagined that they will happen in future. I have more trust in the people of this country and in the guardians than to believe that they will allow people to be badly treated or over-charged. The fact that hon. Members speak as they have done leads me to think that they do not really understand or appreciate what is the position in this country. When startling pictures are drawn by hon. Members of officials going after the father, the grandfather, and the grandmother they are painting pictures which are not true.

Mr. PETHICK-LAWRENCE

The hon. Member is misrepresenting what we said. Our point is that this Clause makes a new situation which will differ from the old.

Dr. DAVIES

The terrible state of things which has been put before us never happened under the Poor Law and why should it happen now. We are bringing this system up to the present standard of the Poor Law. No one would be more pleased than I should be if it were possible to do away with the complications of the Poor Law, but that is not practical politics to-day, and we have to recognise things as they are at the present time. I ask hon. Members not to read into this Bill things which are not there because they are only upsetting the people of this country and frightening them by saying that once this Bill becomes an Act you will have those wicked guardians and assistance committees rushing up and saying "You cannot come into the hospital unless you can afford to pay anything from £2 to £6 a week." I am sure that this Clause will be of great benefit to the people. The ordinary decent working folk do not wish to be treated any better than the paupers are treated in regard to payment for medical attention.

Mr. GILLETT

It is absurd to imagine that the people who go into hospitals are all anxious to pay for their treatment. The Parliamentary Secretary said that people were only too glad to pay for their hospital treatment, but I think it is well known that of all professional men in this world the doctors are the class who have the largest number of bad debts. The right hon. Gentleman must know perfectly well that the voluntary hospitals have organised their charges, because such a large number of people have been taking advantage of hospital treatment without payment when they could afford to pay for their treatment. The Parliamentary Secretary has told us that people are only too glad to pay for medical treatment in the hospitals, but we all know that nobody wants to pay a doctor's bill; in fact, nobody wants to pay anything. [An HON. MEMBER: "What nonsense"] It is absurd for hon. Members to say that people want to pay for these things, because they do not. None of us want to pay for things that we can get free.

What is the position in regard to the people who are forced to use these institutions? The right hon. Gentleman, having built up this piece of humbug, tries to apply it to a certain section of the population, saying that they like to pay. My experience is that when a man, the father of a family, finds himself in one of these hospitals, he may not be prepared to say that he is treated harshly, but what is bothering him is what is going to happen to his people at home, and then, on the top of that, he has the thought that he will have to pay so much every week towards the expenses of the institution. I am not saying that he is necessarily complaining, but it may be that he has hardly anything at home. I do not myself profess to have been through any such experience, any more than the right hon. Gentleman has, but I have come in contact with many families where the father has been in this position, and I know that what troubles the mind of a sick man in those circumstances is the condition of his family on the one hand, and, on the other hand, the question where the money is coming from for his medical expenses.

It is perfectly futile for the House to try to make believe that this is not a tremendous burden. Hon. Members opposite say that some contribution should be made, but personally I say straight away that I believe the only reasonable thing to do is to have all this provision perfectly free. As my hon. Friend the Member for East Ham North (Miss Lawrence) has pointed out, medical attention in the case of certain diseases is already given free, and I would apply it to the whole system. I make no apology for saying that, because I believe it is the only sound and reasonable system. Now, however, we are dealing with the scheme that is before the House, and I think that anything that is going to tighten it up is a misfortune. My hon. Friend has pointed out the extreme weakness of the Government's proposals in the Clause as it has been worded, and the attempt of the right hon. Gentleman to ride off and say that this is a thing which does not matter is absolutely contrary to all the experience of life. Anyone who really has come in contact with it in the slightest degree knows that this is one of the greatest burdens which weigh upon families of the working class in this country, and that at a period in their lives when they most need help, and when it is important, above everything else, that they should have the most generous attention that can possibly be given, and that the burden, if it has to be imposed, should be as slight as possible.

The ATTORNEY-GENERAL

The hon. Member for Finsbury (Mr. Gillett) used a word about my right hon. Friend the Parliamentary Secretary which I must say caused me a little surprise. I have not the slightest doubt about the complete sincerity and earnestness of the hon. Member who moved this Amendment, and I hope I need not say that I have no greater doubt as to the complete sincerity of the hon. Lady the Member for East Ham, North (Miss Lawrence). Both by their arguments and by their manner they showed that, even if, as I respectfully think, they are mistaken in one or two points, yet they are perfectly in earnest, and believe that their views are in the interests of these poor people and the unmarried mothers. I wonder what the House or the hon. Members would have said if I had got up and said that they were humbug; and yet the hon. Member for Finsbury seems to think that he advances the cause which was perfectly properly, and, indeed, eloquently advocated by the two hon. Members, when he makes against my right hon. Friend—who has as much right as hon. Members opposite to represent his views—a charge of that sort.

The hon. Member then made a statement which I think excited the surprise even of his own party, namely, that no one wants to pay for anything. I do not know whether that is the hon. Member's experience in Lombard Street. I believe that what we sometimes hear from the benches opposite is much more accurate than the hon. Member's statement that no one wants to pay for anything. Hon. Members opposite often say, with truth, that what we call the working-classes do not want charity. I will not say that I have as much acquaintance as some hon. Members opposite have with the conditions in which some of the poorer classes live, but I think that I may claim a little knowledge and acquaintance, and I believe that on the whole, provided they are not tortured by anxiety as to ways and means, they do prefer to pay for services received.

Let us, without these irrelevant discussions into which the hon. Member for Finsbury has led us, consider for a moment the purpose of the Clause. The hon. Member for Royton (Dr. Davies), himself a man of great experience, as we all know, has expressed his views about it and made it unnecessary for me, even if time allowed, to say much. I think the hon. Member for East Ham, North does not quite face the point. The point here is that under the Poor Law at present there is a certain obligation. Under the new law, as laid down by this Bill, it will be within the province of these local authorities to administer certain medical services either under the Poor Law or outside it. If they administer them under their powers under the Poor Law, they will be bound to charge, unless we alter it altogether, and, under the other powers, they will not be bound to charge. The hon. Member for Finsbury cuts the Gordian knot by saying he would like to see everyone provided with all sorts of medical service that they may require free of charge. I think that that is an impossible solution. I do not believe the party opposite would tolerate that people who can afford to pay—I am thinking of people of substantial means-should not be asked to pay, and, therefore, it is obvious that there must be some machinery for compelling people who can afford to pay to pay.

The only question is whether you will have the variety of ways of dealing with the problem which will exist unless we level up, or, if hon. Members prefer it, level down, the practice so as to provide that when the authorities administer, as they will in the future, Poor Law and public health institutions, the practice in both shall be the same. I think, with the hon. Member for Royton, that it is convenient that we should have identity of practice, and I do not believe the least little hit in the world in the view that has been presented, that in the future there will be a harsh enforcement of the powers that public authorities in the future will have entrusted to them. [HON. MEMBERS: "There will!"] Nothing is so easy as to prophesy that things will he as they want them to be. When they are prophesying in that way, Members can make an asser- tion, but, if we judge the future from the experience of the past, I see no reason at all for, believing that public authorities will be harsh. The hon. Lady says that at present there is many a poor unmarried mother who goes into a home and wishes to cover up her ease. In the future, voluntary societies and institutions will be just as free to administer to poor people as in the past. Public health authorities will not be driven to enforce harshly any rights that they have.

If people can reasonably pay, the public authorities will have the duty of enforcing a reasonable amount of payment under the new law, and I believe that will be congenial to the commonsense of the House.

Question put, "That the words proposed to be left out to the second word 'are,' in page 13, line 11, stand part of the Bill."

The House divided: Ayes, 221; Noes, 114.

Division No. 194.] AYES. [10.30 p.m.
Acland-Troyte, Lieut.-Colonel Erskine, Lord (Somerset, Weston-s.-M.) McDonnell, Colonel Hon. Angus
Alexander, E. E. (Leyton) Everard, W. Lindsay McLean, Major A.
Alexander, Sir Wm. (Glasgow, Cent'l) Falie, Sir Bertram G. Macmillan Captain H.
Ashley, Lt.-Col. Rt. Hon. Wilfrid w. Fanshawe, Captain G. D. MacRobert, Alexander M.
Astor, Maj. Hn. John J. (Kent,Dover) Fermoy, Lord Maitland, A. (Kent, Faversham)
Atkinson, C. Fielden, E. B. Makins, Brigadier-General E.
Baldwin, Rt. Hon. Stanley Forestler-Walker, Sir L. Manningham-Buller, Sir Mervyn
Balniel, Lord Frece, Sir Walter de Margesson, Captain D.
Barclay-Harvey, C, M. Fremantle, Lieut.-Colonel Francis E. Marriott, Sir J. A. R.
Beamish, Rear-Admiral T. P. H. Ganzoni, Sir John Mason, Colonel Glyn K.
Beckett, Sir Gervase (Leeds, N.) Gates, Percy Merriman. Sir F. Boyd
Bethel, A. Gault, Lieut.-Col. Andrew Hamilton Meyer, Sir Frank
Bevan, S. J. Gilmour, Lt.-Col. Rt. Hon. Sir John Milne, J. S. Wardlaw
Birchall, Major J. Dearman Glyn, Major R. G. C. Mitchell, S. (Lanark, Lanark)
Bird, E. R. (Yorks, W. R. Skipton) Goff, Sir Park. Mitchell, W. Foot (Saffron Walden)
Bourne, Captain Robert Croft Graham, Fergus (Cumberland, N.) Monsell, Eyres, Com. Ht. Hon. B. M.
Bowater, Col. Sir T. Vansittart Grattan-Doyle, Sir N. Moore, Sir Newton J.
Bowyer, Captain G. E. W, Greaves-Lord, Sir Walter Moore-Brabazon, Lieut.-Col. J. T. C.
Braithwaite, Major A. N. Greene, W. P. Crawford Moreing, Captain H.
Brass, Captain W. Grenfell, Edward C. (City of London) Morrison, H. (Wilts, Salisbury)
Brassey, Sir Leonard Gretton, Colonel Rt. Hon. John Nail, Colonel Sir Joseph,
Briggs, J. Harold Grotrian, H. Brent Newman, Sir R. H. S. D. L. (Exeter)
Briscoe, Richard George Guinness, Rt. Hon. Walter E. Nicholson, O. (Westminster)
Brittain, Sir Harry. Hall capt. W. D'A. (Brecon & Rad.) Nield, Rt. Hon. Sir Herbert
Brocklebank, C. E. R. Hamilton, Sir George Oakley, T,
Brooke, Brigadier-General C. R. I. Hanbury, C. O'Connor, T. J. (Bedford, Luton)
Broun-Lindsay, Major H. Hannon, Patrick Joseph Henry Oman, Sir Charles William C.
Bullock, Captain M. Harland, A. Ormsby-Gore, Rt. Hon. William
Burman, J. B. Hartington, Marquees of Perring, Sir William George
Campbell, E. T. Harvey, G. (Lambeth, Kennington) Peto, Sir Basil E. (Devon, Barnstaple)
Carver, Major W. H. Harvey, Major S. E. (Devon, Totnes) Pilcher, G.
Cayzer, sir C. (Chester, City) Headlam, Lieut.-Colonel C. M. Power, sir John Cecil
Cayzer, Maj. Sir Herbt. R.(Prtsmth,S.) Henderson, Capt. R. R.(Oxf'd,Henley) Pownall, sir Assheton
Cecil, Rt. Hon. Sir Evelyn (Aston) Henderson, Lieut.-Col. Sir Vivian Preston, Sir Walter (Cheltenham)
Cecil, Rt. Hon. Lord H. (Ox. Univ.) Hennessy, Major Sir G. R. J. Raine, Sir Walter
Chamberlain, Rt. Hon. N. (Ladywood) Hoare, Lt.-Col. Rt. Hon. Sir S. J. G, Ramsden, E.
Charteris, Brigadier-General J. Hope, Sir Harry (Forfar) Rawson, Sir Cooper
Chilcott, Sir Warden Hopkinson, A. (Lancaster, Mossley) Reid, Capt. Cunningham (Warrington)
Christie, J. A. Horilck, Lieut.-Colonel J. N. Remer, J. R.
Churchill, Rt. Hon. Winston Spencer Hume, Sir G. H. Richardson, Sir P. W. (Sur'y, Chts'y)
Cobb, Sir Cyril Hurd, Percy A. Roberts, E. H. G. (Flint)
Cohen, Major J. Brunel Hurst, Gerald B. Rodd, Rt. Hon. Sir James Rennell
Colfox, Major Wm. Phillips Inskip, Sir Thomas Walker H. Ropner, Major L.
Colman, N. C. D. Iveagh, Countess of Ross, R. D.
Conway, Sir W. Martin Jackson, Sir H. (Wandsworth, Cen'l) Ruggles-Brise. Lieut.-Colonel E. A.
Cooper, A. Duff James, Lieut.-Colonel Hon. Cuthbert Rye, F. G.
Cope, Major Sir William Kennedy, A. R. (Preston) Salmon, Major I.
Couper, J. B. King, Commodore Henry Douglas Samuel, A. M. (Surrey, Farnham)
Courthope, Colonel Sir G. L. Kinloch-Cooke, Sir Clement Sendeman, N. Stewart
Craig, Sir Ernest (Chester, Crewe) Lamb, J. Q. Senders, Sir Robert A.
Crooke, J. Smedley (Deritend) Leigh, Sir John (Clapham) Sanderson, Sir Frank
Crookshank, Col. C. de W. (Berwick) Lister, Cunliffe-, Rt. Hon. Sir Philip Sandon, Lord
Crookshank,Cpt.H.(Lindsey,Gainsbro) Little, Dr. E. Graham Sassoon, Sir Philip Albert Gustave D.
Davies, Dr. Vernon Loder, J. de V. Savery, S. S.
Davison, Sir W. H. (Kensington, S.) Long, Major Eric Scott, Rt. Hon. Sir Leslie
Dawson, Sir Philip Looker, Herbert William Shepperson, E. w.
Duckworth, John Laugher, Lewis Skelton, A. N.
Eden, Captain Anthony Luce, Maj.-Gen. Sir Richard Harman Smith, Louis W. (Sheffield, Hallam)
Edmondson, Major A. J. Lumley, L. R. Smith, R. W. (Aberd'n A Kinc'dine, C.)
Edwards, J, Hugh (Accrington) MacAndrew, Major Charles Glen Smith-Carington, Neville W.
Elliot, Major Walter E. Macdonald, Sir Murdoch (Inverness) Somerville, A. A. (Windsor)
Elite, R. G. Macdonald, Capt. P. D. (I. of W.) Spender-Clay, Colonel H.
England, Colonel A. Macdonald, R. (Glasgow, Cathcart) Stanley, Lieut.-Colonel Rt. Hon. G. F.
Stanley, Lord (Fyide) Turton, Sir Edmund Russborough Williams, Herbert G. (Reading)
Stanley, Hon. D. F. G. (Westm'eland) Vaughan-Morgan, Col. K. P, Wilson, Sir C. H. (Leeds, Central)
Storry-Deans, R. Waddington, R. Windsor-Clive, Lieut.-Colonel George
Stott, Lieut.-Colonel W. H. Ward, Lt.-Col. A. L.(Kingston-on-Hull) Winterton, Rt. Hon. Earl
Streatfeild, Captain S. R. Warrender, Sir Victor Womerslay, W. J.
Stuart, Crichton-, Lord C, Waterhouse, Captain Charles Wood, Rt. Hon. Sir Kingsley
Sueter, Rear-Admiral Murray Fraser Watson, Sir F. (Pudsey and Otley) Woodcock, Colonel H, C.
Sugden, Sir Wilfrid Watson, Rt. Hon. W. (Carlisle) Wragg, Herbert
Tasker, R. Inigo. Watts, Sir Thomas
Thomson, F. C. (Aberdeen, South) Wells, S. R. TELLERS FOR THE AYES.—
Tomlinson, R. P. Williams, A. M. (Cornwall, Northern) Mr. Penny and Major the Marquess of Titchfield.
Tryon, Rt. Hon. George Clement Williams, Com. C, (Devon, Torquay)
NOES.
Adamson, Rt. Hon. W. (Fife, West) Halt, F. (York, W. R., Normanton) Potts, John S.
Ammon, Charles George Hall, G. H. (Merthyr Tydvil) Purcell, A. A.
Baker, J. (Wolverhampton, Bilston) Hardie, George D. Richardson, R. (Houghton-le-Spring)
Barr, J. Harris, Percy A. Roberts, Rt. Hon. F. O.(W.Bromwich)
Beckett, John (Gateshead) Hayday, Arthur Scrymgeour, E.
Bellamy, A. Henderson, T. (Glasgow) Scurr, John
Benn, Wedgwood Hirst, G. H. Shaw, Rt. Hon. Thomas (Preston)
Bondfield, Margaret Hirst, W. (Bradford, South) Shepherd, Arthur Lewis
Bowerman, Rt. Hon. Charles w. Hollins, A, Shinwell, E.
Briant, Frank Hore-Belisha, Leslie Short, Alfred (Wednesbury)
Broad, F. A. Hudson, J. H. (Huddersfield) Sitch, Charles H.
Bromfield, William Jenkins, W. (Glamorgan, Neath) Slesser, Sir Henry, H.
Bromley, J. John, William (Rhondda, West) Smith, Rennie (Penistone)
Brown, Ernest (Leith) Jones, Henry Haydn (Merioneth) Snell, Harry
Brown, James (Ayr and Bute) Jones, Morgan (Caerphilly) Snowden, Rt. Hon. Philip
Buxton, Rt. Hon. Noel. Jones, T. I. Mardy (Pontypridd) Stamford, T. W.
Cape, Thomas Jones, W. N. (Carmarthen) Stewart, J. (St. Rollox)
Charleton, H. C, Kelly, W. T. Sullivan, J.
Clarke, A. B. Kennedy, T. Sutton, J. E.
Cluse, W. S. Lawrence, Susan Taylor, R. A.
Clynes, Rt. Hon. John R. Lawson, John James Thorne, G. R. (Wolverhampton, E.)
Compton, Joseph Lee, F. Thorne, W. (West Ham, Plaistow)
Cowan, D. M. (Scottish Universities) Lindley, F. W. Thurtle, Ernest
Crawfurd, H. E. Longbottom, A. W. Tinker, John Joseph
Duncan, C. Lowth, T. Townend, A. E.
Dunnico, H. Lunn, William Viant, S. P.
Edne, Sir William MacDonald, Rt. Hon. J. R. (Aberavon) Watson, W. M. (Dunfermline)
Edwards, C. (Monmouth, Bedwellty) Mackinder, W. Webb, Rt. Hon. Sidney
Gardner, J. P. Maclean, Nell (Glasgow, Govan) Wellock, Wilfred
Gibbins, Joseph MacNeill-Weir, L. Welsh, J. C.
Gillett, George M. Malone, C. L'Estrange (N'thampton) Wiggins, William Martin
Graham, D. M. (Lanark, Hamilton) March, S. Wilkinson, Ellen C.
Graham, Rt. Hon. Wm. (Edin., Cant.) Morris, R. H. Williams, Dr. J. H. (Llanelly)
Greenall, T. Morrison, R. C. (Tottenham, N.) Williams, T. (York, Don Valley)
Greenwood, A. (Nelson and Colne) Oliver, George Harold Wilson, R. J. (Jarrow)
Griffith, F. Kingsley Palin, John, Henry Windsor, Walter
Griffiths, T. (Monmouth, Pontypool) Paling, W.
Groves, T. Parkinson, John Allen (Wigan) TELLERS FOR THE NOES.—
Grundy, T. W. Pethick-Lawrence, F. W. Mr. B. Smith and Mr. Hayes.

It being after half-past Ten of the Clock, Mr. SPEAKER proceeded, pursuant to the Order of the House of 12th December, successively to put forthwith the Questions on any Amendments moved by the Government of which notice had been given to that part of the Bill to be con-eluded at half-past Ten of the Clock at this day's Sitting.

Amendment made:

In page 13, leave out from the word "recoverable" in line 11, to the word "to," in line 13, and insert instead thereof the words: cannot reasonably, having regard to their financial circumstances be required,"—[Sir K. Wood.]