HC Deb 12 February 1929 vol 225 cc305-14
Lieut.-Colonel ACLAND TROYTE

I beg to move, in page 3, line 36, after the first word "county," to insert the words in consultation with representatives of district councils or combinations of such councils having populations exceeding five thousand according to the census of nineteen hundred and twenty-one. This Amendment is simply designed to ensure that there shall be consultations between the county councils and the district councils before schemes are prepared and submitted to the Minister. Under the Bill as it stands, there is no such opportunity for consultation, and it, would be much better that the consultation should take place before the scheme is submitted to the Minister. The district councils regard the present arrangement with great suspicion, because they fear that they will have no chance of having their views considered. An Amendment similar to this was considered during the Committee stage, when it was proposed that all district councils should be consulted. Under this Amendment, however, it will be necessary only to consult those district councils which have a population of 5,000, or a combination of district councils making up a total of 5,000. That will reduce the number of consultations by 40 to 50 per cent. It was rightly pointed out on the Committee stage that to consult all the district councils would be cumbersome and would cause delay, but, by putting in the limit of 5,000—a figure to which I do not bind myself—the delay will be very much reduced, and it will make it easier for consultations to take place. Everyone must be agreed of the importance of county councils and district councils working together in perfect harmony in preparing these schemes, but, if the district councils are suspicious of the county councils, and feel that they are being left out in the cold, we shall not have that harmony. This Amendment would lead to a smoother and more effective working of the scheme.

Lieut.-Colonel RUGGLES-BRISE

I beg to second the Amendment.


I am not at all unsympathetic with the purpose which my hon. and gallant Friend the Member for Tiverton (Lieut.-Colonel Acland-Troyte) has in mind, and I agree with him that it is desirable that there should be the utmost possible harmony and co-operation between county councils and the district councils in the matter in which they will have to work together. We are, however, faced with the same difficulty which I put before the House on the Committee stage. The time for the preparation and submission of schemes and their approval by the Minister is strictly limited. My hon. and gallant Friend seems to think that he has got over that difficulty by introducing a limitation of population, but I do not think that gets over the difficulty. I anticipate that these schemes, which are prepared by the county councils which contain a number of representatives of the districts, will not be made without some extended knowledge of the desires of the districts. In Clause 8, we have provided that, when the county council submit a scheme to the Minister, they must at the same time send a copy to the district council, so that they may have material upon which to base any representations to the Minister. In making that provision, I have gone as far as I can without jeopardising the possibility of getting schemes prepared and approved by the Minister in time to come into operation on the appointed day. I regret, therefore, that I cannot accept the Amendment, but I do not expect that any serious difficulty will arise on this matter in view of the Amendment that has already been made to Clause 8.


I am very sorry to have to differ from my hon. and gallant Friend, who has assisted the county councils throughout the consideration of this Bill, but I think his proposal would probably lead to friction. We have every desire to work most harmoniously with the district councils, and I think this proposal might very likely give rise to a good deal of trouble, and possibly a certain amount of irritation, and unquestionably very much longer time would he taken over the preparation of these different schemes. Surely this is a matter for which the county councils must themselves be absolutely responsible. As the Minister has pointed out, these schemes must first be submitted to the Minister, then they have to be published in the papers circulating in the district, and district councils themselves are to have a copy of the scheme sent to them. In these circumstances, surely it is better to leave the county council responsible for the scheme, and if, subsequently, representations are made by the district councils on any matter, full weight can be given to their views and the scheme can, if necessary, be amended. I suggest it is far better to leave the Bill as it stands and to make the county councils responsible for the schemes.

Lieut.-Colonel ACLAND-TROYTE

In view of what has been said by the Minister, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.


I beg to move, in page 3, line 42, at the end, to insert the words: In so far as such scheme relates to hospitals the council shall consult with representatives of the voluntary hospitals in its area in the preparation of the scheme. When you, Sir, dealt with my proposed New Clause a few minutes ago, you said you did not call it because the subject matter could be better deal with on my subsequent Amendments. Accordingly in moving this Amendment, I would like also to draw attention to an Amend- ment standing in my name to Clause 6, which deals with the same question. What I wish to secure is that there shall be consultation between the public assistance committees, when formed, and the workers for the voluntary hospitals. The object of this series of Amendments is to provide the most efficient service for the sick after the scheme has come into operation. The voluntary hospitals have a very high standard of efficiency in their technical work, and there is an admirable spirit behind that work. When the county councils take over the local infirmaries it is very important indeed that there should be co-operation between what will be the county council hospitals and the voluntary hospitals, because, if not, there will be overlapping, and trouble will arise. It must be disastrous to the voluntary hospitals if the impression is given that these two classes of hospitals are in competition. It is very important indeed that they should work in harmony together, and that it should be understood that the one is not going to supersede the other. Therefore, I hope the Minister will help in some way by indicating to the public assistance committees that in the drawing up of these schemes there must be co-operation on these lines. I cannot do more than raise this question in a series of Amendments and I hope the point I have put forward may have the favourable consideration of Minister.

Major GLYN

I beg to second the Amendment.


Here, again, I sympathise with the object of my hon. and learned Friend. I certainly think that any county council in preparing a scheme must have regard to the voluntary hospital provision already existing in the area. It is quite obvious that no scheme which professed to deal with the hospital services of the area could really be adequate unless it took account of the existing accommodation in the voluntary hospitals. Therefore, I am in full sympathy with his general idea that there should be consultation and co-operation between the two classes; but I do not think it would be possible to include here this particular Amendment. It must be obvious, if you are to provide for consultation with representatives of the voluntary hospitals, that logically, you cannot stop there. There are other voluntary associations doing work which is on parallel lines with some of the work which it will be the duty of the county councils to perform, and if they are to consult with the representatives of the voluntary hospitals, it will be only logical to say they must consult also with the representatives of these other associations. But there is another practical difficulty, and that is that neither the voluntary hospitals nor these other bodies are organised. There is no organisation or system by which they can, as a body, consult with the county council. There may be organisations in some districts, but not in most districts. To make this a statutory provision would be a mistake. My own view is that consultation and cooperation will take place between the voluntary hospitals and the public authorities, but I think it would not be acceptable to the local authorities if we were to try to lay down precisely and exactly how that consultation and cooperation were to be carried out.


I am sorry the right hon. Gentleman has taken that point of view, because it is very important that the voluntary hospitals should be considered in any scheme of reorganisation. In the Bill we are being asked, for the first time, to unify and place under one control all the institutions now serving the public health, either under the county borough on the one hand or the county council on the other; and then, I understand, the idea is to make a selection amongst those institutions of those which are most likely to be best suited for particular services. For example, one building may be the best suited for tuber-culous cases, one for maternity cases, and so forth. Surely when a survey is to be made of a whole area, the first thing to be taken into consideration is what accommodation for the treatment of poor people is available outside the public health services.

The hon. and learned Member for Cambridge (Mr. Withers) has raised a very important point indeed, because if the Bill is to reach its goal on its idealistic side the most careful consideration must be given to all institutions. An hon. Member smiles, but I repeat what I have said—there is here a great ideal, at any rate, for which much can be said, and that is to secure the concen- tration of the public health services under one control. When that is being done, surely we must take into consideration not merely the institutions which at the moment are under the local authorities and the others which are under the Poor Law guardians, but also the institutions which are in voluntary hands.

I do not think the answer of the right hon. Gentleman is quite convincing regarding the lack of organisations for effecting co-ordination. The King Edward Hospital Fund would form a coordinating body for the whole of London, and I have no doubt that in each area arrangements could be made to secure the representation of all the institutions. The crux of the whole matter is what use we are going to make of all the institutions, and in considering the precise use to which we are going to put the existing public institutons we ought not to leave out of consideration the voluntary hospitals and what those who have done such magnificent work in connection with them have to say as to the effect of the scheme on their particular institutions. There is a good deal more to be said on this subject than has been said just now by the Minister.

Major GLYN

In rural areas there are a large number of workers who have for a very long time been contributing so much a week to particular voluntary hospitals, and it would be very hard on these men if by any ill-chance a scheme did not take into account the enormous amount of work done as a result of the 1½d. a week which men are contributing to these hospitals in this way. I have in my mind the Radcliffe Infirmary, Oxford, which I think was one of the first voluntary hospitals. Many members of friendly societies are also contributing to such voluntary hospitals. I think those who are interested in hospital work feel that the Voluntary Hospitals Association or an organisation of that kind—even an ad hoc organisation specially created—ought to be taken into consultation in connection with these schemes. Knowing the right hon. Gentleman's personal interest in these matters, I think that if it is not possible to include the words of the Amendment it may yet be possible for him to give such directions from the Ministry as will ensure that these hospitals are brought into any scheme, and to ensure that men who have been contributing to these hospitals for many years are not damnified by any scheme which is put into operation for the improvement of the general health of the people. I do not think we can improve upon the service given in the country districts by these great institutions, which in some instances, I think, are afraid of their work suffering under a scheme in the preparation of which the people in the towns will have had a good deal to say. I hope the Minister may be able to do something to assure these hospitals that their position will not suffer.


I have had one or two letters on this subject from residents in my constituency; I daresay the Scottish Bill will in this respect follow the lines of the English Bill. I am surprised and disappointed that the right hon. Gentleman could not see his way to accept the Amendment, which is not either formidable or drastic. We have heard so much about the co-ordination which is to be effected by the Bill that it is surprising that the right hon. Gentleman cannot support this piece of co-ordination. One is tempted to recall the record of this Government with respect to hospitals. It would be out of order to remind the right hon. Gentleman that under the safeguarding provisions the Government tax their drugs. Then the Government de-rate breweries and distilleries, which fill the hospitals, and refuse to de-rate the hospitals, which are forced to make a public protest against the increase of their assessments. Two days ago a document was published showing that the assessment of the hospitals are actually being raised. These things are a strange record for a. Ministry of Health.


While I have great sympathy with the view that the hospitals should have their say in whatever arrangements are come to, I think this Amendment is a purely theoretical Provision to deal with a difficulty which does not exist. I think you will find that on every county council in the country there is someone who represents every hospital and can speak for it, so that already we have there men who understand the work which the hospitals are doing. In practice, though not in theory, they are there to represent the hospitals, and the hospitals will not suffer by the omission of these words.

8.0 p.m.


There is a fear among those responsible for the management of voluntary hospitals and among large numbers of people who support them, that this Bill will damage them. The Amendment of my hon. and learned Friend is intended to allay their fears and safeguard their position to some extent. I do not wish to repeat arguments which have already been made, but I have two considerations to put forward. I have had a good deal to do with the management of two small local hospitals. No one who has not had that experience can realise the real difficulties of these institutions, which are supported by all classes and all sections of the community and who all have their representatives on the managements. The right hon. Gentleman does not perhaps realise how very deep this feeling is, not only in the country districts but in the large cities also. The large hospitals in the country, no less than the hospitals in the metropolis, should be taken into consultation in these matters, because they are schools of medicine; they are the ground where the medical profession receives its training, and they will not be superseded by the system which the right hon. Gentleman has set up. I very much regret the attitude which the right hon. Gentleman has taken up.


I realise the difficulty of finding appropriate words, but I think that, if the Minister had sympathy with the Amendment, he would find ways of meeting that difficulty. The London County Council has already considered this problem so far as London is concerned; and our way is comparatively easy. In London, we have an immense opportunity to make something like a perfect hospital system for the metropolitan area. Once the infirmaries are taken over, it will be possible to specialise and to make each infirmary into a hospital dealing with one particular side of disease. Already, the county council is working out a scheme which will co-ordinate the voluntary hospitals with his new health system. I would suggest that any word which may be put into the Bill will not be received with opposition from the central authority in London, although, even without these words, the hon. and learned Member for Cambridge University (Mr. Withers) may rely, so far as London is concerned, on the co-operation of the local authority.

Amendment negatived.