§ (1) It shall be competent for the county council of a county or the town council of a large burgh to submit for the approval of the Department of Health a scheme for the re-organisation of the hospital facilities at the disposal of the council with a view to the provision of treatment for sick persons residing within their area and the Department before giving their approval shall have regard to any other facilities for treatment of any such sick persons including those provided by any voluntary hospital or other institution.
§ (2) It shall also be competent for any such council as aforesaid to make a representation to the Department of Health that the hospital facilities available are inadequate for the reasonable requirements of sick persons residing within their area and to submit a scheme for the extension of such facilities, and the Department, before approving such scheme, shall satisfy themselves by inquiry that hospital accommodation at the disposal of the council, together with the accommodation provided by voluntary hospitals or other institutions, is not reasonably adequate for the needs of the inhabitants of the area and that the council have taken reasonable steps to seek and to continue to secure full co-operation with every voluntary hospital, university, or medical school within or serving the area of the council.
§ (3) The Department of Health may approve any scheme under this Section either as submitted or with such modifications and amendments as they may think proper.
§ (4) Where a scheme, with or without modification or amendment, has been approved by the Department of Health it shall be lawful for the county council or town council in accordance with the scheme as approved to provide, furnish, and maintain for the accommodation of sick persons residing within their area hospitals, temporary or permanent, and houses of reception for convalescents, and for that purpose to—
- (a) themselves supply such hospital or houses; or
- (b) contract for the use of any such hospital or house; or
- (c) enter into any agreement with any person having the management of any such hospital or house, or part thereof, on payment of such annual or other sum as may be agreed on; or
- (d) utilise any hospital or house or other building belonging to them.
§ (4) utilise any hospital or house or other building belonging to them.
§ (5) Two or more such councils as aforesaid may submit a scheme to the Depart- 1638 ment of Health for the provision by one of these councils of hospital facilities for the sick persons residing within the area of the other council or councils and, on the scheme being approved by the Department, each of the councils concerned shall have all powers necessary for carrying the scheme as approved into effect, provided that the provisions of Sub-section (2) of this Section so far as relating to the approval of the Department shall apply with any necessary modification to any such scheme which involves the erection of additional accommodation.
§ (6) For the purposes of this Section, hospital facilities, so far as the same may hp provided by a council, shall include arrangements with respect to the provision of treatment.
§ (7) All statutory provisions relating to hospitals for infectious diseases shall with the necessary modifications apply to hospitals and other buildings provided under or in pursuance of this Section, and any expenses incurred by a council under or in pursuance of this Section shall be defrayed by the council in like manner as expenses under the Public Health (Scotland) Act, 1897.
§ (8) A scheme made under this Section may be revoked or varied by a subsequent scheme.—[The Solicitor-General for Scotland.]
§ Brought up, and read the First time.
§ The SOLICITOR-GENERAL for SCOTLAND
I beg to move, "That the Clause be read a Second time."
The object of this Clause is to enable authorities to submit schemes for reorganisation with the view of removing the distinctions between Poor Law patients and the public health patients and to provide for hospital treatment under public health and not under the Poor Law. In the Clause there are safeguards with regard to the voluntary hospitals. One of the objects of the Clause is to secure co-operation between the public authorities, the voluntary hospitals, and the medical schools. The Committee will find in the first Sub-section of the Clause that the schemes for reorganisation have to be submitted to the Secretary of State for Scotland by the various authorities, that is to say, either by the county council or council of the burgh. Subsection (2) gives power to the authorities to spend money in extensions, where the present facilities are inadequate. A scheme has to he submitted, and under the scheme the position of the voluntary hospitals will be safeguarded. The Department will satisfy itself with regard to an appro- 1639 priate scheme by inquiry, not necessarily by a formal inquiry or a local inquiry. Sub-section (3) provides that in the event of the scheme not being approved, in terms, by the Department, they may modify the scheme. They do not require either to accept the scheme in whole or to reject it in whole, but they may modify it or amend it.
Sub-section (4) gives statutory powers to the authorities in connection with general hospital services. At the present time they have only statutory powers with regard to hospitals for infectious diseases. This Sub-section will give them statutory powers with regard not only to infectious diseases hospitals, but also with regard to general hospitals. The statutory powers are to extend to general hospital facilities in the same way that they extend to the infectious diseases hospitals. Sub-section (5) provides that the authorities may give hospital services for those living in another area under schemes; it is also provided that Subsection (2) with regard to the scheme being approved by the Department shall apply. Sub-section (6) gives an extended meaning to the words "hospital facilities." Sub-section (7) stipulates that the statutory provisions relating to hospitals for infectious diseases shall, with the necessary modifications, apply to hospitals for general purposes. I think we shall all agree with the general scope and purpose of the new Clause, and I hope that it will be approved by the Committee.
§ Mr. STEWART
I should like to know whether we can have a general discussion on the whole of the Clause, or whether the dicussion must be limited to the Amendments.
§ The CHAIRMAN (Mr. James Hope)
Perhaps it will be better to have a general discussion, but it must be understood that the hon. Member's colleagues will not desire to anticipate the later Amendments.
§ The CHAIRMAN
The point I had in mind was that if the hon. Member for East Edinburgh (Dr. Shiels) at the end 1640 of a speech on the general discussion, suddenly moved his Amendment which stands upon the Paper, that would prejudice the position of the hon. Member for St. Rollox (Mr. Stewart). I would suggest that we read the Clause a Second time.
§ Mr. STEWART
The Amendment which I have on the Paper is to leave out the words "It shall be competent for." This new Clause marks a step forward in the treatment of the sick. For the first time it separates sickness from the Poor Law. It gives the local authorities power to establish hospitals for the treatment of sick persons, but it leaves some flaws, and it would be better that the flaws were amended in the Bill. At this moment I am not entitled to move my Amendment, but I am able to speak generally on the provisions of the new Clause. The Clause says:It shall be competent for the county council of a county or the town council of a large burgh to submit for the approval of the Department of Health a scheme for the re-organisation of the hospital facilities.It seems to me that the words "It shall be competent for," constitute a grievous mistake. If we want to make this Clause effective, we must make it obligatory upon every county council and every town council to prepare a scheme for the consideration of the central department. In that way we shall make a step forward. I can visualise, and I am sure that those in the Department of Health can remember, occasions when local authorities have been very dilatory and difficulties have occurred in the case of two authorities, neither of which was prepared to submit a scheme, and the two were not able to agree upon a scheme. I am glad to notice that in this new Clause opportunity is taken to remove the difficulty which now exists in regard to the joining together of schemes. If the Government would accept the Amendments which we shall move subsequently, the new Clause would be strengthened.
Take the position as I visualise it at the moment. Every health authority in the country has power to make provision for infectious disease, without regard to cost. Tuberculosis, which is one of the infectious diseases, is costing in Glasgow £141 per patient for treatment, and the treatment for pulmonary tuberculosis is 1641 costing over £43 per patient. The patients are treated for five months for pulmonary tuberculosis and for two months for other tuberculosis. If this new Clause proceeds, it will make it possible for us to deal with cancer and other diseases, which are not considered at the moment infectious, in a way that we could not deal with them before. If the Government will accept our Amendments, providing that it shall be obligatory upon authorities to submit schemes, we shall make the Clause watertight and perfect, but if we leave it the new Clause, as it stands, a reactionary town council, which is perhaps more concerned about saving money and saving the rates than in spending money in the improvement of health, and thereby ultimately saving money, such a council may refuse to do the work. If we make it obligatory on them, as is proposed in our Amendments, the work will have to be done. I hope that the Lord Advocate will be prepared to accept our Amendments, because I am certain that they will strengthen the new Clause.
I should like to deal with another side of the proposed new Clause. I did not hear the word "compensation" used by the Solicitor-General. I have the privilege of representing some of the most progressive seaside towns in Scotland. These towns have to make arrangements for a very large summer population, and in those arrangements hospital accommodation becomes very prominent. In certain cases the town councils have established very fine hospitals for fever and other cases, and out of the rates they have practically paid off the entire capital cost incurred in building and equipping the hospitals. Under this new Clause, these hospitals will be taken over by the new county authorities and, as far as I can see, no question of compensation arises. It seems to me that as the ratepayers have subscribed out of the rates for building the hospitals and paying off the original capital debt for construction and equipment, they should be refunded by the county authority.
§ The CHAIRMAN
The matter which is being raised by the hon. and gallant Member is appropriate to Clause 6, and not to the present new Clause. Clause 6 deals with the transfer of property and liabilities. If the hon. and gallant Mem- 1642 ber wishes to raise the question of compensation, he must do it on Clause 6, on Report.
I noticed the words "duties and responsibilities," but they did not seem to cover the cost of buildings and equipments and compensation. The matter seemed to me appropriate to this particular new Clause. However, I will accept your ruling.
§ The CHAIRMAN
The matter to which the hon. and gallant Member has drawn attention is one between the county authority and the lesser authorities. That hardly arises on this new Clause. The hon. and gallant Member must deal with it on Clause 6, on Report, if he wishes to raise it.
In that case I will merely ask the Lord Advocate to bear in mind that there is this general feeling in regard to cases like this.
§ Dr. DRUMMOND SHIELS
As the hon. Member for the St. Rollox Division (Mr. Stewart) has said, we regard this part of the Bill much more favourably than some of its other sections. While we agree with the main principles of the proposed new Clause there are certain features of it which we would like to see altered so that the Clause might be really effective when put into operation. In the first place, it deals with the reorganisation of hospital facilities in a district. Everybody knows that as far as the larger industrial districts in Scotland and England are concerned the hospital arrangements are in a more or less chaotic condition. Reorganisation in these cases is absolutely essential if the full facilities available in the public and voluntary hospitals are to be utilised. We feel that the words "it shall be competent" leaves us in the same old position with regard to reactionary or lazy authorities. There may be no scheme for reorganisation where the need for it may be very urgent, and we may, on the other hand, have a, council applying for a reorganisation in an area where there is not so much need.
If what I have said is true of the first Sub-section of this new Clause, it is much more true of the second Subsection, which deals with the extension of hospital services. One of the hopeful features of this Sub-section is that it 1643 provides some remedy for the serious condition of our voluntary hospitals as regards their accommodation. The MacKenzie Commission, which reported in December, 1925, gave the total number of voluntary hospital beds in Scotland as 8,589. There has probably been an increase since that time, but they estimated that 3,600 additional beds were immediately needed in order to provide the accommodation necessary. And that need is at least as great to-day. The Edinburgh Royal Infirmary, which everyone agrees is one of the best-equipped voluntary hospitals in the country, has a waiting list of over 2,000 people, many of them being surgical and medical cases, including cancer cases. It is a matter of great sorrow to those who have any acquaintance with the work of this institution that there should be a waiting list at all. It is the same in regard to Glasgow and, indeed, the voluntary hospitals in Scotland, admittedly, do not at the present time provide anything but partially for the needs of the community. In addition to this number of beds, we have in the Poor Law hospitals and sick wards of Poorhouses, 6,100 beds. Of that number, 4,285 are grouped in the larger Poor Law hospitals. One effect of this new Clause will be that in those cases where the Poor Law beds are not fully occupied, as is sometimes the case, they will be available to the local authority for the needs of the sick people in the district. It is surely even more necessary that immediate steps should be taken, seeing that there are these facilities, to prepare a scheme not only for coordination, but for making the necessary additions and extensions in areas which quite evidently require it. There is a very strong reason why that should be done as a big gap will still be left.
I should like to ask a question with regard to the inquiry which is to be held. In the first Sub-section the department is able to decide on the information given to them without any inquiry at all, but, in the second case, they are evidently to hold an inquiry. I should like to know whether it is to be a public inquiry with witnesses, whether it is likely to be an expensive inquiry, with counsel representing the various conflicting authorities, and whether people with vested interests will be able to 1644 object to the necessary extensions and either defeat the object of the local authority or add considerably to its expenses in establishing approval of the proposed scheme. Various other matters arise in connection with this subject but the most -important of these are in connection with a later Clause. All I desire to say now is that hon. Members on this side give general approval to the objects and purposes of the new Clause, but we feel that these powers for reorganisation and extensions should be made compulsory. We have plently of compulsion in the Bill already and surely this is one of the few matters in which compulsion is desirable. The needs of the sick and suffering are involved. If these powers are made compulsory, and if the inquiry which is to be held is not to be of a vexatious or expensive nature, then hon. Members on this side will be satisfied.
§ Sir A. SINCLAIR
I join in the approval which has been given to this Clause as a whole. We know how successfully the question of hospital accommodation has been grappled with in some parts of Scotland, but, at the same time, I hope the Government will not fail to give the fullest possible consideration to the needs of communities in other parts of the country. We have reason to believe that there is a desire to centralise the hospital accommodation in Caithness and Sutherlandshire at Inverness. That is a proposal to which we strongly object. We can provide ample accommodation for ordinary cases, and the more serious cases would prefer to go to Glasgow or Edinburgh rather than to Inverness. I listened with great sympathy to the point put by the hon. and gallant Member for Ayr Burghs (Lieut.-Colonel Moore). We all know what fine hospitals have been erected in the burghs to which he referred; and I hope the point he put will be taken into account. At the same time, I cannot help but reflect that if only people would go further north to Caithness and Sutherland they would find holiday resorts where the hospital accommodation might not be quite so up-to-date but where the air is the finest and the surroundings are the healthiest in the world.
§ Mr. SCRYMGEOUR
This is a very gratifying proposal as far as the principle of the new Clause is concerned. There is, undoubtedly, a great necessity for 1645 re-organisation in the matter of hospitals and hospital accommodation in Scotland. We are all well aware of the distressful condition of many of them from the financial point of view, but at the same time we must not forget that our working people have responded splendidly to the appeals which have been made on behalf of voluntary hospitals. The Government are now laying down a plan which will undoubtedly be of immense advantage to those who are under the necessity of attending these institutions, and we hope they will accept an Amendment to make it compulsory on local authorities to prepare schemes, otherwise we shall find laxity on the part of some councils in the preparation and development of much needed schemes. Having taken a step which will be of great advantage, I think we should urge the Government to complete and perfect their proposal by making it explicit in the Bill that county councils shall act in this matter.
§ Mr. MACQUISTEN
This is, undoubtedly, an admirable new Clause, and I do not think much objection can be taken to any of the proposed Amendments. There is one Amendment, however, on line 8 which I do not think will read. The Amendment says:It shall be the duty of any such council as aforesaid to make a representation to the Department of Health.You cannot tell every town council that it is their duty to make representations when, in point of fact, it will not be their duty to do so. The point made by the hon. and gallant Member for Ayr Burghs (Lieut.-Colonel Moore), which was ruled out of order, will come up, I believe, on Report. If it was incompetent for him to deal with it at this stage it is equally incompetent for me to deal with now, but I should like to say this, that in Oban we have splendid hospital facilities already for the whole district, and they are splendidly managed. I understood that it is within the power of the Secretary of State not to transfer this accommodation into the hands of any other body. In that district we have adequate provision in the matter of hospital accommodation, and we have a seaside burgh which will vie in salubrity with any of the burghs represented by the hon. and gallant Member for Ayr Burghs, and which exceeds in salubrity those districts in the North represented by the hon. and gallant Member for Caithness and 1646 Sutheriandshire (Sir A. Sinclair). These facilities have been provided partly by voluntary effort and partly out of the rates and, therefore, I hope the Secretary of State, in the exercise of his discretion, will not hand these splendid facilities, locally provided, to other hands.
§ The LORD ADVOCATE
I must say a few words in reply to the speeches that have been made. First of all, I would express gratitude for the welcome given to the great scheme that is outlined in this Clause. I am only sorry that neither my right hon. Friend the Secretary of State, nor my hon. and gallant Friend the Under-Secretary, was able to be here tonight. They are experts in this matter, and I cannot pretend to be. It is well to realise that this is a proposal for including in one general scheme of treatment not only the poor or pauper sick persons and persons suffering from infectious disease, but also the ordinary sick person. That, of course, is a somewhat novel experiment, though a very desirable one. We feel that it would be a bit hard and unwise to make the preparation of schemes peremptory or mandatory in the way suggested by one of the Amendments on the Paper; but I want to make it clear that the Clause does not mean that there is no duty placed on the local authorities. Hon. Members will remember that under Clause 50 every local authority is bound to exercise its functions up to a certain standard, and to provide adequately for the health of the people of its district. The word "function" is defined as including not only duties but powers, and I as a lawyer say undoubtedly that the power which is conferred on the local authority under this proposed new Clause is a power which it will be bound to exercise so far as Clause 50 is concerned.
§ Mr. SCRYMGEOUR
The matter will be carried to the point of compulsion if that should be found to be necessary?
§ The LORD ADVOCATE
It is difficult to put on the local authority a direct mandatory duty to provide a scheme in every case, and to start straight away with it whether it may be absolutely essential or not. We think the preferable course, especially in a new proposal of this kind, is to say "We give you this power, and that power being available, you must exercise it where otherwise 1647 the health of the people under your control is being seriously damaged."The view of the Government is that the protection of Clause 50 is a wise protection.
§ Dr. SHIELS
Does the Lord Advocate's statement mean that in future, if a local authority has not put forward a scheme when in the opinion of the Department the conditions of the locality justify such a procedure, it is liable to have its grant reduced?
§ The LORD ADVOCATE
Yes, Sir. This is an important matter. It will be seen that in Clause 50 there is given power to reduce the grantif the Secretary of State is satisfied that the council have failed to achieve or maintain a reasonable standard of efficiency in the discharge of their functions relating to public health …When we turn to the definition Clause on page 53 of the Bill we find that the word "functions" is defined as including "powers and duties" Undoubtedly this new Clause embodies powers. Therefore, I say that if the exercise of this power is essential to the maintenance of an efficient standard of health, not only for the poor and those suffering from infectious disease but for the people of the district under a local authority's control, then Clause 50 comes into operation.
§ Question put, and agreed to.
§ Clause read a Second time.
§ Motion made, and Question proposed, "That the Clause be added to the Bill."
§ Mr. STEWART
I regret that the Lord Advocate has not been able to meet us altogether, and despite what he has said about the powers mentioned in Clause 50, I have had experience enough to know that such powers it is very difficult to put into operation in the case of a refractory town council, and that even with a Board of Health anxious and willing to do things, where it has met a town council or county council that was unwilling to act, it has taken years before that local authority was compelled to act. For the time being we accept the position taken up by the Lord Advocate. None the less I regret, and I believe that he also in future will regret, that this was not made a mandatory instruction to local authorities.
§ Question put, and agreed to.1648
§ Clause added to the Bill.