CLAUSE 1.—(Duty of local authorities.)

HC Deb 13 February 1939 vol 343 cc1397-432

3.59 p.m.

Sir Henry Morris-Jones

I beg to move, in page 1, line 8, after the second "the," to insert "investigation and."

There is no great question of principle involved in this Amendment, as my right hon. Friend will appreciate. Sub-section (2, a) provides for arrangements for facilitating the diagnosis of cancer. I am very anxious to encourage all medical men, especially in the rural districts, not to be afraid of sending cases of suspected cancer to hospital, even though they may not be quite satisfied in their own minds that it is cancer. I do not want to go into the technical aspects of the matter here, but the Committee will appreciate that cancer is a form of growth that it is not always easy to diagnose. Therefore, I am anxious that medical men should be able to send cases to hospital, for investigation as well as for treatment. Unless there is some very special objection, I hope my right hon. Friend will accept the Amendment.

4.0 p.m.

The Minister of Health (Mr. Elliot)

I have no very strong objection to the Amendment, but I think if my hon. Friend will look at the part of the Bill now under consideration he will see that it is rather addressed to the local authorities, and I would suggest that his point can better be met under Sub-section (2) which deals with arrangements not only for facilitating the diagnosis of cancer but the treatment of cancer. I am anxious not to insert further words in the Bill if we can do without them, and I think the words proposed would not be appropriate here.

Sir H. Morris-Jones

My right hon. Friend has not stated any very adequate objection to the Amendment, but I have no desire to press it, and I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

The Chairman

The next Amendment I propose to call is that in the name of the Minister. The Amendment standing in the name of the hon. Member for St. Albans (Sir F. Fremantle), I think will be sufficiently covered by the Amendment next following the Minister's Amendment: (a) an advisory committee reresenting the interests concerned nominated by the Minister after consultation with their several representative organisations. —I think, will be sufficiently covered by the Minister's Amendment.

4.4 p.m.

Mr. Elliot

I beg to move, in page 2, to leave out line 10.

It might, perhaps, be for the convenience of the Committee if we were to have something in the nature of a general discussion upon this Amendment, because one aspect of it is raised in the Amendment put down by the hon. Member for St. Albans (Sir F. Fremantle), and a further aspect of it in the Amendment standing in the names of several Members of the Liberal Opposition. I would like to make a statement which goes rather beyond the Amendment I have put down, and, if possible, to refer to the Amendment on the Paper in the name of the hon. Member for St. Albans and the subsequent Amendment by hon. Members of the Liberal Opposition, if the Chairman can allow that.

The Chairman

I will help the Committee as far as I can, but, on the face of it, I do not quite see how this Amendment can cover the others. The right hon. Gentleman's statement may enlighten me so I will ask him to proceed.

Mr. Elliot

I think it was the general desire of the House in discussing this Bill on Second Reading that it should cover cancer problems generally, and that consultation should take place between those engaged in every aspect of the treatment of cancer, and should not be limited to the radium treatment of cancer, if full advantage was to be taken of the money and skill which were to be put at the disposal of cancer patients in the future. Several speeches were made—by the hon. Member for Hammersmith South (Mr. Cooke) and the hon. Member for the University of Wales (Mr. E. Evans)—among others, suggesting that specific statutory consultation with the Radium Commission might reasonably be omitted from the Bill. I promised the House that this should be a Measure which the whole House could take part in framing, and on consideration I decided to omit specific consultation with the Radium Commission. Some consultation, however, must take place, because it would be undesirable that the Minister should himself decide all these matters. He should have the advantage of the best technical opinion possible. Therefore, I propose to appoint a sub-committee of the Medical Advisory Committee at present in existence, to advise me on general principles in regard to the treatment of cancer and to consider any questions referred to them by me. This sub-committee would include experts in medicine, surgery, gynaecology, radium-therapy, pathology and public health administration. I think that will cover the point which the hon. Member for St. Albans had in mind in regard to the advisory committee which he thought of suggesting to the Committee this afternoon, and I think, also, it will cover the advisory commission suggested by Members of the Liberal apposition.

Mr. Graham White

May I ask whether the local authorities would have access to this sub-committee or only the Minister?

Mr. Elliot

My idea was that the local authorities should draw up their schemes and submit them to the Minister, who in considering them would have the advantage of the best technical opinion. I think it would be inadvisable that the local authorities should separately consult a committee which the Minister would also consult. It would be very much better that a local authority—let us say, the London County Council—when drawing up a scheme should take into consultation anybody whose advice they wish to have, such as the representatives of voluntary hospitals and medical practitioners, and should then submit the scheme to the Minister, who would consider it, and would have to stand the racket for his decision afterwards in the House. I think that would be the proper chain of responsibility. It is for that reason that I have put down this Amendment. I do not think it desirable to make it compulsory for the local authority to consult this committee, but there is no reason why they should not informally consult the Radium Commission, and it would be very much better that that consultation should be of an informal nature, and that the statutory consultation should be merely with the hospitals and medical practitioners.

I hope that plan will commend itself to the Committee. In the first place, I hope, it will meet the fear of some hon. Members that radium is given too prominent a place in the Bill, and, secondly the fear that local authorities are going in some way to be put under a technical commission. Their powers of informal consultation will remain unimpaired, and there need be no fear that the Minister will not take advantage of all technical opinion, and not merely of radium experts. By this Amendment the advice of experts in medicine, surgery, gynaecology, radium-therapy, pathology and public health administration will be at the disposal of the Minister, and, of course, I undertake to consult with this proposed committee, although I think it is hardly necessary to say so, because I should not set up a committee and then not consult it.

Miss Wilkinson

Will this advisory committee have any powers of initiation? Will it be able to prepare schemes and put them before the Minister, or will it be able only to deliberate upon or give an opinion upon matters directly referred to it by the Minister?

Mr. Elliot

I am not laying down the terms of reference to the committee now, but I rather thought that its function should be to deliberate on matters referred to it by me. However, I am perfectly willing to consider whether the committee should have the power of initiation as well. As it will not be a statutory committee, I am quite certain that the members will not only say to the Minister that they do not like the scheme submitted to them, but will say that they think the Minister ought to do this and that instead of what he proposes to do. In fact, if not in theory, the committee, therefore, will have powers of initiation, but I will consider further the relations between the committee and the Minister. All I am asking now is that the committee should strike out line 10 and should agree to the suggestion I make as to the setting up of a cancer sub-committee.

The Chairman

Before the discussion goes on, I think I had better make a reference to what the right hon. Gentleman said at the beginning of his statement. I have no complaint of what he said or of the reference he made to his intentions, but we must not further discuss the next Amendment on the Order Paper.

4.14 p.m.

Sir Francis Fremantle

This Amendment will make a very considerable change in the Bill, but it is very different from the Amendment which I put down. It is quite true that one of the main objects of my Amendment was to strike out the unequal emphasis attached to the word "radium" in the Bill, and the Minister's proposal to leave that out is undoubtedly a valuable thing. The question is what is to be substituted for it. My Amendment proposed a very different committee from that suggested by the Minister.

The Chairman

That is just the point. That must come on the next Amendment. The only Question before the Committee at the present moment is whether line 10 should stand part.

Sir F. Fremantle

You called my Amendment with that of the Minister.

The Chairman

No. I said I did not select it, and that I thought it would be covered by the discussion on the Amendment in the name of the hon. Member for East Birkenhead next following.

Sir F. Fremantle

I understood you to say that the Minister's Amendment would be called in order that mine might be included in it.

The Chairman

I am afraid that the hon. Member misheard me. I said that I did not select his Amendment, and that I thought that perhaps he could discuss it on the next Amendment in the name of the hon. Member for East Birkenhead (Mr. White).

Mr. White

May I inquire whether, in the event of the Minister's Amendment being carried, it would preclude the possibility of further discussion on my Amendment, and also, am I to understand that, if I were to accept the Minister's Amendment and his explanation now, it would almost preclude me from putting my Amendment without showing greater hostility to the Minister's Amendment than I feel?

The Chairman

I have nothing to do with hostility or otherwise in the relations between Ministers and hon. Members, but I am bound to treat these two Amendments as separate. As soon as that of the Minister is disposed of, I propose to call the Amendment standing in the name of the hon. Member for East Birkenhead. We can discuss that quite fully when we come to it, and whatever may happen to the Minister's Amendment will not narrow the discussion on the next Amendment.

Sir F. Fremantle

Clearly the reason of the Minister for leaving out the Radium Commission is the substitution of the committee which he proposes to set up, and, therefore, we cannot discuss his Amendment without considering the reason of the Amendment and the nature of the committee which he is setting up. I will confine myself to that when stating the proposal contained in my Amendment. I want some further explanation of the sub-committee which he is to set up. It is, I understand, to be a committee of the Advisory Medical Committee. There are two committees of which I know in the Ministry of Health, one being the Medical Committee and the other the Housing Committee. I sit on the Housing Committee and the procedure—and no doubt it is the same on the Medical Committee—is that it is worked largely through sub-committees which have to report to the main committee, which meets once a quarter and gives advice to the Minister.

I should like some assurance from the Minister that that very tardy procedure which is followed with regard to the Housing Committee will not be followed in regard to this proposal. We cannot wait for a sub-committee to pass its resolutions on to a committee which meets so occasionally. I hope that the sub-committee will be required to report direct to the Minister. The proposal in which he substitutes the sub-committee for the Radium Commission does not entirely meet the ideas in the minds of many people. The enlargement of the committee as suggested very possibly would best be considered on the next Amendment to be moved. When we are considering that we should consider whether the nature of the sub-committee that is to be set up is sufficiently wide in its interests and composition to meet the case. I entirely agree with the elimination of the Radium Com- mission as such as long as the members of the Radium Commission will be recognised as a body of the very highest order and that their opinions, with others, will be properly considered.

4.20 p.m.

Mr. White

I believe that the Amendment of the Minister to leave out line 10 will be welcomed without any reserve at all by the whole Committee, and certainly by a very large body of opinion outside this House. Authoritative opinion, as far as there is any authoritative opinion with regard to cancer, would undoubtedly be made very unhappy by what appeared to be an undue bias in favour of radium in this Bill. It was described as a Radium Bill, and that belief was very prevalent. I regret to say that, in spite of the very definite statement made by the right hon. Gentleman, and also by the Parliamentary Secretary in the Second Reading Debate, that opinion is still held, though perhaps not widely. I have received communications from outside authorities who will persist in calling it a Radium Bill. We now know that that is not the case, whatever was the first impression, which was undoubtedly encouraged by fantastic stories in the Press about the price of radium and the action the Minister proposed to take.

The Radium Commission now disappears from the Bill, and I think all concerned will welcome its disappearance. No one has ventured to criticise the Radium Commission in the way in which it has discharged the particular duty given to it, but I have yet to meet anybody who would suggest that the Radium Commission was a suitable body to direct a national campaign, to co-ordinate, stimulate and put life into the machinery of the local authorities for the purpose of bringing about a national campaign against cancer. There can be no two opinions about the actual Amendment which the right hon. Gentleman has moved. The Radium Commission has done nothing whatever to increase the number of personnel, nor would it have, if this Amendment were not carried, any authority to increase the personnel to the extent envisaged if this Bill is to be successful. There must be an enormous increase in the personnel of the highest technical and scientific practice and attainment if the Bill is to meet its full purpose. The Radium Commission certainly has done nothing, nor can it do anything to promote the personnel and make the work effective. Whether the new sub-committee which the right hon. Gentleman suggests should be set up, with the direction, on the consultative side, of a national cancer campaign, would be able to take into account the necessity for personnel, and would be able to give advice to the local authorities in the preparation of their schemes or to the Minister, I do not know. That is a matter which will call for further consideration.

The hon. Gentleman the Member for St. Albans (Sir F. Fremantle) raised a practical point of substance when he spoke of the time factor in these negotiations between the Minister and his advisory committee and the local authorities. If the local authority are preparing a scheme, and they submit it to the Minister he may, in his discretion, take the opinion of his advisory committee on some aspects of it. Then it may have to go back to the local authority, and yet again it may come up.

The Chairman

I think that all this will come on the next Amendment.

Mr. White

It may be in order on the next Amendment, but the right hon. Gentleman has, in fact, suggested a sub-committee, and I was merely putting forward, in an interrogative way, an inquiry as to how it would work. If the proposed committee of the right hon. Gentleman had better be discussed on a subsequent Amendment, well and good, but if I may put my inquiry now, it may save time.

4.25 p.m.

Mr. Elliot

I should certainly be prepared to deal with the sub-committee when coming to the Amendment standing in the name of the hon. Member for East Birkenhead (Mr. White) and others. I merely referred to my intention, though it is not part of the Amendment which I have presently put down. I referred to it as giving the Committee some idea of what I had in mind later on. It would not be in order to discuss that now, and clearly it could be more suitably discussed when replying to the Amendment of the hon. Member for East Birkenhead. I am grateful to the Committee for the support which they have given to my proposal, that line 10 should be left out. The Radium Commission has been consulted in this matter and will be very glad, no doubt, to be relieved of that statutory consultation.

Mr. White

In view of what the right hon. Gentleman has said, I have nothing further to say except to accept gratefully the suggestion made in the Amendment which he has moved with regard to the Radium Commission.

4.27 p.m.

Colonel Nathan

I welcome the deletion of the reference to the Radium Commission, because it is an underlining of the undertaking which the right hon. Gentleman gave on the Second Reading that this is in no sense a Radium Bill. The sub-committee which the right hon. Gentleman has mentioned is one which he is to consult, whereas the Amendment in the name of my hon. Friend the Member for East Birkenhead (Mr. White) is a sub-committee which the local authorities are to consult. I would like to ask the Minister, or the Parliamentary Secretary in his absence, one question with regard to the sub-committee which the Minister has indicated he proposes to set up for consultation by himself. He has indicated that it is to be a sub-committee of his Medical Advisory Committee. As the right hon. Gentleman is aware, the British Hospitals Association, which is a body comprising representatives of the voluntary hospitals, has had this matter under consideration. It holds the view that the right hon. Gentleman will be well advised to set up, as he suggests setting up, an advisory committee, but equally holds the view that that committee should not be restricted in its membership merely to those who can advise upon the technical aspects of the diagnosis or treatment of cancer. The questions which will be raised in any scheme that may be put forward for the consideration of the Minister must necessarily involve a number of matters of a purely administrative and practical character. Experience in the administration of hospitals shows that it is not, as a matter of practice, possible for the medical staff, however skilled it may be, to take into effective account the whole of the considerations that have been considered when putting forward a new suggestion for diagnosis or treatment, because there are all sorts of ancillary matters involved in the way of equipment, nursing accommodation and things of that kind.

The Chairman

The hon. and gallant Gentleman is going a long way beyond the purpose of this Amendment.

Colonel Nathan

May I venture to direct your attention, Sir Dennis, to the fact that the next Amendment relates to a committee to be set up for consultation by the local authorities? That is under the scheme of the Bill. The sub-committee to which the right hon. Gentleman has referred is not a sub-committee to be consulted by the local authorities, but a sub-committee which he is proposing to set up for consultation by himself, for which there is no provision in the terms of the Bill.

The Chairman

It is true that the Minister has stated that it is his intention to do something not within the terms of the Bill, but outside it. That is not in the Clause. We must deal with the next Amendment when we come to it.

Colonel Nathan

I hope you will not think I am in any way obstructive. Perhaps you will allow me to make my point clear. I am directing my mind exclusively to the suggestion which you permitted the right hon. Gentleman to make as to the setting up by him of a sub-committee, not mentioned in the Bill. He has told us of the composition of that sub-committee, and the point that I wish to make is on that same question of the composition of the sub-committee. It is entirely unrelated to the advisory committee which is the subject of the next Amendment.

The Chairman

I will hear the hon. and gallant Member.

Colonel Nathan

I will put the point briefly. For the reasons which I have roughly indicated, the voluntary hospitals feel it most desirable that, as administrative bodies, they should have representation upon any committee which the right hon. Gentleman may set up for his own guidance, and I express the hope that when creating such a sub-committee the right hon. Gentleman will bear in mind that the local authorities will have direct access to him, as their statutory right under the Bill and that although the voluntary hospitals have to be consulted by the local authorities, they will have no direct access to him. It is that direct access for which I ask.

4.33 p.m.

Mr. Rhys Davies

I should like to make a few observations on the right hon. Gentleman's Amendment. The complaint of hon. Members was that the words that he is proposing to delete would compel the local authorities to consult the Commission. Without those words, there is nothing to prevent a local authority from consulting the Commission if they want to do so. I should like to say a few words in favour of the Amendment. I favour it because in looking at the 9th annual report of the National Radium Trust and the Radium Commission it seems to me, without offending them, that the Commission is more or less a commercial body which buys radium and sees that it is distributed in the country. It has very little to do with the problem of cancer as such. I know nothing about the technicalities of this business, being a layman, like most hon. Members, but it may be that when the Act is in operation, science will find something other than radium to cure people of cancer. Consequently, on that score I am in favour of deleting the words mentioned by the right hon. Gentleman.

4.35 p.m.

Mr. Elliot

It might be considered that I was discourteous if I did not reply to the point raised by the hon. and gallant Member for Central Wandsworth (Colonel Nathan), who asked that, in addition to the technical sub-committee, there should also be a hospital sub-committee of laymen to advise me. I do not close my mind to the necessity of other consultations, but I am bound to say that, as I see the problem at present, there is a danger of getting ourselves so entangled in committees that it may not be possible to get forward with the work. Therefore, I should not like to pledge myself to a consultative committee for the voluntary hospitals, set up for that purpose, but I shall, of course, have full discussions with the hospitals on any matters which concern them.

Amendment agreed to.

4.36 p.m.

Mr. White

I beg to move, in page 2, line 10, at the end, to insert: a National Council representing physicians, surgeons, radiologists, pathologists, and biochemists, to be set up under this Act. One particular consideration which has led to the moving of this Amendment has been discussed and disposed of in the dis- cussion on the previous Amendment moved by the right hon. Gentleman. It was generally agreed that the Bill is stronger and better without the inclusion of the Radium Commission. The commission is available for consultation in connection with the service which it is well fitted to perform, but it would, obviously, be a mistake to include in the Bill as a statutory consultative body a body whose very existence may become unnecessary on a date which we hope will be not distant when radium may be succeeded by some other more effective method of treatment for the cure of cancer. That being the case, the problem that presents itself is what sort of committee or body should be set up in order that all the available knowledge and directive influence may be made available for a national cancer campaign, and be at the disposal of the local authorities in the preparation of their schemes.

I and my hon. Friends would like, and, what is more important, those outside who are in the ranks of those who are called upon to consider methods for the treatment of cancer and the establishment of hospitals, would like, a committee or council available, embodying all the experience which has been gained up to the present time, which would make effective all those methods, new and old, in the cumulative experience in the treatment of this dreadful disease. I submit that a committee of the kind suggested by my Amendment, which could be consulted by the local authorities prior to the submission of their schemes, which would be representative of the practice and experience in the country on this subject, would be the best kind of body to be set up for the purpose.

Having considered the suggestion of the right hon. Gentleman, I am inclined to think that a body with greater prestige than a sub-committee would probably be more effective and more efficient. The right hon. Gentleman said, truly, that we must be careful not to become involved in too many committees. Already, there is a multitude of bodies, and it is difficult to say where the new committee is to take its place in the hierarchy that exists. There is the Medical Research Council, which performs very valuable functions. The body which the right hon. Gentleman proposes to set up is to be a sub-committee of his own advisory committee. I do not want to disparage the sub- committee, because I do not even know its constitution, but I hope the right hon. Gentleman will see that there is representation upon it of the different interests specially enumerated in my Amendment, which comprise all the elements of the medical and scientific profession which are essential in the direction of any campaign of this kind.

One point that has come to my mind is that we should know the present state of our knowledge in regard to the cure of cancer. A great many parallel investigations are being conducted, and it is very important that any body which is directing a national campaign should have access to this knowledge as it is brought to light. In the ordinary course of events if any particular discovery is made, although it may be published in the scientific journals, it may not become common knowledge for 12 months or two years. If a national council were set up it could deal promptly with such matters and see that they were made available without delay to those who are in the front trenches, fighting the battle against cancer.

I should like an assurance from the right hon. Gentleman that the sub-committee which he proposes to set up will be an effective body. Perhaps he will give us some idea what he thinks the process will be by which the schemes of the local authorities can reach their final stage. Presumably, they will be drawn up by the medical officer and the council, in consultation with bodies equipped for the purpose, but the materials and the methods will vary from county to county and from county borough to county borough. He will have to consider a number of schemes which will present an extraordinary variety of features and ideas. Consultation before the scheme reached him with a body to which the local authority could have direct access would simplify their task, save a great deal of time and cut out the necessity for a great deal of correspondence between the right hon. Gentleman and his Department and the local authorities. Having heard the right hon. Gentleman's explanation, as far as it went, on the Amendment which we have accepted, I still think that, on the whole, a more authoritative committee, to which the local authorities would have access for advice before their schemes were submitted, would be preferable.

4.44 p.m.

Sir F. Fremantle

I cannot entirely support the wording of the Amendment. It varies very little from my Amendment, but it includes certain bodies of individuals, while others are left out. For instance, the hon. Member for Birkenhead, East (Mr. White) leaves out the gynaecologists and the physicists. Therefore, I should prefer my Amendment, which suggests several representative organisations. One of the organisations that would, obviously, be required would be one representing the general practitioners. The difficulty in all these schemes is that when you are going to have the highest technical experience in the land giving their advice, the people who are really going to carry out the work, and who are the keystone of it, are the general practitioners.

If the general medical practitioner is not included in the Bill his patients will practically never get treated at all. It is up to the general medical practitioner to be seized with the idea of the scheme and then to advise his patients that it is worth their while to get out of his clutches and into the hands of the main central body for advice and treatment, and then, when they come out, to be in close touch with the experts of the hospital centres, to give them after-care treatment. Above all, you want to have the general medical practitioners represented, although they may not consider themselves as coming under any of the categories named in the Amendment. It may be that they may be included in the sub-committee which the Minister is setting up. I believe there have been consultations between the right hon. Gentleman and the British Medical Association, and I should like to be satisfied that the British Medical Association have put forward proposals for the general practitioner to be included.

But we are up against a more difficult matter than that. This is a radical change in the structure of the Bill. It is important for the Minister to have advice. When a scheme is put before him we want to be sure that the Minister of Health in the future, who may not be so well equipped with technical knowledge as the present Minister of Health, will have the best advice at hand as to how far a scheme is useful, how far it must be amended, or whether it is incompatible with the main object of the Bill. In the latter case he will have to reject the scheme altogether. Think of the position in which we may be landed. A local authority, a comparatively small one, a borough of 60,000 or 100,000 inhabitants, happens to be progressive and has a certain number of people who are very generous and say that they will bear the whole expense. It decides to have one of these great centres. It gets great publicity, big public meeting and advertises the scheme. It goes through all its stages and then comes to the Minister who submits it to his sub-committee. The sub-committee may think it is a perfectly absurd scheme for such a little town; it cannot provide the facilities which are necessary and it is turned down.

We want a scheme by which local authorities will be guided in the earliest stages of their proposals. Take the analogy when town planning first came in in 1910, under Mr. John Burns. It was an entirely new proposal and cut across old ideas of administration. A local authority, first of all, had to have leave from the Minister to prepare a scheme, and there were all sorts of stages before a scheme was approved. It was a dilatory proceeding, and has rightly been curtailed. But the idea of going to the Minister for leave to prepare a scheme is required if you are not going to have a national council which local authorities will be required to consult, and I hope my right hon. Friend will consider whether it is not necessary to bring in some suggestion of that sort as an amendment on the Report stage. The Minister has not yet made a statement as to how he proposes to work this Measure. I think local authorities should have a body which they can consult at the earliest stages when they are preparing their schemes. It is true that under the Bill they are bound to consult various bodies, but they are local bodies. They have to consult a body representing the medical profession. It may be a very valuable body and may consist of a large number of men who are very busy locally, or it may be a very dull body with a secretary so incompetent that they really are not worth consulting. I think there should be a larger body which is thoroughly representative, and which can take the larger view which is required. If this larger view is to be taken, it seems to me that it must come from headquarters. We are here concerned with a large new scheme of expenditure and, what is even more important, we want to arouse intelligent interest in the treatment of this dread disease. I say clearly that we should have a scheme in the Bill which will enable proper advice to be given to local authorities in the early stages of preparing their schemes. I hope the Minister will give us a lead on this matter.

4.55 p.m

Mr. Herbert Morrison

In addition to medical cancer there is such a thing as administrative cancer, and one of the best ways in which to bring about administrative cancer is to complicate the procedure by setting up a whole host of committees before you start to do the job of work. It seems to me that the Amendment is a good example of administrative cancer. John Stuart Mill said that the price of liberty is eternal vigilance. Nowadays the price of liberty is eternal committees. I cannot stop the Minister appointing an advisory committee, and there may be a great deal to be said for it in this case. I do not want to argue that point. For myself, I would sooner the House of Commons passed a Bill giving the Minister and local authorities the proper power and then expect them to get on with the job. The hon. Member wants to pass a Bill placing duties on local authorities and then say that they must go to some national committee for permission to prepare a scheme to administer the Bill.

Sir F. Fremantle

It is riot for permission; it is mainly for advice on matters about which they are not very conversant. I am not thinking about the London County Council, but about the smaller authorities.

Mr. Morrison

I can assure the hon. Member that I am not thinking of the London County Council at all. The hon. Member referred to the analogy of the Town Planning Act whereby local authorities have to go to the Minister for leave to prepare plans. That is a very dilatory and slow process. The Bill proposes, and I think quite properly, that before a local authority prepares a scheme for submission to the Minister it should consult local voluntary hospitals and the local medical profession. That is right, because the voluntary hospitals are or may be doing things in connection with cancer, and they should be taken into account by a local authority before it submits a scheme. The local medical profession will have its experts and its knowledge, and it is right that they should be consulted. But, having done that, it seems to me that local authorities should deal with the Minister, and nobody but the Minister, in asking for approval of their schemes. If the Minister likes to consult the National Council or technical bodies, that is his business, and no doubt he will learn all he can from these learned societies, but if local authorities are to satisfy not only the Minister but some sort of national committee representing all these professions and learned societies, the work of local authorities will be gravely injured.

Sir F. Fremantle

May I point out that the proposal is that they shall consult these bodies?

Mr. Morrison

If local authorities are to argue with a miscellaneous collection of people representing various professions, technical bodies and learned societies, with all their known specialist ideas, some of them with cranky ideas, then, in my opinion, things are going to be slowed down and local authorities are not going to have a clean piece of administration as between themselves and the Minister. The Minister, no doubt, will be in touch with these various bodies, and they will certainly be in touch with the Minister. They will make representations to him, as they have every right to do, but it is a totally different matter for administrative schemes to be handled by non-administrators, who are not able to appreciate all the administrative problems involved. I am glad that the right hon. Gentleman proposed the previous Amendment on grounds of simplicity of administration, and I hope that the present Amendment will not be pressed. The hon. Member should leave it with the undertaking that has been given by the Minister, that he will be in consultation with these people. It will be very unwise to introduce a national consultative body between the Minister and the local authorities of the country.

4.59 p.m.

Sir Percy Harris

This is purely a matter of practical convenience, and we on these benches do not attach vast importance to what is pure machinery. Our aim and purpose is to short-circuit, not to elaborate the procedure and make greater difficulties. We suggest that a national council of this kind should be set up not merely for the London County Council but for all local authorities who are concerned in the administration of this dread disease. My hon. Friend the Member for East Birkenhead (Mr. White) is anxious that the Minister should have a national council to "vet" the proposals submitted by the local authorities. I cannot help thinking that it would be more simple and effective, and would lead to a more speedy result, if there were such a council which the local authorities could consult and from which they could receive advice.

Certainly, we do not wish to set up a cumbersome organisation which would delay or render more difficult the local authorities' work; on the contrary, the idea behind the Amendment is that there should be a national council, representing the various branches of the great medical profession, to co-ordinate the schemes and advise the various local authorities, thus lightening the burden which falls upon the Minister of Health. The Minister of Health is a hardworking Minister, charged with one of the most difficult and complex Departments, touching every section of the life of the people. It would be far better if the schemes could be thoroughly "vetted" by the medical profession, after passing automatically to such a national council, so that the Minister would not have thrust upon him the burden of having to go to a consultative committee afterwards. In moving the Amendment, we do not wish to make difficulties, but only to achieve practical results. I think the Amendment represents the great body of opinion in the medical profession, which would like to see a council of this sort set up to co-operate with the local authorities.

5.3 p.m.

Mr. Elliot

I appreciate the purpose of the hon. Member for East Birkenhead (Mr. White) and the hon. Baronet the Member for South-West Bethnal Green (Sir P. Harris), and also the desire of my hon. Friend the Member for St. Albans (Sir F. Fremantle). They wish to create a piece of machinery by which expert and technical opinion can, with the least possible friction, be brought to bear on the schemes while they are in the informal stage. That is the desire of all of us, There are two things which have to be considered: first, whether there should be a statutory provision by which consultation would take place before the schemes reached the Minister, or, secondly, whether it should be left to the Minister to undertake that consultation himself.

Let us examine the Amendment. I do not wish to stress the point that when enumerating the interests which would be concerned, one might leave out one—for instance, my hon. Friend the Member for St. Albans mentioned the gynaecologists, whose opinion we would wish to have—for the Amendment is brought forward as a sort of token Amendment, raising the question whether the scheme of the Bill is the best one for eliciting expert and technical opinion and bringing it to bear on this problem. I suggest that the proposal contained in the Amendment rather runs counter to the Amendment which the Committee has just accepted, by which a statutory provision for consultation was omitted from the Bill. That Amendment was accepted by way of cleaning up the Bill and leaving the administrative problem as one to be dealt with between the administrators of the local authorities and the administrators of the Department.

The schemes would not come straight to the Minister, but would come through the filter of the skilled technical opinion of the Department. It would not be possible for the Minister to divest himself of the responsibility of having the schemes so examined; he would never be able to pass them automatically, for the House would always, rightly, hold that it was his responsibility, and that it was his decision, no matter whom he consulted or did not consult. With regard to the difficulties which my hon. Friend the Member for St. Albans foresaw, not in the case of great bodies such as the London County Council or the West Riding of Yorkshire, but in the case of smaller bodies, that they would not have the skilled technical opinion which is readily at the disposal of great bodies, I would remind hon. Members that the Department has experience of housing, water, and sewage schemes coming from the smaller local authorities, involving considerable technical problems. In such cases there is informal consultation with the town clerks and the county clerks, who come to town and get in touch with the officer of the Ministry dealing with the particular subject. It has been our aim and endeavour—and I think we have been successful—in recent years to make that course as informal as possible.

Mr. Maxton

Just one big happy family?

Mr. Elliot

We do our best; we are, so to speak, the city office of these organisations. I do not think any local authority administration would deny that it has, so to speak, the telephone number of the Department. A great deal of the consultation which my hon. Friend the Member for St. Albans desires does take place now. My hon. Friend fears that a borough might get deeply committed in some ambitious scheme and would then feel very sore if the scheme were modified or turned down; but I think it would feel equally sore if the scheme were modified or turned down by a national council such as is suggested in the Amendment or by an advisory committee such as my hon. Friend suggested. I feel that the Bill as it is will conduce to what the hon. Members have in mind, namely, informal consultation when the schemes are in the informal stage. It is that which we all desire.

Hon. Members will ask, quite properly, what I suggest as an alternative to the Amendment, and what is the machinery by which I expect it to be worked. I would appoint a Cancer Committee, including experts in surgery, medicine, gynaecology, radio therapy, pathology, and public health administration. I would make that a sub-committee of my Medical Advisory Committee for the purpose of getting that wider review which my hon. Friend the Member for St. Albans desires. My hon. Friend mentioned the general practitioners. There is a Statutory provision for consultation between the local authorities and the general practitioners, but my hon. Friend said that the schemes would need to be reviewed by those who looked upon them from a rather wider aspect. That will be secured by dovetailing the sub-committee to which I have referred and the Medical Advisory Committee, for that body consists of the President of the Royal College of Physicians, the President of the Royal College of Surgeons, the President of the Royal College of Obstetricians and Gynaecologists, the Chairman of the Council of the British Medical Association, and others. Therefore, I think the general review, as well as the particular review, will be secured.

Finally, the question of delay was raised. It is true that these large committees meet infrequently, and as far as possible work in sub-committees. One desires, where possible, to avoid calling together a number of busy men, say, once a week or once a fortnight. I shall give the sub-committee the right of direct access to me as Minister. If any member of the main committee desired to have a special meeting to consider some particular matter, the committee could be called, or if I thought there was an important question which required further consideration, I could ask the committee to meet. The Cancer Committee, however, would have the right of direct access to the Minister, and this, I think, would obviate the danger of there being a delay. I suggest that this flexible and non-Statutory piece of machinery, which could be modified at short notice, would be expeditious in action and would not weaken the chain of executive authority between the local authority, upon whom the duty is placed of bringing these schemes into existence, and the Minister, who is responsible to Parliament for seeing that the work is done. I submit that we have there a workable solution, which I commend to the Committee; and having heard this explanation, I hope the hon. Member will be willing to withdraw the Amendment.

5.13 p.m.

Mr. White

I have listened with gratitude to the explanation which the Minister has given and the evidence of his having devoted considerable thought to this subject. The matters raised are matters of opinion, upon which one can only agree or disagree, and I am quite prepared to admit that there may be as many advantages and disadvantages on the right hon. Gentleman's side of the argument as there are on mine. My Amendment specifies certain people representing various branches of the profession, and it was promptly pointed out by the hon. Member for St. Albans (Sir F. Fremantle) that I had not included representatives of all the branches interested. I suppose it is the intention of the Minister that the sub-committee to which he has referred shall be representative of all those able to make any substantial and effective contribution.

Mr. Elliot

That is my intention, and even if the list originally contemplated does not fully meet all the interests, since the committee is not a Statutory com- mittee it will be possible for me to add other members.

Mr. White

My only regret is that work of this importance should have to be relegated to a body whose official designation is to be a sub-committee. That hardly seems to be appropriate when one considers the great importance of the work that may be done. In the circumstances, however, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

5.15 p.m.

Mr. H. Morrison

I beg to move, in page 2, line 31, at the end, to insert: (6) Nothing in the arrangements or alteration or extension of arrangements made or approved under this Section shall impose an obligation upon a council to—

1. (a) make any payments to the governing body of any voluntary hospital in respect of the diagnosis or treatment of cancer in that hospital; or
2. (b) defray any expenses in relation to any person resident outside the area of the council."

I hope the Minister will be able to give us some assurances with regard to this Amendment, which is moved primarily on behalf of the London County Council but deals with a matter in which local authorities generally are interested. Clause 1 of the Bill requires local authorities to make schemes and submit them to the Minister. We are anxious to get an assurance that it is not intended that the Minister's power shall be used in the direction of giving particular grants to particular hospitals. A local authority will know the quality and character of the voluntary hospitals in its city or district and certainly all those facts would be taken into account in London. It is bound to be the case that some voluntary and indeed some municipal hospitals will be better than others for the treatment of cancer, and there may be an effort on the part of voluntary hospitals to make hay while the sun shines, and to get grants under this Bill for the purpose of assisting them in dealing with the general financial problems with which they are faced.

I think it is agreed by the voluntary hospital people themselves, both in London and the country generally, that the quality of these voluntary hospitals varies very much, and undoubtedly, some of them—it may be a minority— will be unable to do an efficient and economical job of work under this Bill. It is important that whatever assistance goes to voluntary hospitals for work under the Bill, should be concentrated on those hospitals which can do that work effectively and should not be diffused and wasted on hospitals which cannot "deliver the goods" in accordance with the terms of the Bill. In that respect, local authorities have a great knowledge, and their representations, or the provisions of their schemes, ought not to be lightly upset by the Minister, out of kindness to particular voluntary hospitals which might be in financial difficulties and to which, perhaps, under some Parliamentary or constituency pressure, he might wish to do a good turn.

It is profoundly important, from the voluntary hospital point of view, that the help should go to the voluntary hospitals which can really do, as many of them can, a good job of work according to the requirements of this Bill, in the treatment of cancer. Therefore, we should like some protection from the possibility of the Minister forcing us to give assistance to particular voluntary hospitals in a way which might upset the balance of a scheme in a well-regulated area. I admit forthwith that there is a difficulty about the wording of paragraph (a) of the Amendment, in that if a local authority, acting on some abstract principle, refused to make any grant to any voluntary hospital, the provisions of the Measure could possibly be upset under this wording. It may need reconsideration in that respect. If it were the case, for example, that in a borough or county the municipal hospital was not well run for purposes of cancer treatment and the voluntary hospital was well run, then, I agree, it would be wrong if the county council or borough council refused a grant to the voluntary hospital and insisted on using all the money for its own hospital.

I am admitting the case against me, but I ask that the case in favour of my proposal should be recognised and that the Minister should do what he can to meet it. Under paragraph (b) the Amendment seeks to protect local authorities who are doing their job under the Bill, against other local authorities who are not doing so, who leave their people to be treated in other areas and who, through some technicality of the law, are able to evade financial responsibility for the treatment of their own citizens. I raised this point in the Second Reading Debate and the Parliamentary Secretary was good enough in replying to refer to the fact in these words: He raised the question of the right of recovery of the cost of their treatment from patients who come from outside the area of the local authority and are treated in the organisations of that local authority. It is not the intention of the Bill that the London County Council, for instance, should pay for the treatment of patients who come from outside their areas. If Berkshire or Buckinghamshire sent a patient to a London voluntary hospital, then, clearly Berkshire or Buckinghamshire must pay for the treatment."—[OFEICIAL REPORT, 12th December, 1938; col. 1749, Vol. 342.] He went on to say that it was for the county council to secure that they paid only for their own patients, and indicated that we had a fair case on the merits. All I ask now is proper legal protection—and here I am not speaking of the London County Council, because this is a general matter and affects the whole country. Suppose that some of the authorities in the counties surrounding Birmingham were to neglect their duty under this Bill and their citizens were allowed to drift into Birmingham to be treated under the Birmingham Corporation's scheme. That would be very unfair to the corporation. It would punish them for being progressive and efficient. They ought to have a remedy at law against those outside authorities and should be able to recover from those authorities a proper charge in respect of the treatment of patients from those areas. I think that is a reasonable request.

As I say, this question affects not only this mixed-up area of Greater London but every area in the country, and particularly those where there is a big city in the middle of a number of rather far-flung districts. We are asking only that each local authority shall bear the cost of the treatment of its own citizens. I hope that the Minister will be able to give us some satisfaction if only by an Amendment on the lines of paragraph (b). I admit there are technical drafting difficulties about paragraph (a). I do not want the Amendment to go further than our real intention, but I hope that at any rate the right hon. Gentleman will give us an indication of his administrative intentions under the Bill and perhaps he will be able to meet, substantially, the points which I have raised.

5.23 p.m.

Mr. Elliot

I think I can meet the right hon. Gentleman on both points. Like him, I see great difficulty in finding words to cover the points which he has in mind. He has very fairly indicated that the drafting of paragraph (a) of his Amendment would actually go further than he desires, and that he does not insist upon it. I think he indicated that he would be satisfied if he could get some idea of what the administrative purpose of the Minister was under the Bill, and an assurance that the Minister did not intend to take advantage of the great position of authority which this Measure would give him to show bias towards particular hospitals on the ground that they were doing their best and that if they were not admitted to a place under the scheme, it would go hardly with them when they were next appealing for subscriptions or when the board of governors next met. I give him that assurance in the most unequivocal terms. What I have in mind is the advantage of the patient, and only the advantage of the patient. If the work is being better done in one hospital than in another, whether it be municipal or voluntary or whether it is a case of one voluntary hospital against another, the interest of the patient must not only be paramount; it must be the only interest considered. I shall do nothing to throw work towards a voluntary hospital which would be incapable of properly performing it. I should consider that to do so was not merely sinning against the light as an administrator, but sinning against the laws of Aesculapius which some of us in the medical profession would perhaps regard as an even more binding obligation.

The only difficulty which arises is the difficulty so often mentioned—a difficulty which arises when the administration passes from one Minister to another. I do not think you could draft words to say that the Minister shall not show bias, because in fact the only way in which you can guard against bias is by being able to raise it on the Floor of the House. If the Minister is showing bias he can be hammered here, until the bias has been knocked out of him. I have already refused to shelter myself behind a consultative committee and statutory consultations, for this very reason—that I wish the responsibility to be here on the Floor of the House upon the Minister. I am sure the right hon. Gentleman will admit that I have gone far to meet the position from the statutory point of view. His second point was that, either in London or Birmingham, it would be wrong if the ratepayers of those authorities were taxed for the treatment of patients for whom they had no real responsibility and that it would be wrong of authorities in surrounding areas to evade their obligations and leave the work of the treatment of their own people to those who were more ready to do it—that in fact the willing horse should take the heavy load.

I was interested in the point which the right hon. Gentleman made on the Second Reading. I have gone into it carefully with my legal advisers and they assure me positively that there is nothing in the Bill to suggest any obligation to provide treatment to persons outside the area of the local authority. No such obligation, I am told, is imposed by the Bill or could he imposed by the arrangements. The words of the Bill are: It shall be the duty of the council of every county and county borough in England to make arrangements to secure that the facilities for the treatment of persons suffering from cancer are adequate for the needs of the county or borough. I am assured unequivocally that it would be impossible, under those words, to found a claim upon a county or borough to pay for treatment which went beyond that which was adequate for the needs of that county or borough. I dos not think anyone would say that the needs of a county or borough could be stretched to cover the treatment of all the cancer patients from outside that county or borough who might turn up in its hospitals. How we are to deal with the question of recovery is much better left for the arrangements which are proposed, but I can give an assurance to the right hon. Gentleman and the House that it is not the intention that a council should be under any obligation to provide treatment for persons who do not belong to its area. I have said that there is nothing in the drafting of the Bill which could compel such a burden to be imposed and in framing the arrangements I shall do my best, in consultation with the local authorities, both central local authorities such as those which the right hon. Gentleman has in mind and the other local authorities as well, in order to ensure a fair arrangement between the local authority from which a case may come and the local authority to which a case may go. But the problem is too complicated to allow us to work this proposal into the terms of the Bill. Therefore, I hope that with that explanation the right hon. Gentleman will be prepared to rely upon the consultations which I shall undertake to make and on the assurance of my legal advisers.

5.30 p.m.

Mr. Silkin

I think the Minister has fairly met the precise point in the Amendment of my right hon. Friend. It is, perhaps, difficult to go beyond what he has said, and I am inclined to think my right hon. Friend will accept the assurance he has given. There is, however, a second point. The difficulty is not so much that the local authority is under no obligation to treat a person who comes from outside its area, but that in an area like London it is very difficult to check where a person does come from before treatment is given. It is cases like that which we are anxious to have met. It is within the experience of the London County Council, and I imagine of other large authorities, that when persons from outside the county have been treated, there is considerable difficulty in recovering the cost. I hope the Minister will direct close attention to that point. The question is not so much the obligation to take persons from outside, because in an emergency one does not want to turn a person away merely because he is domiciled outside the area. The trouble is that when we have given treatment and find a person is chargeable to another authority, if that authority refuses to pay we have no effective remedy. If the Minister would give consideration to that point, I think it would give satisfaction to my right hon. Friend.

Mr. Elliot

I think the hon. Member will see that that difficulty is not met by this Amendment, because it says "person resident outside the area." What he presses now is the difficulty of ascertaining whether a person is or is not resident outside the area. While I am perfectly willing that that should be the principle upon which we should go, I think the details had better be left to be dealt with in the arrangements we are drawing up.

Mr. Silkin

I think there are difficulties in regard to wording and perhaps the Amendment does not altogether meet the case.

5.35 p.m.

Colonel Nathan

The assurance which the Minister has given goes a very long way. My right hon. Friend said quite frankly that he spoke from the standpoint of the London County Council and other local authorities, and I may say with equal frankness that I am speaking now from the standpoint of voluntary hospitals. The attitude of voluntary hospitals, as I understand it, is that they do not desire—to use a phrase of my right hon. Friend—that there should be any particular grant to a particular hospital in the sense of supplementing the income which otherwise they might lack. The attitude of the voluntary hospitals is that, as in the case of arrangements with local authorities for the treatment of venereal disease, they should be paid for the work which by agreement they have undertaken to do. I do not think my right hon. Friend would dissent from that. I think it is in line with what he has in his mind, although the wording of this Amendment goes very far beyond that. I agree that there is great difficulty in framing an Amendment, and I think that upon this point the undertaking which the Minister gives is satisfactory, but I am not so clear on the other point in regard to the defraying of expenses incurred in relation to persons outside the area of the county.

My right hon. Friend the Member for South Hackney (Mr. H. Morrison), with his great and ripe experience in these matters, has spoken of the difficulties of recovering from other authorities. The difficulty, as I visualise it in the case of voluntary hospitals, is how and from whom the voluntary hospitals are to recover expenditure in respect of a patient who comes from outside the area of the council which has jurisdiction over that hospital. It is very difficult indeed, and I think impossible, for a voluntary hospital to refuse to treat a patient just because he comes from outside the area. It is common knowledge that many voluntary hospitals, certainly in London, by reason of the facilities they offer and the reputation they have gained, receive patients from every part of the country. If there is an arrangement that they are to reserve a certain amount of accommodation for London patients that does not mean, I take it, that they would be entitled to refuse patients from outside. The London County Council, according to the statement made by the Minister, from which I do not in the least dissent, would be under no obligation to pay the hospital.

My concern is to see that the voluntary hospitals should have some means of recovering the cost of treatment of outside patients from outside authorities. I am not quite sure what arrangement should be made. It might be possible to ask the London County Council to act as a sort of agent for recovery, although I do not suppose my right hon. Friend the Member for South Hackney would accept that position with much gratification, or it may be necessary to insert something in the Bill. I understood the Minister to say that he would deal with this as a matter of administrative practice. Speaking subject to correction, I am not quite sure whether in the way the Bill is framed he could make it compulsory upon, let us say, the County Council of Berkshire to pay for a patient taken into the Westminster Hospital in the County of London. I am not sure that he can do that by the exercise of his administrative functions, and I would ask him to consider whether there should not be some specific legislation enabling him to do so.

5.40 p.m.

Sir F. Fremantle

I was alarmed by the second part of the right hon. Gentleman's Amendment, and the reception given to it by the Minister. The Bill relates only to the obligation of a county or county borough to deal with its own area. I am concerned with those counties or county boroughs which cannot provide arrangements for the treatment of cancer. When this scheme was being debated it was made clear that, instead of being an enormous scheme covering all the 1,900 local authorities it must be confined to a few definite centres where radium could be properly used by radiologists and others who are sufficiently trained in the extremely difficult work that will be required of them. It has been pointed out that there are comparatively few such men. Therefore, it will be very difficult for some of the smaller or more scattered counties to provide any such scheme. Are the people in those counties going to be left out of the scheme compulsorily? We are being asked to provide a large sum of money for contri- butions under the scheme. There is a limited amount of radium, and it is going to be distributed to a few centres. Are the others to be excluded? Is it going to be compulsory for the particular areas favoured with the largesse of Parliament and the taxpayer in the form of radium contributions to include the less favoured areas? I ask the question in order to have the situation made clear.

5.42 p.m.

Mr. Elliot

I would like at once to clear up that point, and I would refer my hon. Friend the Member for St. Albans (Sir F. Fremantle) to the Clauses of the Bill we have already passed. If he will look at Clause 1 he will see that Sub-section (2, b) says: the arrangements submitted by any such council shall include arrangements … for the treatment of cancer either in hospitals maintained by the council or in hospitals maintained by other councils or local authorities or in voluntary hospitals. I think that meets the point taken up by the hon. and gallant Member for Central Wandsworth (Colonel Nathan) and the hon. Member for St. Albans. It is provided in Sub-section (1) that the council of every county and county borough must make arrangements to secure that the facilities for the treatment of persons suffering from cancer are adequate. That means that a person in a remote county does come under the Bill. The council of a remote county must make arrangements to see that the facilities for treatment are adequate for the needs of the inhabitants of the county. Moreover, in the case of remote counties in England and Wales and Scotland arrangements must be made for patients travelling from those remote areas to the centres where facilities exist. It is provided in Subsection (2, c) that there shall be arrangements for the payment, in such cases as the council considers necessary, of travelling expenses reasonably incurred by persons for the purpose of availing themselves of cancer services. Therefore, I think the obligation is clear that an authority may discharge its duty by making provision in some cases for treatment outside its boundary and for paying travelling expenses to persons passing from remote to central regions for treatment.

As to the specific point put by the hon. and gallant Member for Central Wandsworth as to the position of a voluntary hospital which was treating such a person, I will not say that that cannot be provided against in the Statute, but it can easily be provided for in the arrangements we propose to approve. As he has asked me to look into that point I will do so during the later stages of the Bill.

5.46 p.m.

Mr. H. Morrison

In the circumstances I do not propose to press the Amendment. I am not at all happy, however, with what the Minister has said about paragraph (b) of the Amendment. I do not think we shall have any statutory protection at all under the declaration of the Bill that it is the duty of any local authority to make proper provision. That imposes a duty on the local authority, but it does not give us a right to get money back from a local authority in respect of expenses which we have incurred.

Mr. Elliot

I think that that is true, but the right hon. Gentleman is probably looking at it only from the reception end and not from the despatching end. There is no intention that an authority that sends a patient shall evade its obligations.

Mr. Morrison

But suppose a county outside Manchester—I am sure in the case of Manchester it will not be so, for I am certain they will have a good scheme—but suppose a county contiguous to a great borough, or a county borough within a county where the county has a thoroughly efficient scheme and the borough has not. The county borough makes a scheme, it is submitted to the Minister, and it is approved. The citizens of the county borough, however, know that they will get better treatment if they go to a hospital of the county council or, it may be, vice versa, and the county people will know that they can get better treatment in the town, which probably will be the case because the towns have more money. A patient goes to the town because he thinks he will have a better time or he likes it or it may be more convenient. In due course the receiving authority wants to be paid. Any decent local authority will pay, but authorities do not always do it. The London County Council have had cases in which it has been kind and considerate to people who have come into the hospitals in the county, and the outside local authority, having a technical point of view, have slid out of their obligations. It is not playing the game.

It is not a matter of politics, because such local authorities have been of more than one kind, and I do not like it. I want to tell the right hon. Gentleman that the London County Council are not going to be exploited by anybody under this Bill. My hon. and gallant Friend the Member for Central Wandsworth (Colonel Nathan) put the point of the voluntary hospitals. I have no objection to his putting that point, but if a voluntary hospital is within the administrative county of London, the County Council are not going to be landed with the cost of the patients of such a hospital, no matter where they came from. I should have thought it easy to find words to cover this point in the Bill. If the Minister cannot find them for the Bill, can he find them for the scheme, and if he can find them for the scheme will they have legal authority unless they are in the major legal instrument, namely, the Act?

On paragraph (a) I accept the right hon. Gentleman's assurance, because I think it reasonable in the circumstances, and I do not see that he can do much more for us on that point; but I would ask him, without prejudice either way, whether he will look further into paragraph (b) between now and the Report stage. I will ask the London County Council officers to do the same, and no doubt other local authorities will do it. Our officers might confer to see whether we cannot find words to cover us in the Bill and to give the Minister the necessary authority to provide properly for it in the arrangements he makes under the Bill.

Mr. Elliot

I will certainly do that.

Mr. Morrison

In the circumstances, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Amendment made: In page 3, line 14, after the first "the," insert "board or."—[Mr. Elliot.]

Motion made, and Question proposed, "That the Clause, as amended, stand part of the Bill."

5.50 p.m.

Mr. White

I should like to take the opportunity of addressing an inquiry to my right hon. Friend on Sub-section (6). Inquiries which reach me lead me to believe that there is a certain amount of uncertainty with regard to the meaning of this Sub-section. The general purpose of this Bill is, of course, curative, but there is the section of treatment which deals with incurable cases. Sub-section (6) precludes the possibility of the establishment by any council of a general domiciliary service by medical practitioners. There is apprehension in the minds of some people that this may preclude any domiciliary treatment by a visiting nurse or a medical practitioner in incurable cases. If there is anything in Sub-section (6) which would render nugatory those services of mercy it is felt it would be a great misfortune.

5.51 p.m.

Mr. Silkin

I should like to raise the question of home nursing and to ask the Minister to give an assurance that he will be prepared to recognise home nursing in the arrangements submitted to him for approval under this Clause. The Minister has already made it clear that this Bill is not necessarily a Radium Bill. It is described in the explanatory memorandum as a Bill to provide facilities for diagnosis and treatment of cancer, whether by radium or any other means. While radium treatment is necessary in hospitals, there may be the possibility of giving treatment in a satisfactory way in the home through nurses without reference to radium. This would particularly be the case where a hospital was unable any further to benefit a patient and where the patient nevertheless requires a good deal of care such as could be given by a skilled nurse. Nurses might also be employed at home in following up cases and reporting to a hospital about the treatment, and possibly reporting that further treatment might be desirable. There is no intention of asking the Minister to authorise the setting up by any council of general domiciliary services by medical practitioners. We are not anxious to evade that provision, but it is thought that home nursing in certain circumstances would be desirable and beneficial and be a saving of money to the local authorities. I hope that the Minister can give an assurance that he will be prepared to recognise home nursing as part of the arrangements submitted by local authorities under this Clause.

5.45 p.m.

Colonel Nathan

The point I would like to raise on this Clause is with regard to the clinical treatment to be included in the schemes sent to the Minister, and the attitude he will adopt to them in giving or withholding his sanction. The opinion is widely held that to establish clinics for the purpose of diagnosing and treating cancer would have a detrimental effect upon the public mind and would be likely to prevent persons going to the clinic in the early stages of the disease as it is essential that they should. Certain of the professional bodies which have considered this matter, and certainly the voluntary hospitals, would consider the creation of diagnostic centres, however labelled, with great alarm as being calculated to prevent patients going there when they might go if the clinics were associated with and organically part of some hospital, because it would at once be known by all their friends and relations that they were or suspected to be sufferers from cancer, with the unfortunate psychological effect which experience has shown that that knowledge has. I hope, therefore, that the Minister will bear in mind the profound concern which would be created if it were proposed to establish clinics independently of existing hospital organisation.

Experience has shown, with regard, for instance, to tuberculosis clinics, which were established some years ago and which have been most beneficial, that they have prevented the great teaching hospitals from acquiring that clinical material which is required for the training of the new generation of medical men. I hope, therefore, that the Minister, in considering the schemes, will bear in mind the necessity of ensuring that by the attachment of clinics to the great voluntary hospitals which are dealing with cancer opportunities will be given to those who are in the teaching schools there of obtaining the necessary clinical material without which they cannot succeed with research or training for their profession.

5.58 p.m.

Mr. Elliot

I was thinking when listening to the hon. and gallant Member for Central Wandsworth (Colonel Nathan) how wise I have been to indicate to the House my desire to get the best possible technical advice in the Cancer Committee which I have mentioned. This is just the sort of problem which one would desire to review with the technical advisers. I think the House and the right hon. Gentleman the Member for South Hackney (Mr. H. Morrison) will agree that it will be sound administration to seek that advice, although of course the whole responsibility rests on myself. The two important points which were raised by the hon. Member for East Birkenhead (Mr. White) and the hon. Member for Peckham (Mr. Silkin) related to Subsection (6), which says that there shall be no power to establish a domiciliary medical service. I think that would also clearly apply to a domiciliary nursing service, but I do not think there is any intention of precluding the following-up visit of a nurse to a patient or some investigation by a medical practitioner of a patient's progress. I do not think, however, that within the plan of the Bill a domiciliary medical or nursing service should be established.

Mr. White

I should like to know whether there is anything in the phrase "general domiciliary service" which would prevent treatment in cases such as I have indicated being carried out elsewhere than in the hospital.

Mr. Elliot

I think such cases would be more properly treated in hospital than in the home. I think it would be the desire of all of us that in those final stages the treatment should be given in hospitals. I do not think we could take the responsibility for persons in that condition undergoing treatment in a private house.

6.1 p.m.

Mr. Rhys Davies

The first few words of the Clause read: It shall be the duty of the council of every county and county borough in England. I have raised this point with the right hon. Gentleman before, and I can assure him that the Welsh people are very much disappointed that he has supposed that the word "England" in this Bill covers Wales. He had better know that Wales is a country on its own, just as Scotland is, and we want to know whether he means that "England" used in this connection includes Wales. Is it not a fact that up to a few years ago whenever England was mentioned in legislation it was mentioned in conjunction with Wales, and that it is only recently that Wales has been omitted from the phraseology of Parliamentary Bills? Will the right hon. Gentleman be good enough to say how it comes about that this insult has been given to the country of my birth?

6.2 p.m.

Mr. Elliot

I greatly regret that any insult should have been levelled at the country of the hon. Gentleman's birth, but surely if he felt it was such an insult he should have put down an Amendment to remove the stigma. The Bill has been before the House for some time.

Mr. Rhys Davies

We will do it later.

Mr. Elliot

Surely the hon. Member cannot have felt the insult very keenly, or he would have put down an Amendment before. Naturally no insult was intended. We were following administrative practice, but I think I could shelter myself behind the fact that it is a little late to call my attention to the omission on the question of the Clause standing part.

Mr. H. Morrison

My hon. Friend is in the difficulty of being a Welshman representing a Lancashire constituency, but on Report stage we may have an Amendment put down by a Welshman who really comes from Wales and really represents Wales.

Mr. David Adams

As regards Subsection (6) I should like to inquire what is the position of a local authority such as that at Newcastle-upon-Tyne, which already has a general domiciliary service carried out by medical practitioners. I take it there is nothing in the Bill which would prevent the continuation of that domiciliary service.

Mr. Elliot

The Sub-section says: Nothing in this Section shall authorise the establishment. …' That will not take away any powers which are already exercised.