HC Deb 10 June 1943 vol 390 cc957-76
Dr. Russell Thomas (Southampton)

The matter I am going to raise concerns the negotiations which have taken place between the Minister of Health and the medical profession. I would ask the House to believe that my position in regard to this matter is somewhat embarrassing, but I want the Minister and the House to understand that I raise this matter with no personal feeling at all towards any one, but purely and simply because I think that the Members of this House should have some idea before the White Paper is published, perhaps months ahead, of what has taken place between the Minister and the medical profession. After this House had suggested to the Minister that he should begin negotiations with regard to Assumption B of the Beveridge Report, on 26th May, the hon. Member for London University (Sir E. Graham-Little) asked the Minister in this House: What answer he has given to a large meeting of medical practitioners held recently to discuss future: arrangements for medical practice. I am not going to read the whole of the Minister's answer but only the main point, as hon. Members can read for themselves exactly what was said. He said: As a basis for discussion I have from time to time put ideas of my own before this committee and have invited them similarly to let me have their ideas and their full and free criticism of mine."—[OFFICIAL REPORT, 26th May, 1943; cols. 1585–1586, Vol. 389.] The impression one got was that the Minister and representatives of the medical profession had sat round a table and had suggested ideas to one another—a sort of game of tennis. But I do not think that that is the whole story and it is the memorandum put forward by the Minister that I want to bring to the notice of the House. The hon. Member for London University asked the Minister whether his attention had been drawn to a large meeting of medical practitioners held recently and the Minister in regard to that part of the Question said he was not sure to what meeting the hon. Member referred. I will quote from the words of the chairman of that meeting who is, I believe, chairman of the representative committee which meets the Minister. The meeting was held on 16th May. The chairman said: As chairman of the representative committee which is meeting the Minister on the morrow— that was on the 17th— I only wish I could carry the atmosphere of this meeting with me. Yet the Minister in reply to the hon. Member for London University on 26th May was not clear as to what that meeting was and when it was held. The fact was that on 16th May the British Medical Association was highly perturbed and held a mass meeting of medical practitioners from the Metropolitan area at which over 1,000 people attended. That was on a Sunday, the one day that a doctor expects peace but seldom gets it. It was an urgent meeting and it was crowded. It was impossible to obtain contact with the whole of the practitioners of the country but it did the best it could and mobilised the practitioners of the London area. That meeting was addressed by the Deputy Secretary of the British Medical Association who spoke to them because he thought the profession should be informed of the proposals which had been put forward by the Minister. So urgent had the matter become that Sunday was chosen. I want, as far as I can, not o intrude any opinions of my own or indeed to side-track from the narrative that I hope to put before the House. I would rather rely on what happened at that meeting and thereby, bit by bit, put before the House the proposals put forward by the Minister.

Sir Patrick Hannon (Birmingham, Moseley)

A Sunday meeting of 1,000 doctors.

Br. Thomas

A Sunday meeting of 1,000 doctors. The Deputy Secretary said that the discussions with the Minister were supposed to be confidential and he also made it clear that the tentative conclusions they embodied would be published in a White Paper and in the light of its consideration by the public and by interested bodies the Government would proceed with legislative preparations for a comprehensive medical service scheme at or soon after the end of the war. I would point out that the "British Medical Journal," the organ of the medical profession, said that Dr. Hill was received with an acclamation seldom found at these meetings. The negotiations between the Minister and the medical profession were supposed to be confidential but they had leaked out. The "Daily Express" and "The Evening Standard." had made some reference to them some time ago and the consequence was that it was thought better to make a clean breast of the whole thing.

But, as the "British Medical Journal" in its leading article of 29th May said, they are committal in the sense that they show clearly the direction in which the Ministerial mind is moving and its conception of what should happen to the profession of medicine in this country. Put briefly and bluntly, medical men should cease freely to practise as doctors and instead, should become whole-time employees of local authorities. If this happens doctors will no longer constitute a learned profession but instead form a service of technicians controlled by central bureaucrats and by men and women entirely ignorant of medical matters. The Minister it appears had undertaken with the medical profession to begin the negotiations "from the ground upwards." I think that that was the Minister's own expression. Again, I will quote the "British Medical Journal" in regard to that. It was said that discussions would proceed not on the basis of any preconceived plan of the Minister, but from the ground. The meaning of this rather obscure phrase is now becoming clear. The representative committee during its two months existence has met several times. Quite recently it had placed before it a memorandum from the Ministry which made plain how far from the ground the Ministerial plan had got. Dr. Hill, in discussing what he called the "dusty subject of the administrative proposals," made it clear that the Ministry rejected the conception of a corporate body, preferring Departmental control under the leadership of the Minister. Again, I will quote the exact words, which are always very much better: A special compartment of the present Ministry should be set up to run the show with a Minister—a political figure with a high degree of insecurity of tenure—responsible to Parliament for the health of the nation. At the centre of this organisation which the Minister has suggested in the Memorandum to be put forward to the medical profession there would be a body known as the Medical Services Council. This would be a statutory body with the right to make public its recommendations and proposals and issue a report. I am not quite clear how far the body would go, but I think it would probably concern itself chiefly with medical matters. There would also be a Central Medical Board, which would have executive authority over domestic matters and would act as an Appointments Bureau for whole-time State-salaried domiciliary services. At the periphery, and this point is most important, it is suggested that there would be a grouping of local authorities under joint boards for health purposes. These people would seem to be a combination of different local authorities, and the medical profession would largely be excluded. I think the Minister did promise that he would keep an open mind on this matter and, possibly, recommend the addition of a small number of medical personnel, but that is not clear. I am speaking strictly on the report given by Dr. Hill. The Minister proposed in the Memorandum that general practice, at least in areas of considerable population, should be based on health centres under the control of the local authority where, as Dr. Hill says, although this would be rather vague, such local authority clinical work as normally came within general practice would also be done. Health centres would be on the basis of these services, that is, a group of doctors working under a local authority would use a building, perhaps the town hall or some other place, where they would perform their work and where they would see any member of the public who wished to seek their services.

The Minister made it clear that he would allow no competitive practice of any kind in these central clinics. The desire of the British Medical Association has been to preserve the element of private practice and competition, which the Minister would not allow. The objections to the local authority arrangement were quite well set out by Dr. Anderson, Secretary of the British Medical Association, in a letter to "The Times" yesterday. He made it clear, for instance, that the joint local authority board would by no moans coincide with a hospital area. That, however, was a minor point. The main objection was this: The medical profession would be in the hands of the personnel of the local authorities, people who are elected periodically, who are frequently under the influence of party politics and who cannot have a proper understanding of the vital personal relationship which exists between doctor and patient. I would also remind the Minister that in addition to that the other services of the local authority would not come under this scheme. For instance, school clinics would be left outside.

I will gave an example of the danger of control by an action of a local authority. The London County Council at the outbreak of war thought that as their population was decreasing on account of the blitz and as their district medical officers would not have so many patients to attend to, the best thing to do was to decrease their salaries. That might happen under such a scheme as this. One thing that Sir William Beveridge asked for in his Report was that any medical scheme should have a comprehensiveness about it. In the words of Dr. Hill at the great meeting which was held: As for the comprehensiveness of the scheme it was not comprehensive as far as Government Departments were concerned. There was no proposal by the Government to put its own house in order and bring in all the scattered medical services in its Departments. Local authority government was embedded in the social fabric, but was this a genuine proposal to abolish smaller authorities and to concentrate health functions in bodies of sufficient strength and financial capacity to discharge them? The fact was that rural and urban district councils were still to be left with environmental health functions; that education authorities would remain responsible for the school medical service. Again, the mental health services were to be left as a separate entity, simply because mental health legislation was in a terrible mess which would take time to clear up. From the Government's point of view there was no time for this. So you see that in any case the scheme put forward by the Minister would lack the comprehensiveness which was an essential of the Beveridge Plan. In Dr. Anderson's letter to "The Times" tie said: The medical profession is aware of the part local authorities have played in our collective medical services but there is now involved, something different—personal service of which local authorities have little experience. It is service which is based on the intimate personal relations between patient and doctor. That is a matter of vast importance to the layman who has not been consulted at all and who would probably place security of food and housing before any other health measures, certainly before any transformation of his doctor into a local government official. I would like to tell the House of the conditions of service that the Minister proposes in this scheme. Those who are in general practice already—and you would always have to meet that difficulty—could enter service as whole-time medical officers, or, if they wished, could become part-time medical officers. That is rather interesting, because the Minister, I believe, suggested, according to Dr. Hill, that part-time people who came in might then augment their incomes by getting fees from people who were too self-respecting to attend the town hall. He said that new entrants, that is, the people who would be recruited as the years go by, would either enter the service or stay out. If they stayed out and did not put themselves under other local service, if such remained in being, they would have a poor chance indeed of obtaining a livelihood. The Central Medical Board to which I have referred would prepare a roll of members. That would be the first hurdle which the applicant would have to get over. After being enrolled, he would seek appointment by a local health authority. The contract of service suggested by the Memorandum would be terminable on either side, at three months' notice.

The proposals for the consultant service were extremely vague. It was clear that the Minister had not come to the definite conclusion that he seemed to have come to in regard to the general practitioners. They would be centred in a hospital. The appointment would be by the local authority and would be full or part-time, according to circumstances. Let us see what the Minister proposes to pay those new entrants to the service, or anyone who would undertake the practice of medicine under such conditions. He proposes to pay a salary of £400 a year. Supposing a young man finished his medical training at the age of 24, he would receive £400 a year. Probably for some time before that he would have held a house appointment in a hospital at £250 and all found. When he enters this magnificent scheme, on which so much depends on the intimate personal relationship between patient and doctor, he receives £400, and he remains on that basis for three years. After that he receives £650 a year, rising by £30 a year for a number of years. At the age of 40 or 50 he might be able to make the magnificent sum of £1,200 a year. These are days of high taxation in which the cost of living has risen considerably, and the difficulties of this young man in the post-war time would be very considerable, but perhaps there will be many young men released from the Army who will be only too glad to take a job of that kind!

The Minister mentioned compensation for practice. He said there would be compensation, but no details were given. Compensation for practice is a very serious matter. Only a few years ago a subject of high political controvery in this House was the compensation that would be paid to the owners of coal royalties. I believe feeling ran high. The matter was of first class importance and occupied a considerable amount of time. It eventually meant that the Government had to pay, I believe, something around £67,000,000. It has been estimated by certain people that the value of doctors' practices amounts to £87,000,000. The sum total of the money invested in practices is probably between £50,000,000 and £100,000,000. The whole of this was, I believe, dismissed in the Minister's Memorandum with small consideration, at any rate as far as I know. Certainly it was not given to the meeting of the British Medical Association. Dr. Hill made some comment on these proposals. He said: Why the hurry? Why was the Government pressing forward with such energy one section of the Beveridge proposals? It might be that it was anxious to do something and found a body of 50,000 men and women comparatively easy to handle. But in his view the fact was that the Government had decided that before the major structure of the security scheme could be elaborated it was found necessary to control the medical profession so that certification could be controlled. Remarks in the Beveridge Report and in Ministerial statements suggested that interpretation. Medical certification would be responsible for the major outgoings of the proposed security fund, and as these outgoings were to be increased it was necessary to establish a stricter control over certification. Our answer is obvious. The doctor's job is to decide whether a man is fit for work no matter whether the cash value of the certificate is 5s. or 50s. a week. Dr. Hill then suggested this cogent point: Is the profession being exploited for political expediency? I leave the House to ponder over that phrase, because it is well worth considering. The least politically dangerous move from the point of view of the Minister and the Government would be to act upon Assumption B. The public will admit Assumptions A and C. It is essential to keep an eye on the security fund. Again, I will quote the British Medical Journal: We have nationalised the doctors and so given effect to Assumption B. It almost looks as if the Government wishes to claim absolute control of the general practitioner for at least one purpose—strict supervision of certification by the doctor. Here is a further quotation from Dr. Hill: As for the health centre it was agreed that group practice would produce a better service, but before a single health centre had been built the Government proposed to recast medical practice and place it in toto on a health centre basis. They declared that the health centre method to be inconsistent with free competitive practice. But they showed great zeal for salaried method of service before one health centre was in being. This had been described as the translation of a free profession into a branch of local government service. Whatever might be thought about methods of remuneration as a profession they could not accept such translation of status. Dr. Hill later said: You need not have any doubt about the line which the representative committee is taking. It is difficult to avoid at this time of great apprehension an emotional approach to this problem, and I ask you to leave tie matter to those who are speaking on your behalf. We must avoid a repetition of 1912. Let us have no disunion in the next two months. Trust the people who are doing the talking for you and hold your forces until the time comes, as it may come, for a fight. Dr. Grigg, also, I believe, one of the representatives who meets the Minister, mentioned the state of hurry and bustle which pervaded the whole affair and said that if the Minister found his task more difficult he had only himself to blame, having committed himself already to the local authorities. The upshot of it all was that the medical profession turned down any further discussion of that Memorandum as being completely unfruitful. They demanded the setting up of a Royal Commission but after some further consultation that was set aside.

I have given a true and fair account of the negotiations up to date. They have done incalculable harm throughout the whole rank and file of the medical profession. Some time ago the British Medical Association formed a commission to examine the whole workings of the profession. This was carried out studiously and with great care by those who understood the difficulties of medical practice and recommendations of a far-reaching kind were made. Opinion on these matters and on the attitude of the profession towards the full-time State salaried service was sounded. The overwhelming majority supported freedom for doctor and patient. At the request of the Minister representatives of the profession willingly entered into negotiations without any preconceived understanding. They were to negotiate from the ground upwards. Within a short time they were met by a pigeon-holed ill-paid scheme of nationalisation. This caused bitterness and dismay throughout the profession, and they have indicated that negotiations on these lines would be unfruitful. Nevertheless, Dr. Hill and the leading article of the "British Medical Journal" have shown the workings of the Ministerial mind.

It being the hour appointed for the interruption of Business, the Motion for the Adjournment of the House lapsed, without Question put.

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

Dr. Thomas

My object has been merely to give Members of the House an idea of the discussions leading up to the present unfortunate position. I have tried to do it fairly. I can assure the House that I have no personal animosity against the Minister. What I have done would, I am sure, have been done with greater vigour by any barrister in the House if the Attorney-General had offered to nationalise the Bar or the Inns of Court or to make solicitors the minions of local authorities. But I shall not go into any deep argument to-day. I shall not be drawn into any long dissertation on this matter except to say that if the members of a great, learned, liberal profession, whose history goes so far into the distant past, which has served mankind throughout the ages and always worked for the alleviation of human suffering, and which has ever sustained a high standard of ethics, are to be reduced to being functionaries of a local authority they stand to lose their souls, but the masses themselves, these numbers, these cyphers who will be called their patients will be reduced to a form of slavery in this regard.

I have had some impression that the right hon. Gentleman was a Liberal, indeed, that he prided himself on being in the line of the great Liberals of the past, those men who believed in private enterprise, believed that a man should be free to follow his own calling in his own way if he did not injure others in doing so; but I cannot help thinking that the principles of the right hon. Gentleman savour very much of the theory of Karl Marx. I would warn the right hon. Gentleman that in 1912 a man of great stature, a man to whom this country owes much, nearly injured himself on this rock. Let him remember this. I am perfectly satisfied. I have given to the House the points which I think the House should know. I think it is essential for it to know the state of the negotiations. The whole profession 01 medicine to-day is disheartened and dismayed by the Memorandum which was put forward by the Minister. Doctors' have lost confidence in the negotiations with him, whatever their representatives may do, and I think it has been wise and vital, even at some length, to have informed Members of this House of what has occurred.

Dr. Morgan (Rochdale)

We have just had from the hon. Member for Southampton (Dr. Russelll Thomas) what one would have anticipated from him, a speech which was the concentrated essence of medical stupidity. I intend to take off the gloves and to speak the truth in the very few minutes allowed me. The hon. Member has not the faintest idea of what he is talking about. I, on the contrary, happen to be the representative of the West Indian doctors on the Council of the British Medical Association, so I am actually inside the sanctum sanctorum of the profession, and I fight them there. I do not go for them from this privileged position in a Debate on the Adjournment. If we were to have had a Debate of this kind, we should have had it when we could all speak our minds fully, have had a full day's Debate—not speak only for a few minutes and then not give way if another Member ventures to make an intervention. This is a big, national issue. It is a difficult problem at the best of times. Even with the best service available, provided after the most delicate negotiations, there will still be anomalies to smooth out, and it is essential that people should keep calm minds and should approach this question, not from the position of privileged or emotional opposition, but really as statesmen willing to do the best they can for the poor working class in this country.

Sir Henry Morris-Jones (Denbigh)

Not for the working classes, but for all classes.

Dr. Morgan

The hon. Member may have a very limited idea of the working class. By "working class" I meant the definition adopted by the Labour Party, which covers all who are workers by brain or hand, and if the hon. Member wishes to exclude anybody, even himself, he can do so. The present medical services are completely chaotic and disjointed. We have not a unified system, and the whole thing is absolutely futile, yet medical men are concentrating on petty little differences which could be got over in any decent scheme quite easily. The private relationship between the doctor and his patient is supposed to be involved, but I would ask hon. Members to examine the State medical service in Malaya. Ask the hon. and gallant Member for Hornsey (Captain Gammans) about it. He has had experience in the Government service in Malaya, where there is a general practitioner service, with medical officers of health and with institutions under the Government. Ask him whether the system does not work well there. The thing is feasible, provided there is good will.

I know that the Minister of Health has a heavy task in front of him. The present negotiations are non-committal. They are merely exploratory. You must explore a situation before you can evolve a policy. I have no hard words to say about the Minister—although I have said hard words before. Sometimes he is badly advised. I think he depends too much upon the British Medical Association, and he leans too much towards bureaucracy. After all, he is a Minister, and he has to consider the policy of his Government and take his proper place in it. It is a position in which any of us at any time might find ourselves. [HON. MEMBERS: "Hear, hear."] Oh no, I have no ambitions of that kind. I am getting too old now. My time is past to have ambitions of that kind. I want to retire, not to dabble about in party politics. The Beveridge Report does not make any medical proposals, but it says that one of the pillars on which it must stand is a national, comprehensive policy of medical service, free and available to all. It must be free of cost to the individual. The patient ought not to have to consider his means in order to get better.

A lot depends upon the doctor's certification. Many doctors certify a man as fit for work when they do not know what kind of work the man has been doing. I have been medical officer to one of the biggest trade union organisations in this country, dealing with certificates given by other doctors who evidently have not had the faintest idea of their patients' work. They have certified men as fit for work, but the certificates have not been worth the paper they were written on. They said the man was fit after an accident or a disease or a convalescence, when he was quite unfit and needed a period of refitment, rehabilitation, or retraining to get him back to his job. I was at a Catholic meeting where there were four speakers against any proposals of the Minister, and after three hours I was the only one who got up and spoke for 12 minutes in their favour. That is the kind of thing you get, privileged persons who are placed by this Parliament upon a special register, given a special education and a special grant which is a claim on the taxpayers and upon what money they may have to spend on tobacco or beer. Medical education or research is not under our control. If a man wants a consultative opinion at home under national health insurance, he cannot get it. You can sometimes spend as long as six hours telephoning to hospitals to get a patient in. I have friends who have been in panel practice, and I have been in panel practice myself deliberately. I have had the difficulty of getting patients desperately ill into hospitals which were so overcrowded that they could not get in, and I have done what one does when one has rich patients and has gone to a consultant, paid him two guineas, and got the patient into the hospital that way. If a man can afford to pay a consultant, he can very often get into one of the voluntary hospitals.

The present system is no credit to the professional organisation in this country or to Parliament's knowledge of medical conditions. It affects the health of the children and of the adults and is completely unco-ordinated. We are told that the medical service cannot be under the control of the local authorities, which takes away the basic principle of democracy. It is alleged that the personnel elected from the members of local authorities are not fit to control the relationship between doctor and patient. As if anybody appointed to a local authority wants to tell a doctor when he is to give a pill, or when he is to give a bottle of medicine, or make an examination or not. The thing is perfectly absurd. But on the question of whether a certain hospital is to be sited in a certain position, the doctors cannot be asked their views, because if the project was made public, the price of the land would go up to an extent which might jeopardise the scheme. But in the purview of the profession Whitley machinery, national, regional or local, can be arranged to get over these trivial difficulties. I could go on for days and days. I have handled this subject for 20 years, and officially for 10 years. I am a person whose advice has to be taken or rejected on this by important bodies in this country. [Interruption.] Laughter may come from some people with more knowledge and experience than I have, but I do not think it does, with due respect. The British Medical Association have been good enough in previous years to put me on six or seven of their committees.

In these negotiations I want the Minister to negotiate with other bodies, medical as well as lay. I want to ask him in particular also to have certain principles in front of his mind—no public finance without lay control; that medical education should, if possible, be democratised and brought within the purview of some authoritative body. At present those in control take your doctors early, as most religions do, and turn them out Tory sausages. I have seen it done. [Interruption.] The present sausages are not very much, and some of these who have not reached the Brains Trust can sometimes be wiser than those who can crawl into that sacred home. There are certain principles I want the Minister to lay down. That is one of them. The second is that the foundations must be basically democratic, and the privileges of the profession must not be exploited against the public interest, but, rather, a due sense of responsibility must be given to the professional representatives, with the right of the public to have a full service of treatment of all kinds, at home, in hospitals and when convalescent, of having a period of convalescence when necessary, and a period of rehabilitation and training. That could be properly organised with great benefit to the public without doing any harm to the ethics of the profession or to the calm, professional attitude which men who have to treat the sick ought to adopt, and without their thinking of finance all the time, of "How much are we going to get?" My salary has never been more than £1,200 a year, and I have been perfectly satisfied with that. I know many practitioners who are getting very much less and are perfectly well satisfied because they are interested in their profession as a profession and not as a money-making occupation. I am sorry I have taken so long, but a subject like this could occupy a much longer time, and each speaker could take an hour with very much benefit to the community and to the profession.

The Minister of Health (Mr. Ernest Brown)

I am sure the House has been interested in this Debate. My hon. Friend the Member for Rochdale (Dr. Morgan) is perfectly right—what we are dealing with is a gigantic national issue. It is the whole of the implications of Assumption B of the Beveridge Report. It is with those implications that I have to deal, since the Government have accepted the principle of Assumption B. It is not only, as my hon. Friend rightly suggested, a question of dealing with the medical profession, but a question of the whole administrative structure of a comprehensive health and hospital service. It includes the question of the relationship between the municipal hospitals on the one hand, and the voluntary hospitals on the other. I daresay there are 100 separate issues involved in Assumption B. Therefore, I welcome this opportunity of making clear what is happening in regard to the preliminary discussions of a comprehensive health service. I do not intend to enter into any of the details raised by my hon. Friend, because he has shown by his speech that his knowledge is not intimate: it is from reports, which, of course, I have read, equally with all those who follow the course of these discussions. There has been, in one way and another, and for one reason and another, a good deal of partial or second-hand information and rumour in circulation. Some direct statement from myself may not be amiss.

I will begin from February last. Although the idea of a really comprehensive health service is much older than that, it was in February last that the Government announced their acceptance in principle of Assumption B. That meant that they announced their decision to go ahead with the preparation of a comprehensive health service for the whole nation. Why I should be charged with some dereliction of duty for having used energy in this matter, I fail to understand. There is need for speed, although there is no need for haste—for speed and haste are not the same thing. There are several major issues which demand that decisions should be made as soon as possible. I, as Minister of Health, and my colleague the Secretary of State for Scotland are charged with the administration at the present moment of a very new thing, an emergency medical and hospital service. It is very certain that this country and all concerned in that service will want to know in good time what decisions ought to be taken about that service and its future when the war comes to an end. Also, there is a very large body of medical men, and especially young medical men, in the Forces now, and we have a duty to them and to their future. So the charge of speed leaves me quite cold. I can assure the House that there will be no undue haste, but there will be no lack of energy in trying to find solutions which will be characterised by what I believe is not merely the cement of all society, but the cement which alone will make a service like this strong, namely, good will. It is not enough to get a great machine, but we shall want a great machine that works smoothly in all its ramifications: the doctors, the authorities concerned—the local authorities or new authorities representing wider areas—the hospitals, municipal or voluntary, and the organisation at the centre. Whatever the conclusions we come to, we shall want the utmost good will. Without that, you may talk about a plan, but it will not operate as it ought to operate, to the benefit of the people as a whole, for whom the comprehensive health service is designed.

From that point in February, I felt all along that there ought to be broadly three stages in the preparation of this new service. The first stage was the preliminary one, in which we are now. That should be the one in which I sounded representatives of the medical profession, the major local authorities, and the voluntary hospitals, to find out how their minds were running on the various issues, and to put before them various ideas of my own. This is essentially an early stage, and so I informed the House; and I want to thank the House for the reticence it has shown at this stage. All those concerned with long and difficult negotiations know that there is no possibility of getting a just decision unless people are allowed to sound each other's minds, without necessarily committing themselves to the first view they put forward or even the second, or it may be the third. As the House knows, in my Ministerial life I have had a good many difficult negotiations in the industrial sphere at any rate, some of them taking many months. This present stage I saw as essentially an early stage. It was a case for the free and noncommittal, and preferably confidential, exchange of ideas, and that was agreed on all hands, and we had not in any sense reached the main discussion stage that would be followed by concrete legislative proposals when the Government had come to their conclusions. I saw indeed the importance of clearing some of the issues for all of us in my own mind before I embarked on the stage of inviting general public discussion, first in this House and then outside.

The second, and main stage, I wanted—and still want—to be one of full and open review of the whole subject both in Parliament and elsewhere, among all the organisations and professions and persons likely to be affected—and that includes, eminently, many who may at the moment be serving in the Forces as well as those engaged in their normal occupations. For this stage, which is the most important one, I thought—and still think, and I hope the House will agree with me—that the discussion may be focused and made more fruitful if I can put before it an appreciation of the main issues which will give everyone something tangible to bite on.

Dr. Haden Guest (Islington, North)

Without commitment?

Mr. Brown

Certainly, at that stage. That would be the stage when we should all find out best the feelings of everyone, and not least of the general public who are going to be the patients of this service and for whom the service will be designed, the service which will succeed in achieving its end only if it gives them a better service than they have ever had before. We should find out their feelings without these distractions of rumour or tendentious forecast which inevitably accompany the early and preliminary discussions.

The third stage is the introduction of draft legislation, the stage when, after all the open and public discussion and expression of opinion, the Government have to make up their mind what is on the whole the right and most practicable measure to introduce to Parliament. That was the general programme in my mind last February, and it still is. It is a sound and wise programme and likely to be fruitful, given good will.

Let me now go back and tell the House what has happened since February. I duly arranged with representatives of the medical profession, the major local authorities—and I have also seen others beside the major authorities—and the voluntary hospitals to embark on the first stage with me, that is, on the preliminary and informal exchange of ideas. The medical representatives—and I will confine myself to them in this account, as it is in that aspect that my hon. Friend is interested—consisted of a group of medical men and women brought together by the British Medical Association and the Royal Colleges. This group, or Representative Committee, as it has come to be called, agreed with me to discuss and exchange ideas entirely in confidence and informally and without commitment.

Dr. Morgan

Why the Royal Colleges? They have nothing to do with it.

Mr. Brown

It was not for me but for the profession to decide who was to represent them. The Committee was not in my appointment but in that of the profession. I put a number of ideas to it—including, at its own request, some ideas on a possible salaried basis for general practice in a comprehensive service—and I invited throughout the group's own criticisms and counter-suggestions. After a number of meetings and discussions the group came to me and suggested that the whole subject should be referred to a Royal Commission. We discussed this suggestion, but we agreed that our previous exchange of ideas should be resumed. There has perhaps been rather disproportionate attention directed to certain phrases, such as that about the "discard," but I am certain that the group itself had no misunderstanding of what I meant, which was simply that I was ready to consider equally any and every alternative suggestion on each of the issues under discussion and should certainly not embarrass the free range of discussion by asserting any unchangeable views of my own, whether on salaries or on anything else. If it advanced discussion, I would discard for the present any ideas so far considered and would consider each issue quite afresh, as has been my desire from the beginning, but when the proper time came I could obviously review all the various alternatives, including all my own alternatives, and see what I thought the most likely solutions were. This, I suggest to the House, is only common sense. It is a pity that so much misunderstanding seems to have attached to it outside those taking part in the actual discussions with me.

Well, we have resumed our discussions, as we agreed, and I am sure they will continue to be helpful. But I myself feel—as I think many of the others concerned feel—that the time is quite near when the most useful step will be to broaden out these preliminary talks into the next and main stage of public discussion. Fairly soon, then, I hope to be able to publish a statement, perhaps as a White Paper, in which I can survey the subject use- fully and so afford a focus for all concerned to discuss and to say for themselves what they really think about this very vital and important new service which is contained in Assumption B of the Beveridge Report, and the best way to organise it and make it effective with good will. I am sure that we ought not to take any final decisions on so intimately personal a project as this until not only the ordinary man in the street but also the individual doctor in practice or in the Forces has had a full chance to consider the main issues fairly and on his own behalf. I hope the issue of a White Paper will be of help.

That is all I think I need say to-day, except to express the hope that people will not allow themselves to be influenced too much by unofficial, partial and almost always inaccurate accounts of what is said to be the Government's plan. I am amused to see it suggested that it is the official intention of the Government to aim no higher than to dragoon one of the oldest of the learned professions into a corps of "State lackeys"—a description given in one particular place—or even deny the ordinary individual the elementary right to have his own say in choosing his medical adviser. For my part, until the time for a White Paper comes, I shall adhere to the understanding which I made, that the preliminary talks should be confidential, and I shall not anticipate the next stage.

It being the hour appointed for the Adjournment of the House, Mr. SPEAKER adjourned the House, without Question Put, pursuant to the Standing Order, till Tuesday, 22nd June, pursuant to the Resolution of the House this day.