HC Deb 12 April 1945 vol 409 cc1954-8
17 Dr. Edith Summerskill

asked the Minister of Health (1) what purpose has been achieved by issuing the White Paper on the health services, in view of the fact that he has now, in response to representations from the B.M.A., proposed an alternative structure fundamentally different from that outlined in the White Paper;

(2) why the proposed Salaried Medical Service operated from health centres and offering a new advance in medical practice, has been dropped at the request of the B.M.A.;

(3) what is the purpose of the experimental health centres contemplated in the alternative proposals to those contained in the White Paper, in view of the fact that they will provide accommodation from which doctors can conduct private practice more conveniently but on the same terms and lines as those practising from their homes.

The Minister of Health (Mr. Willink)

With permission, I will answer Question 17 and the two following Questions together.

Dr. Summerskill

Mr. Speaker, I am not willing to give the Minister permission to answer these Questions together. They are entirely different, though they deal with the same matter, and I want the Minister's answers to be quite clear.

Mr. Willink

The three Questions are all concerned with a wide subject and perhaps the hon. Lady will wait until she has heard the answer and see whether it covers her three Questions adequately.

Dr. Summerskill

Mr. Speaker, does that mean that I may put three supplementaries?

Mr. Speaker

The hon. Lady must wait and see.

Mr. Shinwell

On a point of Order. The right hon. and learned Gentleman said he would answer these three Questions together, with permission. Why did he ask the permission of the House, when he had the answers prepared in a combined form?

Mr. Speaker

I think it is common form to do that; the only alternative would be for the Minister to read out the same answer three times running.

Mr. Willink

There seems to be much misunderstanding on this matter, and I welcome this opportunity of clearing it up. The proposals in the White Paper were for discussion before the Government decided on the terms of draft legislation. Discussion was invited with all the major professional and other organisations affected, and this discussion has been—and is still—taking place. In the course of it various possible modifications of the detailed proposals have been discussed by my right hon. Friend the Secretary of State for Scotland and myself with the several organisations; that is what the discussions were for. Soon my right hon. Friend and myself will consider with our colleagues some of these alternative methods of achieving the White Paper's objective, a comprehensive service of health for the nation. The Government will have then to decide whether these—or any of them—are desirable alternatives or not.

Before informing the Government of their views on these possible alternatives, the, various organisations — medical, dental, voluntary hospital, local authority —are considering, on reports from their representatives who took part in the talks, the matters which have been discussed. It is to some of those reports, no doubt, or to varying rumours about those reports, that recent references have been made.

When the views of the different organisations are available, the Government will decide upon the content of draft legislation for submission to the House, while discussion of much detail which may not need to be included in the Bill itself will go on. Until then the three stages of the procedure originally laid down—the White Paper, discussion of the White Paper and final preparation of draft legislation—are being adhered to, and the objects of this second stage have been those which were clearly set out in the introductory paragraphs of the White Paper.

Dr. Summerskill

Is it not a fact that before a White Paper is published full discussions have already taken place between the people who are interested, and that so far as this question is concerned the British Medical Association, and other medical organisations, had already thrashed out every question of principle with the Ministry?[HON. MEMBERS: "No."] The Minister said that only details are being altered, but is it not a fact that in this report, which has been published, and which is in the hands of every doctor in the country, and many lay people, too, every fundamental principle laid down in the White Paper has been altered?

Mr. Willink

The hon. Lady is under a complete misapprehension with regard to the function of a White Paper. A White Paper in such a case as this represents the outcome of discussions, but it also affords a new focus for discussion, particularly after the White Paper has been discussed in this House. The White Paper itself contemplated that there would be such discussions. The hon. Lady is under a further misapprehension, as I understand the facts, when she refers to the publication of this report. My information is that every copy of this report was marked "Not for Publication." She is under a third misapprehension when she refers to anything having been dropped. My answer makes it perfectly clear that the Government as a whole have not considered the outcome of these discussions.

Dr. Russell Thomas

Is not the real reason for the Minister's change of mind the realisation that this Parliament has no mandate to enslave a free profession?

Mr. McNeil

Will the Minister tell us whether or not the Government had given any indication to the British Medical Association that the proposals which they are now discussing are acceptable to the Government as a basis for negotiation?

Mr. Willink

I have already said quite clearly that the Secretary of State for Scotland and myself have not discussed the outcome of these discussions with our colleagues.

Mr. Stephen

Does the Minister's statement mean that he himself is dissatisfied with the conclusions reached by his predecessor?

Mr. Willink

No, Sir, but when it is stated expressly that a White Paper is published for discussion that statement is made sincerely on behalf of the Government, and invites free and confidential discussion with all those who will take part in the Service in question.

Mr. Pethick-Lawrence

Has the Minister given any indication to the medical authorities that he himself will support these particular proposals, with his colleagues in the Government?

Mr. Willink

In the course of discussions of this kind I should certainly not express an attitude to any particular proposals, which might embarrass the Government's ultimate decision on them. Discussions such as this give rise to alternatives and modifications for consideration by the Government.

Mr. Petherick

Whether one approves the general system of issuing White Papers or not, is is not a perfectly proper and democratic method of operation, when a White Paper has been issued, to call into consultation all those who are likely to be affected; and would it not be quite absurd to issue a White Paper and then say that it cannot be amended in any form?

Mr. Shinwell

Is the Minister aware that statements have been made by members of the British Medical Association to the effect that their interpretation of their discussions with the Minister has led them to the conclusion that he has made certain concessions, or has agreed to put certain modifications before his colleagues in the Government? Is that correct?

Mr. Willink

I cannot take responsibility, for I have no knowledge of what statements have been made by the different members of this large Association.

Several hon. Members rose

—

Dr. Summerskill

In view of the unsatisfactory nature of the Minister's replies I beg to give notice that I will raise the matter on the Adjournment at the first opportunity.

Mr. Woodburn

On a point of Order. As my hon. Friend has just given notice that she will raise this matter on the Adjournment, will that prevent a discussion on this subject between now and the date of that Adjournment Debate?

Mr. Speaker

I do not think so, but I do not know what discussion the hon. Gentleman has in mind.

Mr. Woodburn

My hon. Friend gave notice that she would raise this matter again on the Adjournment and I would like to know whether that will prevent the matter coming up again in the ordinary course in other circumstances.

Mr. Speaker

Oh, no; this Adjournment would certainly not prevent previous discussion in the course of Business.