HC Deb 30 April 1946 vol 422 cc142-9 The Labour Party is determined that history shall not repeat itself. The Blackpool Conference has decided that nothing less than the proposals of the White Paper must form the basis for a comprehensive National Health Service, and that no scheme is acceptable which does not accept full public accountability for expenditure from public funds; give to Local Authorities control over municipal hospitals and medical services on statutory Health Councils and Committees."

These statutory Health Councils and Committees would obviously be elected bodies.

"End the National Health Insurance 'panel' system, with its one standard of service for the poor and another for the rich; give Local Authorities power of initiation and control of health centres." If hon. Members want to know, that is a quotation taken from a paper called "The Tribune" dated 29th June, 1945."
Mr. Bevan:

As the hon. Gentleman has just eloquently denounced the local authority area as the proper catchment area for hospital purposes, does he suggest that the Health Bill should have been postponed until the reorganisation of the whole of local government into regional areas?

Mr. Messer:

No, I do not suggest that but what I do suggest is the Advisory Committee to plan catchment areas and ad hoc elected bodies. But the Minister, in any event, has an ad hoc body. The difference between his body and mine is that his is not elected, and mine is. They are not even to be allowed to elect their chairman. The chairman can be appointed. I do not think that is the correct idea of democracy.

Now let me come to what I believe to be weaknesses. I have always believed in the necessity for continuity in health services. What has happened in the past, and what is happening now, is quite wrong. A woman, when she is to have a baby, goes to the maternity and child welfare clinic of the urban district or municipal borough, but that authority has no power whatever to ensure that she should have a hospital bed. It may be a difficult case, in which event arrangements may be made for her to be admitted to the hospital. The Minister improves on that because he says that a specialist can now examine the woman before she goes to hospital. But in view of the fact that the admitting authority has no authority to examine ante-natal cases, I do not know that she will be assured of that bed. After she has gone to hospital, and has had her treatment, she goes back, after the birth of the baby, and again comes under the local authority. When the child gets old enough to go to school it comes under the school medical service.

Here, may I digress for a moment to say that this Bill does not do enough in regard to the school medical service? It still leaves the school medical service to he school authority. At the present time—and I say this with a due sense of responsibility—there are literally thousands of children in the country who ire educable yet who are getting no education because of their physical condition. There is need for hospital schools. In some places there are such schools, where beds are given over to teachers as well is to doctors. There is bedside instruction. I am not referring to mental defectives, or physical cripples. I am referring o tuberculosis sanatoria, where children remain for a long time. There is great need for linking up the educational and health organisations. Because you get an ad hoc authority you separate it, and I want to know how we are to get over that difficulty.

Let me proceed with this variety of treatments. After the child has left school, where it had been under the so-called school medical service, it goes to work, and the Bill is sadly lacking in not providing proper medical service for the child then. We know that there are factories and workshops which have sections devoted to medical services, where cuts, wounds and bruises are dressed, but what is wanted is a medical service which will ensure that the workers are working under healthy conditions. We want a service which will take cognisance of the fact that a worker is coming back from an illness, and which will ensure that he is not working under too great a strain. As my hon. Friend the Member for Rochdale said, to those of us who are interested in this point that time has no meaning. I am sufficiently conscious of the infliction I am imposing on the House not to develop my argument at greater length.

I hope we shall see this Bill changed in the process of time so that it will do the three things that I regard as essential —make it democratic, make it comprehensive, and make it unified. The Bill brings hope to many of those who at the present time are hopeless; merely because we are making a health service gives them the hope which has been needed for so long. Notwithstanding my criticism I cannot do anything but admit that the Bill makes a very big step forward. It gives to men and women the right to a hospital bed, a thing they have never had before. I have never been able to under- stand why it should be said by law that every child is entitled to a place at school and yet should not be said that every man and woman, when ill, is entitled to a place in bed in a hospital. This Bill does that. The Bill certainly widens the range of opportunity for the people, and to that extent I give it my blessing, with the qualification that it could be better. I hope that by the time its final stages are reached it will be better.

9.42 p.m.

Sir Henry Morris-Jones (Denbigh):

I listened with interest to the remarks of the hon. Member for South Tottenham (Mr. Messer), who has for many years taken a great interest in public health and in hospitals, and up to the very last sentences of his speech I felt that, judging by the general tone of his remarks, he would support the Amendment from this side of the House. I want to congratulate the right hon. Gentleman the Minister of Health on his speech and on the way in which he presented the Bill. It must have called for no small effort on the part of himself and his advisers to bring before the House a Bill of this kind. The right hon. Gentleman dealt with the subject in the masterly and clear way that we would expect of him. Having said that, I want to say at once that, to those who believe in nationalisation, this is a good Bill. It is the nationalisation of the health service at one short remove. The Minister is going the whole hog. He is undertaking changes on lines which are unfamiliar. That is the effect of nationalisation. There is no experimental, evolutionary process. One is irrevocably committed to ascertain course. The Bill is a good one to those who believe in nationalisation, but that can hardly commend it to hon. Members on this side of the House. I believe that no industry, and certainly no profession, can be improved by nationalisation. I am sure that to begin to nationalise the Health Service is to enter on very thorny and difficult ground.

I am sorry the right hon. Gentleman did not, after all, have consultations with the various bodies involved in the Bill, because, according to the dictionary meaning of the word "consultation"—one does not need to explain the dictionary meaning to the right hon. Gentleman, who is such a master of vocabulary—he had no consultation with any body interested in the Measure. The House has never objected to consultation. I do not advocate bringing before the House a cut and dried scheme agreed beforehand, but the House of Commons has never objected to consultations carried to a degree that established a fair measure of agreement.

Mr. Bevan:

The hon. Member is quite wrong. He is imagining that practices which arose during the Coalition years, were the practices which existed previously. The fact is that a Coalition Government does carry out a much greater degree of consultation than a Party Government, but I have known Bills which have had to be withdrawn, because consultation had taken place.

Sir H. Morris-Jones:

I am quite sure that a Bill of this description, touching so many interests in this country and the life of the people at so many points, would not have suffered from consultation with those who are responsible for carrying it out. In fact this is not a National Health Bill at all, but might not inappropriately be called "national ill health" or "national disease service" Bill, in the sense that it deals with ill health and sickness, and not with their prevention. The emphasis in the Bill is on disease. By a series of preventive measures in the realms of public health, housing, and sanitation over different areas, the Minister of Health might have been able to survey the field and bring to this House a Measure which would have laid emphasis not upon curing but upon preventing illness. The right hon. Gentleman has not done that. After all, this country has a very great record with regard to the prevention of illness, and I do not hesitate to say that Liberal Administrations in the past had a very considerable share in some of the legislation which has prevented and diminished the incidence of sickness in this country. I will not give figures in detail but the House may recall that the death rate has been reduced from 22.7 per thousand in 1875 to 11.9 in 1944, the infant mortality rate from 150 per thousand 50 years ago to 45 per thousand today, and deaths from typhus fever from 5,000 a year to 54. Smallpox is scarcely known at all at the present time, although I warn the Minister that by abolishing compulsory vaccination he will bring it back again before very long. I am very surprised that the responsible advisers of his Department should have listened to a lot of faddists on this matter, for the protection of the health of the people is the most vital thing involved. I think the right hon. Gentleman has taken rather a serious step in abolishing compulsory vaccination.

As has been pointed out, this Bill, although comprehensive, leaves very wide gaps in services of health. There will be a large number of health services that will not come under the Bill at all, among them the school medical service, and services under the Ministry of Labour, the Home Office, the Ministry of Education, the Ministry of Pensions and the Board of Trade. There are medical services in practically every Department of the State. The Ministry of Supply have a medical service. All these people, from top to bottom, will be coming compulsorily under the Bill and will have to pay. A large number of them will not come under the doctors provided by the Bill. That is a serious gap, in the sense that there will not be continuation of treatment and inspection. Illness cannot be divorced altogether from environment and the home, but, under the State scheme, the family doctor will not be treating these people.

Legislation cannot create a good medical service. You cannot cure a man by a committee or a board. It has to be done by an individual. The Willink plan had the merit that it did, at all events, satisfy the people who were to undertake the work. That was very important The present Minister should have used the machinery in existence without too great a disturbance, and should have left it to the efflux of time to amend and correct a defect which would be found in his scheme. The right hon. Gentleman has chosen to make a clean cut. Nobody will deny that a large number of voluntary, and even of municipal, hospitals are inefficient and ill-equipped, but the voluntary hospitals have performed magnificent service, as the right hon. Gentleman admitted. They have been the source and the stimulus of every advance in medicine for generations. For centuries of history, in the evolution of medicine, their governing staff and medical staff have brought about reforms in an atmosphere of freedom. They have brought their profession to a fine art, till Anglo-Saxon medicine has been established in the very forefront of the medical art throughout the world. I am afraid that central guidance under the scheme will curtail local interests and initiative. I hope that the right hon. Gentleman will allow as much autonomy as possible to the voluntary hospitals, both in finance and in government. I am terribly afraid that there will be rigid standards of service allowing no originality, that officialdom will curtail the movement and the scope of service, and also the enterprise and enthusiasm which are needed and will clamp down upon the spirit of service in such a way as to take the whole life out of it. That is what I fear more than anything.

I come now to a very important part of the Bill, the general practitioners service. It is very unfortunate that the terms of service are not incorporated in the Bill. It is hardly fair to the House, in relation to a Measure so large as this, that the large body of people concerned know nothing at all at present of the terms of service which they will have to render under the Bill. I do not think it is treating the House fairly. What medical men are more afraid of even than the terms of service is the loss of their freedom. The art and practice of medicine can only survive in an atmosphere of freedom. Initiative and enterprise in medicine have made a great contribution to the world.

The doctor's responsibility is to his patient and not to the State. In the way doctors have been criticised, hon. Gentlemen opposite seem to think that the medical man has no right of his own at all. The position of a medical man is like that of any other individual in this country. He has three rights or duties. First, he must bow to the majority of this House. Secondly, he has the right as an expert to give technical advice on all matters on which he is in a position to be consulted. Thirdly, he has the same right as the miner, the docker, the agricultural labourer and everyone else in the country to practise his livelihood and to protect the livelihood of his family. It is a very great mistake to think that all medical men have gone into the profession as a pure vocation like clergymen. Large numbers have gone into the profession for economic reasons. They have chosen medicine as a profession for economic reasons just as they might have chosen any other profession, and we cannot treat them as a body of people who are surrendering all their rights without any regard to terms of service. Fifty thousand doctors have chosen this profession for economic reasons, to make an economic livelihood in a sphere in which they think they can render service to the people and to the State, and to satisfy their aspirations to do the work they think they are capable of doing. From that point of view, they have every right to be consulted at every stage of this Bill and not to have reflections passed on their patriotism.

I conclude by saying that the Minister of Health could have done as much for the state of health of this country by providing houses for the people as by introducing this Bill. There are not at the moment the doctors to work the Bill, nor have we the hospitals. In New Zealand doctors are grossly overworked and it takes six weeks to make an appointment with the doctor under the State scheme, and that country is over-populated with medical men and hospitals compared with this country. This Bill could easily be postponed until there is a better foundation for carrying it out. The hon. Lady the Parliamentary Secretary to the Ministry of Food joined the anti-queue party before she came into office. I do not think she has done much to reduce queues. I can promise her that when these health centres come, she will have plenty of queues.

It being Ten, o'Clock, the Debate stood adjourned.

Debate to be resumed Tomorrow.